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1

[Transdermal fentanyl patch for the treatment of chronic intractable pain].  

PubMed

The purpose of the treatment of chronic non-cancer pain is the improvement of the patient's quality of life, not the complete alleviation of pain. In Japan transdermal fentanyl patch can be used for the treatment of chronic intractable pain including cancer pain and chronic non-cancer pain. In prescribing transdermal fentanyl patch for patients with chronic non-cancer pain, cares should be focused on the selection of the patients and the periodic and continuous observation of analgesic effect and side effects. Patients with mental disorders need the consultation with specialists. In most cases side effects such as nausea, vomiting, constipation and sedation can be well tolerated. However, respiratory suppression or over sedation would also occur and such side effects can sometimes be fatal. Furthermore, long term effects on endocrine and immune systems have not been clarified yet. Proper prescription of opioids during a limited period of time is definitely the primary concern of medical professionals. PMID:23905400

Ibuki, Takae

2013-07-01

2

Intractable Chronic Low-Back Pain Caused by Ligamentopathia Treated Using a Spinous Process Plate (S-plate)  

PubMed Central

We report a case of intractable chronic low-back pain in a gymnast that was caused by ligamentopathia in the interspinous region of the lumbar vertebrae. Sprained interspinous ligaments are a common mechanical cause of acute low-back pain in athletes. Although conservative therapy is generally effective in such cases, in this case it was not. The patient experienced severe low-back pain during lumbar flexion with tension between the L5/S interspinous ligaments. We performed interspinous fixation by using a spinous process plate system, which has been developed for short in situ fusions, and following which the low-back pain resolved. Conservative therapy for low-back pain caused by ligamentopathia is first-line choice, but interspinous fixation with instrumentation might be recommended in intractable cases with conservative therapy. PMID:21124690

Iwatsuki, Koichi; Yoshimine, Toshiki; Yoshimura, Kazuhiro; Ishihara, Masahiro; Ohnishi, Yu-ichiro; Goto, Yuko

2010-01-01

3

The Long-Term Safety and Efficacy of Intrathecal Therapy Using Sufentanil in Chronic Intractable Non-Malignant Pain  

PubMed Central

This report describes the long term safety and efficacy of intrathecal therapy using Sufentanil for the management of chronic intractable neuropathic pain in 12 chronic pain patients. Standardized psychological screening was used to determine treatment suitability. Evaluation data included the Visual Analog Scale (VAS), Wong-Baker Faces Scale, Brief Pain Inventory (BPI), Disability of Arm, Shoulder, and Hand (DASH), McGill Quality of Life Questionnaire, and complications (granulomas, toxicity, withdrawal, or deaths). SPSS version 18 was used for data analysis. Pre- and post- treatment BPI measures and pain scale scores showed a statistically significant difference. There were no complications directly related to drug toxicity, nor drug withdrawals, granulomas, or deaths. Intrathecal therapy with Sufentanil therapy offers a good treatment alternative for those cases that have failed both surgery and standard pain treatment. Strict patient selection based on psychological screening, control of co-morbidities, a proper pain management may contribute to successful outcome. PMID:25031819

Monsivais, Diane Burn

2014-01-01

4

The long-term safety and efficacy of opioids: A survey of 84 selected patients with intractable chronic noncancer pain  

PubMed Central

BACKGROUND: The use of opioids for chronic noncancer pain (CNCP) remains controversial. Despite a number of randomized controlled trials showing efficacy and safety in the short term, long-term data are limited. OBJECTIVE: To survey a selected cohort of patients with intractable CNCP with regard to long-term efficacy and safety of opioids. METHODS: The present study reports long-term results from a survey of 84 patients with CNCP. The majority of patients had neuropathic pain, were treated with opioids and were followed every three months for a median of 8.4 years. Outcomes examined were pain severity, adverse effects, pain relief, satisfaction, mood, problematic opioid use, tolerance, physical dependency, functional status, health-related quality of life, immune status, sexual function, morbidity and mortality. Measures included a numerical rating scale, the Hospital Anxiety and Depression Scale, Brief Pain Inventory interference scale, Pain Disability Index and Short-Form Health Survey 12, version 2. RESULTS AND CONCLUSIONS: Both long- and short-acting opioids were reported to be effective, with few significant long-term adverse effects in many subjects in the present selected cohort. The majority of patients reported at least 50% or greater pain relief and a moderate improvement in disability. Functional status and health-related quality of life scores were not severely affected. Problematic opioid use, tolerance and serious adverse effects, including constipation, were not major issues. The authors emphasize that the results obtained in the present selected group may not be generalizable to all CNCP patients in whom opioids are being initiated. PMID:20808965

Watson, C Peter N; Watt-Watson, Judy; Chipman, Mary

2010-01-01

5

Intractable pain--the present position.  

PubMed Central

The broad changes that have occurred in the treatment of intractable pain are considered. There is a new understanding of the anatomy and physiology of pain pathways and pain appreciation. Thus gate control theory, the spinal laminae, and the descending inhibitory pain pathway through the raphe nuclei are discussed in relation to the recent discovery of the opioid (enkephalin) systems. Out of this arises the stimulation methods of pain relief--transcutaneous neural stimulation, periaqueductal stimulation, and acupuncture. These are valuable in patients with a normal expectation of life. For patients with a shortened expectation of life other methods, especially destructive ones, are valuable (though in all types of chronic pain drug therapy is still the most used method). Basic changes in techniques and the equipment used to bring this about are detailed broadly. In particular, the use of the image intensifier X-ray machine and the stimulation and destruction available from the modern lesion generator when used in combination provide accuracy and safety. Techniques and methods are constantly altering and examples of this are given. All this costs money in time, personnel, and equipment; the costings of the Liverpool Centre for Pain Relief are given. Finally, the Pain Relief Foundation is in being in Liverpool in the grounds of Walton Hospital. This has been made possible by a large 'seed' donation by the Wolfson Foundation. Images Fig. 1 Fig. 2 PMID:6894676

Lipton, S.

1981-01-01

6

Intracerebroventricular opioids for intractable pain  

PubMed Central

When pain is refractory to systemic opioid and non-opioid analgesic therapy and palliative chemoradiation or ablative or stimulant neurosurgical procedures are not possible, palliative treatment becomes limited, particularly if the patient wishes to be at home at the end of life. Intracerebroventricular (ICV) infusion of morphine in the home setting might be presented as an option. The present article reviews the basic and clinical evidence of the efficacy and safety of ICV administration of opioids. Information was gathered from various bibliographic sources, including PubMed and others, and summarized and evaluated to assess the efficacy and safety of ICV opioids for pain relief. Results from ICV infusion of morphine into terminally ill patients refractory to other pain treatments have been reported since the early 1980s. Good efficacy has been achieved for the vast majority of patients, without serious development of analgesic tolerance. There have also been a low incidence of adverse effects, such as constipation and respiratory depression, and a significant retention of alertness associated with this route of administration. Intracerebroventricular infusion of opioid analgesics thus appears to be a safe and effective therapy for the palliative treatment of refractory pain. PMID:22295988

Raffa, Robert B; Pergolizzi, Joseph V

2012-01-01

7

Eosinophilic jejunitis presenting as intractable abdominal pain.  

PubMed

Eosinophilic gastroenteritis is an uncommon disease characterized by eosinophilic infiltration of the gastrointestinal tract. The clinical manifestations are related to the layer(s) and extent of the bowel involved. In this paper, we present a case of intractable abdominal pain caused by jejunal submucosal eosinophilic infiltration without mucosal involvement, diagnosed by deep endoscopic biopsies. The patient was successfully treated with steroids without need for surgery for diagnosis or therapy. PMID:25565932

Mungan, Zeynel; Attila, Tan; Kapran, Yersu; Tokatli, Ilyas Pinar; Unal, Zeynep

2014-09-01

8

Eosinophilic Jejunitis Presenting as Intractable Abdominal Pain  

PubMed Central

Eosinophilic gastroenteritis is an uncommon disease characterized by eosinophilic infiltration of the gastrointestinal tract. The clinical manifestations are related to the layer(s) and extent of the bowel involved. In this paper, we present a case of intractable abdominal pain caused by jejunal submucosal eosinophilic infiltration without mucosal involvement, diagnosed by deep endoscopic biopsies. The patient was successfully treated with steroids without need for surgery for diagnosis or therapy. PMID:25565932

Mungan, Zeynel; Attila, Tan; Kapran, Yersu; Tokatli, Ilyas Pinar; Unal, Zeynep

2014-01-01

9

Low back pain - chronic  

MedlinePLUS

Nonspecific back pain; Backache - chronic; Lumbar pain - chronic; Pain - back - chronic; Chronic back pain - low ... waist, leads to pain. Many people with chronic back pain have arthritis. Or they may have extra wear ...

10

Renal Artery Embolization Controls Intractable Pain in a Patient with Polycystic Kidney Disease  

SciTech Connect

A 65-year-old man with adult polycystic kidney disease (APKD) and chronic renal failure suffered from intractable abdominal pain and distension for 2 weeks. Meperidine infusion did not alleviate his pain. However, pain and abdominal distension were successfully controlled by embolization of both renal arteries.

Hahn, Seong Tai; Park, Seog Hee; Lee, Jae Mun; Kim, Choon-Yul [Department of Radiology, St. Mary's Hospital, Catholic Medical Center, Catholic University of Korea, 62, Youido-dong, Yongdungpo-gu, Seoul, 150-010 (Korea, Republic of); Chang, Yoon Sik [Department of Internal Medicine, St. Mary's Hospital, Catholic Medical Center, Catholic University of Korea, 62, Youido-dong, Yongdungpo-gu, Seoul, 150-010, Korea (Korea, Republic of)

1999-09-15

11

Chronic Pain  

Microsoft Academic Search

The primary purposes of acute pain and the reason it is noxious are to interrupt ongoing activity in order to warn the sufferer of tissue damage, to discourage movement that might exacerbate injury or prevent healing, and to teach the organism to avoid the pain-producing circumstances. Therefore, it is no wonder that when pain persists to become chronic, many sufferers

Malcolm H. Johnson

12

Chronic Pain Medicines  

MedlinePLUS

MENU Return to Web version Chronic Pain | Chronic Pain Medicines How is chronic pain treated? Treatment of chronic ... or she tells you how to use your pain medicine. If you have questions about side effects or ...

13

Stimulation of primary motor cortex for intractable deafferentation pain.  

PubMed

The stimulation of the primary motor cortex (M1) has proved to be an effective treatment for intractable deafferentation pain. This treatment started in 1990, and twenty-eight studies involving 271 patients have been reported so far. The patients who have been operated on were suffering from post-stroke pain (59%), trigeminal neuropathic pain, brachial plexus injury, spinal cord injury, peripheral nerve injury and phantom-limb pain. The method of stimulation was: a) epidural, b) subdural, and c) within the central sulcus. Overall, considering the difficulty in treating central neuropathic pain, trigeminal neuropathic pain and certain types of refractory peripheral pain, the electrical stimulation of M1 is a very promising technique; nearly 60% of the treated patients improved with a higher than 50% pain relief after several months of follow-up and sometimes of a few years in most reports. The mechanism of pain relief by the electrical stimulation of M1 has been under investigation. Recently, repetitive transcranial magnetic stimulation (rTMS) of M1 has been reported to be effective on deafferentation pain. In the future, rTMS may take over from electrical stimulation as a treatment for deafferentation pain. PMID:17691289

Saitoh, Y; Yoshimine, T

2007-01-01

14

Chronic Pain and Fatigue  

E-print Network

Chronic Pain and Fatigue Research Center Department of Anesthesiology 24 Frank Lloyd Wright Dr, information regarding this condition The UMHS Chronic Pain and Fatigue Research Center (CPFRC) offers of other pain syndromes such as irritable bowel, pelvic pain, and headaches. The FM Workshop is conducted

Shyy, Wei

15

Chronic pelvic pain.  

PubMed

Chronic pelvic pain is pain lasting longer than 6 months and is estimated to occur in 15% of women. Causes of pelvic pain include disorders of gynecologic, urologic, gastroenterologic, and musculoskeletal systems. The multidisciplinary nature of chronic pelvic pain may complicate diagnosis and treatment. Treatments vary by cause but may include medicinal, neuroablative, and surgical treatments. PMID:24280400

Stein, Sharon L

2013-12-01

16

Spinal Cord Stimulation for Intractable Visceral Pain Due to Sphincter of Oddi Dysfunction  

PubMed Central

Sphincter of Oddi dysfunction (SOD) is a syndrome of chronic biliary pain or recurrent pancreatitis due to the functional obstruction of the pancreaticobiliary flow. We report a case of spinal cord stimulation (SCS) for chronic abdominal pain due to SOD. The patient had a history of cholecystectomy and had suffered from chronic right upper quadrant abdominal pain. The patient had been diagnosed as having SOD. The patient was treated with opioid analgesics and nerve blocks, including a splanchnic nerve block. However, two years later, the pain became intractable. We implanted percutaneous SCS at the T5-7 level for this patient. Visual analog scale (VAS) scores for pain and the amount of opioid intake decreased. The patient was tracked for more than six months without significant complications. From our clinical case, SCS is an effective and alternative treatment option for SOD. Further studies and long-term follow-up are necessary to understand the effectiveness and the limitations of SCS on SOD. PMID:25589948

Lee, Kang Hun; Lee, Sang Eun; Jung, Jae Wook

2015-01-01

17

Chronic spinal cord stimulation in medically intractable orthostatic tremor  

PubMed Central

Background Orthostatic tremor with its sense of unsteadiness when standing may have a devastating effect on affected persons. Currently, there are no other treatment options in those who do not respond or who do not tolerate medical treatment. Objectives To report on a pilot study on spinal cord stimulation in medically intractable orthostatic tremor. Methods Chronic spinal cord stimulation (SCS) was performed in two patients with medically?intractable orthostatic tremor via quadripolar plate electrodes implanted at the lower thoracic spine. The electrodes were connected to implantable pulse generators. Results Subjective and objective improvement of unsteadiness was achieved within a frequency range of 50 to 150?Hz, and occurred in the presence of stimulation?induced paraesthesia. With optimized stimulation settings polygraphic electromyelogram (EMG) recordings continued to show the typical 14–16?Hz EMG activity. The beneficial effect of SCS was maintained at long?term follow?up. Conclusions The results of this pilot study indicate that SCS may be an option in patients with otherwise intractable orthostatic tremor. PMID:16735398

Krauss, J K; Weigel, R; Blahak, C; Bäzner, H; Capelle, H?H; Grips, E; Rittmann, M; Wöhrle, J C

2006-01-01

18

Cortical pathophysiology of chronic pain  

E-print Network

Cortical pathophysiology of chronic pain A. Vania Apkarian Department of Physiology multiple non-invasive brain imaging techniques to study the characteristics of patients with chronic pain in chronic pain are summarized, emphasizing the unique role of the prefrontal cortex in chronic, especially

Apkarian, A. Vania

19

Eosinophilic meningitis: cause of a chronic pain syndrome.  

PubMed Central

Three tourists developed eosinophilic meningitis after visiting the Fijian Islands. Two had a severe and long lasting illness with chronic intractable pain. In one patient electrophysiological studies and MRI scan of the brain were abnormal and provided evidence of both radicular and cerebral parenchymal involvement by the most likely causative agent, Angiostrongylus cantonensis. Images PMID:2246659

Clouston, P D; Corbett, A J; Pryor, D S; Garrick, R

1990-01-01

20

Peripheral Pain Mechanisms in Chronic Widespread Pain  

PubMed Central

Clinical symptoms of chronic widespread pain (CWP) conditions including fibromyalgia (FM), include pain, stiffness, subjective weakness, and muscle fatigue. Muscle pain in CWP is usually described as fluctuating and often associated with local or generalized tenderness (hyperalgesia and/or allodynia). This tenderness related to muscle pain depends on increased peripheral and/or central nervous system responsiveness to peripheral stimuli which can be either noxious (hyperalgesia) or non-noxious (allodynia). For example, patients with muscle hyperalgesia will rate painful muscle stimuli higher than normal controls, whereas patients with allodynia may perceive light touch as painful, something that a “normal” individual will never describe as painful. The pathogenesis of such peripheral and/or central nervous system changes in CWP is unclear, but peripheral soft tissue changes have been implicated. Indirect evidence from interventions that attenuate tonic peripheral nociceptive impulses in patients with CWP syndromes like FM suggest that overall FM pain is dependent on peripheral input. More importantly, allodynia and hyperalgesia can be improved or abolished by removal of peripheral impulse input. Another potential mechanism for CWP pain is central disinhibition. However, this pain mechanism also depends on tonic impulse input, even if only inadequately inhibited. Thus a promising approach to understanding CWP is to determine whether abnormal activity of receptors in deep tissues is fundamental to the development and maintenance of this chronic pain disorder. Conclusions Most CWP patients present with focal tissue abnormalities including myofascial trigger points, ligamentous trigger points, or osteoarthritis of the joints and spine. While not predictive for the development of CWP these changes nevertheless represent important pain generators that may initiate or perpetuate chronic pain. Local chemical mediators, including lactic acid, ATP, and cytokines seem to play an important role in sensitizing deep tissue nociceptors of CWP patients. Thus the combination of peripheral impulse input and increased central pain sensitivity may be responsible for wide-spread chronic pain disorders including FM. PMID:22094192

Staud, Roland

2011-01-01

21

A clinical trial of gene therapy for chronic pain  

PubMed Central

The first human trial of gene therapy for chronic pain, a phase 1 study of a non-replicating herpes simplex virus (HSV)-based vector engineered to express preproenkephalin in patients with intractable pain from cancer, began enrolling subjects in December 2008. In this article we describe the rationale underlying this potential approach to treatment of pain, the preclinical animal data in support of this approach, the design of the study, and studies with additional HSV-based vectors that may be used to develop treatment for other types of pain. PMID:19818042

Wolfe, Darren; Wechuck, James; Krisky, David; Mata, Marina; Fink, David J.

2011-01-01

22

Neuromodulation for intractable headaches.  

PubMed

Intractable chronic headaches are a major challenge for both patients and healthcare professionals. Over the last two decades, implantable electrical neuromodulators, previously established to manage other forms of chronic pain, have been used increasingly for intractable primary and secondary headache disorders. We review the current approaches to the management of refractory headaches using neuromodulation. Indications, operative considerations and complications are discussed based on our experience and a review of the literature. The field of neuromodulation has been rapidly advancing, with many new targets being discovered and novel devices being developed for treating craniofacial pain. We discuss some of these targets, detailing the latest advances in the area of neuromodulation for intractable headaches. PMID:24488653

Hassanzadeh, Roya; Jones, Jeremy C; Ross, Edgar L

2014-02-01

23

Pulsed radiofrequency treatment within brachial plexus for the management of intractable neoplastic plexopathic pain.  

PubMed

We report on the use of pulsed radiofrequency (RF) within the plexus for the management of intractable pain in three patients with metastatic or invasive plexopathy. The patients were a 38-year-old woman with a history of breast cancer 6 years earlier whose computed tomography (CT) scans revealed a mass lesion at the infraclavicular part of the right brachial plexus, a 68-year-old man diagnosed with advanced lung cancer whose CT scans revealed a bone metastasis in the right humerus invading the axillary region of the right brachial plexus, and a 67-year-old woman diagnosed with advanced lung cancer whose CT scans revealed a bone metastasis in the left humerus invading the axillary region of the left brachial plexus. Ultrasound-guided pulsed RF was performed within the interscalene brachial plexus. During the follow-up period, their intractable pain was moderately controlled. PMID:23070568

Arai, Young-Chang P; Nishihara, Makoto; Aono, Shuichi; Ikemoto, Tatsunori; Suzuki, Chiharu; Kinoshita, Akiko; Ushida, Takahiro

2013-04-01

24

Ketamine treatment for intractable pain in a patient with severe refractory complex regional pain syndrome: a case report.  

PubMed

In this case report, we describe the effect of ketamine infusion in a case of severe refractory complex regional pain syndrome I (CRPS I). The patient was initially diagnosed with CRPS I in her right upper extremity. Over the next 6 years, CRPS was consecutively diagnosed in her thoracic region, left upper extremity, and both lower extremities. The severity of her pain, combined with the extensive areas afflicted by CRPS, caused traumatic emotional problems for this patient. Conventional treatments, including anticonvulsants, bisphosphonates, oral steroids and opioids, topical creams, dorsal column spinal cord stimulation, spinal morphine infusion, sympathetic ganglion block, and sympathectomy, failed to provide long-term relief from pain. An N-methyl-d-aspartate (NMDA) antagonist inhibitor, ketamine, was recently suggested to be effective at resolving intractable pain. The patient was then given several infusions of intravenous ketamine. After the third infusion, the edema, discoloration, and temperature of the affected areas normalized. The patient became completely pain-free. At one-year of follow-up, the patient reported that she has not experienced any pain since the last ketamine infusion. Treatment with intravenous ketamine appeared to be effective in completely resolving intractable pain caused by severe refractory CRPS I. Future research on this treatment is needed. PMID:18523505

Shirani, Peyman; Salamone, Alicia R; Schulz, Paul E; Edmondson, Everton A

2008-01-01

25

Neurovascular Unit in Chronic Pain  

PubMed Central

Chronic pain is a debilitating condition with major socioeconomic impact, whose neurobiological basis is still not clear. An involvement of the neurovascular unit (NVU) has been recently proposed. In particular, the blood-brain barrier (BBB) and blood-spinal cord barrier (BSCB), two NVU key players, may be affected during the development of chronic pain; in particular, transient permeabilization of the barrier is suggested by several inflammatory- and nerve-injury-based pain models, and we argue that the clarification of molecular BBB/BSCB permeabilization events will shed new light in understanding chronic pain mechanisms. Possible biases in experiments supporting this theory and its translational potentials are discussed. Moving beyond an exclusive focus on the role of the endothelium, we propose that our understanding of the mechanisms subserving chronic pain will benefit from the extension of research efforts to the NVU as a whole. In this view, the available evidence on the interaction between analgesic drugs and the NVU is here reviewed. Chronic pain comorbidities, such as neuroinflammatory and neurodegenerative diseases, are also discussed in view of NVU changes, together with innovative pharmacological solutions targeting NVU components in chronic pain treatment. PMID:23840097

Radu, Beatrice Mihaela; Bramanti, Placido; Osculati, Francesco; Flonta, Maria-Luisa; Radu, Mihai; Bertini, Giuseppe; Fabene, Paolo Francesco

2013-01-01

26

Chronic Pain and Exercise Therapy.  

ERIC Educational Resources Information Center

Aerobic and resistance exercise are currently prescribed by physicians to treat chronic pain. However, patient fitness level must improve before he/she feels better. Pain management programs help patients become more active so they can function at work and home. (SM)

Raithel, Kathryn Simmons

1989-01-01

27

Occipital nerve stimulation for the treatment of intractable chronic migraine headache: ONSTIM feasibility study  

PubMed Central

Background: Medically intractable chronic migraine (CM) is a disabling illness characterized by headache ?15 days per month. Methods: A multicenter, randomized, blinded, controlled feasibility study was conducted to obtain preliminary safety and efficacy data on occipital nerve stimulation (ONS) in CM. Eligible subjects received an occipital nerve block, and responders were randomized to adjustable stimulation (AS), preset stimulation (PS) or medical management (MM) groups. Results: Seventy-five of 110 subjects were assigned to a treatment group; complete diary data were available for 66. A responder was defined as a subject who achieved a 50% or greater reduction in number of headache days per month or a three-point or greater reduction in average overall pain intensity compared with baseline. Three-month responder rates were 39% for AS, 6% for PS and 0% for MM. No unanticipated adverse device events occurred. Lead migration occurred in 12 of 51 (24%) subjects. Conclusion: The results of this feasibility study offer promise and should prompt further controlled studies of ONS in CM. PMID:20861241

Saper, Joel R; Dodick, David W; Silberstein, Stephen D; McCarville, Sally; Sun, Mark; Goadsby, Peter J

2011-01-01

28

Chronic abdominal pain in children.  

PubMed

Chronic abdominal pain, defined as long-lasting intermittent or constant abdominal pain, is a common pediatric problem encountered by primary care physicians, medical subspecialists, and surgical specialists. Chronic abdominal pain in children is usually functional, that is, without objective evidence of an underlying organic disorder. The Subcommittee on Chronic Abdominal Pain of the American Academy of Pediatrics and the North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition has prepared this report based on a comprehensive, systematic review and rating of the medical literature. This report accompanies a clinical report based on the literature review and expert opinion. The subcommittee examined the diagnostic and therapeutic value of a medical and psychological history, diagnostic tests, and pharmacologic and behavioral therapy. The presence of alarm symptoms or signs (such as weight loss, gastrointestinal bleeding, persistent fever, chronic severe diarrhea, and significant vomiting) is associated with a higher prevalence of organic disease. There was insufficient evidence to state that the nature of the abdominal pain or the presence of associated symptoms (such as anorexia, nausea, headache, and joint pain) can discriminate between functional and organic disorders. Although children with chronic abdominal pain and their parents are more often anxious or depressed, the presence of anxiety, depression, behavior problems, or recent negative life events does not distinguish between functional and organic abdominal pain. Most children who are brought to the primary care physician's office for chronic abdominal pain are unlikely to require diagnostic testing. Pediatric studies of therapeutic interventions were examined and found to be limited or inconclusive. PMID:15741363

2005-03-01

29

Bupivacaine administered intrathecally versus rectally in the management of intractable rectal cancer pain in palliative care  

PubMed Central

Background Unacceptable adverse effects, contraindications to and/or ineffectiveness of World Health Organization step III “pain ladder” drugs causes needless suffering among a population of cancer patients. Successful management of severe cancer pain may require invasive treatment. However, a patient’s refusal of an invasive procedure necessitates that clinicians consider alternative options. Objective Intrathecal bupivacaine delivery as a viable treatment of intractable pain is well documented. There are no data on rectal bupivacaine use in cancer patients or in the treatment of cancer tenesmoid pain. This study aims to demonstrate that bupivacaine administered rectally could be a step in between the current treatment options for intractable cancer pain (conventional/conservative analgesia or invasive procedures), and to evaluate the effect of the mode of administration (intrathecal versus rectal) on the bupivacaine plasma concentration. Cases We present two Caucasian, elderly inpatients admitted to hospice due to intractable rectal/tenesmoid pain. The first case is a female with vulvar cancer, and malignant infiltration of the rectum/vagina. Bupivacaine was used intrathecally (0.25–0.5%, 1–2 mL every 6 hours). The second case is a female with ovarian cancer and malignant rectal infiltration. Bupivacaine was adminstered rectally (0.05–0.1%, 100 mL every 4.5–11 hours). Methods Total bupivacaine plasma concentrations were determined using the high-performance liquid chromatography-ultraviolet method. Results Effective pain control was achieved with intrathecal bupivacaine (0.077–0.154 mg·kg?1) and bupivacaine in enema (1.820 mg·kg?1). Intrathecal bupivacaine (0.5%, 2 mL) caused a drop in blood pressure; other side effects were absent in both cases. Total plasma bupivacaine concentrations following intrathecal and rectal bupivacaine application did not exceed 317.2 ng·mL?1 and 235.7 ng·mL?1, respectively. Bupivacaine elimination was slower after rectal than after intrathecal administration (t½= 5.50 versus 2.02 hours, respectively). Limitations This study reports two cases only, and there could be inter-patient variation. Conclusion Bupivacaine in boluses administered intrathecally (0.25%, 2 mL) provided effective, safe analgesia in advanced cancer patients. Bupivacaine enema (100 mg·100 mL?1) was shown to be a valuable option for control of end-of-life tenesmoid cancer pain. PMID:25336967

Zaporowska-Stachowiak, Iwona; Kowalski, Grzegorz; ?uczak, Jacek; Kosicka, Katarzyna; Kotlinska-Lemieszek, Aleksandra; Sopata, Maciej; G?ówka, Franciszek

2014-01-01

30

Chronic abdominal pain in children.  

PubMed

Chronic abdominal pain in children is usually not caused by organic disease. Diagnostic triage focuses on the assessment of alarm symptoms by means of history and physical examination. Additional diagnostic evaluation is not required in children without alarm symptoms. Family characteristics have an important influence on the chronicity of abdominal pain. A specific intervention is not recommended owing to lack of evidence of a beneficial effect. The greatest challenge is to identify children at risk of a prolonged course of pain and its correlated functional disability. The evaluation of family for coping strategies, psychosocial factors and appropriate follow-up can prevent ineffective use of healthcare resources. PMID:22886462

Singh, Utpal Kant; Prasad, Rajniti; Verma, Nishant

2013-02-01

31

Hypnotherapy for the Management of Chronic Pain  

Microsoft Academic Search

This article reviews controlled prospective trials of hypnosis for the treatment of chronic pain. Thirteen studies, excluding studies of headaches, were identified that compared outcomes from hypnosis for the treatment of chronic pain to either baseline data or a control condition. The findings indicate that hypnosis interventions consistently produce significant decreases in pain associated with a variety of chronic-pain problems.

Gary Elkins; Mark P. Jensen; David R. Patterson

2007-01-01

32

Intractable Facial Pain and Numb Chin due to Metastatic Esophageal Adenocarcinoma  

PubMed Central

The etiologies of facial pain are innumerable, thus facial pain misdiagnosis and resultant mismanagement is common. Numb chin syndrome presents with hypoesthesia and/or anesthesia in the dermatomal distribution of the inferior alveolar or the mental nerve. In this case report, we will discuss a case of intractable facial pain in a 57-year-old male with a history of esophageal adenocarcinoma who was initially misdiagnosed and treated as trigeminal neuralgia. During clinical examination, the loss of sensation in the inferior alveolar nerve distribution was identified and led to the diagnosis of mandibular metastasis. The details of the clinical presentation will be discussed in the context of accurate identification and diagnosis. Focal radiation to the metastatic location along with sphenopalatine ganglion radiofrequency ablation and medication management provided significant pain relief. This case report provides additional information to the current medical knowledge and it enhances the clinical vigilance of the clinicians when they encounter similar cases. We concluded that patients with a history of neoplasms who present with atypical symptoms of facial pain should undergo further investigation with advanced imaging. Targeted treatment based on an accurate diagnosis is the foundation of pain management. PMID:25606033

Elahi, Foad; Luke, Whitney; Elahi, Fazel

2014-01-01

33

Percutaneous spinal cord stimulation for chronic pain: indications and patient selection.  

PubMed

Percutaneous spinal cord stimulation has a clinical benefit in selected patients with chronic neuropathic pain related to failed back surgery syndrome and complex regional pain syndrome. Patients with other peripheral neuropathic pain syndromes may also respond favorably. The cause of the chronic pain must be established to rule out remediable causes. Drug abuse or aberrant drug-related behaviors should be assessed before proceeding. A psychological evaluation identifies patients who may not benefit. Risk factors for infection should be corrected where possible. This safe, reversible treatment should be considered early for patients with intractable peripheral neuropathic pain. PMID:25240659

Nagel, Sean J; Lempka, Scott F; Machado, Andre G

2014-10-01

34

Spinal Cord Simulation for Chronic Pain Management  

E-print Network

Oak, Suite 275 Houston, TX 77090 2 Center for Computational Science and Advanced Distributed strong pain (chronic pain) that is not an indication of any physiological damage. Chronic pain the physiology of pain is still at its infancy, we need some indirect heuristic methods to get rid of the pain

Kreinovich, Vladik

35

The management of intractable pain with adjuvant pulsed electromagnetic field therapy.  

PubMed

This case describes a 51-year-old woman who reported experiencing severe, constant pain, diffusely located in the region of her right mandible neck (primarily involving the mandible, lower right molars, the neck, the upper back, and the shoulder) during the course of several years. Surgical interventions (root canal, spinal fusion) were performed to address potential sources of pain. Despite these interventions, the patient reported severe pain after both surgeries, which persisted beyond the acute postoperative period. Additional pharmacological interventions and physical therapy were also attempted; nonetheless, the patient reported that pain remained severe and constant for approximately 2 years. On the basis of the patient's poor response to conventional treatments, a novel approach of botulinum toxin (BTX) injections was initiated. When pulsed electromagnetic field therapy was added, the need for BTX injections decreased, with the patient reporting a noticeable decrease in pain intensity and an improvement in quality of life measures. Currently, the patient continues to use pulsed electromagnetic field therapy regularly for pain management, which has allowed her to reduce the use of other interventions and avoid continued use of narcotic medications. Considering the need for multifaceted pain management approaches in the treatment of chronic pain, this case is relevant for wound care practitioners attending to patients with chronic postincisional wound pain because the outcome highlights the utility of a nonpharmacological, complementary pain management intervention for closed, yet persistently painful, postoperative wounds. PMID:24732123

Niezgoda, Jeffrey A; Hardin, Scott T; Kubat, Nicole; Acompanado, Jocelyn

2014-05-01

36

Chronic and Recurrent Pelvic Pain  

Microsoft Academic Search

\\u000a Chronic and recurrent pelvic pain (CPP) in ­children and adolescents has been recognized for decades. However, data on the\\u000a etiology, natural history, treatment, and long-term consequences of painful pelvic conditions in these patients are lacking.\\u000a The problem’s prevalence remains uncertain, and the majority of therapies are extrapolated from research on adults. The normal\\u000a developmental changes and coping strategies of children

Lynda Wells

37

[Strontium-89 therapy and subarachnoid phenol block successfully eliminated intractable pain of metastasis in the patient with advanced urachal carcinoma].  

PubMed

We report a case of a 39-year-old man with intractable multifocal pain caused by metastatic urachal carcinoma to the bone. The patient underwent a partial cystectomy in May 2008, and lung metastasis occurred 9 months after the surgery. He then received salvage chemotherapy, but developed metastasis to the liver, brain, and bone. He was hospitalized due to a shoulder pain, a lower back pain, buttocks pain, numbness in both legs, and drop foot in right leg. MRI revealed metastases to the spine, and lumbar spinal canal stenosis with cauda equina compression. Even a combination of fentanyl-patch, oral acetaminophen, gabapentin and paroxetine was not effective for pain control. Strontium-89 therapy and subarachnoid phenol block successfully eliminated intractable pain. The patient could be discharged from hospital and received a palliative care at home for a short period of time. PMID:22189321

Arakawa, Yasuhiro; Inoue, Daisuke; Sakuyama, Toshikazu; Nagasaki, Eijiro; Aiba, Keisuke

2011-12-01

38

PAIN MEDICINE Neural Correlates of Chronic Low Back Pain Measured  

E-print Network

PAIN MEDICINE Neural Correlates of Chronic Low Back Pain Measured by Arterial Spin Labeling Ajay D of the CP exacerba- tions for each back pain subject. Results: The clinically significant worsening.D., Randy L. Gollub, M.D., Ph.D.# ABSTRACT Background: The varying nature of chronic pain (CP) is difficult

Napadow, Vitaly

39

INTRODUCTION Chronic prostatitis/chronic pelvic pain syndrome  

E-print Network

INTRODUCTION · Chronic prostatitis/chronic pelvic pain syndrome affects 5-10% of men pathophysiological correlates of CP/CPPS pain (prostate inflammation, endocrine abnormalities, pelvic floor muscle in Chronic Prostatitis / Chronic Pelvic Pain Syndrome M. A. Farmer1, M. L. Chanda1, E. L. Parks1, M. N

Apkarian, A. Vania

40

Evidence Based Practice of Chronic Pain  

PubMed Central

The patients with chronic pain are increasingly reporting to the physicians for its management. Chronic pain are associated with head, neck and shoulder pain, spinal pain, pain in the joints and extremities, complex regional pain syndrome and phantom pain. The chronic pain is being managed worldwide. The different specialty of medicine is producing a lot of evidence through the published literature but the same is not being published in the field of chronic pain management. Though some evidence is being reported as to different aspects of pain management from different parts of the world but same is lacking from Indian subcontinent. This is in contrast to much done clinical work in this field as well. We present here the available evidence in relation to chronic pain management. PMID:23439674

Garg, Rakesh; Joshi, Saurabh; Mishra, Seema; Bhatnagar, Sushma

2012-01-01

41

Comprehensive management of chronic pain in haemophilia.  

PubMed

Chronic pain, most often due to haemophilic arthropathy, is a pervasive problem in persons with haemophilia (PWH) that adversely impacts function and quality of life. PWH with inhibitors and older PWH may be especially vulnerable to progressive arthropathy and resulting chronic pain. The development of chronic pain from acute pain involves a complex interplay of biological and psychosocial factors that may all contribute to the perpetuation of chronic pain and the outcome of therapy. In the absence of evidence-based guidelines, an individualized, multimodal approach to chronic pain management is proposed, as it is in individuals without haemophilia who have chronic pain. Pharmacological treatment is central to the management of chronic pain and must be modified based on pain intensity, ongoing response to therapy and the risk for adverse events. Non-pharmacological interventions, including physiotherapy, complementary treatments and surgical (e.g. orthopaedic) or other invasive procedures, may be integral to chronic pain management in this population. Ongoing psychosocial assessment is critical to identify those factors that may be contributing to the perpetuation of chronic pain or acting as barriers to effective management. Additional study is needed to identify optimal pharmacological treatments for chronic pain in PWH based on the unique pathophysiology of haemophilic arthropathy and on risk profile. Systematic determination of the particular psychosocial factors impacting the experience and management of chronic pain in PWH would likewise add value to the treatment of this pervasive problem. PMID:24372731

Young, G; Tachdjian, R; Baumann, K; Panopoulos, G

2014-03-01

42

Opioids for Chronic Non-Cancer Pain  

E-print Network

Opioids for Chronic Non-Cancer Pain: Using the Canadian Guideline inYour Practice Subject Matter Experts: Allison Blain, BSc, BEd, MD, FRCPC Anesthesiologist and Chronic Pain Specialist, Hamilton Health Sciences, Pain Management Centre, Hamilton, ON. General Hospital, Minerva Pain Management Centre, Hamilton

Haykin, Simon

43

Management of chronic pelvic pain.  

PubMed

Chronic pelvic pain (CPP) is a common complaint of women presenting for gynecologic and primary care. Evaluation of CPP requires obtaining a careful history including not only obstetrical and gynecologic information but also screening for gastrointestinal, urologic, musculoskeletal, and neurological disorders. A detailed physical examination is also necessary. Management of CPP depends largely on the cause. Gynecologic causes include endometriosis, pelvic inflammatory disease, adhesive disease, pelvic congestion syndrome, ovarian retention syndrome, ovarian remnant syndrome, adenomyosis, and leiomyomas. Some non-gynecologic causes are interstitial cystitis/painful bladder syndrome, irritable bowel syndrome, pelvic floor tension myalgia, and abdominal myofascial pain syndrome. Treatments may be directed toward specific causes or may be targeted to general pain management. The most effective therapy may involve using both approaches. The diagnosis and treatment of each of the above disorders, and the management of CPP itself, is discussed. PMID:20938429

Benjamin-Pratt, A R; Howard, F M

2010-10-01

44

Early visceral pain predicts chronic pain after laparoscopic cholecystectomy.  

PubMed

Chronic pain after laparoscopic cholecystectomy is related to postoperative pain during the first postoperative week, but it is unknown which components of the early pain response is important. In this prospective study, 100 consecutive patients were examined preoperatively, 1week postoperatively, and 3, 6, and 12months postoperatively for pain, psychological factors, and signs of hypersensitivity. Overall pain, incisional pain (somatic pain component), deep abdominal pain (visceral pain component), and shoulder pain (referred pain component) were registered on a 100-mm visual analogue scale during the first postoperative week. Nine patients developed chronic unexplained pain 12months postoperatively. In a multivariate analysis model, cumulated visceral pain during the first week and number of preoperative biliary pain attacks were identified as independent risk factors for unexplained chronic pain 12months postoperatively. There were no consistent signs of hypersensitivity in the referred pain area either pre- or postoperatively. There were no significant associations to any other variables examined. The risk of chronic pain after laparoscopic cholecystectomy is relatively low, but significantly related to the visceral pain response during the first postoperative week. PMID:25250720

Blichfeldt-Eckhardt, Morten Rune; Ording, Helle; Andersen, Claus; Licht, Peter B; Toft, Palle

2014-11-01

45

Coping Styles, Pain Expressiveness, and Implicit Theories of Chronic Pain.  

PubMed

ABSTRACT Whereas some individuals use active coping strategies and are able to adaptively cope with their pain, others use passive strategies and catastrophic appraisals, which are often associated with increased displays of pain behavior and negative pain-related outcomes. To investigate attribution-based implicit theories as a potential underlying mechanism that might affect coping success, we hypothesized that pain patients with an incremental implicit theory of pain (i.e., view pain as malleable) would have more active coping strategies, lower levels of pain expressiveness, and better pain-related outcomes than those with an entity implicit theory of pain (i.e., view pain as nonmalleable). Patients with chronic back pain undergoing a functional assessment completed a variety of self-report measures and participated in a pain-inducing physiotherapy procedure. The results revealed those with an incremental theory of pain used more active coping strategies, displayed less pain behavior, and reported better pain-related outcomes (e.g., lower levels of depression) than individuals with an entity theory of pain. The findings suggest implicit theories of pain may represent an underlying social-cognitive mechanism linked to important coping, emotional, and expressive reactions to chronic pain. Identifying such a mechanism may provide valuable information for the assessment and treatment of chronic pain. PMID:25396698

Higgins, N C; Bailey, S Jeffrey; LaChapelle, Diane L; Harman, Katherine; Hadjistavropoulos, Thomas

2014-11-14

46

Multimodal Stepped Care Approach Involving Topical Analgesics for Severe Intractable Neuropathic Pain in CRPS Type 1: A Case Report  

PubMed Central

A multimodal stepped care approach has been successfully applied to a patient with complex regional pain syndrome type 1 and severe intractable pain, not responding to regular neuropathic pain medication. The choice to administer drugs in creams was made because of the intolerable adverse effects to oral medication. With this method, peak-dose adverse effects did not occur. The multimodal stepped care approach resulted in considerable and clinically relevant decrease in pain after every step, using topical amitriptyline, ketamine, and dimethylsulphoxide. PMID:22028723

Kopsky, David J.; Keppel Hesselink, Jan M.

2011-01-01

47

Multimodal Stepped Care Approach Involving Topical Analgesics for Severe Intractable Neuropathic Pain in CRPS Type 1: A Case Report.  

PubMed

A multimodal stepped care approach has been successfully applied to a patient with complex regional pain syndrome type 1 and severe intractable pain, not responding to regular neuropathic pain medication. The choice to administer drugs in creams was made because of the intolerable adverse effects to oral medication. With this method, peak-dose adverse effects did not occur. The multimodal stepped care approach resulted in considerable and clinically relevant decrease in pain after every step, using topical amitriptyline, ketamine, and dimethylsulphoxide. PMID:22028723

Kopsky, David J; Keppel Hesselink, Jan M

2011-01-01

48

Genetics of chronic pain states.  

PubMed

Chronic pain states are common in the general population. Genetic factors can explain a significant amount of the variability in the perception of pain. Fibromyalgia syndrome (FMS) and related conditions are syndromes characterized by generalized pain sensitivity as well as a constellation of other symptoms. Family studies show a strong familial aggregation of FMS and related conditions, suggesting the importance of genetic factors in the development of these conditions. Recent evidence suggests a role for polymorphisms of genes in the serotoninergic, dopaminergic and catecholaminergic systems in the pathogenesis of FMS and related conditions. Environmental factors may trigger the development of these disorders in genetically predisposed individuals. Future large well-designed studies are needed to further clarify the role of genetic factors in FMS and related conditions. The knowledge of these gene polymorphisms may help with better subgrouping of FMS patients and in designing a more specific pharmacologic treatment approach. PMID:17602998

Buskila, Dan

2007-06-01

49

Basic aspects of musculoskeletal pain: from acute to chronic pain  

PubMed Central

The transition from acute to chronic musculoskeletal pain is not well understood. To understand this transition, it is important to know how peripheral and central sensitization are manifested and how they can be assessed. A variety of human pain biomarkers have been developed to quantify localized and widespread musculoskeletal pain. In addition, human surrogate models may be used to induce sensitization in otherwise healthy volunteers. Pain can arise from different musculoskeletal structures (e.g. muscles, joints, ligaments, or tendons), and differentiating the origin of pain from those different structures is a challenge. Tissue specific pain biomarkers can be used to tease these different aspects. Chronic musculoskeletal pain patients in general show signs of local/central sensitization and spread of pain to degrees which correlate to pain intensity and duration. From a management perspective, it is therefore highly important to reduce pain intensity and try to minimize the duration of pain. PMID:23115471

Arendt-Nielsen, Lars; Fernández-de-las-Peñas, César; Graven-Nielsen, Thomas

2011-01-01

50

Motor cortex stimulation: functional magnetic resonance imaging-localized treatment for three sources of intractable facial pain.  

PubMed

Neuropathic facial pain can be a debilitating condition characterized by stabbing, burning, dysesthetic sensation. With a large range of causes and types, including deafferentation, postherpetic, atypical, and idiopathic, both medicine and neurosurgery have struggled to find effective treatments that address this broad spectrum of facial pain. The authors report the use of motor cortex stimulation to alleviate 3 distinct conditions associated with intractable facial pain: trigeminal deafferentation pain following rhizotomy, deafferentation pain secondary to meningioma, and postherpetic neuralgia. Functional MR imaging was used to localize facial areas on the precentral gyrus prior to surgery. All 3 patients experienced long-lasting complete or near-complete resolution of pain following electrode implantation. Efficacy in pain reduction was achieved through variation of stimulation settings over the course of treatment, and it was assessed using the visual analog scale and narrative report. Surgical complications included moderate postsurgical incisional pain, transient cerebral edema, and intraoperative seizure. The authors' results affirm the efficacy and broaden the application of motor cortex stimulation to several forms of intractable facial pain. PMID:20509733

Esfahani, Darian R; Pisansky, Marc T; Dafer, Rima M; Anderson, Douglas E

2011-01-01

51

Towards a theory of chronic pain  

PubMed Central

In this review we integrate recent human and animal studies from the viewpoint of chronic pain. First, we briefly review the impact of chronic pain on society and address current pitfalls of its definition and clinical management. Second, we examine pain mechanisms via nociceptive information transmission cephalad and its impact and interaction with the cortex. Third, we present recent discoveries on the active role of the cortex in chronic pain, with findings indicating that the human cortex continuously reorganizes as it lives in chronic pain. We also introduce data emphasizing that distinct chronic pain conditions impact on the cortex in unique patterns. Fourth, animal studies regarding nociceptive transmission, recent evidence for supraspinal reorganization during pain, the necessity of descending modulation for maintenance of neuropathic behavior, and the impact of cortical manipulations on neuropathic pain is also reviewed. We further expound on the notion that chronic pain can be reformulated within the context of learning and memory, and demonstrate the relevance of the idea in the design of novel pharmacotherapies. Lastly, we integrate the human and animal data into a unified working model outlining the mechanism by which acute pain transitions into a chronic state. It incorporates knowledge of underlying brain structures and their reorganization, and also includes specific variations as a function of pain persistence and injury type, thereby providing mechanistic descriptions of several unique chronic pain conditions within a single model. PMID:18952143

Apkarian, A. Vania; Baliki, Marwan N.; Geha, Paul Y.

2009-01-01

52

Safely Managing Chronic Pain | NIH MedlinePlus the Magazine  

MedlinePLUS

... this page please turn Javascript on. Feature: Chronic Pain Safely Managing Chronic Pain Past Issues / Spring 2011 Table of Contents Helping ... can help, as well. The Two Faces of Pain: Acute and Chronic What is pain? The International ...

53

Pain Catastrophizing in Youths With Physical Disabilities and Chronic Pain  

PubMed Central

Objective?The current study examined the associations between catastrophizing and pain intensity, psychological adjustment, functional ability, and community participation in youths with physical disability and chronic pain.?Methods?Participants consisted of 80 youths, aged 8–20 years, with cerebral palsy (n = 34), neuromuscular disease (n = 22), or spina bifida (n = 24). Measures from a cross-sectional survey included demographic, pain, and disability information, the Pain Catastrophizing Scale, the Child Health Questionnaire, and the Functional Disability Inventory.?Results?Results suggested that catastrophizing was significantly associated with pain intensity and psychological adjustment; however, catastrophizing did not demonstrate significant associations with functional ability or community participation.?Conclusions?The study extends previous findings of significant associations between catastrophizing and both pain intensity and psychological adjustment to samples of youths with chronic pain and disabilities not previously examined. Further research that examines the causal association between catastrophizing and outcomes in youths with chronic pain and physical disability is warranted. PMID:23033363

Engel, Joyce M.; Wilson, Sylia; Tran, Susan T.; Jensen, Mark P.; Ciol, Marcia A.

2013-01-01

54

Chronic postsurgical pain: still a neglected topic?  

PubMed Central

Background Surgical injury can frequently lead to chronic pain. Despite the obvious importance of this problem, the first publications on chronic pain after surgery as a general topic appeared only a decade ago. This study tests the hypothesis that chronic postsurgical pain was, and still is, represented insufficiently. Methods We analyzed the presentation of this topic in journal articles covered by PubMed and in surgical textbooks. The following signs of insufficient representation in journal articles were used: (1) the lack of journal editorials on chronic pain after surgery, (2) the lack of journal articles with titles clearly indicating that they are devoted to chronic postsurgical pain, and (3) the insufficient representation of chronic postsurgical pain in the top surgical journals. Results It was demonstrated that insufficient representation of this topic existed in 1981–2000, especially in surgical journals and textbooks. Interest in this topic began to increase, however, mostly regarding one specific surgery: herniorrhaphy. It is important that the change in the attitude toward chronic postsurgical pain spreads to other groups of surgeries. Conclusion Chronic postsurgical pain is still a neglected topic, except for pain after herniorrhaphy. The change in the attitude toward chronic postsurgical pain is the important first step in the approach to this problem. PMID:23152698

Kissin, Igor; Gelman, Simon

2012-01-01

55

Easing Chronic Pain: Better Treatments and Medications  

MedlinePLUS

... Bar Home Current Issue Past Issues Easing Chronic Pain: Better Treatments and Medications Past Issues / Fall 2007 ... this page please turn Javascript on. What Is Pain? You know it at once. It may be ...

56

Halt the Hurt! Dealing with Chronic Pain  

MedlinePLUS

... with chronic low-back pain might benefit from acupuncture, massage therapy, yoga or cognitive-behavioral therapy (a ... and CAM Pain: You Can Get Help Understanding Acupuncture CONTACT US NIH Office of Communications and Public ...

57

Pharmacological pain management in chronic pancreatitis  

PubMed Central

Intense abdominal pain is a prominent feature of chronic pancreatitis and its treatment remains a major clinical challenge. Basic studies of pancreatic nerves and experimental human pain research have provided evidence that pain processing is abnormal in these patients and in many cases resembles that seen in neuropathic and chronic pain disorders. An important ultimate outcome of such aberrant pain processing is that once the disease has advanced and the pathophysiological processes are firmly established, the generation of pain can become self-perpetuating and independent of the initial peripheral nociceptive drive. Consequently, the management of pain by traditional methods based on nociceptive deafferentation (e.g., surgery and visceral nerve blockade) becomes difficult and often ineffective. This novel and improved understanding of pain aetiology requires a paradigm shift in pain management of chronic pancreatitis. Modern mechanism based pain treatments taking into account altered pain processing are likely to increasingly replace invasive therapies targeting the nociceptive source, which should be reserved for special and carefully selected cases. In this review, we offer an overview of the current available pharmacological options for pain management in chronic pancreatitis. In addition, future options for pain management are discussed with special emphasis on personalized pain medicine and multidisciplinarity. PMID:24259960

Olesen, Søren S; Juel, Jacob; Graversen, Carina; Kolesnikov, Yuri; Wilder-Smith, Oliver HG; Drewes, Asbjørn M

2013-01-01

58

Chronic Pain in the Classroom: Teachers' Attributions about the Causes of Chronic Pain  

ERIC Educational Resources Information Center

Background: School absenteeism and other impairments in school function are significant problems among children with chronic pain syndromes; yet, little is known about how chronic pain is perceived in the school setting. The purpose of this study was to examine teachers' attributions about the causes of chronic pain in adolescent students.…

Logan, Deirdre E.; Catanese, Sarah P.; Coakley, Rachael M.; Scharff, Lisa

2007-01-01

59

Effective management of intractable neuropathic pain using an intrathecal morphine pump in a patient with acute transverse myelitis  

PubMed Central

Transverse myelitis is a rare inflammatory myelopathy characterized by loss of motor and sensory function below the affected level of the spinal cord, and causes neurogenic bowel and bladder. Occasionally, it also causes neuropathic pain with spasticity. Traditional therapies for neuropathic pain are multiple, including multimodal analgesic regimens, antiepileptic or antidepressant medications, opioids, sympathetic blocks, and spinal cord stimulation. Persistent neuropathic pain can cause emotional distress by affecting sleep, work, recreation, and emotional well-being. Here we report the case of a patient suffering from intractable neuropathic pain following acute transverse myelitis that was not relieved by combinations of nonsteroidal anti-inflammatory, anti-epileptic, antidepressant, and opioid medications, or by acupuncture. Implantation of an intrathecal morphine pump controlled the pain successfully without side effects, and enabled the patient to embark on intensive rehabilitation. The patient’s muscle strength has improved significantly and the patient may soon be able to use a walker with minimal assistance. PMID:23935366

Wu, Wei-Ting; Huang, Yu-Hui; Chen, Der-Cherng; Huang, Yu-Hsuan; Chou, Li-Wei

2013-01-01

60

Cutaneous nerve transection for the management of intractable upper extremity pain caused by invasive squamous cell carcinoma.  

PubMed

A recurrent clinical dilemma in the management of patients with painful metastatic lesions is achieving a balance between effective analgesic therapies versus intolerable side effects, in particular altered mental status. We present the case of an immunosuppressed patient post-lung transplant who was suffering from intractable pain caused by widely metastatic squamous cell carcinoma. The patient's progressive, excruciating neuropathic pain was localized to the area of the left wrist and forearm. Additionally, the patient complained of moderate pain at sites of tumor involvement on her right arm and scalp. Attempts to adequately manage her left upper extremity pain included a combination of pharmacologic treatments intended to treat neuropathic pain (gabapentin, SNRI, ketamine, opioids) and focused regional analgesia (infraclavicular infusion of local anesthetic). However, the patient developed intolerable side effects including altered mental status and delirium associated with the systemic agents and suboptimal control with the infraclavicular infusion. Given that the most severe pain was well localized, we undertook a diagnostic block of the cutaneous nerves of the left forearm. As this intervention significantly reduced her pain, we subsequently performed neurectomies to the left superficial radial nerve, lateral cutaneous nerve of the forearm and the posterior cutaneous nerve of the forearm. This resulted in immediate and continued relief of her left upper extremity pain without an altered mental status. Residual focal pain from lesions over her right arm and scalp was successfully managed with daily topical applications of lidocaine and capsaicin cream. Successful pain control continued until the patient's death five months later. PMID:21306862

Turnbull, John H; Gebauer, Sara L; Miller, Bruce L; Barbaro, Nicholas M; Blanc, Paul D; Schumacher, Mark A

2011-07-01

61

Addiction and Chronic Pain in Lesbians  

Microsoft Academic Search

This article addresses some of the complexities that arise in sexual minorities, primarily lesbians, who require treatment for chronic pain. Particular emphasis is on the additional complication introduced when such patients also suffer from some form of chemical abuse or dependence in different stages of evolution, ranging from active use to recovery to relapse. The intermingling of chronic pain and

Penelope Ziegler

2010-01-01

62

Counseling Adult Clients Experiencing Chronic Pain  

ERIC Educational Resources Information Center

Chronic pain affects 35% to 57% of the adult population in the United States and results in billions of dollars spent annually in direct health-care costs and lost productivity. Extensive research confirms the considerable role psychological factors play in the experience and expression of chronic pain. The author discusses implications for…

Burns, Stephanie T.

2010-01-01

63

Chronic Pain Patients: Implications for Rehabilitation Counseling.  

ERIC Educational Resources Information Center

Chronic pain syndrome appears to have certain dimensions which make it unique as a disabling condition. When pain persists, the resulting anxiety and depression, others' reactions to the patient's sick role behaviors, and situational variables such as disability benefits may all contribute to the pain syndrome and complicate the rehabilitation…

Scott, Lori T.

64

Chronic Pain Syndromes and Violence Against Women  

Microsoft Academic Search

Chronic pain is a common form of disability, and is often reported among women with a history of victimization. In the present study, we combine six pain symptoms into a measure of self-reported pain, and compare women who have experienced child or domestic abuse with those who do not report such a history. A sample of 110 female patients (57

Kathleen Kendall-Tackett; Roberta Marshall; Kenneth Ness

2003-01-01

65

Disrupted amygdala connectivity in chronic back pain reflects spontaneous pain perception  

E-print Network

Disrupted amygdala connectivity in chronic back pain reflects spontaneous pain perception 3974 OHBM 2013 INTRODUCTION · Chronic, spontaneous back pain (CBP) is known to engage brain systems involved of chronic pain and immediate pain perception in subacute back pain (SBP) patients who have had back pain

Apkarian, A. Vania

66

Combined ultrasound and fluoroscopic guidance for radiofrequency ablation of the obturator nerve for intractable cancer-associated hip pain.  

PubMed

Management of pain from skeletal metastases is notoriously difficult. Case reports and case series have described radiofrequency ablation of the obturator nerve branches to the femoral head for treatment of intractable hip pain. Ablation of the obturator branches to the femoral head is technically difficult because of bony and vascular anatomy, including close proximity of the femoral vessels. Here we present the case of a 79-year-old woman with intractable right hip pain and inability to ambulate secondary to metastatic non-small cell lung cancer in the femoral head and acetabulum, treated with thermal radiofrequency ablation of the obturator and femoral nerve branches to the femoral head. Ablation of the obturator nerve was done via anterior placement of the radiofrequency needle under combined ultrasound and fluoroscopic guidance, passing the radiofrequency needle between the femoral artery and femoral vein. Real-time ultrasound guidance was used to avoid vascular puncture. Thermal radiofrequency ablation resulted in sustained pain relief, and resumption in the ability of the patient to ambulate. From this case we suggest that an anterior approach to the obturator nerve branches to the femoral head may be technically feasible using combined ultrasound and fluoroscopic guidance to avoid vascular puncture. PMID:24452660

Stone, Jonathan; Matchett, Gerald

2014-01-01

67

ANALYZING MUSCULAR PAIN AND THE EFFECTS OF EXERCISE ON CHRONIC PAIN  

E-print Network

Most people suffering from various chronic pain syndromes report deep tissue pain. However, our knowledge about chronic musculoskeletal pain is primarily based on rodent models of cutaneous pain. Little is known about muscle nociception and its...

Sharma, Neena

2008-08-22

68

Childhood chronic pain and health care professional interactions: shaping the chronic pain experiences of children  

Microsoft Academic Search

Children with chronic pain meet numerous healthcare professionals during their search to understand their pain. Through semi-structured interviews, this qualitative study sought to understand the experiences of five children with chronic pain as they encountered healthcare pro- fessionals. In the majority of these interactions, children reported feeling misunderstood, disbelieved and abandoned. The findings of this study demonstrate that children's experiences

CHRISTINA ROSMUS

69

Lamotrigine for acute and chronic pain  

PubMed Central

Background This is an update of the original Cochrane review published in Issue 2, 2007. Some antiepileptic medicines have a place in the treatment of neuropathic pain (pain due to nerve damage). This updated review adds five new additional studies looking at evidence for Lamotrigine as an effective treatment for acute and chronic pain. Objectives To assess analgesic efficacy and adverse effects of the antiepileptic drug lamotrigine in acute and chronic pain. Search methods Randomised controlled trials (RCTs) of lamotrigine in acute, and chronic pain (including cancer pain) were identified from MEDLINE, EMBASE and CENTRAL up to January 2011. Additional studies were sought from the reference list of the retrieved papers. Selection criteria RCTs investigating the use of lamotrigine (any dose, by any route, and for any study duration) for the treatment of acute or chronic pain. Assessment of pain intensity or pain relief, or both, using validated scales. Participants were adults aged 18 and over. Only full journal publication articles were included. Data collection and analysis Dichotomous data (ideally for the outcome of at least 50% pain relief) were used to calculate relative risk with 95% confidence intervals. Meta-analysis was undertaken using a fixed-effect model. Numbers needed to treat to benefit (NNTs) were calculated as the reciprocal of the absolute risk reduction. For unwanted effects, the NNT becomes the number needed to harm (NNH) and was calculated. Main results Twelve included studies in 11 publications (1511 participants), all with chronic neuropathic pain: central post stroke pain (1), chemotherapy induced neuropathic pain (1), diabetic neuropathy (4), HIV related neuropathy (2), mixed neuropathic pain (2), spinal cord injury related pain (1), and trigeminal neuralgia (1); none investigated lamotrigine in acute pain. The update had five additional studies (1111 additional participants). Participants were aged between 26 and 77 years. Study duration was 2 weeks in one study and at least 6 weeks in the remainder; eight were of eight week duration or longer. There is no convincing evidence that lamotrigine is effective in treating acute or chronic pain at doses of about 200-400 mg daily. Almost 10% of participants taking lamotrigine reported a skin rash. Authors’ conclusions The additional studies tripled participant numbers providing data for analysis, and new, more stringent criteria for outcomes and analysis were used; conclusions about lamotrigine’s lack of efficacy in chronic pain did not change. Given availability of more effective treatments including antiepileptics and antidepressant medicines, lamotrigine does not have a significant place in therapy based on available evidence. PMID:21328280

Wiffen, Philip J; Derry, Sheena; Moore, R Andrew

2014-01-01

70

Central Hypersensitivity in Chronic Hemiplegic Shoulder Pain  

PubMed Central

Objective This study aimed to examine the association of hemiplegic shoulder pain with central hypersensitivity through pressure-pain thresholds (PPT) at healthy, distant tissues. Design This study is a cross-sectional study. A total of 40 patients (n=20 hemiplegic shoulder pain (HSP), n=20 stroke without HSP) were enrolled in this study. Pressure-pain thresholds were measured at the affected deltoid and contralateral deltoid and tibialis anterior using a handheld algometer. Differences in PPTs were analyzed by Wilcoxon Rank Sum test and with linear regression analysis controlling for gender, a known confounder of PPTs. Results Subjects with hemiplegic shoulder pain had lower local PPTs than stroke control subjects when comparing the painful to dominant shoulders and comparing the non-painful shoulder and tibialis anterior to the non-dominant side controls. Similarly, those with hemiplegic shoulder pain had lower PPTs when comparing to controls in contralesional-to-contralesional comparisons as well as ipsilesional-to-ipsilesional comparisons. Conclusions Subjects with hemiplegic shoulder pain have lower local and distal PPTs than subjects without hemiplegic shoulder pain. Our study suggests that chronic shoulder pain may be associated with widespread central hypersensitivity, which has been previously found to be associated with other chronic pain syndromes. This further understanding can then help develop better treatment options for those with this hemiplegic shoulder pain. PMID:23255268

Hoo, Jennifer Soo; Paul, Tracy; Chae, John; Wilson, Richard

2013-01-01

71

CHRONIC PAIN FOLLOWING SPINAL CORD INJURY  

PubMed Central

Most patients with insults to the spinal cord or central nervous system suffer from excruciating, unrelenting, chronic pain that is largely resistant to treatment. This condition affects a large percentage of spinal cord injury patients, and numerous patients with multiple sclerosis, stroke and other conditions. Despite the recent advances in basic science and clinical research the pathophysiological mechanisms of pain following spinal cord injury remain unknown. Here we describe a novel mechanism of loss of inhibition within the thalamus that may predispose for the development of this chronic pain and discuss a potential treatment that may restore inhibition and ameliorate pain. PMID:23281514

Masri, Radi; Keller, Asaf

2013-01-01

72

Opioids in chronic noncancer pain: More faces from the crowd  

PubMed Central

BACKGROUND: The use of opioids for chronic noncancer pain (CNCP) remains very controversial. There are several randomized controlled trials, mostly in neuropathic pain, reporting efficacy and safety in the short term, but more long-term data are needed. Randomized controlled trials may be limited in providing data about the patients who benefit from often high-dose opioids over the long term. The present article provides details of these patients and adds to a previous case series. METHODS: The present article contains 17 case reports of 11 CNCP conditions (followed to 2011) selected to illustrate specific issues from a survey of 84 patients with intractable CNCP treated with opioids and followed every three months for a median of 11 years. The previous published survey of this group reported outcomes of pain severity, adverse effects, pain relief, satisfaction, mood, problematic opioid use, tolerance, physical dependency, functional status, health-related quality of life (HRQL), immune status and sexual function. The outcome measures for that study included a numerical rating scale for pain, the Hospital Anxiety and Depression Scale, the Brief Pain Inventory Interference Scale, the Pain Disability Index and, for HRQL, the Short-Form Health Survey 12 version 2. Most patients in the total sample reported 50% or greater relief and a moderate improvement in disability. Scores for functional status and HRQL were not severely affected. Problematic use, tolerance and serious adverse effects, including constipation, were not major issues. These selected patient reports were chosen, not to illustrate optimal results, but rather important aspects of the diagnoses, opioids and doses, the paucity of intolerable adverse effects, particular issues (concurrent addiction history, bipolar disorder and combination therapy), disease-specific and other outcomes and duration of follow-up with complex pain problems. RESULTS: Opioids were found to be safe and useful in the long term for these particular patients, as well as in the larger group from which they originated. INTERPRETATION: These 17 reports of patients with intractable CNCP treated with opioids with some success over many years puts a face on more of the participants in the larger survey of 84 subjects, suggesting that this approach is effective and safe for some patients over many years. PMID:22891192

Watson, C Peter N

2012-01-01

73

Intradural approach to selective stimulation in the spinal cord for treatment of intractable pain: design principles and wireless protocol  

NASA Astrophysics Data System (ADS)

We introduce an intradural approach to spinal cord stimulation for the relief of intractable pain, and describe the biophysical rationale that underlies its design and performance requirements. The proposed device relies on wireless, inductive coupling between a pial surface implant and its epidural controller, and we present the results of benchtop experiments that demonstrate the ability to transmit and receive a frequency-modulated 1.6 MHz carrier signal between micro-coil antennae scaled to the ? 1 cm dimensions of the implant, at power levels of about 5 mW. Plans for materials selection, microfabrication, and other aspects of future development are presented and discussed.

Howard, M. A.; Utz, M.; Brennan, T. J.; Dalm, B. D.; Viljoen, S.; Jeffery, N. D.; Gillies, G. T.

2011-08-01

74

Chronic pain. Decreased motivation during chronic pain requires long-term depression in the nucleus accumbens.  

PubMed

Several symptoms associated with chronic pain, including fatigue and depression, are characterized by reduced motivation to initiate or complete goal-directed tasks. However, it is unknown whether maladaptive modifications in neural circuits that regulate motivation occur during chronic pain. Here, we demonstrate that the decreased motivation elicited in mice by two different models of chronic pain requires a galanin receptor 1-triggered depression of excitatory synaptic transmission in indirect pathway nucleus accumbens medium spiny neurons. These results demonstrate a previously unknown pathological adaption in a key node of motivational neural circuitry that is required for one of the major sequela of chronic pain states and syndromes. PMID:25082697

Schwartz, Neil; Temkin, Paul; Jurado, Sandra; Lim, Byung Kook; Heifets, Boris D; Polepalli, Jai S; Malenka, Robert C

2014-08-01

75

Uropathogenic Escherichia coli Induces Chronic Pelvic Pain ?  

PubMed Central

Chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) is a debilitating syndrome of unknown etiology often postulated, but not proven, to be associated with microbial infection of the prostate gland. We hypothesized that infection of the prostate by clinically relevant uropathogenic Escherichia coli (UPEC) can initiate and establish chronic pain. We utilized an E. coli strain newly isolated from a patient with CP/CPPS (strain CP1) and examined its molecular pathogenesis in cell culture and in a murine model of bacterial prostatitis. We found that CP1 is an atypical isolate distinct from most UPEC in its phylotype and virulence factor profile. CP1 adhered to, invaded, and proliferated within prostate epithelia and colonized the prostate and bladder of NOD and C57BL/6J mice. Using behavioral measures of pelvic pain, we showed that CP1 induced and sustained chronic pelvic pain in NOD mice, an attribute not exhibited by a clinical cystitis strain. Furthermore, pain was observed to persist even after bacterial clearance from genitourinary tissues. CP1 induced pelvic pain behavior exclusively in NOD mice and not in C57BL/6J mice, despite comparable levels of colonization and inflammation. Microbial infections can thus serve as initiating agents for chronic pelvic pain through mechanisms that are dependent on both the virulence of the bacterial strain and the genetic background of the host. PMID:21078846

Rudick, Charles N.; Berry, Ruth E.; Johnson, James R.; Johnston, Brian; Klumpp, David J.; Schaeffer, Anthony J.; Thumbikat, Praveen

2011-01-01

76

Clinical Management of Chronic Testicular Pain  

Microsoft Academic Search

Aim: To review the causes and principles and recent concepts in the management of testicular pain. Introduction: Chronic testicular pain is a common presenting symptom in genitourinary surgery. Due to increased awareness of testicular cancer and in men’s health more cases are likely to be referred. Material and Methods: A literature search was made for abstracts, original papers and review

Priyadarshi Kumar; Vivek Mehta; Vinod H. Nargund

2010-01-01

77

Diagnosis and treatment of chronic ankle pain.  

PubMed

The differential diagnosis for chronic ankle pain is quite broad. Ankle pain can be caused by intra-articular or extra-articular pathology and may be a result of a traumatic or nontraumatic event. A detailed patient history and physical examination, coupled with judicious selection of the appropriate imaging modalities, are vital in making an accurate diagnosis and providing effective treatment. Chronic ankle pain can affect all age groups, ranging from young athletes to elderly patients with degenerative joint and soft-tissue disorders. It has been estimated that 23,000 ankle sprains occur each day in the United States, representing approximately 1 sprain per 10,000 people per day. Because nearly one in five ankle injuries result in chronic symptoms, orthopaedic surgeons are likely to see patients with chronic ankle pain. Many patients with chronic ankle pain do not recall any history of trauma. Reviewing the management of the various disorders that can cause chronic ankle pain will help orthopaedic surgeons provide the best treatment for their patients. PMID:21553785

Wukich, Dane K; Tuason, Dominick A

2011-01-01

78

Chronic Pain and Mortality: A Systematic Review  

PubMed Central

Background Chronic pain is common, often widespread and has a substantial impact on health and quality of life. The relationship between chronic pain and mortality is unclear. This systematic review aimed to identify and evaluate evidence for a relationship between chronic pain and mortality. Methods A search of ten electronic databases including EMBASE and MEDLINE was conducted in March 2012, and updated until March 2014. Observational studies investigating the association between chronic or widespread pain (including fibromyalgia) and mortality were included. Risk of bias was assessed and a meta-analysis was undertaken to quantify heterogeneity and pool results. A narrative review was undertaken to explore similarities and differences between the included studies. Results Ten studies were included in the review. Three reported significant associations between chronic or widespread pain and mortality in unadjusted results. In adjusted analyses, four studies reported a significant association. The remaining studies reported no statistically significant association. A meta-analysis showed statistically significant heterogeneity of results from studies using comparable outcome measures (n?=?7)(I2?=?78.8%) and a modest but non-significant pooled estimate (MRR1.14,95%CI 0.95–1.37) for the relationship between chronic pain and all-cause mortality. This association was stronger when analysis was restricted to studies of widespread pain (n?=?5,I2?=?82.3%) MRR1.22(95%CI 0.93–1.60). The same pattern was observed with deaths from cancer and cardiovascular diseases. Heterogeneity is likely to be due to differences in study populations, follow-up time, pain phenotype, methods of analysis and use of confounding factors. Conclusion This review showed a mildly increased risk of death in people with chronic pain, particularly from cancer. However, the small number of studies and methodological differences prevented clear conclusions from being drawn. Consistently applied definitions of chronic pain and further investigation of the role of health, lifestyle, social and psychological factors in future studies will improve understanding of the relationship between chronic pain and mortality. PMID:24901358

Smith, Diane; Wilkie, Ross; Uthman, Olalekan; Jordan, Joanne L.; McBeth, John

2014-01-01

79

Low back pain: risk factors for chronicity.  

PubMed

The burden of low back pain disability has increased steadily over the last few decades in western countries. The high social and economic cost of low back pain is related to the minority of individuals who lose more than six months from work. Although the risk factors for low back pain have been well delineated, methodologic obstacles have hindered the collection of information on factors associated with a chronic course. The most reliable data are those generated by prospective studies involving multivariate analyses. Advanced age is associated with an increased risk of chronic pain, as is male gender (except in some recent studies). Weight and height are not related to chronicity. Disease-related factors predictive of chronic pain include presence of multiple functional symptoms, evidence of nonorganic disease, pain in the legs, significant disability at onset, a protracted initial episode, multiple recurrences and a history of low back pain or inhospital treatment. Occupational factors have a very substantial impact: workers in blue-collar jobs, those involved in heavy labor or in jobs that require efforts beyond their physical capabilities and those who have a low level of job satisfaction or poor working conditions, who are new at their job, or who are not well rated by their superiors are more likely to develop chronic pain. A history of compensation for a spinal condition, receipt of work-related sickness payments, or litigation about compensation are also associated with an increased risk of chronic pain. Social and economic factors predictive of a chronic course are a low level of schooling, language problems, a low income and an unfavorable family status. The impact of psychological factors is controversial. Depression, a number of specific coping strategies and a sensation of being "sick all the time" may be associated with an increase in the risk of chronicity. Overall, progression to a chronic pattern of pain is more closely dependent on demographic, psychosocial and occupational factors than on the medical characteristics of the spinal condition itself. Simple questionnaires can be used to identify patients at a high risk for chronicity. Treatment should be prompt and comprehensive in these patients since the likelihood of a return to work decreases rapidly as sick leave duration increases. PMID:9090769

Valat, J P; Goupille, P; Védere, V

1997-03-01

80

Glia and pain: Is chronic pain a gliopathy?  

PubMed Central

Activation of glial cells and neuro-glial interactions are emerging as key mechanisms underlying chronic pain. Accumulating evidence has implicated 3 types of glial cells in the development and maintenance of chronic pain: microglia and astrocytes of the central nervous system (CNS), and satellite glial cells of the dorsal root and trigeminal ganglia. Painful syndromes are associated with different glial activation states: (1) glial reaction (ie, upregulation of glial markers such as IBA1 and glial fibrillary acidic protein (GFAP) and/or morphological changes, including hypertrophy, proliferation, and modifications of glial networks); (2) phosphorylation of mitogen-activated protein kinase signaling pathways; (3) upregulation of adenosine triphosphate and chemokine receptors and hemichannels and downregulation of glutamate transporters; and (4) synthesis and release of glial mediators (eg, cytokines, chemokines, growth factors, and proteases) to the extracellular space. Although widely detected in chronic pain resulting from nerve trauma, inflammation, cancer, and chemotherapy in rodents, and more recently, human immunodeficiency virus-associated neuropathy in human beings, glial reaction (activation state 1) is not thought to mediate pain sensitivity directly. Instead, activation states 2 to 4 have been demonstrated to enhance pain sensitivity via a number of synergistic neuro-glial interactions. Glial mediators have been shown to powerfully modulate excitatory and inhibitory synaptic transmission at presynaptic, postsynaptic, and extrasynaptic sites. Glial activation also occurs in acute pain conditions, and acute opioid treatment activates peripheral glia to mask opioid analgesia. Thus, chronic pain could be a result of “gliopathy,” that is, dysregulation of glial functions in the central and peripheral nervous system. In this review, we provide an update on recent advances and discuss remaining questions. PMID:23792284

Ji, Ru-Rong; Berta, Temugin; Nedergaard, Maiken

2013-01-01

81

Pain. Author manuscript Prevalence of chronic pain with neuropathic characteristics in the general  

E-print Network

Pain. Author manuscript Page /1 10 Prevalence of chronic pain with neuropathic characteristics.bouhassira@apr.aphp.fr> Abstract We conducted a large nationwide postal survey to estimate the prevalence of chronic pain chronic pain (defined as daily pain for at least 3 months), evaluating its intensity, duration and body

Paris-Sud XI, Université de

82

Pregabalin in Chronic Post–thoracotomy Pain  

PubMed Central

Introduction: Chronic post–thoracotomy pain (CPP) has very high incidence and therefore it needs attention. Usually, it is burning, dysaesthetic and aching in nature and it displays many features of neuropathic pain. No one technique of thoracotomy has been shown to reduce the incidence of chronic post thoracotomy pain. Objectives: To evaluate the efficacy and safety of pregabalin in patients with chronic post–thoracotomy pain. Methods: This prospective, randomized study was conducted on 50 consenting patients who underwent posterolateral thoracotomy. 25 patients were given pregabalin for 21 days (Group A). Another 25 were given diclofenac sodium (Group B) on demand and they escaped treatment. Visual Analogue Scale (VAS) scoring was performed on days 0, 1 and 7, then follow up was done at 3, 6, 12 and 24 weeks. The data was analyzed by using t-test and Chi- square test for various variables. Results: The pain VAS scores in Group A were significantly low at all observation points except on day 0, day 1 and day 7 post-operatively, when the difference in pain scores in both the groups were comparable. The overall pain scores of Group A were comparable at day 0, day 1 and at day 7 as compared to those of Group B (p>0.9). Pain was significantly low at three weeks (p<0.05). Pain scores of Group A were significantly low at 6 weeks,12 weeks and 24 weeks as compared to those of Group B (p<0.001) and the difference was statistically significant. No significant adverse reactions were observed during study period. Conclusion: Pregabalin is a safe and an effective adjuvant which is used for reducing the chronic post thoracotomy pain, which has no side effects and a high patient compliance. These results should be supported with multidisciplinary studies with larger sample sizes and longer follow-ups. PMID:24086867

Mishra, Atul; Nar, Amandeep Singh; Bawa, Ashvind; Kaur, Gurinder; Bawa, Sayesha; Mishra, Seema

2013-01-01

83

Physical modalities in chronic pain management.  

PubMed

The following conclusions can be made based on review of the evidence: There is limited but positive evidence that select physical modalities are effective in managing chronic pain associated with specific conditions experienced by adults and older individuals. Overall, studies have provided the most support for the modality of therapeutic exercise. Different physical modalities have similar magnitudes of effects on chronic pain. Therefore, selection of the most appropriate physical modality may depend on the desired functional outcome for the patient, the underlying impairment, and the patient's preference or prior experience with the modality. Certain patient characteristics may decrease the effectiveness of physical modalities, as has been seen with TENS. These characteristics include depression, high trait anxiety, a powerful others locus of control, obesity, narcotic use, and neuroticism. The effect on pain by various modalities is generally strongest in the short-term period immediately after the intervention series, but effects can last as long as 1 year after treatment (e.g., with massage). Most research has tested the effect of physical modalities on chronic low back pain and knee OA. The effectiveness of physical modalities for other chronic pain conditions needs to be evaluated more completely. Older and younger adults often experience similar effects on their perception of pain from treatment with physical modalities. Therefore, use of these modalities for chronic pain in older adults is appropriate, but special precautions need to be taken. Practitioners applying physical modalities need formal training that includes the risks and precautions for these modalities. If practitioners lack formal training in the use of physical modalities, or if modality use is not within their scope of practice, it is important to consult with and refer patients to members of the team who have this specialized training. Use of a multidisciplinary approach to chronic pain management is of value for all adults and older individuals in particular [79-81]. Historically, physical therapists have been trained to evaluate and treat patients with the range of physical modalities discussed in this article. Although members of the nursing staff traditionally have used some of these modalities (e.g. some forms of heat or cold and massage), increasing numbers of nurses now are being trained to apply more specialized procedures (e.g., TENS). Healthcare professionals must be knowledgeable about the strength of evidence underlying the use of physical modalities for the management of chronic pain. Based on the limited research evidence available (especially related to assistive devices, orthotics, and thermal modalities), it often is difficult to accept or exclude select modalities as having a potential role in chronic pain management for adults and older individuals. Improved research methodologies are needed to address physical modality effectiveness better. PMID:14567204

Rakel, Barbara; Barr, John O

2003-09-01

84

Chronic pain management in pregnancy and lactation.  

PubMed

During pregnancy most of women will experience some kind of pain, either as a result of a pre-existing condition (low back pain, headache, fibromyalgia, and rheumatoid arthritis) or as a direct consequence of pregnancy (weight gain, postural changes, pelvic floor dysfunction, hormonal factors). However, chronic pain management during pregnancy and lactation remains a challenge for clinicians and pregnant women are at risk of undertreatment for painful conditions, because of fear about use of drugs during pregnancy. Few analgesic drugs have been demonstrated to be absolutely contraindicated during pregnancy and breastfeeding, but studies in pregnant women are not available for most of pain medications. The aim of this paper is to review the safety profile in pregnancy or lactation of the commonly prescribed pain medications and non-pharmacological treatments. In addition to the conventional classifications from the Food and Drug Administration and the American Academy of Paediatrics, authors analyzed the currently available clinical data from literature. PMID:23857445

Coluzzi, F; Valensise, H; Sacco, M; Allegri, M

2014-02-01

85

Intractable Headache - The Pain in Your Head that Just Won't Quit  

MedlinePLUS

... We think that the brain of someone with constant, treatment-resistant pain actually processes information differently from the way people who don’t have constant pain. There is very exciting research going on ...

86

Chronic Pain: The Impact on Academic, Social, and Emotional Functioning  

ERIC Educational Resources Information Center

Chronic pain is persistent and recurrent pain that tends to fluctuate in severity, quality, regularity, and predictability. It can occur in a single or multiple body regions or organ systems. Some of the most frequently reported types of chronic pain include headaches, recurrent abdominal pain (RAP), and musculoskeletal pain. In contrast to acute…

Parkins, Jason M.; Gfroerer, Susan D.

2009-01-01

87

The mechanisms underlying chronic osteoarthritis (OA) pain remain obscure.  

E-print Network

activity patterns for spontaneous chronic back pain (CBP) , and acute thermal pain in normal subjects For Stimulating The Painful Knee in Osteoarthritis Contrasted With Brain Activity For Back Pain and Acute Thermal for spontaneous CBP is 13 Chronic Back patients. Random effect analysis of (pain ­ visual control) shows

Apkarian, A. Vania

88

Prevention of chronic pain after whiplash  

PubMed Central

The acute whiplash injury is a significant health burden for patients and the healthcare system. Traditional approaches to treatment fail to resolve this ever growing medicolegal and social problem. A new biopsychosocial model of whiplash disorder encourages new ways of treating and preventing of the chronic disability. This biopsychosocial model takes into account the mechanism by which acute pain becomes chronic pain, and how this can be prevented. Specific education and treatments encourage a behaviour after whiplash injury that is conducive to more rapid recovery, and provides the whiplash patient with insight into the mediators of chronic pain. The article describes in practical terms how to use education, reassurance, a more judicious use of therapy, and exercise to achieve this goal. Practical guidelines are provided on educating the patient about other symptoms that may cause concern. PMID:12421777

Ferrari, R

2002-01-01

89

Effect of pain chronification and chronic pain on an endogenous pain modulation circuit in rats.  

PubMed

We tested the hypothesis that chronic pain development (pain chronification) and ongoing chronic pain (chronic pain) reduce the activity and induce plastic changes in an endogenous analgesia circuit, the ascending nociceptive control. An important mechanism mediating this form of endogenous analgesia, referred to as capsaicin-induced analgesia, is its dependence on nucleus accumbens ?-opioid receptor mechanisms. Therefore, we also investigated whether pain chronification and chronic pain alter the requirement for nucleus accumbens ?-opioid receptor mechanisms in capsaicin-induced analgesia. We used an animal model of pain chronification in which daily subcutaneous prostaglandin E2 (PGE2) injections into the rat's hind paw for 14days, referred to as the induction period of persistent hyperalgesia, induce a long-lasting state of nociceptor sensitization referred to as the maintenance period of persistent hyperalgesia, that lasts for at least 30days following the cessation of the PGE2 treatment. The nociceptor hypersensitivity was measured by the shortening of the time interval for the animal to respond to a mechanical stimulation of the hind paw. We found a significant reduction in the duration of capsaicin-induced analgesia during the induction and maintenance period of persistent mechanical hyperalgesia. Intra-accumbens injection of the ?-opioid receptor selective antagonist Cys(2),Tyr(3),Orn(5),Pen(7)amide (CTOP) 10min before the subcutaneous injection of capsaicin into the rat's fore paw blocked capsaicin-induced analgesia. Taken together, these findings indicate that pain chronification and chronic pain reduce the duration of capsaicin-induced analgesia, without affecting its dependence on nucleus accumbens ?-opioid receptor mechanisms. The attenuation of endogenous analgesia during pain chronification and chronic pain suggests that endogenous pain circuits play an important role in the development and maintenance of chronic pain. PMID:25451282

Miranda, J; Lamana, S M S; Dias, E V; Athie, M; Parada, C A; Tambeli, C H

2015-02-12

90

Physical and emotional functioning of adult patients with chronic abdominal pain: Comparison with patients with chronic back pain  

Microsoft Academic Search

Adults with chronic abdominal pain remain a poorly defined population, despite the debilitation and depression associated with this therapeutically challenging condition. This study compared patients with chronic abdominal pain with an empirically well-known group of patients with chronic pain (back pain) to investigate similarities and differences in their physical and mental functioning. This retrospective, cross-sectional study included 136 patients with

Cynthia O. Townsend; Christopher D. Sletten; Barbara K. Bruce; Jeffrey D. Rome; Connie A. Luedtke; John E. Hodgson

2005-01-01

91

The Neurobiology of Chronic Pain in Children  

Microsoft Academic Search

\\u000a Chronic pain arises from plastic changes in the peripheral and central nervous system. These changes are triggered and may\\u000a be maintained by an insult to tissues, organs or to the nervous system itself. Because neural connections within the sensory\\u000a and nociceptive systems have been altered, pain can take on a ‘life of its own’ and no longer require the presence

Maria Fitzgerald

92

The Epidemiology of Pediatric Chronic Pain  

Microsoft Academic Search

\\u000a Chronic pain has a substantial adverse impact on the health-related quality of life of children and adolescents, resulting\\u000a in significantly worse physical functioning, psychological functioning, social functioning, lower satisfaction with life,\\u000a and poorer self-perceived health status (Merlijn et al. 2006; Palermo 2000; Palermo et al. 2008). The current Pediatric Initiative\\u000a on Methods, Measurement, and Pain Assessment in Clinical Trials (PedIMMPACT)

Thomas R. Vetter

93

Outcome measures in chronic low back pain  

Microsoft Academic Search

The purpose of this prospective, single site cohort quasi-experimental study was to determine the responsiveness of the numerical\\u000a rating scale (NRS), Roland–Morris disability questionnaire (RMDQ), Oswestry disability index (ODI), pain self-efficacy questionnaire\\u000a (PSEQ) and the patient-specific functional scale (PSFS) in order to determine which would best measure clinically meaningful\\u000a change in a chronic low back pain (LBP) population. Several patient-based

Elaine F. MaughanJeremy; Jeremy S. Lewis

2010-01-01

94

Chronic morphine reduces pain-related disability in a rodent model of chronic, inflammatory pain.  

PubMed

Chronic pain is disabling, and the adverse effects of morphine are also disabling. The best way to assess the beneficial effects relative to the potential adverse effects of chronic morphine may be through the use of quantitative measures of functional disability in people and animals experiencing pain. If chronic morphine alleviates chronic pain and its beneficial analgesic effects outweigh whatever adverse effects it may produce, then it should reduce pain-related disability. Rats with adjuvant-induced arthritis were implanted with subcutaneous morphine pellets. Continuous morphine reduced pain-related disability in tasks motivated by food reward or shock avoidance throughout the 35 days of continuous administration--first, in tests that primarily assessed the function of the less severely affected forelimbs, and later, as the inflammation subsided, in tests more dependent on the function of the more severely affected hind limbs. PMID:10472506

Lindner, M D; Plone, M A; Francis, J M; Cain, C K

1999-08-01

95

[Multimodal therapy programs for chronic pain].  

PubMed

Chronic pain is a common and disabling disorder with major consequences for patient quality of life and it is also a major economic burden to society. The management of chronic pain comprises a large range of different intervention strategies including pharmacological therapy, non-medicinal and invasive therapeutic options. While non-pharmacological and multimodal options are underused, monomodal options, especially pharmacotherapy and invasive therapies are overused. The effectiveness of multidisciplinary and multimodal treatment programs including physical and rehabilitation interventions and psychological treatment has been extensively studied in the last two decades. Evidence from randomized controlled trials demonstrates that there is low quality evidence for the effectiveness of exercise therapy alone, there is some evidence for the effectiveness of behavioral therapy and there is at least moderate evidence for the effectiveness of multidisciplinary and multimodal treatment and other active treatment reducing pain and increasing functional capacity at short and intermediate term. Therefore, blanket coverage with provision of adequate treatment programs for chronic pain as well as studies evaluating the best composition of treatment elements are needed. The characteristics of chronic pain, the necessary assessment procedures and treatment types are described. PMID:25616569

Kopf, A; Gjoni, E

2015-02-01

96

Study of experimental pain measures and nociceptive reflex in chronic pain patients and normal subjects.  

PubMed

This study evaluates (i) the effect of heterotopic chronic pain on various experimental pain measures, (ii) the relationship between experimental pain measures and chronic pain symptomatology assessment, and (iii) the influence of the various pain aetiologies on experimental pain measures. Fifty-three chronic pain patients were compared to 17 pain-free subjects with the following psychophysical and physiological indices: pain threshold (PTh), pain tolerance (PTol), verbal estimation of intensity and unpleasantness (intensity scale, IS; unpleasantness scale, US), threshold for intensity and unpleasantness (ITh and UTh), lower limb RIII nociceptive reflex (RIIITh and RIII frequency of occurrence). Chronic pain syndromes included neuropathic pain (n = 12), iodopathic pain (n = 12), myofascial syndromes (n = 9), headache (n = 9), and miscellaneous pain (n = 11). Chronic pain symptomatology was assessed with a visual analogue scale (VAS), a French MPQ adaptation (QDSA), Beck Depression Inventory (BDI), Spielberger State Trait Inventory (STAI) and Eysenck Personality Inventory (EPI). No significant difference was observed between chronic pain patients and pain-free control groups and between patient subgroups for PTh, PTol and RIIITh. No significant correlation was found between experimental pain measures and clinical pain, anxiety or depression scores. However, the chronic pain patients had a higher threshold for unpleasantness and judged the suprathreshold stimuli significantly less intense and less unpleasant than the control group. These results are discussed in relation to diffuse noxious inhibitory controls and the adaptation level theory of chronic pain experience. PMID:2052379

Boureau, F; Luu, M; Doubrère, J F

1991-02-01

97

Intractable chest pain in cardiomyopathy: treatment by a novel technique of cardiac cryodenervation with quantitative immunohistochemical assessment of success.  

PubMed

A novel method of cardiac denervation by cryoablation has been developed experimentally. The technique uses liquid nitrogen delivered under pressure to ablate the principal sources of cardiac innervation--namely, the adventitia surrounding the aorta, pulmonary arteries, and veins. The technique has been verified experimentally both in vivo by physiological means and in vitro by quantitative immunohistochemistry and the measurement of myocardial noradrenaline concentrations. A 35 year old woman presented with intractable precordial pain, normal epicardial coronary arteries, and hypertrophic cardiomyopathy. Her symptoms were refractory to maximal medical treatment and she was thought to be unsuitable for either conventional myocardial revascularisation, autotransplantation, or allografting with the concomitant risk of transplant coronary artery disease. She therefore underwent cardiac denervation by the method developed in the laboratory. There was quantitative immunohistochemical evidence of extrinsic cardiac denervation associated with a considerable improvement in her symptoms. This improvement persisted during a follow up period of over 16 months. PMID:8280529

Gaer, J A; Gordon, L; Wharton, J; Polak, J M; Taylor, K M; McKenna, W; Parker, D J

1993-12-01

98

Beyond pain: modeling decision-making deficits in chronic pain  

PubMed Central

Risky decision-making seems to be markedly disrupted in patients with chronic pain, probably due to the high cost that impose pain and negative mood on executive control functions. Patients’ behavioral performance on decision-making tasks such as the Iowa Gambling Task (IGT) is characterized by selecting cards more frequently from disadvantageous than from advantageous decks, and by switching often between competing responses in comparison with healthy controls (HCs). In the present study, we developed a simple heuristic model to simulate individuals’ choice behavior by varying the level of decision randomness and the importance given to gains and losses. The findings revealed that the model was able to differentiate the behavioral performance of patients with chronic pain and HCs at the group, as well as at the individual level. The best fit of the model in patients with chronic pain was yielded when decisions were not based on previous choices and when gains were considered more relevant than losses. By contrast, the best account of the available data in HCs was obtained when decisions were based on previous experiences and losses loomed larger than gains. In conclusion, our model seems to provide useful information to measure each individual participant extensively, and to deal with the data on a participant-by-participant basis. PMID:25136301

Hess, Leonardo Emanuel; Haimovici, Ariel; Muñoz, Miguel Angel; Montoya, Pedro

2014-01-01

99

Attempted Gene Therapy for Intractable Pain: Dexamethasone-Mediated Exogenous Control of ?-Endorphin Secretion in Genetically Modified Cells and Intrathecal Transplantation  

Microsoft Academic Search

For optimal neural transplantation using gene engineering, it might be important to control the expression of the transfected gene extrinsically as required. This strategy could be very useful for the treatment of intractable pain that responds to opioids. For this purpose, we established a genetically modified embryonal carcinoma cell line (P19) in which the expression of ?-endorphin (?-EP) could be

Keisuke Ishii; Mitsuo Isono; Ryo Inoue; Shigeaki Hori

2000-01-01

100

Objective Evidence of Severe Disease: Opioid Use in Chronic Pain  

PubMed Central

Treating chronic pain presents numerous challenges. First, assessing patients with chronic pain is complicated by the lack of objective measures of pain itself. Chronic pain guidelines already developed by national organizations rely on careful history taking rather than objective measures. Second, opioids are an accepted element of chronic pain management, but their use is tempered by risks of overdose, dependency, and the potential for diversion. This essay proposes a new standard for the use of long-term opioids for chronic pain: the presence or absence of objective evidence of severe disease. This standard, which supports responsible prescribing of opioids, is one that clinicians can understand and apply when considering prescribing long-term opioids for chronic pain. Until we have measures of pain itself, we should insist upon objective evidence of severe disease before prescribing opioids for chronic pain. PMID:22778125

Zweifler, John A.

2012-01-01

101

Art Therapy for Chronic Pain: Applications and Future Directions  

ERIC Educational Resources Information Center

Chronic pain is acknowledged as a phenomenological experience resulting from biological, psychological, and social interactions. Consequently, treatment for this complex and debilitating health phenomenon is often approached from multidisciplinary and biopsychosocial perspectives. One approach to treating chronic pain involves implementing…

Angheluta, Anne-Marie; Lee, Bonnie K.

2011-01-01

102

Opioid use and depression in chronic pelvic pain.  

PubMed

Opioid pain medications and antidepressants are commonly prescribed to patients for chronic non-cancer pain. However, little evidence exists for their effectiveness in most pain states, including chronic pelvic pain. Whenever possible, initiation of opioid pain medications in chronic non-cancer pain should be avoided. If patients present for evaluation of disease states such as endometriosis or interstitial cystitis already using regular narcotics, physicians should be aware of ways to mediate misuse and diversion. Women with chronic pain should be screened for depression as well as a history of prior sexual abuse, and treatment or referral initiated when indicated. PMID:25155127

Steele, Andrew

2014-09-01

103

Abnormal Pain Modulation in Patients with Spatially Distributed Chronic Pain: Fibromyalgia  

PubMed Central

Many chronic pain syndromes including fibromyalgia, irritable bowel syndrome, chronic fatigue syndrome, migraine headache, chronic back pain, and complex regional pain syndrome are associated with hypersensitivity to painful stimuli and with reduced endogenous pain inhibition. These findings suggest that modulation of pain-related information may be related to the onset and/or maintenance of chronic pain. Although pain sensitivity and pain inhibition are normally distributed in the general population, they are not useful as reliable predictors of future pain. The combination of heightened pain sensitivity and reduced pain-inhibition, however, appears to predispose individuals to greater risk for increased acute clinical pain (e.g., postoperative pain). It is unknown at this time whether such pain processing abnormalities may also place individuals at increased risk for chronic pain. Psychophysical methods, including heat sensory and pressure pain testing have become increasingly available and can be used for the evaluation of pain sensitivity and pain inhibition. However, long-term prospective studies in the general population are lacking which could yield insight into the role of heightened pain sensitivity and pain disinhibition for the development of chronic pain disorders like fibromyalgia. PMID:19647141

Staud, Roland

2009-01-01

104

Chronic pelvic pain syndrome: a clinical enigma.  

PubMed

Chronic nonbacterial prostatitis is an ill-defined, painful clinical condition that is characterized by various nonspecific symptoms, some of which are related to urination or the male reproductive organs. Urologists diagnose this particular condition when the symptoms are not associated with urinary bacterial growth before and after transrectal prostate massage. In this review, we describe the recommended and optional tests that can be performed in these cases. There is significant overlap between chronic nonbacterial prostatitis and other unexplained pain conditions, raising the question as to whether the prostate is the culprit. The sources and mediators of pain and the psychological aspects of this complex condition are discussed. Treatments consist of traditional antibiotics and ?-blockers. Because the pain relief is often temporary, patients seek other solutions. Various therapeutics have been introduced to satisfy the expectations of patients and physicians. We discuss other pain medications, as well as intraprostatic drug injections and shockwave therapy. Importantly, however, not all of these suggestions have been widely accepted by urologists or pain clinics. PMID:25141249

Stein, Avi; May, Tal; Dekel, Yoram

2014-07-01

105

When does acute pain become chronic?  

PubMed

The transition from acute to chronic pain appears to occur in discrete pathophysiological and histopathological steps. Stimuli initiating a nociceptive response vary, but receptors and endogenous defence mechanisms in the periphery interact in a similar manner regardless of the insult. Chemical, mechanical, and thermal receptors, along with leucocytes and macrophages, determine the intensity, location, and duration of noxious events. Noxious stimuli are transduced to the dorsal horn of the spinal cord, where amino acid and peptide transmitters activate second-order neurones. Spinal neurones then transmit signals to the brain. The resultant actions by the individual involve sensory-discriminative, motivational-affective, and modulatory processes in an attempt to limit or stop the painful process. Under normal conditions, noxious stimuli diminish as healing progresses and pain sensation lessens until minimal or no pain is detected. Persistent, intense pain, however, activates secondary mechanisms both at the periphery and within the central nervous system that cause allodynia, hyperalgesia, and hyperpathia that can diminish normal functioning. These changes begin in the periphery with upregulation of cyclo-oxygenase-2 and interleukin-1?-sensitizing first-order neurones, which eventually sensitize second-order spinal neurones by activating N-methyl-d-aspartic acid channels and signalling microglia to alter neuronal cytoarchitecture. Throughout these processes, prostaglandins, endocannabinoids, ion-specific channels, and scavenger cells all play a key role in the transformation of acute to chronic pain. A better understanding of the interplay among these substances will assist in the development of agents designed to ameliorate or reverse chronic pain. PMID:21148657

Voscopoulos, C; Lema, M

2010-12-01

106

Brief Communications Beyond Feeling: Chronic Pain Hurts the Brain, Disrupting  

E-print Network

back pain (CBP) patients and healthy controls while executing a simple visual attention task, weBrief Communications Beyond Feeling: Chronic Pain Hurts the Brain, Disrupting the Default, Northwestern University, Chicago, Illinois 60611 Chronic pain patients suffer from more than just pain

Apkarian, A. Vania

107

Prefrontal cortical hyperactivity in patients with sympathetically mediated chronic pain  

E-print Network

Prefrontal cortical hyperactivity in patients with sympathetically mediated chronic pain A. Vania form 12 July 2001; accepted 12 July 2001 Abstract Chronic pain continues to impose a large burden of suffering, yet its neural correlates remain poorly understood. In sympathetically mediated chronic pain (SMP

Apkarian, A. Vania

108

Long-term use of narcotic analgesics in chronic pain  

Microsoft Academic Search

The use of narcotic analgesics have been avoided by clinicians in patients with chronic pain syndromes. Uncertainty as to the etiological cause of chronic pain, development of addiction and habituation and associated psychological and behavioral symptoms found in chronic pain states which are not amenable to narcotic medications are the major reasons narcotics are not prescribed. This communication describes the

Randal D. France; Bruno J. Urban; Francis J. Keefe

1984-01-01

109

Chronic Pain Rehabilitation with a Serious Game using Multimodal Input  

E-print Network

of patients with chronic pain of the lower back and neck. The focus of this work is on the multimodal inputChronic Pain Rehabilitation with a Serious Game using Multimodal Input Christian Schönauer, Thomas and Computer Science, University of Twente, Enschede Abstract--Rehabilitation for chronic pain follows

110

The cortical rhythms of chronic back pain INTRODUCTION  

E-print Network

The cortical rhythms of chronic back pain 1051 OHBM 2011 INTRODUCTION · Compared with normal and patients suffering for chronic back pain (CBP) ·We find that CBP is associated with specific changes ·Chronic back pain is associated with increased fluctuation in 0.12 ­ 0.2 Hz especially in the mPFC. ·This

Apkarian, A. Vania

111

Abnormal endogenous pain modulation is a shared characteristic of many chronic pain conditions  

PubMed Central

The intensity of acute and chronic pain depends on interactions between peripheral impulse input and CNS pain mechanisms, including facilitation and inhibition. Whereas tonic pain inhibition is a characteristic of most pain-free individuals, pain facilitation can be detected in many chronic pain patients. The capability to inhibit pain is normally distributed along a wide continuum in the general population and can be used to predict chronic pain. Accumulating evidence suggests that endogenous pain inhibition depends on activation of the prefrontal cortex, periaqueductal gray and rostral ventral medulla. Quantitative sensory test paradigms have been designed to acquire detailed information regarding each individual’s endogenous pain inhibition and facilitation. Such tests include: temporal summation of pain, which is mostly used to assess facilitatory pain modulation by measuring the change in pain perception during a series of identical nociceptive stimuli; and conditioned pain modulation, which tests pain inhibition by utilizing two simultaneously applied painful stimuli (the ‘pain inhibits pain’ paradigm). Considerable indirect evidence seems to indicate that not only increased pain facilitation but also ineffective pain inhibition represents a predisposition for chronic pain. This view is supported by the fact that many chronic pain syndromes (e.g., fibromyalgia, temporomandibular joint disorder, irritable bowel syndrome, headache and chronic fatigue syndrome) are associated with hypersensitivity to painful stimuli and reduced endogenous pain inhibition. However, future prospective studies will be necessary to provide definitive evidence for this relationship. Such research would not only provide important information about mechanisms relevant to chronic pain but would also permit identification of individuals at high risk for future chronic pain. PMID:22550986

Staud, Roland

2012-01-01

112

Immune mediators of chronic pelvic pain syndrome.  

PubMed

The cause of chronic pelvic pain syndrome (CPPS) has yet to be established. Since the late 1980s, cytokine, chemokine, and immunological classification studies using human samples have focused on identifying biomarkers for CPPS, but no diagnostically beneficial biomarkers have been identified, and these studies have done little to deepen our understanding of the mechanisms underlying chronic prostatic pain. Given the large number of men thought to be affected by this condition and the ineffective nature of current treatments, there is a pressing need to elucidate these mechanisms. Prostatitis types IIIa and IIIb are classified according to the presence of pain without concurrent presence of bacteria; however, it is becoming more evident that, although levels of bacteria are not directly associated with levels of pain, the presence of bacteria might act as the initiating factor that drives primary activation of mast-cell-mediated inflammation in the prostate. Mast cell activation is also known to suppress regulatory T cell (Treg) control of self-tolerance and also activate neural sensitization. This combination of established autoimmunity coupled with peripheral and central neural sensitization can result in the development of multiple symptoms, including pelvic pain and bladder irritation. Identifying these mechanisms as central mediators in CPPS offers new insight into the prospective treatment of the disease. PMID:24686526

Murphy, Stephen F; Schaeffer, Anthony J; Thumbikat, Praveen

2014-05-01

113

Treatment of chronic regional pain syndrome type 1 with palmitoylethanolamide and topical ketamine cream: modulation of nonneuronal cells  

PubMed Central

Chronic regional pain syndrome (CRPS) can be intractable to treat and patients sometimes suffer for many years. Therefore, new treatment strategies are needed to alleviate symptoms in CRPS patients. This case report describes a patient suffering from intractable CRPS type 1 for 13 years. Due to her swollen painful feet and left knee she is wheelchair-bound. The combination of palmitoylethanolamide and ketamine 10% cream reduced her pain by more than 50% after 1 month of treatment, and a marked reduction in swelling and skin discoloration was noticed. Furthermore, she could walk independently again and she experienced no side effects. Thus, palmitoylethanolamide and topical ketamine could be a combination therapy option for treating CRPS patients. PMID:23658493

Keppel Hesselink, Jan M; Kopsky, David J

2013-01-01

114

Treatment of chronic regional pain syndrome type 1 with palmitoylethanolamide and topical ketamine cream: modulation of nonneuronal cells.  

PubMed

Chronic regional pain syndrome (CRPS) can be intractable to treat and patients sometimes suffer for many years. Therefore, new treatment strategies are needed to alleviate symptoms in CRPS patients. This case report describes a patient suffering from intractable CRPS type 1 for 13 years. Due to her swollen painful feet and left knee she is wheelchair-bound. The combination of palmitoylethanolamide and ketamine 10% cream reduced her pain by more than 50% after 1 month of treatment, and a marked reduction in swelling and skin discoloration was noticed. Furthermore, she could walk independently again and she experienced no side effects. Thus, palmitoylethanolamide and topical ketamine could be a combination therapy option for treating CRPS patients. PMID:23658493

Keppel Hesselink, Jan M; Kopsky, David J

2013-01-01

115

Risk Assessment of Opioid Misuse in Italian Patients with Chronic Noncancer Pain  

PubMed Central

Objective. Opioid therapy in patients with chronic noncancer pain must be preceded by evaluation of the risk of opioid misuse. The aim of this study was to evaluate the predictive validity of the Italian translation of the Pain Medication Questionnaire (PMQ) and of the Diagnosis Intractability Risk and Efficacy Score (DIRE) in chronic pain patients. Design. 75 chronic noncancer pain patients treated with opioids were enrolled and followed longitudinally. Risk of opioid misuse was evaluated through PMQ, DIRE, and the physician's clinical evaluation. Pain experience and psychological characteristics were assessed through specific self-report instruments. At follow-ups, pain intensity, aberrant drug behaviors, and presence of the prescribed opioid and of illegal substances in urine were also checked. Results. PMQ demonstrated good internal consistency (Cronbach's ? = 0.77) and test-retest reliability (r = 0.86). Significant correlations were found between higher PMQ scores and the number of aberrant drug behaviors detected at 2-, 4-, and 6-month follow-ups (P < 0.01). Also the DIRE demonstrated good predictive validity. Conclusions. The results obtained with specific tools are more reliable than the clinician's evaluation alone in predicting the risk of opioid misuse; regular monitoring and psychological intervention will contribute to improving compliance and outcome of long-term opioid use. PMID:25177499

Ferrari, Renata; Duse, Genni; Capraro, Michela; Visentin, Marco

2014-01-01

116

Adult Chronic Pain Specialist Referral Please print clearly  

E-print Network

/syndromes that apply and circle the most disabling at present Low Back Pain with radiculopathy Emerging Complex Regional Pain Syndrome Low Back Pain without radiculopathy Established Complex Regional Pain SyndromeAdult Chronic Pain Specialist Referral Please print clearly Place Patient Label Here Mandatory Data

MacMillan, Andrew

117

Resilience: A New Paradigm for Adaptation to Chronic Pain  

Microsoft Academic Search

Chronic pain is an affliction that affects a large proportion of the general population and is often accompanied by a myriad\\u000a of negative emotional, cognitive, and physical effects. However, current pain adaptation paradigms do not account for the\\u000a many chronic pain patients who demonstrate little or no noticeable impairment due to the effects of chronic pain. This paper\\u000a offers resilience

John A. Sturgeon; Alex J. Zautra

2010-01-01

118

Abdominal Implantation of Testicles in the Management of Intractable Testicular Pain in Fournier Gangrene  

PubMed Central

Fournier gangrene (FG) is a necrotizing soft tissue infection involving the superficial and fascial planes of the perineum. In many cases of FG, debridement of the scrotum is necessary, leaving definitive management of the exposed testicles a significant surgical challenge. Frequent incidental trauma to the testicles can cause severe pain, especially in laborers. Practical surgical solutions are few and not well detailed. Various options exist, including creating a neoscrotum with adjacent thigh tissue, split-thickness skin grafts (STSGs), or even creating a subcutaneous thigh pocket. We describe a case of abdominal implantation of bilateral testicles for persistent testicular pain in a case where STSGs did not provide adequate protection, adjacent thigh skin was not available for creation of a neoscrotum, and significant cord contracture occurred. We detail the advantages and disadvantages of the commonly described techniques, including this approach, and how in select individuals this may be a suitable alternative. PMID:24229025

Chan, Cyrus C.; Shahrour, Khaled; Collier, Ronald D.; Welch, Marlene; Chang, Shiliang; Williams, Mallory

2013-01-01

119

Lumbar paravertebral blockade as intractable pain management method in palliative care  

PubMed Central

Optimal symptoms control in advanced cancer disease, with refractory to conventional pain treatment, needs an interventional procedure. This paper presents coadministration of local anesthetic (LA) via paravertebral blockade (PVB) as the alternative to an unsuccessful subcutaneous fentanyl pain control in a 71-year old cancer patient with pathological fracture of femoral neck, bone metastases, and contraindications to morphine. Bupivacaine in continuous infusion (0.25%, 5 mL · hour?1) or in boluses (10 mL of 0.125%–0.5% solution), used for lumbar PVB, resulted in pain relief, decreased demand for opioids, and led to better social interactions. The factors contributing to an increased risk of systemic toxicity from LA in the patient were: renal impairment; heart failure; hypoalbuminemia; hypocalcemia; and a complex therapy with possible drug-drug interactions. These factors were taken into consideration during treatment. Bupivacaine’s side effects were absent. Coadministered drugs could mask LA’s toxicity. Elevated plasma ?1-acid glycoprotein levels were a protective factor. To evaluate the benefit-risk ratio of the PVB treatment in boluses and in constant infusion, bupivacaine serum levels were determined and the drug plasma half-lives were calculated. Bupivacaine’s elimination was slower when administered in constant infusion than in boluses (t½ = 7.80 hours versus 2.64 hours). Total drug serum concentrations remained within the safe ranges during the whole treatment course (22.9–927.4 ng mL?1). In the case presented, lumbar PVB with bupivacaine in boluses (? 137.5 mg · 24 hours?1) was an easy to perform, safe, effective method for pain control. Bupivacaine in continuous infusion (?150 mg · 12 hours?1) had an acceptable risk-benefits ratio, but was ineffective. PMID:24043944

Zaporowska-Stachowiak, Iwona; Kotlinska-Lemieszek, Aleksandra; Kowalski, Grzegorz; Kosicka, Katarzyna; Hoffmann, Karolina; G?ówka, Franciszek; ?uczak, Jacek

2013-01-01

120

Expressive dimensions of pain catastrophizing: An observational study in adolescents with chronic pain.  

PubMed

Investigated was the relationship between pain catastrophizing and pain intensity in adolescents suffering from chronic pain (n = 38) and the extent to which they expressed communicative pain and pain-related protective behaviours. Adolescents were observed on video performing a 2-Min Walk Test (2MWT). Behaviours were coded on videotape. The adolescents' verbalizations about the 2MWT were also rated by their parents. Analyses revealed that higher levels of catastrophic thinking about pain were associated with higher levels of facial pain expressions and verbalizations about their pain experience, beyond the effects of age, gender, pain duration and pain intensity. Pain-related protective behaviours did not vary with the adolescents' level of pain catastrophizing, but varied with pain intensity. The findings corroborate the functional distinctiveness of different types of pain behaviours. The results are discussed in terms of the processes linking (1) catastrophizing to communicative pain behaviours and (2) pain to pain-related protective behaviours. PMID:19683394

Vervoort, T; Goubert, L; Eccleston, C; Vandenhende, M; Claeys, O; Clarke, J; Crombez, G

2009-11-01

121

Chronic Pelvic Pain in Endometriosis: An Overview  

PubMed Central

Chronic pelvic pain (CPP) could be considered nowadays a deep health problem that challenges physicians all over the world. This because its aetiology is still unclear, the course of the disease could vary a lot among different patients and through time in the same patient, and the response to treatments is not every time successful. Among women who underwent laparoscopy for CPP, endometriosis is found in about 1/3 of the cases, while only 25% of women with histological confirmed endometriosis are asymptomatic. A wide range of variables may exert their influence on the resulting pain syndrome in endometriosis; for example, score according to American society for reproductive medicine (rASRM), size of the sub-peritoneal and pelvic wall implants, Douglas obliteration, previous surgery. It is widely accepted nowadays that central nervous system (CNS) and peripheral nervous system (PNS) seems to influence each other and this interconnection play a key role in pain modulation. Moreover, the phenomena induced by endometriosis in the pelvis, including the breakdown of peritoneal homeostasis and the induction of the production of proinflammatory and proangiogenic cytokines, are responsible of altered innervations and modulation of pain pathways in these patients. There are many proposed medical and surgical approach to treat this painful syndrome, although there is necessity of more efforts to create new non-invasive strategies that set a more accurate diagnosis of the causes of endometriotic-related CPP, and therefore facilitate its eradication. PMID:23671540

Triolo, Onofrio; Laganà, Antonio Simone; Sturlese, Emanuele

2013-01-01

122

Nucleus accumbens responses to painful aversive and rewarding stimuli change in chronic pain  

E-print Network

Nucleus accumbens responses to painful aversive and rewarding stimuli change in chronic pain M. N of Neurol. and Physiol., UCSF, San Francisco, CA Brain activity maps for perception of thermal pain 1 back pain (CBP) patients to acute thermal painful stimuli within the context of reward

Apkarian, A. Vania

123

Evoked Pain Analgesia in Chronic Pelvic Pain Patients Using Respiratory-Gated Auricular  

E-print Network

with respiratory events to better optimize bs_bs_banner Pain Medicine 2012; *: **­** Wiley Periodicals, Inc. 1 #12Evoked Pain Analgesia in Chronic Pelvic Pain Patients Using Respiratory-Gated Auricular Vagal pain (CPP) due to endometriosis in a specialty pain clinic. Interventions/Outcomes. We evaluated evoked

Napadow, Vitaly

124

Behavioral/Systems/Cognitive Chronic Pain and the Emotional Brain: Specific Brain  

E-print Network

Associated with Spontaneous Fluctuations of Intensity of Chronic Back Pain Marwan N. Baliki,1 Dante R,yetthereisalackofknowledgeregardingbrainelementsinvolvedinsuchconditions.Here,weidentifybrainregionsinvolvedin spontaneous pain of chronic back pain (CBP) in two separate groups of patients (n 13 and n 11), and contrast, specifically in chronic back pain (CBP). Chronic pain is often associated with spontaneous pain (pain

Apkarian, A. Vania

125

Psychosocial Risks for Disability in Children With Chronic Back Pain  

Microsoft Academic Search

Psychosocial factors related to disability in adults with chronic back pain have been well studied, but little is known about factors associated with functional impairment in pediatric patients with chronic back pain. The purpose of this study was to examine whether 2 potential risk factors—use of catastrophizing as a coping technique and presence of a familial pain history—were associated with

Anne M. Lynch; Susmita Kashikar-Zuck; Kenneth R. Goldschneider; Benjamin A. Jones

2006-01-01

126

Pain-Associated Adaptive Cortical Reorganisation in Chronic Pancreatitis  

Microsoft Academic Search

Background\\/Aims: In various chronic pain conditions cortical reorganisation seems to play a role in the symptomatology. The aims of this study were to investigate cortical reorganisation in patients with pain caused by chronic pancreatitis (CP) and to correlate putative cortical reorganisation to clinical pain scores. Methods: 24 patients suffering from CP and 14 healthy volunteers were included. Patients’ daily experience

Søren Schou Olesen; Jens Brøndum Frøkjær; Dina Lelic; Massimiliano Valeriani; Asbjørn Mohr Drewes

2010-01-01

127

Immersive VR: A Non-pharmacological Analgesic for Chronic Pain?  

E-print Network

Immersive VR: A Non-pharmacological Analgesic for Chronic Pain? Abstract This paper describes the research work being carried out by the Transforming Pain Research Group ­ the only group whose work is exclusively focused on the use of immersive VR for chronic pain management. Unlike VR research for acute

Shaw, Chris

128

Naturopathic Care for Chronic Low Back Pain: A Randomized Trial  

Microsoft Academic Search

Objective. Chronic low back pain represents a substantial cost to employers through benefits coverage and days missed due to incapacity. We sought to explore the effectiveness of Naturopathic care on chronic low back pain. Methods. This study was a randomized clinical trial. We randomized 75 postal employees with low back pain of longer than six weeks duration to receive Naturopathic

Orest Szczurko; Kieran Cooley; Jason W. Busse; Dugald Seely; Bob Bernhardt; Gordon H. Guyatt; Qi Zhou; Edward J. Mills

2007-01-01

129

Naturopathic Care for Chronic Low Back Pain: A Randomized Trial  

Microsoft Academic Search

ObjectiveChronic low back pain represents a substantial cost to employers through benefits coverage and days missed due to incapacity. We sought to explore the effectiveness of Naturopathic care on chronic low back pain.MethodsThis study was a randomized clinical trial. We randomized 75 postal employees with low back pain of longer than six weeks duration to receive Naturopathic care (n =

Orest Szczurko; Kieran Cooley; Jason W. Busse; Dugald Seely; Bob Bernhardt; Gordon H. Guyatt; Qi Zhou; Edward J. Mills; Peter Tugwell

2007-01-01

130

Treating Chronic Pelvic Pain: A Review of the Research for Women  

MedlinePLUS

... Consumer Summary – Apr. 16, 2012 Treating Chronic Pelvic Pain: A Review of the Research for Women Formats ... assistant. Understanding Your Condition What is chronic pelvic pain? Chronic pelvic pain (CPP) is ongoing pain in ...

131

Measuring parent beliefs about child acceptance of pain: A preliminary validation of the Chronic Pain Acceptance Questionnaire, parent report  

Microsoft Academic Search

Parent perceptions of and responses to pain have been identified as important factors in understanding pain-related disability among children and adolescents with chronic pain. The ability to accept chronic pain rather than focus on ways to avoid or control it has been linked to positive outcomes in chronic pain research. To examine parent beliefs about child acceptance of pain, the

Laura E. Simons; Christine B. Sieberg; Karen J. Kaczynski

2011-01-01

132

Untying chronic pain: prevalence and societal burden of chronic pain stages in the general population - a cross-sectional survey  

PubMed Central

Background Chronic pain is a major public health problem. The impact of stages of chronic pain adjusted for disease load on societal burden has not been assessed in population surveys. Methods A cross-sectional survey with 4360 people aged???14 years representative of the German population was conducted. Measures obtained included demographic variables, presence of chronic pain (based on the definition of the International Association for the Study of Pain), chronic pain stages (by chronic pain grade questionnaire), disease load (by self-reported comorbidity questionnaire) and societal burden (by self-reported number of doctor visits, nights spent in hospital and days of sick leave/disability in the previous 12 months, and by current unemployment). Associations between chronic pain stages with societal burden, adjusted for demographic variables and disease load, were tested by Poisson and logistic regression analyses. Results 2508 responses were received. 19.4% (95% CI 16.8% to 22.0%) of participants met the criteria of chronic non-disabling non-malignant pain. 7.4% (95% CI 5.0% to 9.9%) met criteria for chronic disabling non-malignant pain. Compared with no chronic pain, the rate ratio (RR) of days with sick leave/disability was 1.6 for non-disabling pain and 6.4 for disabling pain. After adjusting for age and disease load, the RRs increased to 1.8 and 6.8. The RR of doctor visits was 2.5 for non-disabling pain and 4.5 for disabling pain if compared with no chronic pain. After adjusting for age and disease load, the RR fell to 1.7 and 2.6. The RR of days in hospital was 2.7 for non-disabling pain and 11.7 for disabling pain if compared with no chronic pain. After adjusting for age and disease load, the RR fell to 1.5 and 4.0. Unemployment was predicted by lower educational level (Odds Ratio OR 3.27 [95% CI 1.70-6.29]), disabling pain (OR 3.30 [95% CI 1.76-6.21]) and disease load (OR 1.70 [95% CI 1.41-2.05]). Conclusion Chronic pain stages, but also disease load and societal inequalities contributed to societal burden. Pain measurements in epidemiology research of chronic pain should include chronic pain grades and disease load. PMID:24725286

2014-01-01

133

Improving outcomes for chronic pain in primary care.  

PubMed

Although the patient's goal is often complete pain relief, this is rarely a realistic outcome, so the role of the physician in managing chronic pain involves optimising pain relief as far as possible. Careful explanation and education may be needed to enable the focus to shift from cure to better management of pain, and improvement of function and quality of life. Chronic pain is defined as pain continuing beyond the normal time for tissue healing. Pain may be broadly classified on the basis of mechanism, as neuropathic, nociceptive or mixed. A thorough biopsychosocial assessment is essential so that an individualised multidisciplinary approach to management can be developed. The aims of assessment of chronic pain are to rule out any underlying serious pathology, identify the pain mechanism and identify and evaluate risk factors that contribute to chronicity. SIGN emphasises the need for a multidisciplinary team approach to improve outcomes, and highlights five broad categories of care: supported self-management, drug treatment, psychologically-based interventions, physical therapies and complementary therapies. Exercise, regardless of its type and the source of pain, is recommended for the management of chronic pain. In chronic low back pain, exercise therapy can improve strength and range of motion across joints, cardiorespiratory fitness and sense of wellbeing. Pain management programmes reduce anxiety and depressive symptoms, increase function and improve mood. They may be considered in patients with poor functional capacity, pain-related social and occupational problems and in cases where other management strategies have failed. PMID:25588280

Govenden, Daniel; Serpell, Mick

2014-09-01

134

Cannabinoid-opioid interaction in chronic pain.  

PubMed

Cannabinoids and opioids share several pharmacologic properties and may act synergistically. The potential pharmacokinetics and the safety of the combination in humans are unknown. We therefore undertook a study to answer these questions. Twenty-one individuals with chronic pain, on a regimen of twice-daily doses of sustained-release morphine or oxycodone were enrolled in the study and admitted for a 5-day inpatient stay. Participants were asked to inhale vaporized cannabis in the evening of day 1, three times a day on days 2-4, and in the morning of day 5. Blood sampling was performed at 12-h intervals on days 1 and 5. The extent of chronic pain was also assessed daily. Pharmacokinetic investigations revealed no significant change in the area under the plasma concentration-time curves for either morphine or oxycodone after exposure to cannabis. Pain was significantly decreased (average 27%, 95% confidence interval (CI) 9, 46) after the addition of vaporized cannabis. We therefore concluded that vaporized cannabis augments the analgesic effects of opioids without significantly altering plasma opioid levels. The combination may allow for opioid treatment at lower doses with fewer side effects. PMID:22048225

Abrams, D I; Couey, P; Shade, S B; Kelly, M E; Benowitz, N L

2011-12-01

135

Chronic Low Back Pain: Toward an Integrated Psychosocial Assessment Model.  

ERIC Educational Resources Information Center

Integrated six dimensions of chronic low back pain (pain intensity, functional disability, attitudes toward pain, pain coping strategies, depression, illness behavior) to provide multidimensional patient profile. Data from 100 patients revealed presence of three distinct patient groups: patients who were in control, patients who were depressed and…

Strong, Jenny; And Others

1994-01-01

136

Duloxetine in the management of chronic musculoskeletal pain  

PubMed Central

Chronic musculoskeletal pain is among the most frequent painful complaints that healthcare providers address. The bulk of these complaints are chronic low back pain and chronic osteoarthritis. Osteoarthritis is the most common form of arthritis in the United States. It is a chronic degenerative disorder characterized by a loss of cartilage, and occurs most often in older persons. The management of osteoarthritis and chronic low back pain may involve both nonpharmacologic (eg, weight loss, resistive and aerobic exercise, patient education, cognitive behavioral therapy) and pharmacologic approaches. Older adults with severe osteoarthritis pain are more likely to take analgesics than those with less severe pain. The pharmacologic approaches to painful osteoarthritis remain controversial, but may include topical as well as oral nonsteroidal antiinflammatory drugs, acetaminophen, duloxetine, and opioids. The role of duloxetine for musculoskeletal conditions is still evolving. PMID:22767991

Smith, Howard S; Smith, Eric J; Smith, Benjamin R

2012-01-01

137

Caring for patients with chronic pain: pearls and pitfalls.  

PubMed

Chronic, nonmalignant pain is a substantial public health problem in the United States. Research over the past 2 decades has defined chronic pain by using a "biopsychosocial model" that considers a patient's biology and psychological makeup in the context of his or her social and cultural milieu. Whereas this model addresses the pathology of chronic pain, it also places many demands on the physician, who is expected to assess and manage chronic pain safely and successfully. There is a growing body of evidence suggesting that opioids can be effective in the management of chronic pain, but there has also been a rise in opioid-related overdoses and deaths. Clinicians should be aware of assessment tools that may be used to evaluate the risk of opioid abuse. A basic understanding of chronic pain pathophysiology and a uniform approach to patient care can satisfy the needs of both patients and physicians. PMID:23918913

Debono, David J; Hoeksema, Laura J; Hobbs, Raymond D

2013-08-01

138

Anatomical and Physiological Factors Contributing to Chronic Muscle Pain  

PubMed Central

Chronic muscle pain remains a significant source of suffering and disability despite the adoption of pharmacologic and physical therapies. Muscle pain is mediated by free nerve endings distributed through the muscle along arteries. These nerves project to the superficial dorsal horn and are transmitted primarily through the spinothalamic tract to several cortical and subcortical structures, some of which are more active during the processing of muscle pain than other painful conditions. Mechanical forces, ischemia, and inflammation are the primary stimuli for muscle pain, which is reflected in the array of peripheral receptors contributing to muscle pain-ASIC, P2X, and TRP channels. Sensitization of peripheral receptors and of central pain processing structures are both critical for the development and maintenance of chronic muscle pain. Further, variations in peripheral receptors and central structures contribute to the significantly greater prevalence of chronic muscle pain in females. PMID:24633937

Gregory, Nicholas S.; Sluka, Kathleen A.

2015-01-01

139

Dynamic pain–emotion relations in chronic pain: a theoretical review of moderation studies  

Microsoft Academic Search

Current developments in chronic pain research are changing the focus in the study of pain–emotion relations from the identification of general patterns to the study of dynamic and context-related interactions manifesting both within and between individuals. This shift towards understanding variation at both intra- and interpersonal levels has significant clinical implications for psychological adjustment to chronic pain conditions, and thus

Alexandra L. Dima; David T. Gillanders; Mick J. Power

2011-01-01

140

A typology of pain coping strategies in pediatric patients with chronic abdominal pain  

Microsoft Academic Search

This study aimed to identify clinically meaningful profiles of pain coping strategies used by youth with chronic abdominal pain (CAP). Participants (n=699) were pediatric patients (ages 8–18 years) and their parents. Patients completed the Pain Response Inventory (PRI) and measures of somatic and depressive symptoms, disability, pain severity and pain efficacy, and perceived competence. Parents rated their children’s pain severity

Lynn S. Walker; Kari Freeman Baber; Judy Garber; Craig A. Smith

2008-01-01

141

CAF Scientifique What a Pain! Debate Around the Use of Opioids in Chronic Pain Management  

E-print Network

CAFÃ? Scientifique What a Pain! Debate Around the Use of Opioids in Chronic Pain Management November prescription KEY MESSAGES From Patients: The person living with pain and their physician need to be open and honest with each other. Opioids are part of a pain management program, not the entire plan. Patients

Haykin, Simon

142

The Relationship between Strategies of Coping and Perception of Pain in Three Chronic Pain Groups.  

ERIC Educational Resources Information Center

Examined the relationship between perception of pain, personality, coping, and the reaction of family members in three chronic pain groups (sickle cell anemia, arthritis, and low back pain) (N=60). Analyses suggested that the three groups were not distinguishable in coping, personality, or in their experience of pain. (LLL)

Anderson, Louis P.; Rehm, Lynn P.

1984-01-01

143

Avoidance behavior in chronic pain research: A cold case revisited.  

PubMed

In chronic musculoskeletal pain, avoidance behavior is a prominent behavioral characteristic that can manifest itself in various ways. It is also considered a crucial component in the development and maintenance of chronic pain-related disability, supposedly fueled by pain-related fear and catastrophic beliefs. Despite the frequent occurrence of avoidance behavior and its potential impact on quality of life, relatively little research has been dedicated to the nature of avoidance in chronic pain and its assessment, leaving its underlying mechanisms poorly understood. In the current paper, we stipulate some of the existing parallels between chronic pain research and more basic fear and anxiety research inspired by modern learning theories. After a brief introduction, we discuss avoidance theories that are likely apt to be applied to chronic pain, including avoidance as a response that can affect fear responding, and the role of avoidant decision making and motivational context. Finally, we will outline how these theories may impact clinical treatment. PMID:25506905

Volders, Stéphanie; Boddez, Yannick; De Peuter, Steven; Meulders, Ann; Vlaeyen, Johan W S

2015-01-01

144

Programmable intrathecal pumps for the management of chronic pain: recommendations for improved efficiency  

PubMed Central

The management of chronic pain can be very challenging. Often, physicians employ intrathecal (IT) drug delivery systems as a last resort to relieve intractable pain. The system consists of an implantable pump that stores and delivers medication through a catheter to the IT space. Programmability is achieved by positioning an external devise over the implanted pump to change the mode of drug delivery. The innovations in programmable IT drug delivery systems are expanding more rapidly than ever before. Unfortunately, the rapid expansion is accompanied by a lack of prospective randomized trials examining these new options. In an effort to improve results and reduce side effects, publications by experts or expert consensus panels provide guidance for the community. The purpose of this article is to provide a summary of high interest topics in recent publications. PMID:25336986

Wilkes, Denise

2014-01-01

145

Alleviation of chronic pain following rat spinal cord compression injury with multimodal actions of huperzine A.  

PubMed

Diverse mechanisms including activation of NMDA receptors, microglial activation, reactive astrogliosis, loss of descending inhibition, and spasticity are responsible for ?40% of cases of intractable neuropathic pain after spinal cord injury (SCI). Because conventional treatments blocking individual mechanisms elicit only short-term effectiveness, a multimodal approach with simultaneous actions against major pain-related pathways may have value for clinical management of chronic pain. We hypothesize that [-]-huperzine A (HUP-A), an alkaloid isolated from the club moss Huperzia serrata, that is a potent reversible inhibitor of acetylcholinesterase and NMDA receptors, could mitigate pain without invoking drug tolerance or dependence by stimulating cholinergic interneurons to impede pain signaling, inhibiting inflammation via microglial cholinergic activation, and blocking NMDA-mediated central hypersensitization. We tested our hypothesis by administering HUP-A i.p. or intrathecally to female Sprague-Dawley rats (200-235 g body weight) after moderate static compression (35 g for 5 min) of T10 spinal cord. Compared with controls, HUP-A treatment demonstrates significant analgesic effects in both regimens. SCI rats manifested no drug tolerance following repeated bolus i.p. or chronic intrathecal HUP-A dosing. The pain-ameliorating effect of HUP-A is cholinergic dependent. Relative to vehicle treatment, HUP-A administration also reduced neural inflammation, retained higher numbers of calcium-impermeable GluR2-containing AMPA receptors, and prevented Homer1a up-regulation in dorsal horn sensory neurons. Therefore, HUP-A may provide safe and effective management for chronic postneurotrauma pain by reestablishing homeostasis of sensory circuits. PMID:23386718

Yu, Dou; Thakor, Devang K; Han, Inbo; Ropper, Alexander E; Haragopal, Hariprakash; Sidman, Richard L; Zafonte, Ross; Schachter, Steven C; Teng, Yang D

2013-02-19

146

Alleviation of chronic pain following rat spinal cord compression injury with multimodal actions of huperzine A  

PubMed Central

Diverse mechanisms including activation of NMDA receptors, microglial activation, reactive astrogliosis, loss of descending inhibition, and spasticity are responsible for ?40% of cases of intractable neuropathic pain after spinal cord injury (SCI). Because conventional treatments blocking individual mechanisms elicit only short-term effectiveness, a multimodal approach with simultaneous actions against major pain-related pathways may have value for clinical management of chronic pain. We hypothesize that [-]-huperzine A (HUP-A), an alkaloid isolated from the club moss Huperzia serrata, that is a potent reversible inhibitor of acetylcholinesterase and NMDA receptors, could mitigate pain without invoking drug tolerance or dependence by stimulating cholinergic interneurons to impede pain signaling, inhibiting inflammation via microglial cholinergic activation, and blocking NMDA-mediated central hypersensitization. We tested our hypothesis by administering HUP-A i.p. or intrathecally to female Sprague–Dawley rats (200–235 g body weight) after moderate static compression (35 g for 5 min) of T10 spinal cord. Compared with controls, HUP-A treatment demonstrates significant analgesic effects in both regimens. SCI rats manifested no drug tolerance following repeated bolus i.p. or chronic intrathecal HUP-A dosing. The pain-ameliorating effect of HUP-A is cholinergic dependent. Relative to vehicle treatment, HUP-A administration also reduced neural inflammation, retained higher numbers of calcium-impermeable GluR2-containing AMPA receptors, and prevented Homer1a up-regulation in dorsal horn sensory neurons. Therefore, HUP-A may provide safe and effective management for chronic postneurotrauma pain by reestablishing homeostasis of sensory circuits. PMID:23386718

Yu, Dou; Thakor, Devang K.; Han, Inbo; Ropper, Alexander E.; Haragopal, Hariprakash; Sidman, Richard L.; Zafonte, Ross; Schachter, Steven C.; Teng, Yang D.

2013-01-01

147

Pain sensitivity and tactile spatial acuity are altered in healthy musicians as in chronic pain patients  

PubMed Central

Extensive training of repetitive and highly skilled movements, as it occurs in professional classical musicians, may lead to changes in tactile sensitivity and corresponding cortical reorganization of somatosensory cortices. It is also known that professional musicians frequently experience musculoskeletal pain and pain-related symptoms during their careers. The present study aimed at understanding the complex interaction between chronic pain and music training with respect to somatosensory processing. For this purpose, tactile thresholds (mechanical detection, grating orientation, two-point discrimination) and subjective ratings to thermal and pressure pain stimuli were assessed in 17 professional musicians with chronic pain, 30 pain-free musicians, 20 non-musicians with chronic pain, and 18 pain-free non-musicians. We found that pain-free musicians displayed greater touch sensitivity (i.e., lower mechanical detection thresholds), lower tactile spatial acuity (i.e., higher grating orientation thresholds) and increased pain sensitivity to pressure and heat compared to pain-free non-musicians. Moreover, we also found that musicians and non-musicians with chronic pain presented lower tactile spatial acuity and increased pain sensitivity to pressure and heat compared to pain-free non-musicians. The significant increment of pain sensitivity together with decreased spatial discrimination in pain-free musicians and the similarity of results found in chronic pain patients, suggests that the extensive training of repetitive and highly skilled movements in classical musicians could be considered as a risk factor for developing chronic pain, probably due to use-dependent plastic changes elicited in somatosensory pathways. PMID:25610384

Zamorano, Anna M.; Riquelme, Inmaculada; Kleber, Boris; Altenmüller, Eckart; Hatem, Samar M.; Montoya, Pedro

2015-01-01

148

Opioid Pharmacotherapy for Chronic Noncancer Pain: The American Experience  

PubMed Central

Chronic noncancer pain is a significant and growing public health challenge in the United States. Lacking effective alternative interventions for effective chronic noncancer pain management, many physicians have turned to opioid pharmacotherapy. Increased opioid prescribing brings not only gains in therapeutic benefit but also a higher incidence of adverse drug events including increased medication misuse and opioid related mortality. Currently the United States must confront the dual problems of widespread undertreated chronic noncancer pain and a prescription opioid abuse crisis. Withholding pain relieving drugs from patients in need is unjustifiable, yet drug diversion, abuse and adverse drug events have become major social as well as medical problems. At the heart of this crisis is the lack of definitive evidence about the risk to benefit ratio of opioid pharmacotherapy for chronic noncancer pain both on an individual case and on a population basis. This article describes the extent and severity of the American chronic noncancer pain problem and the history of opioid pharmacotherapy for chronic noncancer pain in the United States. It then discusses the concept of evidence based practice and reviews current evidence supporting opioid pharmacotherapy for chronic noncancer pain as well as adverse drug events related to opioid pharmacotherapy including misuse and abuse. Finally, it considers the conflict of providing pain relief versus protecting society and reviews steps that governmental agencies, industry and others are taking to contain and ultimately resolve the problems of excessive prescribing and conflicting priorities. PMID:23342201

2013-01-01

149

Transvaginal ultrasound findings in women with chronic pelvic pain  

Microsoft Academic Search

Objective: To determine the prevalence of anatomic abnormalities as diagnosed by transvaginal ultrasonography in women with chronic pelvic pain whose pelvic examination did not demonstrate an anatomic abnormality.Methods: Transvaginal ultrasonography was performed in premenopausal women who were diagnosed with chronic pelvic pain, had a speculum and bimanual pelvic examination that revealed no evidence of gynecologic pathology, and were subsequently referred

Dale W. Stovall

2000-01-01

150

Chronic pain and fatigue: Associations with religion and spirituality  

PubMed Central

BACKGROUND: Conditions with chronic, non-life-threatening pain and fatigue remain a challenge to treat, and are associated with high health care use. Understanding psychological and psychosocial contributing and coping factors, and working with patients to modify them, is one goal of management. An individual’s spirituality and/or religion may be one such factor that can influence the experience of chronic pain or fatigue. METHODS: The Canadian Community Health Survey (2002) obtained data from 37,000 individuals 15 years of age or older. From these data, four conditions with chronic pain and fatigue were analyzed together – fibromyalgia, back pain, migraine headaches and chronic fatigue syndrome. Additional data from the survey were used to determine how religion and spirituality affect psychological well-being, as well as the use of various coping methods. RESULTS: Religious persons were less likely to have chronic pain and fatigue, while those who were spiritual but not affiliated with regular worship attendance were more likely to have those conditions. Individuals with chronic pain and fatigue were more likely to use prayer and seek spiritual support as a coping method than the general population. Furthermore, chronic pain and fatigue sufferers who were both religious and spiritual were more likely to have better psychological well-being and use positive coping strategies. INTERPRETATION: Consideration of an individual’s spirituality and/or religion, and how it may be used in coping may be an additional component to the overall management of chronic pain and fatigue. PMID:18958309

Baetz, Marilyn; Bowen, Rudy

2008-01-01

151

Targeting Chronic and Neuropathic Pain: The N-type Calcium Channel Comes of Age  

PubMed Central

Summary: The rapid entry of calcium into cells through activation of voltage-gated calcium channels directly affects membrane potential and contributes to electrical excitability, repetitive firing patterns, excitation-contraction coupling, and gene expression. At presynaptic nerve terminals, calcium entry is the initial trigger mediating the release of neurotransmitters via the calcium-dependent fusion of synaptic vesicles and involves interactions with the soluble N-ethylmaleimide-sensitive factor attachment protein receptor complex of synaptic release proteins. Physiological factors or drugs that affect either presynaptic calcium channel activity or the efficacy of calcium-dependent vesicle fusion have dramatic consequences on synaptic transmission, including that mediating pain signaling. The N-type calcium channel exhibits a number of characteristics that make it an attractive target for therapeutic intervention concerning chronic and neuropathic pain conditions. Within the past year, both U.S. and European regulatory agencies have approved the use of the cationic peptide Prialt for the treatment of intractable pain. Prialt is the first N-type calcium channel blocker approved for clinical use and represents the first new proven mechanism of action for chronic pain intervention in many years. The present review discusses the rationale behind targeting the N-type calcium channel, some of the limitations confronting the widespread clinical application of Prialt, and outlines possible strategies to improve upon Prialt's relatively narrow therapeutic window. PMID:16489373

Snutch, Terrance P.

2005-01-01

152

FAP-Enhanced Group Therapy for Chronic Pain  

Microsoft Academic Search

Chronic pain is often maintained as part of a series of vicious circles. Orofacial pain, for instance, can be related to spasms of the chewing muscles, which can be both the cause and the effect of a variety of factors including dysfunctional oral habits, changes in dental occlusion, continuous excessive contraction, and any combination of these. Increasing pain can provoke

Luc Vandenberghe

153

Diagnosis of Chronic Pancreatitis and Newer Aspects of Pain Control  

Microsoft Academic Search

The diagnosis of chronic pancreatitis in the UK largely rests on the combination of the clinical presentation which usually features pain which is often provoked by food and\\/or alcohol. There is usually a 30 to 40-min delay between the stimulus and the pain and, after exclusion of other causes of pain, an ERCP is performed. A minority of patients will

C. W. Imrie; N. Menezes; C. R. Carter

1999-01-01

154

Computer Assessment and Diagnostic Classification of Chronic Pain Patients  

Microsoft Academic Search

New Hampshire; § Psychological Applications, Waterbury, Vermont, USA ABSTRACT Objective. In order to establish a diagnosis of chronic pain, emphasis is placed on a patient's report of the pain's intensity, location, and character. The aim of this study was to evaluate the feasibility of a computer assessment method to collect self-reports of pain that were then used in discriminant analyses

David A. Provenzano; Gilbert J. Fanciullo; Robert N. Jamison; Gregory J. McHugo; John C. Baird

2007-01-01

155

Psychological Processing in Chronic Pain: A Neural Systems Approach  

PubMed Central

Our understanding of chronic pain involves complex brain circuits that include sensory, emotional, cognitive and interoceptive processing. The feed-forward interactions between physical (e.g., trauma) and emotional pain and the consequences of altered psychological status on the expression of pain have made the evaluation and treatment of chronic pain a challenge in the clinic. By understanding the neural circuits involved in psychological processes, a mechanistic approach to the implementation of psychology-based treatments may be better understood. In this review we evaluate some of the principle processes that may be altered as a consequence of chronic pain in the context of localized and integrated neural networks. These changes are ongoing, vary in their magnitude, and their hierarchical manifestations, and may be temporally and sequentially altered by treatments, and all contribute to an overall pain phenotype. Furthermore, we link altered psychological processes to specific evidence-based treatments to put forth a model of pain neuroscience psychology. PMID:24374383

Simons, Laura; Elman, Igor; Borsook, David

2014-01-01

156

The Fear of Pain Questionnaire (FOPQ): Assessment of Pain-Related Fear Among Children and Adolescents With Chronic Pain  

Microsoft Academic Search

An important construct in understanding pain-related disability is pain-related fear. Heightened pain-related fear may result in behavioral avoidance leading to disuse, disability, and depression; whereas confrontation of avoided activities may result in a reduction of fear over time and reengagement with activities of daily living. Although there are several measures to assess pain-related fear among adults with chronic pain, none

Laura E. Simons; Christine B. Sieberg; Elizabeth Carpino; Deirdre Logan; Charles Berde

2011-01-01

157

Baseline pain intensity is a predictor of chronic pain in individuals with distal radius fracture.  

PubMed

Study Design Secondary analysis of cohort study. Objective This study examined whether baseline pain intensity is a predictor of chronic pain and wrist/hand functions at 1 year following distal radius fracture (DRF). The study also examined the cutoff level for baseline pain intensity that best predicted chronic pain. Background Many individuals experience wrist/hand pain and functional impairments for as long as 1 year after DRF. Early identification of individuals at risk of these adverse outcomes can facilitate the delivery of required interventions to mitigate the risk. Methods Data for the Patient-Rated Wrist Evaluation (PRWE) pain and function subscales at baseline and 1 year after DRF, age, sex, injury to the dominant side, presence of comorbidity, education level, mechanism of fracture, smoking status, fall history, and energy of fracture were extracted from an existing data set. Multivariate regression analysis examined the utility of baseline pain intensity and the above variables in predicting pain and functional status at 1 year in individuals with DRF. Receiver operating characteristic curves examined the sensitivity/specificity of baseline pain intensity in predicting chronic pain and functional impairment. Results Required data were available for 386 individuals. Baseline pain intensity was found to be a strong predictor of chronic pain, explaining 22% of the variance. A baseline score of 35 out of 50 on the pain subscale of the PRWE had the best sensitivity (85%) and specificity (79%) cutoff values for predicting chronic pain at 1 year after DRF. Conclusion Rehabilitation practitioners may be able to use a score of greater than 35/50 on the PRWE pain subscale to screen individuals at risk of chronic pain following DRF. Level of Evidence Prognosis, level 4. J Orthop Sports Phys Ther 2015;45(2):119-127. Epub 8 Jan 2015. doi:10.2519/jospt.2015.5129. PMID:25573007

Mehta, Saurabh P; MacDermid, Joy C; Richardson, Julie; MacIntyre, Norma J; Grewal, Ruby

2015-02-01

158

Non-invasive brain stimulation techniques for chronic pain in adults  

Microsoft Academic Search

Description of the condition: Chronic pain is a common problem. When defined as pain of greater than three months duration, prevalence studies indicate that up to half the adult population suffer from chronic pain, and 10 to 20% experience clinically significant chronic pain (Smith 2008). In Europe 19% of adults experience chronic pain of moderate to severe intensity with serious

Neil E OConnell; Benedict M Wand; Louise Marston; Sally Spencer; Lorraine H De Souza

2010-01-01

159

Reduced Cold Pain Tolerance in Chronic Pain Patients Following Opioid Detoxification  

PubMed Central

Objective One potential consequence of chronic opioid analgesic administration is a paradoxical increase of pain sensitivity over time. Little scientific attention has been given to how cessation of opioid medication affects the hyperalgesic state. In this study, we examined the effects of opioid tapering on pain sensitivity in chronic pain patients. Design Twelve chronic pain patients on long-term opioid analgesic treatment were observed in a 7- to 14-day inpatient pain rehabilitation program, with cold pain tolerance assessed at admission and discharge. The majority of participants were completely withdrawn from their opioids during their stay. Outcome Measures We hypothesized that those patients with the greatest reduction in daily opioid use would show the greatest increases in pain tolerance, as assessed by a cold pressor task. Results A linear regression revealed that the amount of opioid medication withdrawn was a significant predictor of pain tolerance changes, but not in the direction hypothesized. Greater opioid reduction was associated with decreased pain tolerance. This reduction of pain tolerance was not associated with opioid withdrawal symptoms or changes in general pain. Conclusions These findings suggest that the withdrawal of opioids in a chronic pain sample leads to an acute increase in pain sensitivity. PMID:18564998

Younger, Jarred; Barelka, Peter; Carroll, Ian; Kaplan, Kim; Chu, Larry; Prasad, Ravi; Gaeta, Ray; Mackey, Sean

2009-01-01

160

Analgesics as Reinforcers with Chronic Pain: Evidence from Operant Studies  

PubMed Central

Previously preclinical pain research has focused on simple behavioral endpoints to assess the efficacy of analgesics in acute and chronic pain models, primarily reflexive withdrawal from an applied mechanical or thermal stimulus. However recent research has been aimed at investigating other behavioral states in the presence of pain, including spontaneous, non-elicited pain. One approach is to investigate the reinforcing effects of analgesics in animals with experimental pain, which should serve as reinforcers by virtue of their ability to alleviate the relevant subjective states induced by pain. The gold standard for assessing drug reinforcement is generally accepted to be drug self-administration, and this review highlights the ability of drugs to serve as reinforcers in animals with experimental neuropathic pain, and the extent to which this behavior is altered in chronic pain states. Additionally, intracranial self-stimulation is an operant procedure that has been used extensively to study drug reinforcement mechanisms and the manner in which neuropathic pain alters the ability of drugs to serve as reinforcers in this paradigm will also be discussed. Drug self-administration and intracranial self-stimulation have promise as tools to investigate behavioral effects of analgesics in animals with chronic pain, particularly regarding the mechanisms through which these drugs motivate consumption in a chronic pain state. PMID:23973302

Ewan, Eric E.; Martin, Thomas J.

2013-01-01

161

Central pain mechanisms in chronic pain states – maybe it is all in their head  

PubMed Central

Mechanisms underlying chronic pain differ from those underlying acute pain. In chronic pain states, central nervous system (CNS) factors appear to play particularly prominent roles. In the absence of anatomical causes of persistent pain, medical sub-specialties have historically applied wide-ranging labels (e.g. fibromyalgia -FM, irritable bowel syndrome, interstitial cystitis, somatization) for what now is emerging as a single common set of CNS processes. The hallmark of these “centrally-driven” pain conditions is a diffuse hyperalgesic state identifiable using experimental sensory testing, and corroborated by functional neuroimaging. The characteristic symptoms of these central pain conditions include multifocal pain, fatigue, insomnia, memory difficulties, and a higher rate of co-morbid mood disorders. In contrast to acute and “peripheral” pain states that are responsive to NSAIDs and opioids, central pain conditions respond best to CNS neuromodulating agents such as serotonin-norepinephrine re-uptake inhibitors (SNRIs) and anticonvulsants. PMID:22094191

Phillips, Kristine; Clauw, Daniel J.

2011-01-01

162

Remediation of pain-related memory bias as a result of recovery from chronic pain  

Microsoft Academic Search

Cognitive biases are increasingly implicated as vulnerability factors in emotional and physical disorders. This issue is examined here in chronic pain sufferers using a recall memory paradigm. A sample of chronic pelvic pain patients undergoing hysterectomy and oophorectomy were assessed prior to the intervention, 8 weeks post-surgery, and again 6 months post-surgery. On each occasion patients were aurally presented four

Lindsey C. Edwards; Shirley A. Pearce; Richard W. Beard

1995-01-01

163

Preoperative widespread pain sensitization and chronic pain after hip and knee replacement: a cohort analysis  

PubMed Central

Abstract Chronic pain after joint replacement is common, affecting approximately 10% of patients after total hip replacement (THR) and 20% of patients after total knee replacement (TKR). Heightened generalized sensitivity to nociceptive input could be a risk factor for the development of this pain. The primary aim of this study was to investigate whether preoperative widespread pain sensitivity was associated with chronic pain after joint replacement. Data were analyzed from 254 patients receiving THR and 239 patients receiving TKR. Pain was assessed preoperatively and at 12 months after surgery using the Western Ontario and McMaster Universities Osteoarthritis Pain Scale. Preoperative widespread pain sensitivity was assessed through measurement of pressure pain thresholds (PPTs) at the forearm using an algometer. Statistical analysis was conducted using linear regression and linear mixed models, and adjustments were made for confounding variables. In both the THR and TKR cohort, lower PPTs (heightened widespread pain sensitivity) were significantly associated with higher preoperative pain severity. Lower PPTs were also significantly associated with higher pain severity at 12 months after surgery in the THR cohort. However, PPTs were not associated with the change in pain severity from preoperative to 12 months postoperative in either the TKR or THR cohort. These findings suggest that although preoperative widespread pressure pain sensitivity is associated with pain severity before and after joint replacement, it is not a predictor of the amount of pain relief that patients gain from joint replacement surgery, independent of preoperative pain severity.

Wylde, Vikki; Sayers, Adrian; Lenguerrand, Erik; Gooberman-Hill, Rachael; Pyke, Mark; Beswick, Andrew D.; Dieppe, Paul; Blom, Ashley W.

2015-01-01

164

Systematic mechanism-orientated approach to chronic pancreatitis pain  

PubMed Central

Pain in chronic pancreatitis (CP) shows similarities with other visceral pain syndromes (i.e., inflammatory bowel disease and esophagitis), which should thus be managed in a similar fashion. Typical causes of CP pain include increased intrapancreatic pressure, pancreatic inflammation and pancreatic/extrapancreatic complications. Unfortunately, CP pain continues to be a major clinical challenge. It is recognized that ongoing pain may induce altered central pain processing, e.g., central sensitization or pro-nociceptive pain modulation. When this is present conventional pain treatment targeting the nociceptive focus, e.g., opioid analgesia or surgical/endoscopic intervention, often fails even if technically successful. If central nervous system pain processing is altered, specific treatment targeting these changes should be instituted (e.g., gabapentinoids, ketamine or tricyclic antidepressants). Suitable tools are now available to make altered central processing visible, including quantitative sensory testing, electroencephalograpy and (functional) magnetic resonance imaging. These techniques are potentially clinically useful diagnostic tools to analyze central pain processing and thus define optimum management approaches for pain in CP and other visceral pain syndromes. The present review proposes a systematic mechanism-orientated approach to pain management in CP based on a holistic view of the mechanisms involved. Future research should address the circumstances under which central nervous system pain processing changes in CP, and how this is influenced by ongoing nociceptive input and therapies. Thus we hope to predict which patients are at risk for developing chronic pain or not responding to therapy, leading to improved treatment of chronic pain in CP and other visceral pain disorders. PMID:25574079

Bouwense, Stefan AW; de Vries, Marjan; Schreuder, Luuk TW; Olesen, Søren S; Frøkjær, Jens B; Drewes, Asbjørn M; van Goor, Harry; Wilder-Smith, Oliver HG

2015-01-01

165

Recognizing Myofascial Pelvic Pain in the Female Patient with Chronic Pelvic Pain  

PubMed Central

Myofascial pelvic pain (MFPP) is a major component of chronic pelvic pain (CPP) and often is not properly identified by healthcare providers. The hallmark diagnostic indicator of MFPP is myofascial trigger points in the pelvic floor musculature that refer pain to adjacent sites. Effective treatments are available to reduce MFPP, including myofascial trigger point release, PMID:22862153

Pastore, Elizabeth Anne; Katzman, Wendy B.

2012-01-01

166

INTRODUCTION Dynamics of Pain perception: Distinctive Features of Ongoing Chronic Pain Ratings Revealed By Nonlinear Analysis  

E-print Network

highly prevalent conditions, post herpetic neuropathy (PHN) and chronic low back pain (CLBP), and normal subjects imagining back pain. We use a non-linear technique to demonstrate that the time-series examined spectrum gives the scaling exponent a. Lower Back Pain Example An analog to the power spectrum

Apkarian, A. Vania

167

The impact of group singing on mood, coping and perceived pain in chronic pain patients attending a multidisciplinary pain clinic  

Microsoft Academic Search

This study explored the impact of group singing on mood, coping, and perceived pain in chronic pain patients attending a multi- disciplinary pain clinic. Singers participated in nine 30-minute sessions of small group singing, while comparisons listened to music while exercising. A short form of The Profi le of Mood States (POMS) was administered before and after selected singing sessions

Dianna T. Kenny; Gavin Faunce

168

Adult attachment and approaches to activity engagement in chronic pain  

PubMed Central

BACKGROUND: The way in which individuals with chronic pain habitually approach activity engagement has been shown to impact daily functioning, with both avoidance of one’s daily activities and overactivity (activity engagement that significantly exacerbates pain) associated with more pain, higher levels of physical disability and poorer psychological functioning. OBJECTIVE: To provide insight into the development of maladaptive habitual approaches to activity engagement in chronic pain by applying an attachment theory framework. METHODS: A sample of 164 adults with chronic pain completed selfreport measures of attachment, approach to activity and pain cognitions. Mediation analyses were undertaken to examine the direct association between attachment variables and maladaptive approaches to activity, and to test for the mediating role of pain cognitions (catastrophizing and thought suppression). RESULTS: Results demonstrated that higher levels of secure attachment were associated with lower levels of activity avoidance, which was fully mediated by lower levels of pain catastrophizing; higher levels of preoccupied or fearful attachment were directly associated with higher levels overactivity; higher levels of preoccupied attachment were associated with higher levels of activity avoidance, which was partially mediated by higher levels of pain catastrophizing; and higher levels of fearful attachment were indirectly associated with higher levels of activity avoidance through higher levels of catastrophizing. CONCLUSIONS: These results provide preliminary support for the suggestion that insecure attachment may be a source of vulnerability to the development of disabling activity patterns in chronic pain. PMID:25337857

Andrews, Nicole E; Meredith, Pamela J; Strong, Jenny; Donohue, Genevieve F

2014-01-01

169

Pain acceptance moderates the relation between pain and negative affect in female osteoarthritis and fibromyalgia patients  

Microsoft Academic Search

Background: Chronic pain is often intractable despite advanced medical and psychotherapeutic treatments. Pain acceptance is emerging\\u000a as a promising complement to control-based pain management strategies and a likely approach to maintaining quality of life\\u000a for chronic pain patients.Purpose: This theoretically based analysis of an existing database examined the extent to which pain acceptance predicted weekly reports\\u000a of positive affect (PA)

Anna L. Kratz; Mary C. Davis; Alex J. Zautra

2007-01-01

170

Radiofrequency ablation for chronic pain control  

Microsoft Academic Search

With an increased knowledge of neural anatomy and technologic improvement, radiofrequency ablation (RFA) became an often-used\\u000a technique for the pain control over an extended time period. Today, RFA is used safely for spinal pains of facet or discogenic\\u000a origin, sympathetically maintained pain, and other pains of neural origin.

Leonardo Kapural; Nagy Mekhail

2001-01-01

171

Gastric electrical stimulation for intractable vomiting in patients with chronic intestinal pseudoobstruction.  

PubMed

Gastric electrical stimulation (GES) is effective for medically refractory nausea and vomiting in patients with idiopathic or diabetic gastroparesis (DGP). We studied whether GES has similar effects in chronic intestinal pseudoobstruction (CIP). Patients referred for chronic small bowel (SB) motor dysfunction requiring parenteral nutrition and having a weekly vomiting frequency (WVF) >/=7 refractory to prokinetics and antiemetics were included. Patients were implanted for high-frequency GES 12 stimuli min(-1), laparoscopy being the first-line implantation procedure. Results were compared with those obtained in 11 DGP patients. Three patients with familial CIP and one patient with postsurgical CIP fulfilled the criteria. Gastric emptying was delayed in two and was normal in two patients. SB transit time was markedly delayed. Laparoscopy was used in three patients, one patient required laparotomy. During GES, WVF decreased from 24 (mean) before GES to 6.9 at 12 months and 7.5 at last visit. Vomiting reduction was 50-90% at last visit. For the DGP patients, WVF decreased from 23 before GES to 3.5 at 12 months and 3.5 (P < 0.01) at last visit. In patients with CIP and medically refractory vomiting, GES seems to have an anti-vomiting effect comparable to that seen in patients with severe DGP. GES should be considered as a therapeutic option for these patients. PMID:16918761

Andersson, S; Lönroth, H; Simrén, M; Ringström, G; Elfvin, A; Abrahamsson, H

2006-09-01

172

The Importance of Psychological Assessment in Chronic Pain  

PubMed Central

Purpose of Review Much confusion has surrounded the purpose of the psychological assessment in the context of chronic pain. For many clinicians the psychological assessment is used to rule out psychiatric illness and/or to identify non- medical causes for pain and disability. In essence it is used to identify causes of pain that fall outside of the biomedical model. Supported by over 30 years of evidence, the bio-psycho-social model acknowledges that psychosocial factors are inherent in chronic pain and require assessment if meaningful diagnostics and treatments are to occur. Recent Findings Five broad categories of psychosocial assessment are relevant to chronic pain. These categories have been shown to enhance the diagnosis of underlying forms of pain, predict the transition from acute to chronic status, and help to phenotype individuals for the discovery of underlying mechanisms responsible for pain. Summary Informed assessment of chronic pain needs to include relevant biological, psychological, and social domains. This paper describes those domains and offers suggestions of specific instruments to use in clinical or research settings. PMID:24080806

Williams, David A.

2015-01-01

173

Pain catastrophizing as a risk factor for chronic pain after total knee arthroplasty: a systematic review  

PubMed Central

Background Total knee arthroplasty (TKA) is a common and costly surgical procedure. Despite high success rates, many TKA patients develop chronic pain in the months and years following surgery, constituting a public health burden. Pain catastrophizing is a construct that reflects anxious preoccupation with pain, inability to inhibit pain-related fears, amplification of the significance of pain vis-à-vis health implications, and a sense of helplessness regarding pain. Recent research suggests that it may be an important risk factor for untoward TKA outcomes. To clarify this impact, we systematically reviewed the literature to date on pain catastrophizing as a prospective predictor of chronic pain following TKA. Methods We searched MEDLINE, EMBASE, and PsycINFO databases to identify articles related to pain catastrophizing, TKA, risk models, and chronic pain. We reviewed titles and abstracts to identify original research articles that met our specified inclusion criteria. Included articles were then rated for methodological quality. including methodological quality. Due to heterogeneity in follow-up, analyses, and outcomes reported across studies, a quantitative meta-analysis could not be performed. Results We identified six prospective longitudinal studies with small-to-mid-sized samples that met the inclusion criteria. Despite considerable variability in reported pain outcomes, pain catastrophizing was identified as a significant predictor of chronic pain persisting ?3 months following TKA in five of the studies assessed. Limitations of studies included lack of large-scale data, absence of standardized pain measurements, inadequate multivariate adjustment, such as failure to control for analgesic use and other relevant covariates, and failure to report non-significant parameter estimates. Conclusion This study provides moderate-level evidence for pain catastrophizing as an independent predictor of chronic pain post-TKA. Directions for future research include larger, well-controlled studies with standard pain outcomes, identification of clinically-relevant catastrophizing cut-offs that predict pain outcomes, investigation of other psychosocial risk factors, and assessment of interventions aimed to reduce pain catastrophizing on chronic pain outcomes following TKA surgery. PMID:25609995

Burns, Lindsay C; Ritvo, Sarah E; Ferguson, Meaghan K; Clarke, Hance; Seltzer, Ze’ev; Katz, Joel

2015-01-01

174

Alterations in Endogenous Opioid Functional Measures in Chronic Back Pain  

PubMed Central

The absence of consistent end organ abnormalities in many chronic pain syndromes has led to a search for maladaptive CNS mechanisms that may explain their clinical presentations and course. Here, we addressed the role of brain regional ?-opioid receptor-mediated neurotransmission, one of the best recognized mechanisms of pain regulation, in chronic back pain in human subjects. We compared ?-opioid receptor availability in vivo at baseline, during pain expectation, and with moderate levels of sustained pain in 16 patients with chronic nonspecific back pain (CNBP) and in 16 age- and gender-matched healthy control subjects, using the ?-opioid receptor-selective radioligand [11C]carfentanil and positron emission tomography. We found that CNBP patients showed baseline increases in thalamic ?-opioid receptor availability, contrary to a previously studied sample of patients diagnosed with fibromyalgia. During both pain expectation and sustained pain challenges, CNBP patients showed regional reductions in the capacity to activate this neurotransmitter system compared with their control sample, further associated with clinical pain and affective state ratings. Our results demonstrate heterogeneity in endogenous opioid system functional measures across pain conditions, and alterations in both receptor availability and endogenous opioid function in CNBP that are relevant to the clinical presentation of these patients and the effects of opioid analgesics on ?-opioid receptors. PMID:24027273

Martikainen, Ilkka K.; Peciña, Marta; Love, Tiffany M.; Nuechterlein, Emily B.; Cummiford, Chelsea M.; Green, Carmen R.; Harris, Richard E.; Stohler, Christian S.

2013-01-01

175

Sleep Disturbances in School-age Children with Chronic Pain  

PubMed Central

Objectives To examine associations between pain, functional outcomes, and sleep disturbances in children with chronic pain, specifically juvenile idiopathic arthritis (JIA), sickle cell disease (SCD), and headache (HA). Sleep disturbances were tested as a risk factor for increased functional disability and decreased health-related quality of life (HRQOL). Methods One hundred children (JIA n = 30, SCD n = 26, HA n = 44; 8–12 years; 56% female) and their caregivers participated. Children completed questionnaires regarding pain, depression, and functional disability. Caregivers completed questionnaires regarding sociodemographics, child sleep habits, functional disability, and HRQOL. Results Levels of overall sleep disturbances were above the clinical cutoff for 53% of children with chronic pain. Sleep disturbances predicted lower physical HRQOL and higher functional disability, according to parent report. Conclusions Sleep disturbances are common and associated with daytime functioning in school-age children with chronic pain, suggesting that assessment and treatment of sleep problems is clinically relevant. PMID:18079168

Long, Anna C.; Krishnamurthy, Vidhya; Palermo, Tonya M.

2010-01-01

176

‘Two Pains Together’: Patient Perspectives on Psychological Aspects of Chronic Pain while Living with HIV  

PubMed Central

Objective Chronic pain is common in HIV-infected individuals. Understanding HIV-infected patients’ chronic pain experience not just from a biological, but also from a psychological perspective, is a critical first step toward improving care for this population. Our objective was to explore HIV-infected patients’ perspectives on psychological aspects of chronic pain using in-depth qualitative interviews. Methods Investigators engaged in an iterative process of independent and group coding until theme saturation was reached. Results Of the 25 patients with chronic pain interviewed, 20 were male, 15 were younger than age 50, and 15 were African-American. Key themes that emerged included the close relationship between mood and pain; mood and pain in the context of living with HIV; use of alcohol/drugs to self-medicate for pain; and the challenge of receiving prescription pain medications while dealing with substance use disorders. Conclusions The results suggest that psychological approaches to chronic pain treatment may be well received by HIV-infected patients. PMID:25365306

Merlin, Jessica S.; Walcott, Melonie; Ritchie, Christine; Herbey, Ivan; Kertesz, Stefan G.; Chamot, Eric; Saag, Michael; Turan, Janet M.

2014-01-01

177

[Chronic pain related to AIDS: perspective of nurses and doctors].  

PubMed

The objective was to identify the features and the management of chronic pain associated to Acquired Immunodeficiency Syndrome (AIDS) from the perspective of nurses and doctors. Qualitative study conducted at a reference hospital in Fortaleza- CE, Brazil, with 20 professionals. It was applied semi-structured interview and the speeches were analyzed using content analysis of Bardin, emerging three categories: Characterization of pain, Clinical evaluation of pain and Clinical care of pain. It was found that pain in AIDS manifests itself as persistent, disabling, with difficult control, and its management based on accurate identification of the causal factors and on implementation of pharmacological and non pharmacological treatment offered by the interdisciplinary team. The study provides relevant data on pain in AIDS patients, demonstrating the need to rethink the model of care management interventions to promote greater efficacy of analgesia and to improve interdisciplinary approach to pain for better pain evaluation and treatment. PMID:24676069

Oliveira, Roberta Meneses; da Silva, Lucilane Maria Sales

2014-01-01

178

Chronic diseases in the European Union: the prevalence and health cost implications of chronic pain.  

PubMed

The objective of this study was to assess recent data on the prevalence of chronic pain as part of chronic diseases; the prevalence of chronic pain as a chronic condition in its own right; the costs attributed to chronic pain; and the European Union (EU) policies to addressing chronic pain. Recent literature was reviewed for data on the prevalence and cost implications of chronic pain in the EU. Following on from an earlier systematic review, 8 databases were searched for prevalence and 10 for cost information from 2009 to 2011 and relevant EU organizations were contacted. Ten cost and 29 prevalence studies were included from the 142 full papers screened. The general adult population reported an average chronic pain prevalence of 27%, which was similar to those for common chronic conditions. Fibromyalgia had the highest unemployment rate (6%; Rivera et al., Clin Exp Rheumatol. 2009;27[Suppl 56]:S39-S45) claims for incapacity benefit (up to 29.9%; Sicras-Mainar et al., Arthritis Res Ther. 2009;11:R54), and greatest number of days of absence from work (Rivera et al., Clin Exp Rheumatol. 2009;27[Suppl 56]:S39-S45). Chronic pain is common and the total population cost is high. Despite its high impact, chronic pain as a condition seems to have had little specific policy response. However, there does appear to be sufficient evidence to at least make addressing chronic pain a high priority alongside other chronic diseases as well as to conduct more research, particularly regarding cost. PMID:23216170

Leadley, R M; Armstrong, N; Lee, Y C; Allen, A; Kleijnen, J

2012-12-01

179

Psychiatric Considerations in Pediatric Chronic Pain  

Microsoft Academic Search

\\u000a The International Association for the Study of Pain defines pain as “an unpleasant sensory and emotional experience,” which\\u000a recognizes both the physiological and psychological aspects of pain. According to the Biobehavioral Model of Pediatric Pain\\u000a (Varni 1989), biological factors (e.g., temperament, age, gender, cognitive development), family factors, cognitive perceptions,\\u000a coping styles, and perception of social support work together to influence

Mi-Young Ryee

180

Insecure attachment style is associated with chronic widespread pain.  

PubMed

Individuals with "insecure" adult attachment styles have been shown to experience more pain than people with secure attachment, though results of previous studies have been inconsistent. We performed a cross-sectional study on a large population-based sample to investigate whether, compared to pain free individuals, subjects with chronic widespread pain were more likely to report insecure adult attachment style. Subjects in a population-based cross-sectional study completed a self-rated assessment of adult attachment style. Attachment style was categorised as secure (i.e., normal attachment style); or preoccupied, dismissing or fearful (insecure attachment styles). Subjects completed a pain questionnaire from which three groups were identified: pain free; chronic widespread pain; and other pain. Subjects rated their pain intensity and pain-related disability on an 11 point Likert scale. Subjects (2509) returned a completed questionnaire (median age 49.9 years (IQR 41.2-50.0); 59.2% female). Subjects with CWP were more likely to report a preoccupied (RRR 2.6; 95%CI 1.8-3.7), dismissing (RRR 1.9; 95%CI 1.2-3.1) or fearful attachment style (RRR 1.4; 95%CI 1.1-1.8) than those free of pain. Among CWP subjects, insecure attachment style was associated with number of pain sites (Dismissing: RRR 2.8; 95%CI 1.2-2.3, Preoccupied: RRR=1.8, 95%CI 0.98-3.5) and degree of pain-related disability (Preoccupied: RRR=2.1, 95%CI 1.0-4.1), but not pain intensity. These findings suggest that treatment strategies based on knowledge of attachment style, possibly using support and education, may alleviate distress and disability in people at risk of, or affected by, chronic widespread pain. PMID:19345016

Davies, K A; Macfarlane, G J; McBeth, J; Morriss, R; Dickens, C

2009-06-01

181

Non-invasive brain stimulation techniques for chronic pain  

Microsoft Academic Search

Background: Non-invasive brain stimulation techniques aim to induce an electrical stimulation of the brain in an attempt to reduce chronic pain by directly altering brain activity. They include repetitive transcranial magnetic stimulation (rTMS), cranial electrotherapy stimulation (CES) and transcranial direct current stimulation (tDCS).\\u000aObjectives: To evaluate the efficacy of non-invasive brain stimulation techniques in chronic pain.\\u000aSearch strategy: We searched

Neil E OConnor; Benedict M Wand; Louise Marston; Sally Spencer; Lorraine H DeSouza

2010-01-01

182

Research Papers Abnormal brain chemistry in chronic back pain: an in vivo proton  

E-print Network

Research Papers Abnormal brain chemistry in chronic back pain: an in vivo proton magnetic resonance April 2000; accepted 2 May 2000 Abstract The neurobiology of chronic pain, including chronic back pain, is unknown. Structural imaging studies of the spine cannot explain all cases of chronic back pain. Functional

Apkarian, A. Vania

183

Oral and maxillofacial surgery in patients with chronic orofacial pain  

Microsoft Academic Search

Purpose: In this investigation, we evaluated a population of patients with chronic orofacial pain who sought treatment at a pain center in an academic institution. These patients were evaluated with respect to 1) the frequency and types of previous oral and maxillofacial surgery procedures, 2) the frequency of previous significant misdiagnoses, and 3) the number of patients who subsequently required

Howard A. Israel; John Desmond Ward; Brenda Horrell; Steven J. Scrivani

2003-01-01

184

FREQUENCY OF DISACCHARIDASE DEFICIENCIES IN CHILDHOOD CHRONIC ABDOMINAL PAIN  

Technology Transfer Automated Retrieval System (TEKTRAN)

BACKGROUND: Recurrent abdominal pain and discomfort are common symptoms in children. Childhood chronic abdominal pain (CCAP) is a poorly understood condition, which occasionally requires EGD. Endoscopy is performed to search for etiologies such as peptic ulcer disease. Lactose and sucrase-isomaltas...

185

The reliability of depression diagnosis in chronic low back pain  

Microsoft Academic Search

The variability in estimated rates of major depressive disorder (MDD) in chronic pain samples may be accounted for by sample and methodological differences. Most studies rely on a single measure of depression and lack independent or repeated measures. This study investigated the prevalence of psychiatric disorders in a convenience sample of 18 patients disabled by low back pain (LBP) referred

Rollin M. Gallagher; Pamela Moore; Ira Chernoff

1995-01-01

186

Systematic review of dexketoprofen in acute and chronic pain  

Microsoft Academic Search

BACKGROUND: Dexketoprofen, an NSAID used in the management of acute and chronic pains, is licensed in several countries but has not previously been the subjected of a systematic review. We used published and unpublished information from randomised clinical trials (RCTs) of dexketoprofen in painful conditions to assess evidence on efficacy and harm. METHODS: PubMed and Cochrane Central were searched for

R Andrew Moore; Jodie Barden

2008-01-01

187

Chronic Imperceptible Pain as a Cause of Addiction.  

ERIC Educational Resources Information Center

Argues that acute, chronic pain, whether arising from environmental or psychological contexts, is a necessary condition of addiction; conditioning and neurochemical changes are assigned a catalyzing role. Inadequate self-esteem is thought to be a common source of imperceptible pain, and therefore a cause of addiction. (Author/ABL)

Sullivan, Arthur P.; Guglielmo, Robert

1985-01-01

188

DNA methylation of SPARC and chronic low back pain  

PubMed Central

Background The extracellular matrix protein SPARC (Secreted Protein, Acidic, Rich in Cysteine) has been linked to degeneration of the intervertebral discs and chronic low back pain (LBP). In humans, SPARC protein expression is decreased as a function of age and disc degeneration. In mice, inactivation of the SPARC gene results in the development of accelerated age-dependent disc degeneration concurrent with age-dependent behavioral signs of chronic LBP. DNA methylation is the covalent modification of DNA by addition of methyl moieties to cytosines in DNA. DNA methylation plays an important role in programming of gene expression, including in the dynamic regulation of changes in gene expression in response to aging and environmental signals. We tested the hypothesis that DNA methylation down-regulates SPARC expression in chronic LBP in pre-clinical models and in patients with chronic LBP. Results Our data shows that aging mice develop anatomical and behavioral signs of disc degeneration and back pain, decreased SPARC expression and increased methylation of the SPARC promoter. In parallel, we show that human subjects with back pain exhibit signs of disc degeneration and increased methylation of the SPARC promoter. Methylation of either the human or mouse SPARC promoter silences its activity in transient transfection assays. Conclusions This study provides the first evidence that DNA methylation of a single gene plays a role in chronic pain in humans and animal models. This has important implications for understanding the mechanisms involved in chronic pain and for pain therapy. PMID:21867537

2011-01-01

189

Behavioural alteration in chronic pain: are brain glia involved?  

PubMed

Behavioural symptoms such as abnormal emotionality (including anxious and depressive episodes) and cognition (for instance weakened decision-making) are highly frequent in both chronic pain patients and their animal models. The theory developed in the present article posits that alterations in glial cells (astrocytes and microglia) in cortical and limbic brain regions might be the origin of such emotional and cognitive chronic pain-associated impairments. Indeed, in mood disorders (unipolar depression, anxiety disorders, autism or schizophrenia) glial changes in brain regions involved in mood control (prefrontal and cingulate cortices, amygdala and the hippocampus) have been recurrently described. Besides, glial cells have been undoubtedly identified as key actors in the sensory component of chronic pain, owing to the profound phenotypical changes they undergo throughout the sensory pathway. Hence, the possibility arises that brain astrocytes and microglia react in upper brain structures as well, mediating the related mood and cognitive dysfunctions in chronic pain. So far, only very few studies have provided results in this prospect, mainly indirectly in pain-independent researches. Nevertheless, the first scant available data seem to merge in a unified description of a brain glial reaction occurring after chronic peripheral lesion. The present article uses this scarce literature to formulate the provocative theory of a glia-driven mood and cognitive dysfunction in chronic pain, expounding upon its validity and putative therapeutical impact as well as its current limitations and expected future developments. PMID:21741179

Panigada, T; Gosselin, R-D

2011-10-01

190

Sleep and Quality of Life in Chronic Pain  

Microsoft Academic Search

Assessment of quality of life (QOL) is important in evaluating the well-being of patients suffering from chronically painful\\u000a conditions. In addition to identifying the degree of psychosocial distress experienced by these patients, QOL assessments\\u000a allow quantification of how pain specifically impacts daily functioning, and it serves as a treatment outcome in clinical\\u000a research. The effect of pain on QOL depends

Dieuwke S. Veldhuijzen; Joel D. Greenspan; Michael T. Smith

191

[Mesenteric angina: infrequent cause of chronic pain in hemodialysis patient].  

PubMed

We report a 73 years old male undergoing chronic hemodialysis with a history of seven years of abdominal pain and weight loss. A mesenteric angiography disclosed a critical stenosis of the celiac artery and a partial stenosis of the superior mesenteric artery. Other causes of abdominal pain were excluded. The patient was subjected to a successful angioplasty with stent placement that resulted in a complete relief of the pain. PMID:12491833

Duclos, Jaime; Urquieta, María Soledad; Opazo, Marcos

2002-10-01

192

Treatment options for chronic abdominal pain in children and adolescents  

Microsoft Academic Search

Chronic abdominal pain is a common feature of most functional gastrointestinal disorders in children, including functional\\u000a abdominal pain (FAP) and irritable bowel syndrome (IBS). FAP can impair a child’s life and often leads to significant school\\u000a absences. Although the underlying mechanism is likely multifactorial, early pain experiences during a vulnerable period in\\u000a the developing nervous system can cause longterm changes

Adrian Miranda; Manu Sood

2006-01-01

193

Prescribing smoked cannabis for chronic noncancer pain  

PubMed Central

Objective To offer preliminary guidance on prescribing smoked cannabis for chronic pain before the release of formal guidelines. Quality of evidence We reviewed the literature on the analgesic effectiveness of smoked cannabis and the harms of medical and recreational cannabis use. We developed recommendations on indications, contraindications, precautions, and dosing of smoked cannabis, and categorized the recommendations based on levels of evidence. Evidence is mostly level II (well conducted observational studies) and III (expert opinion). Main message Smoked cannabis might be indicated for patients with severe neuropathic pain conditions who have not responded to adequate trials of pharmaceutical cannabinoids and standard analgesics (level II evidence). Smoked cannabis is contraindicated in patients who are 25 years of age or younger (level II evidence); who have a current, past, or strong family history of psychosis (level II evidence); who have a current or past cannabis use disorder (level III evidence); who have a current substance use disorder (level III evidence); who have cardiovascular or respiratory disease (level III evidence); or who are pregnant or planning to become pregnant (level II evidence). It should be used with caution in patients who smoke tobacco (level II evidence), who are at increased risk of cardiovascular disease (level III evidence), who have anxiety or mood disorders (level II evidence), or who are taking higher doses of opioids or benzodiazepines (level III evidence). Cannabis users should be advised not to drive for at least 3 to 4 hours after smoking, for at least 6 hours after oral ingestion, and for at least 8 hours if they experience a subjective “high” (level II evidence). The maximum recommended dose is 1 inhalation 4 times per day (approximately 400 mg per day) of dried cannabis containing 9% delta-9-tetrahydrocannabinol (level III evidence). Physicians should avoid referring patients to “cannabinoid” clinics (level III evidence). Conclusion Future guidelines should be based on systematic review of the literature on the safety and effectiveness of smoked cannabis. Further research is needed on the effectiveness and long-term safety of smoked cannabis compared with pharmaceutical cannabinoids, opioids, and other standard analgesics. PMID:25500598

Kahan, Meldon; Srivastava, Anita; Spithoff, Sheryl; Bromley, Lisa

2014-01-01

194

Management of postthoracotomy pain: acute and chronic.  

PubMed

Given the discomfort of thoracic surgical incisions, thoracic surgeons must understand and use contemporary multimodality pain treatments. Acute postthoracotomy pain not only causes psychologic distress to the patient but also has detrimental effects on pulmonary function and postoperative mobility, leading to increased morbidity. By choosing the most appropriate and least traumatic surgical incision, adhering to meticulous surgical techniques, and avoiding intercostal nerve injury or rib fractures, surgeons can minimize postoperative pain. Aggressive perioperative and postoperative pain management is best accomplished with use of an epidural anesthetic and covering breakthrough pain with an IV-PCA. Alternatively, an infusion system for continuous administration of local anesthetics directly in the subpleural plane, posterior to the intercostal incision, also provides excellent pain control. Again, use of an IV-PCA as adjuvant therapy is recommended. With careful planning, severe pain and its negative impact on thoracic surgical patients can be prevented. PMID:17004557

Koehler, Richard P; Keenan, Robert J

2006-08-01

195

A Biopsychosocial Therapy Model for Chronic Prostatitis\\/Chronic Pelvic Pain Syndrome  

Microsoft Academic Search

\\u000a Chronic prostatitis\\/chronic pelvic pain syndrome (CP\\/CPPS) has long been considered a frustrating and prevalent condition\\u000a by patients and treating physicians alike. Pain is noted as the cardinal symptom in CP\\/CPPS and is strongly associated with\\u000a a host of intra and interpersonal difficulties reported by patients in domains such as pain, disability, relations, and overall\\u000a quality of life. With no tenable

Dean A. Tripp

196

Identifying potential predictors of pain–related disability in Turkish patients with chronic temporomandibular disorder pain  

PubMed Central

Background The aims of this study were to examine whether patients’ psychosocial profiles influence the location of pain, and to identify the clinical and psychosocial predictors of high levels of pain-related disability in temporomandibular disorders (TMD) patients with chronic pain at least 6?months in duration. Methods The Research Diagnostic Criteria of TMD (RDC/TMD) data for Axis I and II were obtained for 104 consecutive patients seeking treatment. Data were analyzed using descriptive statistics, t-test, Mann–Whitney U-test, chi-square test, One-way ANOVA, Kruskal-Wallis test, and binary multiple logistic regression tests. Patients were classified into two groups according to Graded Chronic Pain Scale scores: Grade III and IV were scored for patients with high levels of pain-related disability, whereas Grade I and II were scored for patients with low disability. Results Muscle and joint pain were found in 64.9% and 31.8% of the patients, respectively, and 27.3% of the patients suffered from both muscle and joint pain. Psychosocial disability was found in 26% of patients. There were no statistically significant differences among the diagnostic subgroups with regards to the demographic, behavioral, psychological, and psychosocial characteristics. Patients with high levels of pain-related disability had significantly higher depression, somatization, pain intensity and jaw disability scores than those with low levels of pain-related disability. Patients with high levels of pain-related disability were more likely to have higher pain intensity, to report higher somatization symptoms and functional impairment, and were less likely to have joint pain than those with low levels of pain related disability. Conclusion In conclusion, the Turkish version RDC/TMD, based on a dual axis system, may be used to screen chronic TMD patients at high-risk for pain-related disability who need comprehensive care treatment program. PMID:23565825

2013-01-01

197

Chronic pain syndromes and their treatment. II. Trigger points.  

PubMed

Trigger points are distinct areas of focal hyperirritability which give rise to areas of refered pain in well-defined areas of the musculo-skeletal system, sometimes remote from the point itself and not related to it by anatomically definable pathways. While the vast majority of pain manifestations from trigger points are related to the musculo-skeletal system, this need not be invariably so, as has been demonstrated in two of the cases cited, where injection of trigger points in the neck relieved chronic tinnitus. In all manifestations of chronic pain it is recommended that a diligent search be made for such trigger points. PMID:466566

Wyant, G M

1979-05-01

198

HSV gene transfer in the treatment of chronic pain  

PubMed Central

It has proven difficult to use systemic administration of small molecules to selectively modulate nociception. Over the past decade, we and others have developed non-replicating herpes simplex virus (HSV)-based vectors to treat chronic pain. Subcutaneous inoculation of an HSV vector effectively transduces sensory neurons in the dorsal root ganglion; release of transgene-coded inhibitory neurotransmitters or anti-inflammatory peptides reduces pain-related behaviors in rodent models of chronic inflammatory and neuro-pathic pain. A phase 1 trial of this therapy in patients is set to begin soon. PMID:18958369

Fink, David J.; Mata, Marina

2008-01-01

199

Painful periostitis in the setting of chronic voriconazole therapy  

PubMed Central

A 72-year-old woman on chronic voriconazole therapy for recurrent histoplasmosis developed a painful forearm mass. Laboratory and imaging findings were consistent with a diffuse periostitis. Her symptoms resolved after discontinuation of voriconazole. To our knowledge, this is the first case of voriconazole-induced periostitis to be reported in a patient with chronic histoplasmosis. PMID:25484509

Spak, Cedric; Oza, Umesh

2014-01-01

200

Exercise therapy for chronic musculoskeletal pain: Innovation by altering pain memories.  

PubMed

Even though nociceptive pathology has often long subsided, the brain of patients with chronic musculoskeletal pain has typically acquired a protective (movement-related) pain memory. Exercise therapy for patients with chronic musculoskeletal pain is often hampered by such pain memories. Here the authors explain how musculoskeletal therapists can alter pain memories in patients with chronic musculoskeletal pain, by integrating pain neuroscience education with exercise interventions. The latter includes applying graded exposure in vivo principles during exercise therapy, for targeting the brain circuitries orchestrated by the amygdala (the memory of fear centre in the brain). Before initiating exercise therapy, a preparatory phase of intensive pain neuroscience education is required. Next, exercise therapy can address movement-related pain memories by applying the 'exposure without danger' principle. By addressing patients' perceptions about exercises, therapists should try to decrease the anticipated danger (threat level) of the exercises by challenging the nature of, and reasoning behind their fears, assuring the safety of the exercises, and increasing confidence in a successful accomplishment of the exercise. This way, exercise therapy accounts for the current understanding of pain neuroscience, including the mechanisms of central sensitization. PMID:25090974

Nijs, Jo; Lluch Girbés, Enrique; Lundberg, Mari; Malfliet, Anneleen; Sterling, Michele

2015-02-01

201

A new paradigm in chronic bladder pain.  

PubMed

ABSTRACT The concept of visceral pain has moved from organ-centered disease to a conceptualization based on pathophysiological mechanisms, integrating psychosocial and sexual dimensions. The terms painful bladder syndrome and bladder pain syndrome have been coined to include all patients with bladder pain. There is substantial overlap between IC/BPS and other pelvic/abdominal pain syndromes IC/BPS is likely to be underdiagnosed and undertreated in both men and women IC/BPS requires a multidisciplinary team approach toward management. This report is adapted from paineurope 2014; Issue 2, ©Haymarket Medical Publications Ltd, and is presented with permission. Paineurope is provided as a service to pain management by Mundipharma International, LTD and is distributed free of charge to healthcare professionals in Europe. Archival issues can be accessed via the website: http://www.paineurope.com at which European health professionals can register online to receive copies of the quarterly publication. PMID:25348226

Wesselmann, Ursula

2014-12-01

202

Clinical Guidelines for the Use of Chronic Opioid Therapy in Chronic Noncancer Pain  

PubMed Central

Use of chronic opioid therapy for chronic noncancer pain has increased substantially. The American Pain Society and the American Academy of Pain Medicine commissioned a systematic review of the evidence on chronic opioid therapy for chronic noncancer pain and convened a multidisciplinary expert panel to review the evidence and formulate recommendations. Although evidence is limited, the expert panel concluded that chronic opioid therapy can be an effective therapy for carefully selected and monitored patients with chronic noncancer pain. However, opioids are also associated with potentially serious harms, including opioid-related adverse effects and outcomes related to the abuse potential of opioids. The recommendations presented in this document provide guidance on patient selection and risk stratification; informed consent and opioid management plans; initiation and titration of chronic opioid therapy; use of methadone; monitoring of patients on chronic opioid therapy; dose escalations, high-dose opioid therapy, opioid rotation, and indications for discontinuation of therapy; prevention and management of opioid-related adverse effects; driving and work safety; identifying a medical home and when to obtain consultation; management of breakthrough pain; chronic opioid therapy in pregnancy; and opioid-related polices. Perspective: Safe and effective chronic opioid therapy for chronic noncancer pain requires clinical skills and knowledge in both the principles of opioid prescribing and on the assessment and management of risks associated with opioid abuse, addiction, and diversion. Although evidence is limited in many areas related to use of opioids for chronic noncancer pain, this guideline provides recommendations developed by a multidisciplinary expert panel following a systematic review of the evidence. PMID:19187889

Chou, Roger; Fanciullo, Gilbert J.; Fine, Perry G.; Adler, Jeremy A.; Ballantyne, Jane C.; Davies, Pamela; Donovan, Marilee I.; Fishbain, David A.; Foley, Kathy M.; Fudin, Jeffrey; Gilson, Aaron M.; Kelter, Alexander; Mauskop, Alexander; O'Connor, Patrick G.; Passik, Steven D.; Pasternak, Gavril W.; Portenoy, Russell K.; Rich, Ben A.; Roberts, Richard G.; Todd, Knox H.; Miaskowski, Christine

2014-01-01

203

Psychological therapies for the management of chronic pain.  

PubMed

Pain is a complex stressor that presents a significant challenge to most aspects of functioning and contributes to substantial physical, psychological, occupational, and financial cost, particularly in its chronic form. As medical intervention frequently cannot resolve pain completely, there is a need for management approaches to chronic pain, including psychological intervention. Psychotherapy for chronic pain primarily targets improvements in physical, emotional, social, and occupational functioning rather than focusing on resolution of pain itself. However, psychological therapies for chronic pain differ in their scope, duration, and goals, and thus show distinct patterns of treatment efficacy. These therapies fall into four categories: operant-behavioral therapy, cognitive-behavioral therapy, mindfulness-based therapy, and acceptance and commitment therapy. The current article explores the theoretical distinctiveness, therapeutic targets, and effectiveness of these approaches as well as mechanisms and individual differences that factor into treatment response and pain-related dysfunction and distress. Implications for future research, dissemination of treatment, and the integration of psychological principles with other treatment modalities are also discussed. PMID:24748826

Sturgeon, John A

2014-01-01

204

Altered resting state EEG in chronic pancreatitis patients: toward a marker for chronic pain  

PubMed Central

Objectives Electroencephalography (EEG) may be a promising source of physiological biomarkers accompanying chronic pain. Several studies in patients with chronic neuropathic pain have reported alterations in central pain processing, manifested as slowed EEG rhythmicity and increased EEG power in the brain’s resting state. We aimed to investigate novel potential markers of chronic pain in the resting state EEG of patients with chronic pancreatitis. Participants Resting state EEG data from 16 patients with persistent abdominal pain due to chronic pancreatitis (CP) were compared to data from healthy controls matched for age, sex and education. Methods The peak alpha frequency (PAF) and power amplitude in the alpha band (7.5–13 Hz) were compared between groups in four regions of interest (frontal, central, parietal, and occipital) and were correlated with pain duration. Results The average PAF was lowered in CP patients compared with that in healthy controls, observed as a statistically significant between-group effect (mean 9.9 versus 9.5 Hz; P=0.049). Exploratory post hoc analysis of average PAF per region of interest revealed a significant difference, particularly in the parietal and occipital regions. In addition, we observed a significant correlation between pain duration and PAF and showed increased shifts in PAF with longer pain durations. No significant group differences were found in peak power amplitudes. Conclusion CP pain is associated with alterations in spontaneous brain activity, observed as a shift toward lower PAF. This shift correlates with the duration of pain, which demonstrates that PAF has the potential to be a clinically feasible biomarker for chronic pain. These findings could be helpful for assisting diagnosis, establishing optimal treatment, and studying efficacy of new therapeutic agents in chronic pain patients. PMID:24379694

de Vries, Marjan; Wilder-Smith, Oliver HG; Jongsma, Marijtje LA; van den Broeke, Emanuel N; Arns, Martijn; van Goor, Harry; van Rijn, Clementina M

2013-01-01

205

Treatment of thalamic pain by chronic motor cortex stimulation.  

PubMed

All forms of therapy, including chronic stimulation of the thalamic relay nucleus, can provide satisfactory pain control in only 20%-30% of cases of thalamic pain syndrome. In order to develop a more effective treatment for thalamic pain syndrome, we investigated the effects of stimulation of various brain regions on the burst hyperactivity of thalamic neurons recorded in cats after deafferentiation of the spinothalamic pathway. Complete, long-term inhibition of the burst hyperactivity was induced by stimulation of the motor cortex. Based on this experimental finding, we treated seven cases of thalamic pain syndrome by chronic motor cortex stimulation employing epidural plate electrodes. Excellent or good pain control was obtained in all cases without any complications or side effects. During the stimulation, an increase in regional blood flow of the cerebral cortex and thalamus, a marked rise in temperature of the painful skin regions, and improved movements of the painful limbs were observed. These results suggest that thalamic pain syndrome can be most effectively treated by chronic motor cortex stimulation. PMID:1705329

Tsubokawa, T; Katayama, Y; Yamamoto, T; Hirayama, T; Koyama, S

1991-01-01

206

Opioids for managing chronic non-malignant pain  

PubMed Central

OBJECTIVE To review the evidence on safe and effective prescribing of opioids for chronic non-malignant pain. QUALITY OF EVIDENCE MEDLINE was searched using the terms “opioid effectiveness” and “adverse effects.” There is strong evidence that opioids are effective for both nociceptive and neuropathic pain, but limited evidence that they are effective for pain disorder. There is little information on their effectiveness at high doses or on the adverse effects of high doses. MAIN MESSAGE Opioids should be initiated after an adequate trial of acetaminophen or nonsteroidal anti-inflammatory drugs for nociceptive pain and of tricyclic antidepressants or anticonvulsants for neuropathic pain. Patients should be asked to sign treatment agreements and to give informed consent to treatment. Patients should experience a graded analgesic response with each dose increase. Titrate doses of immediate-release opioids slowly upward until pain reduction is achieved, and then switch patients to controlled-release opioids. Most patients with chronic non-malignant pain can be managed with<300 mg/d of morphine (or equivalent). CONCLUSION Opioids are safe and effective for managing chronic pain. PMID:17279219

Kahan, Meldon; Srivastava, Anita; Wilson, Lynn; Mailis-Gagnon, Angela; Midmer, Deana

2006-01-01

207

Traumatization and chronic pain: a further model of interaction  

PubMed Central

Up to 80% of patients with severe posttraumatic stress disorder are suffering from “unexplained” chronic pain. Theories about the links between traumatization and chronic pain have become the subject of increased interest over the last several years. We will give a short summary about the existing interaction models that emphasize particularly psychological and behavioral aspects of this interaction. After a synopsis of the most important psychoneurobiological mechanisms of pain in the context of traumatization, we introduce the hypermnesia–hyperarousal model, which focuses on two psychoneurobiological aspects of the physiology of learning. This hypothesis provides an answer to the hitherto open question about the origin of pain persistence and pain sensitization following a traumatic event and also provides a straightforward explanatory model for educational purposes. PMID:24231792

Egloff, Niklaus; Hirschi, Anna; von Känel, Roland

2013-01-01

208

Pain pharmacology: focus on opioids  

PubMed Central

Summary The incidence of chronic pain is estimated to be 20–25% worldwide. Although major improvements in pain control have been obtained, more than 50% of the patients reports inadequate relief. It is accepted that chronic pain, if not adequately and rapidly treated, can become a disease in itself, often intractable and maybe irreversible. This is mainly due to neuroplasticity of pain pathways. In the present review I will discuss about pain depicting the rational for the principal pharmacological interventions and finally focusing on opioids, that represent a primary class of drug to treat pain. PMID:25568646

Fornasari, Diego

2014-01-01

209

Chronic intraoral pain--assessment of diagnostic methods and prognosis.  

PubMed

The overall goal of this thesis was to broaden our knowledge of chronic intraoral pain. The research questions were: What methods can be used to differentiate inflammatory, odontogenic tooth pain from pain that presents as toothache but is non-odontogenic in origin? What is the prognosis of chronic tooth pain of non-odontogenic origin, and which factors affect the prognosis? Atypical odontalgia (AO) is a relatively rare but severe and chronic pain condition affecting the dentoalveolar region. Recent research indicates that the origin is peripheral nerve damage: neuropathic pain. The condition presents as tooth pain and is challenging to dentists because it is difficult to distinguish from ordinary toothache due to inflammation or infection. AO is of interest to the pain community because it shares many characteristics with other chronic pain conditions, and pain perpetuation mechanisms are likely to be similar. An AO diagnosis is made after a comprehensive examination and assessment of patients' self-reported characteristics: the pain history. Traditional dental diagnostic methods do not appear to suffice, since many patients report repeated care-seeking and numerous treatment efforts with little or no pain relief. Developing methods that are useful in the clinical setting is a prerequisite for a correct diagnosis and adequate treatment decisions. Quantitative sensory testing (QST) is used to assess sensory function on skin when nerve damage or disease is suspected. A variety of stimuli has been used to examine the perception of, for example, touch, temperature (painful and non-painful), vibration, pinprick pain, and pressure pain. To detect sensory abnormalities and nerve damage in the oral cavity, the same methods may be possible to use. Study I examined properties of thermal thresholds in and around the mouth in 30 pain-free subjects: the influence of measurement location and stimulation area size on threshold levels, and time variability of thresholds. Thresholds for cold, warmth and painful heat were measured in four intraoral and two extraoral sites. Measurements were repeated 3 times over 6 weeks, using four sizes of stimulation area (0.125-0.81 cm2). The threshold levels were highly dependent on location but less dependent on measuring probe size and time variability was small, and this knowledge is important for the interpretation of QST results. Study II applied a recently developed standardized QST examination protocol (intended for use on skin) inside the oral cavity. Two trained examiners evaluated 21 pain-free subjects on three occasions over 1-3 weeks, at four sites-three intraoral and one extraoral. Most tests had acceptable reliability and the original test instruments and techniques could be applied intraorally with only minor adjustments. Study III examined the value of cone-beam computed tomography (CBCT) in pain investigations. Twenty patients with AO and 5 with symptomatic apical periodontitis (inflammatory tooth pain) participated. The results indicate that when AO is suspected, addition of CBCT can improve the diagnostic certainty compared to sole use of periapical and panoramic radiographs, especially because of the superior ability of CBCT to exclude inflammation as the pain cause. Study IV assessed the long-term prognosis of AO, and analyzed potential outcome predictors. A comprehensive questionnaire including validated and reliable instruments was used to gather data on patient and pain characteristics and pain consequences from 37 patients in 2002 and 2009. Thirty-five percent of the patients reported substantial overall improvement at follow-up, but almost all still had pain of some degree after many years. The initial high level of emotional distress was unchanged. Low baseline pain intensity predicted improvement over time. PMID:22338784

Pigg, Maria

2011-01-01

210

Universal Precautions in Pain Medicine: A Rational Approach to the Treatment of Chronic Pain  

Microsoft Academic Search

Health, Toronto, Ontario, Canada Abstract The heightened interest in pain management is making the need for appropriate boundary setting within the clinician-patient relationship even more apparent. Unfortunately, it is impossible to determine before hand, with any degree of certainty, who will become problematic users of pre- scription medications. With this in mind, a parallel is drawn between the chronic pain

Douglas L. Gourlay; Howard A. Heit; Abdulaziz Almahrezi

2005-01-01

211

Functional abdominal pain in childhood and adolescence increases risk for chronic pain in adulthood  

Microsoft Academic Search

A few studies of long-term outcomes for pediatric functional abdominal pain (FAP) have assessed acute non-abdominal pain at follow-up, but none has assessed chronic pain. We followed a cohort of pediatric patients with FAP (n=155) and a well control group (n=45) prospectively for up to 15years. Participants ranged in age from 18 to 32years at a follow-up telephone interview. FAP

Lynn S. Walker; Christine M. Dengler-Crish; Sara Rippel; Stephen Bruehl

2010-01-01

212

Toll-Like Receptors in Chronic Pain  

PubMed Central

Proinflammatory central immune signaling contributes significantly to the initiation and maintenance of heightened pain states. Recent discoveries have implicated the innate immune system, pattern recognition Toll-like receptors in triggering these proinflammatory central immune signaling events. These exciting developments have been complemented by the discovery of neuronal expression of Toll-like receptors, suggesting pain pathways can be activated directly by the detection of pathogen associated molecular patterns or danger associated molecular patterns. This review will examine the evidence to date implicating Toll-like receptors and their associated signaling components in heightened pain states. In addition, insights into the impact Toll-like receptors have on priming central immune signaling systems for heightened pain states will be discussed. The influence possible sex differences in Toll-like receptor signaling have for female pain and the recognition of small molecule xenobiotics by Toll-like receptors will also be reviewed. PMID:22001158

Nicotra, Lauren; Loram, Lisa C; Watkins, Linda R; Hutchinson, Mark R

2011-01-01

213

Empathic and Nonempathic Interaction in Chronic Pain Couples  

PubMed Central

Empathy and empathic response are receiving greater attention in pain research as investigators acknowledge that other forms of interaction may impact the pain process. The purpose of this study was to examine validation and invalidation as forms of empathic and nonempathic responses in chronic pain couples. Participants were 92 couples in which at least one spouse reported chronic musculoskeletal pain. Each couple participated in two videotaped interactions about the ways in which the pain has impacted their lives together. Trained raters then coded interactions for each partner’s use of validation and invalidation. Couples also completed surveys on spouse responses to pain, marital satisfaction, and perceived spousal support. Correlations demonstrated validation by spouses of persons with pain was associated with punishing, solicitous, and distracting spouse responses to pain, marital satisfaction, and perceived spousal support. In contrast, spouses’ invalidation scores were correlated with punishing spouse responses. Exploratory factor analyses were then conducted to determine the extent to which spouses’ responses to pain and spouse validation and invalidation loaded on similar factors. Results indicated that validation and invalidation are more closely related to punishing spouse responses than to solicitous or distracting spouse responses. These results have implications for theoretical and clinical work on spouse responding. PMID:18806532

Cano, Annmarie; Barterian, Justin A.; Heller, Jaclyn B.

2008-01-01

214

Neurodegenerative Properties of Chronic Pain: Cognitive Decline in Patients with Chronic Pancreatitis  

PubMed Central

Chronic pain has been associated with impaired cognitive function. We examined cognitive performance in patients with severe chronic pancreatitis pain. We explored the following factors for their contribution to observed cognitive deficits: pain duration, comorbidity (depression, sleep disturbance), use of opioids, and premorbid alcohol abuse. The cognitive profiles of 16 patients with severe pain due to chronic pancreatitis were determined using an extensive neuropsychological test battery. Data from three cognitive domains (psychomotor performance, memory, executive functions) were compared to data from healthy controls matched for age, gender and education. Multivariate multilevel analysis of the data showed decreased test scores in patients with chronic pancreatitis pain in different cognitive domains. Psychomotor performance and executive functions showed the most prominent decline. Interestingly, pain duration appeared to be the strongest predictor for observed cognitive decline. Depressive symptoms, sleep disturbance, opioid use and history of alcohol abuse provided additional explanations for the observed cognitive decline in some of the tests, but to a lesser extent than pain duration. The negative effect of pain duration on cognitive performance is compatible with the theory of neurodegenerative properties of chronic pain. Therefore, early and effective therapeutic interventions might reduce or prevent decline in cognitive performance, thereby improving outcomes and quality of life in these patients. PMID:21876748

Souren, Pierre; Arns, Martijn; Gordon, Evian; Vissers, Kris; Wilder-Smith, Oliver; van Rijn, Clementina M.; van Goor, Harry

2011-01-01

215

Epigenetics and the Transition from Acute to Chronic Pain  

PubMed Central

Objective To review the epigenetic modifications involved in the transition from acute to chronic pain and to identify potential targets for the development of novel, individualized pain therapeutics. Background Epigenetics is the study of heritable modifications in gene expression and phenotype that do not require a change in genetic sequence to manifest their effects. Environmental toxins, medications, diet, and psychological stresses can alter epigenetic processes such as DNA methylation, histone acetylation, and RNA interference. Since epigenetic modifications potentially play an important role in inflammatory cytokine metabolism, steroid responsiveness, and opioid sensitivity, they are likely key factors in the development of chronic pain. Although our knowledge of the human genetic code and disease-associated polymorphisms has grown significantly in the past decade, we have not yet been able to elucidate the mechanisms that lead to the development of persistent pain after nerve injury or surgery. Design Focused literature review Results Significant laboratory and clinical data support the notion that epigenetic modifications are affected by the environment and lead to differential gene expression. Similar to mechanisms involved in the development of cancer, neurodegenerative disease, and inflammatory disorders, the literature endorses an important potential role for epigenetics in chronic pain. Conclusions Epigenetic analysis may identify mechanisms critical to the development of chronic pain after injury, and may provide new pathways and target mechanisms for future drug development and individualized medicine. PMID:22978429

Buchheit, Thomas; Van de Ven, Thomas; Shaw, Andrew

2012-01-01

216

Reconceptualizing John F. Kennedy's chronic low back pain.  

PubMed

When the medical records for John Fitzgerald Kennedy were made public, it became clear that the 35th President of the United States suffered greatly from a series of medical illnesses from the time he was a toddler until his assassination in November of 1963. Aside from having Addison disease, no condition seemed to cause him more distress than did his chronic low back pain. A number of surgical procedures to address the presumed structural cause of the pain resulted in little relief and increased disability. Later, a conservative program, including trigger point injections and exercises, provided modest benefit. Herein, the mechanisms underlying his pain are evaluated based on more contemporary pain research. This reconceptualizing of John Fitzgerald Kennedy's pain could serve as a model for other cases where the main cause of the pain is presumed to be located in the periphery. PMID:23900054

Pinals, Robert S; Hassett, Afton L

2013-01-01

217

Is acupuncture effective for the treatment of chronic pain? A systematic review  

Microsoft Academic Search

Pain is the major complaint of the estimated one million U.S. consumers who use acupuncture each year. Although acupuncture is widely available in chronic pain clinics, the effectiveness of acupuncture for chronic pain remains in question. Our aim was to assess the effectiveness of acupuncture as a treatment for chronic pain within the context of the methodological quality of the

Jeanette Ezzo; Brian Berman; Victoria A Hadhazy; Alejandro R Jadad; Lixing Lao; Betsy B Singh

2000-01-01

218

PHARMACOLOGIC INTERVENTIONS FOR CHRONIC PAIN IN CHILDREN: AN EVIDENCE-BASED REVIEW  

Microsoft Academic Search

Chronic pain, defined as continuous or recurrent pain of three months duration, is a widespread problem in pediatric patients with an overall prevalence of up to 25% in a study of 5424 Dutch children 0 -18 years old1. The prevalence of chronic pain however varies considerably depending on patient age and sex. A peak incidence of chronic pain of nearly

John B. Rose

2006-01-01

219

Towards a theory of chronic pain A. Vania Apkarian a,b,  

E-print Network

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 83 2.2.3. Management of chronic pain: current management of low back pain remains insufficientTowards a theory of chronic pain A. Vania Apkarian a,b, *, Marwan N. Baliki a , Paul Y. Geha . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 82 2. What is chronic pain

Apkarian, A. Vania

220

Pain and Opioid Use in Chronic Liver Disease  

PubMed Central

Background Pain is common in patients with liver disease, difficult to treat, and poorly understood. Aims The aim of this study was to determine factors associated with pain and prescription opioid use in a large cohort of patients with confirmed chronic liver. Methods This was a retrospective cohort study of consecutive patients with chronic liver disease visiting a tertiary-care hepatology clinic. Pain was determined by self-report and rated numerically from 0–10. Symptoms of mood and sleep disorders and emotional distress were based on a symptom checklist. Etiology and stage of liver disease and use of prescribed opioids were abstracted from the electronic medical record. Logistic regression was used to establish factors associated with pain and prescription opioid use. Results Among 1286 patients with chronic liver disease, 34% had pain and 25% used opioids. The strongest predictor of pain in multivariate modeling was emotional distress (OR=3.66, CI=2.40,5.64), followed by non-white race (OR=1.87, CI=1.24,2.79), mood symptoms (OR=1.47, CI=1.04,2.07), sleep disturbance/fatigue (OR=1.70, CI=1.24,2.32), and advanced liver disease (Child class B: OR=1.73, CI=1.15,2.60; Child class C: OR=2.78 CI=1.49,5.24) compared to no cirrhosis. Emotional distress, mood-related symptoms, and advanced liver disease were also significant predictors of prescription opioid use, as were age, nicotine use, and etiology of liver disease. Conclusions This large cohort study demonstrates the high prevalence of pain and opioid use in chronic liver disease. While disease variables contribute to pain, psychological symptoms were most strongly associated with pain and opioid use, providing rationale and target for therapeutic interventions. PMID:23512406

Rogal, Shari S.; Winger, Daniel; Bielefeldt, Klaus; Szigethy, Eva

2013-01-01

221

A measure for quality of life assessment in chronic pain: preliminary properties of the WHOQOL-pain  

Microsoft Academic Search

Chronic pain has a considerable impact on patient-reported outcomes such as quality of life (QoL). To assess QoL in people\\u000a with chronic pain, a pain and discomfort module (PDM) was developed for use with the WHOQOL-100 and its psychometric properties\\u000a assessed. Sixteen items covered four facets on pain relief; anger and frustration; vulnerability, fear and worry; and uncertainty.\\u000a Chronic low

V. L. Mason; S. M. Skevington; M. Osborn

2009-01-01

222

Treatment Preferences for CAM in children with chronic pain.  

PubMed

CAM therapies have become increasingly popular in pediatric populations. Yet, little is known about children's preferences for CAM. This study examined treatment preferences in chronic pediatric pain patients offered a choice of CAM therapies for their pain. Participants were 129 children (94 girls) (mean age = 14.5 years +/- 2.4; range = 8-18 years) presenting at a multidisciplinary, tertiary clinic specializing in pediatric chronic pain. Bivariate and multivariate analyses were used to examine the relationships between CAM treatment preferences and patient's sociodemographic and clinical characteristics, as well as their self-reported level of functioning. Over 60% of patients elected to try at least one CAM approach for pain. The most popular CAM therapies were biofeedback, yoga and hypnosis; the least popular were art therapy and energy healing, with craniosacral, acupuncture and massage being intermediate. Patients with a diagnosis of fibromyalgia (80%) were the most likely to try CAM versus those with other pain diagnoses. In multivariate analyses, pain duration emerged as a significant predictor of CAM preferences. For mind-based approaches (i.e. hypnosis, biofeedback and art therapy), pain duration and limitations in family activities were both significant predictors. When given a choice of CAM therapies, this sample of children with chronic pain, irrespective of pain diagnosis, preferred non-invasive approaches that enhanced relaxation and increased somatic control. Longer duration of pain and greater impairment in functioning, particularly during family activities increased the likelihood that such patients agreed to engage in CAM treatments, especially those that were categorized as mind-based modalities. PMID:17965769

Tsao, Jennie C I; Meldrum, Marcia; Kim, Su C; Jacob, Margaret C; Zeltzer, Lonnie K

2007-09-01

223

Effect and Treatment of Chronic Pain in Inflammatory Arthritis  

PubMed Central

Pain is the most common reason patients with inflammatory arthritis see a rheumatologist. Patients consistently rate pain as one of their highest priorities, and pain is the single most important determinant of patient global assessment of disease activity. Although pain is commonly interpreted as a marker of inflammation, the correlation between pain intensity and measures of peripheral inflammation is imperfect. The prevalence of chronic, non-inflammatory pain syndromes such as fibromyalgia is higher among patients with inflammatory arthritis than in the general population. Inflammatory arthritis patients with fibromyalgia have higher measures of disease activity and lower quality of life than inflammatory patients who do not have fibromyalgia. This review article focuses on current literature involving the effects of pain on disease assessment and quality of life for patients with inflammatory arthritis. It also reviews non-pharmacologic and pharmacologic options for treatment of pain for patients with inflammatory arthritis, focusing on the implications of comorbidities and concurrent disease-modifying antirheumatic drug therapy. Although several studies have examined the effects of reducing inflammation for patients with inflammatory arthritis, very few clinical trials have examined the safety and efficacy of treatment directed specifically towards pain pathways. Most studies have been small, have focused on rheumatoid arthritis or mixed populations (e.g., rheumatoid arthritis plus osteoarthritis), and have been at high risk of bias. Larger, longitudinal studies are needed to examine the mechanisms of pain in inflammatory arthritis and to determine the safety and efficacy of analgesic medications in this specific patient population. PMID:23292816

2013-01-01

224

[Peculiarities of cognitive functions in patients with chronic back pain].  

PubMed

The authors have studied cognitive functions and influencing factors in 64 patients with chronic low back pain. All patients have been examined using neurologic, neuroorthopedic, pathopsychological and neuropsychological methods. Patients have been divided into 2 groups according to their age: group 1 (aged 30-50 years) and group 2 (aged 51-60 years). Healthy controls were matched to patients for age, sex and education. Significant differences in neuropsychological testing, i.e. mental flexibility, delayed memory, psychomotor speed, which referred to the subtle cognitive impairment with executive function disturbances, were found in both groups of patients with chronic low back pain as compared to pain-free adults. Sensory-discriminative (pain intensity) and affective-emotional (negative emotions, in particular, anxiety) characteristics had the effect on cognitive functions in younger patients without depressive symptoms. Affective-emotional (anxiety, psychological distress) and cognitive characteristics (i.e. catastrophising) contributed to the cognitive disturbances in older patients. PMID:20032949

Melkumova, K A; Podchufarova, E V; Iakhno, N N

2009-01-01

225

Association of anxiety with intracortical inhibition and descending pain modulation in chronic myofascial pain syndrome  

PubMed Central

Background This study aimed to answer three questions related to chronic myofascial pain syndrome (MPS): 1) Is the motor cortex excitability, as assessed by transcranial magnetic stimulation parameters (TMS), related to state-trait anxiety? 2) Does anxiety modulate corticospinal excitability changes after evoked pain by Quantitative Sensory Testing (QST)? 3) Does the state-trait anxiety predict the response to pain evoked by QST if simultaneously receiving a heterotopic stimulus [Conditional Pain Modulation (CPM)]? We included females with chronic MPS (n?=?47) and healthy controls (n?=?11), aged 19 to 65 years. Motor cortex excitability was assessed by TMS, and anxiety was assessed based on the State-Trait Anxiety Inventory. The disability related to pain (DRP) was assessed by the Profile of Chronic Pain scale for the Brazilian population (B:PCP:S), and the psychophysical pain measurements were measured by the QST and CPM. Results In patients, trait-anxiety was positively correlated to intracortical facilitation (ICF) at baseline and after QST evoked pain (??=?0.05 and ??=?0.04, respectively) and negatively correlated to the cortical silent period (CSP) (??=?-1.17 and ??=?-1.23, respectively) (P <0.05 for all comparisons). After QST evoked pain, the DRP was positively correlated to ICF (??=?0.02) (P?Pain scores during CPM were positively correlated with trait-anxiety when it was concurrently with high DRP (??=?0.39; P?=?0.02). Controls’ cortical excitability remained unchanged after QST. Conclusions These findings suggest that, in chronic MPS, the imbalance between excitatory and inhibitory descending systems of the corticospinal tract is associated with higher trait-anxiety concurrent with higher DRP. PMID:24645677

2014-01-01

226

Pain-related disability and effects of chronic morphine in the adjuvant-induced arthritis model of chronic pain.  

PubMed

Functional disability has been identified as one of the most important aspects of chronic pain, yet modeling pain-related disability has received little attention. Adjuvant-induced arthritis was induced, and one group of arthritic rats was implanted with SC 75-mg morphine pellets 1 week postadjuvant, and reimplanted every 2 weeks thereafter. The results confirm that the rodent adjuvant-induced arthritis model of severe chronic pain can be used to model pain-related disability: spontaneous activity levels and ambulatory function were reduced in arthritic rats and they exhibited substantial weight loss. The results of the present study suggest that the operant delayed nonmatching-to-position task can be used as a measure of pain-related disability, which may be especially relevant to the effects of chronic pain on performance in a work setting. The delayed nonmatching-to-position operant bar-pressing task is an "apical" test that is sensitive to deficits across a wide range of behavioral functions: motor ability, attention, motivation, learning, and memory, and arthritic rats were severely impaired in this task. In addition, analgesic treatments that impair functional abilities in normal healthy rats may actually improve the performance of rats exhibiting pain-related disability. Previous work demonstrated that acute morphine injections of only 4 mg/kg impaired performance in the delayed matching-to-position task. The results of the present study demonstrate that chronic morphine attenuates the degree of pain-related disability exhibited by arthritic rats in the test of ambulatory function and the delayed nonmatching-to-position bar-pressing test. These results demonstrate that novel analgesic treatments can be screened preclinically, both with respect to their direct analgesic effects, and with respect to their ability to reduce pain-related disability. PMID:9226363

Cain, C K; Francis, J M; Plone, M A; Emerich, D F; Lindner, M D

1997-07-01

227

Radiation therapy for palliation of cancer-related chronic pain  

Microsoft Academic Search

Percutaneous radiotherapy is highly effective as a part of an interdisciplinary approach in the treatment of cancer-related\\u000a chronic pain. Overall response rates of 70–90% and complete pain relief rates of 40–50% have been reported in numerous retrospective\\u000a and randomized clinical trials. Beside the analgesic effect, radiation therapy enables the restoration of bony structure and\\u000a musculoskeletal function, improves patients’ mobility and

Arpad Sztankay

2009-01-01

228

Prevalence, Practice Patterns and Evidence for Chronic Neck Pain  

PubMed Central

Objective The primary objectives of this study were to estimate the prevalence of chronic neck pain in North Carolina, to describe health care use (providers, treatments and diagnostic testing) for chronic neck pain and to correlate health care use with current best evidence. Methods A cross-sectional, telephone survey of a representative sample of North Carolina households in 2006. Five thousand three hundred fifty seven households were contacted in 2006 to identify 141 non-institutionalized adults 21 years and older with chronic neck pain and no chronic low back pain. Subjects were interviewed about their health and health care use (i.e., provider, tests, and treatments). Patterns of health care use were compared to current systematic reviews. Results The estimated prevalence of chronic neck pain in 2006 among non-institutionalized individuals for the state of North Carolina was 2.2% (95% CI 1.7 – 2.6). Individuals with chronic neck pain were middle- aged (mean age 48.9 years and a majority were female (56%) and non-Hispanic White (81%). Subjects saw a mean of 5.21 (95% CI 4.8 – 5.6) provider types and had a mean of 21 visits. The types of treatments subjects reported varied with treatments such as electrotherapy stimulation (30.3%), corsets or braces (20.9%), massage (28.1%), ultrasound (27.3%), heat (57.0%) and cold (47.4%) having unclear or little benefit based on current best available reviews. Conclusion Based on current evidence for best practice, our findings indicate over utilization of diagnostic testing, narcotics and modalities, and the under utilization of effective treatments such as therapeutic exercise. PMID:20521306

Goode, Adam P.; Freburger, Janet; Carey, Timothy

2010-01-01

229

Overtreating Chronic Back Pain: Time to Back Off?  

PubMed Central

Chronic back pain is among the most common patient complaints. Its prevalence and impact have spawned a rapidly expanding range of tests and treatments. Some of these have become widely used for indications that are not well-validated, leading to uncertainty about efficacy and safety, increasing complication rates, and marketing abuses. Recent studies document – over approximately a decade - a 629% increase in Medicare expenditures for epidural steroid injections; a 423% increase in expenditures for opioids for back pain; a 307% increase in the number of lumbar MRIs among Medicare beneficiaries; and a 220% increase in spinal fusion surgery rates. The limited studies available suggest that these increases have not been accompanied by population-level improvements in patient outcomes or disability rates. We suggest a need for a better understanding of the basic science of pain mechanisms; more rigorous and independent trials of many treatments; a stronger regulatory stance toward approval and post-marketing surveillance of new drugs and devices for chronic pain; and a chronic disease model for managing chronic back pain. PMID:19124635

Deyo, Richard A.; Mirza, Sohail K.; Turner, Judith A.; Martin, Brook I.

2009-01-01

230

Converging Perspectives in the Treatment of Chronic Prostatitis\\/Chronic Pelvic Pain Syndrome Symptoms  

Microsoft Academic Search

Chronic prostatitis\\/chronic pelvic pain syndrome (CP\\/CPPS) is a common urological condition characterized by persistent pain\\u000a in the perineum, pelvic area, and\\/or genitalia but exhibiting noted symptom variation in men across socioeconomic status,\\u000a race, and age. Treatment using a biopsychosocial model must focus on providing the individual with specific techniques designed\\u000a to help increase feelings of control over-persistent and problematic symptoms.

Dean A. Tripp

231

Functional and chronic anorectal and pelvic pain disorders.  

PubMed

Several organic and functional disorders of the urinary bladder, reproductive tract, anorectum, and the pelvic floor musculature cause pelvic pain. This article describes functional disorders in which chronic pelvic and anorectal pain cannot be explained by a structural or other specified pathology. Currently, these functional disorders are classified into urogynecologic conditions or cystitis and painful bladder syndrome, anorectal disorders, and the levator ani syndrome. Although nomenclature suggests that these conditions are distinct, there is considerable overlap of their symptoms and these disorders have much in common. PMID:18794003

Bharucha, Adil E; Trabuco, Emanuel

2008-09-01

232

Psychosocial perspectives in the treatment of pediatric chronic pain.  

PubMed

Chronic pain in children and adolescents is associated with major disruption to developmental experiences crucial to personal adjustment, quality of life, academic, vocational and social success. Caring for these patients involves understanding cognitive, affective, social and family dynamic factors associated with persistent pain syndromes. Evaluation and treatment necessitate a comprehensive multimodal approach including psychological and behavioral interventions that maximize return to more developmentally appropriate physical, academic and social activities. This article will provide an overview of major psychosocial factors impacting on pediatric pain and disability, propose an explanatory model for conceptualizing the development and maintenance of pain and functional disability in medically difficult-to-explain pain syndromes, and review representative evidence-based cognitive behavioral and systemic treatment approaches for improving functioning in this pediatric population. PMID:22676345

Carter, Bryan D; Threlkeld, Brooke M

2012-01-01

233

Psychosocial perspectives in the treatment of pediatric chronic pain  

PubMed Central

Chronic pain in children and adolescents is associated with major disruption to developmental experiences crucial to personal adjustment, quality of life, academic, vocational and social success. Caring for these patients involves understanding cognitive, affective, social and family dynamic factors associated with persistent pain syndromes. Evaluation and treatment necessitate a comprehensive multimodal approach including psychological and behavioral interventions that maximize return to more developmentally appropriate physical, academic and social activities. This article will provide an overview of major psychosocial factors impacting on pediatric pain and disability, propose an explanatory model for conceptualizing the development and maintenance of pain and functional disability in medically difficult-to-explain pain syndromes, and review representative evidence-based cognitive behavioral and systemic treatment approaches for improving functioning in this pediatric population. PMID:22676345

2012-01-01

234

Emotional Disturbance and Chronic Low Back Pain.  

ERIC Educational Resources Information Center

Patients high in alientation and distrust may be poor compliers. Because only the somatic concern dimension predicted outcome, a single scale that measures this characteristic may be sufficient for effective identification of the potential good v poor responders to conservative treatment of low back pain. (Author)

McCreary, Charles P.; And Others

1980-01-01

235

Remediation of pain-related memory bias as a result of recovery from chronic pain.  

PubMed

Cognitive biases are increasingly implicated as vulnerability factors in emotional and physical disorders. This issue is examined here in chronic pain sufferers using a recall memory paradigm. A sample of chronic pelvic pain patients undergoing hysterectomy and oophorectomy were assessed prior to the intervention, 8 weeks post-surgery, and again 6 months post-surgery. On each occasion patients were aurally presented four mixed lists of sensory, affective, neutral and gardening words, matched for frequency and length. No difference in the recall of neutral and gardening words was found, suggesting that selective memory for pain-related information cannot be attributed to superior recall of words belonging to a common semantic category. A clear pattern of more pain-related words being remembered before surgery, but better recall of non-pain-related words 6 months post-surgery when pain intensity ratings are significantly reduced, was evidenced. These results suggest that selective memory for pain-related words is more likely to be a secondary consequence of the long term experience of pain than a stable, enduring cognitive vulnerability factor. PMID:7595875

Edwards, L C; Pearce, S A; Beard, R W

1995-02-01

236

Understanding Help Seeking for Chronic Joint Pain  

PubMed Central

Osteoarthritis-related joint pain is prevalent and potentially disabling. United Kingdom clinical guidelines suggest that patients should be supported to self-manage in primary care settings. However, the processes and mechanisms that influence patient consultation decisions for joint pain are not comprehensively understood. We recruited participants (N = 22) from an existing longitudinal survey to take part in in-depth interviews and a diary study. We found that consultation decisions and illness actions were ongoing social processes. The need for and benefits of consulting were weighed against the value of consuming the time of a professional who was considered an expert. We suggest that how general practitioners manage consultations influences patient actions and is part of a broader process of defining the utility and moral worth of consulting. Recognizing these factors will improve self-management support and consultation outcomes. PMID:24970250

Jinks, Clare; Ong, Bie Nio

2014-01-01

237

Chronic Low-Back Pain and Complementary Health Approaches: What the Science Says  

MedlinePLUS

... Integrative Health Chronic Low-Back Pain and Complementary Health Approaches : What the Science Says March 2014 Spinal ... More About Chronic Low-Back Pain and Complementary Health Approaches Clinical Guidelines, Scientific Literature, Research Spotlights, Info ...

238

Acupuncture May Be Helpful for Chronic Pain: A Meta-Analysis  

MedlinePLUS

... links Read our disclaimer about external links Menu Acupuncture May Be Helpful for Chronic Pain: A Meta- ... provides the most rigorous evidence to date that acupuncture may be helpful for chronic pain. In addition, ...

239

Determining the Optimal Number of Spinal Manipulation Sessions for Chronic Low-Back Pain  

MedlinePLUS

... Number of Spinal Manipulation Sessions for Chronic Low-Back Pain Findings from the largest and most rigorous, randomized ... of spinal manipulative therapy (SMT) for chronic low-back pain suggest that 12 sessions (SMT) may be the ...

240

The need for knowledge translation in chronic pain  

PubMed Central

One in five Canadians suffers from some form of persistent or chronic pain. The impact on individual lives, families and friends, the health services sector and the economy is huge. Reliable evidence is available that the burden of persistent pain can be markedly reduced when available knowledge is applied. Bridging the quality chasm between chronic pain and the care process will require a unique confluence of opinion from all stakeholders committed within a focused community of practice to address the impact of pain. Various levels of success in this regard have been demonstrated when there is exchange, synthesis and ethically sound application of research findings within a complex set of interactions among researchers and knowledge users. It is now critical to accelerate the capture of the benefits of research for Canadians through improved health, more effective and responsive services and products, and a strengthened health care system to bring about health reform and health care reform across Canada as it pertains to the one in five Canadians living with chronic, disabling pain. The overarching outcome of such an initiative needs to be promoted to sustain a balanced portfolio of curiosity-and needs-based research, which along with existing knowledge, can be mobilized and applied for the benefit of Canadians, the health care system and the economy. PMID:19225603

Henry, James L

2008-01-01

241

Chronic lower back pain due to sarcoma.  

PubMed

We describe a 74-year-old woman with extensive pelvic leiomyosarcoma presenting with uncharacteristic musculoskeletal pain of the lumbosacral region and left lower extremity. Hemipelvectomy was considered the treatment of choice, and a model for a pelvic prosthesis was constructed based on imaging analysis. However, the tumour (and the complaints) responded surprisingly well to a combined treatment regimen including superselective arterial catheter embolization, which led to tumour regression to such a degree that aggressive surgical treatment became unnecessary. PMID:9631756

Hueber, W; Dominkus, M; Vesely, M; Mendel, M; Kotz, R; Czembirek, H; Smolen, J S

1998-01-01

242

Post-traumatic stress disorder among patients with chronic pain and chronic fatigue  

Microsoft Academic Search

Background. Fibromyalgia (FM), a chronic pain condition of unknown aetiology often develops following a traumatic event. FM has been associated with post-traumatic stress disorder (PTSD) and major depression disorder (MDD). Method. Patients seen in a referral clinic (N = 571) were evaluated for FM and chronic fatigue syndrome (CFS) criteria. Patients completed questionnaires, and underwent a physical examination and a

P. ROY-BYRNE; W. R. SMITH; J. GOLDBERG; N. AFARI; D. BUCHWALD

2004-01-01

243

[Health maintenance, relaxation and hypnosis for chronic pain patients].  

PubMed

The treatment of chronic pain patients integrates more and more complementary therapies such as relaxation and hypnosis, implemented by specially trained nurses. These techniques are offered on the basis of nurses' diagnoses carried out in the framework of a clinical approach. PMID:25518140

Boiron, Clare

2014-10-01

244

Coping Constructs Related to College Students with Chronic Pain  

ERIC Educational Resources Information Center

This phenomenological, qualitative research study involved in-depth interviews with 22 participants enrolled in a private Midwestern university. Each participant reported living with a respective chronic pain syndrome while also being a full-time student. Our semi-structured, interviews centered around the constructs of physical, social,…

Firmin, Michael W.; Burger, Amanda J.; Sherman, Amanda L.; Grigsby, Megan E.; Croft, Jennifer N.

2011-01-01

245

Treating chronic pain in the presence of substance abuse.  

PubMed Central

Substance abuse and chronic pain are both debilitating illnesses. It is difficult to treat these disorders when they co-occur. We discuss such a case in the context of relevant literature and make recommendations for assessment, management, and documentation. PMID:15303416

Stanley, Ava H.; Safford, Monika M.

2004-01-01

246

Chronic Pain and Depression: Does the Evidence Support a Relationship?  

ERIC Educational Resources Information Center

A critical evaluation of the relevant literature provides some support for an association between depression and chronic pain. Common conceptual and methodological problems are discussed. Current biological and psychological models of the mechanisms by which the two syndromes may interact are summarized, and suggestions are made for future…

Romano, Joan M.; Turner, Judith A.

1985-01-01

247

Predictors of alcohol use among people experiencing chronic pain  

Microsoft Academic Search

The aim of this study was to investigate the relationship between demographic, mood, physical and coping factors, and alcohol use in people experiencing chronic pain. It was hypothesised that a combined model would be more effective in explaining the variance in alcohol use than any single block of predictors individually. The study was cross-sectional in nature. Self-report measures of demographic

Jane Lawton; Jane Simpson

2009-01-01

248

RESEARCH ARTICLE Open Access Chronic pain associated with the Chikungunya  

E-print Network

RESEARCH ARTICLE Open Access Chronic pain associated with the Chikungunya Fever: long lasting Dallel3 , Didier Bouhassira1* Abstract Background: Chikungunya virus (CHIKV) is responsible for majorL and more challenging pharmacological treatment. Background Chikungunya fever is a viral disease caused

Paris-Sud XI, Université de

249

Core outcome domains for chronic pain clinical trials: IMMPACT recommendations  

Microsoft Academic Search

Objective. To provide recommendations for the core outcome domains that should be considered by investigators conducting clinical trials of the efficacy and effectiveness of treatments for chronic pain. Development of a core set of outcome domains would facilitate comparison and pooling of data, encourage more complete reporting of outcomes, simplify the preparation and review of research proposals and manuscripts, and

Dennis C. Turk; Robert H. Dworkin; Robert R. Allen; Nicholas Bellamy; Nancy Brandenburg; Daniel B. Carr; Charles Cleeland; Raymond Dionne; John T. Farrar; Bradley S. Galer; David J. Hewitt; Alejandro R. Jadad; Nathaniel P. Katz; Lynn D. Kramer; Donald C. Manning; Cynthia G. Mccormick; Michael P. Mcdermott; Patrick McGrath; Steve Quessy; Bob A. Rappaport; James P. Robinson; Mike A. Royal; Lee Simon; Joseph W Stauffer; Wendy Stein; Jane Tollett; James Witter

2003-01-01

250

Sex Differences in the Presentation of Chronic Low Back Pain  

ERIC Educational Resources Information Center

Sex differences in 351 patients with chronic low back pain were examined. Biological, psychological, and psychosocial factors were considered. Sex differences in adaptive functioning were consistent with traditional gender roles. Significant interactions were found for sex and employment status, and sex and marital status. Retired women reported…

Sheffer, Christine E.; Cassisi, Jeffrey E.; Ferraresi, Laurette M.; Lofland, Kenneth R.; McCracken, Lance M.

2002-01-01

251

Oxycodone. Pharmacological profile and clinical data in chronic pain management.  

PubMed

Opioids are widely used as effective analgesic therapy for cancer pain. Despite years of controversy, their use has been also accepted in chronic non-cancer pain. Oxycodone alone and in combination has been used for over 80 years in the treatment of a variety of pain syndromes. As single agent, the controlled release (CR) oxycodone's market in the USA grew from 10% in 1996 to 53% in 2000 and it has become a leading opioid in the United States. Recent data showed that the fixed-combination oxycodone/acetaminophen (5 mg/325 mg) is the most often prescribed opioid across all the different chronic pain diagnoses. Compared with morphine, oxycodone has a higher oral bioavailability and is about twice as potent. Pharmacokinetic-pharmacodynamic data support oxycodone as a pharmacologically active opiod that does not require conversion to oxymoprhone for pharmacological activity. Seven studies addressed the safety and efficacy of oxycodone for the treatment of non-cancer pain (low back pain, osteoarthritis pain, and painful diabetic neuropathy). Both immediate release (IR) and CR oxycodone are equally effective and safe. Along these trials, mean daily dosage of oxycodone was approximately 40 mg, with a low incidence of intolerable typical opiate side effects. In cancer pain, oxycodone can be considered a valid alternative to oral morphine to be used for opioid rotation. No difference in analgesic efficacy between CR oxycodone and CR morphine was found. Controlled-release preparations, with a long duration of action, are attractive because they offer the advantage of longer dosing intervals and sustained analgesic effect. PMID:16012419

Coluzzi, F; Mattia, C

2005-01-01

252

[Chronic pelvic pain in women from a gynecologic viewpoint].  

PubMed

Chronic pelvic pain in women is a difficult subject that challenges the gynecologist in practice. Possible gynecological causes are endometriosis, adhesions/PID, pelvic varicosis and ovarian retention syndrome/ovarian remnant syndrome. Other somatic causes are irritable bowel syndrome, bladder pain syndrome and fibromyalgia.Confirmed psychosocial factors contributing to chronic pelvic pain are comorbidity with anxiety disorders, substance abuse or depression, but the influence of social factors is less certain. The connection to physical and sexual abuse also remains unclear. Important diagnostic steps are studying the patient's history, a gynecological examination and laparoscopy. Multidisciplinary therapeutic approaches are helpful. Basic psychosomatic care and psychotherapy should be integrated into the therapeutic concept at an early stage of the disease. PMID:19777202

Siedentopf, F

2009-10-01

253

[Psychodynamic therapy in chronic pain patients: a systematic review].  

PubMed

Psychoanalysis has made fundamental contributions to our understanding of somatoform pain disorder; however, psychodynamic therapy procedures have not been accorded their due recognition in the treatment of chronic pain. This is due to the inadequate differential indication for the employment of psychodynamic treatment methods, on the one hand, and to the refusal of most of the psychoanalysts to modify the standard psychoanalytic procedures in accordance with the requirements of pain treatment. This article reviews evidence of the modification of psychodynamic therapy procedures and their outcome in chronic pain patients in the context of past research. We conducted a systematic computer-based literature research employing MEDLINE, EVIDENCE BASED MEDICINE, and PSYNDEX data-bases between 1980 and 2000. Psychodynamic therapy procedures are indicated in the first instance for patients with psychic co-morbidity and those with somatoform pain disorder. A modification of the psychotherapeutic technique, involving an approach that is more structured and is also rather supportive at least at the beginning, is necessary. While employing psychodynamic methods in the treatment of pain patients, greater importance should be attached to the physical level and to the 'holding function' of the therapist than is usually the case with the conventional psychoanalytic therapy procedures. PMID:11593457

Söllner, W; Schüssler, G

2001-01-01

254

Chronic proctalgia and chronic pelvic pain syndromes: new etiologic insights and treatment options.  

PubMed

This systematic review addresses the pathophysiology, diagnostic evaluation, and treatment of several chronic pain syndromes affecting the pelvic organs: chronic proctalgia, coccygodynia, pudendal neuralgia, and chronic pelvic pain. Chronic or recurrent pain in the anal canal, rectum, or other pelvic organs occurs in 7% to 24% of the population and is associated with impaired quality of life and high health care costs. However, these pain syndromes are poorly understood, with little research evidence available to guide their diagnosis and treatment. This situation appears to be changing: a recently published large randomized, controlled trial by our group comparing biofeedback, electrogalvanic stimulation, and massage for the treatment of chronic proctalgia has shown success rates of 85% for biofeedback when patients are selected based on physical examination evidence of tenderness in response to traction on the levator ani muscle--a physical sign suggestive of striated muscle tension. Excessive tension (spasm) in the striated muscles of the pelvic floor appears to be common to most of the pelvic pain syndromes. This suggests the possibility that similar approaches to diagnostic assessment and treatment may improve outcomes in other pelvic pain disorders. PMID:22110274

Chiarioni, Giuseppe; Asteria, Corrado; Whitehead, William E

2011-10-28

255

Prevalence and clinical features of lumbar zygapophysial joint pain: a study in an Australian population with chronic low back pain  

Microsoft Academic Search

OBJECTIVES--To determine the prevalence of pain arising from the zygapophysial joint in patients with chronic low back pain and to determine whether any clinical features could distinguish patients with and without such pain. METHODS--Sixty three patients with chronic low back pain were studied prospectively. All patients underwent a detailed history and physical examination as well as a series of intra-articular

A C Schwarzer; S C Wang; N Bogduk; P J McNaught; R Laurent

1995-01-01

256

Determining pain scale preference in a veteran population experiencing chronic pain.  

PubMed

The purpose of this study was to determine veteran pain scale preference of four common pain scales: the Faces Scale, the Visual Analog Scale, the Numeric Rating Scale, and the Mankoski Pain Scale. The study also examined the reliability and validity of the Mankoski Pain Scale with the other three scales. A sample of veterans (N = 200) with chronic pain receiving treatment in a residential rehabilitation treatment program (RRTP) and a surgical and specialty care (SSC) outpatient clinic at a Department of Veterans Affairs (VA) medical center participated in the study. There was a significant difference between scales in regard to preference, ?2(3) = 64.59, p < .001. A large percentage of the sample preferred the Mankoski Pain Scale (46%). Test-retest of the reliability was comparable for all the scales. Validity of the Mankoski scale was excellent, as it correlated very well with the Numeric (r = .84, p < .001), Analog (r = .83, p < .001), and Faces (r = .78, p < .001) scales. The findings indicate that the Mankoski Pain Scale is a valid and reliable tool for pain with veterans, and it was the preferred scale by veterans for use when describing pain. PMID:24530196

Douglas, Mary E; Randleman, Mary L; DeLane, Alice M; Palmer, Glen A

2014-09-01

257

Cognitive-Processing Bias in Chronic Pain: A Review and Integration  

Microsoft Academic Search

Do patients with chronic pain selectively process pain- and illness-related stimuli? The evidence with regard to attention, interpretation, and recall biases is critically reviewed. A model is proposed to account for the findings in which it is suggested that biases in information processing in chronic pain are the result of overlap between 3 schemas: pain, illness, and self. With frequent

Tamar Pincus; Stephen Morley

2001-01-01

258

Sex and Age Differences in Coping Styles Among Children with Chronic Pain  

Microsoft Academic Search

The purpose of this study was to examine sex and age differences in coping strategies among pediatric patients with chronic pain. Sex differences are reported in the adult pain and coping literatures, but little attention has been given to possible distinctions in coping styles in the pediatric chronic pain population. Investigating pain coping skills at an early age may provide

Anne M. Lynch; Susmita Kashikar-Zuck; Kenneth R. Goldschneider; Benjamin A. Jones

2007-01-01

259

Chronic Pain in People with an Intellectual Disability: Under-Recognised and Under-Treated?  

ERIC Educational Resources Information Center

Aim: To examine the nature, prevalence and impact of chronic pain in adults with an intellectual disability (ID) based on carer report. Methods: Postal questionnaires were sent to 250 care-givers and 157 responses were received (63%). Results: Chronic pain was reported in 13% of the sample (n = 21), 6.3% had pain in two sites and 2% had pain in…

McGuire, B. E.; Daly, P.; Smyth, F.

2010-01-01

260

Religious and Spiritual Beliefs and Practices of Persons with Chronic Pain  

ERIC Educational Resources Information Center

Ninety-five persons receiving treatment for chronic pain were surveyed using the Spirituality and Chronic Pain Survey (SCPS). The survey included a pain assessment, a spiritual/religious practices assessment, and questions related to spiritual/religious beliefs and attitudes. Most participants reported experiencing constant, higher-level pain. The…

Glover-Graf, Noreen M.; Marini, Irmo; Baker, Jeff; Buck, Tina

2007-01-01

261

Chronic back pain intensity is associated with hub disruption of small world brain networks  

E-print Network

Chronic back pain intensity is associated with hub disruption of small world brain networks 3998 topology in resting state fMRI in back pain patients and animal models to investigate what aspects of brain Apkarian1 · 25 chronic back pain (CBP) patients (mean age 47.5 years, 16 females, mean pain duration = 15

Apkarian, A. Vania

262

Our recent fMRI studies indicate that spontaneous chronic back-pain (CBP) is  

E-print Network

Our recent fMRI studies indicate that spontaneous chronic back-pain (CBP) is associated Herpetic Neuropathy, Back Pain, and Acute Thermal Pain P.Y.Geha1, R.N. Harden2, J. Paice3, M.N. Baliki1,R activity for spontaneous CBP is 13 Chronic Back patients. Random effect analysis of (pain ­ visual control

Apkarian, A. Vania

263

Pain intensity, disability and depression in individuals with chronic back pain1  

PubMed Central

OBJECTIVES: to measure the pain intensity, identify the disability and depression levels in people with chronic back pain and to correlate these variables. A cross-sectional, descriptive and exploratory study was undertaken at the Pain Treatment Clinic of the University of São Paulo at Ribeirão Preto Hospital das Clínicas, between February and June 2012, after receiving approval from the Ethics Committee at the University of São Paulo at Ribeirão Preto College of Nursing. METHOD: sixty subjects with chronic back pain participated. The instruments used were: the 11-point Numerical Category Scale, the Roland-Morris Disability Questionnaire and the Beck Depression Inventory. To analyze the data, the arithmetic means, standard deviations and Spearman's correlation coefficient were calculated. RESULTS: the findings show that the participants presented high pain, disability and depression levels. The correlation between pain intensity and disability and between pain intensity and depression was positive and weak and, between disability and depression, positive and moderate. CONCLUSION: the study variables showed moderate and weak indices and the mutual correlations were positive. PMID:25296139

Garbi, Márcia de Oliveira Sakamoto Silva; Hortense, Priscilla; Gomez, Rodrigo Ramon Falconi; da Silva, Talita de Cássia Raminelli; Castanho, Ana Carolina Ferreira; Sousa, Fátima Aparecida Emm Faleiros

2014-01-01

264

Risk factors predicting the development of widespread pain from chronic back or neck pain  

PubMed Central

Emerging evidence suggests that some individuals with regional pain disorders go on to develop chronic widespread pain (CWP). However, the mechanism behind this transition and nature of risk factors that predispose a person to develop CWP remain to be elucidated. The purpose of this study was to describe the frequency with which participants with chronic back or neck pain develop CWP and to determine the risk factors associated with this development. In a sample of 512 individuals, we found that nearly a quarter (22.6%) of subjects who presented with regional back or neck pain in 2001/2002 had developed CWP by 2007. Logistic regression indicated that seven factors were associated with the transition to CWP: moderate or severe pain intensity, female gender, history of abuse, family history of CWP, severe interference with general activity, having one or more central sensitivity syndromes, and using more pain management strategies. History of abuse was not significant in multivariate analysis. Notably number of depressive symptoms endorsed, pain duration, age, body mass index, number of medication classes used, and receipt of disability benefits were not significantly associated with this transition. PMID:20488762

Kindler, Lindsay L.; Jones, Kim D.; Perrin, Nancy; Bennett, Robert M.

2010-01-01

265

The Biopsychosocial Approach to Chronic Pain: Scientific Advances and Future Directions  

E-print Network

The prevalence and cost of chronic pain is a major physical and mental health care problem in the United States, the prevalence and cost of chronic pain is a major physical and mental health care problem in the United States a 19% prevalence for chronic spinal pain (neck and back) in the United States in the previous year

Meagher, Mary

266

Validation of the Chronic Pain Acceptance Questionnaire (CPAQ) in Cantonese-Speaking Chinese Patients  

Microsoft Academic Search

Acceptance of chronic pain has become an important concept in understanding and predicting that chronic pain sufferers can remain engaged with meaningful aspects of life. Assessment of acceptance has been facilitated by the development of Chronic Pain Acceptance Questionnaire (CPAQ). In this study, we aimed to test the reliability and validity of translated Chinese version of CPAQ to use this

Michelle Cheung Ning; Tony Wong Chi Ming; Jacqueline Yap Chooi Mae; Chen Phoon Ping

2008-01-01

267

Sacral perineural cyst presenting as chronic perineal pain: a case report.  

PubMed

We present an interesting case of sacral perineural cyst which caused chronic perineal pain. Perineural cyst is relatively rare, especially the sacral region. Chronic perineural pain is an often encountered problem that is difficult to evaluate and sacral perineural cyst may be the etiology of chronic perineal pain in many instances. PMID:12577111

Jain, S K; Chopra, S; Bagaria, H; Mathur, P P S

2002-12-01

268

Trunk muscle recruitment patterns in specific chronic low back pain populations  

E-print Network

Trunk muscle recruitment patterns in specific chronic low back pain populations Sheri P. Silfies a modeling has supported this hypothesis, studies of muscle recruitment patterns in chronic low back pain spine position between subgroups of patients with chronic mechanical low back pain and asymptomatic

Karduna, Andrew

269

Increased taste intensity perception exhibited by patients with chronic back pain  

E-print Network

Increased taste intensity perception exhibited by patients with chronic back pain Dana M. Small a as well as decreases in sensitivity to taste. Recently it was shown that chronic back pain (CBP (Formaker and Frank, 2000). Gustation and chronic back pain (CBP) also appear to have overlapping neural

Apkarian, A. Vania

270

Behavioral/Systems/Cognitive Chronic Back Pain Is Associated with Decreased Prefrontal  

E-print Network

Behavioral/Systems/Cognitive Chronic Back Pain Is Associated with Decreased Prefrontal and Thalamic of the brain in chronic pain conditions remains speculative. We compared brain morphology of 26 chronic back; frontal cortex; thalamus; neuropathic back pain; aging Introduction Ten percent of adults suffer from

Apkarian, A. Vania

271

Chronic perineal pain: current pathophysiological aspects, diagnostic approaches and treatment.  

PubMed

Chronic perineal pain is the anorectal and perineal pain without underlying organic disease, anorectal or endopelvic, which has been excluded by careful physical examination, radiological and endoscopic investigations. A variety of neuromuscular disorders of the pelvic floor lead to the different pathological conditions such as anorectal incontinence, urinary incontinence and constipation of obstructed defecation, sexual dysfunction and pain syndromes. The most common functional disorders of the pelvic floor muscles, accompanied by perineal pain are levator ani syndrome, proctalgia fugax, myofascial syndrome and coccygodynia. In the diagnosis of these syndromes, contributing to a thorough history, physical examination, selected specialized investigations and the exclusion of organic disease with proctalgia is carried out. Accurate diagnosis of the syndromes helps in choosing an appropriate treatment and in avoiding unnecessary and ineffective surgical procedures, which often are performed in an attempt to alleviate the patient's symptoms. PMID:21079515

Andromanakos, Nikolaos P; Kouraklis, Grigorios; Alkiviadis, Kostakis

2011-01-01

272

Avoidance and Confrontation of Painful, Back-Straining Movements in Chronic Back Pain Patients  

Microsoft Academic Search

Avoidance of painful activities has been proposed to be an important n'sk factor for the initiation and maintenance of chronic low back suffering, whereas exposure to these activities has been suggested to be beneficial for recovery. In a cross-sectional study, the differences between chronic patients with avoidant and confrontational styles were investigated using self-report measures and a behavioral test. Participants

Geert Crombez; Leen Vervaet; Roland Lysens; Frank Baeyens; Paul Eelen

1998-01-01

273

Acute stress contributes to individual differences in pain and pain-related brain activity in healthy and chronic pain patients.  

PubMed

Individual differences in pain sensitivity and reactivity are well recognized but the underlying mechanisms are likely to be diverse. The phenomenon of stress-induced analgesia is well documented in animal research and individual variability in the stress response in humans may produce corresponding changes in pain. We assessed the magnitude of the acute stress response of 16 chronic back pain (CBP) patients and 18 healthy individuals exposed to noxious thermal stimulations administered in a functional magnetic resonance imaging experiment and tested its possible contribution to individual differences in pain perception. The temperature of the noxious stimulations was determined individually to control for differences in pain sensitivity. The two groups showed similar significant increases in reactive cortisol across the scanning session when compared with their basal levels collected over 7 consecutive days, suggesting normal hypothalamic-pituitary-adrenal axis reactivity to painful stressors in CBP patients. Critically, after controlling for any effect of group and stimulus temperature, individuals with stronger cortisol responses reported less pain unpleasantness and showed reduced blood oxygenation level-dependent activation in nucleus accumbens at the stimulus onset and in the anterior mid-cingulate cortex (aMCC), the primary somatosensory cortex, and the posterior insula. Mediation analyses indicated that pain-related activity in the aMCC mediated the relationship between the reactive cortisol response and the pain unpleasantness. Psychophysiological interaction analysis further revealed that higher stress reactivity was associated with reduced functional connectivity between the aMCC and the brainstem. These findings suggest that acute stress modulates pain in humans and contributes to individual variability in pain affect and pain-related brain activity. PMID:23595741

Vachon-Presseau, Etienne; Martel, Marc-Oliver; Roy, Mathieu; Caron, Etienne; Albouy, Geneviève; Marin, Marie-France; Plante, Isabelle; Sullivan, Michael J; Lupien, Sonia J; Rainville, Pierre

2013-04-17

274

From interstitial cystitis to chronic pelvic pain  

PubMed Central

There are still many things to be found out about interstitial cystitis/painful bladder syndrome (IC/PBS) because the pathological processes underlying the condition are not yet elucidated, biological markers of the condition are not yet available, and the type and severity of symptoms can vary, so, clearly defining the condition is not yet possible. For example, it is not clearly understood whether IC/PBS represents a systemic disease, if it is localized in the bladder, or if it was initially localized in the bladder and it later evolved into a systemic disease. This condition is best managed by using a multidisciplinary approach. Management requires a good integration and knowledge of all pelvic organ systems and other systems including musculoskeletal, neurologic, and psychiatric systems. PMID:20968203

Cauni, V; Gutue, S; Blaj, I; Jinga, V; Geavlete, P

2010-01-01

275

From interstitial cystitis to chronic pelvic pain.  

PubMed

There are still many things to be found out about interstitial cystitis/painful bladder syndrome (IC/PBS) because the pathological processes underlying the condition are not yet elucidated, biological markers of the condition are not yet available, and the type and severity of symptoms can vary, so, clearly defining the condition is not yet possible. For example, it is not clearly understood whether IC/PBS represents a systemic disease, if it is localized in the bladder, or if it was initially localized in the bladder and it later evolved into a systemic disease. This condition is best managed by using a multidisciplinary approach. Management requires a good integration and knowledge of all pelvic organ systems and other systems including musculoskeletal, neurologic, and psychiatric systems. PMID:20968203

Persu, C; Cauni, V; Gutue, S; Blaj, Irina; Jinga, V; Geavlete, P

2010-01-01

276

Pain detector joint effort near testing The pain-measuring device could help communicate what level of pain a chronic sufferer is in to  

E-print Network

Science Pain detector joint effort near testing The pain-measuring device could help communicate what level of pain a chronic sufferer is in to better tailor treatments. Story by: Ikenna Oguguo of building a pain detector which would quantify the difference between what patients describe as "a little

Chiao, Jung-Chih

277

Effects of Pain Acceptance and Pain Control Strategies on Physical Impairment in Individuals with Chronic Low Back Pain  

ERIC Educational Resources Information Center

Psychosocial treatments for chronic pain are effective. There is a need, however, to understand the processes involved in determining how these treatments contribute to behavior change. Control and acceptance strategies represent two potentially important processes involved in treatment, although they differ significantly in approach. Results from…

Vowles, Kevin E.; McNeil, Daniel W.; Gross, Richard T.; McDaniel, Michael L.; Mouse, Angela; Bates, Mick; Gallimore, Paula; McCall, Cindy

2007-01-01

278

Chronic pain management in the active-duty military  

NASA Astrophysics Data System (ADS)

As in the general population, chronic pain is a prevalent and burdensome affliction in active-duty military personnel. Painful conditions in military members can be categorized broadly in terms of whether they arise directly from combat injuries (gunshot, fragmentation wound, blast impact) or whether they result from non-combat injuries (sprains, herniated discs, motor vehicle accidents). Both combat-related and non-combat-related causes of pain can further be classified as either acute or chronic. Here we discuss the state of pain management as it relates to the military population in both deployed and non-deployed settings. The term non-battle injury (NBI) is commonly used to refer to those conditions not directly associated with the combat actions of war. In the history of warfare, NBI have far outstripped battle-related injuries in terms not only of morbidity, but also mortality. It was not until improvements in health care and field medicine were applied in World War I that battle-related deaths finally outnumbered those attributed to disease and pestilence. However, NBI have been the leading cause of morbidity and hospital admission in every major conflict since the Korean War. Pain remains a leading cause of presentation to military medical facilities, both in and out of theater. The absence of pain services is associated with a low return-to-duty rate among the deployed population. The most common pain complaints involve the low-back and neck, and studies have suggested that earlier treatment is associated with more significant improvement and a higher return to duty rate. It is recognized that military medicine is often at the forefront of medical innovation, and that many fields of medicine have reaped benefit from the conduct of war.

Jamison, David; Cohen, Steven P.

2012-06-01

279

[Imaging of chronic hip pain in adults].  

PubMed

Adult hip pathologies are mainly represented by the degenerative disease, so called "osteoarthrosis, or more precisely coxarthrosis". The means of imaging are exposed, according to their specific value: X Rays (measurement of the characteristic angles of the adult hip), Arthrography, CT Scanner, Arthro-CT Scanner, MRI, Bone Scintigraphy, Ultrasonography. Clinical findings differentiate a mechanical syndrome and an inflammatory syndrome. The coxarthrosis is the most frequent, under two forms: primary (idiopathic) coxarthrosis and secondary coxarthrosis. Primary (idiopathic) coxarthrosis has a localised narrowing of the joint space, osteophyte formation, subchondral sclerosis, cyst formation. The destruction progresses slowly, in 10 to 15 years leading to a complete destruction. Bilaterality is frequent. it is treated with total hip prosthesis. There is a rapid form (1 to 2 years) (Postel's Disease). Secondary coxarthrosis occurs after architectural vice, chondral diseases, lack of balance between the size of the head and the acetabulum as in the case of previous fracture or dislocation, avascular bone necrosis of the head of the femur, Paget's disease. Calcium pyrophosphate Deposition disease (CPPD) involves mostly aged women, and also leads to cox-arthrosis. Avascular bone necrosis of the head of the femur involves young adults. Bilateral involvement are frequent. MRI is the most sensitive and the most specific means of early diagnosis, The area of bone necrosis appears as well defined modifications of the upper head of the femur, precisely surrounded by a low signal intensity line on both Ti and T2 weighted imaging. MRI shows articular effusion, bone marrow edema. Scintigraphy gives early findings which are a characteristic, but non specific, hot spot. CT scanner is used for hip destruction evaluation. o Algodystrophy: transient osteoporosis of the hip has a cyclic course, lasting 3 to 9 months. MRI shows an inflammatory pattern in the area of the process(dark in Ti and white in T2, with positive Gadolinium response). Scintigraphy is positive. Staphylococcus location in the hip can be acute or chronic. MRI shows joint effusion, cystic formation and subchondral non specific modifications. Tuberculosis of the hip joint is relatively rare. Greater trochanteric tuberculous involvement is possible under special contexts. Chronic Inflammatory diseases are represented by Rheumatoid Arthritis, Spondylarthritis and other chronic inflammatory diseases. Synovial tumors such as Pigmented Villo Nodular Synovitis, Primary Osteochondromatosis, synovial sarcoma have special presentations. The subchondral bone can be involved by amorphous depositions such as in tophaceous gout, different varieties of lipidosis, amyloidosis, reticulo histiocytosis. Pen arthropathies are enthesopathies in the anterior rectus tendon, calcifying tendonitis (not to be confused with calcifying soft tissue tumor/chondrosarcoma). The pelvis bone and the femur are involved by primary and secondary tumors or by insufficiency fractures which can mislead to hip pathologies. PMID:10930882

Chevrot, A; Drapé, J; Godefroy, D; Dupont, A

2000-03-01

280

Measuring parent beliefs about child acceptance of pain: a preliminary validation of the Chronic Pain Acceptance Questionnaire, parent report.  

PubMed

Parent perceptions of and responses to pain have been identified as important factors in understanding pain-related disability among children and adolescents with chronic pain. The ability to accept chronic pain rather than focus on ways to avoid or control it has been linked to positive outcomes in chronic pain research. To examine parent beliefs about child acceptance of pain, the Chronic Pain Acceptance Questionnaire, parent report (CPAQ-P), was developed and administered to 195 parents of children with persistent pain evaluated in a multidisciplinary pain clinic. Analyses support the internal consistency of the CPAQ-P (?=.89) and 1-month stability estimates were acceptable for the total scale score (?=.72), and results suggest some responsivity to change. Exploratory factor analysis identified a 2-factor model with 4 items removed from the original 20-item measure. Confirmatory factor analysis strongly supported the modified version. For construct validity, parent beliefs about child acceptance were negatively correlated with parent pain catastrophizing and parent fear of pain. Greater acceptance was also negatively associated with protective parent responses to pain. These results support the CPAQ-P as a promising measure for assessing parent beliefs about child acceptance of pain and reinforce the importance of the social context and parental influence on child functioning. PMID:21783324

Simons, Laura E; Sieberg, Christine B; Kaczynski, Karen J

2011-10-01

281

Systematic review of dexketoprofen in acute and chronic pain  

PubMed Central

Background Dexketoprofen, an NSAID used in the management of acute and chronic pains, is licensed in several countries but has not previously been the subjected of a systematic review. We used published and unpublished information from randomised clinical trials (RCTs) of dexketoprofen in painful conditions to assess evidence on efficacy and harm. Methods PubMed and Cochrane Central were searched for RCTs of dexketoprofen for pain of any aetiology. Reference lists of retrieved articles and reviews were also searched. Menarini Group produced copies of published and unpublished studies (clinical trial reports). Data were abstracted into a standard form. For studies reporting results of single dose administration, the number of patients with at least 50% pain relief was derived and used to calculate the relative benefit (RB) and number-needed-to-treat (NNT) for one patient to achieve at least 50% pain relief compared with placebo. Results Thirty-five trials were found in acute pain and chronic pain; 6,380 patients were included, 3,381 receiving dexketoprofen. Information from 16 trials (almost half the total patients) was obtained from clinical trial reports from previously unpublished trials or abstracts. Almost all of the trials were of short duration in acute conditions or recent onset pain. All 12 randomised trials that compared dexketoprofen (any dose) with placebo found dexketoprofen to be statistically superior. Five trials in postoperative pain yielded NNTs for 12.5 mg dexketoprofen of 3.5 (2.7 to 4.9), 25 mg dexketoprofen of 3.0 (2.4 to 3.9), and 50 mg dexketoprofen of 2.1 (1.5 to 3.5). In 29/30 active comparator trials, dexketoprofen at the dose used was at least equivalent in efficacy to comparator drugs. Adverse event withdrawal rates were low in postoperative pain and somewhat higher in trials of longer duration; no serious adverse events were reported. Conclusion Dexketoprofen was at least as effective as other NSAIDs and paracetamol/opioid combinations. While adverse event withdrawal was not different between dexketoprofen and comparator analgesics, the different conditions and comparators studies precluded any formal analysis. Exposure was limited, and no conclusions could be drawn about safety in terms of serious adverse events like gastrointestinal bleeding or cardiovascular events. PMID:18976451

Moore, R Andrew; Barden, Jodie

2008-01-01

282

Chronic Pain in a Couples Context: A Review and Integration of Theoretical Models and Empirical Evidence  

PubMed Central

Researchers have become increasingly interested in the social context of chronic pain conditions. The purpose of this article is to provide an integrated review of the evidence linking marital functioning with chronic pain outcomes including pain severity, physical disability, pain behaviors, and psychological distress. We first present an overview of existing models that identify an association between marital functioning and pain variables. We then review the empirical evidence for a relationship between pain variables and several marital functioning variables including marital satisfaction, spousal support, spouse responses to pain, and marital interaction. On the basis of the evidence, we present a working model of marital and pain variables, identify gaps in the literature, and offer recommendations for research and clinical work. Perspective The authors provide a comprehensive review of the relationships between marital functioning and chronic pain variables to advance future research and help treatment providers understand marital processes in chronic pain. PMID:16750794

Leonard, Michelle T.; Cano, Annmarie; Johansen, Ayna B.

2007-01-01

283

Psychologic and Psychosocial Factors Contributing to Chronic Pain  

Microsoft Academic Search

This article explores psychologic and psychosocial factors contributing to chronic pain including depression, seasonal affective\\u000a disorder, anxiety, posttraumatic stress disorder, and anger.Also included are alexithymia and somatothymia, which are perhaps\\u000a less easily identified but can have a negative impact on treatment outcome. Psychosocial factors such as family influence\\u000a and litigation or compensation are also reviewed.

Janice M. Livengood

1999-01-01

284

Perceived Early Childhood Family Influence, Perceived Pain Self-Efficacy, and Chronic Pain Disability: An Exploratory Study  

ERIC Educational Resources Information Center

Chronic pain is an exponentially increasing issue for aging adults in the United States and has stretched the limits of technology and the ability of health care professionals to provide adequate care. Chronic pain deprives individuals of their independence, confidence, quality of life, and often their primary support groups while leaving them…

Walker, Kate R. M.; Watts, Richard E.

2009-01-01

285

The relationship between PTSD and chronic pain: mediating role of coping strategies and depression.  

PubMed

People with chronic pain and comorbid posttraumatic stress disorder (PTSD) report more severe pain and poorer quality of life than those with chronic pain alone. This study evaluated the extent to which associations between PTSD and chronic pain interference and severity are mediated by pain-related coping strategies and depressive symptoms. Veterans with chronic pain were divided into 2 groups, those with (n=65) and those without (n=136) concurrent PTSD. All participants completed measures of pain severity, interference, emotional functioning, and coping strategies. Those with current PTSD reported significantly greater pain severity and pain interference, had more symptoms of depression, and were more likely to meet diagnostic criteria for a current alcohol or substance use disorder (all p-values <.01). Participants with PTSD reported more use of several coping strategies, including guarding, resting, relaxation, exercise/stretching, and coping self-statements. Illness-focused pain coping (i.e., guarding, resting, and asking for assistance) and depressive symptoms jointly mediated the relationship between PTSD and both pain interference (total indirect effect=0.194, p<.001) and pain severity (total indirect effect=0.153, p=.004). Illness-focused pain coping also evidenced specific mediating effects, independent of depression. In summary, specific pain coping strategies and depressive symptoms partially mediated the relationship between PTSD and both pain interference and severity. Future research should examine whether changes in types of coping strategies after targeted treatments predict improvements in pain-related function for chronic pain patients with concurrent PTSD. PMID:23398939

Morasco, Benjamin J; Lovejoy, Travis I; Lu, Mary; Turk, Dennis C; Lewis, Lynsey; Dobscha, Steven K

2013-04-01

286

Can attitudes of stoicism and cautiousness explain observed age-related variation in levels of self-rated pain, mood disturbance and functional interference in chronic pain patients?  

Microsoft Academic Search

The aims of the present study were (a) to examine the relationship between age, attitudes and self-reported pain and suffering in a sample of chronic pain patients and (b) to determine the extent to which attitudes of stoicism and cautiousness might mediate between age and chronic pain experience. Psychometric measures were administered to 338 chronic pain patients. The results indicate

Hua-Hie Yong

2006-01-01

287

Sodium Hydrosulfide Relieves Neuropathic Pain in Chronic Constriction Injured Rats  

PubMed Central

Aberrant neuronal activity in injured peripheral nerves is believed to be an important factor in the development of neuropathic pain (NPP). Channel protein pCREB of that activity has been shown to mitigate the onset of associated molecular events in the nervous system, and sodium hydrosulfide (NaHS) could inhibit the expression of pCREB. However, whether NaHS could relieve the pain, it needs further experimental research. Furthermore, the clinical potential that NaHS was used to relieve pain was limited so it would be required. To address these issues, the rats of sciatic nerve chronic constriction injury (CCI) were given intraperitoneal injection of NaHS containing hydrogen sulfide (H2S). The experimental results showed that NaHS inhibited the reduction of paw withdrawal thermal latency (PWTL), mechanical withdrawal threshold (MWT), and the level of pCREB in CCI rats in a dose-dependent manner and they were greatly decreased in NaHSM group (P < 0.05). NaHS alleviates chronic neuropathic pain by inhibiting expression of pCREB in the spinal cord of Sprague-Dawley rats. PMID:25506383

Lin, Jian-qing; Luo, Hui-qin; Lin, Cai-zhu; Chen, Jin-zhuan; Lin, Xian-zhong

2014-01-01

288

Fibronectin Inhibits Chronic Pain Development after Spinal Cord Injury  

PubMed Central

Abstract Chronic pain following spinal cord injury (SCI) is a highly prevalent clinical condition that is difficult to treat. Using both von Frey filaments and radiant infrared heat to assess mechanical allodynia and thermal hyperalgesia, respectively, we have demonstrated that a one-time injection of fibronectin (50??g/mL) into the spinal dorsal column (1??L/min each injection for a total of 5??L) immediately after SCI inhibits the development of mechanical allodynia (but not thermal hyperalgesia) over an 8-month observation period following spinal cord dorsal column crush (DCC). DCC will only induce mechanical Allodynia, but not thermal hyperalgesia or overt motor deficits. By applying various fibronectin fragments as well as competitive inhibitors, these effects were shown to be dependent on the connecting segment-1 (CS-1) motif of fibronectin. Furthermore, we found that acute fibronectin treatment diminished inflammation and blood–spinal cord barrier permeability, which in turn leads to enhanced fiber sparing and sprouting. In particular, the reduction of serotonin (5-HT) in the superficial dorsal horn, an important descending brainstem system in the modulation of pain, was blocked with fibronectin treatment. We conclude that treatment of SCI with fibronectin preserves sensory regulation and prevents the development of chronic allodynia, providing a potential therapeutic intervention to treat chronic pain following SCI. PMID:22022865

Lee, Yu-Shang; Lin, Vernon W.; Silver, Jerry

2012-01-01

289

Effect of Ilioinguinal Neurectomy on Chronic Pain following Herniorrhaphy  

PubMed Central

Background Inguinal hernia is one of the most common male diseases all over the world with an incidence rate of 18-24% throughout life. Chronic inguinal pain is one of the complications that prolong return to work time. Objectives The main aim of this study was to determine the effect of ilioinguinal neurectomy on postoperative chronic pain (PCP) in patients that underwent open inguinal hernia repair via the Lichtenstein method. Materials and Methods In this randomised controlled clinical trial, male patients with unilateral inguinal hernia were randomized into two groups: 74 cases in the preserved-nerve group and 66 cases in the nerve-excised group. The method of herniorrhaphy was the classic Lichtenstein method. Pain and numbness were evaluated at 1 day, 1 week, 1 month, 6 months and 1 year after surgery via visual analogue scale (VAS) system. We used SPSS ver.16 for analysis. Results All patients were male with mean age of 39.1 years (with a range of 18 to 68 years). The follow-up rate was 100% after 1 year. Pain severity was significantly lower in nerve-excised patients at 1 day, 1week, 1 month and 6 months after surgery; but it was not significant after one year, although overall pain severity was low. Numbness was significantly higher in excised patients at all endpoints (1 day, 1month, 3 months, 6 months and one year after surgery). Conclusions Ilioinguinal nerve excision at the time of inguinal hernia repair decreased post-surgical inguinal pain, and it can be used as a routine method in herniorrhaphy. PMID:24350117

Khoshmohabat, Hadi; Panahi, Farzad; Alvandi, Ali Akbar; Mehrvarz, Shaban; Mohebi, Hasan Ali; Shams Koushki, Ehsan

2012-01-01

290

Effects of chronic widespread pain on the health status and quality of life of women after breast cancer surgery  

Microsoft Academic Search

BACKGROUND: Most research and treatment of post-breast cancer chronic pain has focused on local or regional pain problems in the operated area. The purpose of this pilot study was to compare and contrast the pain characteristics, symptom impact, health status, and quality of life of post-breast cancer surgery women with regional chronic pain versus those with widespread chronic pain. METHODS:

Carol S Burckhardt; Kim D Jones

2005-01-01

291

Chronic pain patients are impaired on an emotional decision-making task A. Vania Apkariana,*, Yamaya Sosaa  

E-print Network

pain. Chronic back pain (CBP) patients, chronic complex regional pain syndrome (CRPS) patientsChronic pain patients are impaired on an emotional decision-making task A. Vania Apkariana pain can result in anxiety, depression and reduced quality of life. However, its effects on cognitive

Chialvo, Dante R.

292

Sex differences in the stability of conditioned pain modulation (CPM) among patients with chronic pain  

PubMed Central

Objectives To examine the temporal stability of conditioned pain modulation (CPM), formerly termed diffuse noxious inhibitory controls (DNIC), among a sample of patients with chronic pain. The study also examined the factors that might be responsible for the stability of CPM. Design & subjects, and methods In this test-retest study, patients underwent a series of standardized psychophysical pain testing procedures designed to assess CPM on two separate occasions (i.e., baseline, follow-up). Patients also completed self-report measures of catastrophizing (PCS) and negative affect (NA). Results Overall, results provided evidence for the stability of CPM among patients with chronic pain. Results, however, revealed considerable sex differences in the stability of CPM. For women, results revealed a significant test-retest correlation between baseline and follow-up CPM scores. For men, however, the test-retest correlation between baseline and follow-up CPM scores was not significant. Results of a Fisher’s Z-test revealed that the stability of CPM was significantly greater for women than for men. Follow-up analyses revealed that the difference between men and women in the stability of CPM could not be accounted for by any demographic (e.g., age) and/or psychologic factors (PCS, NA). Conclusions Our findings suggest that CPM paradigms possess sufficient reliability to be incorporated into bedside clinical evaluation of patients with chronic pain, but only among women. The lack of CPM reproducibility/stability observed among men places limits on the potential use of CPM paradigms in clinical settings for the assessment of men’s endogenous pain-inhibitory function. PMID:23924369

Martel, MO; Wasan, AD; Edwards, RR

2013-01-01

293

Associations between serotonin transporter gene polymorphisms and heat pain perception in adults with chronic pain  

PubMed Central

Background The triallelic serotonin transporter gene linked polymorphic region (5-HTTLPR) has been associated with alterations in thermal pain perception. The primary aim of this study was to investigate the associations between heat pain (HP) perception and the triallelic 5-HTTLPR in a large cohort of adults with chronic pain. Methods The cohort included 277 adults with chronic pain who met inclusion criteria, and were consecutively admitted to an outpatient pain rehabilitation program from March 2009 through March 2010. Individuals were genotyped for the triallelic 5-HTTLPR (including rs25531) and categorized as high, intermediate, or low expressors of the serotonin transporter. Standardized measures of HP perception were obtained using a validated quantitative sensory test method of levels. Results The distribution of the high, intermediate, and low expressing genotypes was 61 (22%), 149 (54%) and 67 (24%), respectively. The Hardy-Weinberg P-value was 0.204 which indicated no departure from equilibrium. A significant effect of genotype was observed for values of HP threshold (P?=?0.029). Individual group comparisons showed that values of HP threshold were significantly greater in the intermediate compared to the high expressing group (P?=?0.009) but not the low expressing group (P?>?0.1). In a multiple variable linear regression model, the intermediate group (P?=?0.034) and male sex (P?=?0.021) were associated with significantly greater values of HP 0.5, but no significant genotype-by-sex interaction effect was observed. Conclusions In this study that involved adults with chronic pain, the intermediate triallelic 5-HTTLPR expressing group, but not the low expressing group, was associated with greater HP thresholds compared to the high expressing group. PMID:23895108

2013-01-01

294

Chronic Back Pain Patients Show Differences in Behavior and Brain Activity During a Loss-Aversion Gambling Task  

E-print Network

Chronic Back Pain Patients Show Differences in Behavior and Brain Activity During a Loss with chronic back pain. Additionally, many labs have observed that people with a variety of chronic pain with chronic back pain. We then correlate these scores to participants' resting state data obtained on the same

Apkarian, A. Vania

295

Evaluation of chronic pelvic pain syndrome in men: Is it chronic prostatitis?  

Microsoft Academic Search

Chronic prostatitis\\/chronic pelvic pain syndrome (CP\\/CPPS) is not well understood. The mechanisms involved in its pathophysiology\\u000a have yet to be fully elucidated. Men with CP\\/CPPS suffer from symptoms that may not necessarily be linked to concurrent prostate\\u000a involvement. Recent literature embraces the notion that symptoms may result from complex interactions, and studies have looked\\u000a at other disease syndromes in an

Raymond M. Bernal; Michel A. Pontari

2009-01-01

296

[Complex regional pain syndrome versus chronic regional pain syndrome (Hand-Finger Syndrome)].  

PubMed

Dystrophy is a main factor of CRPS. A large number of patients do not develop dystrophy but, instead, they suffer from pain with limitation in movement, possible paraesthesia and/or swelling. This is then a chronic regional pain syndrome or (shoulder-arm-) hand-finger syndrome. These patients should never be confronted with the diagnosis Morbus Sudeck or algodystrophy, which are today also well known among non-professionals, to avoid pushing them into a status of constant severe invalidity. Histories, clinical examination, as well as a good personal understanding of the patient are indispensable. Knowing that pain, or the extent of pain, remains subjective until today, the clinical diagnosis depends on the absence of side differences in: a) the circumference of soft tissues of both upper extremities; b) the callosity of the palm; c) the bone-density. These three parameters allow verification of the consequences of the pain complaints (indirect pain verification). It is essential to find the cause for their suffering and to treat it as far as possible: 1) Too long and inappropriate immobilisation (patient's suffering not considered sufficiently). These patients can recover quickly when the right diagnosis is made in good time. 2) Limitation of movement due to scar, neuroma, or elongation pain: a) bizarre functional disabilities can develop; b) due to the patient's complaints, one or several operations would finally be performed, which will not lead to an improvement but rather to an aggravation of the pain; c) socially-induced purposeful pain increase, the typical statement of the patient will be: "I can't stand it any longer". Patients who are socially over-burdened, or have psycho-social problems, may experience a decline of performance or a post-traumatic stress disorder. Several patients will be introduced as illustrations for each of the relevant groups. PMID:20205065

Wulle, C

2010-02-01

297

Ovarian hormones and chronic pain: A comprehensive review.  

PubMed

Most chronic noncancer pain (CNCP) conditions are more common in women and have been reported to worsen, particularly during the peak reproductive years. This phenomenon suggests that ovarian hormones might play a role in modulating CNCP pain. To this end, we reviewed human literature aiming to assess the potential role of ovarian hormones in modulating the following CNCP conditions: musculoskeletal pain, migraine headache, temporal mandibular disorder, and pelvic pain. We found 50 relevant clinical studies, the majority of which demonstrated a correlation between hormone changes or treatments and pain intensity, threshold, or symptoms. Taken together, the findings suggest that changes in hormonal levels may well play a role in modulating the severity of CNCP conditions. However, the lack of consistency in study design, methodology, and interpretation of menstrual cycle phases impedes comparison between the studies. Thus, while the literature is highly suggestive of the role of ovarian hormones in modulating CNCP conditions, serious confounds impede a definitive understanding for most conditions except menstrual migraine and endometriosis. It may be that these inconsistencies and the resulting lack of clarity have contributed to the failure of hormonal effects being translated into medical practice for treatment of CNCP conditions. PMID:25172822

Hassan, Samah; Muere, Abi; Einstein, Gillian

2014-12-01

298

Reasons for opioid use among patients with dependence on prescription opioids: the role of chronic pain.  

PubMed

The number of individuals seeking treatment for prescription opioid dependence has increased dramatically, fostering a need for research on this population. The aim of this study was to examine reasons for prescription opioid use among 653 participants with and without chronic pain, enrolled in the Prescription Opioid Addiction Treatment Study, a randomized controlled trial of treatment for prescription opioid dependence. Participants identified initial and current reasons for opioid use. Participants with chronic pain were more likely to report pain as their primary initial reason for use; avoiding withdrawal was rated as the most important reason for current use in both groups. Participants with chronic pain rated using opioids to cope with physical pain as more important, and using opioids in response to social interactions and craving as less important, than those without chronic pain. Results highlight the importance of physical pain as a reason for opioid use among patients with chronic pain. PMID:24814051

Weiss, Roger D; Potter, Jennifer Sharpe; Griffin, Margaret L; McHugh, R Kathryn; Haller, Deborah; Jacobs, Petra; Gardin, John; Fischer, Dan; Rosen, Kristen D

2014-08-01

299

Predictive Factors of Chronic Pediatric Pain and Disability: A Delphi Poll  

Microsoft Academic Search

The purpose of this study was to establish consensus on the factors that predict chronic pediatric pain and pain-related disability. A Delphi poll involving 2 rounds of data collection was used as a way to reach consensus among professionals with a specific interest in chronic pain in children and adolescents. Factors that had the greatest influence on long-term maintenance of

Jordi Miró; Anna Huguet; Rubén Nieto

2007-01-01

300

Chronic pain and parent–child relations in later life: An important, but understudied issue  

Microsoft Academic Search

Chronic pain is a debilitating and pervasive health problem, particularly among older adults. Researchers and clinicians acknowledge that pain conditions do not occur in isolation, but rather exact a toll on the individual sufferer and the family system at large. No research, however, has explicitly explored the impact of older parents' chronic pain symptoms on their adult children. In this

Catherine Riffin; J. Jill Suitor; M. C. Reid; Karl Pillemer

2012-01-01

301

Predictive Factors of Chronic Pediatric Pain and Disability: A Delphi Poll  

Microsoft Academic Search

The purpose of this study was to establish consensus on the factors that predict chronic pediatric pain and pain-related disability. A Delphi poll involving 2 rounds of data collection was used as a way to reach consensus among professionals with a specific interest in chronic pain in children and adolescents. Factors that had the greatest influence on long-term maintenance of

Jordi Miró; Anna Huguet; Rubén Nieto

302

Pain in Chronic Pancreatitis: A Salutogenic Mechanism or a Maladaptive Brain Response?  

Microsoft Academic Search

Pain in chronic pancreatitis is frequently refractory to medical and even surgical treatment. This refractoriness leads us to believe that a pancreas-independent, brain-mediated mechanism must be responsible. If so, several scenarios are worth considering. First, chronic pain could be the consequence of undesirable neuroplastic changes, by which pathology becomes established and causes disability. Alternatively, pain may be linked to the

Felipe Fregni; Alvaro Pascual-Leone; Steven D. Freedman

2007-01-01

303

Managing Chronic Pain in People with Learning Disabilities: A Case Study  

ERIC Educational Resources Information Center

Chronic pain is a prevalent, under-diagnosed problem in the learning disability population. This is in part due to communication problems, unrecognized pain behaviours and the effects of medication. As a consequence, chronic pain often goes untreated and causes ongoing distress. This paper initially describes the main research that has been…

Lewis, Sarah; Bell, Dorothy; Gillanders, David

2007-01-01

304

The Effects of Psychosocial Factors on Quality of Life among Individuals with Chronic Pain  

ERIC Educational Resources Information Center

This study investigated the psychosocial factors affecting the quality of life (QOL) of 171 individuals with chronic pain. Participants completed a battery of self-rated inventories measuring three sets of predictor variables--demographic (age, gender, income, marital status), pain-specific (chronicity, severity, duration, frequency, pain

Lee, Gloria K.; Chronister, Julie; Bishop, Malachy

2008-01-01

305

The role of psychological variables in explaining depression in older people with chronic pain  

Microsoft Academic Search

Objectives: Depression is commonly associated with chronic pain, and is also a common condition in the elderly. However research in the area of depression and pain is scarce. The aim of the present work was to analyse how cognitive–behavioural and perceptual variables help to explain the presence or absence of depression in older people with chronic pain caused by osteoarthritis.Method:

Almudena López-López; Ignacio Montorio; María Izal; Lilian Velasco

2008-01-01

306

Risk Factor Assessment for Problematic Use of Opioids for Chronic Pain  

Microsoft Academic Search

Opioid analgesics provide effective treatment for noncancer pain, but many health providers have concerns about cognitive effects, tolerance, dependence, and addiction. Misuse of opioids is prominent in patients with chronic pain and early recognition of misuse risk could help providers offer adequate patient care while implementing appropriate levels of monitoring to reduce aberrant drug-related behaviors. Many persons with chronic pain

Robert N. Jamison; Robert R. Edwards

2012-01-01

307

Mediators of change in Acceptance and Commitment Therapy for pediatric chronic pain  

Microsoft Academic Search

Even though psychological interventions are well established in the treatment of pediatric chronic pain, there is a clear need for further development, especially with severely disabled patients. However, optimizing effectiveness in psychological treatments for pain requires clarification of the mechanisms of action. Studies addressing change processes are scarce, however, particularly in relation to pediatric chronic pain. Acceptance and Commitment Therapy

Rikard K. Wicksell; Gunnar L. Olsson; Steven C. Hayes

2011-01-01

308

PREVALENCE OF CHRONIC PAIN WITH NEUROPATHIC CHARACTERISTICS IN THE GENERAL POPULATION  

E-print Network

PREVALENCE OF CHRONIC PAIN WITH NEUROPATHIC CHARACTERISTICS IN THE GENERAL POPULATION Didier.pain.2007.08.013 #12; ABSTRACT We conducted a large nationwide postal survey to estimate the prevalence returned and 23,712 (96.8%) could be assessed. 7,522 respondents reported chronic pain (prevalence =31

Paris-Sud XI, Université de

309

Effectiveness of Massage Therapy for Chronic, NonMalignant Pain: A Review  

Microsoft Academic Search

Previous reviews of massage therapy for chronic, non-malignant pain have focused on discrete pain conditions. This article aims to provide a broad overview of the literature on the effectiveness of massage for a variety of chronic, non-malignant pain complaints to identify gaps in the research and to inform future clinical trials. Computerized databases were searched for relevant studies including prior

Jennie C. I. Tsao

2007-01-01

310

Sustained Effectiveness of 10?kHz High-Frequency Spinal Cord Stimulation for Patients with Chronic, Low Back Pain: 24-Month Results of a Prospective Multicenter Study  

PubMed Central

Objective The aim of this study was to investigate the long-term efficacy and safety of paresthesia-free high-frequency spinal cord stimulation (HF10 SCS) for the treatment of chronic, intractable pain of the low back and legs. Design Prospective, multicenter, observational study. Method Patients with significant chronic low back pain underwent implantation of a spinal cord stimulator capable of HF10 SCS. Patients' pain ratings, disability, sleep disturbances, opioid use, satisfaction, and adverse events were assessed for 24 months. Results After a trial period, 88% (72 of 82) of patients reported a significant improvement in pain scores and underwent the permanent implantation of the system. Ninety?percent (65 of 72) of patients attended a 24-month follow-up visit. Mean back pain was reduced from 8.4?±?0.1 at baseline to 3.3?±?0.3 at 24 months (P?pain from 5.4?±?0.4 to 2.3?±?0.3 (P?pain relief, there were significant decreases in opioid use, Oswestry Disability Index score, and sleep disturbances. Patients' satisfaction and recommendation ratings were high. Adverse Events were similar in type and frequency to those observed with traditional SCS systems. Conclusions In patients with chronic low back pain, HF10 SCS resulted in clinically significant and sustained back and leg pain relief, functional and sleep improvements, opioid use reduction, and high patient satisfaction. These results support the long-term safety and sustained efficacy of HF10 SCS. PMID:24308759

Al-Kaisy, Adnan; Van Buyten, Jean-Pierre; Smet, Iris; Palmisani, Stefano; Pang, David; Smith, Thomas

2014-01-01

311

Strategies Aimed at Preventing Chronic Post-surgical Pain: Comprehensive Perioperative Pain Management after Total Joint Replacement Surgery  

PubMed Central

ABSTRACT Purpose: Chronic post-surgical pain (CPSP) is a frequent outcome of musculoskeletal surgery. Physiotherapists often treat patients with pain before and after musculoskeletal surgery. The purposes of this paper are (1) to raise awareness of the nature, mechanisms, and significance of CPSP; and (2) to highlight the necessity for an inter-professional team to understand and address its complexity. Using total joint replacement surgeries as a model, we provide a review of pain mechanisms and pain management strategies. Summary of Key Points: By understanding the mechanisms by which pain alters the body's normal physiological responses to surgery, clinicians selectively target pain in post-surgical patients through the use of multi-modal management strategies. Clinicians should not assume that patients receiving multiple medications have a problem with pain. Rather, the modern-day approach is to manage pain using preventive strategies, with the aims of reducing the intensity of acute postoperative pain and minimizing the development of CPSP. Conclusions: The roles of biological, surgical, psychosocial, and patient-related risk factors in the transition to pain chronicity require further investigation if we are to better understand their relationships with pain. Measuring pain intensity and analgesic use is not sufficient. Proper evaluation and management of risk factors for CPSP require inter-professional teams to characterize a patient's experience of postoperative pain and to examine pain arising during functional activities. PMID:22654235

Woodhouse, Linda J.; Kennedy, Deborah; Stratford, Paul; Katz, Joel

2011-01-01

312

Prevalence of chronic axial pain, inflammatory back pain and spondyloarthritis in diagnosed psoriasis.  

PubMed

Objective Psoriasis is a chronic inflammatory disorder affecting 3% of the population. The objective of our study was to provide prevalence estimates for inflammatory back pain (IBP) and spondyloarthritis (SpA) in those subjects with psoriasis using 2009-2010 NHANES data. Methods In the NHANES 2009-2010 sample set, 6,684 persons between 20-69 years of age were screened for participation and 5,103 answered questions regarding onset of back pain, location of pain and functional limitations. Dataset assembly and statistical analysis were performed using SASTM and SUDAAN™. Standard errors were estimated by Taylor series linearization. The equality of the prevalence estimates for selected variables were tested (univariately) at the ?=0.05 level using a 2-sided Student's t statistic with appropriate degrees of freedom. Results 148 persons had self-reported medically diagnosed psoriasis. The psoriasis group, versus the non-psoriasis group, had a significantly higher prevalence of axial pain using the 3-month duration criterion (31.1% vs. 18.9%; p=0.04) and alternating buttock pain (7.2% vs. 2.4%; p=0.03) and met IBP criteria - Berlin 7b and 8a - more frequently (p=0.04, 0.02 respectively). The prevalence of SpA was significantly higher in the psoriasis group versus the non-psoriasis group when using Amor or ESSG criteria (14.3% vs. 1.5%; p<0.001). Sudden-onset of axial pain was significantly higher in the psoriasis group (23.3% vs. 13.0%; p=0.01). Conclusion There is a higher prevalence of lower axial pain, IBP, SpA, and alternating buttock pain associated with a prior diagnosis of psoriasis. This data may influence the way psoriasis patients are approached in primary care and specialty clinics. This article is protected by copyright. All rights reserved. PMID:25469666

Thom, Nicole; Ritchlin, Christopher T; Zhang, Xiao; Reveille, John; Weisman, Michael H

2014-12-01

313

Mechanical pain sensitivity and the severity of chronic neck pain and disability are not modulated across the menstrual cycle  

PubMed Central

Despite the high prevalence of neck pain among women, menstrual effects on regional pain outcomes have not been investigated in this clinical population. This study evaluated menstrual effects on mechanical pain sensitivity (Pressure Pain Threshold; PPT), neck pain intensity (Numeric Pain Rating Scale; NPRS) and neck-related disability (Neck Disability Index; NDI) in 22 normally menstruating (NM) and 17 hormonal contraceptive (HC) users with chronic neck pain. Sex hormones, PPT, and NDI were measured during the early follicular (F1), late follicular (F2), and luteal (L) menstrual phases. Daily NPRS scores were recorded in an online symptom diary and averaged within each phase. Estradiol and progesterone increased only for NM women in F2 and L, respectively. Phase effects on PPT (?2=0.003), NDI (?2=0.003), and NPRS (?2=0.016) for NM women were small, and did not differ from the HC group (p?0.386). Averaged across the menstrual cycle, PPT scores explained 29% of the variance in NPRS scores for NM women, but were not associated with NDI scores in either group. Results indicate that that magnitude of menstrual effects on mechanical pain sensitivity, and the severity of neck pain and disability do not exceed thresholds of clinically detectable change in women with chronic neck pain. PERSPECTIVE Fluctuations in evoked and clinical pain outcomes across the menstrual cycle do not appear to be of sufficient magnitude to impact clinical decision-making for women with chronic neck pain. PMID:24021578

Balter, JE; Molner, JL; Kohrt, WM; Maluf, KS

2013-01-01

314

Topical NSAIDs for chronic musculoskeletal pain in adults  

PubMed Central

Background Non-steroidal anti-inflammatory drugs (NSAIDs) are commonly taken orally, but they are also available in topical preparations to be applied to or rubbed onto the skin of a painful joint, typically one affected by arthritis, with the aim of relieving pain locally. Topical NSAIDs are widely used in some parts of the world for acute and chronic painful conditions, but have not been universally accepted until recently. One of the problems has been that older clinical studies were generally short, lasting four weeks or less, and short duration studies are not regarded as adequate in ongoing painful conditions. Objectives To examine the use of topical NSAIDs in chronic musculoskeletal pain, focusing on studies of high methodological quality, and examining the measured effect of the preparations according to study duration. The principal aim was to estimate treatment efficacy in longer duration studies of at least 8 weeks. Search methods A series of electronic searches, together with bibliographic searches, and searches of in-house databases were combined with electronic searches of clinical trial registers and manufacturers of topical NSAIDs, or companies known to be actively researching topical NSAIDs. There had to be at least 10 participants in each treatment arm, with application of treatment at least once daily. Selection criteria Randomised, double blind studies with placebo or active comparators, where at least one treatment was a topical NSAID product, in any topical formulation (cream, gel, patch, solution), in studies lasting at least two weeks. Data collection and analysis Two review authors independently assessed study quality and validity, and extracted data. Numbers of participants achieving each outcome were used to calculate relative risk (RR) and numbers needed to treat (NNT) or harm (NNH) compared to placebo or other active treatment. Main results Information was available from 7688 participants in 34 studies from 32 publications; 23 studies compared a topical NSAID with placebo. Topical NSAIDs were significantly more effective than placebo for reducing pain due to chronic musculoskeletal conditions. The best data were for topical diclofenac in osteoarthritis, where the NNT for at least 50% pain relief over 8 to 12 weeks compared with placebo was 6.4 for the solution, and 11 for the gel formulation. There were too few data of good quality to calculate NNTs for other individual topical NSAIDs compared with placebo. Direct comparison of topical NSAID with an oral NSAID did not show any difference in efficacy. There was an increase in local adverse events (mostly mild skin reactions) with topical NSAIDs compared with placebo or oral NSAIDs, but no increase in serious adverse events. Gastrointestinal adverse events with topical NSAID did not differ from placebo, but were less frequent than with oral NSAIDs. A substantial amount of data from unpublished studies was unavailable. Much of this probably relates to formulations that have never been marketed. Authors’ conclusions Topical NSAIDs can provide good levels of pain relief; topical diclofenac solution is equivalent to that of oral NSAIDs in knee and hand osteoarthritis, but there is no evidence for other chronic painful conditions. Formulation can influence efficacy. The incidence of local adverse events is increased with topical NSAIDs, but gastrointestinal adverse events are reduced compared with oral NSAIDs. PMID:22972108

Derry, Sheena; Moore, R Andrew; Rabbie, Roy

2014-01-01

315

Perspectives on Yoga Inputs in the Management of Chronic Pain  

PubMed Central

Chronic pain is multi-dimensional. At the physical level itself, beyond the nociceptive pathway, there is hyper arousal state of the components of the nervous system, which negatively influences tension component of the muscles, patterns of breathing, energy levels and mindset, all of which exacerbate the distress and affect the quality of life of the individual and family. Beginning with the physical body, Yoga eventually influences all aspects of the person: vital, mental, emotional, intellectual and spiritual. It offers various levels and approaches to relax, energize, remodel and strengthen body and psyche. The asanas and pranayama harmonize the physiological system and initiate a “relaxation response” in the neuro endocrinal system. This consists of decreased metabolism, quieter breathing, stable blood pressure, reduced muscle tension, lower heart rate and slow brain wave pattern. As the neural discharge pattern gets modulated, hyper arousal of the nervous system and the static load on postural muscle come down. The function of viscera improves with the sense of relaxation and sleep gets deeper and sustained; fatigue diminishes. Several subtle level notional corrections can happen in case the subject meditates and that changes the context of the disease, pain and the meaning of life. Meditation and pranayama, along with relaxing asanas, can help individuals deal with the emotional aspects of chronic pain, reduce anxiety and depression effectively and improve the quality of life perceived. PMID:20859464

Vallath, Nandini

2010-01-01

316

The place of oxycodone/naloxone in chronic pain management  

PubMed Central

Opioid analgesics are usually effective in the management of severe chronic pain. However, symptoms of opioid-induced bowel dysfunction (OIBD) are common during opioid therapy. Opioid-induced bowel dysfunction is often unsuccessfully managed due to limited effectiveness and numerous adverse effects of traditional laxatives. Newer treatment possibilities directed at the pathomechanism of OIBD comprise combined prolonged-release oxycodone with prolonged-release naloxone (oxycodone/naloxone) tablets. Oxycodone/naloxone provides effective analgesia with limited impact on bowel function as oxycodone displays high oral bioavailability and naloxone act as local antagonist on opioid receptors in the gastrointestinal tract due to nearly complete inactivation in the liver. Oxycodone/naloxone is administered to opioid-naive patients with severe pain and those unsuccessfully treated with weak opioids. Oxycodone/naloxone may be also administered to patients treated with strong opioids who experience intense symptoms of OIBD. Studies conducted to date indicate that oxycodone/naloxone is an important drug in chronic pain management, prevention and treatment of OIBD. PMID:23788978

2013-01-01

317

Pain and pressure pain thresholds in adolescents with chronic fatigue syndrome and healthy controls: a cross-sectional study  

PubMed Central

Objectives Although pain is a significant symptom in chronic fatigue syndrome (CFS), pain is poorly understood in adolescents with CFS. The aim of this study was to explore pain distribution and prevalence, pain intensity and its functional interference in everyday life, as well as pressure pain thresholds (PPT) in adolescents with CFS and compare this with a control group of healthy adolescents (HC). Methods This is a case–control, cross-sectional study on pain including 120 adolescents with CFS and 39 HCs, aged 12–18?years. We measured pain frequency, pain severity and pain interference using self-reporting questionnaires. PPT was measured using pressure algometry. Data were collected from March 2010 until October 2012 as part of the Norwegian Study of Chronic Fatigue Syndrome in Adolescents: Pathophysiology and Intervention Trial. Results Adolescents with CFS had significantly lower PPTs compared with HCs (p<0.001). The Pain Severity Score and the Pain Interference Score were significantly higher in adolescents with CFS compared with HCs (p<0.001). Almost all adolescents with CFS experienced headache, abdominal pain and/or pain in muscles and joints. Moreover, in all sites, the pain intensity levels were significantly higher than in HCs (p<0.001). Conclusions We found a higher prevalence of severe pain among adolescents with CFS and lowered pain thresholds compared with HCs. The mechanisms, however, are still obscure. Large longitudinal population surveys are warranted measuring pain thresholds prior to the onset of CFS. Trial registration number Clinical Trials, NCT01040429; The Norwegian Study of Chronic Fatigue Syndrome in Adolescents: Pathophysiology and Intervention Trial (NorCAPITAL) http://www.clinicaltrials.gov. PMID:25287104

Winger, Anette; Kvarstein, Gunnvald; Wyller, Vegard Bruun; Sulheim, Dag; Fagermoen, Even; Småstuen, Milada Cvancarova; Helseth, Sølvi

2014-01-01

318

BOTULINUM TOXIN A INDUCES DIRECT ANALGESIC EFFECTS IN CHRONIC NEUROPATHIC PAIN  

E-print Network

BOTULINUM TOXIN A INDUCES DIRECT ANALGESIC EFFECTS IN CHRONIC NEUROPATHIC PAIN D. Ranoux1 , N. Such mechanism may be involved in peripheral neuropathic pain. Methods: A possible direct analgesic effect of BTX-A pain processing was investigated in 29 patients with focal painful neuropathies and mechanical

Paris-Sud XI, Université de

319

Empirically derived Symptom Checklist 90 subgroups of chronic pain patients: A cluster analysis  

Microsoft Academic Search

Four hundred fifty-three chronic pain patients completed a Symptom Checklist 90 (SCL-90) and a comprehensive pain evaluation questionnaire. All patients were evaluated by a physician and rated on degree of pain pathology and pain behavior. The SCL-90 data were analyzed using two clustering procedures and replicated over two similar samples. Three distinct profiles emerged and represented high, medium, and low

Robert N. Jamison; Daniel L. Rock; Winston C. V. Parris

1988-01-01

320

But the causes of chronic pain aren't always clear."It's a complex  

E-print Network

come in many forms, and it accompanies several conditions including low-back pain, arthritis, cancer skinned knee to the headaches, back pain and creaky joints as we age, pain is something we encounter many with chronic low-back pain might benefit from acupuncture, massage therapy, yoga or cognitive

Bezrukov, Sergey M.

321

Extensive reorganization of primary somatosensory cortex in chronic back pain patients  

Microsoft Academic Search

The hypothesis of reorganization of the primary somatosensory cortex in states of chronic pain was assessed in 10 low back pain patients and nine matched healthy controls. Intracutaneous electric stimuli were applied to the left back and index finger at a standard, a non-painful and a painful intensity. Magnetic fields were recorded by a 37-channel BTi biomagnetometer from the hemisphere

Herta Flor; Christoph Braun; Thomas Elbert; Niels Birbaumer

1997-01-01

322

A Systematic Review of the Prevalence and Measurement of Chronic Pain in Asian Adults.  

PubMed

There are limited epidemiologic studies on chronic pain in Asian populations. The aim of this review was to gather all epidemiologic studies of chronic pain in Asian countries and systematically describe the measurement and prevalence of chronic pain in Asian adults. A systematic review was performed using PubMed, MEDLINE, EMBASE, Psych INFO, Cochrane Database for Systematic Review, and CINAHL. Additional studies were identified manually by searching bibliographies. We identified 19 relevant articles for this review. Most articles used the definition of chronic pain set by the International Association for the Study of Pain. The majority of the articles used simple single-question methods to measure chronic pain. The prevalence of chronic pain among Asian adults ranges from 7.1% (Malaysia) to 61% (Cambodia and Northern Iraq), whereas among the Asian geriatric population, the prevalence is even higher and ranges from 42% to 90.8%. This review showed that there is great variation in the reported prevalence of chronic pain in Asian adults and the prevalence of chronic pain is high among the Asian geriatric population. To measure the distribution of chronic pain in adults, a uniform measurement strategy should be adopted. PMID:25439125

Mohamed Zaki, Lily R; Hairi, Noran N

2014-11-01

323

Intrathecal bupivacaine for head and neck pain  

PubMed Central

Direct central nervous system (CNS) analgesic delivery is a useful option when more traditional means of dealing with chronic pain fail. Solutions containing local anesthetic have been effective in certain disease states, particularly in patients suffering from intractable head and neck pain. This review discusses historical aspects of CNS drug delivery and the role of intrathecal bupivacaine-containing solutions in refractory head and neck pain patients. PMID:22915879

Belverud, Shawn A; Mogilner, Alon Y; Schulder, Michael

2010-01-01

324

Effects of obesity on function and quality of life in chronic pain conditions.  

PubMed

Many people throughout the world have both chronic pain and obesity. Overweight and obese people are more prone to a proinflammatory state manifesting as metabolic syndrome but also to a higher prevalence of chronic pain comorbidities. Obesity and a high body mass index (BMI) are associated with impaired functional capacity and reduced quality of life (QoL) in patients with chronic pain conditions. Systemic inflammation is not only involved in metabolic syndrome but it also initiates and perpetuates chronic pain. Changes in lifestyle, behavior, physical activity, and diet have demonstrated benefits in functional capacity and QoL; therefore, patient assessment should tackle high BMI and metabolic syndrome as part of the treatment of chronic pain. A healthier lifestyle would lead to a lower inflammatory state and consequently to an improvement in function and QoL in overweight or obese patients who have chronic pain conditions. PMID:24264719

Arranz, Laura-Isabel; Rafecas, Magda; Alegre, Cayetano

2014-01-01

325

Oxytocin – A Multifunctional Analgesic for Chronic Deep Tissue Pain  

PubMed Central

The treatment of chronic pain arising from deep tissues is currently inadequate and there is need for new pharmacological agents to provide analgesia. The endogenous paracrine hormone/neurotransmitter oxytocin is intimately involved in the modulation of multiple physiological and psychological functions. Recent experiments have given clear evidence for a role of oxytocin in the modulation of nociception. The present article reviews the existent human and basic science data related to the direct and indirect effects of oxytocin on pain. Due to its analgesic, anxiolytic, antidepressant and other central nervous system effects, there is strong evidence that oxytocin and other drugs acting through the oxytocin receptor could act as multifunctional analgesics with unique therapeutic value. PMID:25345612

Goodin, Burel R.; Ness, Timothy J.; Robbins, Meredith T.

2014-01-01

326

[Pain in chronic pancreatitis and pancreatic cancer - treatment options].  

PubMed

Treatment of pain is one of the main pillars of treatment of pancreatic diseases. Abdominal pain is a common and often debilitating symptom in patients with chronic pancreatitis and pancreatic cancer. Treatment involves abstinence from tobacco, alcohol and analgetics and adjunctive agents. Surgical and endoscopic treatment requires careful patient selection based on a detailed analysis of ductal anatomy. The limited possibilities of this therapy are patients without dilatation of the main pancreatic duct. Results of randomized trials suggest that the effect of surgical treatment is sustained over time and more efficient than the endoscopic treatment. Less frequently used options include EUS - assisted celiac plexus blockade, thoracoscopic splanchniectomia or total pancreatectomy with islet cell autotransplantation. These methods are rarely used when all other options have failed and only in carefully selected patients. PMID:24981695

Bojková, Martina; Klva?a, Pavel; Svoboda, Pavel; Kupka, Tomáš; Martínek, Arnošt; Bojko, Marian; Dít?, Petr

2014-03-01

327

Chronic low back pain patients with accompanying leg pain: the relationship between pain extent and pain intensity, disability and health status.  

PubMed

Accompanying leg pain is commonly observed in patients with chronic low back pain (CLBP) and is assumed to be an indicator for the disorder severity. However, it is still unknown whether it is possible to estimate a patient's functional status by the extent of leg pain present. In a post rehabilitation cohort of 132 patients with CLBP (mean age 44.3 years) the relationship between pain extent and functional status was determined using pain drawings scored for pain extent by a simplified scoring system (Lower Extremity Region: LER) and several function related questionnaires. Primary outcomes were pain extent, pain intensity ratings (Visual Analog Scale: VAS), disability status (Oswestry Disability Index: ODI) and physical and mental health (Short Format 12: SF-12). Statistically significant differences between patients with low (1-2) and high (? 3) LER scores were found in VAS, ODI and SF-12 physical health scores, however, the LER score has a poor diagnostic accuracy in predicting desirable versus undesirable VAS, ODI and SF-12 scores. Pain intensity (VAS), back disability (ODI) and physical health are worse in CLBP patients with high LER scores. However LER scores cannot be used to predict elevated VAS, ODI and SF-12 scores in an individual patient. PMID:23411649

Prins, Maarten R; van der Wurff, Peter; Groen, Gerbrand J

2013-01-01

328

Nerve stimulation for chronic pelvic pain and bladder pain syndrome: a systematic review.  

PubMed

Chronic pelvic pain (CPP) and bladder pain syndrome (BPS) can have a negative impact on quality of life. Neuromodulation has been suggested as a possible treatment for refractory pain. To assess the effectiveness of tibial and sacral nerve stimulation in the treatment of BPS and CPP. We searched until July 2012: the Cochrane Library, EMBASE (1980-2012), Medline (1950-2012), Web of knowledge (1900-2012), LILACS (1982-2012) and SIGLE (1990-2012) with no language restrictions. We manually searched through bibliographies and conference proceedings of the International Continence Society. Randomized and prospective quasi-randomized controlled studies vs. sham nerve stimulation treatment or usual care of patients with CPP and BPS who underwent sacral or tibial nerve stimulation were included. Any studies involving transcutaneous stimulation were excluded. The outcome was a cure or improvement in symptoms. Three studies with 169 patients treated with tibial nerve stimulation were included; two for CPP and one for BPS. There were improvements in pain, urinary and quality of life scores. There were no reported data for sacral nerve stimulation. There is scanty literature reporting variable success of posterior tibial nerve stimulation in improving pain, urinary symptoms and quality of life in CPP and BPS. In view of the dearth of quality literature, a large multi-centered clinical trial investigating the effectiveness of electrical nerve stimulation to treat BPS and CPP along with the cost-analysis of this treatment is recommended. PMID:23710833

Tirlapur, Seema A; Vlismas, Antonis; Ball, Elizabeth; Khan, Khalid S

2013-08-01

329

Acute pain after total hip arthroplasty does not predict the development of chronic postsurgical pain 6 months later  

Microsoft Academic Search

Purpose  Much remains unknown about the relationship between acute postoperative pain and the development of pathologic chronic postsurgical\\u000a pain (CPSP). The purpose of this project was to identify the extent to which maximum pain scores on movement over the first\\u000a two days after total hip arthroplasty predicted the presence of chronic pain 6 months later after controlling for potentially\\u000a important covariates.\\u000a \\u000a \\u000a \\u000a \\u000a Methods  The sample

Hance Clarke; Joseph Kay; Nicholas Mitsakakis; Joel Katz

2010-01-01

330

Too sick for school? Parent influences on school functioning among children with chronic pain  

Microsoft Academic Search

Parental responses to children with chronic pain have been shown to influence the extent of the child’s functional disability, but these associations have not been well-studied in relation to children’s pain-related school functioning. The current study tests the hypothesis that parental pain catastrophizing and parental protective responses to child pain influence the extent of school impairment in children with chronic

Deirdre E. Logan; Laura E. Simons; Elizabeth Carpino

331

Chronic pain-related disability and use of analgesia and health services in a Sydney community  

Microsoft Academic Search

with high levels of pain-related disability in 129\\/439 (27%). Nominated causes of chronic pain were injury in 173 (38%), most commonly sports injury (54; 13%), and a health problem in 132 (29%). Pain was work-related in 62 (14%). A musculoskeletal condition was the leading diagnosis (127; 26%). Of the 474 with chronic pain, 374 (78%) had consulted at least one

Fiona M Blyth; Lyn M March; Michael J Cousins

332

The Chronic Pain Grade questionnaire: validation and reliability in postal research  

Microsoft Academic Search

The Chronic Pain Grade questionnaire has been proposed as an interview-administered, multi-dimensional measure of chronic pain severity in selected populations with chronic pain in the United States of America. It has not previously been tested in the United Kingdom, in self-completion form or in an unselected general population. We undertook a postal survey to assess its reliability, validity and acceptability

Blair H Smith; Kay I Penny; Alison M Purves; Calum Munro; Brenda Wilson; Jeremy Grimshaw; W. Alastair Chambers; W. Cairns Smith

1997-01-01

333

Centering as a Model for Group Visits Among Women with Chronic Pelvic Pain  

PubMed Central

Providing comprehensive care for chronic pelvic pain is impeded by time and resource constraints of the standard healthcare visit. To provide patient education, psychosocial support, and healthcare assessment, we developed group visits for women with chronic pelvic pain using an evidence-based, holistic nursing approach. In this article, we describe the structure of group visits, the process of conducting Centering group visits focused on empowerment, and the content of a holistic curriculum for women with chronic pelvic pain. PMID:22862426

Chao, Maria T.; Abercrombie, Priscilla D.; Duncan, Larissa G.

2012-01-01

334

A Pilot Study of Pain-Related Anxiety and Smoking Dependence Motives Among Persons with Chronic Pain  

PubMed Central

Complex interactions between pain and tobacco smoking have been of increasing interest to researchers and clinicians from a variety of disciplines. There is also recent evidence to suggest that pain-related anxiety may play an important role in the maintenance of tobacco dependence among persons with comorbid pain disorders. The goal of the current study was to evaluate the explanatory relevance of pain-related anxiety in relation to tobacco dependence, among a sample of daily smokers with current chronic pain. Participants were recruited from the general population to complete an online survey that was developed to examine interrelations between chronic pain and tobacco smoking. Approximately 43% of 129 daily smoking respondents met criteria for current chronic pain. Results indicated that pain-related anxiety accounted for a significant portion of the unique variance in total smoking dependence scores, and both primary and secondary dependence composite scores (as measured by the Wisconsin Inventory of Smoking Dependence Motives). Importantly, these effects were observed above and beyond the variance accounted for by relevant sociodemographic factors, generalized anxiety, and pain severity. Pain-related anxiety was observed to be strongly associated with secondary dependence motives, which is consistent with a conceptualization of pain-related anxiety as an instrumental or situational motivator of smoking. These results suggest that tobacco smokers with comorbid pain disorders may be at risk for maintaining or exacerbating their dependence on tobacco, possibly due to individual differences in pain-related anxiety. These findings may help inform the development of tailored interventions for smokers with comorbid chronic pain. PMID:24080021

Ditre, Joseph W.; Zale, Emily L.; Kosiba, Jesse D.; Zvolensky, Michael J.

2014-01-01

335

Capsicum pain plaster in chronic non-specific low back pain.  

PubMed

Topically applied capsaicin (CAS 404-86-4) induces the release of substance P, a neurotransmitter, from sensory C-fibres. In addition, there is a specific blockade of transport and de-novo synthesis of substance P. As a result, repeated applications of capsaicin bring about a long lasting desensitisation to pain (increase of pain threshold). The desensitising effect is fully reversible. The confirmed pharmacodynamic actions and a number of double-blind clinical studies indicate that local capsicum preparations are very suitable for the treatment of neuropathic pain or musculoskeletal disorders, with or without inflammatory components. In a double-blind, randomised parallel-group study a capsicum plaster was compared with a placebo for 3 weeks in 154 patients with non-specific back pain. Inclusion criteria were a history of back pain for a minimum period of 3 months and a degree of pain of 5 or more on an eleven grade visual analogue scale. The principal target variable consisted of the score of 3 combined pain scales. Secondary efficacy measures were tests of mobility, a disability index (in the context of Arhus low back rating scale) and global assessments by physicians and patients. For patients to be rated as responders their total pain score at the final examination after 3 weeks of treatment had to show a reduction by at least 30% of the baseline value. The study unequivocally achieved the target criterion with a rate of responders in the capsicum group of 60.8% against 42.1% in the placebo group (p = 0.0219). The sum of the 3 separate pain scales decreased more markedly in the capsicum group than in the placebo group (38.5% compared to 28.0%; p = 0.002). Relatively slight improvements of the impaired mobility and the functional status are explained by the characteristics of the disorder treated. The efficacy ratings by observers and patients was definitely in favour of capsicum. Adverse effects--mostly harmless and resolving spontaneously--were reported by 15 patients in the capsicum group and by 9 in the placebo group. The tolerance ratings by investigators and patients were superior to the placebo product. This, however, partly is due to the local pharmacological actions of the drug. As in comparably positive randomised studies with capsaicin cream in patients with osteoarthritis or fibromyalgia it was shown that a capsicum plaster preparation can also be used to advantage in chronic non-specific back pain. PMID:11765591

Keitel, W; Frerick, H; Kuhn, U; Schmidt, U; Kuhlmann, M; Bredehorst, A

2001-11-01

336

Early maladaptive schemas in Finnish adult chronic pain patients and a control sample.  

PubMed

Engel (1959) suggested that negative physical or emotional experiences in childhood predispose to the development of chronic pain. Studies have shown that physical and sexual abuse in early life is connected with chronic pain. Emotional adversities are much less studied causes contributing to the development of chronic pain and disability. Early emotional abuse, neglect, maltreatment and other adversities are deleterious childhood experiences which, according to Young's schema theory (1990), produce early maladaptive schemas (EMSs). The primary goal of this study was to examine whether early adversities were more common in chronic pain patients than in a control group. A total of 271 (53% women) first-visit chronic pain patients and 331 (86% women) control participants took part in the study. Their socio-demographic data, pain variables and pain disability were measured. To estimate EMSs the Young Schema Questionnaire was used. Chronic pain patients scored higher EMSs reflecting incapacity to perform independently, catastrophic beliefs and pessimism. The most severely disabled chronic pain patients showed an increase in all the EMSs in the Disconnection and Rejection schema domain, namely Abandonment/Instability, Mistrust/Abuse, Emotional Deprivation, Defectiveness/Shame and Social Isolation/Alienation EMSs. The results of the study suggested that chronic pain patients had suffered early emotional maltreatment. PMID:21054422

Saariaho, Tom Harri; Saariaho, Anita Sylvia; Karila, Irma Anneli; Joukamaa, Matti I

2011-04-01

337

Pain epidemiology and health related quality of life in chronic non-malignant pain patients referred to a Danish multidisciplinary pain center  

Microsoft Academic Search

This paper presents the results of a detailed study of the pain epidemiology and health related quality of life (HRQL) in 150 chronic non-malignant pain patients consecutively referred to a Danish multidisciplinary pain center. Mean pain severity was 71.6 (SD=18.5) on the VAS scale. Forty-two percent reported poor quality of sleep. HRQL was evaluated with the Medical Outcome Study-Short Form

Niels Becker; Annemarie Bondegaard Thomsen; Alf Kornelius Olsen; Per Sjøgren; Per Bech; Jørgen Eriksen

1997-01-01

338

Decreased motivation during chronic pain requires long-term depression in the nucleus accumbens  

PubMed Central

Several symptoms associated with chronic pain, including fatigue and depression, are characterized by reduced motivation to initiate or complete goal-directed tasks. However, it is unknown whether maladaptive modifications in neural circuits that regulate motivation occur during chronic pain. Here, we demonstrate that the decreased motivation elicited in mice by two different models of chronic pain requires a galanin receptor 1–triggered depression of excitatory synaptic transmission in indirect pathway nucleus accumbens medium spiny neurons. These results demonstrate a previously unknown pathological adaption in a key node of motivational neural circuitry that is required for one of the major sequela of chronic pain states and syndromes. PMID:25082697

Schwartz, Neil; Temkin, Paul; Jurado, Sandra; Lim, Byung Kook; Heifets, Boris D.; Polepalli, Jai S.; Malenka, Robert C.

2014-01-01

339

A phenomenological approach to understanding the psychological response to chronic low back pain.  

E-print Network

??Chronic low back pain (CLBP) is a complex health problem of psychological manifestations not fully understood. Using interpretive phenomenological analysis, 11 semi-structured interviews were conducted… (more)

Aymar, Matthew

2010-01-01

340

Enhanced medial prefrontal-default mode network functional connectivity in chronic pain and its association with pain rumination.  

PubMed

Rumination is a form of thought characterized by repetitive focus on discomforting emotions or stimuli. In chronic pain disorders, rumination can impede treatment efficacy. The brain mechanisms underlying rumination about chronic pain are not understood. Interestingly, a link between rumination and functional connectivity (FC) of the brain's default mode network (DMN) has been identified within the context of mood disorders. We, and others, have also found DMN dysfunction in chronic pain populations. The medial prefrontal cortex (mPFC) is a key node of the DMN that is anatomically connected with the descending pain modulatory system. Therefore, we tested the hypothesis that in patients with chronic pain, the mPFC exhibits abnormal FC related to the patient's degree of rumination about their pain. Seventeen patients with idiopathic temporomandibular disorder (TMD) and 17 age- and sex-matched healthy controls underwent resting state functional MRI, and rumination about pain was assessed through the rumination subscale of the Pain Catastrophizing Scale. Compared with healthy controls, we found that TMD patients exhibited enhanced mPFC FC with other DMN regions, including the posterior cingulate cortex (PCC)/precuneus (PCu) and retrosplenial cortex. We also found that individual differences in pain rumination in the chronic pain patients (but not in healthy controls) were positively correlated to mPFC FC with the PCC/PCu, retrosplenial cortex, medial thalamus, and periaqueductal/periventricular gray. These data implicate communication within the DMN and of the DMN with the descending modulatory system as a mechanism underlying the degree to which patients ruminate about their chronic pain. PMID:24623774

Kucyi, Aaron; Moayedi, Massieh; Weissman-Fogel, Irit; Goldberg, Michael B; Freeman, Bruce V; Tenenbaum, Howard C; Davis, Karen D

2014-03-12

341

Bennett and Xie (Pain 33: 87, 1988) Chronic Constrictive Injury Model  

E-print Network

understood. In this project we monitor the immediate effects of chronic constriction nerve injury over pain-organize cortical electrical dynamics. Thus, we expect to see: · In the transition from acute to chronic: i

Apkarian, A. Vania

342

The impact of chronic pain in children and adolescents: Development and initial validation of a child and parent version of the Pain Experience Questionnaire  

Microsoft Academic Search

Psychosocial factors are crucial for understanding and treating chronic pain in adults, but also in children. For children, very few questionnaires for a multidimensional pain assessment exist. In adults, the Multidimensional Pain Inventory (MPI; [Kerns RD, Turk DC, Rudy TE. The West Haven-Yale Multidimensional Pain Inventory (WHYMPI). Pain 1985;23:345–56]) has been widely used to determine patients’ adjustment to chronic pain.

Christiane Hermann; Johanna Hohmeister; Katrin Zohsel; Marie-Luise Tuttas; Herta Flor

2008-01-01

343

Too sick for school? Parent influences on school functioning among children with chronic pain.  

PubMed

Parental responses to children with chronic pain have been shown to influence the extent of the child's functional disability, but these associations have not been well studied in relation to children's pain-related school functioning. The current study tests the hypothesis that parental pain catastrophizing and parental protective responses to child pain influence the extent of school impairment in children with chronic pain. A mediational model was tested to determine whether parental protective behaviors serve a mediating role between parental pain catastrophizing and child school impairment. Study participants were a clinical sample of 350 children ages 8-17 years with chronic pain and their parents. Measures of pain characteristics, demographic characteristics, child depressive symptoms, school attendance rates, overall school functioning, parental pain catastrophizing, and parental protective responses to pain were collected. Results show that, controlling for the known influences of pain intensity and child depressive symptoms, parental pain catastrophizing and parental protective responses to child pain each independently predict child school attendance rates and reports of overall school impairment. Parental protectiveness was found to mediate the association between parental cognitions (i.e., parent pain catastrophizing) and child school functioning outcomes. These findings underscore the importance of intervening with parents to foster parental responses to child pain that help children engage and succeed in the school environment despite pain. PMID:22169177

Logan, Deirdre E; Simons, Laura E; Carpino, Elizabeth A

2012-02-01

344

Repetitive Transcranial Magnetic Stimulation to Treat Depression and Insomnia with Chronic Low Back Pain  

PubMed Central

Transcranial magnetic stimulation (TMS) is a noninvasive and safe technique for motor cortex stimulation. TMS is used to treat neurological and psychiatric disorders, including mood and movement disorders. TMS can also treat several types of chronic neuropathic pain. The pain relief mechanism of cortical stimulation is caused by modifications in neuronal excitability. Depression is a common co-morbidity with chronic pain. Pain and depression should be treated concurrently to achieve a positive outcome. Insomnia also frequently occurs with chronic lower back pain. Several studies have proposed hypotheses for TMS pain management. Herein, we report two cases with positive results for the treatment of depression and insomnia with chronic low back pain by TMS. PMID:25031816

Park, Eun Jung; Koh, Do Yle; Han, Yoo Mi

2014-01-01

345

Living with difference: Exploring the social self of adolescents with chronic pain  

PubMed Central

BACKGROUND: Chronic pain negatively affects an adolescent’s life; however, little is known about the social impact of chronic pain for adolescents. More is known about the general peer relationships of adolescents with chronic pain than their close friendships. Close friendships begin to take on more importance during adolescence as these relationships facilitate the development of an adolescent’s sense of personal identity and increasing independence from family influences. Thus, chronic pain may create friendship challenges for adolescents beyond those typically experienced during this developmental trajectory, which may negatively impact their abilities to secure social support. OBJECTIVES: To better understand the challenges adolescents with chronic pain face with regard to their friendships. METHODS: An interpretative phenomenological study using individual interviews was conducted. RESULTS: Two themes emerged. ‘Rethinking the self with pain’ describes the intrusive nature of chronic pain, challenging the participants to rethink the way they view themselves and their place within their social network. ‘Rethinking friendships’ describes the interpretation of their friends’ reactions to their chronic pain condition, which led to these adolescents spending more time by themselves, and feeling misunderstood and unsupported. CONCLUSIONS: The impact of chronic pain on the adolescent as an individual as well as the responses of close friends and others within their social network resulted in the development of new friendship needs. However, the adolescents were not always able to secure these new friendship needs. Their experiences suggest factors within friendships that may be ameliorated by interventions, thus maintaining and strengthening their close friendships. PMID:24308027

Forgeron, Paula A; Evans, Joan; McGrath, Patrick J; Stevens, Bonnie; Finley, G Allen

2013-01-01

346

Randomized Trial of Therapeutic Massage for Chronic Neck Pain  

PubMed Central

Objectives Little is known about the effectiveness of therapeutic massage, one of the most popular complementary medical treatments for neck pain. A randomized controlled trial was conducted to evaluate whether therapeutic massage is more beneficial than a self-care book for patients with chronic neck pain. Methods Sixty-four such patients were randomized to receive up to 10 massages over 10 weeks or a self-care book. Follow-up telephone interviews after 4, 10, and 26 weeks assessed outcomes including dysfunction and symptoms. Log-binomial regression was used to assess whether there were differences in the percentages of participants with clinically meaningful improvements in dysfunction and symptoms (i.e., > 5 point improvement on the Neck Disability Index (NDI); > 30% improvement from baseline on the symptom bothersomeness scale) at each time point. Results At 10 weeks, more participants randomized to massage experienced clinically significant improvement on the NDI (39% vs. 14% of book group; RR= 2.7; 95% confidence interval (CI) = 0.99–7.5) and on the symptom bothersomeness scale (55% vs. 25% of book group; RR=2.2; 95% CI=1.04–4.2). After 26 weeks, massage group members tended to be more likely to report improved function (RR=1.8; 95% CI=0.97–3.5), but not symptom bothersomeness (RR=1.1; 95% CI=0.6–2.0). Mean differences between groups were strongest at 4 weeks and not evident by 26 weeks. No serious adverse experiences were reported. Conclusions This study suggests that massage is safe and may have clinical benefits for treating chronic neck pain at least in the short term. A larger trial is warranted to confirm these results. PMID:19333174

Sherman, Karen J.; Cherkin, Daniel C.; Hawkes, Rene J.; Miglioretti, Diana L.; Deyo, Richard A.

2008-01-01

347

Does war hurt? Effects of media exposure after missile attacks on chronic pain.  

PubMed

This study focused on the effects of exposure to terrorist missile attacks on the physical and mental well being of chronic pain patients. In this prospective and longitudinal design, 55 chronic pain patients treated at a specialty pain clinic completed self-report questionnaires regarding their pain, depression and anxiety pre- and post a three week missile attack on the southern region of Israel. In addition, levels of direct and indirect exposure to the attacks were measured. Results of regression analyses showed that exposure to the attacks through the media predicted an increase in pain intensity and in the sensory component of pain during the pre-post war period, but did not predict depression, anxiety or the affective component of pain. These findings contribute to the understanding of the effects of terrorism on physical and emotional distress and identify chronic pain patients as a vulnerable population requiring special attention during terrorism-related stress. PMID:22699798

Lerman, Sheera F; Rudich, Zvia; Shahar, Golan

2013-03-01

348

The role of psychological interventions in the management of patients with chronic pain  

PubMed Central

Chronic pain can be best understood from a biopsychosocial perspective through which pain is viewed as a complex, multifaceted experience emerging from the dynamic interplay of a patient’s physiological state, thoughts, emotions, behaviors, and sociocultural influences. A biopsychosocial perspective focuses on viewing chronic pain as an illness rather than disease, thus recognizing that it is a subjective experience and that treatment approaches are aimed at the management, rather than the cure, of chronic pain. Current psychological approaches to the management of chronic pain include interventions that aim to achieve increased self-management, behavioral change, and cognitive change rather than directly eliminate the locus of pain. Benefits of including psychological treatments in multidisciplinary approaches to the management of chronic pain include, but are not limited to, increased self-management of pain, improved pain-coping resources, reduced pain-related disability, and reduced emotional distress – improvements that are effected via a variety of effective self-regulatory, behavioral, and cognitive techniques. Through implementation of these changes, psychologists can effectively help patients feel more in command of their pain control and enable them to live as normal a life as possible despite pain. Moreover, the skills learned through psychological interventions empower and enable patients to become active participants in the management of their illness and instill valuable skills that patients can employ throughout their lives. PMID:22114534

Roditi, Daniela; Robinson, Michael E

2011-01-01

349

Associations between parent and child pain and functioning in a pediatric chronic pain sample: A mixed methods approach  

PubMed Central

This study employed a mixed-method design to test sex-specific parent-child pain associations. Subjects were 179 chronic pain patients aged 11–19 years (mean = 14.34; 72% female) presenting for treatment at a multidisciplinary, tertiary clinic. Mothers and children completed questionnaires prior to their clinic visit, including measures of children’s pain, functioning and psychological characteristics. Mothers also reported on their own pain and psychological functioning. Interviews were conducted with a sub-sample of 34 mothers and children prior to the clinic visit and analyzed using a grounded theory approach. The quantitative data suggest stronger mother-daughter than mother-son pain relationships. The qualitative data suggest that girls’ pain and pain-related disability is related to an overly enmeshed mother-daughter relationship and the presence of maternal models of pain, while boys’ pain and disability is linked to male pain models and criticism and to maternal worry and solicitousness. Boys and girls appear to have developmentally incongruous levels of autonomy and conformity to maternal expectations. The mixed-method data suggest distinct trajectories through which mother and father involvement may be linked to chronic pain in adolescent boys and girls. PMID:21643522

Evans, Subhadra; Meldrum, Marcia; Tsao, Jennie CI; Fraynt, Rebecca; Zeltzer, Lonnie K

2011-01-01

350

Pain Expectancies, Pain, and Functional Self-Efficacy Expectancies as Determinants of Disability in Patients with Chronic Low Back Disorders.  

ERIC Educational Resources Information Center

Tested the predictive power of self-efficacy expectations of physical capabilities, expectations of pain, and expectations of reinjury on physical function in chronic back pain patients. Before assessment of function, patients rated their abilities to perform essential job tasks--functional self-efficacy (FSE)--and the likelihood working would…

Lackner, Jeffrey M.; And Others

1996-01-01

351

Chronic musculoskeletal pain: review of mechanisms and biochemical biomarkers as assessed by the microdialysis technique  

PubMed Central

Chronic musculoskeletal pain conditions are multifaceted, and approximately 20% of the adult population lives with severe chronic pain, with a higher prevalence in women and in lower income groups. Chronic pain is influenced by and interacts with physical, emotional, psychological, and social factors, and a biopsychosocial framework is increasingly applied in clinical practice. However, there is still a lack of assessment procedures based on the activated neurobiological pain mechanisms (ie, the biological part of the biopsychosocial model of pain), which may be a necessary step for further optimizing outcomes after treatments for patients with chronic pain. It has been suggested that chronic pain conditions are mainly driven by alterations in the central nervous system with little or no peripheral stimuli or nociception. In contrast, other authors argue that such central alterations are driven by peripheral alterations and nociceptive input. Microdialysis is an in vivo method for studying local tissue alterations and allows for sampling of substances in the interstitium of the muscle, where nociceptor free nerve endings are found close to the muscle fibers. The extracellular matrix plays a key role in physiologic functions of cells, including the primary afferent nociceptor. The present review mainly concerns the results of microdialysis studies and how they can contribute to the understanding of activated peripheral nociceptive and pain mechanisms in humans with chronic pain. The primary aim was to review molecular studies using microdialysis for the investigation of human chronic muscle pain, ie, chronic masticatory muscle pain, chronic trapezius myalgia, chronic whiplash-associated disorders, and chronic widespread pain/fibromyalgia syndrome. Several studies clearly showed elevated levels of serotonin, glutamate, lactate, and pyruvate in localized chronic myalgias and may be potential biomarkers. These results indicate that peripheral muscle alterations are parts of the activated pain mechanisms in common chronic pain conditions. Muscle alterations have been reported in fibromyalgia syndrome and chronic widespread pain, but more studies are needed before definite conclusions can be drawn. For other substances, results are inconclusive across studies and patient groups. PMID:24966693

Gerdle, Björn; Ghafouri, Bijar; Ernberg, Malin; Larsson, Britt

2014-01-01

352

Influence of Neuroticism, Catastrophizing, Pain Duration, and Receipt of Compensation on Short-Term Response to Nerve Block Treatment for Chronic Back Pain  

Microsoft Academic Search

This study investigated the influence of pain catastrophizing, neuroticism, pain duration, and receipt of compensation for 60 patients undergoing nerve block treatment for chronic back pain. Follow-up assessment 1 week following nerve block treatment found that neither neuroticism nor catastrophizing predicted level of reported pain or extent of disability. However, receipt of compensation and duration of pain were both associated

Gary Groth-Marnat; Allegra Fletcher

2000-01-01

353

Gray matter alterations in chronic pain: A network-oriented meta-analytic approach  

PubMed Central

Several studies have attempted to characterize morphological brain changes due to chronic pain. Although it has repeatedly been suggested that longstanding pain induces gray matter modifications, there is still some controversy surrounding the direction of the change (increase or decrease in gray matter) and the role of psychological and psychiatric comorbidities. In this study, we propose a novel, network-oriented, meta-analytic approach to characterize morphological changes in chronic pain. We used network decomposition to investigate whether different kinds of chronic pain are associated with a common or specific set of altered networks. Representational similarity techniques, network decomposition and model-based clustering were employed: i) to verify the presence of a core set of brain areas commonly modified by chronic pain; ii) to investigate the involvement of these areas in a large-scale network perspective; iii) to study the relationship between altered networks and; iv) to find out whether chronic pain targets clusters of areas. Our results showed that chronic pain causes both core and pathology-specific gray matter alterations in large-scale networks. Common alterations were observed in the prefrontal regions, in the anterior insula, cingulate cortex, basal ganglia, thalamus, periaqueductal gray, post- and pre-central gyri and inferior parietal lobule. We observed that the salience and attentional networks were targeted in a very similar way by different chronic pain pathologies. Conversely, alterations in the sensorimotor and attention circuits were differentially targeted by chronic pain pathologies. Moreover, model-based clustering revealed that chronic pain, in line with some neurodegenerative diseases, selectively targets some large-scale brain networks. Altogether these findings indicate that chronic pain can be better conceived and studied in a network perspective. PMID:24936419

Cauda, Franco; Palermo, Sara; Costa, Tommaso; Torta, Riccardo; Duca, Sergio; Vercelli, Ugo; Geminiani, Giuliano; Torta, Diana M.E.

2014-01-01

354

mTOR Kinase: A Possible Pharmacological Target in the Management of Chronic Pain  

PubMed Central

Chronic pain represents a major public health problem worldwide. Current pharmacological treatments for chronic pain syndromes, including neuropathic pain, are only partially effective, with significant pain relief achieved in 40–60% of patients. Recent studies suggest that the mammalian target of rapamycin (mTOR) kinase and downstream effectors may be implicated in the development of chronic inflammatory, neuropathic, and cancer pain. The expression and activity of mTOR have been detected in peripheral and central regions involved in pain transmission. mTOR immunoreactivity was found in primary sensory axons, in dorsal root ganglia (DRG), and in dorsal horn neurons. This kinase is a master regulator of protein synthesis, and it is critically involved in the regulation of several neuronal functions, including the synaptic plasticity that is a major mechanism leading to the development of chronic pain. Enhanced activation of this pathway is present in different experimental models of chronic pain. Consistently, pharmacological inhibition of the kinase activity turned out to have significant antinociceptive effects in several experimental models of inflammatory and neuropathic pain. We will review the main evidence from animal and human studies supporting the hypothesis that mTOR may be a novel pharmacological target for the management of chronic pain.

Aceto, Paola; Navarra, Pierluigi

2015-01-01

355

Novel animal models of acute and chronic cancer pain: a pivotal role for PAR2  

PubMed Central

Targeted therapy to prevent the progression from acute to chronic pain in cancer patients remains elusive. We developed three novel cancer models in mice that together recapitulate the anatomical, temporal and functional characteristics of acute and chronic head and neck cancer pain in humans. Using pharmacologic and genetic approaches in these novel cancer models, we identified the interaction between protease-activated receptor 2 (PAR2) and serine proteases to be of central importance. We show serine proteases such as trypsin induce acute cancer pain in a PAR2-dependent manner. Chronic cancer pain is associated with elevated serine proteases in the cancer microenvironment and PAR2 up-regulation in peripheral nerves. Serine protease inhibition greatly reduces the severity of persistent cancer pain in wild-type mice but most strikingly, the development of chronic cancer pain is prevented in PAR2-deficient mice. Our results demonstrate a direct role for PAR2 in acute cancer pain and suggest that PAR2 up-regulation may favor the development and maintenance of chronic cancer pain. Targeting the PAR2—serine protease interaction is a promising approach to the treatment of acute cancer pain and prevention of chronic cancer pain. PMID:23055487

LAM, D.K.; DANG, D.; ZHANG, J.; DOLAN, J.C.; SCHMIDT, B.L.

2012-01-01

356

[Prevalence and characteristics of chronic pain with neuropathic component at Parakou in northern Benin in 2012].  

PubMed

The burden of chronic and neuropathic pain is high making it an important public health problem. The epidemiology is not well known in the general population in sub-Saharan Africa. We aimed to determine the prevalence of chronic pain with a neuropathic component at Tititou in Parakou in northeastern Benin. A cross-sectional study was conducted from 1st April to 31 May 2012 and included 2314 people in a door-to-door survey. Chronic pain was defined as pain occurring for more than three months. Neuropathic pain was assessed with the DN4 score. A neurological exam was performed by a young physician for all people with chronic pain. During the interview, sociodemographic data, past medical history, weight and height were recorded. Multivariate logistic regression was performed to analyze the main associated factors. Among the 2314 people included in this survey, 49.7% were male. The mean age was 32.3±13.1years. Nine hundred seven reported pain occurring for more than 3months. The prevalence of chronic pain was 39.2% (CI95%: 29.3-34.7). It was more frequent in females, older people, among diabetics, people with a history of any surgery, stroke, brain trauma, and alcoholism. The prevalence of chronic pain with a neuropathic component was 6.3% (CI95%: 5.0-7.9). The main associated factors were age, matrimonial status, professional occupation, body mass index, diabetes, history of zoster, history of any surgery, brain trauma. People with neuropathic pain often reported pain with burning (87.6%), prickling (82.8%), numbness (66.9%), tingling (63.4%), and lightning pain (48.3%). The main locations were the lower limbs and low back pain. This study suggested the high frequency of chronic neuropathic pain in the general population in Parakou compared with rates reported in western countries. PMID:25444451

Adoukonou, T; Gnonlonfoun, D; Kpozehouen, A; Adjien, C; Tchaou, B; Tognon-Tchegnonsi, F; Adechina, H; Covi, R; Houinato, D

2014-11-01

357

Chronic Achilles tendon pain treated with eccentric calf-muscle training  

Microsoft Academic Search

Injuries involving the Achilles tendon and manifested as chronic tendon pain are common, especially among recreational athletes. In a pilot study on a small group of patients with chronic painful mid-portion Achilles tendinosis, eccentric calf-muscle training was shown to give good clinical results. The aim of this prospective study was to investigate if the previously achieved good clinical results could

Martin Fahlström; Per Jonsson; Ronny Lorentzon; Håkan Alfredson

2003-01-01

358

A Unified, Transdiagnostic Treatment for Adolescents with Chronic Pain and Comorbid Anxiety and Depression  

ERIC Educational Resources Information Center

Chronic pain disorders represent a significant public health concern, particularly for children and adolescents. High rates of comorbid anxiety and unipolar mood disorders often complicate psychological interventions for chronic pain. Unified treatment approaches, based on emotion regulation skills, are applicable to a broad range of emotional…

Allen, Laura B.; Tsao, Jennie C. I.; Seidman, Laura C.; Ehrenreich-May, Jill; Zeltzer, Lonnie K.

2012-01-01

359

Chronic blockade of melanocortin receptors alleviates allodynia in rats with neuropathic pain  

Microsoft Academic Search

We investigated the involvement of the spinal cord melanocortin (MC) system in neuropathic pain. Because we recently demonstrated that MC receptor ligands acutely alter nociception in an animal model of neuropathic pain, in this study we tested whether chronic administration was also effective. We hypothesized that chronic blockade of the spinal MC system might decrease sensory abnormalities associated with this

W. H. Gispen; D. H. Vrinten; R. A. H. Adan; G. J. Groen

2001-01-01

360

An Exploration of Positive Identity Development in Women Living with Chronic Pain  

ERIC Educational Resources Information Center

We explored the concept of living positively with chronic pain using a mixed-methods design that relied primarily on hermeneutic phenomenology. Ten women described their experiences of developing a positive identity while contending with chronic pain. Throughout their journeys, the women interviewed experienced a number of key themes including:…

Sharpe, Hillary; Alderson, Kevin; Collins, Sandra

2013-01-01

361

Does a Program of Pilates Improve Chronic Non-Specifi c Low Back Pain?  

Microsoft Academic Search

Objective: To evaluate the effect of a program of modifi ed Pilates for active indi- viduals with chronic non-specifi c low back pain. Design: A single blind random- ized controlled trial. Participants: 49 individuals with chronic low back pain were randomly allocated to control (n = 24) or Pilates group (n = 25). Thirty-four indi- viduals completed the study (14

Valerie Gladwell; Samantha Head; Martin Haggar; Ralph Beneke

2006-01-01

362

Efficacy of acupuncture for chronic low back pain: protocol for a randomized controlled trial  

Microsoft Academic Search

BACKGROUND: Chronic back pain is a major public health problem and the primary reason patients seek acupuncture treatment. Therefore, an objective assessment of acupuncture efficacy is critical for making informed decisions about its appropriate role for patients with this common condition. This study addresses methodological shortcomings that have plagued previous studies evaluating acupuncture for chronic low back pain. METHODS AND

Daniel C Cherkin; Karen J Sherman; Charissa J Hogeboom; Janet H Erro; William E Barlow; Richard A Deyo; Andrew L Avins

2008-01-01

363

Drugs for chronic pain in children: A commentary on clinical practice and the absence of evidence  

PubMed Central

Pediatric chronic pain is widespread, under-recognized and undertreated. Best management usually involves a multimodal approach coordinated by a multidisciplinary team. The present commentary specifically discusses common pharmacological approaches to chronic pain in children, identifies gaps in knowledge and suggests several research directions that would benefit future clinical care. PMID:23457686

Grégoire, Marie-Claude; Finley, G Allen

2013-01-01

364

Pulsed radiofrequency lesioning for treatment of chronic breast neuropathic pain after breast reduction -A case report-  

PubMed Central

Breast surgery is a common procedure performed in women. Many women who undergo breast surgery suffer from ill-defined pain syndromes. A nerve block is used in the treatment of the acute and chronic pain, but the effectiveness of the treatment has been limited because of its short duration. Recently, the advent of pulsed radiofrequency lesioning (PRF) has proved a successful treatment for chronic refractory pain involving the peripheral nerves. We experienced a case of a 52-year-old female patient complaining of chronic breast neuropathic pain after breast reduction, which was relieved after PRF lesioning of the 4th thoracic spinal nerve and its root. PMID:21286450

Kim, Hyung Tae; Kim, Kwang Yong; Kim, Yeon Dong

2010-01-01

365

Further Evaluation of the Motivational Model of Pain Self-Management: Coping with Chronic Pain in Multiple Sclerosis  

PubMed Central

Background Growing evidence suggests that motivation to engage in pain-coping strategies is a key predictor of how well a person adjusts to pain. According to the Motivational Model of Pain Self-Management, readiness to engage in pain self-management behaviors is influenced by beliefs about the importance of the behavior (importance) and the ability to carry out the behavior (self-efficacy). Purpose The purpose of this study was to test the Motivational Model of Pain Self-Management for exercise and task persistence pain-coping behaviors in a sample of 114 individuals with multiple sclerosis and chronic pain. Methods Measures included the Multidimensional Pain Readiness to Change Questionnaire-2 and measures of importance, self-efficacy, and coping behavior duration. Tests of mediation were conducted with two path analyses, one for each coping behavior. Results The effects of importance and self-efficacy beliefs on coping behaviors were mediated or partially mediated by readiness to engage in those behaviors. Conclusions These findings provide support for the Motivational Model of Pain Self-Management and have important implications for the development of treatments for chronic pain. PMID:21213092

Molton, Ivan R.; Jensen, Mark P.; Ehde, Dawn M.; Nielson, Warren R.

2012-01-01

366

Fundamentals of chronic pain in children and young people. Part 1.  

PubMed

Persistent and recurrent pain is a common condition in childhood. Chronic pain can have a negative effect on all aspects of quality of life, including physical, emotional, social and role functioning. A small percentage of these children and young people (5-8%) will experience significant impairments due to their pain condition. Most chronic pain requires a holistic multidisciplinary approach to treatment - pharmacological, physical and psychological strategies. Nurses are key members of the health care team in terms of helping children, young people and their families to manage the negative consequences of chronic pain. This article will review the prevalence, pathophysiology, contributing factors, consequences. Part two, to be published next month, will cover multimodal treatment of chronic pain in children and young people. PMID:25289630

A Forgeron, Paula; Stinson, Jennifer

2014-10-01

367

SPINAL CORD STIMULATION FOR CHRONIC PAIN MANAGEMENT: TOWARDS AN EXPERT SYSTEM  

E-print Network

Center Center for Computational Science and University of Texas at El Paso 17270 Red Oak, Suite 275: they lead to a continuous strong pain (chronic pain) that is not an indication of any physiologi­ cal damage of neural impulses. Since the physiology of pain is still at its infancy, we need some indirect heuristic

Kreinovich, Vladik

368

Sclerosing therapy in chronic Achilles tendon insertional pain-results of a pilot study  

Microsoft Academic Search

The origin of Achilles tendon insertional pain has not been clarified. Treatment is considered difficult, though tendon, bone, and bursae, alone or in combination, may all be the source of pain. Recently, neovascularisation in the area with tendon changes was shown to correlate with pain in patients with chronic mid-portion Achilles tendinosis. In a pilot study, sclerosing the neovessels outside

Lars Öhberg; Håkan Alfredson

2003-01-01

369

Treating Chronic Pain in Veterans Presenting to an Addictions Treatment Program  

ERIC Educational Resources Information Center

Chronic pain and substance use disorders frequently co-occur. The pharmacological treatment of pain is complicated in individuals with substance use disorders because of the potential for abuse and diversion of many prescription pain medications. One potential approach is to use a combination of cognitive-behavioral and acceptance-based strategies…

Ilgen, Mark A.; Haas, Elizabeth; Czyz, Ewa; Webster, Linda; Sorrell, John T.; Chermack, Stephen

2011-01-01

370

Gene Therapy for Chronic Neuropathic Pain: How Does It Work and Where Do We Stand Today?  

Microsoft Academic Search

ObjectivesChronic neuropathic pain has been an enigma to physicians and researchers for decades. A better understanding of its pathophysiology has given us more insight into its various mechanisms and possible treatment options. We now have an understanding of the role of various ionic channels, biologically active molecules involved in pain, and also the intricate pain pathways where possible interventions might

Sanjeev Kumar; Rupam Ruchi; Stephen R. James; Elie J. Chidiac

2011-01-01

371

The Safety and Efficacy of Intrathecal Adenosine in Patients with Chronic Neuropathic Pain  

Microsoft Academic Search

Adenosine and adenosine analogs decrease pain-like behavior in animal models of both acute nociceptive and neuropathic pain via adenosine receptor activation at spinal and\\/or supraspinal levels. This open study is the first in a series of intrathecal (IT) adenosine admin- istration studied for the evaluation of efficacy and side effects in 14 patients. All had chronic neuropathic pain with tactile

Måns Belfrage; M arta Segerdahl; Staffan Arner; Alf Sollevi

372

Using Chronic Pain to Predict Depressive Morbidity in the General Population  

Microsoft Academic Search

Background: Pain syndrome is thought to play a role in depression. This study assesses the prevalence of chronic ( 6 months' duration) painful physical condi- tions (CPPCs) (joint\\/articular, limb, or back pain, head- aches, or gastrointestinal diseases) and their relation- ship with major depressive disorder. Methods: We conducted a cross-sectional telephone survey of a random sample of 18980 subjects from

Maurice M. Ohayon; Alan F. Schatzberg

2003-01-01

373

Contextual cognitive-behavioral therapy for severely disabled chronic pain sufferers: Effectiveness and clinically significant change  

Microsoft Academic Search

Interdisciplinary pain management programs have an established record of significantly improving the functioning of persons disabled with chronic pain. There is a group of pain sufferers, however, who have difficulty accessing these programs and for whom the effectiveness of these treatments in unknown, these are patients whose mobility and self-care deficits leave them unable to meet the practical demands of

Lance M. McCracken; Fiona MacKichan; Christopher Eccleston

2007-01-01

374

Multi-dimensionality of chronic pain of the oral cavity and face.  

PubMed

Orofacial pain in its broadest definition can affect up to 7% of the population. Its diagnosis and initial management falls between dentists and doctors and in the secondary care sector among pain physicians, headache neurologists and oral physicians. Chronic facial pain is a long term condition and like all other chronic pain is associated with numerous co-morbidities and treatment outcomes are often related to the presenting co-morbidities such as depression, anxiety, catastrophising and presence of other chronic pain which must be addressed as part of management . The majority of orofacial pain is continuous so a history of episodic pain narrows down the differentials. There are specific oral conditions that rarely present extra orally such as atypical odontalgia and burning mouth syndrome whereas others will present in both areas. Musculoskeletal pain related to the muscles of mastication is very common and may also be associated with disc problems. Trigeminal neuralgia and the rarer glossopharyngeal neuralgia are specific diagnosis with defined care pathways. Other trigeminal neuropathic pain which can be associated with neuropathy is caused most frequently by trauma but secondary causes such as malignancy, infection and auto-immune causes need to be considered. Management is along the lines of other neuropathic pain using accepted pharmacotherapy with psychological support. If no other diagnostic criteria are fulfilled than a diagnosis of chronic or persistent idiopathic facial pain is made and often a combination of antidepressants and cognitive behaviour therapy is effective. Facial pain patients should be managed by a multidisciplinary team. PMID:23617409

Zakrzewska, Joanna M

2013-12-01

375

Diagnostic uncertainty and recall bias in chronic low back pain Danijela Serbica  

E-print Network

1 Diagnostic uncertainty and recall bias in chronic low back pain Danijela Serbica Tamar Pincusa Number of figures ­ 0 #12;2 1. INTRODUCTION The identification of sub-groups of people with low back pain to recovery [5]. Patients' beliefs and expectations about their pain have been shown to predict prognosis [13

Royal Holloway, University of London

376

Management of chronic musculoskeletal pain in the Elderly: Opinions on oral medication use  

Microsoft Academic Search

.  The use of oral medication in the treatment of chronic musculoskeletal pain in the elderly requires careful selection of drugs\\u000a to control pain with consideration for both the physiological state and the presence of disease(s). Recent advances have improved\\u000a the understanding of biomolecular mechanisms of chronic pain. These include the production of powerful pro-inflammatory cytokines\\u000a by glial and microglial cells,

W. F. Kean; K. D. Rainsford; I. R. L. Kean

2008-01-01

377

Efficacy of Massage Therapy in Chronic Pain: A Pragmatic Randomized Trial  

Microsoft Academic Search

Background: Although classic massage is used widely in Germany and elsewhere for treat- ing chronic pain conditions, there are no randomized controlled trials (RCT). Design:Pragmatic RCT of classic massage compared to standard medical care (SMC) in chronic pain conditions of back, neck, shoulders, head and limbs. Outcome measure: Pain rating (nine-point Likert-scale; predefined main outcome criterion) at pretreatment, post-treatment, and

Harald Walach; Corina Guthlin; Miriam Konig

2003-01-01

378

Time to Talk: 6 Things You Should Know: The Science of Chronic Pain and Complementary Health Practices  

MedlinePLUS

... Things You Should Know: The Science of Chronic Pain and Complementary Health Practices As with any treatment, ... complementary health practice to help manage your chronic pain, talk with your health care providers first. And ...

379

Pain Beliefs and Readiness to Change Among Adolescents With Chronic Musculoskeletal Pain and Their Parents Before an Initial Pain Clinic Evaluation  

PubMed Central

Objectives To understand relationships between pain-related beliefs and readiness to change among treatment-seeking adolescents with chronic musculoskeletal pain and their parents. Methods A total of 102 adolescent-parent dyads were recruited at the time of initial evaluation at a multidisciplinary pain management clinic. Dyads completed self-report measures to assess pain, catastrophizing, endorsement of a biopsychosocial perspective of pain, and readiness to change/motivation to adopt a self-management approach to pain coping. Results Agreement between adolescent-parent dyad reports of pain catastrophizing and readiness to change was found; however, adolescents were less likely to view pain as “affected by feelings and emotions” than parents. The hypothesis that greater pain catastrophizing would be correlated with less readiness to change was partially supported. Adolescent and parents who reported lower levels of endorsement of a biopsychosocial perspective were less willing to adopt a self-management approach to pain coping. Endorsement of a biopsychosocial perspective of pain aligned with readiness to change stages more consistently for parents. Discussion This study documents initial relationships among pain catastrophizing, biopsychosocial perspectives of pain, and readiness to engage in a self-management approach to pain coping for adolescents with chronic pain and their parents. Although agreement exists between dyads regarding catastrophizing and readiness to change, differences were noted in biopsychosocial perspective and dominant readiness to change stage before an initial pain clinic encounter. Findings are considered in terms of future research to advance knowledge regarding the role these factors may play in treatment adherence and outcomes. PMID:23446077

Guite, Jessica W.; Kim, Sohee; Chen, Chia-Pei; Sherker, Jennifer L.; Sherry, David D.; Rose, John B.; Hwang, Wei-Ting

2013-01-01

380

Predictive validity of behavioural animal models for chronic pain  

PubMed Central

Rodent models of chronic pain may elucidate pathophysiological mechanisms and identify potential drug targets, but whether they predict clinical efficacy of novel compounds is controversial. Several potential analgesics have failed in clinical trials, in spite of strong animal modelling support for efficacy, but there are also examples of successful modelling. Significant differences in how methods are implemented and results are reported means that a literature-based comparison between preclinical data and clinical trials will not reveal whether a particular model is generally predictive. Limited reports on negative outcomes prevents reliable estimate of specificity of any model. Animal models tend to be validated with standard analgesics and may be biased towards tractable pain mechanisms. But preclinical publications rarely contain drug exposure data, and drugs are usually given in high doses and as a single administration, which may lead to drug distribution and exposure deviating significantly from clinical conditions. The greatest challenge for predictive modelling is, however, the heterogeneity of the target patient populations, in terms of both symptoms and pharmacology, probably reflecting differences in pathophysiology. In well-controlled clinical trials, a majority of patients shows less than 50% reduction in pain. A model that responds well to current analgesics should therefore predict efficacy only in a subset of patients within a diagnostic group. It follows that successful translation requires several models for each indication, reflecting critical pathophysiological processes, combined with data linking exposure levels with effect on target. LINKED ARTICLES This article is part of a themed issue on Translational Neuropharmacology. To view the other articles in this issue visit http://dx.doi.org/10.1111/bph.2011.164.issue-4 PMID:21371010

Berge, Odd-Geir

2011-01-01

381

Profile of sexuality in Moroccan chronic low back pain patients  

PubMed Central

Background Sexual life had an important role in preserving the good quality of life for patients and for their partner. Chronic Low Back Pain (CLBP) as other musculoskeletal diseases may affect all aspects of life including sexual functioning. The purpose of this study is to describe the impact of CLBP on the sexual life of patients and to identify the factors that affect their Sexual Quality of Life (SQOL). Methods One hundred CLBP sexually active patients were included. Patients and disease Characteristics were collected. Impact on sexual life (sexual intercourse and SQOL) was also assessed. Univariate and multivariate analysis were performed to analyze significant determinants associated with the SQOL disturbance. Results Eighty one percent of our patients complained about sexual difficulties related to CLBP. Libido decrease and painful intercourse position were reported respectively in 14.8 and 97.5% of cases. The most pain generating position was supine. Mean of sexual intercourse frequency decrease was at ?10.4?±?4.8 per month. SQOL score mean was at 44.6?±?17.4%. Men suffered more than women from sexual problems (respectively 90% vs. 72%; p?=?0.02). Men had worse SQOL than women (respectively 38.9?±?17.2 vs. 50.3?±?15.7%; p?=?0.001). Univariate and multivariate analysis showed that advanced age (p?=?0.009), poor functional status (p?=?0.03), male gender (p?=?0.03) and sexual intercourse frequency decrease (p?=?0.005) were the independent variables associated with the SQOL disturbance. Conclusion Our study suggests that sexuality is profoundly disturbed in CLBP patients; both their sexual intercourse and SQOL were affected. This disturbance seems to be associated with patient and disease characteristics. Sexuality should be taken into account in managing CLBP patients. PMID:23413914

2013-01-01

382

Cerebrospinal Fluid Cytokines and Neurotrophic Factors in Human Chronic Pain Populations: A Comprehensive Review.  

PubMed

Chronic pain is a prevalent and debilitating condition, conveying immense human burden. Suffering is caused not only by painful symptoms, but also through psychopathological and detrimental physical consequences, generating enormous societal costs. The current treatment armamentarium often fails to achieve satisfying pain relief; thus, research directed toward elucidating the complex pathophysiological mechanisms underlying chronic pain syndromes is imperative. Central neuroimmune activation and neuroinflammation have emerged as driving forces in the transition from acute to chronic pain, leading to central sensitization and decreased opioid efficacy, through processes in which glia have been highlighted as key contributors. Under normal conditions, glia exert a protective role, but in different pathological states, a deleterious role is evident-directly and indirectly modulating and enhancing pain transmission properties of neurons, and shaping synaptic plasticity in a dysfunctional manner. Cytokines and neurotrophic factors have been identified as pivotal mediators involved in neuroimmune activation pathways and cascades in various preclinical chronic pain models. Research confirming these findings in humans has so far been scarce, but this comprehensive review provides coherent data supporting the clear association of a mechanistic role of altered central cytokines and neurotrophic factors in a number of chronic pain states despite varying etiologies. Given the importance of these factors in neuropathic and inflammatory chronic pain states, prospective therapeutic strategies, and directions for future research in this emerging field, are outlined. PMID:25353056

Bjurstrom, Martin F; Giron, Sarah E; Griffis, Charles A

2014-10-29

383

Pharmacological Inhibition of Voltage-gated Ca2+ Channels for Chronic Pain Relief  

PubMed Central

Chronic pain is a major therapeutic problem as the current treatment options are unsatisfactory with low efficacy and deleterious side effects. Voltage-gated Ca2+ channels (VGCCs), which are multi-complex proteins consisting of ?1, ?, ?, and ?2? subunits, play an important role in pain signaling. These channels are involved in neurogenic inflammation, excitability, and neurotransmitter release in nociceptors. It has been previously shown that N-type VGCCs (Cav2.2) are a major pain target. U.S. FDA approval of three Cav2.2 antagonists, gabapentin, pregabalin, and ziconotide, for chronic pain underlies the importance of this channel subtype. Also, there has been increasing evidence that L-type (Cav1.2) or T-type (Cav3.2) VGCCs may be involved in pain signaling and chronic pain. In order to develop novel pain therapeutics and to understand the role of VGCC subtypes, discovering subtype selective VGCC inhibitors or methods that selectively target the inhibitor into nociceptors would be essential. This review describes the various VGCC subtype inhibitors and the potential of utilizing VGCC subtypes as targets of chronic pain. Development of VGCC subtype inhibitors and targeting them into nociceptors will contribute to a better understanding of the roles of VGCC subtypes in pain at a spinal level as well as development of a novel class of analgesics for chronic pain. PMID:24396337

Lee, Seungkyu

2013-01-01

384

Pharmacological Inhibition of Voltage-gated Ca(2+) Channels for Chronic Pain Relief.  

PubMed

Chronic pain is a major therapeutic problem as the current treatment options are unsatisfactory with low efficacy and deleterious side effects. Voltage-gated Ca2+ channels (VGCCs), which are multi-complex proteins consisting of ?1, ?, ?, and ?2? subunits, play an important role in pain signaling. These channels are involved in neurogenic inflammation, excitability, and neurotransmitter release in nociceptors. It has been previously shown that N-type VGCCs (Cav2.2) are a major pain target. U.S. FDA approval of three Cav2.2 antagonists, gabapentin, pregabalin, and ziconotide, for chronic pain underlies the importance of this channel subtype. Also, there has been increasing evidence that L-type (Cav1.2) or T-type (Cav3.2) VGCCs may be involved in pain signaling and chronic pain. In order to develop novel pain therapeutics and to understand the role of VGCC subtypes, discovering subtype selective VGCC inhibitors or methods that selectively target the inhibitor into nociceptors would be essential. This review describes the various VGCC subtype inhibitors and the potential of utilizing VGCC subtypes as targets of chronic pain. Development of VGCC subtype inhibitors and targeting them into nociceptors will contribute to a better understanding of the roles of VGCC subtypes in pain at a spinal level as well as development of a novel class of analgesics for chronic pain. PMID:24396337

Lee, Seungkyu

2013-12-01

385

Chronic medial and lateral epicondylitis: A comparison of pain, disability, and function  

Microsoft Academic Search

Pienim[auml ]ki TT, Siira PT, Vanharanta H. Chronic medial and lateral epicondylitis: a comparison of pain, disability, and function. Arch Phys Med Rehabil 2002;83:317-21. Objectives: To investigate pain, disability, and muscle function of the arm in medial epicondylitis and to compare the results with those in chronic lateral epicondylitis. Design: Cross-sectional, case-control study. Setting: University hospital clinic admitting chronic hand

Pertti T. Siira; Heikki Vanharanta

2002-01-01

386

Responsiveness of five condition-specific and generic outcome assessment instruments for chronic pain  

Microsoft Academic Search

BACKGROUND: Changes of health and quality-of-life in chronic conditions are mostly small and require specific and sensitive instruments. The aim of this study was to determine and compare responsiveness, i.e. the sensitivity to change of five outcome instruments for effect measurement in chronic pain. METHODS: In a prospective cohort study, 273 chronic pain patients were assessed on the Numeric Rating

Felix Angst; Martin L Verra; Susanne Lehmann; André Aeschlimann

2008-01-01

387

Patient versus parental perceptions about pain and disability in children and adolescents with a variety of chronic pain conditions  

PubMed Central

BACKGROUND: Cross-informant variance is often observed in patient self-reports versus parent proxy reports of pediatric chronic pain and disability. OBJECTIVE: To assess the relationship and merit of the child versus parent perspective. METHODS: A total of 99 patients (eight to 17 years of age [mean 13.2 years]; 71% female, 81% Caucasian) and parents completed the Pediatric Pain Questionnaire and Functional Disability Inventory at their initial clinic visit. Patients’ and parents’ pain intensity and disability scores were analyzed using an intraclass correlation coefficient (ICC), Wilcoxon signed-rank test, Bland-Altman plot and Spearman’s correlation coefficient. The association between clinical/demographic variables and differences in patient/parent pain intensity and disability scores was assessed using multivariable regression. RESULTS: There was significant agreement between patients’ self-reports and parents’ proxy reports of their child’s pain intensity (ICC=0.52; P<0.001) and disability (ICC=0.57; P=0.004) at the individual level. There were no significant group differences in patient versus parent-proxy pain intensity scores (P=0.40) and disability scores (P=0.54). The difference between patient and parent-proxy pain intensity was associated with patients’ self-reported pain intensity (P<0.001). The difference between patient and parent-proxy disability was associated with patient’s self-reported pain disability (P<0.001). Bland-Altman plots revealed major inter-rater variation in the Pediatric Pain Questionnaire and Functional Disability Inventory across their score ranges. A significant relationship (r=0.38; P<0.001) was observed between patients’ self-reported pain intensity and disability. CONCLUSIONS: While equal merit should ideally be given to pediatric chronic pain patients’ self-reports and their parents’ proxy reports of pain intensity and disability, it would appear that, as needed, pediatric patients or parents can offer a clinically valid, single clinical perspective. PMID:24147272

Vetter, Thomas R; Bridgewater, Cynthia L; Ascherman, Lee I; Madan-Swain, Avi; McGwin, Gerald L

2014-01-01

388

Eliminating sedimentation for the treatment of chronic pelvic pain syndrome  

PubMed Central

The aim of this study was to evaluate the curative effects of eliminating sedimentation inside the prostate via manipulation for the treatment of chronic pelvic pain syndrome (CPPS) using the National Institutes of Health (NIH)-chronic prostatitis symptom index (CPSI) scores. According to the prostatitis classification standard of the NIH, 721 patients with CPPS were divided into groups IIIA and IIIB by prostatic fluid routine examination (EPSRt) and treated using manipulation. The treatment was performed once per 3 days for 3–5 min and 10 treatments were considered to be a period. The EPSRt and NIH-CPSI scores were tested before and at the end of each period following treatment. After 3 treatment periods, the effectiveness and total effectiveness rates of the IIIA group were 72.3 and 15.9%, respectively and those of the IIIB group were 71.8 and 16.3%, respectively. Statistical analysis showed no significant differences between the curative effects in the two groups (P>0.05). The NIH-CPSI scores of the two groups were significantly improved following each treatment period (P<0.01). Eliminating sedimentation using manipulation dispersed the blockage, discharged the turbidity and cleared the gland, leading to the elimination of sedimentation and the relief of sinus hyperemia around the prostate, which significantly improved the clinical symptoms of CPPS and the quality of life of the patients. PMID:23737875

SUN, ZHONGMING; BAO, YANZHONG

2013-01-01

389

Fear-avoidance and its consequences in chronic musculoskeletal pain: a state of the art  

Microsoft Academic Search

In an attempt to explain how and why some individuals with musculoskeletal pain develop a chronic pain syndrome, Lethem et al.(Lethem J, Slade PD, Troup JDG, Bentley G. Outline of fear-avoidance model of exaggerated pain perceptions. Behav Res Ther 1983; 21: 401-408).ntroduced a so-called ‘fear-avoidance’ model. The central concept of their model is fear of pain. ‘Confrontation’ and ‘avoidance’ are

Johan W. S. Vlaeyen; Steven J. Linton

2000-01-01

390

The clinical use of mindfulness meditation for the self-regulation of chronic pain  

Microsoft Academic Search

Ninety chronic pain patients were trained in mindfulness meditation in a 10-week Stress Reduction and Relaxation Program. Statistically significant reductions were observed in measures of present-moment pain, negative body image, inhibition of activity by pain, symptoms, mood disturbance, and psychological symptomatology, including anxiety and depression. Pain-related drug utilization decreased and activity levels and feelings of self-esteem increased. Improvement appeared to

Jon Kabat-Zinn; Leslie Lipworth; Robert Burney

1985-01-01

391

Backing up the stories: The psychological and social costs of chronic low-back pain  

PubMed Central

Background Chronic low-back pain is a widespread condition whose significance is overlooked. Previous studies have analyzed and evaluated the medical costs and physical symptoms of chronic low-back pain; however, few have looked beyond these factors. The purpose of this study was to analyze and evaluate the personal and psychosocial costs of chronic low-back pain. Methods To measure the various costs of chronic low-back pain, a questionnaire was generated using a visual analog scale, the Depression Anxiety and Stress Scale, the Short Form 36 Health Survey, and the 1998–1999 Australian Bureau of Statistics Household Expenditure Survey (for demographic questions). The comprehensive survey assessing physical, mental, emotional, social, and financial health was administered to 30 subjects aged 18 years or older who had visited a tertiary spine service with complaints of chronic low-back pain. Results It was found that subjects scored significantly higher on scales for depression, anxiety, and stress after the onset of chronic low-back pain than before the onset of back pain. Subjects also reported a reduction in work hours and income, as well as a breakdown in interpersonal relationships, including marital and conjugal relations. Conclusion Chronic low-back pain affects the ability of a patient to work, creating both financial and emotional problems within a home. Relief is delayed for patients because of the sparse allocation of resources for chronic spinal care and inadequate prevention education. Despite this, many patients are exhorted to return to work before they are physically, mentally, or emotionally free of pain, resulting in poor outcomes for recovery. Ultimately, this aggregates into an adverse macrosocial effect, reducing not only the quality of life for individuals with chronic low-back pain but also workforce productivity.

Mathew, Justin; Singh, Samantha B.; Garis, Sally; Diwan, Ashish D.

2013-01-01

392

Effectiveness of focused structural massage and relaxation massage for chronic low back pain: protocol for a randomized controlled trial  

Microsoft Academic Search

BACKGROUND: Chronic back pain is a major public health problem and the primary reason patients seek massage treatment. Despite the growing use of massage for chronic low back pain, there have been few studies of its effectiveness. This trial will be the first evaluation of the effectiveness of relaxation massage for chronic back pain and the first large trial of

Daniel C Cherkin; Karen J Sherman; Janet Kahn; Janet H Erro; Richard A Deyo; Sebastien J Haneuse; Andrea J Cook

2009-01-01

393

The cortical rhythms of chronic back pain M. N. BALIKI, A.T. BARIA and A.V. APKARIAN  

E-print Network

The cortical rhythms of chronic back pain M. N. BALIKI, A.T. BARIA and A.V. APKARIAN Department.05-0.12 Hz, and HF, 0.12-0.2 Hz) between healthy subjects and patients suffering for chronic back pain (CBP Connectivity Milwaukee 2010 009 INTRODUCTION Compared with normal individuals, the brain of chronic pain

Apkarian, A. Vania

394

Validation and Clinical Application of a Biopsychosocial Model of Pain Intensity and Functional Disability in Patients with a Pediatric Chronic Pain Condition Referred to a Subspecialty Clinic  

PubMed Central

Background. Pediatric chronic pain is considered to be a multidimensional construct that includes biological, psychological, and social components. Methods. The 99 enrolled study patients (mean age 13.2 years, 71% female, 81% Caucasian) and an accompanying parent completed a series of health-related questionnaires at the time of their initial appointment in a pediatric chronic pain medicine clinic. Results. Significant correlations (r ? 0.30, P < 0.05) were observed between pediatric chronic pain intensity and patient anxiety, patient depression, patient pain coping, parent chronic pain intensity, and parent functional disability. Pediatric chronic pain intensity was significantly associated with patient anxiety (P = 0.002). Significant correlations (r ? 0.30, P < 0.05) were observed between pediatric functional disability and patient chronic pain intensity, patient anxiety, patient depression, patient pain coping, parent chronic pain intensity, parent functional disability, parent anxiety, parent depression, and parent stress. Pediatric functional disability was significantly associated with patient chronic pain intensity (P = 0.025), patient anxiety (P = 0.021), patient pain coping (P = 0.009), and parent functional disability (P = 0.027). Conclusions. These findings provide empirical support of a multidimensional Biobehavioral Model of Pediatric Pain. However, the practical clinical application of the present findings and much of the similar previously published data may be tenuous. PMID:24251035

Vetter, Thomas R.; McGwin, Gerald; Bridgewater, Cynthia L.; Madan-Swain, Avi; Ascherman, Lee I.

2013-01-01

395

Ketamine: An Introduction for the Pain and Palliative Medicine Physician  

Microsoft Academic Search

A history of an escalating chronic intractable pain in a patient with cryoglob- ulinemia, vasculitis, and severe cutaneous ulcerations is presented. A strategy of progressive, multi-agent, N-methyl-D-aspartate-receptor (NMDA-R) blockade that resulted in adequate pain control and a three-fold reduction in opioid con- sumption is described. Diagnostic process of neuropathic pain and the role of NMDA-R in the development of hyperalgesia

Tomasz Okon

2007-01-01

396

The role of cryoanalgesia for chronic thoracic pain: results of a long-term follow up.  

PubMed Central

Cryoanalgesia (the use of cold to provide anesthesia or analgesia) is the oldest anesthetic and analgesic still in current clinical use. Its intraoperative use in providing postoperative analgesia for acute thoracic pain problems via an open thoracotomy is well described. The long-term efficacy of cryoanalgesia for the management of chronic thoracic pain due to intercostal neuralgia is less clear. We retrospectively examined the medical records of patients who received percutaneous cryoanalgesia following successful intercostal nerve blockade for chronic chest pain. Sixty percent of the patients (N = 43) reported significant pain relief immediately following their procedure. Three months following cryoanalgesia, 50% continued to report significant pain relief. There were no reports of neuritis or neuroma formation and only three patients had a pneumothorax. This work provides evidence that cryoanalgesia is a safe and efficacious method of providing analgesia for chronic thoracic pain due to intercostal neuralgia. PMID:12152929

Green, Carmen R.; de Rosayro, A. Michael; Tait, Alan R.

2002-01-01

397

Migraine in women with chronic pelvic pain with and without endometriosis  

PubMed Central

Objective To examine the prevalence of migraine in women with chronic pelvic pain with and without endometriosis. Design Prospective study of headache, pelvic pain, and quality of life before laparoscopic surgery for pelvic pain. Endometriosis was diagnosed pathologically. Headaches were classified as migraine or non-migraine using International Headache Society criteria. Setting Clinical research hospital. Patient(s) 108 women in a clinical trial for chronic pelvic pain (NCT00001848). Intervention(s) Laparoscopy to diagnose endometriosis, assessment by neurologist to assess headaches. Main Outcome Measure(s) Prevalence of migraine and other headaches in women with chronic pelvic pain with or without endometriosis. Headache frequency, severity and relationship to pelvic pain and endometriosis. Result(s) Lifetime prevalence of definite or possible migraine was 67% of women with chronic pelvic pain. An additional 8% met criteria for possible migraine. Migraine was no more likely in women with endometriosis than those without. Women with the most severe headaches had a lower quality of life compared with those with pelvic pain alone. Conclusion(s) Migraine headache is common in women with chronic pelvic pain, regardless of endometriosis, and contributes to disability in those with both conditions. The strong association suggests a common pathophysiology. PMID:21145540

Karp, Barbara Illowsky; Sinaii, Ninet; Nieman, Lynnette K.; Silberstein, Stephen D.; Stratton, Pamela

2012-01-01

398

Tryptase-PAR2 axis in experimental autoimmune prostatitis, a model for chronic pelvic pain syndrome.  

PubMed

Chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) affects up to 15% of the male population and is characterized by pelvic pain. Mast cells are implicated in the murine experimental autoimmune prostatitis (EAP) model as key to chronic pelvic pain development. The mast cell mediator tryptase-? and its cognate receptor protease-activated receptor 2 (PAR2) are involved in mediating pain in other visceral disease models. Prostatic secretions and urines from CP/CPPS patients were examined for the presence of mast cell degranulation products. Tryptase-? and PAR2 expression were examined in murine EAP. Pelvic pain and inflammation were assessed in the presence or absence of PAR2 expression and upon PAR2 neutralization. Tryptase-? and carboxypeptidase A3 were elevated in CP/CPPS compared to healthy volunteers. Tryptase-? was capable of inducing pelvic pain and was increased in EAP along with its receptor PAR2. PAR2 was required for the development of chronic pelvic pain in EAP. PAR2 signaling in dorsal root ganglia led to extracellular signal-regulated kinase (ERK)1/2 phosphorylation and calcium influx. PAR2 neutralization using antibodies attenuated chronic pelvic pain in EAP. The tryptase-PAR2 axis is an important mediator of pelvic pain in EAP and may play a role in the pathogenesis of CP/CPPS. PMID:24726923

Roman, Kenny; Done, Joseph D; Schaeffer, Anthony J; Murphy, Stephen F; Thumbikat, Praveen

2014-07-01

399

Psychosocial mechanisms of the pain and quality of life relationship for chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS)  

PubMed Central

Introduction: Chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) is a prevalent, chronic pelvic pain condition largely unresponsive to medical interventions. Psychosocial risk factors are associated with poor outcomes in CP/CPPS, but have not been examined for their intervening roles between pain and reduced quality of life (QoL). This study aimed to determine if psychosocial risk factors (i.e., patient coping and catastrophizing) mediate the association between pain and QoL. Methods: Using a cross sectional design, 175 men with CP/CPPS (mean age 46.83; SD 10.86) were recruited from tertiary care urology clinics and completed questionnaires on demographics, pain, QoL, pain coping, depression, and catastrophizing. An exploratory factor analysis was conducted and aggregate factor scores were examined to improve the amount of meaningful measurement to be used in multiple mediations. The models specified multiple risk factors as mechanisms between pain and both physical and mental QoL as the primary outcome measurements. Results: Four aggregate psychosocial factor scores were produced from the psychosocial measures (i.e., illness and wellness-focused behavioural coping, depression and catastrophizing). Illness-focused coping partially mediated the relationship between pain and physical QoL. However, catastrophizing and illness-focused coping fully mediated the relation between pain and mental QoL, showing the association between pain and mental QoL was no longer significant when catastrophizing and illness-focused coping were in the model. Conclusion: Psychosocial factors function as mechanisms between higher pain and they are associated diminished mental QoL. These results introduce illness-focused coping as an important biopsychosocial target in CP/CPPS management. PMID:25553153

Krsmanovic, Adrijana; Tripp, Dean A.; Nickel, J. Curtis; Shoskes, Daniel A.; Pontari, Michel; Litwin, Mark S.; McNaughton-Collins, Mary F.

2014-01-01

400

Just world beliefs moderate the relationship of pain intensity and disability with psychological distress in chronic pain support group members.  

PubMed

The impact of pain beliefs on coping and adjustment is well established. However, less is known about how beliefs unrelated to pain might impact upon this experience. In particular, just world beliefs could impact upon and be influenced by chronic pain, given that pain is not experienced in a vacuum but instead is experienced in a social context where justice issues are potentially salient. The focus of this study was the ability of personal and general just world beliefs to moderate the relationships psychological distress held with pain intensity and disability in chronic pain. The sample (N=95) was recruited from members of arthritis and fibromyalgia support groups to investigate these social beliefs in a controlled community pain context. A cross-sectional, questionnaire design was adopted. The personal just world belief was endorsed significantly more than the general just world belief, and endorsement of the personal just world belief was negatively correlated with pain intensity, disability and psychological distress, while the general just world belief was unrelated to these variables. When interaction terms relating to personal and general just world beliefs were entered simultaneously into regression analyses, the personal just world belief did not predict psychological distress. However, pain intensity positively predicted psychological distress at low but not high levels of the general just world belief, while disability predicted psychological distress at low and high levels of this belief. This suggests that a strong general just world belief has implications for psychological well-being in chronic pain, and as such this belief may occupy a potential coping function in this context. PMID:19121590

McParland, Joanna L; Knussen, Christina

2010-01-01

401

The community prevalence of chronic pelvic pain in women and associated illness behaviour.  

PubMed Central

BACKGROUND: Chronic pelvic pain has often been described as a major women's health issue, but no information exists on the extent of the problem in the United Kingdom. AIM: To investigate the community prevalence of chronic pelvic pain and its effect on the lives of consulting and non-consulting women. DESIGN OF STUDY: Postal questionnaire survey. SETTING: Women aged 18 to 49 (n = 3916) randomly selected from the Oxfordshire Health Authority Register. METHOD: The questionnaire response rate (adjusted for non-deliveries) was 74% (2304/3106). Chronic pelvic pain was defined as recurrent or constant pelvic pain of at least six months' duration, unrelated to periods, intercourse, or pregnancy. Case subgroups comprised recent consulters, past consulters, and non-consulters. Women who reported dysmenorrhoea alone formed a comparison group. RESULTS: The three-month prevalence of chronic pelvic pain was 24.0% (95% CI = 22.1% to 25.8%). One-third of women reported pain that started more than five years ago. Recent consulters (32% of cases) were most affected by their symptoms in terms of pain severity, use of health care, physical and mental health scores, sleep quality, and pain-related absence from work. Non-consulters (41% of cases) did not differ from women with dysmenorrhoea in terms of symptom-related impairment. Irrespective of consulting behaviour, a high rate of symptom-related anxiety was found in women with chronic pelvic pain (31%) compared with women with dysmenorrhoea (7%). CONCLUSIONS: This study showed a high community prevalence of chronic pelvic pain in women of reproductive age. Cases varied substantially in the degree to which they were affected by their symptoms. The high symptom-related anxiety in these women emphasises the need for more information about chronic pelvic pain and its possible causes. PMID:11462313

Zondervan, K T; Yudkin, P L; Vessey, M P; Jenkinson, C P; Dawes, M G; Barlow, D H; Kennedy, S H

2001-01-01

402

[Association between chronic pain and self-reported falls in the SABE study population].  

PubMed

The objective of this study was to assess the association between chronic pain and self-reported falls. This was a cross-sectional sample of elderly individuals without cognitive deficits, living in the city of São Paulo, Brazil, and with chronic pain. The study considered elderly that reported chronic pain for at least one year. History of falls was defined as at least one reported fall in the 12 months prior to the study. Data were obtained by home surveys of the elderly. Stata 11.0 was used for statistical analysis. Prevalence of chronic pain was 29.7% (95%CI: 25.4-33.9). Prevalence of falls in the previous year for individuals with pain was 31.6% (95%CI: 26.4-37.5) and did not differ significantly from those without pain (26.4%; 95%CI: 23.1-30.0; p = 0.145). Risk of falls was 50% higher (p = 0.019) for those with pain and osteoporosis and 48% higher for those with pain and urinary incontinence (p = 0.010). History of pain for at least one year and osteoporosis, pain, and urinary incontinency showed higher odds of falls. PMID:24714942

Dellaroza, Mara Solange Gomes; Pimenta, Cibele Andrucioli de Mattos; Lebrão, Maria Lúcia; Duarte, Yeda Aparecida de Oliveira; Braga, Patricia Emília

2014-03-01

403

Differences in pain, function and coping in Multidimensional Pain Inventory subgroups of chronic back pain: a one-group pretest-posttest study  

Microsoft Academic Search

Background  Patients with non-specific back pain are not a homogeneous group but heterogeneous with regard to their bio-psycho-social\\u000a impairments. This study examined a sample of 173 highly disabled patients with chronic back pain to find out how the three\\u000a subgroups based on the Multidimensional Pain Inventory (MPI) differed in their response to an inpatient pain management program.\\u000a \\u000a \\u000a \\u000a \\u000a Methods  Subgroup classification was conducted

Martin L Verra; Felix Angst; J Bart Staal; Roberto Brioschi; Susanne Lehmann; André Aeschlimann; Rob A de Bie

2011-01-01

404

Mediators of change in acceptance and commitment therapy for pediatric chronic pain.  

PubMed

Even though psychological interventions are well established in the treatment of pediatric chronic pain, there is a clear need for further development, especially with severely disabled patients. However, optimizing effectiveness in psychological treatments for pain requires clarification of the mechanisms of action. Studies addressing change processes are scarce, however, particularly in relation to pediatric chronic pain. Acceptance and Commitment Therapy (ACT), as an extension of traditional cognitive behavior therapy, is essentially aimed at improving functioning by increasing the ability to act effectively in the presence of pain and distress, that is, psychological flexibility. ACT has shown promising results for both adult and pediatric chronic pain. In the present study, the mediators of change in an ACT-oriented treatment for pediatric chronic pain were examined using a bootstrapped cross product of coefficients approach. Pain interference and depression were used as outcome variables. Six different variables relevant to theories underlying ACT and cognitive behavior therapy were included in the analyses as possible mediators of change: pain impairment beliefs, pain reactivity, self-efficacy, kinesiophobia, catastrophizing, and pain intensity. Results illustrated that pain impairment beliefs and pain reactivity were the only variables that significantly mediated the differential effects of treatment on outcomes at follow-up. Also, these 2 mediators were shown to independently predict effects in outcome variables at follow-up while controlling for earlier effects in outcome, but only for the ACT condition. Although tentative, the pattern of results suggests that variables consistent with psychological flexibility mediate the effects of ACT-based interventions to improve functioning in patients with chronic debilitating pain. PMID:21995881

Wicksell, Rikard K; Olsson, Gunnar L; Hayes, Steven C

2011-12-01

405

[Extracorporeal shock wave therapy for chronic pelvic pain syndrome: an update].  

PubMed

Chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) is a common disease in males, which is characterized by persistent discomfort or pain in the pelvic region. As currently used drug therapies fail to produce satisfactory results, it is an urgent task to find new and effective methods for the treatment of CP/CPPS. In recent years, many reports are seen on the extracorporeal shock wave therapy (ESWT) for CP/CPPS. ESWT can significantly improve the symptoms of pelvic pain and urination disorders in CPPS patients, and its therapeutic effect is attributed to the improvement of angiogenesis and block of pain nerves. PMID:25195375

Guo, Qi; Hong, Mei; Wang, Zhi-Ping

2014-08-01

406

A conceptual framework for understanding chronic pain in patients with HIV.  

PubMed

Chronic pain is common in persons with HIV and is often associated with psychiatric illness and substance abuse. Current literature links psychiatric illness and substance abuse with worse HIV outcomes; however, the relationship of chronic pain, alone and in the context of psychiatric illness and substance abuse, to outcomes in HIV has not been described. To develop this new area of inquiry, we propose an adapted biopsychosocial framework specifically for chronic pain in HIV. This framework will describe these relationships and serve as a conceptual framework for future investigations. PMID:23551857

Merlin, Jessica S; Zinski, Anne; Norton, Wynne E; Ritchie, Christine S; Saag, Michael S; Mugavero, Michael J; Treisman, Glenn; Hooten, W Michael

2014-03-01

407

Attentional Strategy Moderates Effects of Pain Catastrophizing on Symptom-Specific Physiological Responses in Chronic Low Back Pain Patients  

Microsoft Academic Search

In the present study, we examined whether experimentally-manipulated attentional strategies moderated relations between pain\\u000a catastrophizing and symptom-specific physiological responses to a cold-pressor task among sixty-eight chronic low back patients.\\u000a Patients completed measures of pain catastrophizing and depression, and were randomly assigned to sensory focus, distraction\\u000a or suppression conditions during a cold pressor. Lumbar paraspinal and trapezius EMG, and cardiovascular responses

Phillip J. Quartana; John W. Burns; Kenneth R. Lofland

2007-01-01

408

Fluoroscopic lumbar interlaminar epidural injections in managing chronic lumbar axial or discogenic pain  

PubMed Central

Among the multiple causes of chronic low back pain, axial and discogenic pain are common. Various modalities of treatments are utilized in managing discogenic and axial low back pain including epidural injections. However, there is a paucity of evidence regarding the effectiveness, indications, and medical necessity of any treatment modality utilized for managing axial or discogenic pain, including epidural injections. In an interventional pain management practice in the US, a randomized, double-blind, active control trial was conducted. The objective was to assess the effectiveness of lumbar interlaminar epidural injections of local anesthetic with or without steroids for managing chronic low back pain of discogenic origin. However, disc herniation, radiculitis, facet joint pain, or sacroiliac joint pain were excluded. Two groups of patients were studied, with 60 patients in each group receiving either local anesthetic only or local anesthetic mixed with non-particulate betamethasone. Primary outcome measures included the pain relief-assessed by numeric rating scale of pain and functional status assessed by the, Oswestry Disability Index, Secondary outcome measurements included employment status, and opioid intake. Significant improvement or success was defined as at least a 50% decrease in pain and disability. Significant improvement was seen in 77% of the patients in Group I and 67% of the patients in Group II. In the successful groups (those with at least 3 weeks of relief with the first two procedures), the improvement was 84% in Group I and 71% in Group II. For those with chronic function-limiting low back pain refractory to conservative management, it is concluded that lumbar interlaminar epidural injections of local anesthetic with or without steroids may be an effective modality for managing chronic axial or discogenic pain. This treatment appears to be effective for those who have had facet joints as well as sacroiliac joints eliminated as the pain source. PMID:23055773

Manchikanti, Laxmaiah; Cash, Kimberly A; McManus, Carla D; Pampati, Vidyasagar; Benyamin, Ramsin

2012-01-01

409

Contemporary treatment options for chronic prostatitis/chronic pelvic pain syndrome.  

PubMed

The prostate gland, about the size a walnut, forms part of the male reproductive system and sits directly underneath the bladder surrounding the urethra. It is a fibromuscular exocrine gland that secretes a complex proteolytic fluid which constitutes one-third of the volume of the seminal fluid. Prostatitis refers to a group of disorders that affect the prostate and cause genitourinary pain, dysuria, urinary frequency and sexual dysfunction. The prevalence of prostatitis in the United States has been estimated to be around 9%, while the worldwide prevalence ranges from 2 to 10%, and 15% of men experience prostatitis-like symptoms at some point in their lives. There are a number of treatments which have been used for chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS), with only a small amount of high-level evidence. The current recommended treatment for CP/CPPS is predominantly a multimodal approach using a combination of antibiotics, ?-blockers, antimuscarinic and anti-inflammatory drugs. The response to treatment and improvement in symptoms is very variable; therefore, as the evidence evolves, it is likely that treatment will become symptom specific rather than a generic, 'one strategy fits all' treatment for CP/CPPS. PMID:23914354

Ismail, M; Mackenzie, K; Hashim, H

2013-07-01

410

Liposome bupivacaine for postsurgical pain in an obese woman with chronic pain undergoing laparoscopic gastrectomy: a case report  

PubMed Central

Introduction To reduce incidence and severity of postsurgical pain and minimize the effect of its clinical and economic correlates, multimodal therapy for surgical patients is recommended. In this report, we discuss the use of liposome bupivacaine, a novel multivesicular formulation of bupivacaine indicated for single-dose infiltration into the surgical site to produce postsurgical analgesia, as part of a multimodal analgesic regimen in a patient with a history of chronic pain scheduled to undergo laparoscopic sleeve gastrectomy. To the best of our knowledge, this is the first published report of liposome bupivacaine in the setting of laparoscopic sleeve gastrectomy. Case presentation A 35-year-old white woman with morbid obesity was admitted for laparoscopic sleeve gastrectomy to lose weight prior to hip replacement surgery. Because of a complicated medical history that included rheumatoid arthritis, fibromyalgia, diabetes mellitus, hypertension, and chronic pain, for which she was receiving high doses of opioid analgesics, postsurgical pain management was a concern and she was considered a candidate for multimodal analgesia. At initiation of surgery, 50mL of lidocaine and epinephrine was infiltrated around the port sites. At the conclusion, 25mL of normal sterile saline was added to a 20mL vial of liposome bupivacaine (266mg) and injected around the port sites and at the site of liver retraction. Laparoscopic sleeve gastrectomy was successfully completed. Our patient was discharged to the postanesthesia care unit for approximately four hours before discharge to the surgical floor with a pain score of 5 (11-point scale; 0 = no pain, 10 = worst possible pain). Her postoperative course was uneventful; no adverse events were recorded during surgery or during the remainder of her hospital stay. Our patient was discharged on the same opioid regimen used previously for control of her preexisting chronic pain. Conclusions Liposome bupivacaine use in this morbidly obese patient undergoing laparoscopic sleeve gastrectomy provided analgesic efficacy and limited postsurgical opioids to a level comparable with her baseline opioid regimen for chronic pain. Given her complex medical history and previous issues with acute and chronic pain, we consider these results highly successful and continue to use liposome bupivacaine as part of a multimodal analgesic regimen in an effort to optimize postsurgical pain management. PMID:24450503

2014-01-01

411

Measuring chronic pain intensity among veterans in a residential rehabilitation treatment program.  

PubMed

The purpose of this study was to identify whether veterans with chronic pain, substance abuse, and posttraumatic stress disorder (PTSD) diagnoses residing in a Residential Rehabilitation Treatment Program (RRTP) perceived a higher level of pain than those veterans who had chronic pain but did not have active substance abuse issues or PTSD. A sample of veterans (n = 200) with chronic pain undergoing treatment for either chemical dependency and/or PTSD in an RRTP and a Surgical Specialty Care outpatient clinic at a Department of Veterans Affairs medical center took part in the study. Multiple analysis of variance and further univariate statistics were examined to determine the association between groups on the different scales. There was a considerable difference in terms of which group of veterans perceived a higher rate of pain even with the use of the same four pain assessment scales (i.e., Numeric Rating, Visual Analog, Faces, and Mankoski). Scores were significantly higher for the RRTP group than the Surgical Specialty Care group on all screening measures (p < .001). Veterans with chronic pain, substance abuse, and/or PTSD diagnoses residing in an RRTP tended to have a higher perception of chronic pain compared to those without substance abuse or PTSD diagnoses. PMID:24905756

Randleman, Mary L; Douglas, Mary E; DeLane, Alice M; Palmer, Glen A

2014-01-01

412

The downward spiral of chronic pain, prescription opioid misuse, and addiction: cognitive, affective, and neuropsychopharmacologic pathways.  

PubMed

Prescription opioid misuse and addiction among chronic pain patients are emerging public health concerns of considerable significance. Estimates suggest that more than 10% of chronic pain patients misuse opioid analgesics, and the number of fatalities related to nonmedical or inappropriate use of prescription opioids is climbing. Because the prevalence and adverse consequences of this threat are increasing, there is a pressing need for research that identifies the biobehavioral risk chain linking chronic pain, opioid analgesia, and addictive behaviors. To that end, the current manuscript draws upon current neuropsychopharmacologic research to provide a conceptual framework of the downward spiral leading to prescription opioid misuse and addiction among chronic pain patients receiving opioid analgesic pharmacotherapy. Addictive use of opioids is described as the outcome of a cycle initiated by chronic pain and negative affect and reinforced by opioidergic-dopamingeric interactions, leading to attentional hypervigilance for pain and drug cues, dysfunctional connectivity between self-referential and cognitive control networks in the brain, and allostatic dysregulation of stress and reward circuitry. Implications for clinical practice are discussed; multimodal, mindfulness-oriented treatment is introduced as a potentially effective approach to disrupting the downward spiral and facilitating recovery from chronic pain and opioid addiction. PMID:23988582

Garland, Eric L; Froeliger, Brett; Zeidan, Fadel; Partin, Kaitlyn; Howard, Matthew O

2013-12-01

413

Substance use in children of parents with chronic pain – the HUNT study  

PubMed Central

Purpose The aim of the present study was to investigate possible associations between parental chronic pain and smoking, alcohol, and drug use in adolescent offspring. Methods Cross-sectional data from Nord-Trøndelag Health Study (HUNT 3), a Norwegian population-based health survey conducted in the period 2006–2008 was utilized. The present sample consisted of adolescents aged 13–18 years (n=3,227) for whom information was available on maternal and paternal health statuses. Results Results from multivariable ordinal and binary logistic regression analyses, adjusting for potential confounding factors (child age, parental age, education, and organ specific illness) indicated that the estimated odds ratios (OR) for smoking (OR =1.72, 95% confidence interval [CI] [1.00, 3.05], P=0.049) and alcohol intoxication (drunkenness) (OR =1.56, 95% CI [1.05, 2.33], P=0.029) were higher for boys whose mother and father had chronic pain, compared with boys for whom neither parent had chronic pain. These associations were slightly attenuated by additional adjustment for pain-related factors, such as parental smoking and symptoms of anxiety and depression. Parental chronic pain was not significantly associated with girls’ levels of substance use. There were significant interaction effects between parental chronic pain and child sex on offspring’s alcohol intoxication and smoking. Conclusion The present study expands on existing knowledge and provides groundwork for preventive and specific measures targeting substance use in families burdened with parental chronic pain. PMID:25187735

Kaasbøll, Jannike; Lydersen, Stian; Indredavik, Marit S

2014-01-01

414

Multicenter, Double-Blind, Randomized, Placebo-Controlled, Parallel-Group Study of the Efficacy, Safety, and Tolerability of THC:CBD Extract and THC Extract in Patients with Intractable Cancer-Related Pain  

Microsoft Academic Search

This study compared the efficacy of a tetrahydrocannabinol:cannabidiol (THC:CBD) extract, a nonopioid analgesic endocannabinoid system modulator, and a THC extract, with placebo, in relieving pain in patients with advanced cancer. In total, 177 patients with cancer pain, who experienced inadequate analgesia despite chronic opioid dosing, entered a two-week, multicenter, double-blind, randomized, placebo-controlled, parallel-group trial. Patients were randomized to THC:CBD extract

Jeremy R. Johnson; Mary Burnell-Nugent; Dominique Lossignol; Elena Doina Ganae-Motan; Richard Potts; Marie T. Fallon

2010-01-01

415

[F45.41: chronic pain disorder with somatic and psychological factors : a coding aid].  

PubMed

In 2009, the German version of ICD-10 (ICD-10 GM version 2009) introduced the diagnosis of "chronic pain disorder with somatic and psychological factors", because current ICD-10 diagnoses did not address the biopsychosocial character of chronic pain adequately. For most patients, a dichotomous classification into psychologically versus biomedically caused pain is inappropriate and does not reflect current knowledge on pain. The new code F45.41 addresses the relevance of psychological factors for chronic pain persistence and chronic pain treatment, even in those conditions with a clear biomedical cause at the beginning. This guideline describes how to use this new diagnosis, which boundaries have to be considered, and how comorbid and associated conditions can be classified. The distinction of this new diagnosis from other pain-associated diagnoses and recommendations for the coding of comorbid conditions are presented. The differentiation of everyday pain symptoms from pain disorders is outlined. Finally, contextual factors of the classification process, as well as problems in integrating this new diagnosis into diagnosis-related group (DRG) systems of financial reimbursement are discussed. PMID:20372936

Nilges, P; Rief, W

2010-06-01

416

Effectiveness and safety of topical capsaicin cream in the treatment of chronic soft tissue pain.  

PubMed

Topical capsaicin is an established treatment option for various pain conditions. In a randomized double-blind multi-centre study, 281 patients suffering from chronic soft tissue pain were treated either with a cream containing capsaicin 0.05% ('Finalgon® CPDWärmecreme', n = 140) or placebo (n = 141). Of these, 151 were excluded from the ITT analysis, as they had in addition to their soft-tissue pain, pain of other origin. The primary outcome measure was a positive treatment response, defined as a pain sum score reduction of 30% or more. After 3 weeks of treatment, the median pain sum score had decreased by 49% (capsicum group) and 23% (placebo group) (ITT analysis, p = 0.0006). The odds ratio of the responders in favour for capsaicin was 4.3 (CI 97.5% lower limit 1.9, p < 0.0001). Improvements in the secondary efficacy measures confirmed the results. Likewise, all outcome measures had significantly more improved in the capsaicin-treated compared with the placebo-treated chronic back pain sufferers. All patients were included in the safety assessments. More adverse events occurred in the capsicum group (n = 13) than in the placebo group (n = 6). The capsaicin cream was generally well tolerated. The results indicate that capsaicin cream is useful in patients with chronic soft tissue pain and is also efficacious in patients with chronic back pain for which effectiveness was already demonstrated in earlier clinical trials. PMID:21104944

Chrubasik, S; Weiser, T; Beime, B

2010-12-01

417

Tonic inhibition of chronic pain by neuropeptide Y  

PubMed Central

Dramatically up-regulated in the dorsal horn of the mammalian spinal cord following inflammation or nerve injury, neuropeptide Y (NPY) is poised to regulate the transmission of sensory signals. We found that doxycycline-induced conditional in vivo (Npytet/tet) knockdown of NPY produced rapid, reversible, and repeatable increases in the intensity and duration of tactile and thermal hypersensitivity. Remarkably, when allowed to resolve for several weeks, behavioral hypersensitivity could be dramatically reinstated with NPY knockdown or intrathecal administration of Y1 or Y2 receptor antagonists. In addition, Y2 antagonism increased dorsal horn expression of Fos and phosphorylated form of extracellular signal-related kinase. Taken together, these data establish spinal NPY receptor systems as an endogenous braking mechanism that exerts a tonic, long-lasting, broad-spectrum inhibitory control of spinal nociceptive transmission, thus impeding the transition from acute to chronic pain. NPY and its receptors appear to be part of a mechanism whereby mammals naturally recover from the hyperalgesia associated with inflammation or nerve injury. PMID:21482764

Solway, Brian; Bose, Soma C.; Corder, Gregory; Donahue, Renee R.; Taylor, Bradley K.

2011-01-01

418

A review of evidence about behavioural and psychological aspects of chronic joint pain among people with haemophilia.  

PubMed

Joint pain related to haemophilia affects large numbers of people and has a significant impact on their quality of life. This article reviews evidence about behavioural and psychological aspects of joint pain in haemophilia, and considers that evidence in the context of research on other chronic pain conditions. The aim is to inform initiatives to improve pain self-management among people with haemophilia (PWH). Reduced pain intensity predicts better physical quality of life, so better pain management should lead to improved physical quality of life. Increased pain acceptance predicts better mental quality of life, so acceptance-based approaches to self-management could potentially be adapted for PWH. Pain self-management interventions could include elements designed to: improve assessment of pain; increase understanding of the difference between acute and chronic pain; improve adherence to clotting factor treatment; improve knowledge and understanding about the benefits and costs of using pain medications; improve judgements about what is excessive use of pain medication; increase motivation to self-manage pain; reduce negative emotional thinking about pain; and increase pain acceptance. The influence of behavioural and psychological factors related to pain are similar in haemophilia and other chronic pain conditions, so there should be scope for self-management approaches and interventions developed for other chronic pain conditions to be adapted for haemophilia, provided that careful account is taken of the need to respond promptly to acute bleeding pain by administering clotting factor. PMID:24533948

Elander, J

2014-03-01

419

Chronic Widespread Pain Drawn on a Body Diagram is a Screening Tool for Increased Pain Sensitization, Psycho-Social Load, and Utilization of Pain Management Strategies.  

PubMed

The aim of this study was to investigate the hypothesis that chronic widespread pain, (CWP) drawn by patients on a body diagram, could be used as a screening tool for increased pain sensitization, psycho-social load, and utilization of pain management strategies. The triage questionnaires of 144 adults attending a chronic pain outpatients' clinic were audited and the percentage pain surface area (PPSA) drawn on their body diagrams was calculated using the "rule of nines" (RON) method for burns area assessment. Outcomes were measured using the painDETECT Questionnaire (PD-Q) and other indices and compared using a nonrandomized, case-control method. It was found that significantly more subjects with CWP (defined as a PPSA ? 20%) reported high (? 19) PD-Q scores (suggesting pain "sensitization" or neuropathic pain) (P = 0.0002), "severe" or "extremely severe" anxiety scores on the Depression, Anxiety and Stress Scale-21 Items Questionnaire (P = 0.0270), ? 5 psycho-social stressors (P = 0.0022), ? 5 significant life events (P = 0.0098), and used ? 7 pain management strategies (PMS) (P < 00001), compared to control subjects with a lower PPSA. A Widespread Pain Index score ? 7 (OR = 11.36), PD-Q score ? 19 (OR = 4.46) and use of ? 7 PMS (OR = 5.49) were independently associated with CWP. This study demonstrates that calculating PPSA on a body diagram (using the RON method) is a valid and convenient "snapshot" screening tool to identify patients with an increased likelihood of pain sensitization, psycho-social load, and utilizing pain management resources. PMID:25469881

Visser, Eric J; Ramachenderan, Jonathan; Davies, Stephanie J; Parsons, Richard

2014-12-01

420

Spinal Cord Stimulation for Neuropathic Pain  

PubMed Central

Executive Summary Objective The objective of this health technology policy assessment was to determine the effectiveness of spinal cord stimulation (SCS) to manage chronic intractable neuropathic pain and to evaluate the adverse events and Ontario-specific economic profile of this technology. Clinical Need SCS is a reversible pain therapy that uses low-voltage electrical pulses to manage chronic, intractable neuropathic pain of the trunk or limbs. Neuropathic pain begins or is caused by damage or dysfunction to the nervous system and can be difficult to manage. The prevalence of neuropathic pain has been estimated at about 1.5% of the population in the United States and 1% of the population in the United Kingdom. These prevalence rates are generalizable to Canada. Neuropathic pain is extremely difficult to manage. People with symptoms that persist for at least 6 months or who have symptoms that last longer than expected for tissue healing or resolution of an underlying disease are considered to have chronic pain