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1

[Chronic intrathecal drug administration for the control of intractable pain].  

PubMed

Intrathecal drug administration for the control of intractable pain has been practiced over many years in various countries; however, because of government regulation, no drugs except baclofen are approved for chronic intrathecal use in Japan. In this review, I have summarized the current international situation regarding the chronic intrathecal administration of various types of drugs for the control of intractable cancer and non-cancer pain. Morphine is the gold standard for this purpose, but its combination with local anesthetics or clonidine may be essential. Although this combination has presented strong evidence of cancer pain control, it shows weak evidence of non-malignant chronic pain control, probably because of the complex pathophysiology of the latter condition. A few new drugs such as ziconotide and gabapentin have been investigated, but the effective control of neuropathic pain, including complex regional pain syndrome, still appears difficult. Contrary to the general belief, intrathecal drug administration via an implantable pump is cost-effective, and I believe that this intrathecal drug delivery system should be used more extensively used for pain management in Japan. PMID:18516973

Taira, Takaomi

2008-05-01

2

[Diagnostic and therapeutic devices for patients with chronic intractable pain: preface and comments].  

PubMed

New diagnostic and therapeutic devices for patients with chronic intractable pain are used in Japan. The following articles describe topics of new diagnostic and therapeutic devices for patients with chronic intractable pain including thermography, functional MRI, device for the quantitative analysis of perception and pain sensation, epiduroscopy, device for phototherapy, Racz catheter and device for spinal cord stimulation (SCS). PMID:25098129

Hanaoka, Kazuo

2014-07-01

3

Spinal Cord Stimulation for Intractable Visceral Pain due to Chronic Pancreatitis  

PubMed Central

Pain caused by chronic pancreatitis is medically intractable and resistant to conventional interventional or surgical treatment. We report a case of spinal cord stimulation (SCS) for intractable pain due to chronic pancreatitis. The patient had a history of nonalcoholic chronic pancreatitis and multiple emergency room visits as well as repeated hospitalization including multiple nerve block and morphine injection for 3 years. We implanted surgical lead at T6-8 level on this patient after successful trial of percutaneous electrode. The patient experienced a decreased visual analog scale (VAS) scores for pain intensity and amount of opioid intake. The patient was followed for more than 14 months with good outcome and no further hospitalization. From our clinical case, spinal cord stimulation on intractable pain due to chronic pancreatitis revealed moderate pain control outcome. We suggest that SCS is an effective, noninvasive treatment option for abdominal visceral pain. Further studies and long term follow-up are needed to fully understand the effect of SCS on abdominal visceral pain. PMID:19763221

Kim, Jin Kyung; Hong, Seok Ho; Kim, Myung-Hwan

2009-01-01

4

Evaluation and treatment of chronic intractable rectal pain—A frustrating endeavor  

Microsoft Academic Search

A study was undertaken to assess the evaluation and treatment of chronic intractable rectal pain. Sixty consecutive patients, 23 males and 37 females with a mean age of 69 (range, 29–87) years and a mean length of symptoms of 4.5 years, were evaluated by questionnaire, office examination, anal manometry, electromyography, cinedefecography, and pudendal nerve study. In all cases, organic abdominopelvic

Gow Ching Ger; Steven D. Wexner; J. Marcio N. Jorge; Eleanor Lee; L. Amar Amaranath; Steve Heymen; Juan J. Nogueras; David G. Jagelman

1993-01-01

5

Does laparoscopy used in open exploration alleviate pain associated with chronic intractable abdominal wall neuralgia?  

Microsoft Academic Search

Background  This study aimed to assess the efficacy of diagnostic laparoscopy and open exploration of trigger points (scar revision and\\u000a neurectomy) in the treatment of intractable chronic abdominal wall pain.\\u000a \\u000a \\u000a \\u000a Methods  This prospective nonrandomized study enrolled 24 patients (21 women) with an average age of 59 ± 11 years. Abdominal wall\\u000a pain was diagnosed by excluding other causes of pain and using

H. Paajanen

2006-01-01

6

Patient satisfaction with spinal cord stimulation for predominant complaints of chronic, intractable low back pain  

Microsoft Academic Search

Background context: Results of subsequent surgical intervention in patients with intractable pain after lumbar spine surgery are typically worse than for initial surgery, particularly in those with predominant complaints of back pain rather than lower extremity pain. Spinal cord stimulation (SCS) has been found to yield good results in patients with primary complaints of intractable lower extremity pain. Technological advances

Donna D Ohnmeiss; Ralph F Rashbaum

2001-01-01

7

Spinal cord stimulation for intractable chronic upper abdominal pain: a case report of the first patient in New Zealand.  

PubMed

We present the first patient in New Zealand to undergo Spinal Cord Stimulation (SCS) for intractable upper abdominal pain. The patient was a 53-year-old man with a 20-year history of debilitating upper abdominal pain associated with chronic pancreatitis secondary to pancreatic divisum. Prior to the SCS, he was prescribed 680 mg of morphine sulphate equi-analgesia a day. Despite the intense analgesia, he still suffered monthly attacks of upper abdominal pain requiring hospitalisation. Nine months after implanting a Spinal Cord Stimulator, the monthly attacks ceased, his background pain was effectively controlled and the need for opioids decreased to 510 mg of morphine sulphate equi-analgesia a day. PMID:23321890

Al-Mahrouqi, Haitham; Munro, Zea; Acland, Richard H; MacFarlane, Martin R

2012-12-14

8

Neuraxial (epidural and intrathecal) opioids for intractable pain  

Microsoft Academic Search

1. Neuraxial opioids are considered for use in patients who have resistant intractable pain that fails to respond to other treatment options or pain that responds to analgesia but for which the doses required result in unacceptable side-effects.2. Neuraxial opiods can be considered for both chronic non-malignant pain and chronic cancer-related pain.3. Effectiveness in chronic non-malignant pain and cancer pain

Paul Farquhar-Smith; Suzanne Chapman

2012-01-01

9

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

10

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

11

Decreased Levels of N-Acetylaspartate in Dorsolateral Prefrontal Cortex in a Case of Intractable Severe Sympathetically Mediated Chronic Pain (Complex Regional Pain Syndrome, Type I)  

Microsoft Academic Search

In our previous in vivo proton magnetic resonance spectroscopy (1H MRS) study we found reduced levels of N-acetylaspartate in dorsolateral prefrontal cortex of chronic back pain patients. This study tests whether these chemical abnormalities can be detected in other pain states. Using 1H MRS, we measured levels for N-acetylaspartate and other identifiable chemicals relative to creatine in four bilateral brain

Igor D. Grachev; P. Sebastian Thomas; Tarakad S. Ramachandran

2002-01-01

12

Neuraxial pain relief for intractable cancer pain  

Microsoft Academic Search

Most patients with cancer pain achieve good analgesia using traditional analgesics and adjuvant medications; however, an important\\u000a minority of patients (2% to 5%) suffers from severe and refractory cancer pain. For these individuals, spinal analgesics (intrathecal\\u000a or epidural) provide significant hope for pain relief over months or years of treatment to help improve quality of life. Spinal\\u000a analgesics have been

Paul A. Sloan

2007-01-01

13

Chronic pain.  

PubMed

Essential facts Chronic pain is pain that persists or recurs for more than three months. It may be related to a condition, or may be pain from an injury or operation that continues after healing would usually take place. According to guidance from the Scottish Intercollegiate Guidelines Network (SIGN), around 18 per cent of Europe's population are currently affected by moderate to severe chronic pain. It has a considerable effect on quality of life, and can cause significant suffering and disability. PMID:25783253

2015-03-18

14

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

15

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

16

Chronic pain - resources  

MedlinePLUS

Pain - resources; Resources - chronic pain ... The following organizations are good resources for information on chronic pain: American Chronic Pain Association - www.theacpa.org National Fibromyalgia and Chronic Pain Association - www.fmcpaware.org ...

17

Neuromodulation of the cervical spinal cord in the treatment of chronic intractable neck and upper extremity pain: a case series and review of the literature.  

PubMed

Electrical spinal neuromodulation in the form of spinal cord stimulation is currently used for treating chronic painful conditions such as complex regional pain syndrome, diabetic neuropathy, postherpetic neuralgia, peripheral ischemia, low back pain, and other conditions refractory to more conservative treatments. To date, there are very few published reports documenting the use of spinal cord stimulation in the treatment of head/neck and upper limb pain. This paper reports a case series of 5 consecutive patients outlining the use of spinal cord stimulation to treat upper extremity pain. All subjects had previously undergone cervical fusion surgery to treat chronic neck and upper limb pain. Patients were referred following failure of the surgery to manage their painful conditions. Spinal cord stimulators were placed in the cervical epidural space through a thoracic needle placement. Stimulation parameters were adjusted to capture as much of the painful area(s) as possible. In total, 4 out of 5 patients moved to implantation. In all cases, patients reported significant (70-90%) reductions in pain, including axial neck pain and upper extremity pain. Interestingly, 2 patients with associated headache and lower extremity pain obtained relief after paresthesia-steering reportedly covered those areas. Moreover, 2 patients reported that cervical spinal cord stimulation significantly improved axial low back pain. Patients continue to report excellent pain relief up to 9 months following implantation. This case series documents the successful treatment of neck and upper extremity pain following unsuccessful cervical spine fusion surgery. Given this initial success, prospective, controlled studies are warranted to more adequately assess the long term utility and cost effectiveness of electrical neuromodulation treatment of chronic neck and upper extremity pain. PMID:17387353

Vallejo, Ricardo; Kramer, Jeffery; Benyamin, Ramsin

2007-03-01

18

Oral bismuth for chronic intractable diarrheal conditions?  

PubMed Central

Objective Bismuth has antidiarrheal, antibacterial, and anti-inflammatory properties. We report our single-center experience with oral colloidal bismuth subcitrate (CBS) treatment for patients with chronic intractable diarrhea. Method We interrogated our web-based Inflammatory Bowel Disease Clinical and Research database to ascertain clinical details on all patients in our tertiary hospital gastroenterology service treated with CBS between 2000 and 2010. Treatment responses were based on prospective scoring of daily number of liquid stools. Responses were recorded prior to commencement of CBS and at follow-up visits over 12 months. Results Thirty-one patients, mean age 47 years (range 17–79 years) and a mean duration of diarrhea of 22 weeks (range 6–104 weeks), were prescribed CBS at doses ranging from 120 mg to 480 mg/day for ?1 month. Of these, 23 patients (74%) had an initial clinical response and 12 (39%) who continued with this treatment had a sustained clinical response at 1 year. Twelve patients with pouchitis and four patients with indeterminate colitis had initial responses of 92% and 75%, respectively, and sustained responses of 50% and 75%, respectively. Ulcerative colitis patients (n = 5) responded poorly with respect to both initial and sustained responses. Three patients with microscopic colitis showed encouraging initial response of 100% but did not have any sustained benefit. Three of four patients with diarrhea-predominant irritable bowel syndrome (dIBS) had an initial response and two (50%) had good sustained responses. There were no serious adverse events. One patient stopped therapy because of nausea. Conclusion This is the largest report of oral bismuth treatment in chronic intractable diarrhea. CBS is cheap and appears to have the potential to be effective for ameliorating diarrheal symptoms in indeterminate colitis, pouchitis, and dIBS. An appropriately powered, blinded, randomized, controlled study appears warranted to establish the position of oral bismuth in routine practice. PMID:23515887

Thazhath, Sony S; Haque, Mazhar; Florin, Timothy H

2013-01-01

19

Intractable Abdominal Pain in a Patient With Spinal Cord Injury: A Case Report  

PubMed Central

Patients with spinal cord injury (SCI) may experience several types of chronic pains. Abdominal pain in patients with SCI has gained limited attention and little is yet known about its characteristics and mechanisms. It often has been regarded as visceral pain associated with constipation and distention. Neuropathic pains localized in the abdomen have rarely been reported. We experience a case of intractable abdominal pain in a patient with SCI, neither of visceral pathology nor of musculoskeletal origin. The nature of pain fulfilled the diagnostic criteria for neuropathic pains. The pain was therefore regarded as neuropathic and managed accordingly. The first- and second-line oral drugs available were being performed, unfortunately, adequate pain control was not achieved. We tried an intrathecal lidocaine injection as another treatment option, and the injection had considerable effects. PMID:24236262

Park, Hye Kyung; Song, Dae Heon; Kim, Young Moon; Kim, Hong Geum; Kim, Soo Yeon

2013-01-01

20

Chronic Pain  

MedlinePLUS

... 2002. Reflex Sympathetic Dystrophy/ Complex Regional Pain Syndromes (CRPS): State-of-the-Science A workshop on Reflex Sympathetic Dystrophy/ Complex Regional Pain Syndromes (CRPS): State-of-the-Science, December 15, 2001. Publicaciones ...

21

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

22

What Is Chronic Pain?  

MedlinePLUS Videos and Cool Tools

... Chronic Pain Medications & Treatments The Art of Pain Management What We Have Learned Going to the ER Communication Tools Pain Management Programs Videos Resources Glossary FAQs Surveys September is ...

23

Historic Evolution of Open Cingulectomy and Stereotactic Cingulotomy in the Management of Medically Intractable Psychiatric Disorders, Pain and Drug Addiction  

Microsoft Academic Search

Stereotactic cingulotomy constitutes a psychosurgical procedure nowadays advocated in the treatment of medically intractable obsessive-compulsive disorder, chronic pain and drug addiction. From its theoretical conception to the first cingulectomies performed and modern stereotactic-guided cingulotomies, various target localization methods, different surgical techniques, and numerous lesioning devices have been utilized. In the current article, the authors performed a literature review related to

Alexandros G. Brotis; Eftychia Z. Kapsalaki; Konstantinos Paterakis; Joseph R. Smith; Kostas N. Fountas

2009-01-01

24

Intractable pain due to rectus abdominis intramuscular haemangioma.  

PubMed

Haemangiomas are tumours of vascular origin accounting for approximately 7 % of all benign tumours. Three types of haemangioma have been described according to the vessel type involved: capillary, cavernous and mixed. Intramuscular haemangiomas (IMHs) are infrequent, accounting for less than 1 % of all haemangiomas and are mostly located in the extremities and the trunk. Intramuscular haemangiomas of the rectus abdominis muscle are extremely rare, with only one previous case reported in the literature to the best of our knowledge. In this report, we present the case of a patient with intractable pain related to IMHs of the rectus abdominis and we analyse diagnostic assessment and surgical management of the condition. PMID:23263560

Scozzari, G; Reddavid, R; Conti, L; Trombetta, F; Toppino, M; Sandrucci, S

2014-08-01

25

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

MedlinePLUS

... Print Email Intractable Headache – The pain in Your Head that Just Won’t Quit ACHE Newsletter Sign ... untreatable headache. What is going on in your head when the pain is so resistant to treatment? ...

26

Chronic pain: lost inhibition?  

PubMed

Human brain imaging has revealed that acute pain results from activation of a network of brain regions, including the somatosensory, insular, prefrontal, and cingulate cortices. In contrast, many investigations report little or no alteration in brain activity associated with chronic pain, particularly neuropathic pain. It has been hypothesized that neuropathic pain results from misinterpretation of thalamocortical activity, and recent evidence has revealed altered thalamocortical rhythm in individuals with neuropathic pain. Indeed, it was suggested nearly four decades ago that neuropathic pain may be maintained by a discrete central generator, possibly within the thalamus. In this investigation, we used multiple brain imaging techniques to explore central changes in subjects with neuropathic pain of the trigeminal nerve resulting in most cases (20 of 23) from a surgical event. Individuals with chronic neuropathic pain displayed significant somatosensory thalamus volume loss (voxel-based morphometry) which was associated with decreased thalamic reticular nucleus and primary somatosensory cortex activity (quantitative arterial spin labeling). Furthermore, thalamic inhibitory neurotransmitter content was significantly reduced (magnetic resonance spectroscopy), which was significantly correlated to the degree of functional connectivity between the somatosensory thalamus and cortical regions including the primary and secondary somatosensory cortices, anterior insula, and cerebellar cortex. These data suggest that chronic neuropathic pain is associated with altered thalamic anatomy and activity, which may result in disturbed thalamocortical circuits. This disturbed thalamocortical activity may result in the constant perception of pain. PMID:23616562

Henderson, Luke A; Peck, Chris C; Petersen, Esben T; Rae, Caroline D; Youssef, Andrew M; Reeves, Jenna M; Wilcox, Sophie L; Akhter, Rahena; Murray, Greg M; Gustin, Sylvia M

2013-04-24

27

Employees with Chronic Pain  

MedlinePLUS

Accommodation and Compliance Series: Employees with Chronic Pain By Beth Loy, Ph.D. Preface Introduction Information About Americans with Disabilities Act Accommodating Employees Resources References PDF Version DOC Version Share Introduction ...

28

A case of intractable facial pain secondary to metastatic lung cancer  

Microsoft Academic Search

Persistent idiopathic facial pain, once called atypical facial pain, rarely anticipates the detection of a lung carcinoma.\\u000a Thirty-six cases of intractable facial pain secondary to lung neoplasm are described in the literature. The onset of facial\\u000a pain usually precedes the onset of symptoms and signs due to lung cancer by several months and therefore it should be considered,\\u000a when present,

Silvia Ruffatti; Giorgio Zanchin; Ferdinando Maggioni

2008-01-01

29

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

30

Neuromodulatory approaches to chronic pelvic pain and coccygodynia  

Microsoft Academic Search

Intractable chronic pelvic pain (CPP) despite a multidisciplinary approach is challenging to treat. Every structure in the\\u000a abdomen and\\/or pelvis could have a role in the etiology of CPP. Management of chronic pelvic pain may require a combination\\u000a of interventions, including pharmacological, physical and psychological therapy. Interventions suggested to date include nerve\\u000a blocks (ilioinguinal, iliohypogastric, genitofemoral, hypogastric, presacral) and trigger

Sandesha Kothari

31

Gene Therapy for Chronic Pain  

Microsoft Academic Search

\\u000a Gene therapy shows great potential to assist numerous patients with inadequate relief of inflammatory or neuropathic pain,\\u000a or intractable pain associated with advanced cancer. A brief overview is provided of the methods of gene therapy and of preclinical\\u000a findings in animal models of prolonged inflammatory, neuropathic and cancer pain. Preclinical findings demonstrate no efficacy\\u000a of gene therapy on basal thermal

William R. Lariviere; Doris K. Cope

32

Intracranial ablative procedures for the treatment of chronic pain.  

PubMed

Three main techniques delineate a possible role for intracranial ablative procedures in patients with chronic pain. Recent studies demonstrate a continued need for clinical investigation into central mechanisms of neuroablation to best define its role in the care of patients with otherwise intractable and severe pain syndromes. Cingulotomy can result in long-term pain relief. Although it can be associated with subtle impairments of attention, there is little risk to other cognitive domains. PMID:25240655

Menon, Jayant P

2014-10-01

33

The treatment of chronic pain with psychotropic drugs  

PubMed Central

The treatment is described of thirty patients with chronic nervous system lesion causing intractable pain. Moderately good relief of pain was obtained with a combination of phenothiazines (especially pericyazine), antidepressant drugs and antihistamines. The theoretical implications of this are discussed and it is suggested that the drugs in question act partly by virtue of an effect on the multisynaptic neuronal systems whose activities are related to the experience of pain. PMID:4404064

Merskey, H.; Hester, R. A.

1972-01-01

34

Thoracoscopic renal denervation for intractable autosomal dominant polycystic kidney disease-related pain  

Microsoft Academic Search

The authors report a case of intractable autosomal dominant polycystic kidney disease-related pain associated with normal renal function, treated with renal denervation. Renal denervation was performed via a thoracoscopic approach. The good medium-term result suggests that thoracoscopic sympatho-splanchnicectomy would be an attractive procedure for pain management in autosomal polycystic kidney disease.

Olivier Chapuis; Philippe Sockeel; Gilbert Pallas; François Pons; René Jancovici

2004-01-01

35

Thoracoscopic renal denervation for intractable autosomal dominant polycystic kidney disease-related pain.  

PubMed

The authors report a case of intractable autosomal dominant polycystic kidney disease-related pain associated with normal renal function, treated with renal denervation. Renal denervation was performed via a thoracoscopic approach. The good medium-term result suggests that thoracoscopic sympatho-splanchnicectomy would be an attractive procedure for pain management in autosomal polycystic kidney disease. PMID:14712440

Chapuis, Olivier; Sockeel, Philippe; Pallas, Gilbert; Pons, François; Jancovici, René

2004-01-01

36

Physiology of Chronic Pain  

Microsoft Academic Search

\\u000a \\u000a \\u000a \\u000a \\u000a \\u000a • \\u000a \\u000a \\u000a Chronic pain is the consequence of abnormal nerve sensitivity, firing, and connections.\\u000a \\u000a \\u000a \\u000a • \\u000a \\u000a \\u000a Pain persisting for 3 months is unlikely to resolve spontaneously.\\u000a \\u000a \\u000a \\u000a • \\u000a \\u000a \\u000a Premorbid psychological distress, occupational issues, nicotine use, and a previous pain condition can be used to predict\\u000a the persistence of pain.\\u000a \\u000a \\u000a \\u000a \\u000a • \\u000a \\u000a \\u000a Complete fabrication of pain complaints or malingering occurs rarely.

Dawn A. Marcus

37

Immunoglobulin Responsive Chronic Pain  

Microsoft Academic Search

Introduction  Over the last 15 years, clinical and experimental data have emerged that suggest that peripheral and central, glial-mediated\\u000a neuroimmune activation is both necessary and sufficient to sustain chronic pain. Immune modulation appears to be, therefore,\\u000a a possible new therapeutic option.\\u000a \\u000a \\u000a \\u000a \\u000a Materials and Methods  The Medline database and international trial registry databases were searched using the keywords “intravenous immunoglobulin”\\u000a or “IVIG,” “pain” or

Andreas Goebel

2010-01-01

38

Thoracoscopic Splanchnicectomy for Control of Intractable Pain in Pancreatic Cancer  

Microsoft Academic Search

Background. Pain is the most distressing feature of pancreatic cancer. Thoracoscopic splanchnicectomy, first performed in 1993, has caused a resurgence of interest in surgical treatment of such excruciating pain.Methods. Twenty patients underwent splanchnicectomy for pancreatic cancer pain over a period of 50 months. All were opiate dependent and unable to pursue normal daily life activities. We evaluated the type of

Françoise Le Pimpec Barthes; Olivier Chapuis; Marc Riquet; Jean-François Cuttat; Christophe Peillon; Jérôme Mouroux; René Jancovici

1998-01-01

39

Stress and chronic pelvic pain.  

PubMed

Chronic pelvic pain is the number one reason that patients suffering from irritable bowel syndrome, interstitial cystitis/painful bladder syndrome, vulvodynia, or chronic prostatitis/chronic pelvic pain syndrome seek medical attention. These syndromes generally have no associated pathology or identified underlying etiology, although dysfunction within the immune system, central nervous system, and peripheral nervous system has been identified. Due to the lack of pathology, chronic pelvic pain syndromes are often diagnosed by exclusion, and the high degree of comorbid symptomology among these and other functional pain disorders complicate identifying appropriate treatment strategies. Chronic stress exposure early in life has been shown to increase the likelihood of pelvic pain later in life, and acute stress exposure can induce or increase symptom severity. In this chapter, we describe the individual chronic pelvic pain syndromes and how stress influences the likelihood of diagnosis and the severity of symptoms experienced by patients. PMID:25744684

Pierce, Angela N; Christianson, Julie A

2015-01-01

40

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

41

[Neurosurgical treatment of chronic pain].  

PubMed

Neurosurgical treatment of pain is based on 3 concepts: 1) lesional techniques interrupt the transmission of nociceptive neural input by lesionning the nociceptive pathways (cordotomy, radicotomy...), they are indicated to treat morphine-resistant cancer pain; 2) neuromodulation techniques try to decrease pain by reinforcing inhibitory mechanisms, using chronic electrical stimulation of the nervous system (peripheral nerve stimulation, spinal cord stimulation, motor cortex stimulation...) to treat chronic neuropathic pain; 3) intrathecal infusion of analgesics (morphine, ziconotide), using implantable pumps, allows to increase their efficacy and to reduce their side effects. These techniques can improve, sometimes dramatically, patients with severe and chronic pain, refractory to all other treatments. PMID:23923757

Fontaine, Denys

2013-06-01

42

[Thalamic relay nucleus stimulation for relief of intractable pain. Clinical results and beta-endorphin immunoreactivity in cerebrospinal fluid].  

PubMed

Chronic implantation of a stimulating electrode in the thalamic relay nucleus (11 cases), in the periaqueductal gray (1 case) and in the internal capsule (2 cases) was performed in fourteen cases which suffered from intractable pain. All these cases could get pain relief at least initial two months. Ventricular fluids were collected before and after stimulation with optimal combination of parameters, and measurements of beta-endorphin were performed by radio-immunoassay. Intrathecal morphine (1mg) injection was performed in eight cases. Cerebrospinal fluids were collected by lumbar tap before and 24 hours after morphine injection. beta-endorphin immunoreactivity was measured by the same method. Pain relief was judged to be excellent if the patient so claimed, and if he discontinued analgesics. Pain relief was thought to be good when it was not completely controllable by stimulation but was sufficiently improved that the patient could do without analgesics. It was thought to be fair when patient could not discontinue analgesics, and poor when patient could not get pain relief. We usually attempt to prevent the stimulation-tolerance by administration of the monoamine precursors , i.e., 1-dopa and 1-tryptophan, on the basis of the experimental observation reported previously. In somatogenic pain patients, the thalamic relay nucleus stimulation was performed in 7 cases (excellent; 3, good; 1, fair; 3) and the periaqueductal gray stimulation in one case (good).(ABSTRACT TRUNCATED AT 250 WORDS) PMID:6330600

Tsubokawa, T; Yamamoto, T; Katayama, Y; Nishimoto, H; Hirayama, A; Shibuya, H

1984-03-01

43

Chronic Pain in Holocaust Survivors  

Microsoft Academic Search

There is limited research on the connection between the Holocaust and chronic pain, despite evidence suggesting that medical and psychological sequelae are common in survivors. The goals of this study were: (1) to define Holocaust survivors’ (n = 33) chronic pain characteristics as manifested 50 years after the war, (2) to compare survivors with controls (n = 33) who did

Ariela Yaari; Elon Eisenberg; Rivka Adler; Jesmond Birkhan

1999-01-01

44

Psychologic interventions for chronic pain.  

PubMed

As a biopsychosocial understanding of chronic pain has become more sophisticated during recent decades, a variety of psychologically based treatment approaches have been developed and empirically validated for helping people better manage their pain. These approaches to pain management have much to offer persons with chronic pain in terms of enhancing quality of life and pain-related coping, as well as reducing disability and pain-related interference with functioning. Although some treatments, like hypnotic analgesia, may require referral to a specialized provider, several of the principles of other psychologically based treatment approaches for pain management (eg, operant behavioral therapy, cognitive-behavioral therapy, motivational interviewing) can easily be integrated into work with persons with pain in a rehabilitation setting. Rehabilitation providers who are interested in incorporating these treatment strategies into their clinical work who do not have prior exposure to these approaches are encouraged to review the suggested references and to seek out related training opportunities. PMID:16616275

Osborne, Travis L; Raichle, Katherine A; Jensen, Mark P

2006-05-01

45

Management of Chronic Facial Pain  

PubMed Central

Pain persisting for at least 6 months is defined as chronic. Chronic facial pain conditions often take on lives of their own deleteriously changing the lives of the sufferer. Although much is known about facial pain, it is clear that those physicians who treat these conditions should continue elucidating the mechanisms and defining successful treatment strategies for these life-changing conditions. This article will review many of the classic causes of chronic facial pain due to the trigeminal nerve and its branches that are amenable to surgical therapies. Testing of facial sensibility is described and its utility introduced. We will also introduce some of the current hypotheses of atypical facial pain and headaches secondary to chronic nerve compressions and will suggest possible treatment strategies. PMID:22110799

Williams, Christopher G.; Dellon, A. Lee; Rosson, Gedge D.

2009-01-01

46

Low back pain (chronic)  

PubMed Central

Introduction Over 70% of people in developed countries develop low back pain (LBP) at some time. But recovery is not always favourable: 82% of non recent-onset patients still experience pain 1 year later. Many patients with chronic LBP who were initially told that their natural history was good spend months or years seeking relief. Methods and outcomes We conducted a systematic review and aimed to answer the following clinical questions: What are the effects of oral drug treatments? What are the effects of injection therapy? What are the effects of non-drug treatments? What are the effects of non-surgical and surgical treatments? We searched: Medline, Embase, The Cochrane Library, and other important databases up to April 2009 (Clinical Evidence reviews are updated periodically; please check our website for the most up-to-date version of this review). We included harms alerts from relevant organisations such as the US Food and Drug Administration (FDA) and the UK Medicines and Healthcare products Regulatory Agency (MHRA). Results We found 64 systematic reviews or RCTs that met our inclusion criteria. We performed a GRADE evaluation of the quality of evidence for interventions. Conclusions In this systematic review, we present information relating to the effectiveness and safety of the following interventions: acupuncture, analgesics, antidepressants, back schools, behavioural therapy, electromyographic biofeedback, exercise, injections (epidural corticosteroid injections, facet joint injections, local injections), intensive multidisciplinary treatment programmes, lumbar supports, massage, muscle relaxants, non-steroidal anti-inflammatory drugs (NSAIDs), non-surgical interventional therapies (intradiscal electrothermal therapy, radiofrequency denervation), spinal manipulative therapy, surgery, traction, and transcutaneous electrical nerve stimulation (TENS). PMID:21418678

2010-01-01

47

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

48

Eating disorders and chronic pain  

Microsoft Academic Search

Eating disorders and chronic pain are among the most vexing problems encountered by the clinician.When both problems occur\\u000a concurrently in a patient, adequate assessment and implementation of an effective treatment program become most complex.

Ching King Chieng; Ronald J. Kulich; Scott Streusels

1999-01-01

49

Chronic Pelvic Pain  

MedlinePLUS

... with pain. Such types include relaxation exercises and biofeedback . FREQUENTLY ASKED QUESTIONS FAQ099 GYNECOLOGIC PROBLEMS The American ... pain signals from reaching tissues and organs. Glossary Biofeedback: A technique in which an attempt is made ...

50

Fighting Chronic Pain  

MedlinePLUS

... and inflammation Heart/Blood Vessels: Heart attack, angina, leg pain from clogged arteries Stomach/Digestive: Gallstones, intestinal obstruction, diverticulitis, ulcers, severe indigestion, severe gas pain, inflammatory bowel disease, ...

51

Epidural space and chronic pain  

Microsoft Academic Search

Epidural fibrosis, flogosis, hyperemia and stasis, are some of the pathological morphologies that can be found in the epidural space (ES) of patients affected from failed back surgery syndrome (FBSS), stenosis and other chronic painful pathologies, usually grouped in the class of low back pain (LBP) syndrome. As a consequence of lumbar spine surgery fibrotic tissue commonly replace epidural fat,

William Raffaeli; Donatella Righetti; Jessica Andruccioli; Donatella Sarti

2010-01-01

52

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

53

Free deepithelialized anterolateral thigh myocutaneous flaps for chronic intractable empyema with bronchopleural fistula  

Microsoft Academic Search

Background. Free deepithelialized anterolateral thigh (DALT) flaps have been used for treatment of chronic intractable empyema with bronchopleural fistula at Chang Gung Memorial Hospital since 1997.Methods. Twelve patients with chronic empyema were treated at Chang Gung Memorial Hospital from January 1997 to January 2001. Their age ranged from 31 to 70 years (mean age 48.6 years). Left-sided involvement was predominant

Feng-chou Tsai; Hung-chi Chen; Samuel Huan-tang Chen; Bruno Coessens; Hui-ping Liu; Yi-cheng Wu; Ping-chang Lin

2002-01-01

54

Pharmacologic Management of Chronic Pain  

PubMed Central

Chronic pain is a multifactorial condition with both physical and psychological symptoms, and it affects around 20% of the population in the developed world. In spite of outstanding advances in pain management over the past decades, chronic pain remains a significant problem. This article provides a mechanism- and evidence-based approach to improve the outcome for pharmacologic management of chronic pain. The usual approach to treat mild to moderate pain is to start with a nonopioid analgesic. If this is inadequate, and if there is an element of sleep deprivation, then it is reasonable to add an antidepressant with analgesic qualities. If there is a component of neuropathic pain or fibromyalgia, then a trial with one of the gabapentinoids is appropriate. If these steps are inadequate, then an opioid analgesic may be added. For moderate to severe pain, one would initiate an earlier trial of a long term opioid. Skeletal muscle relaxants and topicals may also be appropriate as single agents or in combination. Meanwhile, the steps of pharmacologic treatments for neuropathic pain include (1) certain antidepressants (tricyclic antidepressants, serotonin and norepinephrine reuptake inhibitors), calcium channel ?2-? ligands (gabapentin and pregabalin) and topical lidocaine, (2) opioid analgesics and tramadol (for first-line use in selected clinical circumstances) and (3) certain other antidepressant and antiepileptic medications (topical capsaicin, mexiletine, and N-methyl-d-aspartate receptor antagonists). It is essential to have a thorough understanding about the different pain mechanisms of chronic pain and evidence-based multi-mechanistic treatment. It is also essential to increase the individualization of treatment. PMID:20556211

Park, Hue Jung

2010-01-01

55

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

56

University receives grant for chronic pain research  

E-print Network

University receives grant for chronic pain research Written by Bryan Bastible WEDNESDAY, 19 for people to deal with chronic pain. Neuronal signals transmitted between the center of a nerve and the brain cause pain. Researchers are trying to inhibit chronic pain, associated with physical conditions

Chiao, Jung-Chih

57

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

58

Chronic Pelvic Pain  

MedlinePLUS

... Us Sign In AAPM&R - American Academy of Physical Medicine and Rehabilitation Physicians Adding Quality to Life ® AAPM& ... pelvic pain, too What you can do: A physical medicine and rehabilitation physician (physiatrist) can evaluate you for ...

59

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.D., Randy L. Gollub, M.D., Ph.D.# ABSTRACT Background: The varying nature of chronic pain (CP) is difficult and radicular pain and matched healthy normal subjects, undergoing identical procedures, participated in three

Napadow, Vitaly

60

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

61

Vicissitudes of pain and suffering: Chronic pain and liminality  

Microsoft Academic Search

This article looks at how the Finnish experience of chronic pain is shaped by socio?cultural practices. Along with the ambiguity that is necessarily present in all chronic illnesses, the invisibility of chronic pain blurs biomedical categorization and confuses diagnostics. This results in a double delegitimation—that of suffering a chronic illness and that of suffering chronic pain—which, obviously, has a serious

2001-01-01

62

American Chronic Pain Association  

MedlinePLUS

... ACPA New resources to help you better communicate with your health care provider Download the app and take part in this clinical trial Opioid Safety - Public Service Announcement Our Mission To facilitate peer support and education for individuals with chronic ...

63

Chronic pain conditions in women.  

PubMed

There are inconsistent data on the age/sex prevalence pattern of back pain and on chest pain. However, it is possible that for chest pain, the rates are higher in younger women and older men. Neck pain, joint pain, and fibromyalgia all appear to increase with age in both genders, whereas abdominal pain and tension-type headaches decrease with age, and migraine headache and TMD appear to peak in the reproductive years. A concluding example illustrates how epidemiologic data can be used to enhance our understanding of the causes of pain. A higher prevalence in women and a peak prevalence during the reproductive years as seen in TMD suggest that either biologic or psychosocial factors unique to women in this period of life could increase the risk of developing or maintaining this pain. As female reproductive hormones can play a role in migraine, at least for some women, it would be interesting to examine whether hormones play a role in TMD. The situation that occurs when menopause is followed by hormone replacement therapy (HRT) provides a natural experiment similar to a laboratory experiment in which female animals are deprived of the natural sources of hormones and then hormones are replaced exogenously. In women, of course, the decision to receive HRT may be associated with a number of psychosocial variables that might also influence pain. Recognizing these limitations, data from records of a large health maintenance organization were examined to ascertain whether use of estrogen or progestin (or both) in postmenopausal women might be associated with the occurrence of TMD pain and, thus, whether the hormone hypothesis might be worthy of further investigation. More women with TMD than controls used estrogen replacement therapy, and slightly more patients than controls used progestin. The use of estrogen significantly increased the odds of having TMD. Progestin use showed a weaker association, which did not hold up after other factors were controlled. However, the risk of TMD appears to increase with increasing doses of estrogen. A review of the epidemiologic literature indicates that there are definite age and sex differences in the prevalence of many chronic pain conditions. There is little basic information about the source of these differences, such as different onset rates, different probabilities of recurrence, or different durations of pain, or combinations of these in women and men. Nevertheless, a systematic examination of the existing epidemiologic data may be an important step in helping pain researchers to generate hypotheses in the search for a better understanding of chronic pain in both sexes. PMID:10326986

Meisler, J G

1999-04-01

64

Chronic pelvic pain in women  

Microsoft Academic Search

Chronic pelvic pain is a major public health problem for women throughout the developed world. The complex innervation of the pelvis and the anatomical proximity of pelvic viscera mean this symptom frequently overlaps traditional medical specialties, leading to diagnostic delay and frequently inadequate treatment. Careful history taking and examination can in itself be therapeutic and will likely identify a number

K Vincent

2009-01-01

65

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

66

Presentation and management of chronic pain.  

PubMed

Chronic pain is an important clinical problem affecting significant numbers of children and their families. The severity and impact of chronic pain on everyday function is shaped by the complex interaction of biological, psychological and social factors that determine the experience of pain for each individual, rather than a straightforward reflection of the severity of disease or extent of tissue damage. In this article we present the research findings that strongly support a biopsychosocial concept of chronic pain, describe the current best evidence for management strategies and suggest a common general pathway for all types of chronic pain. The principles of management of some of the most important or frequently encountered chronic pain problems in paediatric practice; neuropathic pain, complex regional pain syndrome (CRPS), musculoskeletal pain, abdominal pain and headache are also described. PMID:24554056

Rajapakse, Dilini; Liossi, Christina; Howard, Richard F

2014-05-01

67

Endometriosis and Chronic Pelvic Pain  

PubMed Central

Nurses often encounter patients with chronic pelvic pain associated with endometriosis, which is a puzzling and problematic gynecologic condition that has continued to plague women and baffle doctors and researchers worldwide since it was first identified by Dr. J. Sampson in the 1920s (Sampson, 1940). Endometriosis is defined as the growth, adhesion and progression of endometrial glands and stroma outside of the uterine cavity, with cellular activity evident in lesions, nodules, cysts or endometriomas (Audebert et al., 1992). Although it typically appears benign on histopathology, endometriosis has been likened to a malignant tumor since the lesions grow, infiltrate and adhere to adjacent tissues and interfere with physiologic processes (Kitawaki et al., 2002; Noble, Simpson, Johns, & Bulun, 1996). Ectopic endometriotic growths respond to cyclic changes of estrogen and proliferate and shed in a manner similar to eutopic endometrium. This cyclic ectopic activity results in internal bleeding, formation of scar tissue, inflammation and sometimes debilitating chronic pain (Kitawaki et al.). PMID:18837717

Bloski, Terri; Pierson, Roger

2010-01-01

68

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 ...

69

Spinal Cord Simulation for Chronic Pain Management  

E-print Network

payments, and lost produc­ tivity. To ease the suffering of the patients suffering from the chronic painSpinal Cord Simulation for Chronic Pain Management: Towards an Expert System Kenneth M. Al'o 1 , Richard Al'o 2 , Andre de Korvin 2 , and Vladik Kreinovich 3 1 Pain and Health Management Center 17270 Red

Kreinovich, Vladik

70

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

71

Adverse effects of chronic opioid therapy for chronic musculoskeletal pain  

Microsoft Academic Search

The use of opioids for the treatment of chronic pain has increased dramatically over the past decade. Whether these drugs provide considerable benefits in terms of pain reduction and improved function to balance the risks associated with their use, however, is unclear. Of particular importance to clinicians treating chronic musculoskeletal pain is opioid-induced hyperalgesia, the activation of pronociceptive pathways by

Leslie J. Crofford

2010-01-01

72

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 ...

73

Chronic pain transition: a concept analysis.  

PubMed

Chronic pain is common, costly, and potentially disabling. According to the Medical Expenditure Panel Survey in 2008, approximately 100 million adults were affected by chronic pain, with national costs estimated between $560 and $635 billion annually. Published point-prevalence estimates of adult onset chronic pain from population-based surveys vary widely, with worldwide estimates ranging from 2% to over 55% and, within the United States, from 14.6% to 64%. Among patients who seek out a health care professional after initial injury, pain, and function typically improve substantially in the first month; however, those who do not improve account for the bulk of individual and economic burden (Slater et al., 2009). This improvement or lack thereof has been linked to prognostic variables deemed responsible for the transition to chronic pain. The purpose of this analysis is to examine the concept of chronic pain transition in the context of adult onset non-cancer chronic pain. Defining the concept of chronic pain transition is essential to the future of pain research, as chronic pain transition has not been researched in the context provided here. Using Rodgers' inductive method of concept analysis, the concept of chronic pain transition was studied. A random sample of nursing, medical, psychology, and allied health literature published between 1982 and 2012 was analyzed to identify a consensual definition of chronic pain transition. The attributes, antecedents, consequences, related concepts, and surrogate terms of chronic pain transition are described, and the implications of the findings for practice and future research are discussed. PMID:23769800

Larner, Douglas

2014-09-01

74

Chronic low back pain: Progress in therapy  

Microsoft Academic Search

Low back pain is a common complaint in the primary care setting. Although most patients with acute low back pain will improve\\u000a with conservative treatment, back pain often recurs, and a subset of patients will progress to chronic and sometimes disabling\\u000a symptoms. A variety of treatments have been used for chronic low back pain; the best evidence supports intensive rehabilitation

Jerry D. Joines

2006-01-01

75

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

PubMed

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

76

Managing your chronic back pain  

MedlinePLUS

... Society Low Back Pain Guideline Panel. Interventional therapies, surgery, and interdisciplinary rehabilitation for low back pain: an evidence-based clinical practice guideline from the American Pain Society. ...

77

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

78

Biobehavioral pain profile in individuals with chronic spine pain.  

PubMed

Pain in the spine is the most frequently described pain problem in primary care, afflicting at least 54 million Americans. When spinal pain becomes chronic, the prognosis for recovery is poor, often leading to disability and reduced quality of life. Clinical treatment is inadequate, often focusing on physical pathology alone. To improve treatment outcomes for chronic pain as recommended by current guidelines, the Biobehavioral Pain Profile (BPP), which includes six pain response subscales, was developed to guide cognitive behavioral therapy (CBT). The purpose of this study was to describe the BPP in 100 individuals with chronic spine pain and examine the associations between the BPP and important clinical outcomes, including chronic pain, disability, and quality of life. Participants reported a high level of pain, a low quality of life, and a high level of disability despite receiving treatment with opioids. Scores on BPP subscales including evaluating loss of control, past and current experience, physiologic responsivity, and thoughts of disease progression were elevated, indicating a need for CBT. Five of the six BPP subscales had a significant association with quality of life, chronic pain, and disability with the thought of disease progression being a strong factor for most of the clinical outcome variables. By identifying BPP, clinicians can provide appropriate treatments to improve individuals' quality of life and prevent further disability. Further study using the BPP to guide CBT is needed. PMID:24602429

Matteliano, Deborah; Scherer, Yvonne Krall; Chang, Yu-Ping

2014-03-01

79

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

80

Neuroimaging revolutionizes therapeutic approaches to chronic pain  

Microsoft Academic Search

An understanding of how the brain changes in chronic pain or responds to pharmacological or other therapeutic interventions has been significantly changed as a result of developments in neuroimaging of the CNS. These developments have occurred in 3 domains : (1) Anatomical Imaging which has demonstrated changes in brain volume in chronic pain; (2) Functional Imaging (fMRI) that has demonstrated

David Borsook; Eric A Moulton; Karl F Schmidt; Lino R Becerra

2007-01-01

81

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.

82

Chronic neck pain: How to approach treatment  

Microsoft Academic Search

Chronic neck pain is a common patient complaint. Despite its frequency as a clinical problem, there are few evidence-based\\u000a studies that document efficacy of therapies for neck pain. The treatment of this symptom is based primarily on clinical experience.\\u000a Preventing the development of chronic neck pain can be achieved by modification of the work environment with chairs that encourage\\u000a proper

David G. Borenstein

2007-01-01

83

Chronic pain in Australia: a prevalence study  

Microsoft Academic Search

This study reports chronic pain prevalence in a randomly selected sample of the adult Australian population. Data were collected by Computer-Assisted Telephone Interview (CATI) using randomly generated telephone numbers and a two-stage stratified sample design. Chronic pain was defined as pain experienced every day for three months in the six months prior to interview. There were 17,543 completed interviews (response

Fiona M. Blyth; Lyn M. March; Alan J. M. Brnabic; Louisa R. Jorm; Margaret Williamson; Michael J. Cousins

2001-01-01

84

Demographics of Chronic Pain in Children  

Microsoft Academic Search

\\u000a Much of what is thought to be known about chronic pain in the pediatric population has historically been extrapolated from\\u000a the literature and experience in adults. Before the last several decades of the twentieth century, little research focused\\u000a on pain and its management in children, and very little scientific effort addressed issues related to pediatric chronic pain.\\u000a Even now, few

Holly Denise Richter; Stephen Robert Hays

85

Intrathecal drug administration in chronic pain syndromes.  

PubMed

Chronic pain may recur after initial response to strong opioids in both patients with cancer and patients without cancer or therapy may be complicated by intolerable side effects. When minimally invasive interventional pain management techniques also fail to provide satisfactory pain relief, continuous intrathecal analgesic administration may be considered. Only 3 products have been officially approved for long-term intrathecal administration: morphine, baclofen, and ziconotide. The efficacy of intrathecal ziconotide for the management of patients with severe chronic refractory noncancer pain was illustrated in 3 placebo-controlled trials. A randomized study showed this treatment option to be effective over a short follow-up period for patients with pain due to cancer or AIDS. The efficacy of intrathecal opioid administration for the management of chronic noncancer pain is mainly derived from prospective and retrospective noncontrolled trials. The effect of intrathecal morphine administration in patients with pain due to cancer was compared with oral or transdermal treatment in a randomized controlled trial, which found better pain control and fewer side effects with intrathecal opioids. Other evidence is derived from cohort studies. Side effects of chronic intrathecal therapy may either be technical (catheter or pump malfunction) or biological (infection). The most troublesome complication is, however, the possibility of granuloma formation at the catheter tip that may induce neurological damage. Given limited studies, the evidence for intrathecal drug administration in patients suffering from cancer-related pain is more compelling than that of chronic noncancer pain. PMID:24118774

Ver Donck, Ann; Vranken, Jan H; Puylaert, Martine; Hayek, Salim; Mekhail, Nagy; Van Zundert, Jan

2014-06-01

86

[Chronic pain and regional anesthesia in children].  

PubMed

Chronic pain is usually underestimated in children, due to lack of knowledge and its specific signs. In addition to suffering, chronic pain causes a physical, psychological, emotional, social, and financial burden for the child and his family. Practitioners may find themselves in a situation of failure with depletion of medical resources. Some types of chronic pain are refractory to conventional systemic treatment and may require the use of regional anesthesia. Cancer pain is common in children and its medical management is sometimes insufficient. It is accessible to neuroaxial or peripheral techniques of regional anesthesia if it is limited to an area accessible to one of these techniques and no contraindications (e.g., thrombopenia) are present. Complex regional pain syndrome 1 is not rare in children and adolescents, but it often goes undiagnosed. Regional anesthesia may contribute to the treatment of complex regional pain syndrome 1, mainly in case of recurrence, because it provides rapid effective analgesia and allows rapid implementation of intensive physiotherapy. These techniques have also shown interest in phantom limb pain after limb amputation, but they remain controversial for erythromelalgia pain or chronic abdominopelvic pain. Finally, the treatment of postdural puncture headache due to cerebrospinal fluid leak can be treated by performing an epidural injection of the patient's blood, called a blood-patch. Finally, the management of children with chronic pain should be multidisciplinary (pediatrician, physiotherapist, psychologist, surgeon, anesthesiologist) to support the child and her problem in its entirety. PMID:23953871

Dadure, C; Marec, P; Veyckemans, F; Beloeil, H

2013-10-01

87

Chronic Pain and PTSD: A Guide for Patients  

MedlinePLUS

... here Chronic Pain and PTSD: A Guide for Patients Chronic Pain and PTSD: A Guide for Patients What is chronic pain? Chronic pain is when ... consistency when different doctors try to measure a patient's pain. Sometimes the care provider may not believe ...

88

Chronic abdominal pain--a radiological solution.  

PubMed

Chronic mesenteric ischaemia is not an uncommon disorder. It is associated with high morbidity and mortality. It presents with chronic abdominal pain and the diagnosis is often missed because of nonspecific clinical findings and limitations of diagnostic studies. Although surgery has been considered to be the mainstay of treatment, it is associated with significant morbidity. We report two cases of chronic mesenteric ischaemia managed effectively with endovascular therapy with no morbidity and good long term pain relief. PMID:20649103

Jain, Paresh; Gandhi, Vidhyachandra; Marar, Shaji; Nagral, Aabha; Nagral, Sanjay

2010-01-01

89

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

90

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

91

[Interventional pain therapy].  

PubMed

Treatment of intractable chronic pain employs, nerve block, peripheral nerve stimulation, phototherapy, and drug therapy such as opioid and analgesia adjuvant. We also employ multi disciplinary approach with internal medicine, psychiatry and other related fields. In addition, in a portion of intractable chronic back pain, the pain relief is obtained by interventional approaches such as adhesionlysis and the neuroplasty with epiduroscopy as well as spinal cord stimulation therapy. PMID:19039964

Hosokawa, Toyoshi

2008-11-01

92

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

93

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

94

Chronic phantom sensations, phantom pain, residual limb pain, and other regional pain after lower limb amputation  

Microsoft Academic Search

Ehde DM, Czerniecki JM, Smith DG, Campbell KM, Edwards WT, Jensen MP, Robinson LR. Chronic phantom sensations, phantom pain, residual limb pain, and other regional pain after lower limb amputation. Arch Phys Med Rehabil 2000;81:1039-44. Objectives: To determine the characteristics of phantom limb sensation, phantom limb pain, and residual limb pain, and to evaluate pain-related disability associated with phantom limb

Dawn M. Ehde; Joseph M. Czerniecki; Douglas G. Smith; Kellye M. Campbell; W. Thomas Edwards; Mark P. Jensen; Lawrence R. Robinson

2000-01-01

95

Chronic postsurgical pain: prevention and management.  

PubMed

Chronic postsurgical pain (CPSP) is a common problem, with up to a third of patients reporting persistent or intermittent pain 1 year after common operations. A proposed definition is pain that develops after a surgical procedure, which lasts at least 2 months, and where other causes and preexisting pain have been excluded. A variety of preoperative, intraoperative, and postoperative factors are thought to contribute to the pathogenesis of CPSP. Preventive strategies include effective postsurgical acute pain management, preoperative administration of gabapentin or pregabalin continued postoperatively, and considering the necessity of the surgical procedure itself and exploring alternatives. PMID:24552601

Ravindran, Deepak

2014-03-01

96

Chronic low back pain: evaluation and management.  

PubMed

Chronic low back pain is a common problem in primary care. A history and physical examination should place patients into one of several categories: (1) nonspecific low back pain; (2) back pain associated with radiculopathy or spinal stenosis; (3) back pain referred from a nonspinal source; or (4) back pain associated with another specific spinal cause. For patients who have back pain associated with radiculopathy, spinal stenosis, or another specific spinal cause, magnetic resonance imaging or computed tomography may establish the diagnosis and guide management. Because evidence of improved outcomes is lacking, lumbar spine radiography should be delayed for at least one to two months in patients with nonspecific pain. Acetaminophen and nonsteroidal anti-inflammatory drugs are first-line medications for chronic low back pain. Tramadol, opioids, and other adjunctive medications may benefit some patients who do not respond to nonsteroidal anti-inflammatory drugs. Acupuncture, exercise therapy, multidisciplinary rehabilitation programs, massage, behavior therapy, and spinal manipulation are effective in certain clinical situations. Patients with radicular symptoms may benefit from epidural steroid injections, but studies have produced mixed results. Most patients with chronic low back pain will not benefit from surgery. A surgical evaluation may be considered for select patients with functional disabilities or refractory pain despite multiple nonsurgical treatments. PMID:19530637

Last, Allen R; Hulbert, Karen

2009-06-15

97

[Treatment of chronic back pain: current standards].  

PubMed

Back pain is a significant medical problem and one of the most common causes of medical consultations and missed work. In acute low back pain, patients with "red flags" indicating a serious underlying spinal or extraspinal disease must be identified by medical evaluation. Most cases of acute back pain are non-specific, and education, physical activity and pain medication is recommended. In addition, yellow flags (risks of developing chronic pain) should be recognized. The management of low back pain has been addressed by the German National Disease Management Guideline (NVL) low back pain published in 2010. This guideline evaluates the evidence and effectiveness of diagnostic and therapeutic interventions with a focus on nonspecific back pain. For chronic nonspecific low back pain intervention based on nondrug and drug therapy and a multiprofessional assessment is recommended. In patients with chronic inflammatory low back pain with onset before the age of 45, rheumatic spondyloarthritis should be considered. Recently, a guideline (S3-Leitlinie) for the management of axial spondyloarthritis including ankylosing spondylitis has become available. It provides evidence of physical and drug therapy including nonsteroidal antirheumatic and Tumor necrosis factor (TNF) inhibitor therapy. PMID:25465277

Märker-Hermann, E; Kiltz, U; Braun, J

2014-12-01

98

Veterinarians' attitudes to chronic pain in dogs.  

PubMed

Veterinary surgeons in the UK were invited to complete an internet survey concerning their attitudes to chronic pain in dogs. UK veterinary surgeons numbering 215 completed surveys in full along with 48 worldwide specialists in anaesthesia and 37 worldwide specialists in oncology. Osteoarthritis, dental and aural disease, vertebral and spinal cord conditions, neoplasia and skin conditions were considered important causes of chronic pain in dogs. UK practitioners used significantly fewer classes of analgesic drugs regularly than either category of specialist. The major barriers to adequate treatment of chronic pain were reported as difficulties with pain assessment, expense of drugs, and difficulties with owner compliance. Illustrations of six common neoplastic conditions were used and scored for pain according to prior experience by practitioners. All six conditions were consistently described as involving some degree of pain with primary bone tumour and oral tumour, causing severe pain and moderate to severe pain, respectively. Years since graduation and specialist status affected the pain scores attributed to the conditions. There was a significant correlation between the pain score attributed to the illustrated condition, and the tendency to administer analgesia. PMID:25028465

Bell, A; Helm, J; Reid, J

2014-11-01

99

Imagery and emotion in chronic pain   

E-print Network

Psychological factors have important implications for adjustment to chronic pain, which itself has a variety of emotional consequences. Mental imagery has historically been assumed to be closely connected to emotional ...

Lonsdale, Jennifer Helen

2010-11-26

100

Chronic pain syndromes, mechanisms, and current treatments.  

PubMed

Although acute pain is a physiological response warning the human body of possible harm, chronic pain can be a pathological state associated with various diseases or a disease in itself. In the United States alone, around one-third of the population has experienced a chronic pain condition and annual cost to the society is in the range of 500-600 billion dollars.(1) It should be noted that if at all this is a very modest estimate, it surpasses the costs associated with cancer, heart disease, and diabetes combined.(1) Unfortunately, despite these humongous costs, the treatment of chronic pain is inadequate.(1) Chronic pain affects individuals in a variety of forms, and below we highlight some of the most common chronic pain conditions seen in a pain clinic. Most of these disorders are difficult to treat and typically require multimodal therapy including pharmacotherapy, behavioral modification, and targeted interventions. We have summarized the scope of each disorder, clinical features, proposed mechanisms, and current therapies for them (Table 1). PMID:25744686

Sirianni, Justin; Ibrahim, Mohab; Patwardhan, Amol

2015-01-01

101

The Neurobiology of Chronic Pelvic Pain  

Microsoft Academic Search

Chronic pelvic pain is a response of the nervous system to somatic and visceral pathology. Involving multiple pain pathways,\\u000a it is unlikely to be confined to one organ system or to one mechanism. An understanding of the complex neuroanatomy and pathophysiologic\\u000a mechanisms is essential to the treatment of patients presenting with this disorder.

Jennifer Gunter

102

Neuroimaging revolutionizes therapeutic approaches to chronic pain  

PubMed Central

An understanding of how the brain changes in chronic pain or responds to pharmacological or other therapeutic interventions has been significantly changed as a result of developments in neuroimaging of the CNS. These developments have occurred in 3 domains : (1) Anatomical Imaging which has demonstrated changes in brain volume in chronic pain; (2) Functional Imaging (fMRI) that has demonstrated an altered state in the brain in chronic pain conditions including back pain, neuropathic pain, and complex regional pain syndromes. In addition the response of the brain to drugs has provided new insights into how these may modify normal and abnormal circuits (phMRI or pharmacological MRI); (3) Chemical Imaging (Magnetic Resonance Spectroscopy or MRS) has helped our understanding of measures of chemical changes in chronic pain. Taken together these three domains have already changed the way in which we think of pain – it should now be considered an altered brain state in which there may be altered functional connections or systems and a state that has components of degenerative aspects of the CNS. PMID:17848191

Borsook, David; Moulton, Eric A; Schmidt, Karl F; Becerra, Lino R

2007-01-01

103

Chronic neck pain and cervicogenic headaches  

Microsoft Academic Search

Opinion statement  Chronic axial neck pain and cervicogenic headache are common problems, and there have been significant advances in the understanding\\u000a of the etiology and treatment of each. The severity and duration of pain drives the process. For patients who have had slight\\u000a to moderate pain that has been present for less than 6 months and have no significant motor loss,

Frank L. Feng; Jerome Schofferman

2003-01-01

104

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

105

Targeting Astrocyte Signaling for Chronic Pain  

PubMed Central

Summary Clinical management of chronic pain after nerve injury (neuropathic pain) and tumor invasion (cancer pain) is a real challenge due to our limited understanding of the cellular mechanisms that initiate and maintain chronic pain. It has been increasingly recognized that glial cells, such as microglia and astrocytes in the central nervous system play an important role in the development and maintenance of chronic pain. Notably, astrocytes make very close contacts with synapses and astrocyte reaction after nerve injury, arthritis, and tumor growth is more persistent than microglial reaction and displays a better correlation with chronic pain behaviors. Accumulating evidence indicates that activated astrocytes can release proinflammatory cytokines (e.g., IL-1?) and chemokines (e.g., MCP-1/CCL2) in the spinal cord to enhance and prolong persistent pain states. IL-1? can powerfully modulate synaptic transmission in the spinal cord by enhancing excitatory synaptic transmission and suppressing inhibitory synaptic transmission. IL-1? activation (cleavage) in the spinal cord after nerve injury requires the matrix metalloprotease-2 (MMP-2). In particular, nerve injury and inflammation activate the c-Jun N-terminal kinase (JNK) in spinal astrocytes, leading to a substantial increase in the expression and release of MCP-1. MCP-1 increases pain sensitivity via direct activation of NMDA receptors in dorsal horn neurons. Pharmacological inhibition of the IL-1?, JNK, MCP-1, or MMP-2 signaling via spinal administration has been shown to attenuate inflammatory, neuropathic, or cancer pain. Therefore, interventions in specific signaling pathways in astrocytes may offer new approaches for the management of chronic pain. PMID:20880510

Gao, Yong-Jing; Ji, Ru-Rong

2010-01-01

106

TMD and chronic pain: A current view.  

PubMed

This review aims at presenting a current view on the physiopathologic mechanisms associated with temporomandibular disorders (TMDs). While joint pain is characterized by a well-defined inflammatory process mediated by tumor necrosis factor-? and interleukin, chronic muscle pain presents with enigmatic physiopathologic mechanisms, being considered a functional pain syndrome similar to fibromyalgia, irritable bowel syndrome, interstitial cystitis and chronic fatigue syndrome. Central sensitization is the common factor unifying these conditions, and may be influenced by the autonomic nervous system and genetic polymorphisms. Thus, TMDs symptoms should be understood as a complex response which might get worse or improve depending on an individual's adaptation. PMID:25741834

Furquim, Bruno D'Aurea; Flamengui, Lívia Maria Sales Pinto; Conti, Paulo César Rodrigues

2015-01-01

107

TMD and chronic pain: A current view  

PubMed Central

This review aims at presenting a current view on the physiopathologic mechanisms associated with temporomandibular disorders (TMDs). While joint pain is characterized by a well-defined inflammatory process mediated by tumor necrosis factor-? and interleukin, chronic muscle pain presents with enigmatic physiopathologic mechanisms, being considered a functional pain syndrome similar to fibromyalgia, irritable bowel syndrome, interstitial cystitis and chronic fatigue syndrome. Central sensitization is the common factor unifying these conditions, and may be influenced by the autonomic nervous system and genetic polymorphisms. Thus, TMDs symptoms should be understood as a complex response which might get worse or improve depending on an individual's adaptation. PMID:25741834

Furquim, Bruno D'Aurea; Flamengui, Lívia Maria Sales Pinto; Conti, Paulo César Rodrigues

2015-01-01

108

Pharmacogenetics of Chronic Pain and Its Treatment  

PubMed Central

This paper reviews the impact of genetic variability of drug metabolizing enzymes, transporters, receptors, and pathways involved in chronic pain perception on the efficacy and safety of analgesics and other drugs used for chronic pain treatment. Several candidate genes have been identified in the literature, while there is usually only limited clinical evidence substantiating for the penetration of the testing for these candidate biomarkers into the clinical practice. Further, the pain-perception regulation and modulation are still not fully understood, and thus more complex knowledge of genetic and epigenetic background for analgesia will be needed prior to the clinical use of the candidate genetic biomarkers. PMID:23766564

Sv?tlík, Svatopluk; Hronová, Karolína; Bakhouche, Hana; Matoušková, Olga; Slana?, Ond?ej

2013-01-01

109

The use of cannabinoids in chronic pain.  

PubMed

We present the case of a 56-year-old man who developed chronic pain following the excision of a facial cancer that was poorly controlled despite multiple analgesic medications. Following the starting of nabilone (a synthetic cannabinoid) his pain control was greatly improved and this had a huge impact on his quality of life. We also managed to significantly reduce his doses of opioid analgesia and ketamine. We review the current literature regarding the medicinal use of cannabinoids, with an emphasis on chronic pain, in an attempt to clarify their role and how to select patients who may benefit from this treatment. PMID:23893276

Reynolds, Timothy David; Osborn, Hannah Louise

2013-01-01

110

Prevalence of facet joint pain in chronic spinal pain of cervical, thoracic, and lumbar regions  

Microsoft Academic Search

BACKGROUND: Facet joints are a clinically important source of chronic cervical, thoracic, and lumbar spine pain. The purpose of this study was to systematically evaluate the prevalence of facet joint pain by spinal region in patients with chronic spine pain referred to an interventional pain management practice. METHODS: Five hundred consecutive patients with chronic, non-specific spine pain were evaluated. The

Laxmaiah Manchikanti; Mark V Boswell; Vijay Singh; Vidyasagar Pampati; Kim S Damron; Carla D Beyer

2004-01-01

111

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

112

Surgical Treatment for Chronic Pelvic Pain  

PubMed Central

The source of chronic pelvic pain may be reproductive organ, urological, musculoskeletal - neurological, gastrointestinal, or myofascial. A psychological component almost always is a factor, whether as an antecedent event or presenting as depression as result of the pain. Surgical interventions for chronic pelvic pain include: 1) resection or vaporization of vulvar/vestibular tissue for human papillion virus (HPV) induced or chronic vulvodynia/vestibulitis; 2) cervical dilation for cervix stenosis; 3) hysteroscopic resection for intracavitary or submucous myomas or intracavitary polyps; 4) myomectomy or myolysis for symptomatic intramural, subserosal or pedunculated myomas; 5) adhesiolysis for peritubular and periovarian adhesions, and enterolysis for bowel adhesions, adhesiolysis for all thick adhesions in areas of pain as well as thin ahesions affecting critical structures such as ovaries and tubes; 6) salpingectomy or neosalpingostomy for symptomatic hydrosalpinx; 7) ovarian treatment for symptomatic ovarian pain; 8) uterosacral nerve vaporization for dysmenorrhea; 9) presacral neurectomy for disabling central pain primarily of uterine but also of bladder origin; 10) resection of endometriosis from all surfaces including removal from bladder and bowel as well as from the rectovaginal septal space. Complete resection of all disease in a debulking operation is essential; 11) appendectomy for symptoms of chronic appendicitis, and chronic right lower quadrant pain; 12) uterine suspension for symptoms of collision dyspareunia, pelvic congestion, severe dysmenorrhea, cul-desac endometriosis; 13) repair of all hernia defects whether sciatic, inguinal, femoral, Spigelian, ventral or incisional; 14) hysterectomy if relief has not been achieved by organ-preserving surgery such as resection of all endometriosis and presacral neurectomy, or the central pain continues to be disabling. Before such a radical step is taken, MRI of the uterus to confirm presence of adenomyosis may be helpful; 15) trigger point injection therapy for myofascial pain and dysfunction in pelvic and abdominal muscles. With application of all currently available laparoscopic modalities, 80% of women with chronic pelvic pain will report a decrease of pain to tolerable levels, a significant average reduction which is maintained in 3-year follow-up. Individual factors contributing to pain cannot be determined, although the frequency of endometriosis dictates that its complete treatment be attempted. The beneficial effect of uterosacral nerve ablation may be as much due to treatment of occult endometriosis in the uterosacral ligaments as to transection of the nerve fibers themselves. The benefit of the presacral neurectomy appears to be definite but strictly limited to midline pain. Appendectomy, herniorraphy, and even hysterectomy are all appropriate therapies for patients with chronic pelvic pain. Even with all laparoscopic procedures employed, fully 20% of patients experience unsatisfactory results. In addition, these patients are often depressed. Whether the pain contributes to the depression or the depression to the pain is irrelevant to them. Selected referrals to an integrated pain center with psychologic assistance together with judicious prescription of antidepressant drugs will likely benefit both women who respond to surgical intervention and those who do not. A maximum surgical effort must be expended to resect all endometriosis, restore normal pelvic anatomy, resect nerve fibers, and treat surgically accessible disease. In addition, it is important to provide patients with chronic pelvic pain sufficient psychologic support to overcome the effects of the condition, and to assist them with underlying psychologic disorders. PMID:9876726

1998-01-01

113

Chronic pain as a reticular formation syndrome.  

PubMed

Evidence was previously presented to support the thesis that chronic pain is activated by neuronal elements that make up the multisynaptic short axon core of the reticular system (Andy and Peeler 1985). The present thesis, that chronic pain is a reticular formation syndrome, is based on a retrospective analysis of four patients with chronic pain who were successfully treated with a lesion in the anterior thalamus and stimulation electrode implants in the posterior thalamus and pontomesencephalic brain stem. The reticular formation was the common underlying anatomic substrate at those three sites. In addition to chronic pain, all the patients had other symptoms attributable to other body organs and systems. The number and type of symptoms that made up the syndrome differed between patients. Symptoms making up the core of the syndrome were pain, anxiety, nervousness, insomnia, and depression. Experimental and clinical findings are briefly presented to demonstrate the various reticular formation sites, pragmatically considered "reticular functional systems," from which symptoms may arise. It is hypothesized that the symptoms are recruited by a low threshold "pain oscillator" that is generated at one reticular site and subsequently permeates the rest of the reticular system. Therapeutic stimulation inactivates the low threshold system by "jamming" it. PMID:3487065

Andy, O J

1986-01-01

114

Adenosine for pain relief in a patient with intractable secondary erythromelalgia  

Microsoft Academic Search

An unusual case is reported with severe erythromelalgia secondary to a sensorimotor polyneuropathy of immunological aetiology. The dominating symptoms were ongoing burning dysesthesia and pain in the legs, sustained thermal hyperalgesia and allodynia to pressure which produced intolerable pain on standing and walking. The primary pain-producing pathophysiology was apparently peripheral neurogenic inflammation with sensitization and excitation of nociceptors. The variable

U. Lindblom; L.-O. Nordfors; A. Sollevi; O. Sydow

1997-01-01

115

The cortical rhythms of chronic back pain INTRODUCTION  

E-print Network

and patients suffering for chronic back pain (CBP) ·We find that CBP is associated with specific changesThe cortical rhythms of chronic back pain 1051 OHBM 2011 INTRODUCTION · Compared with normal individuals, the brain of chronic pain patients is never truly at rest, due to the continuous pain percept

Apkarian, A. Vania

116

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

117

Identification and Validation of Brazilian Chronic Pain Descriptors  

Microsoft Academic Search

Appropriate pain assessment is very important for managing chronic pain. Given the cultural differences in verbally expressing pain and in psychosocial problems, specific tools are needed. The goal of this study was to identify and validate Brazilian pain descriptors. A purposive sample of health professionals and chronic pain patients was recruited. Four studies were conducted using direct and indirect psychophysical

Roberta Cardoso; Fatima Ap. E. Faleiros Sousa

2009-01-01

118

Staying Fit with Chronic Pain  

MedlinePLUS

... can aggravate high blood pressure or lead to heart failure . But if taking those medications means a patient can keep moving, the risks can be outweighed by the health benefits of exercise, Dr. Bonow said. If pain medication is needed, ...

119

Spiritual Coping with Chronic Pain   

E-print Network

Intro The object of this study was to investigate the relationship between an individual’s spiritual beliefs and how that affected their pain in those with arthritis. It focused mainly on the coping strategies they chose ...

Henderson, Kevin

2008-06-26

120

Pulsed radiofrequency for chronic pain.  

PubMed

Pulsed radiofrequency (PRF), a technology related to continuous radiofrequency, is unique in that it provides pain relief without causing significant damage to nervous tissue. The mechanism by which PRF controls pain is unclear, but it may involve a temperature-independent pathway mediated by a rapidly changing electrical field. Although much anecdotal evidence exists in favor of PRF, there are few quality studies substantiating its utility. PMID:18417022

Byrd, David; Mackey, Sean

2008-01-01

121

Spouse Beliefs about Partner Chronic Pain  

PubMed Central

While research has shown that patients’ beliefs about their pain are related to pain adjustment and treatment outcomes, little is known about the beliefs of their significant others. The purpose of this study was to develop a measure of pain beliefs in significant others and to examine the correlates of these beliefs. Participants were 104 married couples in which one partner reported chronic pain. Spouses completed an amended version of the Survey of Pain Beliefs (SOPA)14. The scale development procedure described in Jensen et al.12 was used to select appropriate items for the significant other version of the SOPA. This procedure yielded 7 subscales that closely resembled the original SOPA. Spousal pain beliefs about disability, emotion, control, and medication were significantly correlated with partners’ pain severity and other indicators of pain adjustment. Emotion, disability, and other beliefs were related to spouse responses to pain, and spouses’ depressive symptoms and marital dissatisfaction. Spouses’ personal experiences with pain were not related to their beliefs about their partners’ pain. Additional research on the pain-related beliefs of significant others may extend cognitive-behavioral theory concerning the social context of pain and provide an additional avenue through which clinicians can address cognition in patients and families. Perspective: This study describes a new measure that can be used to assess significant others’ beliefs about their partners’ pain problems. Little is known about the beliefs of family members so this measure is expected to provide a way for clinicians and researchers to assess and track changes in those beliefs. PMID:19345155

Cano, Annmarie; Miller, Lisa Renee; Loree, Amy

2009-01-01

122

Chronic neuropathic pain: issues in patient education.  

PubMed

Chronic neuropathic pain is difficult to diagnose and treat. For the patient, multiple aspects of his or her life may be altered, including physical, emotional, and spiritual health, as well as the ability to work, and family and social relationships. Successful treatment plans require more than just pharmacotherapy. Patients often need to receive a lot of information about complex regimens related to both pharmacologic and nonpharmacologic strategies. Additionally, patients with neuropathic pain need nursing support and guidance to help them master the self-management and coping skills required to minimize pain flares, while optimizing mood and functioning. A number of specific strategies are available based on the cognitive-behavioral model. These include the ability to interpret changes in pain in a helpful way, engagement in health promoting behaviors (including diet and exercise), and the development of an action plan for coping with pain exacerbations. A central element in this approach is to help patients become experts in understanding and managing their pain, then addressing the toll it has taken on their emotions, daily activities, and important relationships. Self-initiated techniques, such as relaxation, imagery, and hypnosis, can also be used to alter the subjective experience of pain. This article presents an overview of patient education approaches useful in the management of chronic pain. PMID:15644857

Arnstein, Paul

2004-12-01

123

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 14 days, 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 30 days 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) 10 min 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

124

Radiologic evaluation of chronic foot pain.  

PubMed

Chronic foot pain is a common and often disabling clinical complaint that can interfere with a patient's routine activities. Despite careful and detailed clinical history and physical examination, providing an accurate diagnosis is often difficult because chronic foot pain has a broad spectrum of potential causes. Therefore, imaging studies play a key role in diagnosis and management. Initial assessment is typically done by plain radiography; however, magnetic resonance imaging has superior soft-tissue contrast resolution and multiplanar capability, which makes it important in the early diagnosis of ambiguous or clinically equivocal cases when initial radiographic findings are inconclusive. Computed tomography displays bony detail in stress fractures, as well as in arthritides and tarsal coalition. Bone scanning and ultrasonography also are useful tools for diagnosing specific conditions that produce chronic foot pain. PMID:17956067

Joong, Mo Ahn; El-Khoury, Georges Y

2007-10-01

125

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

126

A sailor's pain: Veterans' musculoskeletal disorders, chronic pain, and disability.  

PubMed

A few years after leaving the navy, a 50-year-old Veteran* presents to a new family physician with chronic knee and back pain. He is seeking a new physician for opioid and benzodiazepine refills, referrals for ongoing acupuncture and massage therapy, and completion of Veteran Affairs Canada (VAC) disability claim forms for his back. He was medically released at the rank of Petty Officer owing to knee impairment secondary to a fracture sustained aboard ship. He twice strained his back on deployments, but did not develop chronic low back pain until after leaving the Canadian Forces (CF). On release from the CF he completed comprehensive medical, psychosocial, and vocational rehabilitation in the VAC Rehabilitation Program for disability related to his knee impairment. Lately, chronic low back pain prevents him from continuing civilian employment and enjoying life.The physician takes the Veteran's history, performs appropriate physical examination and diagnostic investigations, and obtains previous medical records. The physician diagnoses chronic mechanic allow back pain and knee osteoarthritis, and is concerned about the Veteran's mental health. When the family physician tries to explore the mental health differential diagnosis, the Veteran initially becomes upset,but he responds to motivational interviewing. The physician books follow-up appointments to develop a therapeutic relationship with the Veteran and completes the VAC forms. With consent, the physician also sends a referral letter to the VAC district office, outlining the Veteran's health issues. The client is found to be eligible to re-enter the VAC Rehabilitation Program to manage disability related to his back pain. The Veteran is ultimately able to withdraw from chronic opiate and benzodiazepine medications and optimize his participation in life. PMID:19910593

Thompson, James M; Chiasson, Roland; Loisel, Patrick; Besemann, Lt Col Markus; Pranger, Tina

2009-11-01

127

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

128

Pain and depression in acute traumatic spinal cord injury: Origins of chronic problematic pain?  

Microsoft Academic Search

Objective: To examine the relationship between pain and depression over time during acute phases of traumatic spinal cord injury (SCI). Theoretical models of the pain-depression relationship provided a framework: (1) pain causes depression; (2) depression causes pain; (3) pain and depression are independent sequelae to SCI. Understanding the pain-depression relationship provides treatment implications and bypotheses for origins of chronic pain

Douglas M. Cairns; Rodney H. Adkins; Michael D. Scott

1996-01-01

129

The pharmacotherapy of chronic pain: A review  

PubMed Central

The past two decades have contributed a large body of preclinical work that has assisted in our understanding of the underlying pathophysiological mechanisms that cause chronic pain. In this context, it has been recognized that effective treatment of pain is a priority and that treatment often involves the use of one or a combination of agents with analgesic action. The current review presents an evidence-based approach to the pharmacotherapy of chronic pain. Medline searches were done for all agents used as conventional treatment in chronic pain. Published papers up to June 2005 were included. The search strategy included randomized, controlled trials, and where available, systematic reviews and meta-analyses. Further references were found in reference sections of papers located using the above search strategy. Agents for which there were no controlled trials supporting efficacy in treatment of chronic pain were not included in the present review, except in cases where preclinical science was compelling, or where initial human work has been positive and where it was thought the reader would be interested in the scientific evidence to date. PMID:16511612

Lynch, Mary E; Watson, C Peter N

2006-01-01

130

Cholelithiasis Presented as Chronic Right Back Pain  

PubMed Central

Chronic right back pain is a symptom in both biliary lithiasis and chronic cholecystitis. Ten percent of the population in the world suffers from biliary lithiasis. Only 20% are symptomatic. The first diagnostic test of choice is an abdominal ultrasound. When a suggestive clinical sign of biliary colic with negative abdominal ultrasound is identified, we should consider the option of carrying out an endoscopic ultrasound in order to rule out microlithiasis. The case discussed in the report presented with chronic right back pain, which is an atypical manifestation of biliary lithiasis and chronic cholecystitis. It is important to know about the atypical manifestations of the prevalent illnesses as well as the limits of the diagnostic tests, in order to avoid diagnostic delays which may cause complications that could worsen a patient's prognosis. This case should contribute to the medical knowledge and must have educational value or highlight the need for a change in clinical practice, especially in primary care. PMID:25657967

Bobé-Armant, Francesc; Buil-Arasanz, Maria Eugenia; Trubat-Muñoz, Griselda; Llor-Vilà, Carles; Vicente-Guillen, Vicente

2014-01-01

131

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

132

Psychosocial Subgroups, Coping, and Chronic Low-Back Pain  

Microsoft Academic Search

The purpose of this study was to compare psychosocial subgroups in terms of pain coping strategies, pain severity, physical impairment, pain behavior, affective distress, and response to pain management treatment. The Multidimensional Pain Inventory (MPI) was used to classify 67 chronic low-back pain (CLBP) patients into the following psychosocial subgroups: Dysfunctional, Interpersonally Distressed, Adaptive Coping, and Anomalous. These MPI subgroups

Timothy P. Carmody

2001-01-01

133

Opioid Therapy for Chronic Pain  

Microsoft Academic Search

pium is a bitter, brown, granular powder derived from the seedpod of the poppy ( Papaver somniferum ). People have used opium for the re- lief of pain and suffering for thousands of years. Before the 19th century, opi- um was cultivated and used chiefly in the Middle East, whereas in Europe and the United States it was a luxury

Jane C. Ballantyne; Jianren Mao

2003-01-01

134

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

135

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

136

Ziconotide for treatment of severe chronic pain.  

PubMed

Pharmacological management of severe chronic pain is difficult to achieve with currently available analgesic drugs, and remains a large unmet therapeutic need. The synthetic peptide ziconotide has been approved by the US Food and Drug Administration and the European Medicines Agency for intrathecal treatment of patients with severe chronic pain that is refractory to other treatment modalities. Ziconotide is the first member in the new drug class of selective N-type voltage-sensitive calcium-channel blockers. The ziconotide-induced blockade of N-type calcium channels in the spinal cord inhibits release of pain-relevant neurotransmitters from central terminals of primary afferent neurons. By this mechanism, ziconotide can effectively reduce pain. However, ziconotide has a narrow therapeutic window because of substantial CNS side-effects, and thus treatment with ziconotide is appropriate for only a small subset of patients with severe chronic pain. We provide an overview of the benefits and limitations of intrathecal ziconotide treatment and review potential future developments in this new drug class. PMID:20413151

Schmidtko, Achim; Lötsch, Jörn; Freynhagen, Rainer; Geisslinger, Gerd

2010-05-01

137

Imaging brain mechanisms in chronic visceral pain.  

PubMed

Chronic visceral pain syndromes are important clinical problems with largely unmet medical needs. Based on the common overlap with other chronic disorders of visceral or somatic pain, mood and affect, and their responsiveness to centrally targeted treatments, an important role of central nervous system in their pathophysiology is likely. A growing number of brain imaging studies in irritable bowel syndrome, functional dyspepsia, and bladder pain syndrome/interstitial cystitis has identified abnormalities in evoked brain responses, resting state activity, and connectivity, as well as in gray and white matter properties. Structural and functional alterations in brain regions of the salience, emotional arousal, and sensorimotor networks, as well as in prefrontal regions, are the most consistently reported findings. Some of these changes show moderate correlations with behavioral and clinical measures. Most recently, data-driven machine-learning approaches to larger data sets have been able to classify visceral pain syndromes from healthy control subjects. Future studies need to identify the mechanisms underlying the altered brain signatures of chronic visceral pain and identify targets for therapeutic interventions. PMID:25789437

Mayer, Emeran A; Gupta, Arpana; Kilpatrick, Lisa A; Hong, Jui-Yang

2015-04-01

138

Coping with Chronic Pain: Assessing Narrative Approaches.  

ERIC Educational Resources Information Center

Discusses a project developed to gain understanding of the experiences of people suffering from a chronic pain condition with no visible symptoms. Results suggest that narrative approaches helped participants find their own strengths and means of coping and helped them find identities other than as patients. (RJM)

Kelley, Patricia; Clifford, Patrick

1997-01-01

139

Mindfulness-Based Stress Reduction for Chronic Pain Management  

Microsoft Academic Search

\\u000a Pain is a common complaint in primary care, with chronic pain reported in 20% of visits to general practitioners (McCaffrey\\u000a et al., 2003). Twenty percent of adults suffer from chronic pain, rising to half of those of the older age population (Cousins\\u000a et al., 2004). Chronic pain, defined as “intermittent or continuous pain persisting longer than six months or beyond

Jacqueline Gardner-Nix; Jon Kabat-Zinn

140

Therapeutic options for chronic prostatitis\\/chronic pelvic pain syndrome  

Microsoft Academic Search

Chronic prostatitis\\/chronic pelvic pain syndrome continues to pose a treatment challenge for urologists. Most commonly prescribed\\u000a medications, such as antibiotics, ?-blockers, androgen inhibitors, and anti-inflammatory agents, have been shown to help some\\u000a patients. However, the efficacy and durability of such treatments lack consistency among men suffering from this disorder.\\u000a The rationale for such treatments is described in this article, along

Jeannette M. Potts

2005-01-01

141

Thoracic meningioma masquerading as chronic abdominal pain.  

PubMed

Chronic abdominal pain without a structural or metabolic gastroenterological etiology can be extremely challenging to diagnose. Patients presenting with an associated radicular pattern of pain may alert the clinician to a possible structural neurological cause of the symptoms. We present the case of a 70-year-old woman who presented to our institution with an 18-month history of right upper quadrant abdominal pain. She had no associated symptoms or provoking factors. She underwent an extensive gastroenterology evaluation, including colonoscopy that was unrevealing. Ultrasound demonstrated gallstones and she was evaluated for cholecystectomy. She subsequently developed right costal margin pain. Her symptoms remained stable over the course of the next year. Follow-up general surgical evaluation was still unconvincing that the gallstones were the etiology of her symptoms. A thoracic spinal MR demonstrated a large intradural extramedullary mass at T8. The patient's neurological exam was normal. She underwent a thoracic laminectomy and resection of meningioma with intraoperative electrophysiological monitoring. Her abdominal pain resolved. Patients can present with months to years of elusive abdominal symptoms only to be eventually found to be harboring an undiagnosed spinal tumor. We discuss the case and review the literature reports of spinal tumors masquerading as chronic abdominal pain. PMID:22665009

Lyons, Mark; Windgassen, Elizabeth; Kinney, Carolyn; Johnson, Daniel; Birch, Barry; Boucher, Orland

2012-01-01

142

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

143

Clinical Study The Brain in Chronic CRPS Pain  

E-print Network

Neuron Clinical Study The Brain in Chronic CRPS Pain: Abnormal Gray-White Matter Interactions.neuron.2008.08.022 SUMMARY Chronic complex regional pain syndrome (CRPS) is a debilitating pain condition related to pain intensity and duration, the strength of connectivity between specific atrophied regions

Apkarian, A. Vania

144

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

145

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

146

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

Microsoft Academic Search

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

Marijtje L. A. Jongsma; Simone A. E. Postma; Pierre Souren; Martijn Arns; Evian Gordon; Kris Vissers; Oliver Wilder-Smith; Clementina M. van Rijn; Harry van Goor

2011-01-01

147

A review of perinatal acute pain: treating perinatal pain to reduce adult chronic pain  

Microsoft Academic Search

Changes in neural connections and activity after an acute insult are hypothesised to contribute to chronic pain syndromes\\u000a in mature experimental animals and humans. Over the last decade, studies have suggested that exposure to repeated painful\\u000a procedures during the early perinatal period results in profound changes in sensitivity of nociceptive pathways. Both animal\\u000a and human studies show that early pain

D. A. Marcus

2006-01-01

148

Successful management of chronic pelvic pain.  

PubMed

Chronic pelvic pain is a common, multifactorial complaint that affects both women and men, causing disability and frustration for patients. The exact aetiology remains unknown, although several theories have been proposed. Assessment should be undertaken with care and compassion, while considering the sensitive nature of the area. Management involves ruling out treatable pathology concomitant with strategies to control pain. Novel treatment approaches have been investigated for specific clinical scenarios. The more severe CPP cases are best managed using a multidisciplinary approach. Management requires good integration and knowledge of all pelvic organ systems and including musculoskeletal, neurologic and psychological mechanisms. PMID:23909900

Rhodin, Annica

2013-08-01

149

Behavioral Concepts in the Analysis of Chronic Pain Syndromes.  

ERIC Educational Resources Information Center

Reviews behavioral and psychological concepts currently applied to the assessment and treatment of chronic pain syndromes, including operant conditioning and psychophysiologic concepts such as the stress-pain hypothesis, the pain-muscle spasm-pain cycle, and the neuromuscular pain model. Discusses relaxation and biofeedback training and concepts…

Keefe, Francis J.; Gil, Karen M.

1986-01-01

150

Successful laparoscopic exploration and screw extraction for intractable pain after anterior iliosacral arthrodesis.  

PubMed

We report on the case of a patient suffering from L5 radicular pain after previous anterior sacroiliac arthrodesis using 2, 4-hole plates. Technical investigations indicated loosening and migration of a screw from the upper sacroiliac plate, irritating the L5 nerve root. The problem was managed by removal of the screw using an anterior transperitoneal laparoscopic approach. PMID:20871241

Peeters, Geert; Geert, Peeters; Govaers, Kris; Kris, Govaers; Himpens, Jacques; Jacques, Himpens

2010-10-01

151

siRNA relieves chronic neuropathic pain  

PubMed Central

Double stranded, short interfering RNAs (siRNA) of 21–22 nt length initiate a sequence-specific, post-trancriptional gene silencing in animals and plants known as RNA interference (RNAi). Here we show that RNAi can block a pathophysiological pain response and provide relief from neuropathic pain in a rat disease model by down regulating an endogenous, neuronally expressed gene. Rats, intrathecally infused with a 21 nt siRNA perfectly complementary to the pain-related cation-channel P2X3, showed diminished pain responses compared to missense (MS) siRNA-treated and untreated controls in models of both agonist-evoked pain and chronic neuropathic pain. This form of delivery caused no adverse effects in any of the animals receiving P2X3 siRNA, MS siRNA or vehicle. Molecular analysis of tissues revealed that P2X3 mRNA expressed in dorsal root ganglia, and P2X3 protein translocated into the dorsal horn of the spinal cord, were significantly diminished. These observations open a path toward use of siRNA as a genetic tool for drug target validation in the mammalian central nervous system, as well as for proof of concept studies and as therapeutic agents in man. PMID:15026538

Dorn, Gabriele; Patel, Sadhana; Wotherspoon, Glen; Hemmings-Mieszczak, Maja; Barclay, Jane; Natt, Francois J. C.; Martin, Pierre; Bevan, Stuart; Fox, Alyson; Ganju, Pam; Wishart, William; Hall, Jonathan

2004-01-01

152

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

153

Minimally Invasive Therapies for Chronic Pelvic Pain Syndrome  

Microsoft Academic Search

Chronic pelvic pain syndrome (CPPS) is a common problem among men and women worldwide. It is a symptoms-complex term for interstitial\\u000a cystitis\\/painful bladder syndrome in women and chronic prostatitis\\/chronic pelvic pain syndrome in men. Patients often present\\u000a with a combination of lower urinary tract symptoms with pelvic pain and sexual dysfunction. No gold standard exists for diagnosis\\u000a or treatment of

Salim A. Wehbe; Jennifer Y. Fariello; Kristene Whitmore

2010-01-01

154

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

155

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

156

Cognitive and emotional control of pain and its disruption in chronic pain.  

PubMed

Chronic pain is one of the most prevalent health problems in our modern world, with millions of people debilitated by conditions such as back pain, headache and arthritis. To address this growing problem, many people are turning to mind-body therapies, including meditation, yoga and cognitive behavioural therapy. This article will review the neural mechanisms underlying the modulation of pain by cognitive and emotional states - important components of mind-body therapies. It will also examine the accumulating evidence that chronic pain itself alters brain circuitry, including that involved in endogenous pain control, suggesting that controlling pain becomes increasingly difficult as pain becomes chronic. PMID:23719569

Bushnell, M Catherine; Ceko, Marta; Low, Lucie A

2013-07-01

157

Quercetin for chronic prostatitis/chronic pelvic pain syndrome.  

PubMed

Chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) is a common condition with a heterogeneous origin that responds best to multimodal therapy. The bioflavonoid quercetin has antioxidant and antiinflammatory effects that have proven useful for treating this condition. Using the clinical phenotype system UPOINT, quercetin can be helpful for those with organ-specific complaints (bladder or prostate) and pelvic floor spasm. This article discusses the current understanding of CP/CPPS and how treatment with quercetin can be used alone or as part of multimodal therapy. PMID:21798389

Shoskes, Daniel A; Nickel, J Curtis

2011-08-01

158

Muscle Tenderness in Men With Chronic Prostatitis\\/Chronic Pelvic Pain Syndrome: The Chronic Prostatitis Cohort Study  

Microsoft Academic Search

Purpose: Myofascial pain is a possible etiology for category III chronic prostatitis\\/chronic pelvic pain syndrome, either secondary to infection\\/inflammation or as the primary cause. We documented tenderness on physical examination in a large multicenter cohort of patients with chronic pelvic pain syndrome and compared to controls. Materials and Methods: Data were reviewed from the National Institutes of Health Chronic Prostatitis

Daniel A. Shoskes; Richard Berger; Angelo Elmi; J. Richard Landis; Kathleen J. Propert

159

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 ...

160

Presleep Cognitions in Patients with Insomnia Secondary to Chronic Pain  

Microsoft Academic Search

This study had two primary objectives: (1) characterize the content of presleep cognitions of chronic pain patients and (2) evaluate the association between presleep cognitions and sleep disturbance. Thirty-one outpatients with benign chronic pain completed the Beck Depression Inventory, pain and sleep diaries and participated in an in vivo, presleep thought sampling procedure for 1 week in their homes. The

M. T. Smith; M. L. Perlis; T. P. Carmody; M. S. Smith; D. E. Giles

2001-01-01

161

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

162

Classification of chronic pain associated with spinal cord injuries  

Microsoft Academic Search

Cardenas DD, Turner JA, Warms CA, Marshall HM. Classification of chronic pain associated with spinal cord injuries. Arch Phys Med Rehabil 2002;83:1708-14. Objectives: To determine interrater reliability of a classification system for chronic pain in persons with spinal cord injury (SCI) and to determine the frequency and characteristics of various pain types as categorized by this system. Design: Independent categorization

Diana D. Cardenas; Judith A. Turner; Catherine A. Warms; Helen M. Marshall

2002-01-01

163

Transdermal fentanyl as treatment for chronic low back pain  

Microsoft Academic Search

Management of chronic low back pain often includes oral opioid use. The effectiveness of therapy is dependent upon compliance, which in turn is dependent upon response, side effects, access, and convenience. Our hypothesis was that a transdermal fentanyl system would provide more effective pain management than oral opioids. Fifty patients with chronic low back pain were examined. After titration to

Richard K. Simpson; Everton A. Edmondson; Charles F. Constant; Connie Collier

1997-01-01

164

Difficult Cases of Pain and Nonpain Symptoms in Intractable Spinal Infections: A Case Series  

PubMed Central

In the modern age of advanced surgical techniques and pharmacologic management, bacterial spinal infections (SIs) can be managed (either eradicated or suppressed) in many hosts. However, the optimal management of SIs may be limited by patient comorbidities, which do not allow for surgical management, or limited by antimicrobial options due to side effects, toxicities, or emerging drug resistance. In these settings, frank and honest discussion regarding risks and benefits of treatment should be pursued, including that the SI may be a terminal illness. In this case series, we present 3 patients who had bacterial SIs whose treatments were limited by the above-mentioned factors. Furthermore, each case presented challenges regarding optimal medical management of somatic and neuropathic pain associated with the SI. PMID:22144661

Olsen, Molly L.; Havyer, Rachel D. A.; Smith, Thomas J.; Swetz, Keith M.

2014-01-01

165

Chemokines: Integrators of Pain and Inflammation  

Microsoft Academic Search

Chronic (neuropathic) pain is one of the most widespread and intractable of human complaints, as well as being one of the most difficult syndromes to treat successfully with drugs or surgery. The development of new therapeutic approaches to the treatment of painful neuropathies requires a better understanding of the mechanisms that underlie the development of these chronic pain syndromes. It

Fletcher A. White; Sonia K. Bhangoo; Richard J. Miller

2005-01-01

166

Myofascial dysfunction associated with chronic pelvic floor pain: Management strategies  

Microsoft Academic Search

Myofascial pain as a cause of chronic pelvic pain with or without pelvic organ pathology is well-documented in the literature.\\u000a Causes of this pain are multifactorial, including specific pelvic organ pathologies, neuromuscular disorders, and psychologic\\u000a causes. Management of this myofascial component of chronic pelvic pain involves a multidisciplinary approach including physicians,\\u000a physical therapists, neurologists, and psychiatrists. Treatment strategies, including behavioral

Arun K. Srinivasan; Jonathan D. Kaye; Robert Moldwin

2007-01-01

167

Breakthrough pain in chronic non-cancer pain: fact, fiction, or abuse.  

PubMed

Treatment of chronic non-cancer pain with opioid therapy has escalated in recent years, resulting in exploding therapeutic use and misuse of prescription opioids and multiple adverse drug events. Breakthrough pain is defined as a transient exacerbation of pain experienced by individuals who have relatively stable and adequately controlled baseline cancer pain. Further, the definition of breakthrough pain, prevalence, characteristics, implications, and treatment modalities have been extensively described for chronic cancer pain. However, the literature for breakthrough pain in chronic non-cancer pain including its terminology, prevalence, relevance, characteristics, and treatments, have been poorly described and continue to be debated. The philosophy of breakthrough pain in chronic non-cancer pain raises multiple issues leading almost all patients to be on high dose long-acting opioids, followed by supplementing with short-acting drugs, instead of treating the patients with only short-acting drugs as required. Consequently, the subject of breakthrough pain in chronic non-cancer pain is looked at with suspicion due to the lack of evidence and inherent bias associated with its evaluation, followed by escalating use and abuse of opioids. Multiple issues related to the concept of breakthrough pain in chronic non-cancer pain evolve around extensive use, overuse, misuse, and abuse of opioids. In the era of eliminating opioids or significantly curtailing their use to only appropriate indications, the concept of breakthrough pain raises multiple questions without any scientific evidence. This review illustrates that there is no significant evidence for any type of breakthrough pain in chronic non-cancer pain based on available literature, methodology utilized, and response to opioids in chronic non-cancer pain. The advocacy for increased usage of opioids in the treatment of chronic pain dates back to the liberalization of laws governing opioid prescription for the treatment of chronic non-cancer pain by state medical boards in the late 1990s, and is exploding with new pain management standards for inpatient and outpatient medical care implemented by the Joint Commission on Accreditation of Health Care Organizations in 2000, and the advocacy by many physicians and organizations for increased use of opioids. This comprehensive review critically evaluates the available evidence of breakthrough pain in chronic non-cancer pain including its existence, prevalence, and managing symptoms which are described as breakthrough pain or episodic pain. PMID:21412376

Manchikanti, Laxmaiah; Singh, Vijay; Caraway, David L; Benyamin, Ramsin M

2011-01-01

168

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

169

Epidemiology of chronic pain in Denmark: an update.  

PubMed

The most recent Danish health survey of 2005 is based on a region-stratified random sample of 10.916 individuals. Data were collected via personal interviews and self-administrated questionnaires. Respondents suffering from chronic pain were identified through the question 'Do you have chronic/long-lasting pain lasting 6 months or more?' The prevalence of chronic pain among individuals with a present or earlier cancer diagnosis was also assessed. In all, 7275 individuals (66.6%) completed a personal interview and 5552 individuals (50.9% of the original sample) completed and returned the self-administrated questionnaire. The same questions were included in the survey in 2000 and, hence, it was possible to evaluate the trends in the past five years. In all, 20.2% of the adult Danish population has chronic pain. From year 2000-2005 the prevalence of chronic pain has remained stable. Generally, chronic pain was associated with female gender and increasing age. Higher prevalence of chronic pain were associated with being divorced, separated or widowed, having less than 10 years of education and high BMI. Musculoskeletal diseases (66.8%) were the most common cause for chronic pain and most persons with chronic pain rated their health and quality of life as poor. Persons with earlier or present cancer diagnosis were more likely to report chronic pain. A substantial part of persons with chronic pain were not satisfied with the examinations and treatments offered. In conclusion, over a five-year period the prevalence of chronic pain in Denmark has remained stable, but high. PMID:18547844

Sjøgren, Per; Ekholm, Ola; Peuckmann, Vera; Grønbaek, Morten

2009-03-01

170

Necrotic arachnidism and intractable pain from recluse spider bites treated with lumbar sympathetic block: a case report and review of literature.  

PubMed

Brown recluse (Loxosceles reclusa) spider bites mainly occur in the southern and Midwestern United States. The clinical manifestation of brown recluse spider bites varies from skin irritation, a small area of tissue damage to neuropathic pain, necrotic arachnidism and severe systemic reactions such as acute renal failure and even death. Treatment is controversial and nonspecific. We describe a case of extensive right lower extremity tissue necrosis and intractable neuropathic pain treated with lumbar sympathetic block in a patient with a documented brown recluse spider bite. Both his pain and tissue necrosis improved significantly with lumbar sympathetic block with local anesthetic. After a series of lumbar sympathetic blocks, his symptoms resolved and lower extremity wound healed rapidly. We discuss the benefit of sympathetic blockade not only for neuropathic pain but also possibly as a treatment for necrotic arachnidism from a brown recluse spider bite. PMID:21317774

Yi, Xiaobin; AuBuchon, Jacob; Zeltwanger, Shawn; Kirby, John P

2011-06-01

171

Emotional and neurobehavioural status in chronic pain patients  

PubMed Central

OBJECTIVE: To investigate the emotional and neurobehavioural status of patients suffering from chronic pain. METHODS: Fifteen male patients with chronic lower back pain and 15 healthy control subjects were studied for approximately six months. Pain was measured using a visual analogue scale. The WHO Neurobehavioral Core Test Battery (NCTB) was used to assess neurobehavioural effects of environmental and occupational exposures. RESULTS: Visual analogue scale results demonstrated a modest range of reported pain (mean [± SD] 62.0±10.8) in chronic pain patients, whereas control subjects reported no measurable pain. With the NCTB, it was found that scores of negative mood state, including anger-hostility, depression-dejection, fatigue-inertia and tension-anxiety in pain patients were significantly higher than scores in the control subjects. By contrast, scores of positive mood state (vigour-activity) in chronic pain patients were lower than those in the control group. The NCTB scores of the Santa Ana Dexterity and Pursuit Aiming II tests in chronic lower back pain patients were lower than those of the control group. Scores for other NCTB sub-tests, including the Digit Span, Benton Visual Retention and Digit Symbol tests, were not significantly different compared with controls. CONCLUSIONS: Chronic lower back pain patients had more negative mood and less positive mood than controls. These patients also demonstrated neuromotor deficits in coordination and reaction time. Further studies are required to examine possible neurological mechanisms and research potential intervention strategies for patients suffering from chronic pain. PMID:21369540

Shuchang, He; Mingwei, He; Hongxiao, Jia; Si, Wu; Xing, Yang; Antonius, Daniel; Opler, Mark GA

2011-01-01

172

Treatment for Chronic Pain in Patients With Advanced Cancer  

ClinicalTrials.gov

Chronic Myeloproliferative Disorders; Leukemia; Lymphoma; Multiple Myeloma and Plasma Cell Neoplasm; Myelodysplastic Syndromes; Pain; Precancerous/Nonmalignant Condition; Small Intestine Cancer; Unspecified Adult Solid Tumor, Protocol Specific

2010-11-07

173

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

174

Neuropathic pain (NeP) is pain resulting from nervous tissue damage. It is chronic,  

E-print Network

Why? Neuropathic pain (NeP) is pain resulting from nervous tissue damage. It is chronic, affects disturbances likely to be associated with neuropathic pain in your dog. ·Test thermal and pressure thresholds-neuropathic pain to establish the range of threshold in normal dogs for standardisation. Clipping off fur in small

Burn, Charlotte

175

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 and honest with each other. Opioids are part of a pain management program, not the entire plan. Patients benefits of opioids include on average a 30% reduction in pain relief for those conditions for which

Haykin, Simon

176

The risk of suicide mortality in chronic pain patients.  

PubMed

Chronic pain has long been considered an important risk factor for suicidal behavior. Less well understood are the factors associated with the increased risk for suicide death within chronic pain populations. The purpose of this review is to examine recent research with regard to rates of and risk factors for suicide mortality in patients with chronic musculoskeletal pain. We conclude that patients with a number of chronic pain states are at increased risk for suicide death, and that this risk appears to be due, at least in part, to other well-known correlates of pain such as depression and substance use disorders. However, in all likelihood, there are aspects of chronic pain itself that add uniquely to an individual's suicide risk profile. Lastly, we address a theoretical perspective and offer recommendations for clinical practice. PMID:24952608

Hassett, Afton L; Aquino, Jordan K; Ilgen, Mark A

2014-08-01

177

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

178

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

179

Living successfully with pain: The role of illness representations, catastrophising and acceptance in chronic pain functioning   

E-print Network

In the past fifty years psychological factors have been shown to influence adjustment to chronic pain. Research demonstrates that individuals’ internal representations of pain and the processes of catastrophising (focusing ...

Bose, Sujata

2007-01-01

180

Peripheral nerve stimulation for chronic neurogenic pain.  

PubMed

Peripheral nerve stimulation (PNS) has been used for the treatment of neuropathic pain for more than 40 years. Recent interest in the utilization of this technique stems from the many modifications of the original procedure and the refinement of the available hardware. This rendered the procedure less traumatic and more effective, and thus more widely accepted as a neuromodulation technique for the treatment of various chronic pain syndromes including post-traumatic and postsurgical neuropathy, occipital neuralgia, and complex regional pain syndromes, and in relatively new indications for neuromodulation, such as migraines and daily headaches, cluster headaches. We present a review of the principle and indications for the use of PNS, and review our single institution experience that comprises 24 peripheral nerve stimulators as well as 8 occipital nerve stimulators over 13 years. We review the protocol of our approach including the surgical nuances for our implantation technique. Collaborative efforts in future research will lead to a growth in our clinical experience with the utilization of PNS and will help in identifying the best candidates for it. This, along with the development and refinement of the available hardware would lead to a more specific patient selection for each modality of treatment, increasing the efficacy and success of the intended treatment. PMID:21422774

Al-Jehani, Hosam; Jacques, Line

2011-01-01

181

Is number sense impaired in chronic pain patients?  

PubMed Central

Background Recent advances in imaging have improved our understanding of the role of the brain in painful conditions. Discoveries of morphological changes have been made in patients with chronic pain, with little known about the functional consequences when they occur in areas associated with ‘number-sense’; thus, it can be hypothesized that chronic pain impairs this sense. Methods First, an audit of the use of numbers in gold-standard pain assessment tools in patients with acute and chronic pain was undertaken. Secondly, experiments were conducted with patients with acute and chronic pain and healthy controls. Participants marked positions of numbers on lines (number marking), before naming numbers on pre-marked lines (number naming). Finally, subjects bisected lines flanked with ‘2’ and ‘9’. Deviations from expected responses were determined for each experiment. Results Four hundred and ninety-four patients were audited; numeric scores in the ‘moderate’ and ‘severe’ pain categories were significantly higher in chronic compared with acute pain patients. In experiments (n=150), more than one-third of chronic pain patients compared with 1/10th of controls showed greater deviations from the expected in number marking and naming indicating impaired number sense. Line bisection experiments suggest prefrontal and parietal cortical dysfunction as cause of this impairment. Conclusions Audit data suggest patients with chronic pain interpret numbers differently from acute pain sufferers. Support is gained by experiments indicating impaired number sense in one-third of chronic pain patients. These results cast doubts on the appropriateness of the use of visual analogue and numeric rating scales in chronic pain in clinics and research. PMID:25082664

Wolrich, J.; Poots, A. J.; Kuehler, B. M.; Rice, A. S. C.; Rahman, A.; Bantel, C.

2014-01-01

182

Images of pain: Exploration of the characteristics and functions of pain-related mental imagery in chronic pain   

E-print Network

Introduction A recent study by Potter et al. (in submission) reported that many chronic pain sufferers experience a spontaneous mental image of their pain, and that these individuals also report higher levels of anxiety ...

Gosden, Thomas

2008-01-01

183

Health-related quality of life and pain beliefs among people suffering from chronic pain  

Microsoft Academic Search

Chronic pain, when not effectively treated and relieved, may have a harmful effect on all aspects of health-related quality of life (HRQL). Furthermore, pain beliefs are considered an important mediating psychological factor in chronic pain. The present study focused on HRQL as measured by the Medical Outcomes Survey-Short Form (SF-36) and addressed possible relationships between pain beliefs as measured by

Elin Dysvik; Torill Christine Lindstrøm; Ole-Johan Eikeland; Gerd Karin Natvig

2004-01-01

184

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

185

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

PubMed

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

2014-01-01

186

Chronic Pain Rehabilitation: A Challenge for Mental Health Counselors.  

ERIC Educational Resources Information Center

Presents overview of multiple factors affecting the life style of chronic pain patients, with an emphasis on assessment and rehabilitation. Focuses on chronic pain rehabilitation, including assessment, treatment, and evaluation of the rehabilitation outcome with the understanding that the goal of therapy is to restore the patient as closely as…

Finn, Paul E.

1988-01-01

187

Implantable Intrathecal Pumps for Chronic Pain: Highlights and Updates  

Microsoft Academic Search

Management of chronic pain by intrathecal delivery is gaining increas- ing use. The aim of this article is to review the literature pertinent to implantable devices used for treatment of chronic pain, and to high- light what is known. Articles were obtained from Medline database and reviewed. Practical patient selection criteria, trial management, and surgical technique are described. Expert consensus

Karen H. Knight; Frances M. Brand; Ali S. Mchaourab; Giorgio Veneziano

188

Chronic pain and pain-related disability across psychiatric disorders in a clinical adolescent sample  

PubMed Central

Background People who suffer from psychiatric disorders are burdened with a high prevalence of chronic illnesses and pain, but evidence on pain prevalence among adolescents with psychiatric disorders is scarce. The aim of this study was to investigate the frequency and location of self-reported chronic pain and pain-related disability in adolescent psychiatric patients. Methods This study was part of the larger Health Survey administered at the Department of Child and Adolescent Psychiatry (CAP) at St. Olav’s University Hospital, in Trondheim, Norway. All patients aged 13–18 years who visited the CAP clinic at least once between February 15, 2009 and February 15, 2011 were invited to participate. A total of 717 (43.5% of eligible/invited patients) participated; of these, 566 were diagnosed with one or more psychiatric disorders. The adolescents completed a questionnaire, which included questions about pain and pain-related disability. Clinical diagnoses were classified by a clinician according to International Statistical Classification of Diseases and Related Health Problems, 10th revision criteria. Results In adolescents with psychiatric disorders, 70.4% reported chronic pain, and 37.3% experienced chronic pain in three or more locations (multisite pain). Chronic musculoskeletal pain was the most prevalent type of pain (57.7%). Pain-related disability was found in 22.2% of the sample. The frequency of chronic pain and multisite pain increased with age, and girls reported a higher frequency of chronic pain, multisite pain and pain-related disability than boys did. There was an increased risk of chronic pain among adolescents with mood or anxiety disorders versus those with hyperkinetic disorders, yet this was not present after adjusting for sex. Comorbidity between hyperkinetic and mood or anxiety disorders involved an increased risk of pain-related disability. Conclusions In this study, seven out of 10 adolescents with psychiatric disorders reported chronic pain. These findings indicate the importance of early detection of chronic pain in adolescents with psychiatric disorders, to provide targeted treatment and reduce poor long-term outcomes. PMID:24139217

2013-01-01

189

Chronic pain: the role of learning and brain plasticity.  

PubMed

Based on theoretical considerations and recent observations, we argue that continued suffering of chronic pain is critically dependent on the state of motivational and emotional mesolimbic-prefrontal circuitry of the brain. The plastic changes that occur within this circuitry in relation to nociceptive inputs dictate the transition to chronic pain, rendering the pain less somatic and more affective in nature. This theoretical construct is a strong departure from the traditional scientific view of pain, which has focused on encoding and representation of nociceptive signals. We argue that the definition of chronic pain can be recast, within the associative learning and valuation concept, as an inability to extinguish the associated memory trace, implying that supraspinal/cortical manipulations may be a more fruitful venue for adequately modulating suffering and related behavior for chronic pain. We briefly review the evidence generated to date for the proposed model and emphasize that the details of underlying mechanisms remain to be expounded. PMID:23603439

Mansour, A R; Farmer, M A; Baliki, M N; Apkarian, A Vania

2014-01-01

190

Pathological and protective roles of glia in chronic pain  

PubMed Central

Glia have emerged as key contributors to pathological and chronic pain mechanisms. On activation, both astrocytes and microglia respond to and release a number of signalling molecules, which have protective and/or pathological functions. Here we review the current understanding of the contribution of glia to pathological pain and neuroprotection, and how the protective, anti-inflammatory actions of glia are being harnessed to develop new drug targets for neuropathic pain control. Given the prevalence of chronic pain and the partial efficacy of current drugs, which exclusively target neuronal mechanisms, new strategies to manipulate neuron–glia interactions in pain processing hold considerable promise. PMID:19096368

Milligan, Erin D.; Watkins, Linda R.

2009-01-01

191

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

192

Chronic prostatitis and sensory urgency: Whose pain is it?  

Microsoft Academic Search

Difficulties encountered in diagnosing and effectively treating chronic prostatitis\\/chronic pelvic pain syndrome (CP\\/CPPS)\\u000a is frustrating for clinicians and patients. Scientific evidence cannot establish an exact relationship between the prostate\\u000a and the symptoms of CP\\/CPPS, and the prostate continues to be the diagnosis of convenience in this complex syndrome in men.\\u000a However, if the pain is not the prostate’s, whose pain

Ricardo R. Gonzalez; Alexis E. Te

2004-01-01

193

Factors associated with chronic musculoskeletal pain in patients with chronic kidney disease  

PubMed Central

Background Chronic musculoskeletal (MS) pain is common in patients with chronic kidney disease (CKD) undergoing haemodialysis. However, epidemiological data for chronic MS pain and factors associated with chronic MS pain in patients with early- or late-stage CKD who are not undergoing dialysis are limited. Method A cross-sectional study to evaluate the prevalence of chronic MS pain and factors associated with chronic MS pain in patients with early- and late-stage CKD who were not undergoing dialysis, was conducted. In addition, the distribution of pain severity among patients with different stages of CKD was evaluated. Results Of the 456 CKD patients studied, 53.3% (n?=?243/456) had chronic MS pain. Chronic MS pain was independently and significantly associated with hyperuricemia as co-morbidity, as well as with the calcium?×?phosphate product levels. In CKD patients with hyperuricemia, chronic MS pain showed a negative, independent significant association with diabetes mellitus as a co-morbidity (odds ratio: 0.413, p?=?0.020). However, in the CKD patients without hyperuricemia as a co-morbidity, chronic MS pain showed an independent significant association with the calcium?×?phosphate product levels (odds ratio: 1.093, p?=?0.027). Furthermore, stage-5 CKD patients seemed to experience more severe chronic MS pain than patients with other stages of CKD. Conclusion Chronic MS pain is common in CKD patients. Chronic MS pain was independently and significantly associated with hyperuricemia as co-morbidity, and with the calcium?×?phosphate product levels in early- and late-stage CKD patients who were not on dialysis. PMID:24400957

2014-01-01

194

Is Treating Chronic Pain Torture? Internal Medicine Residents' Experience With Patients With Chronic Nonmalignant Pain  

Microsoft Academic Search

Purpose: To assess internal medicine residents' confidence in, experiences with, and attitudes toward managing chronic nonmalignant pain (CNMP) in their outpatient practices.Methods: We surveyed internal medicine residents with regard to their experiences with and attitudes toward patients with CNMP. Mean responses across residency year of training were analyzed.Results: Sixty-three percent of respondents reported feeling somewhat or much less confident in

Joyce T. Chen; Mark J. Fagan; Joseph A. Diaz; Steven E. Reinert

2007-01-01

195

Characteristics of sensitization associated with chronic pain conditions  

PubMed Central

Objectives To describe and understand varieties and characteristics of sensitization contributing to hyperalgesia for patients with chronic pain conditions. Methods Thermal stimulation was delivered to the face, forearm and calf of pain-free subjects and individuals with irritable bowel syndrome (IBS), temporomandibular pain disorder (TMD) and fibromyalgia syndrome (FMS). Three second contacts of a preheated thermode occurred at 30 sec. intervals in ascending and then descending series (0.7°C steps). Results Thermal pain ratings during ascending series were greater at each site for individuals diagnosed with chronic pain. Strong pain at the time of testing further enhanced the ratings at all sites, but mild or moderate clinical pain did not have this effect. Thermal pain for all subjects was greater during descending series than during ascending series of arm and leg stimulation. The hypersensitivity during descending series was comparable for pain-free, FMS and TMD subjects but was increased in duration for arm or leg stimulation of FMS subjects. Discussion The widespread sensitization for IBS and TMD subjects does not rely on mechanisms of spatial and temporal summation often invoked to explain widespread hyperalgesia associated with chronic pain. Increased sensitivity during descending series during stimulation of an arm or leg but not the face indicates a propensity for sensitization of nociceptive input to the spinal cord. Abnormally prolonged sensitization for FMS patients reveals a unique influence of widespread chronic pain referred to deep somatic tissues. PMID:23629594

Vierck, Charles J.; Wong, Fong; King, Christopher D.; Mauderli, Andre P.; Schmidt, Siegfried; Riley, Joseph L.

2014-01-01

196

[Chronic postoperative pain. Epidemiology and psychological risk factors].  

PubMed

Acute postoperative pain is a still inevitable accompaniment of surgery. Up to 50% of the patients undergoing surgery--depending on its type--develop later on chronic postoperative pain. Psychological variables as minor depression, anxiety and pain-related catastrophizing as well as full-blown mental disorders are known risk factors. The relationship between such variables and postoperative pain is likely reciprocal. PMID:20665360

Dimova, Violeta; Lautenbacher, Stefan

2010-07-01

197

Regional Anesthesia for Chronic Pain Management in Children and Adolescents  

Microsoft Academic Search

\\u000a The diagnosis of chronic pain in children and adolescents has often been overshadowed by the potential for malingering and\\u000a school phobia. Nevertheless, with greater stride in the field of pediatric acute pain, there is greater emphasis on the diagnosis\\u000a and management of pain due to the potential for significant bio-behavioral changes with untreated pain (Taddio et al. 1997).\\u000a The purpose

Santhanam Suresh

198

Recommendations for using opioids in chronic non-cancer pain  

Microsoft Academic Search

1.The management of chronic pain should be directed by the underlying cause of the pain. Whatever the cause, the primary goal of patient care should be symptom control.2.Opioid treatment should be considered for both continuous neuropathic and nociceptive pain if other reasonable therapies fail to provide adequate analgesia within a reasonable timeframe.3.The aim of opioid treatment is to relieve pain

Eija Kalso; Laurie Allan; Paul L. I Dellemijn; Clara C Faura; Wilfried K Ilias; Troels S Jensen; Serge Perrot; Leon H Plaghki; Michael Zenz

2003-01-01

199

Midgut malrotation with chronic abdominal pain.  

PubMed

Abnormalities in midgut rotation occur during the physiological herniation of midgut between the 5(th) and 10(th) week of gestation. The most significant abnormality is narrow small bowel mesentery which is prone to volvulus. This occurs most frequently in the neonatal period, less commonly midgut malrotation presents in adulthood with either acute volvulus or chronic abdominal symptoms. It is the latter group that represents a diagnostic challenge. We report a case of a 17-year-old male patient who presented with 10-year history of nonspecific gastro-intestinal symptoms. After extensive investigation the patient was diagnosed with midgut malrotation following computed tomography of abdomen. The patient was treated with a laparoscopic Ladd's procedure and at 3 months he was gaining weight and had stopped vomiting. A laparoscopic Ladd's procedure is an acceptable alternative to the open technique in treating symptomatic malrotation in adults. Midgut malrotation is a rare congenital anomaly which may present as chronic abdominal pain. Abdominal CT is helpful for diagnosis. PMID:22536565

Wanjari, Anil K; Deshmukh, Arjun J; Tayde, Parimal S; Lonkar, Yashwant

2012-04-01

200

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. PMID:25599300

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

2015-01-01

201

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

202

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

203

Sleep deprivation in chronic somatoform pain—effects on mood and pain regulation  

Microsoft Academic Search

Sleep deprivation was found to exert complex effects on affective dimensions and modalities of pain perception both in healthy volunteers and patients with major depression. Considering multifaceted links between mood- and pain regulation in patients with chronic somatoform pain, it is intriguing to study sleep deprivation effects for the first time in this patients group. Twenty patients with a somatoform

Volker Busch; Joachim Haas; Tatjana Crönlein; Christoph Pieh; Peter Geisler; Göran Hajak; Peter Eichhammer

204

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

E-print Network

Evoked Pain Analgesia in Chronic Pelvic Pain Patients Using Respiratory-Gated Auricular Vagal branch of the vagus nerve in the ear. The dorsal medullary vagal system operates in tune with respiration pain analgesia for respiratory-gated auricular vagal affer- ent nerve stimulation (RAVANS) compared

Napadow, Vitaly

205

A 44 year-old lady with chronic renal disease and intractable ulcers: a case report  

PubMed Central

Calciphylaxis is a rare but potentially fatal condition occurring in patients with end stage renal disease on dialysis. Due to interplay of various factors, disturbances occur in the metabolism of calcium and phosphate leading to calcification within the vessel walls. The net result is tissue ischemia and necrosis. Clinically this presents as painful non-healing skin ulcers, which contribute to significant morbidity and mortality due to septic progression of the lesion. In this case report, we highlight the rapidly progressive nature of this disease, its etiopathogenesis and the role of early diagnosis in preventing life-threatening complications. PMID:19646226

Pujar, Thejeswi; Spinello, Irene M

2009-01-01

206

Constructing the experience of chronic pain through discourse.  

PubMed

Abstract The aim of this study was to investigate the discourses used by people with chronic pain. Using qualitative interview data from five Irish people with a variety of chronic pain conditions, Foucauldian discourse analysis was undertaken to identify the discourses in operation in participants' accounts. Three discourses were identified: a moral discourse, a discourse of pain as personal tragedy, and a biomedical discourse. A moral discourse was used to construct participants as moral individuals experiencing real pain who try to accomplish activities and fulfil social roles without burdening others. The discourse of chronic pain as personal tragedy describes the multiple negative consequences of chronic pain including activity, relationship, physical, financial, and emotional consequences, and changed expectations of the future. This discourse bolsters the moral discourse through rejecting any benefits associated with chronic pain. Participants rejected a biomedical discourse by proposing their own explanatory models of pain, resisting psychosocial understandings of pain, criticizing medical professionals and healthcare services, and challenging medical expertise, professionalism, and power. These practices allow participants to reject the patient subject-position with its attendant passivity and requirements for adherence and compliance. PMID:23016628

Robinson, Katie; Kennedy, Norelee; Harmon, Dominic

2013-03-01

207

Pain-QuILT: Clinical Feasibility of a Web-Based Visual Pain Assessment Tool in Adults With Chronic Pain  

PubMed Central

Background Chronic pain is a prevalent and debilitating problem. Accurate and timely pain assessment is critical to pain management. In particular, pain needs to be consistently tracked over time in order to gauge the effectiveness of different treatments. In current clinical practice, paper-based questionnaires are the norm for pain assessment. However, these methods are not conducive to capturing or tracking the complex sensations of chronic pain. Pain-QuILT (previously called the Iconic Pain Assessment Tool) is a Web-based tool for the visual self-report and tracking of pain (quality, intensity, location, tracker) in the form of time-stamped records. It has been iteratively developed and evaluated in adolescents and adults with chronic pain, including usability testing and content validation. Clinical feasibility is an important stepping-stone toward widespread implementation of a new tool. Our group has demonstrated Pain-QuILT clinical feasibility in the context of a pediatric chronic pain clinic. We sought to extend these findings by evaluating Pain-QuILT clinical feasibility from the perspective of adults with chronic pain, in comparison with standard paper-based methods (McGill Pain Questionnaire [MPQ] and Brief Pain Inventory [BPI]). Objective The goal of our study was to assess Pain-QuILT for (1) ease of use, (2) time for completion, (3) patient preferences, and (4) to explore the patterns of self-reported pain across the Pain-QuILT, MPQ, and BPI. Methods Participants were recruited during a scheduled follow-up visit at a hospital-affiliated pain management and physical rehabilitation clinic in southwestern Ontario. Participants self-reported their current pain using the Pain-QuILT, MPQ, and BPI (randomized order). A semistructured interview format was used to capture participant preferences for pain self-report. Results The sample consisted of 50 adults (54% female, 27/50) with a mean age of 50 years. Pain-QuILT was rated as significantly easier to use than both the MPQ and BPI (P<.01) and was also associated with the fewest difficulties in completion. On average, the time to complete each tool was less than 5 minutes. A majority of participants (58%, 29/50) preferred Pain-QuILT for reporting their pain over alternate methods (16%, 8/50 for MPQ; 14%, 7/50 for BPI; 12%, 6/50 for “other”). The most commonly chosen pain descriptors on MPQ were matched with Pain-QuILT across 91% of categories. There was a moderate-to-high correlation between Pain-QuILT and BPI scores for pain intensity (r=.70, P<.01). Conclusions The results of this clinical feasibility study in adults with chronic pain are consistent with our previously published pediatric findings. Specifically, data indicate that Pain-QuILT is (1) easy to use, (2) quick to complete, (3) preferred by a majority of patients, and (4) correlated as expected with validated pain measures. As a digital, patient-friendly method of assessing and tracking pain, we conclude that Pain-QuILT has potential to add significant value as one standard component of chronic pain management. PMID:24819478

Kumbhare, Dinesh; Stinson, Jennifer N; Henry, James L

2014-01-01

208

Knowledge of and Agreement with Chronic Pain Diagnosis: Relation to Affective Distress, Pain Beliefs and Coping, Pain Intensity, and Disability  

Microsoft Academic Search

Many authors report that a high percentage of patients with chronic pain have no or insufficient underlying physical pathology to explain their pain. Even when patients do have an identified diagnosis, many patients profess to have little understanding of the source of their pain or fear that they may suffer from more severe pathology. This may be particularly true for

Michael E. Geisser; Randy S. Roth

1998-01-01

209

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

210

The impact of chronic pain on direct medical utilization and costs in chronic obstructive pulmonary disease  

PubMed Central

Objective To examine how pain affects health care utilization and direct medical costs in individuals with chronic obstructive pulmonary disease (COPD) compared to patients with other chronic diseases. Study design A retrospective cohort analysis using administrative data of a managed health care system in the Southwestern US for years 2006–2010. Methods COPD patients age ?40 years were matched to similar patients with other chronic conditions on age, sex, insurance type, and a health care event (outpatient visit, emergency department visit, or inpatient stay). Chronic pain was indicated by pain-associated diagnoses and procedures, or fills for prescription pain medications. The study population was also stratified into those with and without chronic pain to examine clinical factors and costs associated with chronic pain. Results Seven thousand nine hundred and fifty-two COPD patients (mean age 69 years, 58% women) were matched to 15,904 patients with other chronic disease. COPD patients had significantly higher utilization for pain-related services and for overall services. COPD patients had a higher prevalence of any pain medication use over a 12-month period (41.2% versus 31.5%) and, among those using pain medications, a higher mean number of pain medication prescription fills (10.1 versus 6.4). Factors associated with chronic pain included age 40–65 years, being female, having more than one chronic morbidity, insurance type, some emergency department or hospital utilization, and having either COPD, heart failure, arthritis, or stroke. Among COPD patients, those with chronic pain had a mean annual direct cost for overall utilization of $24,261 versus $10,390 among those without chronic pain (P<0.0001 for all comparisons). Conclusion COPD patients have substantially more utilization for pain medications and pain-related procedures than those with most other chronic diseases. Total direct medical costs among COPD patients who have chronic pain are more than double those of COPD patients without chronic pain. Pain management may be an opportunity for better and more cost-effective care for COPD patients.

Roberts, Melissa H; Mapel, Douglas W; Thomson, Heather N

2015-01-01

211

Hippocampal subfields differentially correlate with chronic pain in older adults.  

PubMed

Although previous studies have demonstrated that the hippocampus plays a role in pain processing, the role of hippocampal subfields is uncertain. The goal of this study was to examine the relationship between hippocampal subfield volumes and chronic pain in nondemented older adults. The study sample included 86 community-residing adults age 70 or older who were free of dementia and recruited from the Einstein Aging Study. Chronic pain was defined as pain over the last 3 months, that was moderate or severe (minimum rating of 4 out of 10) most, or all of the time. Hippocampal subfield volumes were estimated using FreeSurfer software. We modeled the association between chronic pain and hippocampal and subfield volume using linear regression. The sample had a mean age of 80 and was 58% female. Chronic pain, present in 55% of the sample, was associated with smaller right and total hippocampal volumes, particularly in women, after adjusting for age, education, and intracranial volume (eTICV). In addition, in women, volume was significantly reduced in participants with chronic pain in right CA2-3 (?=-0.35, p=0.010), right CA4-DG (?=-0.35, p=0.011), left presubiculum (?=-0.29, p=0.030), and left fimbria (?=-0.30, p=0.023). In men, chronic pain was not associated with the volume of any of the hippocampal subfield volumes. Chronic pain in women is associated with a reduction in the volume of right hippocampus and also selected hippocampal subfields. Future studies should clarify the mechanisms underlying the association between regional hippocampal volumes and chronic pain, particularly in women. PMID:24878607

Ezzati, Ali; Zimmerman, Molly E; Katz, Mindy J; Sundermann, Erin E; Smith, Jeremy L; Lipton, Michael L; Lipton, Richard B

2014-07-21

212

Chronic Pain: The Extra Burden on Canadian Women  

PubMed Central

Health Issue Chronic pain is a major health problem associated with significant costs to both afflicted individuals and society as a whole. These costs seem to be disproportionately borne by women, who generally have higher prevalence rates for chronic pain than do men. Key findings Data obtained from 125,574 respondents to the Canadian Community Health Survey (2000–2001) indicated that 18% of Canadian women suffered from chronic pain, compared to 14% of men. This gender discrepancy, however, seemed to be linked primarily to differences in age, income, and education between adult men and women in this large sample. Age, income, depression and functional interference with activities were strongly associated with chronic pain in general. No gender differences were found in the intensity of pain experienced. Ethnicity was not strongly associated with chronic pain prevalence, although Asians were the group with the highest chronic pain prevalence in the over-65 age group and Aboriginal Canadians had the highest prevalence in the under-65 age group. Data Gaps and Recommendations Current gaps in our knowledge include the types of chronic pain women experience, their impact on domestic responsibilities and parenting and health care utilization patterns of women with chronic pain. Data sources such as provincial databases of billing claims may be useful in the future to enrich our knowledge of health care utilization and analgesic medication use. Enhanced surveillance, assessment, and early identification of pain disorders are recommended to improve outcomes. Considering current demographic patterns toward an older population, there is also some urgency to the development of patient education and self-management programs. PMID:15345080

Meana, Marta; Cho, Robert; DesMeules, Marie

2004-01-01

213

FAILURE OF A MONOTHERAPY STRATEGY FOR DIFFICULT CHRONIC PROSTATITIS\\/CHRONIC PELVIC PAIN SYNDROME  

Microsoft Academic Search

Purpose:We determined the effect of a best evidence based monotherapeutic strategy for patients diagnosed with chronic prostatitis\\/chronic pelvic pain syndrome (CP\\/CPPS) referred to a specialized prostatitis clinic.

J. CURTIS NICKEL; JOE DOWNEY; DALE ARDERN; JANET CLARK; KYLE NICKEL

2004-01-01

214

The Relationship Between Depression and Pain Language in Cancer and Chronic Non-Cancer Pain Patients  

Microsoft Academic Search

The present study investigated the relationship between depression and pain description among cancer and chronic non-cancer pain patients in a large outpatient sample. Participants consisted of 312 patients (158 men and 154 women) attending a pain management clinic at a comprehensive cancer institute. Sixty-one percent of the patients (190\\/312) were experiencing pain related to cancer and 39% (122\\/312) were experiencing

Thomas C. Sist; Gerard A. Florio; Marguerite F. Miner; Mark J. Lema; Michael A. Zevon

1998-01-01

215

Patterns of Pain Descriptor Usage in African Americans and European Americans With Chronic Pain  

Microsoft Academic Search

This study examined ethnic differences in the use of pain descriptors, comparing standardized pain assessment data from African American and European American patients with heterogeneous chronic pain syndromes. The measure was the Short-Form McGill Pain Questionnaire (SF–MPQ) including the embedded Visual Analog Scale (VAS). Exploratory factor analyses of SF–MPQ data identified differences in factor structure with the VAS loading on

Jeffrey E. Cassisi; Masataka Umeda; Julie A. Deisinger; Christine Sheffer; Kenneth R. Lofland; Cheryl Jackson

2004-01-01

216

Chronic Low Back Pain, Sleep Disturbance, and Interleukin-6  

PubMed Central

Objectives Sleep disturbance is a common co-morbidity of chronic pain. Inflammatory processes are dysregulated in sleep disturbance and also contribute to pain sensitivity. Thus, inflammation may play an important role in bi-directional associations between pain and sleep. Little is known about concurrent relationships among chronic pain, sleep, and inflammation. The aim of our study was to examine associations among sleep disturbance and circulating levels of the inflammatory cytokine, interleukin-6 (IL-6), in individuals with and without chronic low back pain. Methods Gender and age-matched adults with chronic low back pain (CLBP; n = 25) or without chronic pain (controls; n = 25) completed measures of sleep quality in the past month and depressive symptoms in the past week, and provided a blood draw for IL-6. The next morning, participants reported their sleep quality the previous night and their current experience of morning pain. Results Individuals with CLBP had more sleep disturbance than controls. Circulating IL-6 levels were similar for the two groups; however, in adults with CLBP, poorer sleep quality was associated with higher IL-6 levels, and both sleep and IL-6 related to pain reports. Unlike CLBP participants, controls showed normal, age-related increases in IL-6 levels, whereas sleep quality was unrelated to IL-6 levels. Depressive symptoms could not fully explain the observed associations. Discussion Inflammatory processes may play a significant role in cycles of pain and sleep disturbance. Clinical interventions that improve sleep and reduce concomitant inflammatory dysregulation hold promise for chronic pain management. PMID:21188850

Heffner, Kathi L.; France, Christopher R.; Trost, Zina; Mei Ng, H.; Pigeon, Wilfred R.

2010-01-01

217

Help-seeking behaviour for the treatment of chronic pain.  

PubMed

There are more people living with chronic pain than cardiovascular disease and cancer combined. Many people with chronic pain do not seek help from health professionals and suffer in silence for many years. Untreated chronic pain can lead to increased disability, increased risk of fall, depression, sleep deprivation, reduced quality of life and social isolation. The aim of this review is to determine the factors associated with help-seeking for chronic pain in an effort to highlight potential reasons why help may or may not be sought. A total of 23 studies were included in the review. On the whole the review has demonstrated that the most significant demographic and clinical factors associated with help-seeking were increasing age, female gender, pain severity and disability. Psychosocial factors included past help seeking, outcome expectancy, age-related beliefs, social cost and social influence. While the evidence presented appears promising, some conflicting results were found and methodological limitations were noted. Further research needs to examine the underlying determinants of help-seeking behaviour for chronic pain underpinned by theory. The information derived from such research will augment the development of a complex nursing intervention to improve help-seeking for chronic pain. PMID:21378675

Cornally, Nicola; McCarthy, Geraldine

2011-02-01

218

Fibromyalgia and chronic widespread pain in autoimmune thyroid disease.  

PubMed

Fibromyalgia and chronic widespread pain syndromes are among the commonest diseases seen in rheumatology practice. Despite advances in the management of these conditions, they remain significant causes of morbidity and disability. Autoimmune thyroid disease is the most prevalent autoimmune disorder, affecting about 10 % of the population, and is a recognized cause of fibromyalgia and chronic widespread pain. Recent reports are shedding light on the mechanisms of pain generation in autoimmune thyroid disease-associated pain syndromes including the role of inflammatory mediators, small-fiber polyneuropathy, and central sensitization. The gradual elucidation of these pain pathways is allowing the rational use of pharmacotherapy in the management of chronic widespread pain in autoimmune thyroid disease. This review looks at the current understanding of the prevalence of pain syndromes in autoimmune thyroid disease, their likely causes, present appreciation of the pathogenesis of chronic widespread pain, and how our knowledge can be used to find lasting and effective treatments for the pain syndromes associated with autoimmune thyroid disease. PMID:24435355

Ahmad, Jowairiyya; Tagoe, Clement E

2014-07-01

219

A Preliminary Investigation of Affective Interaction in Chronic Pain Couples  

PubMed Central

The objective of this preliminary study was to examine the extent to which affective marital interaction related to depressive symptoms in persons with chronic pain and their spouses and to pain severity in persons with pain. Couples from the community completed self-report surveys and engaged in a videotaped conversation on a topic of mutual disagreement that was coded for three affect types (i.e., anger/contempt, sadness, humor). Humor was positively related to marital satisfaction in both partners. Spouse anger/contempt and sadness were positively related to depressive symptoms in spouses. Several significant interaction effects between couple pain status (i.e., whether one or both partners reported pain) and affect also emerged. Specifically, sadness in the participant designated as the person with pain was associated with greater depressive symptoms and pain severity when only he or she reported pain whereas sadness was related to fewer depressive symptoms and less pain severity when both partners reported pain. The relationships between spouse anger and spouse depressive symptoms and between spouse humor and pain severity in the person with pain were also moderated by couple pain status. These exploratory findings can be interpreted in light of emotion regulation and pain empathy theories. For example, partners who have not experienced pain themselves may fail to empathize with persons in pain, thus preventing effective emotion regulation. When both spouses report chronic pain, expressions of negative affect may instead promote emotion regulation because the affect is experienced with a spouse who may be more empathetic. PMID:17521810

Johansen, Ayna Beate; Cano, Annmarie

2007-01-01

220

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

221

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

222

Alterations in endogenous opioid functional measures in chronic back pain.  

PubMed

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 [(11)C]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; Zubieta, Jon-Kar

2013-09-11

223

‘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

224

Brain gray matter decrease in chronic pain is the consequence and not the cause of pain.  

PubMed

Recently, local morphologic alterations of the brain in areas ascribable to the transmission of pain were reported in patients suffering from chronic pain. Although some authors discussed these findings as damage or loss of brain gray matter, one of the key questions is whether these structural alterations in the cerebral pain-transmitting network precede or succeed the chronicity of pain. We investigated 32 patients with chronic pain due to primary hip osteoarthritis and found a characteristic gray matter decrease in patients compared with controls in the anterior cingulate cortex (ACC), right insular cortex and operculum, dorsolateral prefrontal cortex (DLPFC), amygdala, and brainstem. We then investigated a subgroup of these patients (n = 10) 6 weeks and 4 months after total hip replacement surgery, monitoring whole brain structure. After surgery, all 10 patients were completely pain free and we observed a gray matter increase in the DLPFC, ACC, amygdala, and brainstem. As gray matter decrease is at least partly reversible when pain is successfully treated, we suggest that the gray matter abnormalities found in chronic pain do not reflect brain damage but rather are a reversible consequence of chronic nociceptive transmission, which normalizes when the pain is adequately treated. PMID:19889986

Rodriguez-Raecke, Rea; Niemeier, Andreas; Ihle, Kristin; Ruether, Wolfgang; May, Arne

2009-11-01

225

Emerging targets in neuroinflammation-driven chronic pain  

PubMed Central

Current analgesics predominately modulate pain transduction and transmission in neurons and have limited success in controlling disease progression. Accumulating evidence suggests that neuroinflammation, which is characterized by infiltration of immune cells, activation of glial cells and production of inflammatory mediators in the peripheral and central nervous system, has an important role in the induction and maintenance of chronic pain. This review focuses on emerging targets such as chemokines, proteases and the Wnt pathway that promote spinal cord neuroinflammation and chronic pain. It also highlights the anti-inflammatory and pro-resolution lipid mediators that act on immune cells, glial cells and neurons to resolve neuroinflammation, synaptic plasticity and pain. Targeting excessive neuroinflammation could offer new therapeutic opportunities for chronic pain and related neurological and psychiatric disorders. PMID:24948120

Ji, Ru-Rong; Xu, Zhen-Zhong; Gao, Yong-Jing

2014-01-01

226

Active and passive coping strategies in chronic pain patients  

E-print Network

This study assessed the validity of an active/passive conceptualization of coping in a sample of chronic pain patients (N = 84). The validity of active and passive coping dimensions was supported. The Coping Strategies Questionnaire...

Snow-Turek, Andrea Lynn

1994-01-01

227

Chronic pain associated with spinal cord injuries: A community survey  

Microsoft Academic Search

Objective:To investigate, in a community sample of people with spinal cord injuries (SCIs), chronic pain prevalence, associated factors, sites, characteristics, interference with daily functioning, treatments received, and treatment helpfulness.

Judith A. Turner; Diana D. Cardenas; Catherine A. Warms; Catherine B. McClellan

2001-01-01

228

Complementary Health Approaches for Chronic Pain: What the Science Says  

MedlinePLUS

... Complementary Health Approaches for Chronic Pain : What the Science Says September 2014 Fibromyalgia In general, research on ... products and practices in the context of rigorous science, training complementary health researchers, and disseminating authoritative information ...

229

Topical analgesics in the management of acute and chronic pain.  

PubMed

Oral analgesics are commonly prescribed for the treatment of acute and chronic pain, but these agents often produce adverse systemic effects, which sometimes are severe. Topical analgesics offer the potential to provide the same analgesic relief provided by oral analgesics but with minimal adverse systemic effects. This article describes the results of a systematic review of the efficacy of topical analgesics in the management of acute and chronic pain conditions. A literature search of MEDLINE/PubMed was conducted using the keywords topical analgesic AND chronic pain OR acute pain OR neuropathic pain and focused only on individual clinical trials published in English-language journals. The search identified 92 articles, of which 65 were eligible for inclusion in the review. The most commonly studied topical analgesics were nonsteroidal anti-inflammatory drugs (n=27), followed by lidocaine (n=9), capsaicin (n=6), amitriptyline (n=5), glyceryl trinitrate (n=3), opioids (n=2), menthol (n=2), pimecrolimus (n=2), and phenytoin (n=2). The most common indications were acute soft tissue injuries (n=18), followed by neuropathic pain (n=17), experimental pain (n=6), osteoarthritis and other chronic joint-related conditions (n=5), skin or leg ulcers (n=5), and chronic knee pain (n=2). Strong evidence was identified for the use of topical diclofenac and topical ibuprofen in the treatment of acute soft tissue injuries or chronic joint-related conditions, such as osteoarthritis. Evidence also supports the use of topical lidocaine in the treatment of postherpetic neuralgia and diabetic neuropathy. Currently, limited evidence is available to support the use of other topical analgesics in acute and chronic pain. PMID:23374622

Argoff, Charles E

2013-02-01

230

Chronic precentral stimulation in trigeminal neuropathic pain  

Microsoft Academic Search

Summary The results of Deep Brain Stimulation in deafferentation pain syndromes, in particular in thalamic pain, indicate that excellent long-term pain relief can hardly ever be achieved. We report 7 cases using Motor-Cortex-Stimulation for treating severe trigeminal neuropathic pain syndromes, i.e., dysaesthesia, anaesthesia dolorosa and postherpetic neuralgia. The first implantation of the stimulation device for precentral cerebral stimulation was performed

H. Ebel; D. Rust; V. Tronnier; D. Böker; S. Kunze

1996-01-01

231

Exercise Testing and Training in Patients with (Chronic) Pain  

Microsoft Academic Search

A vast body of literature supports the idea that exercise training is an important modality in the treatment and rehabilitation\\u000a of the chronic pain patient. Exercise testing and prescription should therefore be incorporated in the therapeutic armamentarium\\u000a of health care professionals working with chronic pain patients. In this chapter we present the scientific basis of the positive\\u000a effects regular exercise

Harriët Wittink; Tim Takken

232

Chronic prostatitis\\/pelvic pain syndrome: A bladder dysfunction?  

Microsoft Academic Search

Chronic prostatitis\\/chronic pelvic pain syndrome (CP\\/CPPS) is frustrating for both clinicians and patients. The prostate is\\u000a not scientifically proven to cause the symptoms of CP\\/CPPS, yet the prostate continues to be the diagnosis of convenience\\u000a in this complex syndrome in men. However, if the pain is not of prostatic origin, what causes it? A heterogeneous group of\\u000a insults can result

Ricardo R. Gonzalez; Alexis E. Te

2007-01-01

233

Temporal daily associations between pain and sleep in adolescents with chronic pain versus healthy adolescents  

PubMed Central

Adolescents with chronic pain frequently report sleep disturbances, particularly short sleep duration, night wakings, and poor sleep quality. Prior research has been limited by assessment of subjectively reported sleep only and lack of data on daily relationships between sleep and pain. The current study utilized multilevel modeling to compare daily associations between sleep and pain in adolescents with chronic pain and healthy adolescents. Ninety-seven adolescents (n=39 chronic pain; n=58 healthy) aged 12–18, 70.1% female participated. Adolescents completed pain diary ratings (0–10 NRS) and actigraphic sleep monitoring for 10 days. Actigraphic sleep variables (duration, efficiency, WASO) and self-reported sleep quality were tested as predictors of next-day pain, and daytime pain was tested as a predictor of sleep that night. Effects of age, gender, study group, and depressive symptoms on daily associations between sleep and pain were also tested. Multivariate analyses revealed that nighttime sleep (p<.001) and minutes awake after sleep onset (WASO) (p<.05) predicted next-day pain, with longer sleep duration and higher WASO associated with higher pain. Contrary to hypotheses, neither nighttime sleep quality nor sleep efficiency predicted pain the following day. The interaction between nighttime sleep efficiency and study group was significant, with adolescents with pain showing stronger associations between sleep efficiency and next day pain than healthy participants (p=.05). Contrary to hypotheses, daytime pain did not predict nighttime sleep. Daily associations between pain and sleep suggest that further work is needed to identify specific adolescent sleep behaviors (e.g., compensatory sleep behaviors) that may be targeted in interventions. PMID:20719433

Lewandowski, Amy S.; Palermo, Tonya M.; De la Motte, Stacy; Fu, Rochelle

2010-01-01

234

Neuromodulation in Male Chronic Pelvic Pain Syndrome: Rationale and Practice  

PubMed Central

This review explores the treatment of male chronic pelvic pain syndrome (CPPS) (i.e., chronic prostatitis) through the use of neuromodulation, which is the electrical stimulation of the nervous system. Neuromodulation has been used for the treatment of chronic pain for decades, and this review will examine the theory and use of neuromodulation and the various techniques available for the treatment of CPPS. Because of limited published research, much of the data presented will not be explicitly for male CPPS, but will be extrapolated from other chronic pelvic pain studies where neuromodulation has been used. Although several types of neuromodulation techniques are currently available for chronic pelvic pain conditions, none are considered standard therapies for treating CPPS. Despite the limited evidence, neuromodulation appears to provide benefits for some patients with CPPS. The improvement of urinary symptoms is more clearly defined than improvements in pain, but at least a subset of patients in most of the published studies and case series derive some benefit in the short term, and limited evidence suggests that long-term improvement of symptoms is possible. The debate about the pathophysiology of pelvic pain syndromes continues and the mechanism of action of neuromodulation on urinary and pain symptoms has yet to be defined. The fuller understanding of both will inform the evidence basis of using neuromodulation for male CPPS. PMID:23619478

Yang, Claire C.

2013-01-01

235

The Feldenkrais Method and Chronic Low Back Pain  

Microsoft Academic Search

The purpose of this study was to determine if the Feldenkrais Method of somatic education was effective in decreasing pain perception and disability of adults who self- reported experiencing chronic low back pain. Subjects were staff members of California State University, Northridge, who voluntarily recruited for this study. The final sample (n=12) was comprised of ten females and two males,

Aerin Alexander

236

Treatment Preferences for CAM in Children with Chronic Pain  

Microsoft Academic Search

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 ¼ 14.5 years ± 2.4; range ¼ 8-18 years) presenting at a multidisciplinary, tertiary clinic

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

2007-01-01

237

Effect of Iyengar yoga therapy for chronic low back pain  

Microsoft Academic Search

Low back pain is a significant public health problem and one of the most commonly reported reasons for the use of Complementary Alternative Medicine. A randomized control trial was conducted in subjects with non-specific chronic low back pain comparing Iyengar yoga therapy to an educational control group. Both programs were 16 weeks long. Subjects were primarily self-referred and screened by

Kimberly Anne Williams; John Petronis; David Smith; David Goodrich; Juan Wu; Neelima Ravi; Edward J. Doyle; R. Gregory Juckett; Maria Munoz Kolar; Richard Gross; Lois Steinberg

2005-01-01

238

Effect of Iyengar yoga therapy for chronic low back pain  

Microsoft Academic Search

Low back pain is a significant public health problem and one of the most commonly reported reasons for the use of Complementary Alternative Medicine. A randomized control trial was conducted in subjects with non-specific chronic low back pain comparing Iyengar yoga therapy to an educational control group. Both programs were 16 weeks long. Subjects were primarily self-referred and screened by

Kimberly Anne Williamsa; John Petronisb; David Smithc; David Goodrichd; Juan Wue; Neelima Ravif; Edward J. Doyle; R. Gregory Juckettg; Maria Munoz Kolarh; Richard Grossi; Lois Steinbergj

239

Pathological and protective roles of glia in chronic pain  

Microsoft Academic Search

Glia have emerged as key contributors to pathological and chronic pain mechanisms. On activation, both astrocytes and microglia respond to and release a number of signalling molecules, which have protective and\\/or pathological functions. Here we review the current understanding of the contribution of glia to pathological pain and neuroprotection, and how the protective, anti-inflammatory actions of glia are being harnessed

Linda R. Watkins; Erin D. Milligan

2009-01-01

240

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...

241

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

242

Pharmacokinetics and Pharmacodynamics of Intrathecal Ziconotide in Chronic Pain Patients  

Microsoft Academic Search

The pharmacokinetics and pharmacodynamics of ziconotide were assessed over a 48-hour period following intrathecal (IT) administration (1, 5, 7.5, or 10 &mgr;g) to 22 patients with chronic, nonmalignant pain. Plasma and cerebrospinal fluid (CSF) samples were obtained over a 24-hour period. Analgesic efficacy was monitored using Visual Analog Scale of Pain Intensity (VASPI) and Category Pain Relief Scores (CPRS) measurements.

Daniel Wermeling; Michael Drass; David Ellis; Martha Mayo; Dawn McGuire; Damian OConnell; Victoria Hale; Stella Chao

2003-01-01

243

Medication misuse, abuse and dependence in chronic pain patients  

Microsoft Academic Search

We report the prevalence of drug use, misuse, abuse, and dependence in 125 chronic pain patients attending specialist pain clinics in South London. A total of 110 patients (88%) were taking medications for their pain problem. Opioid analgesics (69.6%), nonopioids (48%), antidepressants (25%), and benzodiazepines (17.6%) were the drugs most frequently used. Psychoactive substance abuse or dependence (DSM-III-R) was diagnosed

Kyriaki Kouyanou; Charles E. Pither; Simon Wessely

1997-01-01

244

Oral Opioid Therapy for Chronic Peripheral and Central Neuropathic Pain  

Microsoft Academic Search

background Although opioids are commonly used to treat chronic neuropathic pain, there are lim- ited data to guide their use. Few controlled trials have been performed, and many types of neuropathic pain remain unstudied. methods Adults with neuropathic pain that was refractory to treatment were randomly assigned to receive either high-strength (0.75-mg) or low-strength (0.15-mg) capsules of the potent µ-opioid

Michael C. Rowbotham; Lisa Twilling; Pamela S. Davies; Lori Reisner; Kirk Taylor; David Mohr

2003-01-01

245

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

246

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

247

Postoperative pain management in patients with chronic kidney disease  

PubMed Central

Chronic kidney disease (CKD) is a health care problem with increasing prevalence worldwide. Pain management represents one of the challenges in providing perioperative care for this group of patients. Physicians from different specialties may be involved in pain management of CKD patients, especially in advanced stages. It is important to understand the clinical staging of kidney function in CKD patients as the pharmacotherapeutic pain management strategies change as kidney function becomes progressively impaired. Special emphasis should be placed on dose adjustment of certain analgesics as well as prevention of further deterioration of renal function that could be induced by certain classes of analgesics. Chronic pain is a common finding in CKD patients which may be caused by the primary disease that led to kidney damage or can be a direct result of CKD and hemodialysis. The presence of chronic pain in some of the CKD patients makes postoperative pain management in these patients more challenging. This review focuses on the plans and challenges of postoperative pain management for patient at different stages of CKD undergoing surgical intervention to provide optimum pain control for this patient population. Further clinical studies are required to address the optimal medication regimen for postoperative pain management in the different stages of CKD. PMID:25788766

Tawfic, Qutaiba A.; Bellingham, Geoff

2015-01-01

248

Impairment of pain inhibition in chronic tension-type headache.  

PubMed

Evidence has been accumulated suggesting that a dysfunction in pain inhibitory systems, i.e. in 'diffuse noxious inhibitory controls' (DNIC)-like mechanisms, might be-amongst other factors-responsible for the development of anatomically generalized chronic pain like fibromyalgia. The aim of the present study was to look for similar impairments in chronic tension-type headache (CTTH) as a regionally specific pain syndrome. Twenty-nine CTTH patients and 25 age- and sex-matched healthy control subjects participated in the study. After baseline assessment of electrical detection and pain thresholds, tonic heat stimuli were concurrently applied by a thermode to the thigh to induce DNIC-like pain inhibition. Tonic heat stimuli were applied either slightly above ('pain' condition) or slightly below ('heat' condition) pain threshold. For determination of electrical detection and pain thresholds, electrocutaneous stimuli were administered either to the forearm (extra-cranial site) or to the temple (cranial site), using a multiple staircase procedure. The increase in the electrical detection and pain thresholds induced by concurrent tonic heat stimulation was significantly smaller in the CTTH patients than in the control subjects. This group difference was present during the 'pain' as well as the 'heat' condition. Furthermore, the electrical detection and pain thresholds were affected in this group-specific manner both at the forearm and at the temple. These findings suggest that patients with CTTH suffer from deficient DNIC-like pain inhibitory mechanisms in a similar manner, as do patients with anatomically generalized chronic pain like fibromyalgia. PMID:16202520

Pielsticker, Anke; Haag, Gunther; Zaudig, Michael; Lautenbacher, Stefan

2005-11-01

249

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

250

Conceptualizing and Treating Comorbid Chronic Pain and PTSD  

PubMed Central

The purpose of this paper is to review the rationale for concurrent, evidence-based treatment of chronic pain and posttraumatic stress disorder (PTSD). To meet this end, we review pertinent definitions and extant theories related to the two conditions and their correlations with each other. We then synthesize theoretical components into a proposal of a comprehensive conceptual framework for understanding the relationship and clinical complexity of overlapping chronic pain and PTSD. We conclude with an example of an integrated treatment model designed specifically to address a fundamental factor associated with pain and PTSD: avoidance. PMID:23819047

Gallinati, Jessica L.; Clark, Michael E.

2013-01-01

251

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

252

A new paradigm in chronic bladder pain.  

PubMed

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

253

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

E-print Network

problem. MESH Keywords Adolescent ; Adult ; Aged ; Aged, 80 and over ; Chronic Disease ; Comorbidity epidemiological information. Major causes of neuropathic pain include: diabetes, shingles, spinal cord injury proportions of patients with herpes zoster (Jung et ), diabetic polyneuropathy ( ;

Paris-Sud XI, Université de

254

ZIPping to pain relief: the role (or not) of PKM? in chronic pain  

PubMed Central

Chronic pain remains a significant clinical problem despite substantial advances in our understanding of how persistent nociceptor stimulation drives plasticity in the CNS. A major theme that has emerged in this area of work is the strong similarity between plasticity involved in learning and memory in CNS regions such as cortex and hippocampus with mechanisms underlying chronic pain development and maintenance in the spinal dorsal horn and other CNS areas such as anterior cingulate cortex (ACC). We, and others have recently implicated an atypical PKC (aPKC), called PKM?, in the maintenance of pain plasticity based on biochemical assays and the use of a peptide pseudosubstrate inhibitor called ZIP. These studies indicate remarkable parallels between the potential role of PKM? as a key molecule for the maintenance of long-term memory and long-term potentiation (LTP) and the maintenance of a chronic pain state. On the other hand, very recent studies have disputed the specificity of ZIP and called into question the role of PKM? as a memory maintenance molecule. Here we critically review the evidence that PKM? might represent a new target for the reversal of certain chronic pain states. Furthermore, we consider whether ZIP might have other aPKC or even non-aPKC targets and the significance of such off-target effects for evaluating maintenance mechanisms of chronic pain. We conclude that, current controversies aside, utilization of ZIP as a tool to interrogate maintenance mechanisms of chronic pain and further investigations into the potential role of PKM?, and other aPKCs, in pain plasticity are likely to lead to further insights with the potential to unravel the enigma that is the disease of chronic pain. PMID:23433248

2013-01-01

255

Preventing Chronic Pain following Acute Pain: Risk Factors, Preventive Strategies, and their Efficacy  

PubMed Central

Chronic pain is the leading cause of disability in the United States. The transition from acute to persistent pain is thought to arise from maladaptive neuroplastic mechanisms involving three intertwined processes, peripheral sensitization, central sensitization, and descending modulation. Strategies aimed at preventing persistent pain may target such processes. Models for studying preventive strategies include persistent post-surgical pain (PPP), persistent post-trauma pain (PTP) and post-herpetic neuralgia (PHN). Such entities allow a more defined acute onset of tissue injury after which study of the long-term effects is more easily examined. In this review, we examine the pathophysiology, epidemiology, risk factors, and treatment strategies for the prevention of chronic pain using these models. Both pharmacological and interventional approaches are described, as well as a discussion of preventive strategies on the horizon. PMID:22102847

McGreevy, Kai; Bottros, Michael M.; Raja, Srinivasa N.

2011-01-01

256

Chronic pain and the adaptive significance of positive emotions.  

PubMed

The February-March 2014 special issue of the American Psychologist featured articles summarizing select contributions from the field of psychology to the assessment and treatment of chronic pain. The articles examined a range of psychosocial and family factors that influence individual adjustment and contribute to disparities in pain care. The reviews also considered the psychological correlates and neurophysiological mechanisms of specific pain treatments, including cognitive-behavioral therapy, hypnosis, acceptance and commitment therapy, mindfulness, and meditation. Although a number of articles emphasized the role that negative states of mind play in pain outcomes, positive emotions were given only brief mention. Here, we provide a rationale for the inclusion of positive emotions in chronic pain research. (PsycINFO Database Record PMID:25844656

Ong, Anthony D; Zautra, Alex J; Reid, M Carrington

2015-04-01

257

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

258

[Chronic low back pain and abdominal aortic aneurysm].  

PubMed

Abdominal aortic aneurysm has a population prevalence of 2-5% and mortality in case of rupture of 80%. Up to 91% of cases is accompanied with low back pain, so it is important to include aortic aneurysm in the differential diagnosis of chronic low back pain. Low back pain is one of the most frequent reasons for consultions in Services Emergency Hospital Emergency and Primary Care Services, with an estimated 80% of population having spinal pain at some point in their lives, with 90% of them having a benign course. PMID:24095169

Zúñiga Cedó, E; Vico Besó, L

2013-10-01

259

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

260

Barcoding Human Physical Activity to Assess Chronic Pain Conditions  

PubMed Central

Background Modern theories define chronic pain as a multidimensional experience – the result of complex interplay between physiological and psychological factors with significant impact on patients' physical, emotional and social functioning. The development of reliable assessment tools capable of capturing the multidimensional impact of chronic pain has challenged the medical community for decades. A number of validated tools are currently used in clinical practice however they all rely on self-reporting and are therefore inherently subjective. In this study we show that a comprehensive analysis of physical activity (PA) under real life conditions may capture behavioral aspects that may reflect physical and emotional functioning. Methodology PA was monitored during five consecutive days in 60 chronic pain patients and 15 pain-free healthy subjects. To analyze the various aspects of pain-related activity behaviors we defined the concept of PA ‘barcoding’. The main idea was to combine different features of PA (type, intensity, duration) to define various PA states. The temporal sequence of different states was visualized as a ‘barcode’ which indicated that significant information about daily activity can be contained in the amount and variety of PA states, and in the temporal structure of sequence. This information was quantified using complementary measures such as structural complexity metrics (information and sample entropy, Lempel-Ziv complexity), time spent in PA states, and two composite scores, which integrate all measures. The reliability of these measures to characterize chronic pain conditions was assessed by comparing groups of subjects with clinically different pain intensity. Conclusion The defined measures of PA showed good discriminative features. The results suggest that significant information about pain-related functional limitations is captured by the structural complexity of PA barcodes, which decreases when the intensity of pain increases. We conclude that a comprehensive analysis of daily-life PA can provide an objective appraisal of the intensity of pain. PMID:22384191

Paraschiv-Ionescu, Anisoara; Perruchoud, Christophe; Buchser, Eric; Aminian, Kamiar

2012-01-01

261

Where does it hurt? Describing the body locations of chronic pain  

Microsoft Academic Search

Chronic pain patients have complex problems. Due to this, much research effort has been expended on the classification of pain patients and the classification of pain problems. A mainstay of most pain classification systems is the use of the physical location of the pain. Yet describing the location of the patient's pain is not straightforward. Many patients have pain at

H. T. O. Davies; I. K. Crombie; W. A. Macrae

1998-01-01

262

Where ddes it hurt? Describing the body locations of chronic pain  

Microsoft Academic Search

Chronic pain patients have complex problems. Due to this, much research effort has been expended on the classification of pain patients and the classification of pain problems. A mainstay of most pain classification systems is the use of the physical location of the pain. Yet describing the location of the patient's pain is not straightforward. Many patients have pain at

W. A. Macrae

263

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

264

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

265

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

266

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

267

Sexual Abuse and Sexual Functioning in a Chronic Pelvic Pain Sample  

ERIC Educational Resources Information Center

Sexual abuse, particularly childhood sexual abuse, has been linked to chronic pelvic pain and to sexual dysfunction, though the sexual functioning of survivors of sexual abuse has not been studied in a chronic pain population. Sixty-three women with chronic pelvic pain completed measures of sexual function, sexual abuse, and pain. Using an index…

Randolph, Mary E.; Reddy, Diane M.

2006-01-01

268

Chronic preoperative pain and psychological robustness predict acute postoperative pain outcomes after surgery for breast cancer  

PubMed Central

Background: Few epidemiological studies have prospectively investigated preoperative and surgical risk factors for acute postoperative pain after surgery for breast cancer. We investigated demographic, psychological, pain-related and surgical risk factors in women undergoing resectional surgery for breast cancer. Methods: Primary outcomes were pain severity, at rest (PAR) and movement-evoked pain (MEP), in the first postoperative week. Results: In 338 women undergoing surgery, those with chronic preoperative pain were three times more likely to report moderate to severe MEP after breast cancer surgery (OR 3.18, 95% CI 1.45–6.99). Increased psychological ‘robustness', a composite variable representing positive affect and dispositional optimism, was associated with lower intensity acute postoperative PAR (OR 0.63, 95% CI 0.48–0.82) and MEP (OR 0.71, 95% CI 0.54–0.93). Sentinel lymph node biopsy (SLNB) and intraoperative nerve division were associated with reduced postoperative pain. No relationship was found between preoperative neuropathic pain and acute pain outcomes; altered sensations and numbness postoperatively were more common after axillary sample or clearance compared with SLNB. Conclusion: Chronic preoperative pain, axillary surgery and psychological robustness significantly predicted acute pain outcomes after surgery for breast cancer. Preoperative identification and targeted intervention of subgroups at risk could enhance the recovery trajectory in cancer survivors. PMID:22850552

Bruce, J; Thornton, A J; Scott, N W; Marfizo, S; Powell, R; Johnston, M; Wells, M; Heys, S D; Thompson, A M

2012-01-01

269

Mechanisms of pain in chronic pelvic pain syndrome: influence of prostatic inflammation  

Microsoft Academic Search

Chronic prostatitis\\/chronic pelvic pain syndrome (CP\\/CPPS), is of considerable interest in clinical urology. During the past decade, several new approaches have been made to discover its aetiology and pathophysiological mechanisms and to develop treatment modalities. The aetiology of CPPS has remained unresolved. Bacterial, chemical, urodynamic and immunological aetiologies have been suggested, but none of these has been conclusively proven. The

Aare Mehik; Markku J. Leskinen; Pekka Hellström

2003-01-01

270

Central representation of chronic ongoing neuropathic pain studied by positron emission tomography  

Microsoft Academic Search

This study was undertaken to explore whether the neural substrates demonstrated in brain imaging studies on experimentally induced pain are involved in the perception of chronic neuropathic pain. We investigated the cerebral representation of chronic lateralised ongoing pain in patients with painful mononeuropathy (PMN, i.e., pain in the distribution of a nerve, neuralgia) with positron emission tomography (PET), using regional

Jen-Chuen Hsieh; Måns Belfrage; Sharon Stone-Elander; Per Hansson; Martin Ingvar

1995-01-01

271

[Experiences with the use of pain diaries in the care of outpatients suffering from chronic pain.].  

PubMed

For the present investigation 31 out-patients suffering from chronic pain received a pain diary, that is a booklet in which they recorded their pain level on visual analogue scales and daily activities several times during a day. We used weekly interviews and the patient's records in the diary to evaluate the patient's compliance and the influence of a pain diary on the pain perception and on the physician-patient-interaction. We found that most of the patients were willing and able to use the pain diary. 30 out of 31 patients kept the diary voluntarily for an average period of 4 weeks. 70% of the patients regarded the pain diary as helpful irrespective of whether or not they considered it at the same time as burden. Only 10% reported difficulties in using the pain diary. The majority of patients (70%) noticed no change by the use of the diary in their general pain perception, about 17% reported to feel an increasing fixation on their pain, while 13% felt more distance from their pain by using a pain diary. The use of a pain diary produces a survey over the pain for a longer period than a usual consultation could present. In particular the relationship between the pain level and other recorded events and activities becomes visible. The apin data become especially clear when displayed graphically in a "pain curve". In this way therapeutic interventions can be checked whether or not they are efficient. Each patient was asked at every meeting to indicate on a separate visual analogue scale the pain level he would consider bearable. This mark was accepted by all patients as their aim for the therapy, a more realistic aim than the expectation of a complete freedom from pain. When observed over a period of at least two weeks we found this mark staying constant with half of the patients. In 23.8% the patients decreased this subjectively bearable pain level more than 1 cm, in 14.3% the level was increased. In 9.5% it varied without any clear tendency. For many patients the pain diary was an impulse for an argument with their pain and life situation. Patients from this study reported a better control over their pain and improved conciousness of their own body. As the patient plays an active part the pain diary promotes an equal cooperation between physician and patient. The new information derived from a pain diary enables both patient and physician to alter their point of view. PMID:18415350

Schülin, C; Seemann, H; Zimmermann, M

1989-09-01

272

Halt the Hurt! Dealing with Chronic Pain  

MedlinePLUS

... Another study found that intense feelings of passionate love can provide surprisingly effective pain relief. “It turns ... the areas of the brain activated by intense love are the same areas that drugs use to ...

273

Narcotic analgesics for chronic pain management  

Microsoft Academic Search

“Narcotic” or opioid analgesics are the most efficacious treatment for moderate to severe pain. Expertise in opioid therapy\\u000a is the single most important factor in the successful management of cancer pain. However, the field of opioid therapy is complex\\u000a and rapidly evolving. Newer formulations of old opioid analgesics are emerging. Novel routes of administration including transdermal,\\u000a transmucosal, intranasal, and subcutaneous,

Ike Eriator

1998-01-01

274

Iontophoretically applied microtubule inhibitors induce transganglionic degenerative atrophy of primary central nociceptive terminals and abolish chronic autochtonous pain.  

PubMed

Transcutaneous iontophoresis of microtubule inhibitors (Vinblastin, Vincristin, Formyl-Leurosin) in rats induces depletion of fluoride-resistant acid phosphatase (FRAP) and transganglionic degenerative atrophy (trggl. deg. atr.) of the central terminals of primary nociceptive neurons, probably via blockade of axoplasmic transport in the peripheral sensory nerves. Radiochemical experiments prove that about 0.2% of the microtubule inhibitors applied iontophoretically at the skin reach the level of nociceptive axon terminals. 40 out of 48 patients suffering from chronic intractable pain of diverse etiology (postherpetic, paresthetic, ischaemic and trigeminal neuralgia, alcoholic and diabetic polyneuropathy, meralgia, brachialgia, discopathia, arthropathia and terminal pain) were successfully treated with Vinblastin or Vincristin iontophoresis. Iontophoretically applied microtubule inhibitors do not affect the blood cell count, have no side-effects and do not impair the skin at the site of application. PMID:6183918

Knyihár-Csillik, E; Szücs, A; Csillik, B

1982-10-01

275

Precordial chest pain in patients with chronic Chagas disease.  

PubMed

Precordial chest pain affects about 15% to 33% of patients with chronic Chagas disease. In the absence of megaesophagus, it should be ascribed to chronic Chagas heart disease. Precordial chest pain is atypical because it can usually neither be associated to physical exercise nor be alleviated by nitroglycerin. However, in certain circumstances, precordial chest pain can masquerade as acute coronary syndrome. Although obstructive coronary artery disease can occasionally be found, microvascular angina seems to be the mechanism behind such phenomenon. Precordial chest pain not always has a benign clinical course; sometimes, it can herald a dismal prognosis. On the basis of cases previously reported, it seems that nitrates, betablockers and/or calcium channel blockers can be of value in the treatment of this condition. PMID:25127335

Bestetti, Reinaldo B; Restini, Carolina Baraldi A

2014-09-20

276

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

277

Essure® and chronic pelvic pain: a population-based cohort.  

PubMed

The aim of this study was to assess the incidence of chronic pelvic pain in women after placement of Essure® microinserts. This was a case series study at the hysteroscopy unit in a teaching hospital. We included 4,274 patients undergoing permanent sterilisation with Essure® microinserts from January 2005 to December 2011. Essure devices were removed in all patients reporting pelvic pain after insertion. All data were collected from the hysteroscopy unit database with later review of medical records in cases of chronic pelvic pain and a telephone survey after microinsert removal. Main outcome measures were: grade of procedure difficulty perceived by the surgeon; tolerance described by the patient after placement; the need for analgesics during or immediately after the procedure; side-effects; average time between device placement and the onset of symptoms; time between device placement and removal; technique for device removal and any symptoms thereafter. A total of seven women (0.16%) presented with chronic pelvic pain requiring microinsert removal, with four classifying the pain perceived during the procedure as medium-high. Six patients did not require analgesics after the procedure and a vasovagal syndrome requiring intravenous analgesia and monitoring occurred in only one case. Six women reported pain immediately after the procedure, with a mean time between placement and removal of 29.4 months. In all cases, the symptoms disappeared after Essure removal. We conclude that the development of chronic pelvic pain is very uncommon after placement of Essure microinserts. Removal of these devices usually improves the pain. PMID:24910944

Arjona Berral, J E; Rodríguez Jiménez, B; Velasco Sánchez, E; Povedano Cañizares, B; Monserrat Jordan, J; Lorente Gonzalez, J; Castelo-Branco, C

2014-11-01

278

Balneotherapy for chronic low back pain: a randomized, controlled study.  

PubMed

A large number of treatments were used for patients with chronic low back pain. Frequent episodes have been reported very high. Although balneotherapy was found effective in this disease, there are not well-designed studies. We aimed to determine the effectiveness of balneotherapy versus physical therapy in patients with chronic low back pain. Exercise was added to both treatment programs. Sixty patients with chronic low back pain were randomly divided into two groups. Physical modalities plus exercise were applied to group 1, and group 2 was received balneotherapy plus exercise for ten sessions. The following parameters were measured: visual analogue scale at rest and movement for pain, paracetamol dose, manual muscle test for lumber muscles, modified Schoeber' test, Oswestry disability index, and Short-Form 36 at the beginning and end of the therapies and at the 3 months follow-up. The statistical analyses were performed using the SPSS 10.0 program. Both groups achieved significant improvements within themselves. But balneotherapy groups were improved at back extensor muscle test (P < 0.05), modified Schoeber's test (P < 0.03), Oswestry disability index, and the some scores of SF 36 (energy vitality, social function, role limitations related to physical problems, and general health P < 0.05). Balneotherapy combined with exercise therapy had advantages than therapy with physical modalities plus exercise in improving quality of life and flexibility of patients with chronic low back pain. PMID:21960048

Kesiktas, Nur; Karakas, Sinem; Gun, Kerem; Gun, Nuran; Murat, Sadiye; Uludag, Murat

2012-10-01

279

Toward a taxonomy of adolescents with chronic pain: Exploratory cluster and discriminant analyses of the bath adolescent pain questionnaire  

Microsoft Academic Search

Emerging evidence has indicated that adolescent chronic pain is a significant healthcare issue, the impact of which is determined by a complex interplay of biological, emotional, social, and familial factors. Recently, progress has been made in assessment of pain and functioning in adolescents with chronic pain. A next step is to evaluate whether discrete subgroups of patients exist and whether

Kevin E. Vowles; Abbie Jordan; Christopher Eccleston

2010-01-01

280

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

281

Chronic pelvic pain syndrome\\/chronic prostatitis affect the acrosome reaction in human spermatozoa  

Microsoft Academic Search

Male genital tract inflammations constitute an important factor of male subfertility in which different mediators are discussed\\u000a damaging sperm membranes. As acrosome reaction (AR) is ultimately a membrane function, this study aimed at investigating the\\u000a effects of the chronic pelvic pain syndrome on AR. In a total of 56 patients with chronic pelvic pain syndrome NIH IIIA and\\u000a NIH IIIB,

Ralf Henkel; Martin Ludwig; Hans-Christian Schuppe; Thorsten Diemer; Wolf-Bernhard Schill; Wolfgang Weidner

2006-01-01

282

Activation of corticostriatal circuitry relieves chronic neuropathic pain.  

PubMed

Neural circuits that determine the perception and modulation of pain remain poorly understood. The prefrontal cortex (PFC) provides top-down control of sensory and affective processes. While animal and human imaging studies have shown that the PFC is involved in pain regulation, its exact role in pain states remains incompletely understood. A key output target for the PFC is the nucleus accumbens (NAc), an important component of the reward circuitry. Interestingly, recent human imaging studies suggest that the projection from the PFC to the NAc is altered in chronic pain. The function of this corticostriatal projection in pain states, however, is not known. Here we show that optogenetic activation of the PFC produces strong antinociceptive effects in a rat model (spared nerve injury model) of persistent neuropathic pain. PFC activation also reduces the affective symptoms of pain. Furthermore, we show that this pain-relieving function of the PFC is likely mediated by projections to the NAc. Thus, our results support a novel role for corticostriatal circuitry in pain regulation. PMID:25834050

Lee, Michelle; Manders, Toby R; Eberle, Sarah E; Su, Chen; D'amour, James; Yang, Runtao; Lin, Hau Yueh; Deisseroth, Karl; Froemke, Robert C; Wang, Jing

2015-04-01

283

Pain education to prevent chronic low back pain: a study protocol for a randomised controlled trial  

PubMed Central

Introduction Low back pain (LBP) is the leading cause of disability worldwide. Of those patients who present to primary care with acute LBP, 40% continue to report symptoms 3?months later and develop chronic LBP. Although it is possible to identify these patients early, effective interventions to improve their outcomes are not available. This double-blind (participant/outcome assessor) randomised controlled trial will investigate the efficacy of a brief educational approach to prevent chronic LBP in ‘at-risk’ individuals. Methods/analysis Participants will be recruited from primary care practices in the Sydney metropolitan area. To be eligible for inclusion participants will be aged 18–75?years, with acute LBP (<4?weeks’ duration) preceded by at least a 1?month pain-free period and at-risk of developing chronic LBP. Potential participants with chronic spinal pain and those with suspected serious spinal pathology will be excluded. Eligible participants who agree to take part will be randomly allocated to receive 2×1?h sessions of pain biology education or 2×1?h sessions of sham education from a specially trained study physiotherapist. The study requires 101 participants per group to detect a 1-point difference in pain intensity 3?months after pain onset. Secondary outcomes include the incidence of chronic LBP, disability, pain intensity, depression, healthcare utilisation, pain attitudes and beliefs, global recovery and recurrence and are measured at 1?week post-intervention, and at 3, 6 and 12?months post LBP onset. Ethics/dissemination Ethical approval was obtained from the University of New South Wales Human Ethics Committee in June 2013 (ref number HC12664). Outcomes will be disseminated through publication in peer-reviewed journals and presentations at international conference meetings. Trial registration number https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?ACTRN=12612001180808 PMID:24889854

Traeger, Adrian C; Moseley, G Lorimer; Hübscher, Markus; Lee, Hopin; Skinner, Ian W; Nicholas, Michael K; Henschke, Nicholas; Refshauge, Kathryn M; Blyth, Fiona M; Main, Chris J; Hush, Julia M; Pearce, Garry; McAuley, James H

2014-01-01

284

The use of an intrathecal pump to manage intractable cancer pain in a pediatric patient: a case report.  

PubMed

A 15-year-old girl with combined immune deficiency syndrome, diagnosed with metastatic squamous cell cancer of the anus, had significant pain secondary to vulvar-perianal condyloma. Conventional treatment with oral and intravenous analgesics was limited by significant side effects of mental status changes and urinary retention leading to clinical deterioration that precluded attempts at chemotherapy. An intrathecal pump was implanted in the challenging setting of neutropenia. There was a drastic improvement in her quality of life and the ability to tolerate further chemotherapy. The option of an intrathecal pump for pain control extended our patient's ability to enjoy important quality time with family by several months. PMID:23652866

Bengali, Raheel; Huang, Mary S; Gulur, Padma

2014-04-01

285

Intensive interdisciplinary outpatient pain management program for chronic back pain: a pilot study  

PubMed Central

Background Chronic back pain is relatively resistant to unimodal therapy regimes. The aim of this study was to introduce and evaluate the short-term outcome of a three-week intensive multidisciplinary outpatient program for patients with back pain and sciatica, measured according to decrease of functional impairment and pain. Methods The program was designed for patients suffering from chronic back pain to provide intensive interdisciplinary therapy in an outpatient setting, consisting of interventional injection techniques, medication, exercise therapy, back education, ergotherapy, traction, massage therapy, medical training, transcutaneous electrical nerve stimulation, aquatraining, and relaxation. Results Based on Oswestry Disability Index (ODI) and Numeric Rating Scale (NRS) scores, a significant improvement in pain intensity and functionality of 66.83% NRS and an ODI of 33.33% were achieved by our pain program within 3 weeks. Conclusion This paper describes the organization and short-term outcome of an intensive multidisciplinary program for chronic back pain on an outpatient basis provided by our orthopedic department, with clinically significant results. PMID:22826641

Artner, Juraj; Kurz, Stephan; Cakir, Balkan; Reichel, Heiko; Lattig, Friederike

2012-01-01

286

Gabapentin for chronic neuropathic pain and fibromyalgia in adults  

PubMed Central

Background This review updates parts of two earlier Cochrane reviews investigating effects of gabapentin in chronic neuropathic pain (pain due to nerve damage). Antiepileptic drugs are used to manage pain, predominantly for chronic neuropathic pain, especially when the pain is lancinating or burning. Objectives To evaluate the analgesic effectiveness and adverse effects of gabapentin for chronic neuropathic pain management. Search methods We identified randomised trials of gabapentin in acute, chronic or cancer pain from MEDLINE, EMBASE, and CENTRAL. We obtained clinical trial reports and synopses of published and unpublished studies from Internet sources. The date of the most recent search was January 2011. Selection criteria Randomised, double-blind studies reporting the analgesic and adverse effects of gabapentin in neuropathic pain with assessment of pain intensity and/or pain relief, using validated scales. Participants were adults aged 18 and over. Data collection and analysis Two review authors independently extracted data. We calculated numbers needed to treat to benefit (NNTs), concentrating on IMM-PACT (Initiative on Methods, Measurement and Pain Assessment in Clinical Trials) definitions of at least moderate and substantial benefit, and to harm (NNH) for adverse effects and withdrawal. Meta-analysis was undertaken using a fixed-effect model. Main results Twenty-nine studies (3571 participants), studied gabapentin at daily doses of 1200 mg or more in 12 chronic pain conditions; 78% of participants were in studies of postherpetic neuralgia, painful diabetic neuropathy or mixed neuropathic pain. Using the IMMPACT definition of at least moderate benefit, gabapentin was superior to placebo in 14 studies with 2831 participants, 43% improving with gabapentin and 26% with placebo; the NNT was 5.8 (4.8 to 7.2). Using the IMMPACT definition of substantial benefit, gabapentin was superior to placebo in 13 studies with 2627 participants, 31% improving with gabapentin and 17% with placebo; the NNT was 6.8 (5.6 to 8.7). These estimates of efficacy are more conservative than those reported in a previous review. Data from few studies and participants were available for other painful conditions. Adverse events occurred significantly more often with gabapentin. Persons taking gabapentin can expect to have at least one adverse event (66%), withdraw because of an adverse event (12%), suffer dizziness (21%), somnolence (16%), peripheral oedema (8%), and gait disturbance (9%). Serious adverse events (4%) were no more common than with placebo. There were insufficient data for comparisons with other active treatments. Authors’ conclusions Gabapentin provides pain relief of a high level in about a third of people who take if for painful neuropathic pain. Adverse events are frequent, but mostly tolerable. More conservative estimates of efficacy resulted from using better definitions of efficacy outcome at higher, clinically important, levels, combined with a considerable increase in the numbers of studies and participants available for analysis. PMID:21412914

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

2014-01-01

287

Similarities between interstitial cystitis and male chronic pelvic pain syndrome  

Microsoft Academic Search

Few clinical conditions encountered by the urologist cause more patient and clinician frustration than interstitial cystitis\\u000a and male chronic pelvic pain syndrome, also know as nonbacterial prostatitis. This frustration is fueled by the chronicity\\u000a of often disabling urogenital (and often associated systemic) symptoms coupled with delayed care, misdiagnosis, and suboptimal\\u000a clinical responses. Basic research and therapeutic trials for these syndromes

Robert M. Moldwin

2002-01-01

288

Cosensitization of pain and psychiatric comorbidity in chronic daily headache  

Microsoft Academic Search

Chronic migraine occurs in approximately 20% of migraineurs, typically developing over a period of many years. The pathophysiology\\u000a of this transformation is unknown. However, experts have associated chronic headache with analgesic overuse, physical injury,\\u000a and psychologic trauma. Research in post-traumatic stress disorder has found that hippocampal sensitivity to stress alters\\u000a and often amplifies future pain behaviors. Although the most obvious

Roger Cady; Kathleen Farmer; J. Kent Dexter; Curtis Schreiber

2005-01-01

289

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

MedlinePLUS

... May Be Helpful for Chronic Pain: A Meta-Analysis A recent NCCAM-funded study, employing individual patient ... trials on acupuncture for chronic pain, conducted an analysis of individual patient data from 29 high-quality ...

290

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

E-print Network

SPINAL CORD STIMULATION FOR CHRONIC PAIN MANAGEMENT: TOWARDS AN EXPERT SYSTEM Kenneth M. Al.uh.edu ABSTRACT Chronic pain is a serious health problem affect­ ing millions of people worldwide. Spinal cord; Spinal Cord Stimulation for

Kreinovich, Vladik

291

Capacitively Coupled Electric Field for Pain Relief in Patients with Vertebral Fractures and Chronic Pain  

Microsoft Academic Search

Fragility vertebral fractures often are associated with chronic back pain controlled by analgesic compounds. Capacitive coupling\\u000a electrical stimulation is a type of electrical stimulation technology approved by the US FDA to noninvasively enhance fracture\\u000a repair and spinal fusion. These uses suggest it would be a possible treatment for patients with back pain attributable to\\u000a vertebral fractures. We therefore randomized 51

Maurizio Rossini; Ombretta Viapiana; Davide Gatti; Francesca de Terlizzi; Silvano Adami

2010-01-01

292

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

293

Chronic pain: What colour are the emperor’s clothes?  

Microsoft Academic Search

OST publicly-funded chronic pain clinics are overwhelmed with demands for service. The sheer number of patients suffering from this complex and still largely ill-understood group of conditions dictates that specialists working in referral centres will, at best, only ever be able to see and treat a small proportion of selected cases in a timely fashion. This, in turn, suggests that

Saifee Rashiq

2005-01-01

294

Toe spreading ability in men with chronic pelvic pain syndrome  

Microsoft Academic Search

BACKGROUND: We examined toe-spreading ability in subjects with chronic pelvic pain syndrome (CPPS) to test the hypothesis that subjects with CPPS could have deficiencies in lower extremity functions innervated by sacral spinal roots. METHODS: Seventy two subjects with CPPS and 98 volunteer controls were examined as part of a larger study on CPPS. All the subjects underwent a detailed urologic

Ugur Yilmaz; Ivan Rothman; Marcia A Ciol; Claire C Yang; Richard E Berger

2005-01-01

295

[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

296

Chronic Pain Rehabilitation with a Serious Game using Multimodal Input  

E-print Network

Chronic Pain Rehabilitation with a Serious Game using Multimodal Input Christian Schönauer, Thomas to translate the skills learned in therapy to every day life. Serious games are hypothesized to support games in a medical environment. Finally, a serious game has been implemented, targeting rehabilitation

297

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

298

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

299

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

300

Self-management of chronic low back pain and osteoarthritis  

Microsoft Academic Search

Chronic low back pain and osteoarthritis are two musculoskeletal problems that are highly prevalent in the general population, are frequently episodic and persistent, and are associated with high costs to society, both direct and indirect. This epidemiological picture provides the background that justifies the use of self-management strategies in managing these problems. For this Review, relevant systematic reviews were included

Stephen May

2010-01-01

301

Comorbid Depression, Chronic Pain, and Disability in Primary Care  

Microsoft Academic Search

Objectives: The objectives of this study were to provide estimates of the prevalence and strength of association between major depression and chronic pain in a primary care population and to examine the clinical burden associated with the two conditions, singly and together. Methods: A random sample of Kaiser Permanente patients who visited a primary care clinic was mailed a questionnaire

BRUCE A. ARNOW; ENID M. HUNKELER; CHRISTINE M. BLASEY; JANELLE LEE; MICHAEL J. CONSTANTINO; BRUCE FIREMAN; HELENA C. KRAEMER; ROBIN DEA; REBECCA ROBINSON; CHRIS HAYWARD

2006-01-01

302

Cognitive distortion and disability in chronic low back pain  

Microsoft Academic Search

Numerous authors have suggested that cognitions play an important role in the development, maintenance, and treatment of chronic low back pain (CLBP). However, little evidence exists to support the association between cognitive variables and the CLBP problem. The present study examined the relationship of cognitive distortion, as measured by the Cognitive Error Questionnaire, to disability, as measured by the Sickness

Timothy W. Smith; Michael J. Follick; David K. Ahern; Augustus Adams

1986-01-01

303

Altered motor control patterns in whiplash and chronic neck pain  

PubMed Central

Background Persistent whiplash associated disorders (WAD) have been associated with alterations in kinesthetic sense and motor control. The evidence is however inconclusive, particularly for differences between WAD patients and patients with chronic non-traumatic neck pain. The aim of this study was to investigate motor control deficits in WAD compared to chronic non-traumatic neck pain and healthy controls in relation to cervical range of motion (ROM), conjunct motion, joint position error and ROM-variability. Methods Participants (n = 173) were recruited to three groups: 59 patients with persistent WAD, 57 patients with chronic non-traumatic neck pain and 57 asymptomatic volunteers. A 3D motion tracking system (Fastrak) was used to record maximal range of motion in the three cardinal planes of the cervical spine (sagittal, frontal and horizontal), and concurrent motion in the two associated cardinal planes relative to each primary plane were used to express conjunct motion. Joint position error was registered as the difference in head positions before and after cervical rotations. Results Reduced conjunct motion was found for WAD and chronic neck pain patients compared to asymptomatic subjects. This was most evident during cervical rotation. Reduced conjunct motion was not explained by current pain or by range of motion in the primary plane. Total conjunct motion during primary rotation was 13.9° (95% CI; 12.2–15.6) for the WAD group, 17.9° (95% CI; 16.1–19.6) for the chronic neck pain group and 25.9° (95% CI; 23.7–28.1) for the asymptomatic group. As expected, maximal cervical range of motion was significantly reduced among the WAD patients compared to both control groups. No group differences were found in maximal ROM-variability or joint position error. Conclusion Altered movement patterns in the cervical spine were found for both pain groups, indicating changes in motor control strategies. The changes were not related to a history of neck trauma, nor to current pain, but more likely due to long-lasting pain. No group differences were found for kinaesthetic sense. PMID:18570647

Woodhouse, Astrid; Vasseljen, Ottar

2008-01-01

304

Challenges in design and interpretation of chronic pain trials.  

PubMed

The process of systematic review has shone a light on the methodology of randomized controlled trials. Notably, a range of potential biases hinders the interpretation of chronic pain trials. These include a consistent bias favouring active over placebo in trials that are small and of short duration. The use of the 'last observation carried forward' imputation method is known to inflate results, often generating statistically significance when adverse event withdrawals are high; in clinical practice terms, this is the wrong answer. Patients want outcomes of low pain scores, large reductions in pain and relief from associated symptoms, with improvements in ability to function and in quality of life. Some patients achieve this, but many do not. The distribution of benefit is skewed and the use of average pain scores, or change in pain, can be misleading compared with responder analysis in which withdrawal is regarded as non-response. Historically, chronic pain trials have had a simple classic or a crossover design. They have been small and short, and used inappropriate imputation and outcomes unconnected to the experiences of most patients. While these designs are useful for answering some questions, they may be insensitive for many interventions. Newer designs, like enriched enrolment randomized withdrawal (EERW) trials or clinical effectiveness trials, are potentially more interesting and informative. PMID:23794643

Moore, R A; Derry, S; Wiffen, P J

2013-07-01

305

Ecological system influences in the treatment of pediatric chronic pain  

PubMed Central

Family, school and the peer network each shape the chronic pain experience of the individual child, and each of these contexts also represents a domain of functioning often impaired by chronic pain. The goal of the present article is to summarize what is known about these bidirectional influences between children with pain and the social systems that surround them. Case reports that illustrate these complex, transactional forces and their ultimate impact on the child’s pain-related functioning are included. A case involving siblings participating in an intensive interdisciplinary program for functional restoration and pain rehabilitation highlights how parents change through this treatment approach and how this change is vital to the child’s outcomes. Another case involving a child undergoing intensive interdisciplinary treatment illustrates how school avoidance can be treated in the context of pain rehabilitation, resulting in successful return to the regular school environment. Finally, an acceptance and commitment therapy-focused group intervention for children with sickle cell disease and their parents demonstrates the benefits of peer contact as an element of the therapeutic intervention. PMID:23248814

Logan, Deirdre E; Engle, Lisa; Feinstein, Amanda B; Sieberg, Christine B; Sparling, Penny; Cohen, Lindsey L; Conroy, Caitlin; Driesman, Dana; Masuda, Akihiko

2012-01-01

306

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

PubMed Central

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

2011-01-01

307

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

308

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

309

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

310

Value of diagnostic ultrasound in patients with chronic scrotal pain and normal findings on clinical examination  

Microsoft Academic Search

Objectives. Chronic scrotal pain is a frequent complaint. In many patients with scrotal pain, scrotal ultrasound is performed when the physical examination reveals no abnormalities. We evaluated the yield of scrotal ultrasound in patients with chronic scrotal pain and a normal physical examination.Methods. The study involved the findings in 111 patients with scrotal pain lasting longer than 2 weeks, in

E. P van Haarst; G van Andel; T. H Pels Rijcken; T. J. M Schlatmann; W. K Taconis

1999-01-01

311

Evaluating distance education of a mindfulness-based meditation programme for chronic pain management  

Microsoft Academic Search

Summary Patients with chronic pain were recruited from two large urban hospitals and from rural hospitals in Ontario. Patients on the waiting list served as controls. The intervention was a Mindfulness-Based Chronic Pain Management course, delivered to patients for two hours per week for 10 weeks. Pre- and postcourse measures of quality of life, pain catastrophizing and usual pain ratings

Jacqueline Gardner-Nix; Stéphanie Backman; Julianna Barbati; Jessica Grummitt

2008-01-01

312

Patterns of pain descriptor usage in African Americans and European Americans with chronic pain.  

PubMed

This study examined ethnic differences in the use of pain descriptors, comparing standardized pain assessment data from African American and European American patients with heterogeneous chronic pain syndromes. The measure was the Short-Form McGill Pain Questionnaire (SF-MPQ) including the embedded Visual Analog Scale (VAS). Exploratory factor analyses of SF-MPQ data identified differences in factor structure with the VAS loading on a different factor for each group. A 5-factor solution was obtained from the African American group and a 4-factor solution was obtained from the European American group. There was little overlap in the pattern matrices for African American and European American groups. Results suggest that the VAS is as sensitive to ethnic differences as other traditional pain measures. PMID:14992632

Cassisi, Jeffrey E; Umeda, Masataka; Deisinger, Julie A; Sheffer, Christine; Lofland, Kenneth R; Jackson, Cheryl

2004-02-01

313

Work Loss, Healthcare Utilization, and Costs among US Employees with Chronic Pain  

Microsoft Academic Search

Background: Chronic pain in the workplace significantly affects individuals who experience a variety of conditions resulting in increased financial burden to their employers. The objective of this study was to determine the economic impact of chronic non-cancer pain by measuring the number and cost of days missed from work and the amount paid for healthcare related to chronic pain. Methods:

Laura T. Pizzi; Chureen T. Carter; Jamie B. Howell; Susan M. Vallow; Albert G. Crawford; Evan D. Frank

2005-01-01

314

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

315

Long-term experience with implanted intrathecal drug administration systems for failed back syndrome and chronic mechanical low back pain  

Microsoft Academic Search

BACKGROUND: Continuous intrathecal drug delivery has been shown in open studies to improve pain and quality of life in those with intractable back pain who have had spinal surgery. There is limited data on long term effects and and even less for patients with mechanical back pain without prior spinal surgery. METHODS: We have investigated spinal drug administration systems for

JH Raphael; JL Southall; TV Gnanadurai; GJ Treharne; GD Kitas

2002-01-01

316

Seasonal variation in effect of spa therapy on chronic pain.  

PubMed

This study sought to investigate whether the effects of spa therapy are subject to seasonal variation as suggested by conventional spa therapy research. A total of 268 female (age 31-90 yr) and 119 male (age 35-85 yr) patients with noninflammatory chronic pain were studied. Patients stayed at an Austrian spa for 3 wk and received 2-4 treatments per day, including mudpacks, massages, and exercise therapy. In different groups of patients for 2 yr, pain (self-assessed by questionnaire and Likert scales) and associated variables (mood, fatigue) were measured at the beginning, end, and 6 wk after spa therapy. Data were analyzed by multivariate analysis of covariance controlling for possible group differences between seasons and cosinor analysis. The effect of spa therapy on pain was seasonally dependent; short-term decrease of pain was best between April and June and medium-term decrease of pain was best between October and November, with a second minor peak in fall and spring, respectively. The magnitude of the seasonal variation was greater for back (approximately 30%) than for joint (approximately 20%) pain. Positive mood also improved most between April and June. The observed semi-annual variations of pain do not correspond to the well-known annual change in many physiological and psychological variables. The results suggest that the effects of spa therapy and possibly other related treatments, such as physical and alternative therapies, are subject to seasonal variation. PMID:12025937

Strauss-Blasche, Gerhard; Ekmekcioglu, Cem; Leibetseder, Valentin; Melchart, Herbert; Marktl, Wolfgang

2002-03-01

317

Children with unexplained chronic pain: substantial impairment in everyday life  

PubMed Central

Aims: To describe and quantify impairment in an outpatient population of children with chronic pain of unknown origin (UCP). Methods: A total of 149 children who presented with pain of at least three months' duration and without a satisfactory explanation at presentation were studied. Number of somatic complaints (Children's Somatisation Inventory, CSI), pain intensity (VAS, 0–10 cm), functional disability (Child Health Questionnaire (CHQ-CF) and clinical history), and general health perceptions (CHQ) were determined. Results: Mean age of the children was 11.8 years; 73% were girls. Overall, 72% suffered impairment in sports activities, 51% reported absence from school, 40% experienced limitations in social functioning, and 34% had problems with sleeping. Mean number of somatic symptoms differed significantly between boys (8.4) and girls (10.7). The CHQ-CF scores for physical functioning, role/social functioning, and general health perceptions were 76.4, 70.7, and 57.5, respectively, indicating substantial impairment on all domains. The mean pain intensity was 4.7 for current and 7.1 for worst pain. Children solely evaluated by a general practitioner prior to referral reported less, though still substantial, impairment. Low general health perceptions, impaired role/social functioning, high pain intensity, and having headache or musculoskeletal pain were independent predictors of having significant impairment. Conclusions: Referred children with UCP show substantial impairment on multiple domains in daily life. PMID:15899922

Konijnenberg, A; Uiterwaal, C; Kimpen, J; van der Hoeven, J; Buitelaar, J; de Graeff-Meeder, E R

2005-01-01

318

Chronic post-traumatic neuropathic pain of brachial plexus and upper limb: a new technique of peripheral nerve stimulation.  

PubMed

The aim of the study was to evaluate the effect on pain relief in patients with peripheral neuropathic pain after brachial plexus injuries using an implanted peripheral nerve stimulator applied directly to the nerve branch involved into the axillary cavity. Seven patients with post-traumatic brachial plexus lesions or distal peripheral nerve complaining of severe intractable chronic pain were enrolled in a single-centre, open-label trial. Conventional drugs and traditional surgical treatment were not effective. Patients underwent careful neurological evaluation, pain questionnaires and quantitative sensory testing (QST). Surgical treatment consists of a new surgical technique: a quadripolar electrode lead was placed directly on the sensory peripheral branch of the main nerve involved, proximally to the site of lesion, into the axillary cavity. To assess the effect, we performed a complete neuroalgological evaluation and QST battery after 1 week and again after 1, 6 and 12 weeks. All patients at baseline experienced severe pain with severe positive phenomena in the median (5) and/or radial (2) territory. After turning on the neuro-stimulator system, all patients experienced pain relief within a few minutes (>75 % and >95 % in most), with long-lasting pain relief with a reduction in mean Numerical Rating Scale (NRS) of 76.2 % after 6 months and of 71.5 % after 12 months. No significant adverse events occurred. We recommend and encourage this surgical technique for safety reasons; complications such as dislocation of electrocatheters are avoided. The peripheral nerve stimulation is effective and in severe neuropathic pain after post-traumatic nerve injuries of the upper limbs. PMID:24558032

Stevanato, Giorgio; Devigili, Grazia; Eleopra, Roberto; Fontana, Pietro; Lettieri, Christian; Baracco, Chiara; Guida, Franco; Rinaldo, Sara; Bevilacqua, Marzio

2014-07-01

319

Attenuation of Experimental Pain by Vibro-Tactile Stimulation in Patients with Chronic Local or Widespread Musculoskeletal Pain  

PubMed Central

Patients with chronic pain syndromes, like fibromyalgia (FM) complain of widespread pain and tenderness, as well as non-refreshing sleep, cognitive dysfunction, and negative mood. Several lines of evidence implicate abnormalities of central pain processing as contributors for chronic pain, including dysfunctional descending pain inhibition. One form of endogenous pain inhibition, diffuse noxious inhibitory controls (DNIC), has been found to be abnormal in some chronic pain patients and evidence exists for deficient spatial summation of pain, specifically in FM. Similar findings have been reported in patients with localized musculoskeletal pain (LMP) disorders, like neck and back pain. Whereas DNIC reduces pain through activation of nociceptive afferents, vibro-tactile pain inhibition involves innocuous A-beta fiber. To assess whether patients with localized or widespread pain disorders have dysfunctional A-beta related pain inhibition we enrolled 28 normal pain-free controls (NC), 29 FM patients, and 19 subjects with neck or back pain. All received 10 s sensitivity-adjusted noxious heat stimuli to the forearms as test stimuli. To assess endogenous analgesic mechanisms of study subjects, vibro-tactile conditioning stimuli were simultaneously applied with test stimuli either homotopically or heterotopically. Additionally, the effect of distraction on experimental pain was assessed. Homotopic vibro-tactile stimulation resulted in 40% heat pain reductions in all subject groups. Distraction did not seem to affect experimental pain ratings. Conclusions Vibro-tactile stimulation effectively recruited analgesic mechanisms not only in NC but also in patients with chronic musculoskeletal pain, including FM. Distraction did not seem to contribute to this analgesic effect. PMID:21339076

Staud, Roland; Robinson, Michael E.; Goldman, Casey T.; Price, Donald D.

2011-01-01

320

Ziconotide: neuronal calcium channel blocker for treating severe chronic pain.  

PubMed

Ziconotide (PRIALT) is a neuroactive peptide in the final stages of clinical development as a novel non-opioid treatment for severe chronic pain. It is the synthetic equivalent of omega-MVIIA, a component of the venom of the marine snail, Conus magus. The mechanism of action underlying ziconotide's therapeutic profile derives from its potent and selective blockade of neuronal N-type voltage-sensitive calcium channels (N-VSCCs). Direct blockade of N-VSCCs inhibits the activity of a subset of neurons, including pain-sensing primary nociceptors. This mechanism of action distinguishes ziconotide from all other analgesics, including opioid analgesics. In fact, ziconotide is potently anti-nociceptive in animal models of pain in which morphine exhibits poor anti-nociceptive activity. Moreover, in contrast to opiates, tolerance to ziconotide is not observed. Clinical studies of ziconotide in more than 2,000 patients reveal important correlations to ziconotide's non-clinical pharmacology. For example, ziconotide provides significant pain relief to severe chronic pain sufferers who have failed to obtain relief from opiate therapy and no evidence of tolerance to ziconotide is seen in these patients. Contingent on regulatory approval, ziconotide will be the first in a new class of neurological drugs: the N-type calcium channel blockers, or NCCBs. Its novel mechanism of action as a non-opioid analgesic suggests ziconotide has the potential to play a valuable role in treatment regimens for severe chronic pain. If approved for clinical use, ziconotide will further validate the neuroactive venom peptides as a source of new and useful medicines. PMID:15578997

Miljanich, G P

2004-12-01

321

ANALYZING MUSCULAR PAIN AND THE EFFECTS OF EXERCISE ON CHRONIC PAIN  

E-print Network

, fibromyalgia and similar diseases that present with widespread hypersensitivity to mechanical stimuli. All experiments were carried out in 2 different strains of female mice, C57Bl/6 and CF-1. Widespread chronic pain was induced by injections of acidic saline...

Sharma, Neena

2008-08-22

322

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

323

Alleviation of chronic neuropathic pain by environmental enrichment in mice well after the establishment of chronic pain  

PubMed Central

Background In animal models, the impact of social and environmental manipulations on chronic pain have been investigated in short term studies where enrichment was implemented prior to or concurrently with the injury. The focus of this study was to evaluate the impact of environmental enrichment or impoverishment in mice three months after induction of chronic neuropathic pain. Methods Thirty-four CD-1 seven to eight week-old male mice were used. Mice underwent surgery on the left leg under isoflurane anesthesia to induce the spared nerve injury model of neuropathic pain or sham condition. Mice were then randomly assigned to one of four groups: nerve injury with enriched environment (n?=?9), nerve injury with impoverished environment (n?=?8), sham surgery with enriched environment (n?=?9), or sham surgery with impoverished environment (n?=?8). The effects of environmental manipulations on mechanical (von Frey filaments) heat (hot plate) and cold (acetone test) cutaneous hypersensitivities, motor impairment (Rotarod), spontaneous exploratory behavior (open field test), anxiety-like behavior (elevated plus maze) and depression-like phenotype (tail suspension test) were assessed in neuropathic and control mice 1 and 2 months post-environmental change. Finally, the effect of the environment on spinal expression of the pro-nociceptive neuropeptides substance P and CGRP form the lumbar spinal cord collected at the end of the study was evaluated by tandem liquid chromatography mass spectrometry. Results Environmental enrichment attenuated nerve injury-induced hypersensitivity to mechanical and cold stimuli. In contrast, an impoverished environment exacerbated mechanical hypersensitivity. No antidepressant effects of enrichment were observed in animals with chronic neuropathic pain. Finally, environmental enrichment resulted lower SP and CGRP concentrations in neuropathic animals compared to impoverishment. These effects were all observed in animals that had been neuropathic for several months prior to intervention. Conclusions These results suggest that environmental factors could play an important role in the rehabilitation of chronic pain patients well after the establishment of chronic pain. Enrichment is a potentially inexpensive, safe and easily implemented non-pharmacological intervention for the treatment of chronic pain. PMID:24025218

2013-01-01

324

Inferior vena cava filter presenting as chronic low back pain.  

PubMed

Our purpose is to report a rare complication of an inferior vena cava (IVC) filter with vertebral bone penetration, interval fracture, subsequent endovascular management and outcome. We report a case of an IVC filter embedded within the second lumbar vertebral body and in which one of the primary struts fractured, which presented as chronic low back pain. The filter was retrieved percutaneously approximately 2 years after placement. A fractured small strut remained within the vertebral bone; patient's pain resolved. Symptomatic filter in situ should be retrieved even when fractured. PMID:22542386

Kendirli, Mustafa T; Sildiroglu, Onur; Cage, Dorothy L; Turba, Ulku C

2012-01-01

325

Measurement of chronic pain: A correlation study of verbal and nonverbal scales  

Microsoft Academic Search

The visual analogue rating scale for pain and verbal pain descriptors from the McGill Pain Questionnaire were used to measure changes in pain severity in 77 patients treated with acupuncture for chronic low back pain. A very significant correlation was found between the visual and the verbal scales, which was maintained during repeated testing. It is suggested that the visual

George Mendelson; Thomas S. Selwood

1981-01-01

326

Pentosan polysulfate therapy for chronic nonbacterial prostatitis (chronic pelvic pain syndrome category IIIA): a prospective multicenter clinical trial  

Microsoft Academic Search

Objectives. Chronic nonbacterial prostatitis\\/chronic pelvic pain syndrome (CPPS) has clinical and perhaps etiologic characteristics similar to interstitial cystitis. Pentosan polysulfate sodium (PPS), an oral medication indicated for the treatment of interstitial cystitis, has shown moderate benefit in reducing chronic pelvic pain and voiding symptoms in patients with interstitial cystitis. We undertook a prospective open-label, multicenter Phase II pilot study to

J. Curtis Nickel; Brenda Johnston; Joe Downey; Jack Barkin; Peter Pommerville; Mireille Gregoire; Ernest Ramsey

2000-01-01

327

Topical rubefacients for acute and chronic pain in adults  

PubMed Central

Background Rubefacients (containing salicylates or nicotinamides) cause irritation of the skin, and are believed to relieve various musculoskeletal pains. They are available on prescription, and are common components in over-the-counter remedies. A non-Cochrane review in 2004 found limited evidence for efficacy. Objectives To review current evidence for efficacy and safety of topically applied rubefacients in acute and chronic painful musculoskeletal conditions in adults. Search methods Cochrane CENTRAL, MEDLINE, EMBASE, the Oxford Pain Relief Database, and reference lists of articles were searched; last search December 2008. Selection criteria Randomised, double blind, placebo or active controlled clinical trials of topical rubefacient for musculoskeletal pain in adults, with at least 10 participants per treatment arm, and reporting outcomes at close to 7 (minimum 3, maximum 10) days for acute conditions and 14 (minimum 7) days or longer for chronic conditions. Data collection and analysis Two review authors independently assessed trials for inclusion and quality, and extracted data. Relative benefit or risk and number needed to treat to benefit or harm (NNT or NNH) were calculated with 95% confidence intervals (CI). Acute and chronic conditions were analysed separately. Main results Six placebo and one active controlled studies (560 and 137 participants) in acute pain, and seven placebo and two active controlled studies (489 and 90 participants) in chronic pain were included. All used topical salicylates. The evidence in acute conditions was not robust; using only better quality, valid studies, there was no difference between topical rubefacient and topical control, though overall, including lower quality studies, the NNT for clinical success compared with placebo was 3.2 (95% CI: 2.4 to 4.9). In chronic conditions the NNT was 6.2 (95% CI: 4.0 to 13) compared with topical placebo. Adverse events and withdrawals occurred more often with rubefacients than placebo, but analyses were sensitive to inclusion of individual studies, so not robust. There were insufficient data to draw conclusions against active controls. Authors’ conclusions The evidence does not support the use of topical rubefacients containing salicylates for acute injuries, and suggests that in chronic conditions their efficacy compares poorly with topical non-steroidal antiinflammatory drugs (NSAIDs). Topical salicylates seem to be relatively well tolerated in the short-term, based on limited data. There is no evidence at all for topical rubefacients with other components. PMID:19588430

Matthews, Paul; Derry, Sheena; Moore, R Andrew; McQuay, Henry J

2014-01-01

328

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

329

Racial differences in the physical and psychosocial health among black and white women with chronic pain.  

PubMed Central

Gender-based differences in pain epidemiology, pain threshold, attitudes toward pain management, coping styles and social roles are well described, yet little is known about the chronic pain experience in women or the role race plays. A retrospective analysis of self-reported data using a secondary clinical database was performed to elucidate the relationship between race and pain severity, depression, physical disability, posttraumatic stress disorder (PTSD) as well as affective distress in women with chronic pain. White (n=1,088) and black (n=104) adult women were compared based on their responses to the McGill Pain Questionnaire, Beck Depression Inventory, Pain Disability Index, Posttraumatic Chronic Pain Test and items from the West-Haven Yale Multidisciplinary Pain Inventory. After accounting for sociodemographic, medical, psychological and physical confounders, there was no significant race effect for pain severity or affective distress. However, black women with chronic pain experience more physical impairments than white women with chronic pain (beta = 4.622; p<0.005). Except for the family/home responsibilities, similar differences were found on all PDI subscales. We also found that disability mediates the race-depression relationship such that black women are comparatively more vulnerable to depression as a result of higher disability. Due to the economic, social and emotional impact that disability has on women with chronic pain and their families, these findings have significant implications for chronic pain research as well as its management in black women. PMID:16353658

Ndao-Brumblay, S. Khady; Green, Carmen R.

2005-01-01

330

Update: soccer injury and prevention, concussion, and chronic groin pain.  

PubMed

Soccer, or football, as it is known in much of the world, is one of the most popular sports in the world. The purpose of this article was to provide a concise update on select soccer-specific medical issues published in the last year as they relate to soccer injury and prevention, concussions, and chronic groin pain. Both the Fédération Internationale de Football Association and the Union of European Football Associations published data from their longstanding injury tracking systems, providing foundation for further research. Concussion research continues to drive much interest, especially as it relates to heading and the controversy of subconcussive trauma. Lastly, our understanding of chronic groin pain continues to be refined as we try to understand the complexity of its pathophysiology and attempt to standardize a multispecialty approach of diagnosis and treatment. PMID:25211620

Jones, Nathaniel S

2014-01-01

331

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

332

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

333

Bone Mineral Density in the Chronic Patellofemoral Pain Syndrome  

Microsoft Academic Search

.   Bone mineral density (BMD) and clinical status of 40 patients with a chronic, unilateral patellofemoral pain syndrome (PFPS)\\u000a were determinated. The mean duration of the disease at the time of the follow-up was 7.6 ± 1.8 (SD) years. The BMD was measured\\u000a at the spine (L2–L4), and the femoral neck, trochanter area of the femur, distal femur, patella, proximal

J. Leppälä; P. Kannus; A. Natri; H. Sievänen; M. Järvinen; I. Vuori

1998-01-01

334

Chronic Low Back Pain due to Retroperitoneal Cystic Lymphangioma  

PubMed Central

Abdominal cystic lymphangioma is a rare benign neoplasm. Less than 1% of lymphangiomas is in the retroperitoneum. Lymphangioma is mostly asymptomatic. Chronic symptoms were reported in retroperitoneal type more than others. Acute symptoms due to complications like infection, cyst rupture or hemorrhage may occur. We report an 18-years-old girl with low back pain from 6 months ago with huge pelvic mass and diagnosis of retroperitoneal cystic lymphangioma. PMID:25207319

Fattahi, Asieh Sadat; Maddah, Godratollah; Motamedolshariati, Mohammad; Ghiasi–Moghadam, Taghi

2014-01-01

335

Pelvic Floor Therapies in Chronic Pelvic Pain Syndrome  

Microsoft Academic Search

Chronic pelvic pain syndrome is a poorly understood clinical entity associated with urinary symptoms, pelvic floor dysfunction,\\u000a and multisystem disorders. Treatment of pelvic floor dysfunction is difficult and often frustrating for the patient as well\\u000a as for the involved physician. The purpose of this review is to update clinicians on the latest research for the treatment\\u000a of pelvic floor dysfunction

Ragi Doggweiler; Adam F. Stewart

2011-01-01

336

Components of Mindfulness in Patients with Chronic Pain  

Microsoft Academic Search

Methods of mindfulness are gaining increasing popularity within the behavioral and cognitive therapies and appear helpful\\u000a for a range of clinical problems. The purpose of this study was to examine cognitive and behavioral processes underlying mindfulness.\\u000a One hundred fifty patients seeking treatment for chronic pain completed a battery of questionnaires, including the 15-item\\u000a Mindful Attention Awareness Scale (MAAS; Brown and

Lance M. McCracken; Miles Thompson

2009-01-01

337

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

338

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

339

Exercise in the Management of Chronic Back Pain  

PubMed Central

Background Chronic back pain is one of the most common and expensive medical conditions facing today's population. Its costs are estimated to be as much as $100 billion in the United States alone. Causation is poorly understood and healthcare providers share little common language concerning this pain. In addition, costly medical diagnostic tests are performed that do little to inform treatment. In the era of evidence-based medicine, back pain healthcare providers must find better ways to communicate with one another. Methods The key to better communication is measurement within the context of an evidence-based, protocol-driven clinical rehabilitation model. Measurement is the key to better communication among providers treating spinal pain. Measurement means acquiring both patient-reported outcomes (PROs) and clinician-based outcomes (CBOs). Results Musculoskeletal strengthening of the lumbar and cervical extensors has been shown to significantly reduce pain and provide successful clinical results for patients suffering from chronic back and neck pain. Lumbar strengthening has been successful because it is a safe exercise, it is prescribed based on pretreatment evaluation, and it provides objective measurements. Conclusion Without measurement, clinical results rely more on opinion than on objectively prescribed courses of treatment. Although indirect measures (PROs) are typically presented in clinical papers and clinical reviews, they are not often used in normal physical therapy practices. Adding direct patient-performance measures (CBOs) creates a much clearer clinical picture. The key to understanding the value of clinical practice and its predictable impact on patient treatment is objective measurement. PMID:24688341

Dreisinger, Thomas E.

2014-01-01

340

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

341

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

342

Comparative Effectiveness of CBT Interventions for Co-Morbid Chronic Pain & Insomnia: A Pilot Study  

PubMed Central

Introduction Chronic pain is difficult to treat and often precedes or exacerbates sleep disturbances such as insomnia. Insomnia, in turn, can amplify the pain experience. Both conditions are associated with inflammatory processes, which may be involved in the bidirectional relationship between pain and sleep. Cognitive behavioral therapy (CBT) for pain and CBT for insomnia are evidence based interventions for, respectively, chronic pain and insomnia. The study objectives were to determine the feasibility of combining CBT for pain and for insomnia and to assess the effects of the combined intervention and the stand alone interventions on pain, sleep, and mood outcomes compared to a control condition. Methods Twenty-one adults with co-occurring chronic pain and chronic insomnia were randomized to either CBT for pain, CBT for insomnia, combined CBT for pain and insomnia, or a wait-list control condition. Results The combined CBT intervention was feasible to deliver and produced significant improvements in sleep, disability from pain, depression and fatigue compared to the control condition. Overall, the combined intervention appeared to have a strong advantage over CBT for pain on most outcomes, modest advantage over both CBT for insomnia in reducing insomnia severity in chronic pain patients. Discussion CBT for pain and CBT for insomnia may be combined with good results for patients with co-occurring chronic pain and insomnia. PMID:22982083

Pigeon, Wilfred R.; Moynihan, Jan; Matteson-Rusby, Sara; Jungquist, Carla R.; Xia, Yinglin; Tu, Xin; Perlis, Michael L.

2012-01-01

343

Chronic Prostatitis\\/Chronic Pelvic Pain Syndrome and Pelvic Floor Spasm: Can We Diagnose and Treat?  

Microsoft Academic Search

National Institutes of Health category III prostatitis, also known as chronic prostatitis\\/chronic pelvic pain syndrome, is\\u000a a common condition with significant impact on quality of life. This clinically defined syndrome has a multifactorial etiology\\u000a and seems to respond best to multimodal therapy. At least half of these patients have pelvic floor spasm. There are several\\u000a approaches to therapy including biofeedback,

Karin E. Westesson; Daniel A. Shoskes

2010-01-01

344

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

345

Pain in chronic pancreatitis: Managing beyond the pancreatic duct  

PubMed Central

Chronic pancreatitis (CP) continues to be a clinical challenge. Persistent or recurrent abdominal pain is the most compelling symptom that drives patients to seek medical care. Unfortunately, in spite of using several treatment approaches in the clinical setting, there is no single specific treatment modality that can be earmarked as a cure for this disease. Traditionally, ductal hypertension has been associated with causation of pain in CP; and patients are often subjected to endotherapy and surgery with a goal to decompress the pancreatic duct. Recent studies on humans (clinical and laboratory based) and experimental models have put forward several mechanisms, including neuroimmune alterations, which could be responsible for pain. This might explain the partial or no response to single modality treatment in a significant proportion of patients. The current review discusses the recent concepts of pain generation in CP and evidence based therapeutic approaches (other than ductal decompression) to handle persistent or recurrent pain. We focus primarily on parenchymal and neural components; and discuss the role of antioxidants and the existing controversies, drugs that interfere with neural transmission, pancreatic enzyme supplementation, celiac neurolysis, and pancreatic resection procedures. The review concludes with the treatment approach that we follow at our institute. PMID:24151350

Talukdar, Rupjyoti; Reddy, D Nageshwar

2013-01-01

346

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

347

Evidence for brain glial activation in chronic pain patients.  

PubMed

Although substantial evidence has established that microglia and astrocytes play a key role in the establishment and maintenance of persistent pain in animal models, the role of glial cells in human pain disorders remains unknown. Here, using the novel technology of integrated positron emission tomography-magnetic resonance imaging and the recently developed radioligand (11)C-PBR28, we show increased brain levels of the translocator protein (TSPO), a marker of glial activation, in patients with chronic low back pain. As the Ala147Thr polymorphism in the TSPO gene affects binding affinity for (11)C-PBR28, nine patient-control pairs were identified from a larger sample of subjects screened and genotyped, and compared in a matched-pairs design, in which each patient was matched to a TSPO polymorphism-, age- and sex-matched control subject (seven Ala/Ala and two Ala/Thr, five males and four females in each group; median age difference: 1 year; age range: 29-63 for patients and 28-65 for controls). Standardized uptake values normalized to whole brain were significantly higher in patients than controls in multiple brain regions, including thalamus and the putative somatosensory representations of the lumbar spine and leg. The thalamic levels of TSPO were negatively correlated with clinical pain and circulating levels of the proinflammatory citokine interleukin-6, suggesting that TSPO expression exerts pain-protective/anti-inflammatory effects in humans, as predicted by animal studies. Given the putative role of activated glia in the establishment and or maintenance of persistent pain, the present findings offer clinical implications that may serve to guide future studies of the pathophysiology and management of a variety of persistent pain conditions. PMID:25582579

Loggia, Marco L; Chonde, Daniel B; Akeju, Oluwaseun; Arabasz, Grae; Catana, Ciprian; Edwards, Robert R; Hill, Elena; Hsu, Shirley; Izquierdo-Garcia, David; Ji, Ru-Rong; Riley, Misha; Wasan, Ajay D; Zürcher, Nicole R; Albrecht, Daniel S; Vangel, Mark G; Rosen, Bruce R; Napadow, Vitaly; Hooker, Jacob M

2015-03-01

348

[Clinical characteristics of pain in chronic venous insufficiency].  

PubMed

Since the report of the 1st International Conference of Phlebology at Chambéry, devoted to venous pain, the subject has scarcely attracted attention apart from the meeting of the Benelux Society of Phlebology devoted to "pain in the legs". Pain due to superficial venous insufficiency has scarcely changed in nature for 30 years and remains one of the major presenting symptoms in phlebology. Acute or chronic, punctate or diffuse, modifications in this functional symptomatology have been accentuated, or have varied in their aspects under the influence of certain fashions or certain habits of modern life, i.e.: sedentary behaviour, underfloor heating, the use of oral contraceptives or of menopausal hormone replacement therapy. However, the distribution of the various aspects of venous pain remains in the same proportions as those described by the authors cited previously. While the etiological diagnosis must essentially eliminate all other causes: arterial, neurological, muscular, articular, it is essential not to neglect deep venous insufficiency of the gemellar veins, often responsible for a wide range of symptomatology and still all too often neglected. The pathogenesis of this pain not only involves the concept of pain receptors but also the appearance of algogenic metabolites at the site of the microcirculatory unit, to which endothelial cells are particularly sensitive during stasis. In fact, pain is the expression of disorders concerning local exchanges, whether thermal, pressure, metabolic or hemorheological. It is the alarm bell of venous insufficiency and merits the attention of the phebologist who must thus undertake active treatment before problems become irreversible. PMID:1496035

Coget, J M; Millien, J P

1992-01-01

349

Sclerosing polidocanol injections in chronic painful tennis elbow-promising results in a pilot study  

Microsoft Academic Search

Sclerosing polidocanol injections targeting the area with neovessels (vascularity) have been demonstrated to give promising clinical results in patients with chronic painful Achilles and patellar tendinosis. Recently, we demonstrated vascularity in the extensor origin in patients with chronic painful tennis elbow, but not in controls with pain-free elbows. In this pilot study, 11 patients (four men and seven women, mean

Eva Zeisig; Lars Öhberg; Håkan Alfredson

2006-01-01

350

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

351

OSTEOPAThic Health outcomes In Chronic low back pain: The OSTEOPATHIC Trial  

Microsoft Academic Search

BACKGROUND: Osteopathic manipulative treatment (OMT) and ultrasound physical therapy (UPT) are commonly used for chronic low back pain. Although there is evidence from a systematic review and meta-analysis that OMT generally reduces low back pain, there are no large clinical trials that specifically assess OMT efficacy in chronic low back pain. Similarly, there is a lack of evidence involving UPT

John C Licciardone; Hollis H King; Kendi L Hensel; Daniel G Williams

2008-01-01

352

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

353

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

354

The transition from acute to chronic pain: might intensive care unit patients be at risk?  

PubMed Central

Pain remains a significant problem for patients hospitalized in intensive care units (ICUs). As research has shown, for some of these patients pain might even persist after discharge and become chronic. Exposure to intense pain and stress during medical and nursing procedures could be a risk factor that contributes to the transition from acute to chronic pain, which is a major disruption of the pain neurological system. New evidence suggests that physiological alterations contributing to chronic pain states take place both in the peripheral and central nervous systems. The purpose of this paper is to: 1) review cutting-edge theories regarding pain and mechanisms that underlie the transition from acute to chronic pain, such as increases in membrane excitability of peripheral and central nerve fibers, synaptic plasticity, and loss of the function of descending inhibitory pain fibers; 2) provide information on the association between the immune system and pain and its crucial contribution to development of chronic pain syndromes, and 3) discuss mechanisms at brain levels in the nervous system and their contribution to affective (i.e., emotional) states associated with chronic pain conditions. Finally, we will offer suggestions for ICU clinical interventions to attempt to prevent the transition from acute to chronic pain. PMID:22898192

2012-01-01

355

Effectiveness of nucleoplasty applied for chronic radicular pain  

PubMed Central

Summary Background Over the last several decades there has been a general trend toward reduction and minimalization in surgical treatment of chronic back pain, since open surgery brings complications in small and contained disc herniations instead of achieving expected success. Attention has been focussed on percutaneous nucleoplasty due to the limited success of other minimally invasive methods, as well due to their associated complications. However, there have been few studies in the English literature with a follow-up period of more than 1 year. Material/Methods Patients with chronic disc herniations having more significant radicular leg pain, who did not respond to non-invasive treatment methods and for whom open surgery was not an option were selected for percutaneous nucleoplasty application. Upon intervention, patients were prospectively questioned by an independent physician regarding pain, physical improvement, and operation satisfaction at 1, 6, 12 and 24 months. Pain was evaluated with VAS, and physical improvement was evaluated based on the Oswestry Disability Index. Results Mean VAS that was 8.7±1.1 before the procedure was determined to be 3.4±1.9 at 24 months follow-up. At the latest follow-up, 87.5% of the patients reported a 30% or higher decrease in their pain. While Oswestry scores were 76.1±10.2 in the beginning, they went down to 33.9±14.9 at the end of 2 years. The percent of those stating “good” and “excellent” satisfaction was 66% (23 persons) on the last follow-up. Conclusions While it is once more shown that nucleoplasty is a safe method, it is also shown that its effectiveness continues at the end of 2 years.

Karaman, Haktan; Tüfek, Adnan; Kavak, Gönül Ölmez; Yildirim, Zeynep Baysal; Temel, Vildan; Çelik, Feyzi; Akdemir, Mehmet Salim; Kaya, Sedat

2011-01-01

356

The influence of chronic pain on the daily lives of underprivileged South africans.  

PubMed

Chronic pain is a major public health problem that changes lives and has devastating consequences for the person experiencing the pain, the family, and society. Living with chronic pain is not easy, especially in South Africa where the public health care system, serving 80% of the population, fails people suffering from chronic pain. The purpose of the study was to explore how experiencing chronic pain influenced the daily lives of underprivileged patients receiving nursing care at the palliative care clinic serving a resource-poor community in Tshwane, South Africa. A qualitative descriptive phenomenologic design was selected for the study. Nine purposively selected community members, registered as patients at the palliative care clinic and who suffered chronic pain, participated in the study. In-depth interviews were conducted and Tesch's coding process was used to analyze the data. Data gathering and analysis were done concurrently to determine data saturation. Four themes arose from the data: pain as a multidimensional experience, the influence of pain on physical activities, the psychosocial influence of pain, and the influence of pain on spirituality. Participants' experience of pain tells of severe suffering that hindered them in performing activities of daily living. Participants were confronted with total pain and were caught in a vicious circle where pain was responsible for severe suffering and their suffering added to their pain. However, strong religious beliefs improved pain and gave hope for the future. PMID:25434498

de Villiers, Martjie; Maree, Johanna Elizabeth; van Belkum, Corrien

2015-04-01

357

Systematic review of family functioning in families of children and adolescents with chronic pain  

PubMed Central

Disturbances in family functioning have been identified in youth with chronic pain and are associated with worse child physical and psychological functioning. Assessment measures of family functioning used in research and clinical settings vary. This systematic review summarizes studies investigating relationships among family functioning, pain and pain-related disability in youth with chronic pain. Sixteen articles were reviewed. All studies were cross-sectional, seven utilized between-group comparisons (chronic pain versus healthy/control) and twelve examined within-group associations among family functioning, pain and/or pain-related disability. Studies represented youth with various pain conditions (e.g., headache, abdominal pain, fibromyalgia) aged 6 – 20 years. Findings revealed group differences in family functioning between children with chronic pain and healthy controls in five of seven studies. Significant associations emerged among family variables and pain-related disability in six of nine studies with worse family functioning associated with greater child disability; relationships between family functioning and children’s pain were less consistent. Different patterns of results emerged depending on family functioning measure used. Overall, findings showed that families of children with chronic pain generally have poorer family functioning than healthy populations, and that pain-related disability is more consistently related to family functioning than pain intensity. PMID:21055709

Lewandowski, Amy S.; Palermo, Tonya M.; Stinson, Jennifer; Handley, Susannah; Chambers, Christine T.

2010-01-01

358

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

359

Can workers with chronic back pain shift from pain elimination to function restore at work?  

Microsoft Academic Search

Introduction: Workers with chronic low back pain (LBP) mean a heavy human and social-economic burden. Their medical histories often include different treatments without attention to work-relatedness or communication with occupational health providers, leaving them passive and medicalized in (outpatient) health care. So we developed and implemented an innovative, patient-activating alternative: the multidisciplinary outpatient care (MOC) programme, including work(place) intervention and

P. C. Buijs; L. C. Lambeek; V. Koppenrade; W. E. Hooftman; J. R. Anema

2009-01-01

360

Identifying important outcome domains for chronic pain clinical trials: An IMMPACT survey of people with pain  

Microsoft Academic Search

This two-phase study was conducted to identify relevant domains of patient-reported outcomes from the perspective of people who experience chronic pain. In Phase 1, focus groups were conducted to generate a pool of patient outcome-related domains and their components. The results of the focus groups identified 19 aspects of their lives that were significantly impacted by the presence of their

Dennis C. Turk; Robert H. Dworkin; Dennis Revicki; Gale Harding; Laurie B. Burke; David Cella; Charles S. Cleeland; Penney Cowan; John T. Farrar; Sharon Hertz; Mitchell B. Max; Bob A. Rappaport

2008-01-01

361

Overcoming the Influence of Chronic Pain on Older Patients' Difficulty with Recommended Self-Management Activities  

ERIC Educational Resources Information Center

Purpose: Many older patients with common chronic conditions also experience chronic pain. We examined how chronic pain affects patients' difficulty with recommended self-management activities and the potential intervening role of self-efficacy (the level of confidence in one's own ability to perform a specific task). Design and Methods: We…

Krein, Sarah L.; Heisler, Michele; Piette, John D.; Butchart, Amy; Kerr, Eve A.

2007-01-01

362

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

363

Rational use of opioids for management of chronic nonterminal pain.  

PubMed

Opioid prescribing for chronic nonterminal pain has increased in recent years, although evidence for its long-term effectiveness is weak and its potential for harm is significant. Nonmedical use of prescription opioids, diversion, and overdose deaths have also increased sharply, sparking concern about the safety of these medications. Physicians considering initiation or continuation of opioid therapy for a patient with chronic nonterminal pain should first use a structured approach that includes a biopsychosocial evaluation and a treatment plan that encourages patients to set and reach functional goals. There should be a comprehensive evaluation for the cause of pain, assessment for risk of opioid complications (including misuse and addiction), and a detailed treatment history, including a review of medical records and data from the state prescription monitoring program. Opioids should be prescribed on a trial basis, to be continued only if progress toward functional goals is demonstrated. Long-acting morphine is the preferred initial drug, although several alternatives are available. Ongoing monitoring for safety and effectiveness is essential, including regular review of functional progress or maintenance, urine drug testing, and surveillance of data from the state prescription monitoring program. Ineffective, unsafe, or diverted opioid therapy should be promptly tapered or stopped. PMID:22962988

Berland, Daniel; Rodgers, Phillip

2012-08-01

364

Chronic pain self-management for older adults: a randomized controlled trial [ISRCTN11899548  

Microsoft Academic Search

BACKGROUND: Chronic pain is a common and frequently disabling problem in older adults. Clinical guidelines emphasize the need to use multimodal therapies to manage persistent pain in this population. Pain self-management training is a multimodal therapy that has been found to be effective in young to middle-aged adult samples. This training includes education about pain as well as instruction and

Mary Ersek; Judith A Turner; Kevin C Cain; Carol A Kemp

2004-01-01

365

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

366

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

E-print Network

with chronic low-back pain might benefit from acupuncture, massage therapy, yoga or cognitive 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

Bezrukov, Sergey M.

367

Psychological Factors in Chronic Pelvic Pain in Women: Relevance and Application of the Fear-Avoidance Model of Pain  

PubMed Central

Chronic pelvic pain in women is a debilitating, costly condition often treated by physical therapists. The etiology of this condition is multifactorial and poorly understood, given the complex interplay of muscles, bones, and soft tissue that comprise the pelvis. There are few guidelines directing treatment interventions for this condition. In the last decade, several investigators have highlighted the role of psychological variables in conditions such as vulvodynia and painful bladder syndrome. Pain-related fear is the focus of the fear-avoidance model (FAM) of pain, which theorizes that some people are more likely to develop and maintain pain after an injury because of their emotional and behavioral responses to pain. The FAM groups people into 2 classes on the basis of how they respond to pain: people who have low fear, confront pain, and recover from injury and people who catastrophize pain—a response that leads to avoidance/escape behaviors, disuse, and disability. Given the presence of pain-related cognitions in women with chronic pelvic pain, including hypervigilance, catastrophizing, and anxiety, research directed toward the application of the FAM to guide therapeutic interventions is warranted. Isolated segments of the FAM have been studied to theorize why traditional approaches (ie, medications and surgery) may not lead to successful outcomes. However, the explicit application of the FAM to guide physical therapy interventions for women with chronic pelvic pain is not routine. Integrating the FAM might direct physical therapists' clinical decision making on the basis of the pain-related cognitions and behaviors of patients. The aims of this article are to provide information about the FAM of musculoskeletal pain and to provide evidence for the relevance of the FAM to chronic pelvic pain in women. PMID:21835893

Bishop, Mark D.

2011-01-01

368

Longitudinal course and impact of insomnia symptoms in adolescents with and without chronic pain  

PubMed Central

Abstract and Perspective This study aimed to: 1) examine trajectories of insomnia symptoms in adolescents with chronic pain compared to their healthy peers, 2) evaluate psychological and behavioral risk factors for longitudinal insomnia symptoms, and 3) evaluate insomnia as a predictor of quality of life, activity limitations, and healthcare utilization over 12 months. Participants included 61 adolescents with chronic pain and 60 youth without chronic pain (12–18 years; 72% female). Questionnaires were completed at enrollment, 6-months, and 12-months, and assessed pain intensity, insomnia symptoms, sleep hygiene, pre-sleep arousal, depression, pubertal status, activity limitations, quality of life, and healthcare utilization. Insomnia symptoms persisted for both groups, and remained higher at all time points for youth with chronic pain. GEE modeling identified three risk factors for longitudinal insomnia symptoms: having chronic pain, poorer sleep hygiene, and higher depressive symptoms. Insomnia symptoms also predicted poorer quality of life over time, and were associated with more frequent healthcare utilization. Findings suggest that sleep problems are persistent and associated with negative impact for youth with chronic pain. Treatment of insomnia symptoms in youth with chronic pain may lead to improvements in quality of life and reductions in healthcare costs. Perspective Insomnia symptoms are persistent over a 12 month period and are associated with negative impact for youth with chronic pain. These findings suggest that treatment of insomnia symptoms in youth with chronic pain may lead to improvements in quality of life and reductions in healthcare costs. PMID:23031311

Palermo, Tonya M.; Law, Emily; Churchill, Shervin S.; Walker, Amy

2012-01-01

369

Chronic prostatitis/chronic pelvic pain syndrome and pelvic floor spasm: can we diagnose and treat?  

PubMed

National Institutes of Health category III prostatitis, also known as chronic prostatitis/chronic pelvic pain syndrome, is a common condition with significant impact on quality of life. This clinically defined syndrome has a multifactorial etiology and seems to respond best to multimodal therapy. At least half of these patients have pelvic floor spasm. There are several approaches to therapy including biofeedback, acupuncture, and myofascial release physical therapy. However, the only multicenter study of pelvic floor physical therapy for pelvic floor spasm in men failed to show an advantage over conventional Western massage. We have proposed a clinical phenotyping system called UPOINT to classify patients with urologic chronic pelvic pain and subsequently direct appropriate therapy. Here, we review the current approach to category III prostatitis and describe how clinical phenotyping with UPOINT may improve therapy outcomes. PMID:20490725

Westesson, Karin E; Shoskes, Daniel A

2010-07-01

370

More than meets the eye: visual attention biases in individuals reporting chronic pain  

PubMed Central

The present study used eye-tracking technology to assess whether individuals who report chronic pain direct more attention to sensory pain-related words than do pain-free individuals. A total of 113 participants (51 with chronic pain, 62 pain-free) were recruited. Participants completed a dot-probe task, viewing neutral and sensory pain-related words while their reaction time and eye movements were recorded. Eye-tracking data were analyzed by mixed-design analysis of variance with group (chronic pain versus pain-free) as the between-subjects factor, and word type (sensory pain versus neutral) as the within-subjects factor. Results showed a significant main effect for word type: all participants attended to pain-related words more than neutral words on several eye-tracking parameters. The group main effect was significant for number of fixations, which was greater in the chronic pain group. Finally, the group by word type interaction effect was significant for average visit duration, number of fixations, and total late-phase duration, all greater for sensory pain versus neutral words in the chronic pain group. As well, participants with chronic pain fixated significantly more frequently on pain words than did pain-free participants. In contrast, none of the effects for reaction time were significant. The results support the hypothesis that individuals with chronic pain display specific attentional biases toward pain-related stimuli and demonstrate the value of eye-tracking technology in measuring differences in visual attention variables. PMID:25285022

Fashler, Samantha R; Katz, Joel

2014-01-01

371

Effects of the CORE Exercise Program on Pain and Active Range of Motion in Patients with Chronic Low Back Pain  

PubMed Central

[Purpose] This study aimed to identify the effects of the CORE exercise program on pain and active range of motion (AROM) in patients with chronic low back pain. [Subjects and Methods] Thirty subjects with chronic low back pain were randomly allocated to two groups: the CORE group (n = 15) and the control group (n = 15). The CORE group performed the CORE exercise program for 30 minutes a day, 3 times a week, for 4 weeks, while the control group did not perform any exercise. The visual analog scale (VAS) and an algometer were used to measure pain, and pain-free AROM in the trunk was measured before and after the intervention. [Results] The CORE group showed significantly decreased VAS scores at rest and during movement and had a significantly increased pressure pain threshold in the quadratus lumborum and AROM in the trunk compared with those in the control group. [Conclusion] This study demonstrated that the CORE exercise program is effective in decreasing pain and increasing AROM in patients with chronic low back pain. Thus, the CORE exercise program can be used to manage pain and AROM in patients with chronic low back pain. PMID:25202188

Cho, Hwi-young; Kim, Eun-hye; Kim, Junesun

2014-01-01

372

Musculoskeletal causes of chronic pelvic pain: what a gynecologist should know.  

PubMed

Ten percent of all gynecologic consultations are for chronic pelvic pain, and 20% of patients require a laparoscopy. Chronic pelvic pain affects 15% of all women annually in the United States, with medical costs and loss of productivity estimated at $2.8 billion and $15 billion per year, respectively. Chronic pelvic pain in women may have multifactorial etiology, but 22% have pain associated with musculoskeletal causes. Unfortunately, pelvic musculoskeletal dysfunction is not routinely evaluated as a cause of pelvic pain by gynecologists. A pelvic musculoskeletal examination is simple to perform, is not time-consuming, and is one of the most important components to investigate in all chronic pelvic pain patients. This article describes common musculoskeletal causes of chronic pelvic pain and explains how to perform a simple musculoskeletal examination that can be easily incorporated into the gynecologist physical examination. PMID:23635629

Gyang, Anthony; Hartman, Melissa; Lamvu, Georgine

2013-03-01

373

Evidence for the endothelin system as an emerging therapeutic target for the treatment of chronic pain  

PubMed Central

Many people worldwide suffer from pain and a portion of these sufferers are diagnosed with a chronic pain condition. The management of chronic pain continues to be a challenge, and despite taking prescribed medication for pain, patients continue to have pain of moderate severity. Current pain therapies are often inadequate, with side effects that limit medication adherence. There is a need to identify novel therapeutic targets for the management of chronic pain. One potential candidate for the treatment of chronic pain is therapies aimed at modulating the vasoactive peptide endothelin-1. In addition to vasoactive properties, endothelin-1 has been implicated in pain transmission in both humans and animal models of nociception. Endothelin-1 directly activates nociceptors and potentiates the effect of other algogens, including capsaicin, formalin, and arachidonic acid. In addition, endothelin-1 has been shown to be involved in inflammatory pain, cancer pain, neuropathic pain, diabetic neuropathy, and pain associated with sickle cell disease. Therefore, endothelin-1 may prove a novel therapeutic target for the relief of many types of chronic pain. PMID:25210474

Smith, Terika P; Haymond, Tami; Smith, Sherika N; Sweitzer, Sarah M

2014-01-01

374

Oxytocin - a multifunctional analgesic for chronic deep tissue pain.  

PubMed

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

2015-01-01

375

Opioid addiction screening tools for patients with chronic noncancer pain.  

PubMed

Recent reports of the sharp increase in overdose deaths from prescription opioids have raised concerns regarding the widespread use and abuse of these medications in the treatment of chronic noncancer pain (CNCP). The Centers for Disease Control and Prevention has described prescription drug overdose deaths as an epidemic, with recommendations that strategies for preventing opioid-related deaths should focus on the 10 percent of patients prescribed high doses of medication from a single health professional and the 10 percent of patients who receive high doses from multiple physicians. The CDC report also encourages more education for physicians on prescription of opioids, pain management, and addiction, and specifically encourages physicians to consult state-run prescription databases and to discontinue opioid therapy for patients not receiving benefit. This article reviews important terms for understanding prescription opioid addiction and describes several tools that health professionals can use to screen patients with CNCP being considered for opioid therapy. PMID:25705942

Dela Cruz, Adriane M; Trivedi, Madhukar H

2015-01-01

376

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

377

Chronic low back pain and insomnia : understanding the experience and attributions made by out-patients about sleeplessness, pain and their interaction   

E-print Network

Systematic Review: Chronic pain and insomnia are highly comorbid, and evidence suggests a reciprocal relationship between these. CBT-I has been shown to improve sleep in those with chronic pain, therefore the potential ...

McKenzie, Paul Stephen

2012-11-28

378

Deciphering the Temporal Link between Pain and Sleep in a Heterogeneous Chronic Pain Patient Sample: A Multilevel Daily Process Study  

PubMed Central

Objectives: Because insomnia is a common comorbidity of chronic pain, scientific and clinical interest in the relationship of pain and sleep has surged in recent years. Although experimental studies suggest a sleep-interfering property of pain and a pain-enhancing effect of sleep deprivation/fragmentation, the temporal association between pain and sleep as experienced by patients is less understood. The current study was conducted to examine the influence of presleep pain on subsequent sleep and sleep on pain reports the next day, taking into consideration other related psychophysiologic variables such as mood and arousal. Design: A daily process study, involving participants to monitor their pain, sleep, mood, and presleep arousal for 1 wk. Multilevel modeling was used to analyze the data. Setting: In the patients' natural living and sleeping environment. Patients: One hundred nineteen patients (73.9% female, mean age = 46 years) with chronic pain and concomitant insomnia. Measurement: An electronic diary was used to record patients' self-reported sleep quality/efficiency and ratings of pain, mood, and arousal at different times of the day; actigraphy was also used to provide estimates of sleep efficiency. Results: Results indicated that presleep pain was not a reliable predictor of subsequent sleep. Instead, sleep was better predicted by presleep cognitive arousal. Although sleep quality was a consistent predictor of pain the next day, the pain-relieving effect of sleep was only evident during the first half of the day. Conclusions: These findings challenge the often-assumed reciprocal relationship between pain and sleep and call for a diversification in thinking of the daily interaction of these 2 processes. Citation: Tang NKY; Goodchild CE; Sanborn AN; Howard J; Salkovskis PM. Deciphering the temporal link between pain and sleep in a heterogeneous chronic pain patient sample: a multilevel daily process study. SLEEP 2012;35(5):675-687. PMID:22547894

Tang, Nicole K.Y.; Goodchild, Claire E.; Sanborn, Adam N.; Howard, Jonathan; Salkovskis, Paul M.

2012-01-01

379

A study of chronic pelvic pain after radiotherapy in survivors of locally advanced cervical cancer  

Microsoft Academic Search

Introduction  Chronic pelvic pain (persisting pain in hips, groins or lower back) is poorly described in studies of cervical cancer survivors\\u000a (CCSs). The aims of this study were to describe chronic pelvic pain and associated variables in CCSs surveyed >5 years post-radiotherapy,\\u000a and to compare the presence of pain in hips and lower back in CCSs with findings in the general female

Ingvild Vistad; Milada Cvancarova; Gunnar Balle Kristensen; Sophie Dorothea Fosså

2011-01-01

380

Does spirituality as a coping mechanism help or hinder coping with chronic pain?  

Microsoft Academic Search

Chronic pain is a complex experience stemming from the interrelationship among biological, psychological, social, and spiritual\\u000a factors. Many chronic pain patients use religious\\/spiritual forms of coping, such as prayer and spiritual support, to cope\\u000a with their pain. This article explores empirical research that illustrates how religion\\/spirituality may impact the experience\\u000a of pain and may help or hinder the coping process.

Amy B. Wachholtz; Michelle J. Pearce

2009-01-01

381

Reactive effects of diary self-assessment in chronic pain patients  

Microsoft Academic Search

Several studies of experimental and acute clinical pain have indicated reactive effects of self-assessment on pain intensity and tolerance. A recent study of chronic pain patients (vonBaeyer 1994), however, failed to show these effects. The present investigation sought to determine whether reactive effects can be produced in chronic pain patients by an intensive self-assessment protocol. Using the methodology of ecological

Charles E. Cruise; Joan Broderick; Laura Porter; Alan Kaell; Arthur A. Stone

1996-01-01

382

Survey of chronic pain in Europe: Prevalence, impact on daily life, and treatment  

Microsoft Academic Search

This large scale computer-assisted telephone survey was undertaken to explore the prevalence, severity, treatment and impact of chronic pain in 15 European countries and Israel. Screening interviews identified respondents aged ?18 years with chronic pain for in-depth interviews. 19% of 46,394 respondents willing to participate (refusal rate 46%) had suffered pain for ?6 months, had experienced pain in the last

Harald Breivik; Beverly Collett; Vittorio Ventafridda; Rob Cohen; Derek Gallacher

2006-01-01

383

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

384

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

385

Central sensitization: a biopsychosocial explanation for chronic widespread pain in patients with fibromyalgia and chronic fatigue syndrome  

Microsoft Academic Search

In addition to the debilitating fatigue, the majority of patients with chronic fatigue syndrome (CFS) experience chronic widespread\\u000a pain. These pain complaints show the greatest overlap between CFS and fibromyalgia (FM). Although the literature provides\\u000a evidence for central sensitization as cause for the musculoskeletal pain in FM, in CFS this evidence is currently lacking,\\u000a despite the observed similarities in both

Mira Meeus; Jo Nijs

2007-01-01

386

Communicating the Experience of Chronic Pain and Illness Through Blogging  

PubMed Central

Background Although more individuals are sharing their experiences with chronic pain or illness through blogging (writing an Internet web log), research on the psychosocial effects and motivating factors for initiating and maintaining a blog is lacking. Objective The objective was to examine via online questionnaire the perceived psychosocial and health benefits of blogging among patients who use this media to communicate their experience of chronic pain or illness. Methods A 34-item online questionnaire was created, tested, and promoted through online health/disease forums. The survey employed convenience sampling and was open from May 5 to July 2, 2011. Respondents provided information regarding demographics, health condition, initiation and upkeep of blogs, and dynamics of online communication. Qualitative data regarding respondents’ blogging experiences, expectations for blogging, and the perceived effects from blogging on the blogger’s health, interpersonal relationships, and quality of life were collected in the form of written narrative. Results Out of 372 respondents who started the survey, 230 completed the entire questionnaire. Demographic data showed survey respondents to be predominantly female (81.8%) and highly educated (97.2% > high school education and 39.6% with graduate school or professional degrees). A wide spectrum of chronic pain and illness diagnoses and comorbidities were represented. Respondents reported that initiating and maintaining an illness blog resulted in increased connection with others, decreased isolation, and provided an opportunity to tell their illness story. Blogging promoted accountability (to self and others) and created opportunities for making meaning and gaining insights from the experience of illness, which nurtured a sense of purpose and furthered their understanding of their illness. Conclusions Results suggest that blogging about chronic pain and illness may decrease a sense of isolation through the establishment of online connections with others and increases a sense of purpose to help others in similar situations. Further study involving a larger sample size, a wider range of education levels, and respondents with different types and magnitudes of illnesses will be needed to better elucidate the mechanism of the observed associations in this understudied area. PMID:23092747

2012-01-01

387

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

388

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

E-print Network

who endure long-term pain and suffering. · In the present study, we compare performance scoresChronic 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

Apkarian, A. Vania

389

A protocol-contract for opioid use in patients with chronic pain not due to malignancy.  

PubMed

The legal, psychosocial, and medical factors that we believe have contributed to the success of our protocol-contract in prescribing opioids to patients with chronic pain not due to malignancy are outlined. These factors may be applicable to the treatment of a variety of chronic nonmalignant pain syndromes such as postherpetic neuralgia or human immunodeficiency virus/acquired immunodeficiency syndrome. The intended target audience of this paper is the physician (primary care, chronic pain specialist) who is involved in prescribing opioids for the treatment of chronic, nonmalignant pain. PMID:9702628

Kirkpatrick, A F; Derasari, M; Kovacs, P L; Lamb, B D; Miller, R; Reading, A

1998-08-01

390

COPING STRATEGY USE: DOES IT PREDICT ADJUSTMENT TO CHRONIC BACK PAIN AFTER CONTROLLING FOR CATASTROPHIC THINKING AND SELF-EFFICACY FOR PAIN CONTROL?  

Microsoft Academic Search

Objective: To explore whether coping strategy use predicted levels of adjustment in chronic low back pain after con- trolling for the influence of catastrophic thinking and self- efficacy for pain control. Methods: Eighty-four patients with chronic low back pain completed the Coping Strategies Questionnaire, a pain VAS and the Roland Disability Questionnaire. To derive compo- site measures of coping, the

Neil Roach; Martin Urmston; Steve Woby; Paul Watson

2005-01-01

391

Pain Self-Management in the Process and Outcome of Multidisciplinary Treatment of Chronic Pain: Evaluation of a Stage of Change Model  

Microsoft Academic Search

For chronic pain patients, acceptance of a self-management approach for pain may influence success in treatment, and adopting such a perspective may be conceptualized as a stage of change model. For 65 chronic pain patients in multidisciplinary treatment programs, we examined whether pretreatment self-management stage, assessed with Pain Stage of Change Questionnaire subscales, affected improvements in outcomes, and whether changes

Beth Glenn; John W. Burns

2003-01-01

392

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

393

Neuropathic Pain in Elderly Patients with Chronic Low Back Painand Effects of Pregabalin: A Preliminary Study  

PubMed Central

Study Design Preliminary study. Purpose To assess the association of neuropathic pain with chronic low back pain (LBP) and the effect of pregabalin on neuropathic pain in the elderly. Overview of Literature Of those with chronic LBP, 37% were predominantly presenting with neuropathic pain in young adults. Pregabalin is effective for pain in patients with diabetic neuropathy and peripheral neuralgia. No study has reported on the effects of pregabalin for chronic LBP in elderly patients yet. Methods Pregabalin was administered to 32 patients (age, ?65 years) with chronic LBP for 4 weeks. Pain and activities of daily living were assessed using the Neuropathic Pain Screening Questionnaire (NePSQ), the pain DETECT questionnaire, visual analog scale, the Japanese Orthopedic Association score, the short form of the McGill Pain Questionnaire and the Roland Morris Disability Questionnaire. Modic change and spinal canal stenosis were investigated using magnetic resonance imaging. Results Altogether, 43.3% of patients had neuropathic pain according to the NePSQ and 15.6% patients had pain according to the pain DETECT. The efficacy rate of pregabalin was 73.3%. A significant effect was observed in patients with neuropathic pain after 4 weeks of administration. Conclusions Neuropathic pain was slightly less frequently associated with chronic LBP in the elderly. Pregabalin was effective in reducing pain in patients with chronic LBP accompanied with neuropathic pain. Lumbar spinal stenosis and lower limb symptoms were observed in patients with neuropathic pain. We recommend the use of pregabalin for patients after evaluating a screening score, clinical symptoms and magnetic resonance imaging studies.

Ito, Kenyu; Hida, Tetsuro; Ito, Sadayuki; Harada, Atsushi

2015-01-01

394

Functional reorganization of the default mode network across chronic pain conditions.  

PubMed

Chronic pain is associated with neuronal plasticity. Here we use resting-state functional magnetic resonance imaging to investigate functional changes in patients suffering from chronic back pain (CBP), complex regional pain syndrome (CRPS) and knee osteoarthritis (OA). We isolated five meaningful resting-state networks across the groups, of which only the default mode network (DMN) exhibited deviations from healthy controls. All patient groups showed decreased connectivity of medial prefrontal cortex (MPFC) to the posterior constituents of the DMN, and increased connectivity to the insular cortex in proportion to the intensity of pain. Multiple DMN regions, especially the MPFC, exhibited increased high frequency oscillations, conjoined with decreased phase locking with parietal regions involved in processing attention. Both phase and frequency changes correlated to pain duration in OA and CBP patients. Thus chronic pain seems to reorganize the dynamics of the DMN and as such reflect the maladaptive physiology of different types of chronic pain. PMID:25180885

Baliki, Marwan N; Mansour, Ali R; Baria, Alex T; Apkarian, A Vania

2014-01-01

395

Functional Reorganization of the Default Mode Network across Chronic Pain Conditions  

PubMed Central

Chronic pain is associated with neuronal plasticity. Here we use resting-state functional magnetic resonance imaging to investigate functional changes in patients suffering from chronic back pain (CBP), complex regional pain syndrome (CRPS) and knee osteoarthritis (OA). We isolated five meaningful resting-state networks across the groups, of which only the default mode network (DMN) exhibited deviations from healthy controls. All patient groups showed decreased connectivity of medial prefrontal cortex (MPFC) to the posterior constituents of the DMN, and increased connectivity to the insular cortex in proportion to the intensity of pain. Multiple DMN regions, especially the MPFC, exhibited increased high frequency oscillations, conjoined with decreased phase locking with parietal regions involved in processing attention. Both phase and frequency changes correlated to pain duration in OA and CBP patients. Thus chronic pain seems to reorganize the dynamics of the DMN and as such reflect the maladaptive physiology of different types of chronic pain. PMID:25180885

Baliki, Marwan N.; Mansour, Ali R.; Baria, Alex T.; Apkarian, A. Vania

2014-01-01

396

Managing chronic pelvic pain following reconstructive pelvic surgery with transvaginal mesh.  

PubMed

In 2001, the US Food and Drug Administration (FDA) approved the first transvaginal mesh kit to treat pelvic organ prolapse (POP). Since the introduction of vaginal mesh kits, some vaginal meshes have been associated with chronic pelvic pain after reconstructive pelvic floor surgery. Pelvic pain results in between 0 % and 30 % of patients following transvaginal mesh placement. Common causes of chronic pelvic pain include pelvic floor muscle spasm, pudendal neuralgia, and infection. Paucity of data exists on the effective management of chronic pelvic pain after pelvic reconstructive surgery with mesh. We outline the management of chronic pelvic pain after transvaginal mesh placement for reconstructive pelvic floor repair based on our clinical experience and adaptation of data used in other aspects of managing chronic pelvic pain conditions. PMID:24217793

Gyang, Anthony N; Feranec, Jessica B; Patel, Rakesh C; Lamvu, Georgine M

2014-03-01

397

Navigating the health care system: perceptions of patients with chronic pain.  

PubMed

A new framework is needed for patients with chronic pain and their primary care physicians that acknowledges the individual's experiences and provides evidence-informed education and better linkages to community-based resources. This study describes the experience of 19 chronic-pain sufferers who seek relief via the health care system. Their experiences were recorded through in-depth semistructured interviews and analyzed through qualitative methods. The participants reported early optimism, then disillusionment, and finally acceptance of living with chronic pain. Both individuals with chronic pain and their health care professionals need evidence-informed resources and information on best practices to assist them to manage pain. Empathetic communication between health care professionals and individuals with chronic pain is crucial because insensitive communication negatively affects the individual, reduces treatment compliance and increases health care utilization. PMID:19804680

Dewar, A L; Gregg, K; White, M I; Lander, J

2009-01-01

398

Intersection of chronic pain treatment and opioid analgesic misuse: causes, treatments, and policy strategies  

PubMed Central

Treating chronic pain in the context of opioid misuse can be very challenging. This paper explores the epidemiology and potential treatments for chronic pain and opioid misuse and identifies educational and regulation changes that may reduce diversion of opioid analgesics. We cover the epidemiology of chronic pain and aberrant opioid behaviors, psychosocial influences on pain, pharmacological treatments, psychological treatments, and social treatments, as well as educational and regulatory efforts being made to reduce the diversion of prescription opioids. There are a number of ongoing challenges in treating chronic pain and opioid misuse, and more research is needed to provide strong, integrated, and empirically validated treatments to reduce opioid misuse in the context of chronic pain. PMID:24474854

Wachholtz, Amy; Gonzalez, Gerardo; Boyer, Edward; Naqvi, Zafar N; Rosenbaum, Christopher; Ziedonis, Douglas

2011-01-01

399

Sleep onset insomnia symptoms during hospitalization for major burn injury predict chronic pain  

Microsoft Academic Search

Both cross-sectional studies of chronic pain and sleep deprivation experiments suggest a bi-directional relationship between sleep and pain. Few longitudinal studies, however, have assessed whether acute insomnia following traumatic injury predicts the development of persistent pain. We sought to evaluate (1) whether in-hospital insomnia independently predicts long-term pain after burn injury and (2) whether in-hospital pain predicts future insomnia symptoms.

Michael T. Smith; Brendan Klick; Sharon Kozachik; Robert E. Edwards; Radha Holavanahalli; Shelley Wiechman; Patricia Blakeney; Dennis Lezotte; James A. Fauerbach

2008-01-01

400

The assessment of sleep in pediatric chronic pain sufferers.  

PubMed

The aim of this study is to review the options available for assessing sleep in pediatric chronic pain populations. One subjective measure of sleep (questionnaires) and two objective measures (polysomnography and actigraphy) were reviewed. The following databases were searched from their inception to June 2011: PsycINFO, ERIC, FRANCIS, MEDLINE, PsycARTICLES, Global health, Inspec, Health and Psychosocial Instruments, CINAHL, Scopus and ProQuest Dissertations and Theses databases. A total of nine sleep questionnaires were identified, two of which proved to be reliable and valid when used with pediatric chronic pain patients and, according to evidence-based assessment criteria, can be regarded as "well-established" instruments. Objective measures have been used less frequently. Both polysomnography (PSG) and actigraphy (ACT) have been used in five different studies. PSG is a reliable method for assessing sleep stage problems but is costly and intrusive. Actigraphy is cheaper, more ecological and easier to use than PSG but it deals only with the objective dimension of sleep (total sleep time, sleep efficiency, etc). In order to improve the reliability and validity of the assessment of sleep, a multi-level and multi-method approach is suggested: sleep measurement should be extended to include both objective and subjective assessment. PMID:22750223

de la Vega, Rocío; Miró, Jordi

2013-06-01

401

Effectiveness of Massage Therapy for Chronic, Non-malignant Pain: A Review  

PubMed Central

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 reviews and primary trials of massage therapy for chronic, non-malignant pain. Existing research provides fairly robust support for the analgesic effects of massage for non-specific low back pain, but only moderate support for such effects on shoulder pain and headache pain. There is only modest, preliminary support for massage in the treatment of fibromyalgia, mixed chronic pain conditions, neck pain and carpal tunnel syndrome. Thus, research to date provides varying levels of evidence for the benefits of massage therapy for different chronic pain conditions. Future studies should employ rigorous study designs and include follow-up assessments for additional quantification of the longer-term effects of massage on chronic pain. PMID:17549233

2007-01-01

402

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

403

Pediatric fear-avoidance model of chronic pain: Foundation, application and future directions  

PubMed Central

The fear-avoidance model of chronic musculoskeletal pain has become an increasingly popular conceptualization of the processes and mechanisms through which acute pain can become chronic. Despite rapidly growing interest and research regarding the influence of fear-avoidance constructs on pain-related disability in children and adolescents, there have been no amendments to the model to account for unique aspects of pediatric chronic pain. A comprehensive understanding of the role of fear-avoidance in pediatric chronic pain necessitates understanding of both child/adolescent and parent factors implicated in its development and maintenance. The primary purpose of the present article is to propose an empirically-based pediatric fear-avoidance model of chronic pain that accounts for both child/adolescent and parent factors as well as their potential interactive effects. To accomplish this goal, the present article will define important fear-avoidance constructs, provide a summary of the general fear-avoidance model and review the growing empirical literature regarding the role of fear-avoidance constructs in pediatric chronic pain. Assessment and treatment options for children with chronic pain will also be described in the context of the proposed pediatric fear-avoidance model of chronic pain. Finally, avenues for future investigation will be proposed. PMID:23248813

Asmundson, Gordon JG; Noel, Melanie; Petter, Mark; Parkerson, Holly A

2012-01-01

404

Response phases in methadone treatment for chronic nonmalignant pain.  

PubMed

Although studies on the beliefs of persons with chronic nonmalignant pain (CNMP) are still scarce, methadone is increasingly prescribed for the treatment of CNMP. This qualitative case study uses semistructured interviews to explore the beliefs of 11 patients with CNMP and the challenges they faced coming to terms with and integrating methadone treatment into their lives. The study identifies a two-phase process of acceptance and integration. In the first phase, during acceptance of the prescribed methadone treatment, initial beliefs were mostly determined by the societal stigma that "methadone is for junkies." Different influencing factors such as knowledge about methadone for pain management, family support, and trust in physicians changed behavior in a positive way. In the second phase, patients dealt with the degree of disclosure about their treatment. Full disclosers have no problem in telling others that they were being treated with methadone, whereas partial disclosers were more selective. They were confronted with various barriers: negative encounters with family, friends, and the public; past addict experiences; safety issues; and obstacles within the health care system. As a result of these challenges, their beliefs were summarized as: "others think I'm an addict," and "methadone can harm me and/or my family."This study highlights the important role nurses have in the education of patients on the use of methadone in pain management, and in assisting patients with CNMP to gain confidence and a greater sense of control to cope with the challenging issues related to disclosing information. PMID:16490733

Arnaert, Antonia; Ciccotosto, Gina

2006-03-01

405

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

PubMed

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

2010-11-01

406

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

407

Referred Pain Patterns Provoked on Intra-Pelvic Structures among Women with and without Chronic Pelvic Pain: A Descriptive Study  

PubMed Central

Objectives To describe referred pain patterns provoked from intra-pelvic structures in women with chronic pelvic pain (CPP) persisting after childbirth with the purpose to improve diagnostics and give implications for treatment. Materials and Methods In this descriptive and comparative study 36 parous women with CPP were recruited from a physiotherapy department waiting list and by advertisements in newspapers. A control group of 29 parous women without CPP was consecutively assessed for eligibility from a midwifery surgery. Inclusion criterion for CPP was: moderate pain in the sacral region persisting at least six months after childbirth confirmed by pelvic pain provocation tests. Exclusion criteria in groups with and without CPP were: persistent back or pelvic pain with onset prior to pregnancy, previous back surgery and positive neurological signs. Pain was provoked by palpation of 13 predetermined intra-pelvic anatomical landmarks. The referred pain distribution was expressed in pain drawings and described in pain maps and calculated referred pain areas. Results Pain provoked by palpation of the posterior intra-pelvic landmarks was mostly referred to the sacral region and pain provoked by palpation of the ischial and pubic bones was mostly referred to the groin and pubic regions, with or without pain referred down the ipsilateral leg. The average pain distribution area provoked by palpation of all 13 anatomical landmarks was 30.3 mm² (19.2 to 53.7) in women with CPP as compared to 3.2 mm² (1.0 to 5.1) in women without CPP, p< 0.0001. Conclusions Referred pain patterns provoked from intra-pelvic landmarks in women with CPP are consistent with sclerotomal sensory innervation. Magnification of referred pain patterns indicates allodynia and central sensitization. The results suggest that pain mapping can be used to evaluate and confirm the pain experience among women with CPP and contribute to diagnosis. PMID:25793999

Butler, Stephen; Peterson, Magnus; Eriksson, Margaretha

2015-01-01

408

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

409

Self-Reported Spousal Support Modifies the Negative Impact of Pain on Disability in Men with Chronic Prostatitis / Chronic Pelvic Pain Syndrome  

PubMed Central

OBJECTIVES To examine changes in the association between pain and patient quality of life (QoL), depressive symptoms, and disability in men with chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) at varying levels of spouse responses to pain. METHODS One-hundred and eighty-eight men with CP/CPPS completed a questionnaire including demographic information. The outcome variables were mental QoL (SF-12 MCS), physical QoL (SF-12 PCS), depressive symptoms (Center for Epidemiological Studies Depression Scale), and disability (Pain Disability Index). Patients also reported on the types of responses they experienced from their spouses (Multidimensional Pain Inventory), and pain (Short-Form McGill Pain Questionnaire). RESULTS The association between pain and disability was stronger at higher levels of solicitous responses (e.g., “does some of my chores) (? = 0.66, p<.05) than it was at moderate (? = 0.44, p<.05) and lower (? = 0.23, ns) levels. In contrast, the association between pain and disability was stronger at lower levels (? = 0.64, p<.05) of distracting responses (e.g., “tries to get me involved in some activity”) than it was at moderate (? = 0.44, p<.05) and higher (? = 0.25, p<.05) levels. CONCLUSIONS Solicitous responses to pain increased the negative impact of pain on disability, while distracting responses to pain decreased the negative impact of pain on disability in men with CP/CPPS. Solicitous responses may be a reaction to patient pain and associated disability, or may help create or maintain the patient’s pain and disability. In either case, distracting rather than solicitous responses to patient pain are to be encouraged in symptom management. PMID:22054388

Ginting, Jessica V.; Tripp, Dean A.; Nickel, J. Curtis

2011-01-01

410

[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 ± 13.1 years. Nine hundred seven reported pain occurring for more than 3 months. 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

411

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

412

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. PMID:25685786

Aceto, Paola; Navarra, Pierluigi

2015-01-01

413

The Shared Neuroanatomy and Neurobiology of Comorbid Chronic Pain and PTSD: Therapeutic Implications.  

PubMed

Chronic pain and posttraumatic stress disorder (PTSD) are disabling conditions that affect biological, psychological, and social domains of functioning. Clinical research demonstrates that patients who are affected by chronic pain and PTSD in combination experience greater pain, affective distress, and disability than patients with either condition alone. Additional research is needed to delineate the interrelated pathophysiology of chronic pain and PTSD, with the goal of facilitating more effective therapies to treat both conditions more effectively; current treatment strategies for chronic pain associated with PTSD have limited efficacy and place a heavy burden on patients, who must visit various specialists to manage these conditions separately. This article focuses on neurobiological factors that may contribute to the coprevalence and synergistic interactions of chronic pain and PTSD. First, we outline how circuits that mediate emotional distress and physiological threat, including pain, converge. Secondly, we discuss specific neurobiological mediators and modulators of these circuits that may contribute to chronic pain and PTSD symptoms. For example, neuropeptide Y, and the neuroactive steroids allopregnanolone and pregnanolone (together termed ALLO) have antistress and antinociceptive properties. Reduced levels of neuropeptide Y and ALLO have been implicated in the pathophysiology of both chronic pain and PTSD. The potential contribution of opioid and cannabinoid system factors also will be discussed. Finally, we address potential novel methods to restore the normal function of these systems. Such novel perspectives regarding disease and disease management are vital to the pursuit of relief for the many individuals who struggle with these disabling conditions. PMID:24806468

Scioli-Salter, Erica R; Forman, Daniel E; Otis, John D; Gregor, Kristin; Valovski, Ivan; Rasmusson, Ann M

2015-04-01

414

Structural Brain Changes in Chronic Pain Reflect Probably Neither Damage Nor Atrophy  

PubMed Central

Chronic pain appears to be associated with brain gray matter reduction in areas ascribable to the transmission of pain. The morphological processes underlying these structural changes, probably following functional reorganisation and central plasticity in the brain, remain unclear. The pain in hip osteoarthritis is one of the few chronic pain syndromes which are principally curable. We investigated 20 patients with chronic pain due to unilateral coxarthrosis (mean age 63.25±9.46 (SD) years, 10 female) before hip joint endoprosthetic surgery (pain state) and monitored brain structural changes up to 1 year after surgery: 6–8 weeks, 12–18 weeks and 10–14 month when completely pain free. Patients with chronic pain due to unilateral coxarthrosis had significantly less gray matter compared to controls in the anterior cingulate cortex (ACC), insular cortex and operculum, dorsolateral prefrontal cortex (DLPFC) and orbitofrontal cortex. These regions function as multi-integrative structures during the experience and the anticipation of pain. When the patients were pain free after recovery from endoprosthetic surgery, a gray matter increase in nearly the same areas was found. We also found a progressive increase of brain gray matter in the premotor cortex and the supplementary motor area (SMA). We conclude that gray matter abnormalities in chronic pain are not the cause, but secondary to the disease and are at least in part due to changes in motor function and bodily integration. PMID:23405082

Rodriguez-Raecke, Rea; Niemeier, Andreas; Ihle, Kristin; Ruether, Wolfgang; May, Arne

2013-01-01

415

Structural brain changes in chronic pain reflect probably neither damage nor atrophy.  

PubMed

Chronic pain appears to be associated with brain gray matter reduction in areas ascribable to the transmission of pain. The morphological processes underlying these structural changes, probably following functional reorganisation and central plasticity in the brain, remain unclear. The pain in hip osteoarthritis is one of the few chronic pain syndromes which are principally curable. We investigated 20 patients with chronic pain due to unilateral coxarthrosis (mean age 63.25±9.46 (SD) years, 10 female) before hip joint endoprosthetic surgery (pain state) and monitored brain structural changes up to 1 year after surgery: 6-8 weeks, 12-18 weeks and 10-14 month when completely pain free. Patients with chronic pain due to unilateral coxarthrosis had significantly less gray matter compared to controls in the anterior cingulate cortex (ACC), insular cortex and operculum, dorsolateral prefrontal cortex (DLPFC) and orbitofrontal cortex. These regions function as multi-integrative structures during the experience and the anticipation of pain. When the patients were pain free after recovery from endoprosthetic surgery, a gray matter increase in nearly the same areas was found. We also found a progressive increase of brain gray matter in the premotor cortex and the supplementary motor area (SMA). We conclude that gray matter abnormalities in chronic pain are not the cause, but secondary to the disease and are at least in part due to changes in motor function and bodily integration. PMID:23405082

Rodriguez-Raecke, Rea; Niemeier, Andreas; Ihle, Kristin; Ruether, Wolfgang; May, Arne

2013-01-01

416

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

ERIC Educational Resources Information Center

The prevalence and cost of chronic pain is a major physical and mental health care problem in the United States today. As a result, there has been a recent explosion of research on chronic pain, with significant advances in better understanding its etiology, assessment, and treatment. The purpose of the present article is to provide a review of…

Gatchel, Robert J.; Peng, Yuan Bo; Peters, Madelon L.; Fuchs, Perry N.; Turk, Dennis C.

2007-01-01

417

Child Abuse and Chronic Pain in a Community Survey of Women  

ERIC Educational Resources Information Center

This study examined the relationship between a self-reported history of child physical and sexual abuse and chronic pain among women (N = 3381) in a provincewide community sample. Chronic pain was significantly associated with physical abuse, education, and age of the respondents and was unrelated to child sexual abuse alone or in combination with…

Walsh, Christine A.; Jamieson, Ellen; MacMillan, Harriet; Boyle, Michael

2007-01-01

418

Primary Care Management of Chronic Nonmalignant Pain in Veterans: A Qualitative Study  

ERIC Educational Resources Information Center

Clinicians managing older patients with chronic pain play an important role. This paper explores the attitudes of primary care clinicians (PCPs) toward chronic nonmalignant pain management and their experiences using a clinical decision support system. Our investigation followed a qualitative approach based on grounded theory. Twenty-one PCPs…

Ruiz, Jorge G.; Qadri, S. Sobiya; Nader, Samir; Wang, Jia; Lawler, Timothy; Hagenlocker, Brian; Roos, Bernard A.

2010-01-01

419

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

420

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

421

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

422

Intelligence in childhood and chronic widespread pain in middle age: the National Child Development Survey.  

PubMed

Psychological factors are thought to play a part in the aetiology of chronic widespread pain. We investigated the relationship between intelligence in childhood and risk of chronic widespread pain in adulthood in 6902 men and women from the National Child Development Survey (1958 British Birth Cohort). Participants took a test of general cognitive ability at age 11 years; and chronic widespread pain, defined according to the American College of Rheumatology criteria, was assessed at age 45 years. Risk ratios (RRs) and 95% confidence intervals (CIs) were estimated using log-binomial regression, adjusting for sex and potential confounding or mediating factors. Risk of chronic widespread pain, defined according to the American College of Rheumatology criteria, rose in a stepwise fashion as intelligence fell (P for linear trend <0.0001). In sex-adjusted analyses, for an SD lower intelligence quotient, the RR of chronic widespread pain was 1.26 (95% CI 1.17-1.35). In multivariate backwards stepwise regression, lower childhood intelligence remained as an independent predictor of chronic widespread pain (RR 1.10; 95% CI 1.01-1.19), along with social class, educational attainment, body mass index, smoking status, and psychological distress. Part of the effect of lower childhood intelligence on risk of chronic widespread pain in midlife was significantly mediated through greater body mass index and more disadvantaged socioeconomic position. Men and women with higher intelligence in childhood are less likely as adults to report chronic widespread pain. PMID:23137899

Gale, Catharine R; Deary, Ian J; Cooper, Cyrus; Batty, G David

2012-12-01

423

Treatment of chronic lumbar diskogenic pain with intradiskal electrothermal therapy: A prospective outcome study  

Microsoft Academic Search

Lutz C, Lutz GE, Cooke PM. Treatment of chronic lumbar diskogenic pain with intradiskal electrothermal therapy: a prospective outcome study. Arch Phys Med Rehabil 2003;84:23-8. Objective: To determine the clinical efficacy of intradiskal electrothermal annuloplasty in treating patients with chronic constant lumbar diskogenic pain who have not responded to at least 6 months of aggressive nonoperative care. Design: Prospective case

Christopher Lutz; Gregory E. Lutz; Paul M. Cooke

2003-01-01

424

Evaluation of Factors Associated with Chronic Low Back Pain in Hemodialysis Patients  

Microsoft Academic Search

Background\\/Aims: Low back pain is a common and disabling symptom that has not been properly studied in hemodialysis patients. The aim of this study was to evaluate factors associated with chronic low back pain in these patients. Methods: We evaluated 205 patients undergoing chronic hemodialysis. Data were obtained through medical records, patient interviews and physical examination. Balance was evaluated through

Tatiana Cristofolini; Sergio Draibe; Ricardo Sesso

2008-01-01

425

Predictors of opioid misuse in patients with chronic pain: a prospective cohort study  

Microsoft Academic Search

BACKGROUND: Opioid misuse can complicate chronic pain management, and the non-medical use of opioids is a growing public health problem. The incidence and risk factors for opioid misuse in patients with chronic pain, however, have not been well characterized. We conducted a prospective cohort study to determine the one-year incidence and predictors of opioid misuse among patients enrolled in a

Timothy J Ives; Paul R Chelminski; Catherine A Hammett-Stabler; Robert M Malone; J Stephen Perhac; Nicholas M Potisek; Betsy Bryant Shilliday; Darren A DeWalt; Michael P Pignone

2006-01-01

426

Towards an ICF Core Set for chronic musculoskeletal conditions: commonalities across ICF Core Sets for osteoarthritis, rheumatoid arthritis, osteoporosis, low back pain and chronic widespread pain  

Microsoft Academic Search

The objective of the study was to identify commonalities among the International Classification of Functioning, Disability\\u000a and Health (ICF) Core Sets of osteoarthritis (OA), osteoporosis (OP), low back pain (LBP), rheumatoid arthritis (RA) and chronic\\u000a widespread pain (CWP). The aim is to identify relevant categories for the development of a tentative ICF Core Set for musculoskeletal\\u000a and pain conditions. The

S. R. Schwarzkopf; T. Ewert; K. E. Dreinhöfer; A. Cieza; G. Stucki

2008-01-01

427

How does pain localization affect physical functioning, emotional status and independency in older adults with chronic musculoskeletal pain?  

PubMed

[Purpose] The aim of this study was to show the impact of chronic musculoskeletal pain of the spinal column and lower extremities on physical functioning, emotional status, and independency in older adults. [Subjects] In this cross-sectional study, 258 older adults (mean age, 71.98±5.86?years, 50.8% males, 49.2% females) living in their own residences were evaluated. [Methods] Pain intensity was analyzed using a visual analogue scale. Physical functioning was evaluated with the Timed Up and Go Test (TUG) and a Six-Minute Walk Test. The Geriatric Depression Scale was used to determine emotional status. The independency in daily living of the participants was evaluated using the Lawton Brody IADL Scale. All participants were divided into two groups in accordance with the pain localization: the (1) spinal pain and (2) lower extremity pain groups. [Results] When the pain scores were compared, no significant differences between the two groups were found. The same results were found in terms of TUG scores. The spinal pain group had higher scores in terms of aerobic capacity than the lower extremity pain group. [Conclusion] The results indicate that chronic musculoskeletal pain in the lower extremities decreased aerobic capacity much more than spinal pain in older adults. PMID:25202178

Ya?ci, Nesrin; Duymaz, Tomris; Cavlak, U?ur

2014-08-01

428

How Does Pain Localization Affect Physical Functioning, Emotional Status and Independency in Older Adults with Chronic Musculoskeletal Pain?  

PubMed Central

[Purpose] The aim of this study was to show the impact of chronic musculoskeletal pain of the spinal column and lower extremities on physical functioning, emotional status, and independency in older adults. [Subjects] In this cross-sectional study, 258 older adults (mean age, 71.98±5.86?years, 50.8% males, 49.2% females) living in their own residences were evaluated. [Methods] Pain intensity was analyzed using a visual analogue scale. Physical functioning was evaluated with the Timed Up and Go Test (TUG) and a Six-Minute Walk Test. The Geriatric Depression Scale was used to determine emotional status. The independency in daily living of the participants was evaluated using the Lawton Brody IADL Scale. All participants were divided into two groups in accordance with the pain localization: the (1) spinal pain and (2) lower extremity pain groups. [Results] When the pain scores were compared, no significant differences between the two groups were found. The same results were found in terms of TUG scores. The spinal pain group had higher scores in terms of aerobic capacity than the lower extremity pain group. [Conclusion] The results indicate that chronic musculoskeletal pain in the lower extremities decreased aerobic capacity much more than spinal pain in older adults. PMID:25202178

Ya?ci, Nesrin; Duymaz, Tomris; Cavlak, U?ur

2014-01-01

429

Understanding the role of mitochondria in the pathogenesis of chronic pain.  

PubMed

Chronic pain is a major public health problem. Mitochondria play important roles in a myriad of cellular processes and mitochondrial dysfunction has been implicated in multiple neurological disorders. This review aims to provide an insight into advances in understanding of the role of mitochondrial dysfunction in the pathogenesis of chronic pain. The results show that the five major mitochondrial functions (the mitochondrial energy generating system, reactive oxygen species generation, mitochondrial permeability transition pore, apoptotic pathways and intracellular calcium mobilisation) may play critical roles in neuropathic and inflammatory pain. Therefore, protecting mitochondrial function would be a promising strategy to alleviate or prevent chronic pain states. Related chronic inflammatory and neuropathic pain models, as well as the spectral characteristics of current fluorescent probes to detect mitochondria in pain studies, are also discussed. PMID:24151337

Sui, Bing-dong; Xu, Tian-qi; Liu, Jie-wei; Wei, Wei; Zheng, Chen-xi; Guo, Bao-lin; Wang, Ya-yun; Yang, Yan-ling

2013-12-01

430

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