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Recently, new drugs for intractablechronicpain are available in Japan. The following articles describe topics of new drugs for intractablechronicpain including transdermal fentanyl, tramadol/acetaminophen combination tablets, buprenorphine transdermal patch, pregabalin, and duloxetine. Treatment of constipation in chronicpain patients and management of opioid induced nausea and vomiting are also described to prevent complication of pain-relief drug therapy. PMID:23905399
This study aims at estimating the efficacy of reflexology in managing pain under 4 diseased conditions viz., mastalgia, osteoarthritis, neuropathy with type-II diabetic mellitus and lower limb pain involving intractable epilepsy. The efficiency of reflexology was determined in terms of improvement of pain score, quality of life and the other associated symptoms. The sample size of the randomized clinical trials
K. Dalal; V. B. Maran; D. Elanchezhiyan; A. Srivastava; A. B. Dey; M. Tripathi
... cause. Problems that cause chronicpain include Headache Low back strain Cancer Arthritis Pain from nerve damage Chronicpain usually cannot be cured. But treatments can help. They include medicines, acupuncture, electrical stimulation and surgery. Other treatments include psychotherapy, ...
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)
Bilateral anterior cingulectomies were performed on 23 patients for the relief of intractablepain. 19 patients suffered from pain due to metastatic disease, 3 from arachnoiditis and 1 from a phantom limb syndrome. Of those patients suffering from pain due to metastatic disease, 10 (52.1%) obtained pain relief. Among the patients suffering from arachnoiditis, 1 obtained pain relief. The case
Electrical spinal neuromodulation in the form of spinal cord stimulation is currently used for treating chronicpainful 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
Sacral nerve stimulation (SNS) is an effective treatment for bladder and bowel dysfunction, and also has a role in the treatment of chronic pelvic pain. We report two cases of intractablepain associated with cauda equina syndrome (CES) that were treated successfully by SNS. The first patient suffered from intractable pelvic pain with urinary incontinence and fecal incontinence after surgery for a herniated lumbar disc. The second patient underwent surgery for treatment of a burst fracture and developed intractable pelvic area pain, right leg pain, excessive urinary frequency, urinary incontinence, voiding difficulty and constipation one year after surgery. A SNS trial was performed on both patients. Both patients' pain was significantly improved and urinary symptoms were much relieved. Neuromodulation of the sacral nerves is an effective treatment for idiopathic urinary frequency, urgency, and urge incontinence. Sacral neuromodulation has also been used to control various forms of pelvic pain. Although the mechanism of action of neuromodulation remains unexplained, numerous clinical success reports suggest that it is a therapy with efficacy and durability. From the results of our research, we believe that SNS can be a safe and effective option for the treatment of intractable pelvic pain with incomplete CES.
The stimulation of the primary motor cortex (M1) has proved to be an effective treatment for intractable deafferentation pain.\\u000a This treatment started in 1990, and twenty-eight studies involving 271 patients have been reported so far. The patients who\\u000a have been operated on were suffering from post-stroke pain (59%), trigeminal neuropathic pain, brachial plexus injury, spinal\\u000a cord injury, peripheral nerve injury
Sixty patients with spinal cord stimulators implanted for intractablepain lasting up to 50 years were followed for up to nine years. Forty seven per cent derived significant benefit, 23% modest benefit, 20% experienced no effect and 6.7% were made worse. Two were made worse after initial benefit. Complications, indications and factors relevant to the mode of action are discussed.
The use of hydromorphone and clonidine, delivered intrathecally by an implanted infusion pump, is described in a patient with intractable cancer pain. The patient was a 48-year-old woman with uterine cervical cancer-related pain that was poorly responsive to conventional oral narcotics. Hydromorphone was used because of the patient's history of morphine intolerance. When progressive intrathecal hydromorphone dosages were required, intrathecal clonidine (an alpha 2 adrenergic agonist) was infused concomitantly. Intrathecal hydromorphone and clonidine successfully controlled this patient's pain without the necessity to resort to destructive neurosurgery. PMID:2422332
Coombs, D W; Saunders, R L; Fratkin, J D; Jensen, L E; Murphy, C A
The durable effectiveness of intrathecal morphine administration is well established for the management of intractable cancer pain, after failure of systemic opioids, secondary to the persistence of non-reversible undesirable side effects. Many patients are referred to late in the disease course. This conservative method to control pain of malignant origin must not be reserved for last resort treatment for terminal patients. Intra-cerebro-ventricular morphine administration is a very effective and generally safe method for controlling intractable cancer pain. Because of the chronic implantation of an intra-ventricular catheter this method is somewhat invasive. Its indications remain a simple and effective alternative when the topography of nociceptive pain is diffuse or cephalic. In clinical practice, intrathecal and/or intra-cerebro-ventricular administration of opioids is limited by cost, the need for specialized maintenance and mechanical malfunctions if implantable drug delivery systems, or by the risk of bacterial contamination and ambulatory constraints when repeated daily injections via an intrathecal access port are used. To answer these limitations, cell therapy using intrathecal chromaffin cell allograft is a promising approach for the management of cancer pain refractory to traditional drug therapy and pain lesion surgery. The basic rationale and preclinical studies on experimental pain models have enabled starting prospective clinical trials. Prior to transplantation, handling and preparation of the chromaffin tissue is critical for allograft viability. The initial results of clinical trials with human chromaffin cell grafts from intractable cancer pain have reported long-lasting pain relief, in correlation with met-enkephalin release into the CSF. Convincing evidence will require controlled studies. The limitations of this innovative cell therapy and especially the lack of human adrenal gland availability point to the need for new sources of cells. Perspectives include xenogenic or engineered cell lines. PMID:11084478
Stereotactic cingulotomy constitutes a psychosurgical procedure nowadays advocated in the treatment of medically intractable obsessive-compulsive disorder, chronicpain 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
... Learned Going to the ER Communication Tools Pain Management Programs Videos Resources Glossary FAQs Surveys September is ... for Understanding PainPain Awareness Toolkits Home Pain Management Tools Videos What Is ChronicPain? Featured Tool ...
The efficacy of spinal cord stimulation (SCS) for treatment of various chronicpainful conditions is well established. Very few reports have documented the use of SCS for treatment of chronicpain after spinal cord injury. We present a case showing a good outcome after such treatment, and suggest that high cervical stimulation may be efficacious. A 53-year-old male underwent SCS on the C1-3 level for treatment of intractable neuropathic pain below the T3 level, and in the upper extremities, arising from spinal cord injury resulting from transverse myelitis caused by schistosomiasis. High cervical SCS significantly improved the pain in the upper extremities and at the T3-T10 dermatome level. The patient continues to report excellent pain relief 9 months later. The present case suggests that high cervical stimulation may improve chronicpain in the upper extremities and the T3-T10 dermatome level arising from spinal cord injury.
... in Cart : 0 Resource Guide to ChronicPain Medications & Treatments The Art of Pain Management What We Have Learned Going to the ER Communication Tools Pain Management Programs Videos Resources Glossary FAQs ...
Objective: The ?-EEG sleep anomaly has been associated with chronic benign pain syndromes. Although controversial, the anomaly is believed by some to be an important biologic correlate of certain otherwise poorly explained painful conditions (e.g., fibromyalgia and chronic fatigue syndrome). To shed further light on this phenomenon, this study compared the sleep and psychological characteristics of chronicpain patients who
Chronic neck pain is a common patient complaint. Despite its frequency as a clinical problem, there are few evidence-based studies that document efficacy of therapies for neck pain. The treatment of this symptom is based primarily on clinical experience. Preventing the development of chronic neck pain can be achieved by modification of the work environment with chairs that encourage proper musculoskeletal movement. The use of neck supports for sleep and active neck exercises together can improve neck pain. Passive therapies, including massage, acupuncture, mechanical traction, and electrotherapy, have limited benefit when measured by clinical trial results. NSAIDs, muscle relaxants, and pure analgesics are the mainstays of therapy. Local injections of anesthetics with or without soluble corticosteroid preparations offer additional pain relief. The purpose of these agents is to diminish pain to facilitate normal neck movement. Surgical therapy with cervical spine fusion is indicated for the rare patient with intractable neck pain resistant to all nonsurgical therapies. PMID:18173978
Quantifiable and measurable methods accurately assess pain severity and successfully guide physicians in determining which medications and modalities are appropriate and necessary for the treatment of chronicpain. A variety of pain assessment scales and the World Health Organization's three-step analgesic ladder can be the starting point for successful pain management. PMID:9092278
Pains that persist long after damaged tissue hasrecovered remain a perplexing phenomenon. Theseso-called chronicpains serve no useful function foran organism and, given its disabling effects, mighteven be considered maladaptive. However, a remarkablesimilarity exists between the neural bases thatunderlie the hallmark symptoms of chronicpain andthose that subserve learning and memory. Bothphenomena, wind-up in the pain literature andlong-term potentiation (LTP)
BACKGROUND AND AIM: Intractablepain usually dominates the clinical presentation of chronic pancreatitis (CP). Slowing of electroencephalogram (EEG) rhythmicity has been associated with abnormal cortical pain processing in other chronicpain disorders. The aim of this study was to investigate the spectral distribution of EEG rhythmicity in patients with CP. PATIENTS AND METHODS: Thirty-one patients with painful CP (mean age
S. S. Olesen; T. M. Hansen; C. Graversen; K. Steimle; O. H. G. Wilder-Smith; A. M. Drewes
In this paper the treatment of patients with chronic, intractable trigeminal neuralgia by invasive electrical stimulation of the Gasserion ganglion is reviewed. Two different surgical techniques are employed in this treatment. Most frequently, a method similar to the traditional technique for percutaneous glycerol and radiofrequency trigeminal rhizolysis is used: a small percutaneous stimulation electrode is advanced under fluoroscopic control through a thin needle via the foramen ovale to the Gasserian cistern. Some neurosurgeons use an open surgical technique by which the Gasserian ganglion is approached subtemporally and extradurally, and the bipolar pad electrode is sutured to the dura. When percutaneous test stimulation is successful (at least 50% pain relief) the electrode is internalized and connected to a subcutaneous pulse generator or RF-receiver. Data from 8 clinical studies, including 267 patients have been reviewed. Of all 233 patients with medication-resistant atypical trigeminal neuralgia 48% had at least 50% long term pain relief. The result of test stimulation is a good predictor of the long term effect, because 83% of all patients with successful test stimulation had at least 50% long term relief, and 70% had at least 75% long term relief. Patients generally preferred this invasive method over TENS. The success rate in patients with postherpetic trigeminal neuralgia was very low (less than 10%). It is suggested that the likelihood of pain relief by electrical stimulation is inversely related to the degree of sensory loss. It is concluded that invasive stimulation of the Gasserian ganglion is a promising treatment modality for patients with chronic, intractable, atypical trigeminal neuralgia. PMID:11935364
With over four million deliveries annually in the United States alone and a constant increase in cesarean delivery rate, childbirth is likely to have a huge impact on the occurrence of acute and possibly chronic postpartum pain. Recent awareness that chronicpain may occur after childbirth has prompted clinicians and researchers to investigate this topic. Current evidence points towards a relatively low incidence of chronicpain after cesarean delivery, with rates ranging between 1% and 18%. To provide a potential mechanistic explanation for the relatively low occurrence of chronicpain after cesarean delivery compared with that after other types of surgery, it has been proposed that endogenous secretion of oxytocin may confer specific protection. Clinical interventions to reduce the incidence and severity of chronic post-surgical pain have not been consistently effective. Likely explanations are that the drugs that have been investigated were truly ineffective or that the effect was too modest because with a low incidence of chronicpain, studies were likely to be underpowered and failed to demonstrate an effect. In addition, since not all women require preventive therapies, preoperative testing that may identify women vulnerable to pain may be highly beneficial. Further research is needed to identify valid models that predict persistent pain to allow targeted interventions to women most likely to benefit from more tailored anti-hyperalgesic therapies. PMID:23477888
Pain is one of the major complaints leading to doctor visits. Therefore basic knowledge of frequent pain diagnoses and possible treatment approaches is essential. Numerous medical and interventional therapeutic options are available for causal or symptomatic treatment of pain. The treatment of neuropathic pain is often difficult and demands special knowledge. Antidepressants like amitriptyline and anticonvulsive drugs are the first choice in these cases. Also interventional approaches are useful, such as spinal cord stimulation for angina pectoris. For the treatment of complex regional pain syndrome and phantom pain the use of mirror feed-back is a new effective method for pain relief. The only way to prevent from development of chronicpain is the early and effective treatment of acute pain. PMID:19688304
... a specific diagnosis What you should know: The pelvic floor muscles act as a muscular sling that supports ... causes Chronic constipation or diarrhea can lead to pelvic floor dysfunction and pelvic pain can become very debilitating ...
Objective To contrast differences in pain and treatment outcomes between neuromyelitis optica (NMO) and multiple sclerosis (MS). Design Retrospective, cross-sectional cohort study. Setting Academic MS center. Patients Complete ascertainment of an academic MS center cohort of NMO and an MS comparison sample cohort. Main Outcome Measures Current pain was quantified by a 10-point scale and the McGill Pain Questionnaire. Expanded Disability Status Scale score and number of involved spinal cord levels were collected in addition to testing for cognition, fatigue, depression, and quality of life. Number and types of pain medications were tabulated. Results Current pain was more common in subjects with NMO (n=29) vs MS (n=66) (86.2% vs 40.9%; P<.001) and more severe on a 10-point scale (5.38 vs 1.85; P <.001). Pain remained more common after controlling for disability and number of spinal cord segments (P=.03). Prescription pain medication was used more frequently in subjects with NMO compared with subjects with MS (75.9% vs 37.8%; P<.001), often requiring more than 1 medication (65.5% vs 15.2%; P<.001). No subject with NMO taking pain medication (22 of 29) rated their current pain as 0 of 10, whereas almost half of those taking pain medication with MS were currently free of pain (0% vs 48%; P=.006). Conclusions Neuromyelitis optica is frequently associated with severe pain that appears insufficiently controlled by pharmacologic interventions. Future studies should evaluate the efficacy of a multidisciplinary and multimodal approach to pain management.
Qian, Peiqing; Lancia, Samantha; Alvarez, Enrique; Klawiter, Eric C.; Cross, Anne H.; Naismith, Robert T.
Cordotomy for palliation of intractablepain was simplified by the use of a stereotactic percutaneous technique. The procedure is performed at the high cervical level and has been found to give good results for pain in the upper as well as the lower extremity and the trunk. Respiratory complications are the major hazard, but they may be reduced by careful selection and evaluation of patients. ImagesFigure 1.Figure 2.Figure 3.Figure 4.Figure 5.
BACKGROUND: About 10% of cluster headache patients have the chronic form. At least 10% of this chronic group is intractable to or cannot tolerate medical treatment. Open pilot studies suggest that occipital nerve stimulation (ONS) might offer effective prevention in these patients. Controlled neuromodulation studies in treatments inducing paraesthesias have a general problem in blinding. We have introduced a new design in pain neuromodulation by which we think we can overcome this problem. METHODS/DESIGN: We propose a prospective, randomised, double-blind, parallel-group international clinical study in medically intractable, chronic cluster headache patients of high- versus low-amplitude ONS. Primary outcome measure is the mean number of attacks over the last four weeks. After a study period of six months there is an open extension phase of six months. Alongside the randomised trial an economic evaluation study is performed. DISCUSSION: The ICON study will show if ONS is an effective preventive therapy for patients suffering medically intractablechronic cluster headache and if there is a difference between high- and low-amplitude stimulation. The innovative design of the study will, for the first time, assess efficacy of ONS in a blinded way. PMID:23720502
Wilbrink, Leopoldine A; Teernstra, Onno Pm; Haan, Joost; van Zwet, Erik W; Evers, Silvia Maa; Spincemaille, Geert H; Veltink, Peter H; Mulleners, Wim; Brand, Ronald; Huygen, Frank Jpm; Jensen, Rigmor H; Paemeleire, Koen; Goadsby, Peter J; Visser-Vandewalle, Veerle; Ferrari, Michel D
\\u000a Gene therapy shows great potential to assist numerous patients with inadequate relief of inflammatory or neuropathic pain,\\u000a or intractablepain 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
Three tourists developed eosinophilic meningitis after visiting the Fijian Islands. Two had a severe and long lasting illness with chronicintractablepain. In one patient electrophysiological studies and MRI scan of the brain were abnormal and provided evidence of both radicular and cerebral parenchymal involvement by the most likely causative agent, Angiostrongylus cantonensis. Images
Clouston, P D; Corbett, A J; Pryor, D S; Garrick, R
The study investigated differences in mother-child interaction, child personality, and family characteristics between adolescents who were coping with chronic benign intractablepain and adolescents who were not. Both groups experienced a similar amount and intensity of pain. Behavioural observations indicated that non-copers engaged in significantly more negative behaviour than the copers. In addition, non-copers tended to express more pain and were on-task less often than the copers. Mothers of non-copers more frequently discouraged coping behaviour. No differences between the two groups were evident on the family or personality measures. The data are consistent with clinical impressions that parental behaviour interacts with child coping. PMID:3737229
Dunn-Geier, B J; McGrath, P J; Rourke, B P; Latter, J; D'Astous, J
Objective: Tobacco use and other behavioral factors are associated with chronic back pain. Anecdotes suggest excess caffeine use may also be associated with chronic back pain. We compared caffeine consumption by chronic back pain patients with caffeine consumption by controls.Design: Retrospective case-control study.Setting: A multispecialty outpatient facility.Patients: Sixty new, consecutive patients with chronic back pain compared to 60 new, consecutive
Therapeutic management of chronicpain has not been widely successful owing to a lack of understanding of factors that initiate and maintain the chronicpain condition. Efforts to delineate the mechanisms underlying pain long have focused on neuronal elements of pain pathways, and both opiate- and non–opiate-based therapeutics are thought largely to target neurons. Abnormal neuronal activity at the level
In this case report, we describe the effect of ketamine infusion in a case of severe refractory complex regional pain syndrome I (CRPS I). The patient was initially diagnosed with CRPS I in her right upper extremity. Over the next 6 years, CRPS was consecutively diagnosed in her thoracic region, left upper extremity, and both lower extremities. The severity of her pain, combined with the extensive areas afflicted by CRPS, caused traumatic emotional problems for this patient. Conventional treatments, including anticonvulsants, bisphosphonates, oral steroids and opioids, topical creams, dorsal column spinal cord stimulation, spinal morphine infusion, sympathetic ganglion block, and sympathectomy, failed to provide long-term relief from pain. An N-methyl-d-aspartate (NMDA) antagonist inhibitor, ketamine, was recently suggested to be effective at resolving intractablepain. The patient was then given several infusions of intravenous ketamine. After the third infusion, the edema, discoloration, and temperature of the affected areas normalized. The patient became completely pain-free. At one-year of follow-up, the patient reported that she has not experienced any pain since the last ketamine infusion. Treatment with intravenous ketamine appeared to be effective in completely resolving intractablepain caused by severe refractory CRPS I. Future research on this treatment is needed. PMID:18523505
Shirani, Peyman; Salamone, Alicia R; Schulz, Paul E; Edmondson, Everton A
Objective: To review investigations into an association between brain changes and chronicpain; to synthesize the findings in the hope of generating interest among psychiatrists and casting some light on the road ahead. Conclusions: There is good evidence that chronicpain is associated with changes in brain function. It is possi- ble that these brain changes compound chronicpain and
Background Spinal cord stimulation is known to be a successful treatment for chronicintractable angina pectoris. Its effect may be anti-ischemic. It is uncertain if the clinical effect is partly caused by a placebo effect of surgery for implantation of a stimulator. In this study, clinical efficacy is investigated, together with a possible placebo effect. Methods and Results Efficacy of
Raymond W. M. Hautvast; Mike J. L. DeJongste; Michiel J. Staal; Wiek H. van Gilst; K. I. Lie
Background: Medically intractablechronic migraine (CM) is a disabling illness characterized by headache ?15 days per month. Methods: A multicenter, randomized, blinded, controlled feasibility study was conducted to obtain preliminary safety and efficacy data on occipital nerve stimulation (ONS) in CM. Eligible subjects received an occipital nerve block, and responders were randomized to adjustable stimulation (AS), preset stimulation (PS) or medical management (MM) groups. Results: Seventy-five of 110 subjects were assigned to a treatment group; complete diary data were available for 66. A responder was defined as a subject who achieved a 50% or greater reduction in number of headache days per month or a three-point or greater reduction in average overall pain intensity compared with baseline. Three-month responder rates were 39% for AS, 6% for PS and 0% for MM. No unanticipated adverse device events occurred. Lead migration occurred in 12 of 51 (24%) subjects. Conclusion: The results of this feasibility study offer promise and should prompt further controlled studies of ONS in CM.
Saper, Joel R; Dodick, David W; Silberstein, Stephen D; McCarville, Sally; Sun, Mark; Goadsby, Peter J
A multimodal stepped care approach has been successfully applied to a patient with complex regional pain syndrome type 1 and severe intractablepain, not responding to regular neuropathic pain medication. The choice to administer drugs in creams was made because of the intolerable adverse effects to oral medication. With this method, peak-dose adverse effects did not occur. The multimodal stepped care approach resulted in considerable and clinically relevant decrease in pain after every step, using topical amitriptyline, ketamine, and dimethylsulphoxide.
Chronicpain in elderly people has only recently begun to receive serious empirical consideration. There is compelling evidence that a significant majority of the elderly experience pain which may interfere with normal functioning. Nonetheless, a significant proportion of these individuals do not receive adequate pain management. Three significant factors which may contribute to this are (1) lack of proper pain
Chronicpain requires comprehensive care. While interdisciplinary approaches are recommended, the role of psychiatrists is\\u000a often misunderstood. Psychiatrists should be involved with the care of patients with chronicpain as early as possible to\\u000a maximize outcome. Psychiatrists offer an expertise that specifically addresses important deficiencies in the care of patients\\u000a with chronicpain: 1) the lack of a detailed formulation,
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 chronicpain, refractory to all other treatments. PMID:23923757
The neuroscientific understanding of chronicpain presented evolved through the integration of clinical, research and theoretical conceptualizations associated with chronic idiopathic orofacial pain after posing the following three questions: (1) What if chronic idiopathic orofacial pain was viewed from a neuroscientific perspective as part of a global syndrome rather than a site-specific anatomo-physiological perspective? (2) What if it was assumed that rather than serving no useful purpose chronic idiopathic orofacial pain served a useful purpose? (3) Would current knowledge be sufficient to explain chronic idiopathic orofacial pain? The understanding defines chronicpain as being a centrally perceived event expressing the continual or episodic persistence of a level of peripheral and/or central neural activity above the pain threshold of a sensitized nervous system that is sufficient to maintain the sensitization. This ongoing neural activity may be associated with or independent of the neural activity that initiated the sensitization. In effect the nervous system is "bruised" and the "bruising" is being maintained (prodded) by the total neural activity of the system irrespective of its origin; the normal protective healing function of the nervous system, pain, continues its warning when the activity of the system activates the switch that is the pain threshold. The common clinical history of initial trauma and ongoing stress suggests that chronicpain might be thought of as an expression of post-traumatic stress. Treatment based on the presented understanding would aim to reduce and maintain total neural activity below the pain threshold level and ideally down to where the sensitization can be reduced or even resolved by neuroplastic processes, the level rather than the origin of neural activity being relevant to the pain mitigation. A review of chronicpain in the light of this understanding will provide the opportunity to formulate, test and refine new and existing strategies for its prevention and treatment, thereby offering hope to the millions of sufferers worldwide. PMID:22019262
This article first reviews the evidence for and against chronic opioid therapy. Evidence supporting the opioid responsive- ness of chronicpain, including neuropathic pain, includes multiple randomized trials conducted over months (up to 8 months). Obser- vational studies are conducted for longer, and many also support opioid analgesic efficacy. Concerns have arisen about loss of effi- cacy with prolonged use,
Introduction Over 70% of people in resource-rich countries develop low back pain (LBP) at some time. But recovery is not always favourable: 82% of non-recent-onset patients still experience pain one year later. Many chronic patients 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? We searched: Medline, Embase, The Cochrane Library, and other important databases up to May 2007 (BMJ 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 74 systematic reviews, RCTs, or observational studies 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 steroid injections, facet joint injections, local injections), intensive multidisciplinary treatment programmes, lumbar supports, massage, muscle relaxants, non-steroidal anti-inflammatory drugs (NSAIDs), spinal manipulative therapy, traction, and transcutaneous electrical nerve stimulation (TENS).
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).
Chronicpain 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 chronicpain; 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 chronicpain 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 chronicpain 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. Chronicpain comorbidities, such as neuroinflammatory and neurodegenerative diseases, are also discussed in view of NVU changes, together with innovative pharmacological solutions targeting NVU components in chronicpain treatment.
Radu, Beatrice Mihaela; Bramanti, Placido; Osculati, Francesco; Flonta, Maria-Luisa; Radu, Mihai; Bertini, Giuseppe; Fabene, Paolo Francesco
Chronicpain 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 chronicpain; 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 chronicpain 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 chronicpain 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. Chronicpain comorbidities, such as neuroinflammatory and neurodegenerative diseases, are also discussed in view of NVU changes, together with innovative pharmacological solutions targeting NVU components in chronicpain treatment. PMID:23840097
Radu, Beatrice Mihaela; Bramanti, Placido; Osculati, Francesco; Flonta, Maria-Luisa; Radu, Mihai; Bertini, Giuseppe; Fabene, Paolo Francesco
Psychological treatment has emerged as a common component of a multidimensional and interdisciplinary plan of pain care for many persons with persistent pain. Treatments are informed by a biopsychosocial model of pain and a long history of psychological research that has identified the central role of behavioral, cognitive, and emotional factors that are believed to contribute to the perpetuation, if not the development, of chronicpain and pain-related disability and emotional distress. Empirically supported self-regulatory, behavioral, cognitive-behavioral, and acceptance and commitment interventions are reviewed, and current and future interventions are highlighted. Important issues related to individual differences and disparities in the experience of pain and pain treatment are discussed. In particular, race and ethnicity are considered, and special considerations for the management of pain in children and older adults are discussed. PMID:21128783
Eating disorders and chronicpain 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
|Aerobic and resistance exercise are currently prescribed by physicians to treat chronicpain. However, patient fitness level must improve before he/she feels better. Pain management programs help patients become more active so they can function at work and home. (SM)|
\\u000a Many chronicpain conditions in children are complex and patients can benefi t most when an integrated care plan can be brought\\u000a to bear on the problem. Multidisciplinary pain centers (MPC) and clinics aim to coordinate evaluation and treatment of complex\\u000a pain problems. Disciplines that are routinely part of these centers include medicine, physical therapy, psychology, and advanced\\u000a practice nursing.
An examination of the current understanding of the processes and related therapies aimed at treatment of chronicpain in animals is presented. Discussion focuses on mechanisms involved in the neural pathways of chronicpain, differences between acute and chronicpain, and pharmacologic options for chronicpain as they relate to inflammatory, neoplastic, and neuropathic processes. PMID:20188333
In addition to its possible role as a replacement source in CNS degenerative diseases, neural transplantation may be used to augment the normal production of neuroactive substances. Our laboratory at the University of Illinois at Chicago has shown, in both acute and chronicpain models, that transplantation of adrenal medullary tissue or isolated chromaffin cells into CNS pain modulatory regions can reduce pain sensitivity in rodents. Chromaffin cells were chosen as the donor source since they produce high levels of both opioid peptides and catecholamines, substances which reduce pain sensitivity when injected locally into the spinal subarachnoid space. The analgesia produced by these transplants probably results from the release of both opioid peptides and catecholamines since it can be blocked or attenuated by both opiate and adrenergic antagonists. Studies indicate that even over long periods there is no apparent development of tolerance. Promising results have been obtained in preliminary clinical studies using allografts of adrenal medulla to relieve cancer pain. This clinical review encompasses results at two Medical Centers-University of Illinois at Chicago and University Paul Sabatier, Toulouse, France-in assessing efficacy of subarachnoid adrenal medullary transplantation for alleviating cancer pain. Our clinical and autopsy data strongly support our previous laboratory studies, i.e., that chromaffin cell transplants into the subarachnoid space represent a promising new approach to the alleviation of chronicpain. It is suggested that further clinical studies are now warranted. PMID:9090640
Pappas, G D; Lazorthes, Y; Bès, J C; Tafani, M; Winnie, A P
Back pain is commonly classified based on duration. There is currently limited information regarding differences in the clinical features of back pain between these duration-based groupings. Here, we compared the pain characteristics of patients with subacute (SBP; pain 6–16 weeks, n = 40) and chronic back pain (CBP; pain ?1 year, n = 37) recruited from the general population. CBP
Mona Lisa Chanda; Matthew D. Alvin; Thomas J. Schnitzer; A. Vania Apkarian
Abdominal pain is a major clinical problem in patients with chronic pancreatitis. The cause of pain is usually multifactorial with a complex interplay of factors contributing to a varying degree to the pain in an individual patient and, therefore, a rigid standardized approach for pain control tends to lead to suboptimal results. Pain management usually proceeds in a stepwise approach beginning with general lifestyle recommendations. Low fat diet, alcohol and smoking cessation are encouraged. Analgesics alone are needed in almost all patients. Maneuvers aimed at suppression of pancreatic secretion are routinely tried. Patients with ongoing symptoms may be candidates for more invasive options such as endoscopic therapy, and resective or drainage surgery. The role of pain modifying agents (antidepressants, gabapentin, pregabalin), celiac plexus block, antioxidants, octreotide and total pancreatectomy with islet cell auto transplantation remains to be determined.
Pain is the major presenting symptom of chronic pancreatitis. Patients with chronic pancreatitis experience substantial impairments in health-related quality of life. Pain may be considered as the most important factor affecting the quality of life. The pathogenesis of pancreatic pain is poorly understood. The cause of pain in chronic pancreatitis is probably multifactorial. This article discusses the various hypotheses that
A. A. J. van Esch; O. H. G. Wilder-Smith; J. B. M. J. Jansen; H. van Goor; J. P. H. Drenth
Objective: To examine the use of a new silver needle therapy for treating tender points involved in intractable low-back pain after removal of nucleus pulposus.Subjects: The study involved 24 patients (17 men and 7 women) aged 26 to 67 years with a mean age of 54.5 ± 5 years.Settings: The Department of Orthopedics at the First Military Medical University, the
Chronicpain, an underestimated but complex medical and social phenomenon, is often resistant to currently used analgesic\\u000a drugs. The effect of these substances is frequently self-limiting, with increasing level of unwanted side effects caused by\\u000a increased doses. Moreover, most pharmacological therapies for pain are administered systemically, either via the enteral or\\u000a the parenteral route, and exert their effects on a
This article reviews controlled trials of hypnotic treatment for chronicpain in terms of: (1) analyses comparing the effects\\u000a of hypnotic treatment to six types of control conditions; (2) component analyses; and (3) predictor analyses. The findings\\u000a indicate that hypnotic analgesia produces significantly greater decreases in pain relative to no-treatment and to some non-hypnotic\\u000a interventions such as medication management, physical
External qigong as a pharmacotherapy adjunct was investigated in 50 subjects with chronicpain (pain lasting > 3 months with pain score of > or = 3 on 0-10 numeric analog scale) who presented to a qigong healing center. Participants were randomized to receive either external qigong treatment (EQT) or equivalent attention time (EAT) in weekly 30-min sessions for four consecutive weeks. Outcomes were assessed before and after sessions. The primary outcome measure was intensity of pain by a 10-cm visual analog scale used to rate all pain severity measurements. At 8-week follow-up, participants were contacted by telephone and mailed a questionnaire. Most had experienced pain for > 5 years (66%); the rest, for > 3 to 5 years (8%), 1 to 3 years (10%), or < 1 year but > 3 months (10%). The most frequent concomitant diagnoses were multifactorial (26%), osteoarthritis (18%), and low back pain (12%). Most patients were also receiving other treatments (74%); none previously had EQT. Participants were randomly assigned to EQT (n = 26) or EAT (n = 24). These groups had no significant differences at baseline except for prior awareness of qigong (EQT 31% vs. EAT 63%; p = 0.025). Compared to the EAT group, EQT participants had a significant decrease in pain intensity in the 2nd (p = 0.003), 3rd (p < 0.001), and 4th weeks of treatment (p = 0.003). At week 8, these differences in overall decreased pain intensity persisted but were not statistically significant. PMID:20626055
Vincent, Ann; Hill, Jamia; Kruk, Kelly M; Cha, Stephen S; Bauer, Brent A
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
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
The patients with chronicpain are increasingly reporting to the physicians for its management. Chronicpain are associated with head, neck and shoulder pain, spinal pain, pain in the joints and extremities, complex regional pain syndrome and phantom pain. The chronicpain is being managed worldwide. The different specialty of medicine is producing a lot of evidence through the published literature but the same is not being published in the field of chronicpain management. Though some evidence is being reported as to different aspects of pain management from different parts of the world but same is lacking from Indian subcontinent. This is in contrast to much done clinical work in this field as well. We present here the available evidence in relation to chronicpain management. PMID:23439674
Antidepressants: Another weapon against chronicpain Basics Reprints A single copy of this article may be reprinted for personal, noncommercial use only. Antidepressants: Another weapon against chronicpain By Mayo Clinic staff Original ...
Over the past few years, the control of pain exerted by glial cells has emerged as a promising target against pathological pain. Indeed, changes in glial phenotypes have been reported throughout the entire nociceptive pathway, from peripheral nerves to higher integrative brain regions and pharmacological inhibition of such glial reactions reduces the manifestation of pain in animal models. This complex interplay between glia and neurons relies on various mechanisms depending both on glial cell types considered (astrocytes, microglia, satellite cells or Schwann cells), the anatomical location of the regulatory process (peripheral nerve, spinal cord or brain) and the nature of the chronicpain paradigm. Intracellularly, recent advances have pointed out to the activation of specific cascades, such as mitogen associated protein kinases (MAPK) in the underlying processes behind glial activation. In addition, given the large number of functions accomplished by glial cells, various mechanisms might sensitize nociceptive neurons including a release of pronociceptive cytokines and neurotrophins or changes in neurotransmitter scavenging capacity. The authors review the conceptual advances made in the recent years about the implication of central and peripheral glia in animal models of chronicpain and discuss the possibility to translate it into human therapies in the future.
GOSSELIN, ROMAIN-DANIEL; SUTER, MARC R.; JI, RU-RONG; DECOSTERD, ISABELLE
ChronicPain extracts a "penalty" on society now estimated to be well in excess of $100 million per year. The "penalty" that ChronicPain extracts from its victims is incalculable. ChronicPain is a major component of Temporomandibular Disorders. The current neurological theory of the mechanism of chronic TMD pain is explored along with the current modes of treatment. Pharmacological management of ChronicPain in a clinical setting is outlined. Dentists are involved in pain management on a daily basis. Dentists treat pain both prophylacticly and in response to specific patient symptoms. Most dental treatment involves some type of pain management. We, dentists, have become very adept at managing acute pain. We have much greater difficulty managing chronicpain. The word "pain" derives from the Greek word for penalty, and appeared to them to be a "penalty" inflicted by the gods. In 1984, Bonica estimated that one-third of all Americans suffered from some kind of chronicpain at a "penalty" to society of $65 Billion annually in medical expenses and lost wages and productivity. This figure is certainly much greater now. Chronicpain can be a very complex problem that can require a multidisciplinary approach to treatment. Chronicpain in the dental setting is most frequetly caused by prolonged Temporomandibular Disorders. PMID:10613132
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 chronicpain (Kitawaki et al.).
Using a computer version of the emotional stroop task, it was investigated whether chronicpain patients display an involuntary attentional shift towards pain-related information (sensory, affective pain words and injury related words). Multiple regression analyses were used to investigate which pain and psychosocial variables (pain severity, pain-related fear, pain catastrophizing and negative affect) were predictive of attentional bias. Results indicated:
We introduce an intradural approach to spinal cord stimulation for the relief of intractablepain, 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.
A multidimensional model of chronicpain includes not only physiologic and psychological\\/emotional factors, but also the dimension\\u000a of subtle energy. In this chapter, the subtle energy dynamics of chronicpain are explored by first outlining the subtle anatomy\\u000a and energy physiology described in many healing traditions around the world. Then, specific pain conditions (myofascial pain,\\u000a fibromyalgia, phantom pain, and complex
Chronicpain presents a persistent and significant clinical challenge. Research examining commonly used psychotherapeutic treatments suggests that the results are not always well maintained, and that pain often is unrelieved. Continued exploration of new and more effective approaches is necessary. This article outlines an application of Eye Movement Desensitization and Reprocessing (EMDR), developed to improve coping and reduce chronicpain and suffering. The effectiveness of the EMDR ChronicPain Protocol was investigated with three adult chronicpain sufferers. Intervention effectiveness was measured at baseline, during, and postintervention, with a two-month follow-up. All clients reported substantially decreased pain levels, decreased negative affect, and increased ability to control their pain following treatment. These results indicate that EMDR may be efficacious in the treatment of chronicpain and that further research is warranted. PMID:12455018
For many cancer survivors, disease-related long-term morbidities and the application of advanced cancer treatments have resulted in the development of a chronicpain state. This brief review explores the relationship between what is known about the treatment of active cancer pain syndromes-both continuous pain and breakthrough pain-and persisting pain syndromes in cancer survivors. We also posit that because there is evidence to suggest that poorly treated acute pain can lead to protracted pain conditions, acute pain should be recognized and treated promptly, both for short- and long-term gain. In the short term, better acute pain treatment can improve functionality and psychological well-being, whereas in the long term, mounting evidence suggests that it could prevent of future chronicpain. PMID:22284639
In this review we integrate recent human and animal studies from the viewpoint of chronicpain. First, we briefly review the impact of chronicpain on society and address current pitfalls of its definition and clinical management. Second, we examine pain mechanisms via nociceptive information transmission cephalad and its impact and interaction with the cortex. Third, we present recent discoveries on the active role of the cortex in chronicpain, with findings indicating that the human cortex continuously reorganizes as it lives in chronicpain. We also introduce data emphasizing that distinct chronicpain conditions impact on the cortex in unique patterns. Fourth, animal studies regarding nociceptive transmission, recent evidence for supraspinal reorganization during pain, the necessity of descending modulation for maintenance of neuropathic behavior, and the impact of cortical manipulations on neuropathic pain is also reviewed. We further expound on the notion that chronicpain can be reformulated within the context of learning and memory, and demonstrate the relevance of the idea in the design of novel pharmacotherapies. Lastly, we integrate the human and animal data into a unified working model outlining the mechanism by which acute pain transitions into a chronic state. It incorporates knowledge of underlying brain structures and their reorganization, and also includes specific variations as a function of pain persistence and injury type, thereby providing mechanistic descriptions of several unique chronicpain conditions within a single model.
Apkarian, A. Vania; Baliki, Marwan N.; Geha, Paul Y.
BackgroundPatients with chronic abdominal pain can undergo numerous diagnostic tests with little change in their pain. This study was undertaken to assess the utility of performing diagnostic and therapeutic laparoscopy in patients with chronic abdominal pain for longer than 12 weeks.
Researchers have seldom invited patients with chronicpain to describe their lived experiences. This phenomenologic study involved in-depth interviews with nine women and four men with nonmalignant chronicpain. The essence of participants’ experiences was unremitting torment by a force or monster that cannot be tamed. The body was altered and recalcitrant, the life world was shrunken, and the pain
Chronicpain can be understood not only as an altered functional state, but also as a consequence of neuronal plasticity. Here we use in vivo structural MRI to compare global, local, and architectural changes in gray matter properties in patients suffering from chronic back pain (CBP), complex regional pain syndrome (CRPS) and knee osteoarthritis (OA), relative to healthy controls. We
Marwan N. Baliki; Thomas J. Schnitzer; William R. Bauer; A. Vania Apkarian; Raul M. Luque
Neuropathic pain is pathophysiologically distinct from other types of chronicpain and is defined by the Neuropathic Pain Special Interest Group of the International Association for the Study of Pain as "pain arising as a direct consequence of a lesion or disease affecting the somatosensory system." At least in humans, and perhaps in animals, neuropathic pain causes a much greater impairment in the patient's quality of life than is caused by other pain syndromes. And, unfortunately, this type of pain is generally quite difficult to accurately diagnose and even harder to effectively treat. A brief review of neuropathic pain and its treatment in veterinary patients is presented here. PMID:20188338
It's hard to believe that something as simple as a 15-30 minute consultation can have an impact on chronicpain patients using the ED as their venue of choice for medical care; however, that's just what happened in the ED at Providence Newberg Medical Center in Newberg, OR. The average number of visits per patient per year dropped from 6.8 to 2.3 in just three years. Grad students met patients at the bedside, validating their physical pain while introducing the concept that there are other treatment options besides opioids. A series of letters went to patients after discharge to reinforce follow-up recommendations. Local primary care providers were enlisted to treat patients who had no "medical home." PMID:21141082
The use of opioids for the treatment of chronicpain 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
According to results from the 2007/2008 Canadian Community Health Survey, about 1 in 10 Canadians aged 12 to 44-9% of males and 12% of females, an estimated 1.5 million people--experienced chronicpain. The prevalence of chronicpain increased with age and was significantly higher among people in households where the level of educational attainment was low and among the Aboriginal population. The most common pain-related chronic conditions at ages 12 to 44 were back problems and migraine headaches. Chronicpain prevented at least a few activities in the majority of sufferers. It was associated with activity limitations and needing help with everyday tasks, and had work-related implications. Individuals with chronicpain were frequent users of health care services, and were less likely than people without chronicpain to respond positively on measures of well-being, including mood and anxiety disorders. PMID:21269012
The pharmacologic management of chronic orofacial pain involves the use of medications not used routinely in dental practice. Additionally, many drugs are used for long periods of time necessitating careful monitoring for adverse effects and potential drug interactions. This article will review commonly used medications for chronic orofacial pain and highlight important areas of concern.
Chronicpain is common, costly, and potentially disabling. According to the Medical Expenditure Panel Survey in 2008, approximately 100 million adults were affected by chronicpain, with national costs estimated between $560 and $635 billion annually. Published point-prevalence estimates of adult onset chronicpain 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 chronicpain. The purpose of this analysis is to examine the concept of chronicpain transition in the context of adult onset non-cancer chronicpain. Defining the concept of chronicpain transition is essential to the future of pain research, as chronicpain transition has not been researched in the context provided here. Using Rodgers' inductive method of concept analysis, the concept of chronicpain 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 chronicpain transition. The attributes, antecedents, consequences, related concepts, and surrogate terms of chronicpain transition are described, and the implications of the findings for practice and future research are discussed. PMID:23769800
Summary Clinical management of chronicpain after nerve injury (neuropathic pain) and tumor invasion (cancer pain) is a real challenge\\u000a due to our limited understanding of the cellular mechanisms that initiate and maintain chronicpain. It has been increasingly\\u000a recognized that glial cells, such as microglia and astrocytes in the CNS play an important role in the development and maintenance\\u000a of
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
Our understanding of the natural history of chronicpain in the community is limited. This is partly due to the lack of a validated measure of chronicpain severity known to be responsive to change over time. The ChronicPain Grade questionnaire has been shown to be valid and reliable for use in a general population as a self-completion questionnaire.
Alison M Elliott; Blair H Smith; W. Cairns Smith; W. Alastair Chambers
One of the major problems in modern medicine is to find remedies for the group of people with chronicpain syndromes. Low back pain is one of the most frequent syndromes and perhaps the most invalidating of all of them. Chronicpain seems to develop through several pathways affecting the spinal cord and the brain: (1) neuro-anatomical reorganisation, (2) neuro-physiological changes, and (3) activation of glia cells (immune reaction in the central nervous system). Although all of these pathways seem to provide a (partial) plausible explanation for chronicpain, treatments influencing these pathways often fail to alleviate chronicpain patients. This could be because of the probability that chronicpain develops by all three mechanisms of disease. A treatment influencing just one of these mechanisms can only be partially successful. Other factors that seem to contribute to the development of chronicpain are psychosocial. Fear, attention and anxiety are part of the chronicpain syndrome being cause or consequence. The three pathways and the psycho-emotional factors constitute a psycho-neuro-immunological substrate for chronicpain syndromes; a substrate which resembles the substrate for phantom pain and functional invalidity after stroke. Both phantom pain and functional invalidity are considered non-use syndromes. The similarity of the substrate of both these two neurological disorders and chronicpain makes it reasonable to consider chronicpain a non-use disease (the hypothesis). To test this hypothesis, we developed a "paradoxal pain therapy". A therapy which combines the constraint induced movement therapy and strategies to dissociate pain from conditioning factors like fear, anxiety and attention. The aim of the therapy is to establish a behaviour perpendicular on the pathological pain-behaviour. Clinically, the treatment seems promising, although we just have preliminary results. Further clinical and laboratory studies are needed to measure eventual changes at neuro-anatomical and neuro-psychological level using modern neuro-imaging instruments (PET, SPECT, fMRI). Randomised clinical trials should be carried out to test our hypothesis for all-day use in clinical practice. The hypothesis: chronicpain is a non-use disease produced by psycho-emotional factors like fear, attention and anxiety. Optimal treatment should be based on physiological use, and dissociation of pain and the mentioned psycho-emotional factors. Paradoxal pain therapy could serve these treatment conditions. PMID:17071012
The application of operant learning theory on chronicpain by Fordyce has had a huge impact on chronicpain research and management. The operant model focuses on pain behaviors as a major component of the pain problem, and postulates that they are subject to environmental contingencies. The role of operant learning in pain behaviors generally has been supported by experimental studies, which are reviewed in the present article. Subsequently, the rationale, goals, and methods of operant behavioral treatment of chronicpain are outlined. Special attention is paid to three therapeutic techniques (graded activity, activity pacing, and time-contingent medication management), which are discussed in detail with regard to their operationalization, effectiveness, and (possible) mechanisms of action. Criticisms of the operant model are presented, as are suggestions for the optimization of (operant) behavioral treatment efficacy. PMID:22261987
Gatzounis, Rena; Schrooten, Martien G S; Crombez, Geert; Vlaeyen, Johan W S
: Many ethical and policy analyses of the devastating undertreatment of chronicpain leave unaddressed the role played by stigma, even though the notion that such stigma exists is well documented. This article examines the social and cultural roots of the stigma of chronicpain in American society. I document the long history of illness stigma in Western societies as
Many ethical and policy analyses of the devastating undertreatment of chronicpain leave unaddressed the role played by stigma, even though the notion that such stigma exists is well documented. This article examines the social and cultural roots of the stigma of chronicpain in American society. I document the long history of illness stigma in Western societies as a
An understanding of how the brain changes in chronicpain 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 chronicpain; (2) Functional Imaging (fMRI) that has demonstrated
David Borsook; Eric A Moulton; Karl F Schmidt; Lino R Becerra
|Chronicpain 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 chronicpain. The author discusses implications for…
This meeting report highlights the main topics presented at the conference "Chronic Inflammatory and Neuropathic Pain," convened jointly by the New York Academy of Sciences, MedImmune, and Grünenthal GmbH, on June 2-3, 2011, with the goal of providing a conducive environment for lively, informed, and synergistic conversation among participants from academia, industry, clinical practice, and government to explore new frontiers in our understanding and treatment of chronic and neuropathic pain. The program included leading and emerging investigators studying the pathophysiological mechanisms underlying neuropathic and chronicpain, and experts in the clinical development of pain therapies. Discussion included novel issues, current challenges, and future directions of basic research in pain and preclinical and clinical development of new therapies for chronicpain. PMID:22564068
Hughes, Jane P; Chessell, Iain; Malamut, Richard; Perkins, Martin; Ba?konja, Miroslav; Baron, Ralf; Farrar, John T; Field, Mark J; Gereau, Robert W; Gilron, Ian; McMahon, Stephen B; Porreca, Frank; Rappaport, Bob A; Rice, Frank; Richman, Laura K; Segerdahl, Märta; Seminowicz, David A; Watkins, Linda R; Waxman, Stephen G; Wiech, Katja; Woolf, Clifford
Back pain is commonly classified based on duration. There is currently limited information regarding differences in the clinical features of back pain between these duration-based groupings. Here, we compared the pain characteristics of patients with subacute (SBP; pain 6–16 weeks, n = 40) and chronic back pain (CBP; pain ? 1year, n = 37) recruited from the general population. CBP patients reported significantly higher pain intensity on the Visual Analogue Scale (VAS) compared to SBP patients. Based on this finding, we investigated group differences and their dependence on VAS for the Beck Depression Inventory (BDI), sensory and affective dimensions of the McGill Pain Questionnaire (MPQ-S and MPQ-A), Neuropathic Pain Scale (NPS) and the variability of spontaneous pain. Correction for VAS abolished significant group differences on the MPQ-S, MPQ-A and NPS. Only a significant difference in the variability of spontaneous pain was independent of VAS. Finally, whereas SBP patients displayed a higher incidence of unilateral pain radiating down the legs/buttocks, there was a shift towards more bilateral pain in CBP patients. In summary, SBP and CBP groups differ on three independent parameters: VAS ratings, pain location and temporal dynamics of spontaneous pain.
Chanda, Mona Lisa; Alvin, Matthew D.; Schnitzer, Thomas J; Apkarian, A. Vania
This study reports chronicpain 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. Chronicpain 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
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
\\u000a Much of what is thought to be known about chronicpain 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 chronicpain.\\u000a Even now, few
Background Myofascial pain syndrome (MPS) is a regional musculoskeletal pain disorder that is caused by myofascial trigger points. The objective of this study was to determine the prevalence of MPS among chronic back pain patients, as well as to identify risk factors and the outcome of this disorder. Methods This was a prospective observational study involving 126 patients who attended the Pain Management Unit for chronic back pain between 1st January 2009 and 31st December 2009. Data examined included demographic features of patients, duration of back pain, muscle(s) involved, primary diagnosis, treatment modality and response to treatment. Results The prevalence of MPS among chronic back pain patients was 63.5% (n = 80). Secondary MPS was more common than primary MPS, making up 81.3% of the total MPS. There was an association between female gender and risk of developing MPS (?2 = 5.38, P = 0.02, O.R. = 2.4). Occupation, body mass index and duration of back pain were not significantly associated with MPS occurrence. Repeated measures analysis showed significant changes (P < 0.001) in Visual Analogue Score (VAS) and Modified Oswestry Disability Score (MODS) with standard management during three consecutive visits at six-month intervals. Conclusions MPS prevalence among chronic back pain patients was significantly high, with female gender being a significant risk factor. With proper diagnosis and expert management, MPS has a favourable outcome.
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.
Chronicpain is usually underestimated in children, due to lack of knowledge and its specific signs. In addition to suffering, chronicpain 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 chronicpain 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 chronicpain should be multidisciplinary (pediatrician, physiotherapist, psychologist, surgeon, anesthesiologist) to support the child and her problem in its entirety. PMID:23953871
By using a population-based cohort of the general Dutch population, the authors studied whether an excessively negative orientation toward pain (pain catastrophizing) and fear of movement\\/(re)injury (kinesiophobia) are important in the etiology of chronic low back pain and associated disability, as clinical studies have suggested. A total of 1,845 of the 2,338 inhabitants (without severe disease) aged 25-64 years who
H. Susan; J. Picavet; Johan W. S. Vlaeyen; Jan S. A. G. Schouten
BACKGROUND:: Effective pain management is an essential component of cancer treatment as approximately 75% of all cancer patients experience excruciating nociceptive pain even at maximum safe doses of nonsteroidal anti-inflammatory drugs and/or opioids. We report a case where ritodrine hydrochloride effectively controlled refractory pain due to uterine metastases from thymic carcinoma. CASE PRESENTATION:: A 40-year-old woman presented at our hospital with chest discomfort, severe right femoral pain, and intermittent hypogastralgia. Computed tomography, magnetic resonance imaging, and positron emission tomography revealed a large mass in the anterior mediastinum, multiple nodules in the lungs, and multiple metastases on the uterus, lumbar vertebrae, and pelvic bones. Needle biopsies of the mediastinal and uterine cervical tumors revealed undifferentiated carcinoma of the thymus metastasizing to the uterus. Oxycodone and nonsteroidal anti-inflammatory drugs relieved the right femoral pain but not the hypogastralgia. We speculated that hypogastralgia did not result from somatalgia but from splanchnodynia. Ritodrine was administered in an effort to inhibit uterine contractions and to reduced the refractory pain and improved her quality of life. CONCLUSION:: Ritodrine relieved the pain caused by uterine contraction due to metastases and enhanced the quality of life. PMID:23567162
Most patients with insults to the spinal cord or central nervous system suffer from excruciating, unrelenting, chronicpain that is largely resistant to treatment. This condition affects a large percentage of spinal cord injury patients, and numerous patients with multiple sclerosis, stroke and other conditions. Despite the recent advances in basic science and clinical research the pathophysiological mechanisms of pain following spinal cord injury remain unknown. Here we describe a novel mechanism of loss of inhibition within the thalamus that may predispose for the development of this chronicpain and discuss a potential treatment that may restore inhibition and ameliorate pain.
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
According to Amnesty International government-sanctioned torture is verified in one third of the countries in the world. The physical and psychological sequelae are numerous. This study focuses on pain diagnosis, characterising pain types as nociceptive, visceral or neuropathic. Torture victims from the Middle East, treated at the Rehabilitation and Research Centre for Torture Victims (RCT) in Copenhagen, participated in the study. The patients were referred to a pain specialist for evaluation of unsolved pain problems. Eighteen male torture victims were examined. Twelve patients experienced pain at more than three locations. Nociceptive and neuropathic pain were demonstrated in all patients. Specific neuropathic pain conditions were related to the following four types of physical torture: Palestinian hanging, falanga, beating and kicking of the head, and positional torture. When treating torture victims, it is important to know about torture methods, to think differently than normal on etiological and pathogenetic factors and always consider the presence of neuropathic pain. PMID:10737462
Managing pain in horses afflicted by chronic laminitis is one of the greatest challenges in equine clinical practice because it is the dreadful suffering of the animals that most often forces the veterinarian to end the battle with this disease. The purpose of this review is to summarize our current understanding of the complex mechanisms involved in generating and amplifying pain in animals with laminitis and, based on this information, to propose a modified approach to pain therapy. Furthermore, a recently developed pain scoring technique is presented that may help better quantify pain and the monitoring of responses to analgesic treatment in horses with laminitis. PMID:20699178
Driessen, Bernd; Bauquier, Sébastien H; Zarucco, Laura
Chronicpain is a major health concern affecting 80 million Americans at some time in their lives with significant associated morbidity and effects on individual quality of life. Chronicpain can result from a variety of inflammatory and nerve damaging events that include cancer, infectious diseases, autoimmune-related syndromes and surgery. Current pharmacotherapies have not provided an effective long-term solution as they are limited by drug tolerance and potential abuse. These concerns have led to the development and testing of gene therapy approaches to treat chronicpain. The potential efficacy of gene therapy for pain has been reported in numerous pre-clinical studies that demonstrate pain control at the level of the spinal cord. This promise has been recently supported by a Phase-I human trial in which a replication-defective herpes simplex virus (HSV) vector was used to deliver the human pre-proenkephalin (hPPE) gene, encoding the natural opioid peptides met- and leu-enkephalin (ENK), to cancer patients with intractablepain resulting from bone metastases (Fink et al., 2011). The study showed that the therapy was well tolerated and that patients receiving the higher doses of therapeutic vector experienced a substantial reduction in their overall pain scores for up to a month post vector injection. These exciting early clinical results await further patient testing to demonstrate treatment efficacy and will likely pave the way for other gene therapies to treat chronicpain. PMID:22668775
Goins, William F; Cohen, Justus B; Glorioso, Joseph C
Chronicpain is a major health concern affecting 80 million Americans at some time in their lives with significant associated morbidity and effects on individual quality of life. Chronicpain can result from a variety of inflammatory and nerve damaging events that include cancer, infectious diseases, autoimmune-related syndromes and surgery. Current pharmacotherapies have not provided an effective long-term solution as they are limited by drug tolerance and potential abuse. These concerns have led to the development and testing of gene therapy approaches to treat chronicpain. The potential efficacy of gene therapy for pain has been reported in numerous pre-clinical studies that demonstrate pain control at the level of the spinal cord. This promise has been recently supported by a Phase-I human trial in which a replication-defective herpes simplex virus (HSV) vector was used to deliver the human pre-proenkephalin (hPPE) gene, encoding the natural opioid peptides met- and leu-enkephalin (ENK), to cancer patients with intractablepain resulting from bone metastases (Fink et al., 2011). The study showed that the therapy was well tolerated and that patients receiving the higher doses of therapeutic vector experienced a substantial reduction in their overall pain scores for up to a month post vector injection. These exciting early clinical results await further patient testing to demonstrate treatment efficacy and will likely pave the way for other gene therapies to treat chronicpain.
Goins, William F.; Cohen, Justus B.; Glorioso, Joseph C.
This article provides an overview of recent experimental and clinical research that has advanced our understanding of the\\u000a mechanisms involved in the establishment of chronicpain states. Alterations in physiological, anatomical, cellular; and molecular\\u000a mechanisms that may play a role in the development and persistence of chronicpain are discussed. In addition, correlations\\u000a between these mechanisms and clinical observations in
Thirty-five patients with chronic anal pain of obscure origin are described. This syndrome is ill-defined and treatment is unsatisfactory. There is a high incidence of sciatica and of damage to the pelvic floor musculature, but although the pain has features consistent with a neuralgia, its cause is unknown.
Aim: To review the causes and principles and recent concepts in the management of testicular pain. Introduction: Chronic testicular pain is a common presenting symptom in genitourinary surgery. Due to increased awareness of testicular cancer and in men’s health more cases are likely to be referred. Material and Methods: A literature search was made for abstracts, original papers and review
The present study piloted an investigation of the effectiveness of relaxation training and massage therapy as adjunctive interventions in the management of chronicpain associated with sickle cell disease. Sixteen adults with sickle cell disease were randomly assigned to receive either relaxation training or massage therapy. Visual analogue scales of pain were obtained before and after each session. The McGill
Cynthia D. Myers; Michael E. Robinson; Troy H. Guthrie; Scott P. Lamp; Richard Lottenberg
The recall of chronic physical pain on health surveys may be influenced by several sources of error. This report describes a program of research exploring three factors that potentially influence pain reporting: (1) the complexity of the lexicon used to d...
P. Salovey W. J. Sieber A. F. Smith D. C. Turk J. B Jobe
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,
Summary Clinical management of chronicpain 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 chronicpain. 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 chronicpain. 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 chronicpain 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 chronicpain.
In the past decade there has been a dramatic increase in (1) understanding the neurophysiological components of the pain experiences, (2) randomized clinical trials testing the efficacy of hypnotic treatments on chronicpain, and (3) laboratory research examining the effects of hypnosis on the neurophysiological processes implicated in pain. Work done in these areas has not only demonstrated the efficacy of hypnosis for treating chronicpain but is beginning to shed light on neurophysiological processes that may play a role in its effectiveness. This paper reviews a selection of published studies from these areas of research, focusing on recent findings that have the most potential to inform both clinical work and research in this area. The paper concludes with research and clinical recommendations for maximizing treatment efficacy based on the research findings that are available. PMID:24073099
Dillworth, Tiara; Mendoza, M Elena; Jensen, Mark P
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
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.
Animal models of chronicpain are widely used to investigate basic mechanisms of chronicpain and to evaluate potential novel\\u000a drugs for treating chronicpain. Among the different criteria used to measure chronicpain, behavioral responses are commonly\\u000a used as the end point measurements. However, not all chronicpain conditions can be easily measured by behavioral responses\\u000a such as the
According to Amnesty International government-sanctioned torture is verified in one third of the countries in the world. The physical and psychological sequelae are numerous. This study focuses on pain diagnosis, characterising pain types as nociceptive, visceral or neuropathic. Torture victims from the Middle East, treated at the Rehabilitation and Research Centre for Torture Victims (RCT) in Copenhagen, participated in the
Annemarie B Thomsen; Jørgen Eriksen; Knud Smidt-Nielsen
Summary\\u000a Conclusion A dosage of 300 mg\\/d of allopurinol was not effective in reducing pain or improving activities of daily living in chronic\\u000a pancreatitis.\\u000a \\u000a \\u000a \\u000a Background Allopurinol prevents the generation of oxygen-derived free radicals by inhibiting xanthine oxidase. The purpose of this study\\u000a was to determine whether allopurinol is effective in reducing pain of chronic pancreatitis.\\u000a \\u000a \\u000a \\u000a Methods Thirteen patients with chronic pancreatitis who were
P. A. Banks; M. Hughes; M. Ferrante; E. C. Noordhoek; V. Ramagopal; A. Slivka
Spinal cord stimulation (SCS) is one of the most effective modalities for management of refractory neuropathic pain unresponsive to conservative therapies. The SCS has been successful in providing analgesia, improving function, and enhancing quality of life for patients suffering from chronicpain conditions such as failed back surgery syndrome, complex regional pain syndrome, ischaemic and phantom limb pain, and coronary artery disease. This technique has proven to be cost effective in the long term despite its high initial cost. In this review article, we discuss the history of SCS development, mechanism of action, and indications for SCS. PMID:19956823
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
Introduction: Chronic post–thoracotomy pain (CPP) has very high incidence and therefore it needs attention. Usually, it is burning, dysaesthetic and aching in nature and it displays many features of neuropathic pain. No one technique of thoracotomy has been shown to reduce the incidence of chronic post thoracotomy pain. Objectives: To evaluate the efficacy and safety of pregabalin in patients with chronic post–thoracotomy pain. Methods: This prospective, randomized study was conducted on 50 consenting patients who underwent posterolateral thoracotomy. 25 patients were given pregabalin for 21 days (Group A). Another 25 were given diclofenac sodium (Group B) on demand and they escaped treatment. Visual Analogue Scale (VAS) scoring was performed on days 0, 1 and 7, then follow up was done at 3, 6, 12 and 24 weeks. The data was analyzed by using t-test and Chi- square test for various variables. Results: The pain VAS scores in Group A were significantly low at all observation points except on day 0, day 1 and day 7 post-operatively, when the difference in pain scores in both the groups were comparable. The overall pain scores of Group A were comparable at day 0, day 1 and at day 7 as compared to those of Group B (p>0.9). Pain was significantly low at three weeks (p<0.05). Pain scores of Group A were significantly low at 6 weeks,12 weeks and 24 weeks as compared to those of Group B (p<0.001) and the difference was statistically significant. No significant adverse reactions were observed during study period. Conclusion: Pregabalin is a safe and an effective adjuvant which is used for reducing the chronic post thoracotomy pain, which has no side effects and a high patient compliance. These results should be supported with multidisciplinary studies with larger sample sizes and longer follow-ups.
\\u000a The use of antibiotics in chronic prostatitis\\/chronic pelvic pain syndrome is widespread and generally accepted. This chapter\\u000a explores the reasons for this acceptance, presents the evidence based information that would refute this practice, and delineates\\u000a the areas of confusion that still confound physicians endeavoring to care for these patients.
Breakthrough pain is well-characterized in cancer patients but not in patients with chronic noncancer pain. We recruited 228 patients with diverse types of chronic noncancer pain from 9 pain programs and administered a telephone questionnaire with a breakthrough pain assessment algorithm originally designed for cancer patients. All patients had controlled baseline pain, and 168 (74%) experienced severe to excruciating breakthrough
Russell K. Portenoy; Daniel S. Bennett; Richard Rauck; Steven Simon; Donald Taylor; Michael Brennan; Steven Shoemaker
Pain intensity, disability, and depressive symptoms are hallmarks of chronicpain conditions, but little is known about the relationships among these symptoms in the transition from acute to chronicpain. In this study, an inception cohort of men with low back pain (N = 78) was assessed at 2, 6, and 12 months after pain onset. At 6 months, pain
JoAnne E. Epping-Jordan; Dennis R. Wahlgren; Rebecca A. Williams; Sheri D. Pruitt; Mark A. Slater; Thomas L. Patterson; Igor Grant; John S. Webster; J. Hampton Atkinson
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.
Text Version... 11 Page 12. Age-Sex Specific 1-yr. Prevalence: ... Page 22. Age Prevalence (%) Age-Sex Specific Prevalence of 1+ Pain Condition (of 5 investigated) ... More results from www.fda.gov/downloads/drugs/newsevents
Pulsed radiofrequency (PRF), a technology related to continuous radiofrequency, is unique in that it provides pain relief\\u000a without causing significant damage to nervous tissue. The mechanism by which PRF controls pain is unclear, but it may involve\\u000a a temperature-independent pathway mediated by a rapidly changing electrical field. Although much anecdotal evidence exists\\u000a in favor of PRF, there are few quality
Chronicpain patients who have limited access to opioids may be redirected to methadone maintenance centers for management of their pain. Unfortunately, little information exists on the incidence and characteristics of methadone maintenance patients with chronicpain. The aim of this study was to survey individuals at methadone maintenance centers in order to determine the prevalence of chronicpain and
Robert N. Jamison; Janice Kauffman; Nathaniel P. Katz
Most pain treating physicians have a vague notion, that there may be a psychological component contributing to the severity of chronicpain. The International Association for the Study of Pain defined pain as \\
This study reports on the integration of 6 dimensions of chronic low back pain to provide a multidimensional profile of the patient. These dimensions were pain intensity, functional disability, attitudes toward pain, pain coping strategies, depression, and illness behavior. Cluster analysis of the data obtained from 100 patients with chronic low back pain revealed the presence of 3 distinct patient
|Chronicpain 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 chronicpain include headaches, recurrent abdominal pain (RAP), and musculoskeletal pain. In contrast to acute…
Chronic regional pain syndrome (CRPS) can be intractable to treat and patients sometimes suffer for many years. Therefore, new treatment strategies are needed to alleviate symptoms in CRPS patients. This case report describes a patient suffering from intractable CRPS type 1 for 13 years. Due to her swollen painful feet and left knee she is wheelchair-bound. The combination of palmitoylethanolamide and ketamine 10% cream reduced her pain by more than 50% after 1 month of treatment, and a marked reduction in swelling and skin discoloration was noticed. Furthermore, she could walk independently again and she experienced no side effects. Thus, palmitoylethanolamide and topical ketamine could be a combination therapy option for treating CRPS patients.
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
\\u000a Low back pain is a common problem with an important socio-economical impact. It is defined as chronic after 7–12 weeks of\\u000a non-response to conservative therapies. Its estimated prevalence is 15% in adults, rising to 44% in the elderly (Jacobs et al. 2006). Unlike radicular pain where a cause of nerve root compression is often found, the precise etiology of back
\\u000a Chronicpain in children and adolescents can be diffi cult to treat. Many parents and children are turning to complementary\\u000a and alternative medicine (CAM) to gain relief for conditions as varied as migraines, juvenile arthritis, sickle cell disease,\\u000a and functional abdominal pain (FAP). This chapter highlights some of the more well-known, safe, and effi cacious CAM treatments\\u000a for children and
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 chronicpain. 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 chronicpain. Medline searches were done for all agents used as conventional treatment in chronicpain. 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 chronicpain 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.
Chronicpain is maladaptive and influences brain function and behavior by altering the flow and integration of information across brain regions. Here we use a power spectral analysis to investigate impact of presence of chronicpain on brain oscillatory activity in humans. We examine changes in BOLD fluctuations, across different frequencies, in chronic back pain (CBP) patients (n=15) as compared to healthy controls (n=15) during resting state fMRI. While healthy subjects exhibited a specific, frequency band dependent, large-scale neural organization, patients showed increased high frequency BOLD oscillations (0.12–0.20 Hz) circumscribed mainly to medial prefrontal cortex (mPFC) and parts of the default-mode network (DMN). In the patients a correlation analysis related the mPFC aberrant BOLD high frequency dynamics to altered functional connectivity to pain signaling/modulating brain regions, thus linking BOLD frequency changes to function. We also found that increased frequency fluctuations within the mPFC were temporally synchronous with spontaneous pain changes in patients during a pain-rating task. These observations provide novel insights about the nature of CBP, identifying how it disturbs the resting brain, and link high frequency BOLD oscillations to perception.
Baliki, Marwan M.; Baria, Alex; Apkarian, A. Vania
Adults with chronic abdominal pain remain a poorly defined population, despite the debilitation and depression associated with this therapeutically challenging condition. This study compared patients with chronic abdominal pain with an empirically well-known group of patients with chronicpain (back pain) to investigate similarities and differences in their physical and mental functioning. This retrospective, cross-sectional study included 136 patients with
Cynthia O. Townsend; Christopher D. Sletten; Barbara K. Bruce; Jeffrey D. Rome; Connie A. Luedtke; John E. Hodgson
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
Compares several instruments of potential usefulness in assessment of anxiety and depression among pain patients (N=34). Results showed that the SCL-90-R appeared to offer the best combination of relevant data and efficient assessment. However, significant intercorrelations among SCL-90-R subscales suggest a unitary factor structure. (NRB)
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
Associative connections between cortical cell assemblies representing pain-related memories should be stronger and more extensive in subjects with chronicpain. To test this hypothesis, the dimensional complexity of the electroencephalograph (EEG) was examined during the actual experience as well as during memory for pain. Nine chronicpain patients and nine matched healthy controls participated in the study. During acute pain
BACKGROUND: Extant research comparing laboratory pain responses of children with chronicpain with healthy controls is mixed, with some studies indicating lower pain responsivity for controls and others showing no differences. Few studies have included different pain modalities or assessment protocols. OBJECTIVES: To compare pain responses among 26 children (18 girls) with chronicpain and matched controls (mean age 14.8 years), to laboratory tasks involving thermal heat, pressure and cold pain. Responses to cold pain were assessed using two different protocols: an initial trial of unspecified duration and a second trial of specified duration. METHODS: Four trials of pressure pain and of thermal heat pain stimuli, all of unspecified duration, were administered, as well as the two cold pain trials. Heart rate and blood pressure were assessed at baseline and after completion of the pain tasks. RESULTS: Pain tolerance and pain intensity did not differ between children with chronicpain and controls for the unspecified trials. For the specified cold pressor trial, 92% of children with chronicpain completed the entire trial compared with only 61.5% of controls. Children with chronicpain exhibited a trend toward higher baseline and postsession heart rate and reported more anxiety and depression symptoms compared with control children. CONCLUSIONS: Contextual factors related to the fixed trial may have exerted a greater influence on pain tolerance in children with chronicpain relative to controls. Children with chronicpain demonstrated a tendency toward increased arousal in anticipation of and following pain induction compared with controls.
Tsao, Jennie CI; Evans, Subhadra; Seidman, Laura C; Zeltzer, Lonnie K
Persistent and disabling pain is the hallmark of chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS). However, disease severity (as measured by objective indexes such as those that use radiography or serology) is only marginally related to patients' reports of pain severity, and pain-related presentation can differ widely among individuals with CP/CPPS. Increasing evidence in support of the biopsychosocial model of pain suggests that cognitive and emotional processes are crucial contributors to inter-individual differences in the perception and impact of pain. This review describes the growing body of literature relating depression and catastrophizing to the experience of pain and pain-related sequelae in CP/CPPS. Depression and catastrophizing are consistently associated with the reported severity of pain, sensitivity to pain, physical disability, poor treatment outcomes, and inflammatory disease activity and potentially with early mortality. A variety of pathways, from cognitive to behavioral to neurophysiological, seem to mediate these deleterious effects. Collectively, depression and catastrophizing are critically important variables in understanding the experience of pain in patients with CP/CPPS. Pain, depression, and catastrophizing might all be uniquely important therapeutic targets in the multimodal management of a range of such conditions.
Chronic muscular pain is often regarded as incomprehensible or indefinable when the doctor ''can't find anything'' on examination. However, the physiotherapist often detects physical signs in these patients: changes in posture, holding breath, tense and hard musculature, and poor balance. The findings are dependent on what is being sought. The view of the body as ambiguous, as something a person
Chronic nonmalignant pain is a prevalent and costly phenomenon. Chronicpain induces stressors that affect personal and work lives of sufferers. Because of this interference, quality of life is impacted. The purpose of this pilot study was to explore the impact of stressors on the quality of life of adult patients with chronicpain. The framework guiding this study was Neuman's Systems Model based on the concepts of stress and reaction to stress. A descriptive correlational research design was used to compare participants' quality of life according to their health and function; family, psychological, spiritual, and socioeconomic status; and the stressors of age, gender, income, marital and work status, occupation, monthly treatment costs, and type of insurance. Each participant was administered the Ferrans and Powers Quality-of-Life Index and a demographic survey. Results revealed that a higher quality of life was associated with participants who were older, female, and employed, whereas a lower quality of life was associated with participants with a low income, higher treatment costs, and a lack of workmen's compensation insurance. Based on Neuman's model, the implications of chronicpain sufferers' resistance to the negative impact of various stressors are discussed. PMID:11710091
This ethnographic study describes how a group of women with chronic pelvic pain (CPP) learned to develop self-care strategies that allowed them to function in their culturally prescribed roles through. out their illnesses. The sample consisted of 12 Europ...
Background: Abdominal epilepsy (AE) is an uncommon cause for chronic recurrent abdominal pain in children and adults. It is characterized by paroxysmal episode of abdominal pain, diverse abdominal complaints, definite electroencephalogram (EEG) abnormalities and favorable response to the introduction of anti-epileptic drugs (AED). We studied 150 children with chronic recurrent abdominal pain and after exclusion of more common etiologies for the presenting complaints; workup proceeded with an EEG. We found 111 (74%) children with an abnormal EEG and 39 (26%) children with normal EEG. All children were subjected to AED (Oxcarbazepine) and 139 (92%) children responded to AED out of which 111 (74%) children had an abnormal EEG and 27 (18%) had a normal EEG. On further follow-up the patients were symptom free, which helped us to confirm the clinical diagnosis. Context: Recurrent chronic abdominal pain is a common problem encountered by pediatricians. Variety of investigations are done to come to a diagnosis but a cause is rarely found. In such children diagnosis of AE should be considered and an EEG will confirm the diagnosis and treated with AED. Aims: To find the incidence of AE in children presenting with chronic recurrent abdominal pain and to correlate EEG findings and their clinical response to empirical AEDs in both cases and control. Settings and Design: Krishna Institute of Medical Sciences University, Karad, Maharashtra, India. Prospective analytical study. Materials and Methods: A total of 150 children with chronic recurrent abdominal pain were studied by investigations to rule out common causes of abdominal pain and an EEG. All children were then started with AED oxycarbamezepine and their response to the treatment was noted. Results: 111 (74%) of the total 150 children showed a positive EEG change suggestive of epileptogenic activity and of which 75 (67.56%) were females and 36 (32.43%) were male, majority of children were in the age of group of 9-12 years. Temporal wave discharges were 39 (35.13%) of the total abnormal EEG's. All the children were started on AEDs and those with abnormal EEG showed 100% response to treatment while 27 (18%) children with normal EEG also responded to treatment. Twelve (8%) children did not have any improvement in symptoms. Conclusions: A diagnosis of AE must be considered in children with chronic recurrent abdominal pain, especially in those with suggestive history, and an EEG can save a child from lot of unnecessary investigations and suffering.
Kshirsagar, V. Y.; Nagarsenkar, Suhel; Ahmed, Minhajuddin; Colaco, Sylvia; Wingkar, K. C.
Chronic prostatitis\\/chronic pelvic pain syndrome (CP\\/CPPS) is a common condition among men of a wide age range, with detrimental effects on quality of life. The etiology, pathogenesis, and optimal treatment of CP\\/CPPS remain unknown, although progress has been made in these domains in recent years. A wide variety of pharmacologic and nonpharmacologic therapies have been studied in clinical trials, but
Catastrophizing about pain is related to elevated pain severity and poor adjustment among chronicpain patients, but few physiological\\u000a mechanisms by which pain catastrophizing maintains and exacerbates pain have been explored. We hypothesized that resting levels\\u000a of lower paraspinal muscle tension and\\/or lower paraspinal and cardiovascular reactivity to emotional arousal may: (a) mediate\\u000a links between pain catastrophizing and chronicpain
Brandy Wolff; John W. Burns; Phillip J. Quartana; Kenneth Lofland; Stephen Bruehl; Ok Y. Chung
\\u000a Pain is a common complaint in primary care, with chronicpain reported in 20% of visits to general practitioners (McCaffrey\\u000a et al., 2003). Twenty percent of adults suffer from chronicpain, rising to half of those of the older age population (Cousins\\u000a et al., 2004). Chronicpain, defined as “intermittent or continuous pain persisting longer than six months or beyond
Objectives: ''Mental defeat'' has been found to be an important psychologic reaction to painful trauma. Chronicpain patients also report mental defeat in relation to their experience of pain episodes. A measure of mental defeat was devised and evaluated in terms of (1) psychometric properties and (2) specificity of scores in relation to disabling chronicpain. Methods: A total of
Nicole K. Y. Tang; Paul M. Salkovskis; Magdi Hanna
This study describes the experience of people with chronicpain. Using the method of grounded theory, 29 chronicpain sufferers were interviewed at an outpatient pain clinic. A model depicting the basic social psychological process of maintaining a normal life through constraint was developed. This process revolved around people's perception of the constraints imposed by pain: bodily constraint (constraint on
The use of narcotic analgesics have been avoided by clinicians in patients with chronicpain syndromes. Uncertainty as to the etiological cause of chronicpain, development of addiction and habituation and associated psychological and behavioral symptoms found in chronicpain states which are not amenable to narcotic medications are the major reasons narcotics are not prescribed. This communication describes the
Randal D. France; Bruno J. Urban; Francis J. Keefe
The objective of this project was to determine the relationship between cigarette smoking and the reporting of chronicpain syndromes among participants in the Kentucky Women’s Health Registry. Data was analyzed on 6,092 women over 18 years of age who responded to survey questions on pain and smoking. The chronicpain syndromes included in the analysis were fibromyalgia, sciatica, chronic
Michael D. Mitchell; David M. Mannino; Douglas T. Steinke; Richard J. Kryscio; Heather M. Bush; Leslie J. Crofford
Research has demonstrated the importance of psychological factors in coping, quality of life, and disability in chronicpain. Furthermore, the contributions of psychology in the effectiveness of treatment of chronicpain patients have received empirical support. The authors describe a biopsychosocial model of chronicpain and provide an update on research implicating the importance of people's appraisals of their symptoms,
Objectives The aim of this study was to examine relations among parental responses, adolescent pain coping, and pain behaviors in adolescents with chronicpain. Methods This study included 217 adolescents (12-17 years) evaluated at a multidisciplinary pain clinic and their parents. Adolescents completed measures assessing their pain, pain coping responses, functional disability, and somatic symptoms. Parents reported on their responses
Laura E. Simons; Robyn Lewis Claar; Deirdre L. Logan
Chronicpain represents a major public health problem. A major precursor of a chronicpain state is persistent acute postoperative pain. Risk factors of developing persistent acute postoperative pain are identified and preventative strategies for implementation are discussed. Epidemiological studies have shown that chronicpain represents a major public health problem.1 The prevalence of chronicpain obtained ranges from 8%-80%
Background: This report describes a young woman with incomplete traumatic cervical spinal cord injury and intractable pruritus involving her dorsal forearm. Method: Case report. Findings: Anatomic distribution of the pruritus corresponded to the dermatomal distribution of her level of spinal cord injury and vertebral fusion. Symptoms were attributed to the spinal cord injury and possible cervical root injury. Pruritus was refractory to all treatments, including topical lidocaine, gabapentin, transcutaneous electrical nerve stimulation, intravenous Bier block, stellate ganglion block, and acupuncture. Conclusions: Further understanding of neuropathic pruritus is needed. Diagnostic workup of intractable pruritus should include advanced imaging to detect ongoing nerve root compression. If diagnostic studies suggest radiculopathy, epidural steroid injection should be considered. Because the autonomic nervous system may be involved in complex chronicpain or pruritic syndromes, sympatholysis via such techniques as stellate ganglion block might be effective.
Crane, Deborah A; Jaffee, Kenneth M; Kundu, Anjana
Chronicpain 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
Background: Chronicpain is a clinical challenge for the practicing physician. Lack of knowledge about opioids, negative attitudes toward prescribing opioids, and inadequate pain-assessment skills combine to create major barriers to pain relief. Patient-related barriers, such as lack of communication and un- warranted fears of addiction, further complicate pain assessment and treatment. The health care system itself can hinder pain
Abdominal pain is a principal and in many cases, the only observable symptom of chronic pancreatitis. Like all chronicpain conditions, managing abdominal pain in chronic pancreatitis remains an onerous task for health care providers. Different mechanisms have been postulated in trying to better understand the pathogenesis of pain in chronic pancreatitis. This review seeks to take a broad look at the various options that are available to providers in trying to achieve pain relief and a better quality of life for chronic pancreatitis patients.
Background Chronicpain conditions are characterized by significant individual variability complicating the identification of pathophysiological markers. Leukocyte telomere length (TL), a measure of cellular aging, is associated with age-related disease onset, psychosocial stress, and health-related functional decline. Psychosocial stress has been associated with the onset of chronicpain and chronicpain is experienced as a physical and psychosocial stressor. However, the utility of TL as a biological marker reflecting the burden of chronicpain and psychosocial stress has not yet been explored. Findings The relationship between chronicpain, stress, and TL was analyzed in 36 ethnically diverse, older adults, half of whom reported no chronicpain and the other half had chronic knee osteoarthritis (OA) pain. Subjects completed a physical exam, radiographs, health history, and psychosocial questionnaires. Blood samples were collected and TL was measured by quantitative polymerase chain reaction (qPCR). Four groups were identified characterized by pain status and the Perceived Stress Scale scores: 1) no pain/low stress, 2) no pain/high stress, chronicpain/low stress, and 4) chronicpain/high stress. TL differed between the pain/stress groups (p = 0.01), controlling for relevant covariates. Specifically, the chronicpain/high stress group had significantly shorter TL compared to the no pain/low stress group. Age was negatively correlated with TL, particularly in the chronicpain/high stress group (p = 0.03). Conclusions Although preliminary in nature and based on a modest sample size, these findings indicate that cellular aging may be more pronounced in older adults experiencing high levels of perceived stress and chronicpain.
Structural equation modeling was used to examine the relationships between selected psychological variables and pain perceptions in 103 individuals experiencing chronicpain following traumatic spinal cord injury (SCI). Previous studies have suggested strong relationships between psychological variables and chronic SCI pain, but further delineation of such relationships is needed in order ultimately to develop more effective pain management strategies for
Although, opioids are advocated in various guidelines their use for chronic non-cancer pain is controversial because evidence of long term benefit is weak. The potential for serious adverse effects and local regulations promote caution in both the prescribers and users. However, opioids have a place in the management of chronic non-cancer pain in carefully selected patients with regular monitoring and as a part of the multimodal therapy. It is important for the treating physician to be up-to-date with this form of therapy, in order to have the necessary confidence to prescribe opioids and manage adverse effects. The common adverse effects should be treated promptly to improve patient compliance. We believe that opioid therapy in low doses is beneficial to some patients. It should not be denied but carefully considered on case by case basis.
ObjectivesSeveral recent studies report the presence of a specific EEG pattern named Thalamocortical Dysrhythmia (TCD) in patients with severe chronic neurogenic pain. This is of major interest since so far no neuroscientific indicator of chronicpain could be identified. We investigated whether a TCD-like pattern could be found in patients with moderate chronic back pain, and we compared patients with
Stefan Schmidt; José Raúl Naranjo; Christina Brenneisen; Julian Gundlach; Claudia Schultz; Holger Kaube; Thilo Hinterberger; Daniel Jeanmonod
We review recent advances in brain imaging in humans, concentrating on advances in our understanding of the human brain in clinical chronicpain. Understanding regarding anatomical and functional reorganization of the brain in chronicpain is emphasized. We conclude by proposing a brain model for the transition of the human from acute to chronicpain.
The study examined the prevalence and relationship between sleep disturbance and chronicpain. Research questions were: (1) What is the prevalence of sleep disturbance in adults with chronicpain, and how does this prevalence compare with healthy and insomniac adults? (2) What is the relationship between sleep disturbance and chronicpain? (3) What is the relationship of patient characteristics to
Recently, local morphologic alterations of the brain in areas ascribable to the transmission of pain were detected in patients suffering from phantom pain, chronic back pain, irritable bowl syndrome, fibromyalgia and two types of frequent headaches. These alterations were different for each pain syndrome, but overlapped in the cingulate cortex, the orbitofrontal cortex, the insula and dorsal pons. These regions function as multi-integrative structures during the experience and the anticipation of pain. As it seems that chronicpain patients have a common "brain signature" in areas known to be involved in pain regulation, the question arises whether these changes are the cause or the consequence of chronicpain. The author suggests that the gray matter change observed in chronicpain patients are the consequence of frequent nociceptive input and should thus be reversible when pain is adequately treated. PMID:18410991
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
BACKGROUND: There is no standard method of measuring change in chronicpain severity. Clinical trials commonly use serial assessment scales, completed at two points in time, to estimate change in pain severity, while clinicians usually ask patients to make a retrospective assessment of change. How the two methods compare is not known. AIM: To assess different methods of measuring change in chronicpain severity, by comparing changes in scores on a serial measure of chronicpain severity using the ChronicPain Grade (CPG) questionnaire and responders' retrospective perception of change in pain severity. DESIGN OF STUDY: Postal self-completion questionnaires. SETTING: The Grampian region of Scotland. METHOD: Postal questionnaires were sent in March and September 1998 to a random sample of 535 adults with chronicpain, drawn from responders to a postal survey of the region conducted in 1996. RESULTS: Corrected response rates of 87.5% and 90.7% were obtained. Over a six-month period poor levels of agreement were found, with responders' retrospective perceptions mirroring recorded changes in 41.8% of individuals (kappa = 0.081). A low partial correlation coefficient between the two measures (-0.209) was also found. Over a two-year period there were again poor levels of agreement, with responders' retrospective perceptions mirronng recorded changes in 35.2% of individuals (kappa = 0.071). A low partial correlation coefficient (-0.401) was again found. CONCLUSION: There was poor agreement and low correlation between two commonly used methods for assessing change in pain severity over time. This finding has important implications for both service practitioners and researchers.
Elliott, Alison M; Smith, Blair H; Hannaford, Philip C; Smith, W Cairns; Chambers, W Alastair
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.
The use of unidimensional scales to measure pain intensity has been criticised because of the multidimensional nature of pain. We conducted multiple linear regression analyses to determine which dimensions of pain – sensory versus affective – predicted scores on unidimensional scales measuring pain intensity and emotions in 109 Italian women suffering from chronic, non-malignant musculoskeletal pain. We then compared the
Alexa Huber; Anna Lisa Suman; Carmela Anna Rendo; Giovanni Biasi; Roberto Marcolongo; Giancarlo Carli
Chronicpain 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 chronicpain itself alters brain circuitry, including that involved in endogenous pain control, suggesting that controlling pain becomes increasingly difficult as pain becomes chronic. PMID:23719569
The accurate, precise, and consistent assessment of pain is of particular importance in palliative care. The European Palliative Care Research Collaborative is developing a computer-based pain assessment instrument and has been evaluating the content and dimensionality of existing pain questionnaires. The most important dimensions of pain are intensity and interference. However, since pain interference is a consequence of and largely reflects pain intensity, we postulated that it might either provide information to enhance the evaluation of intensity, or that an overall summary measure of pain severity could be constructed by combining the 2 dimensions. Cancer patients in palliative care (n=395) and chronicpain patients (n=168) completed questionnaires that included 23 pain items culled from existing questionnaires. Psychometric analyses confirmed the existence of 2 main dimensions, intensity and interference, and also guided identification of items that contributed most strongly to these dimensions. However, there was strong evidence that the relationship between the intensity and the interference items differs markedly in palliative care patients compared to chronicpain patients. As hypothesized, there was strong correlation between intensity and interference, lending support to the possibility that, for some purposes, these dimensions may be combined to provide a higher-level summary measure of patients' pain experience. We conclude that these dimensions should be kept distinct when assessing patients in general, although for a single type of patient (such as palliative care patients), it may be possible to regard intensity and interference as contributing to an overall measure of pain severity. PMID:21458921
Fayers, Peter M; Hjermstad, Marianne J; Klepstad, Pål; Loge, Jon Håvard; Caraceni, Augusto; Hanks, Geoffrey W; Borchgrevink, Petter; Kaasa, Stein
Chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) is a common condition among men of a wide age range, with detrimental effects on quality of life. The etiology, pathogenesis, and optimal treatment of CP/CPPS remain unknown, although progress has been made in these domains in recent years. A wide variety of pharmacologic and nonpharmacologic therapies have been studied in clinical trials, but most have shown limited efficacy in symptom alleviation. CP/CPPS is increasingly viewed as a condition that involves variable degrees of neuropathic pain. Medications such as gabapentin, pregabalin, memantine, and tricyclic antidepressants are often used in other neuropathic pain conditions and, therefore, are considered potential treatments for CP/CPPS. Few studies of these agents in patients with CP/CPPS have been reported, but future clinical trials should help to determine their utility and to characterize the pathogenetic mechanisms of pain in CP/CPPS. Combining treatment trials with biomarker, genomic, and imaging studies, in addition to epidemiologic and symptom-based assessments, will maximize the ability to probe disease etiology and pathogenesis, as well as identify effective treatment.
Local morphologic alterations of the brain in areas ascribable to the transmission of pain were recently detected in patients suffering from phantom pain, chronic back pain, irritable bowl syndrome, fibromyalgia and frequent headaches. These alterations were different for each pain syndrome, but overlapped in the cingulate cortex, the orbit frontal cortex, the insula and dorsal pons. As it seems that chronicpain patients have a common "brain signature" in areas known to be involved in pain regulation, the question arises whether these changes are the cause or the consequence of chronicpain. The in vivo demonstration of a loss of brain gray matter in patients suffering from chronicpain compared to age and sex-matched healthy controls could represent the heavily discussed neuroanatomical substrate for pain memory. PMID:19838741
Chronicpain is a significant problem among older adults. Undertreated or poorly managed pain can affect the physical, psychological, social, emotional, and spiritual well-being of older people. Several researchers have found that individuals turn to a wide array of cognitive and behavioral coping strategies when experiencing high levels of chronicpain. In addition, there is a growing body of evidence
Cardenas DD, Turner JA, Warms CA, Marshall HM. Classification of chronicpain associated with spinal cord injuries. Arch Phys Med Rehabil 2002;83:1708-14. Objectives: To determine interrater reliability of a classification system for chronicpain 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
This study had two primary objectives: (1) characterize the content of presleep cognitions of chronicpain patients and (2) evaluate the association between presleep cognitions and sleep disturbance. Thirty-one outpatients with benign chronicpain 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
Objectives. To evaluate the effects of acupuncture on pain and function in patients with chronic knee pain. Methods. Systematic review and meta-analysis of randomized controlled trials of adequate acupuncture. Computerized databases and reference lists of articles were searched in June 2006. Studies were selected in which adults with chronic knee pain or osteoarthritis of the knee were randomized to receive
This paper attempts to review the relevant literature pertaining to the family issues in chronicpain. To begin with, a rationale is developed for adopting a family approach to the understanding of physical and psychosomatic disorders. Pain literature is examined to demonstrate the significance of family factors in the etiology, perpetuation and treatment of chronicpain. Overall research in this
Objective. Chronic low back pain represents a substantial cost to employers through benefits coverage and days missed due to incapacity. We sought to explore the effectiveness of Naturopathic care on chronic low back pain. Methods. This study was a randomized clinical trial. We randomized 75 postal employees with low back pain of longer than six weeks duration to receive Naturopathic
Orest Szczurko; Kieran Cooley; Jason W. Busse; Dugald Seely; Bob Bernhardt; Gordon H. Guyatt; Qi Zhou; Edward J. Mills
ObjectiveChronic low back pain represents a substantial cost to employers through benefits coverage and days missed due to incapacity. We sought to explore the effectiveness of Naturopathic care on chronic low back pain.MethodsThis study was a randomized clinical trial. We randomized 75 postal employees with low back pain of longer than six weeks duration to receive Naturopathic care (n =
Orest Szczurko; Kieran Cooley; Jason W. Busse; Dugald Seely; Bob Bernhardt; Gordon H. Guyatt; Qi Zhou; Edward J. Mills; Peter Tugwell
Integrated six dimensions of chronic low back pain (pain intensity, functional disability, attitudes toward pain, pain coping strategies, depression, illness behavior) to provide multidimensional patient profile. Data from 100 patients revealed presence of three distinct patient groups: patients who were in control, patients who were depressed and…
Chronicpain in children and adolescents is frequently misdiagnosed by caregivers. It is not treated until it results in the loss of routine ability and function. Chronicpain is often associated with underlying diseases commonly seen in childhood, including sickle cell disease, malignancy, rheumatologic disorders, inflammatory bowel disease, trauma, and states where there is no identifiable etiology. Chronicpain differs from acute pain in that it serves no useful function. Untreated or under-treated chronicpain will result in the unnecessary suffering of the patient, disruption of family routine, and cohesiveness and restriction of the child's daily activities, thereby increasing long-term disability. Accurate and repeated assessment of chronicpain is required for therapy to be effective. Assessment of chronicpain in children is difficult due to their developing cognitive abilities. The assessment of childhood pain varies with the child's age, type of pain, situation, and prior painful experiences. Assessment tools such as the Varni-Thompson Pediatric Pain Questionnaire and the Visual Analog Scale are helpful for both the patient and physician in helping to identify situations that precipitate pain, to rate the level of pain and determine if therapy has been effective. Documentation of pain assessments and the effectiveness of interventions in the medical record should be included as a routine part of all patient records. Most caregivers have extensive experience in the treatment of acute pain in children but are often not comfortable with the management of complicated and chronicpain states. The therapy for chronicpain in children is multifactorial. It can include agents from multiple classes of pharmacologic agents (nonsteroidal anti-inflammatory drugs, opioids, tricyclic antidepressants, and antineuroleptics) nonconventional therapies (acupuncture and pressure and aromatherapy), as well as herbal and homeopathic remedies. PMID:12390045
Chambliss, C Robert; Heggen, Judith; Copelan, David N; Pettignano, Robert
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 chronicpain. 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
OBJECTIVE The objective of the present study was to assess the degree of pain relief obtained by applying infrared (IR) energy to the low back in patients with chronic, intractable low back pain. METHODS Forty patients with chronic low back pain of over six years’ duration were recruited from patients attending the Rothbart Pain Management Clinic, North York, Ontario. They came from the patient lists of three physicians at the clinic, and were randomly assigned to IR therapy or placebo treatment. One patient dropped out of the placebo group; as a result, 21 patients received IR therapy and 18 recieved placebo therapy. The IR therapy was provided by two small, portable units in a sturdy waistband powered by small, rechargeable batteries made by MSCT Infrared Wraps Inc (Canada). These units met safety standards for Food and Drug Administration portability, and are registered with the Food and Drug Administration as a therapeutic device. The unit converted electricity to IR energy at 800 nm to 1200 nm wavelength. The treated group received IR therapy. The placebo group had identical units, but the power was not connected to the circuit-board within the IR pad. Patients attended seven weekly sessions. One baseline and six weekly sets of values were recorded. The principle measure of outcome was pain rated on the numerical rating scale (NRS). The pain was assessed overall, then rotating and bending in different directions. RESULTS The mean NRS scores in the treatment group fell from 6.9 of 10 to 3 of 10 at the end of the study. The mean NRS in the placebo group fell from 7.4 of 10 to 6 of 10. CONCLUSION The IR therapy unit used was demonstrated to be effective in reducing chronic low back pain, and no adverse effects were observed.
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 chronicpain. 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.
Yu, Dou; Thakor, Devang K.; Han, Inbo; Ropper, Alexander E.; Haragopal, Hariprakash; Sidman, Richard L.; Zafonte, Ross; Schachter, Steven C.; Teng, Yang D.
Questions from patients about medical marijuana use for chronicpain are becoming more common. The information in this report will help patients understand the potential risks and benefits of using this substance for painful conditions. PMID:22448949
BACKGROUND: There are many measures assessing related dimensions of the chronicpain experience (eg, pain severity, pain coping, depression, activity level), but the relationships among them have not been systematically established. OBJECTIVE: The present study set out to determine the core dimensions requiring assessment in individuals with chronicpain. METHODS: Individuals with chronicpain (n=126) completed the Beck Anxiety Inventory, Beck Depression Inventory, Beck Hopelessness Scale, ChronicPain Coping Index, Multidimensional Pain Inventory, Pain Catastrophizing Scale, McGill Pain Questionnaire – Short Form, Pain Disability Index and the Tampa Scale of Kinesiophobia. RESULTS: Before an exploratory factor analysis (EFA) of the nine chronicpain measures, EFAs were conducted on each of the individual measures, and the derived factors (subscales) from each measure were submitted together for a single EFA. A seven-factor model best fit the data, representing the core factors of pain and disability, pain description, affective distress, support, positive coping strategies, negative coping strategies and activity. CONCLUSIONS: Seven meaningful dimensions of the pain experience were reliably and systematically extracted. Implications and future directions for this work are discussed.
Davidson, Megan A; Tripp, Dean A; Fabrigar, Leandre R; Davidson, Paul R
Chronicpain is a major health concern that affects millions of people. There are no adequate long-term therapies for chronicpain sufferers, leading to significant cost for both society and the individual. The most commonly used therapy for chronicpain is the application of opioid analgesics and nonsteroidal anti-inflammatory drugs, but these drugs can lead to addiction and may cause side effects. Further studies of the mechanisms of chronicpain have opened the way for development of new treatment strategies, one of which is gene therapy. The key to gene therapy is selecting safe and highly efficient gene delivery systems that can deliver therapeutic genes to overexpress or suppress relevant targets in specific cell types. Here we review several promising viral vectors that could be applied in gene transfer for the treatment of chronicpain and further discuss the possible mechanisms of genes of interest that could be delivered with viral vectors for the treatment of chronicpain.
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
Among a subgroup of adolescents with chronicpain syndromes, anxiety about “growing up” appears common and may be exacerbated by developmental transitions. Using the bat mitzvah ceremony as one example of a developmental rite of passage, we present two cases in which adolescent girls facing this transition developed new chronic musculoskeletal pain syndromes or experienced recurrences of pain symptoms. In
Current developments in chronicpain research are changing the focus in the study of pain–emotion relations from the identification of general patterns to the study of dynamic and context-related interactions manifesting both within and between individuals. This shift towards understanding variation at both intra- and interpersonal levels has significant clinical implications for psychological adjustment to chronicpain conditions, and thus
Alexandra L. Dima; David T. Gillanders; Mick J. Power
Objective: Evidence for links between anger inhibition or suppression and chronicpain severity is based mostly on studies with correlation designs. Following from ironic process theory, we proposed that attempts to suppress angry thoughts during provocation would increase subsequent pain intensity among chronic low back pain (CLBP) patients, and do so through paradoxically enhanced accessibility of anger. Design: CLBP patients
John W. Burns; Phillip Quartana; Wesley Gilliam; Erika Gray; Justin Matsuura; Carla Nappi; Brandy Wolfe; Kenneth Lofland
\\u000a Chronicpain is clearly one of the most challenging problems of modern medicine. Chronicpain after trauma in general and\\u000a following combat trauma is not an uncommon component of the problem. Structural lesions affecting central and peripheral neural\\u000a structures, bone and joints, soft tissues and internal organs can all result in chronicpain. Psychological factors associated\\u000a with the trauma, especially
BACKGROUND: Chronicpain is common after thoracotomy. The primary goal of this study was to investigate the incidence of chronic post-thoracotomy pain. The secondary goal was to identify possible risk factors associated with the development of chronic post-operative pain. METHODS: We contacted 255 patients who had undergone a classic postero-lateral thoracotomy at our institution in the period between January 2001
W. A. Pluijms; M. A. H. Steegers; A. F. T. M. Verhagen; G. J. Scheffer; O. H. G. Wilder-Smith
The present study tests whether chronic low back pain (CLBP) patients show a tendency to overpredict or to underpredict pain. Twenty CLBP patients and 20 healthy controls underwent 6 trials of laboratory induced pressure pain. Ratings of predicted and experienced pain intensity were obtained. In contradiction with the hypothesis that CLBP patients show a generalized tendency to overpredict pain, CLBP
Examined the relationship between perception of pain, personality, coping, and the reaction of family members in three chronicpain 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)
|Examined the relationship between perception of pain, personality, coping, and the reaction of family members in three chronicpain 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)|
The present study examined Fields' proposal that depression increases the sensory experience of pain in part through greater somatic focus. Experimental and clinical pain measures were compared to self-report of depression and somatic focus in 60 chronicpain patients. Depression scores were unrelated to pain threshold or tolerance on the cold-pressor test. However, as hypothesized by Fields, path analytic models
Michael E. Geisser; Melodye E. Gaskin; Michael E. Robinson; Anthony F. Greene
\\u000a Neuropathic pain, or chronicpain due to nerve injury, is a prevalent condition for which currently there is no effective\\u000a treatment. These neuropathic pain syndromes include deafferentation pain, diabetic, cancer and ischemic neuropathies, phantom\\u000a limb pain, trigeminal neuralgia, postherpetic neuralgias and nerve injury caused by surgery or trauma . Neuropathic pain is not only chronic and intractable, it is debilitating
This issue of the NCMJ addresses the problem of chronicpain in North Carolina; its diagnosis and management in primary and specialty care; and the need to balance efficacy and safety when prescribing opioid medications, as these drugs are associated with significant potential for misuse and abuse. The commentaries in this issue not only address the use of opioids for the management of chronicpain but also explore various alternatives, including medical marijuana, epidural and other injections, surgery, acupuncture, and other integrative therapies. Articles in this issue also describe the management of chronicpain in palliative care, the ways in which mental health affects pain, and the unintended consequences of chronicpain management. Finally, this issue describes several initiatives across the state that are addressing the epidemic of prescription drug abuse; these initiatives are effecting systematic changes in clinical practice to more effectively manage chronicpain, protect patients, and minimize the negative impact of prescription drug abuse on communities. PMID:23940886
The 2008 report of the Chief Medical Officer of the United Kingdom includes a focus on chronicpain. A description of the report and the impact of pain on persons in the UK are described. Specific recommendations include training of health care staff, including pain in UK primary care's performance management system, pain assessment as a routine vital sign in hospital, developing models for delivery of pain services, and audit and data collection. PMID:20504143
The mechanism of brain reorganization in pain chronification is unknown. In a longitudinal brain imaging study, sub–acute back pain (SBP) patients were followed over one year. When pain persisted (SBPp, in contrast to recovering SBP, and healthy controls), brain gray matter density decreased. Importantly, initially greater functional connectivity of nucleus accumbens with prefrontal cortex predicted pain persistence, implying that corticostriatal circuitry is causally involved in the transition from acute to chronicpain.
Baliki, Marwan N.; Petre, Bogdan; Torbey, Souraya; Herrmann, Kristina M.; Huang, Lejian; Schnitzer, Thomas J.; Fields, Howard L.; Apkarian, A. Vania
The mechanism of brain reorganization in pain chronification is unknown. In a longitudinal brain imaging study, subacute back pain (SBP) patients were followed over the course of 1 year. When pain persisted (SBPp, in contrast to recovering SBP and healthy controls), brain gray matter density decreased. Initially greater functional connectivity of nucleus accumbens with prefrontal cortex predicted pain persistence, implying that corticostriatal circuitry is causally involved in the transition from acute to chronicpain. PMID:22751038
Baliki, Marwan N; Petre, Bogdan; Torbey, Souraya; Herrmann, Kristina M; Huang, Lejian; Schnitzer, Thomas J; Fields, Howard L; Apkarian, A Vania
Objectives?The aim of this study was to examine relations among parental responses, adolescent pain coping, and pain behaviors in adolescents with chronicpain.?Methods?This study included 217 adolescents (12–17 years) evaluated at a multidisciplinary pain clinic and their parents. Adolescents completed measures assessing their pain, pain coping responses, functional disability, and somatic symptoms. Parents reported on their responses to their adolescent's pain.?Results?Passive and active coping interacted with parental protective behavior to predict adolescents’ pain behaviors. Contrary to expectations, among adolescents who reported infrequent use of passive or active coping strategies, higher levels of parental protective behavior were associated with higher levels of disability and somatic symptoms.?Discussion?Among adolescents who report infrequent use of passive and active coping responses, parental protective responses to pain may inadvertently promote greater disability and symptom complaints. Parental responses to pain may be an important target to treat adolescent chronicpain.
Introduction. Estimates on the epidemiology of chronicpain vary widely throughout Europe. It is unclear whether this variation reflects true differences between populations or methodological factors. Information on the epidemiology of chronicpain can support decision makers in allocating adequate health care resources. Methods. In order to obtain epidemiological data on chronicpain in Denmark and Sweden, we conducted a literature review of epidemiological data primarily on chronic noncancer pain, prioritising studies of highest quality, recency, and validity by conducting a systematic search for relevant studies. Following quality assessment, data were summarised and assigned to the research questions. Results. The prevalence of moderate to severe noncancer pain was estimated at 16% in Denmark and 18% in Sweden. Chronicpain impacts negatively on perceived health status, quality of life and is associated with increased cost. Despite using pain medications, a large proportion of chronicpain sufferers have inadequate pain control. There was a lack of high-quality and low-bias studies with clear inclusion criteria. Conclusions. In both Denmark and Sweden, chronicpain is a common health problem which is potentially undertreated and warrants attention of health care workers, policy makers and researchers. Future research should utilise clear reporting guidelines to assist decision and policy makers, in this important area.
Harker, Julie; Reid, Kim J.; Bekkering, Geertruida E.; Kellen, Eliane; Bala, Malgorzata M.; Riemsma, Rob; Worthy, Gill; Misso, Kate; Kleijnen, Jos
Musculoskeletal disorders are the most common causes of severe long-term pain and physical disability, affecting hundreds of millions of people around the world. In industrialized countries, which have increasingly aging populations, chronic musculoskeletal pain has become a significant health care burden and major issue in the 1980s and 1990s. On January 13, 2000, The Bone and Joint Decade was formally launched at the headquarters of the World Health Organization in Geneva, Switzerland. This global campaign aimed to improve the quality of life for people who have musculoskeletal conditions. Complying with this trend, large-scale surveys have been conducted in Europe and the US in recent years to evaluate the effect of chronicpain on society, but in Japan, there has been a paucity of basic information on the status of chronic musculoskeletal pain. We organized a postal survey designed to quantify and describe the prevalence and distribution of chronicpain in the Japanese community. We found that chronicpain of moderate to severe intensity occurs in 17.2%. Chronicpain had a significant impact on the occupational and social relationships, and it seriously affected their psychological conditions and quality of life. Such disabling chronicpain is regarded as the result of interrelated physical, psychological, and social or occupational factors requiring multidisciplinary intervention. We introduce a multidisciplinary clinical approach and report on novel multimodal methodologies -- for patients with chronic musculoskeletal pain. PMID:23131740
\\u000a The pain profile following amputation is complex and can be considered as an amalgam of acute post-operative pain, nociceptive\\u000a pain of the stump, neuropathic pain of the stump, phantom limb pain, mechanical back pain, and pain in more remote sites (such\\u000a as proximal ipsilateral joints, the contralateral limb) caused indirectly by amputation of the limb. The composition of the\\u000a pain
The primary objective of this study is to review the efficacy of duloxetine in treating chronicpain using the Initiative on Methods, Measurement, and Pain Assessment in Clinical Trials (IMMPACT) recommendations for clinical significance across chronicpain states. These include pain intensity, patient ratings of overall improvement, physical functioning, and mental functioning. This review comprised the side-by-side analyses of 12 double-blind, placebo-controlled trials of duloxetine in patients with chronicpain (diabetic peripheral neuropathic pain, fibromyalgia, chronicpain due to osteoarthritis, and chronic low back pain). Patients received duloxetine (60 to 120 mg/day) or placebo. Average pain reduction was assessed over 3 months as the primary efficacy outcome. Other measures used were physical function and Patient Global Impression of Improvement. In 10 of the 12 studies, statistically significant greater pain reduction was observed for duloxetine- compared with placebo-treated patients. The response rates based on average pain reduction, improvement of physical function, and global impression were comparable across all 4 chronicpain states. Compared with patients on placebo, significantly more patients treated with duloxetine reported a moderately important pain reduction (?30% reduction) in 9 of the 12 studies, a minimally important improvement in physical function in 8 of the 12 studies, and a moderately important to substantial improvement in Patient Global Impression of Improvement rating in 11 of the 12 studies. The analyses reported here show that duloxetine is efficacious in treating chronicpain as demonstrated by significant improvement in pain intensity, physical functioning, and patient ratings of overall improvement.
Wittink H, Hoskins Michel T, Sukiennik A, Gascon C, Rogers W. The association of pain with aerobic fitness in patients with chronic low back pain. Arch Phys Med Rehabil 2002;83:1467-71. Objective: To investigate the association of aerobic fitness ([Vdot ]O2max) with pain intensity as reported by a sample of patients with chronic low back pain (LBP). Design: Cross-sectional with partial
Harriët Wittink; Theresa Hoskins Michel; Andrew Sukiennik; Celeste Gascon; William Rogers
Chronic postoperative pain is known to be a significant clinical and economic problem. The estimated mean incidence is high and varies between 10 and 50%, with variations mostly related to procedure-specific conditions. High-risk types of surgeries are e.g. thoracotomy, breast or inguinal hernia surgery and amputations. Although there is increasing knowledge about the incidence of chronic postoperative pain after certain types of surgical procedures, there are only limited data related to the mechanisms and pathophysiology leading to chronicpain after surgery. Neuropathic pain components have been discussed, especially following operations with a high incidence of nerve damage (for example axillary lymphadenectomy). Besides surgical factors it seems that there are a number of other factors which likely increase the risk of chronic postoperative pain. These predictors for the development of chronic postoperative pain are multiple and include individual genetic factors, age and sex of the individual patient, preoperative chronicpain, psychosocial factors, neurophysiological factors, intraoperative nerve and muscle damage, postoperative complications and acute pain in the early postoperative period. Quantitative sensory testing including tests of inhibitory circuits like DNIC might help to predict the risk of individual patients even before surgery has started. The perioperative identification of patients who are at high risk for developing chronicpain after surgery is therefore a major goal for the future. This may help to develop preventive treatment strategies and avoid treatments with side effects for patients who are not at risk for developing chronicpain after surgery. Due to a lack of appropriate data for sufficient preventive approaches an effective postoperative acute pain management and a nerve-conserving surgical technique are the major keys in the prophylaxis of chronic postoperative pain. PMID:20798959
Surgery and trauma are recognized as important causes of chronicpain. In this manuscript, we analyzed the patients who visited our clinic with posttraumatic or delayed surgical pain complaints between January 2001 and January 2004. Identification and evaluation of pain were done as defined in the taxonomy of IASP. Duration and severity of pain as well as diagnosis and etiology were evaluated as suggested in the taxonomy. Our results showed that 107 out of 2866 patients (4 %) were diagnosed of having chronicpain related to the history of trauma or surgery. The age range of the patients was from 32 to 66 years with an average of 48 years. Male/female ratio was 35/72. The duration of pain varied. 15 % of the patients complained of pain lasting for 1 to 6 months, 67 % complained of pain lasting for 6 to 24 months, and 18 % complained of pain lasting more than 24 months. A significant amount of patients (72 %) complained of very severe pain, 21 % complained of moderate pain, and finally only 7 % complained of mild pain. The diagnosis of pain were as follows: radiculopathy and postlaminectomy pain in 48 %, neuropathic pain in 33 %, phantom pain in 12 %, carpal syndrome in 6 %, and thalamic syndrome in 1 %. Pathogenesis of pain was evaluated to be originating from peripheral nervous system in 56 %, muscle and skeletal system in 43 %, and central nervous system in 1 % of the cases. Additionally, fifty-nine percent of the cases complained of back pain. Long-term (?1 year) and continuous follow up of postoperative and posttraumatic pain during acute course may prevent a significant amount of chronicpain complaints. PMID:15382005
Context Sickle cell disease (SCD) is an inherited hematological disease marked by intense pain. Early in life the pain is episodic, but it becomes increasingly chronic in many cases. Little is known about this emergence of a chronicpain state. Objectives The goal of this study was to determine whether adult SCD patients whose pain is still largely episodic show early signs of the disturbed pain processing (hyperalgesia, increased temporal summation) and cognition (hypervigilance and catastrophizing) that are characteristic of a chronicpain state. Methods SCD patients (n=22) and healthy controls (n=52) received noxious pressure stimulation for up to three minutes, and periodically reported pain intensity and unpleasantness on 0–10 scales, allowing the rate of pain increase (temporal summation) to be determined. Pain intensity discrimination also was measured, and attitudes toward pain were assessed. Results There were no overall differences in pain ratings or temporal summation between patient and control groups. However, patients’ experimental pain ratings tended to increase with age, and those reporting a history of very painful episodes showed particularly rapid temporal summation of pain unpleasantness. Patients were significantly impaired at discriminating intensities of noxious stimulation. Patients were more hypervigilant than controls, but catastrophizing was elevated only during pain episodes. Conclusion Most SCD patients whose pain remits entirely between episodes are not in a chronicpain state, but some—those who are older and have a history of highly painful episodes—appear to be transitioning into it. These early signs of disturbed processing may aid clinicians seeking to forestall disease progression.
Cognitive-behavioral interventions have gained wide acceptance as effective treatments for reducing distress and disability among persons with chronicpain. Although cognitive and behavioral theories, and their subsequent applications, were initially developed in independent academic camps, they have been woven together effectively in the field of chronicpain. Research supports clinicians' perceptions of the efficacy of these interventions applied within comprehensive
Objective: To determine the prevalence of interstitial cystitis (IC) and to evaluate the Interstitial Cystitis Symptom and Problem Index as a screening tool for IC in women with chronic pelvic pain.Methods: Forty-five women scheduled to undergo laparoscopy for chronic pelvic pain were recruited. The women were questioned about lower urinary tract symptoms; the Interstitial Cystitis Symptom and Problem Index was
BACKGROUND: Conditions with chronic, non-life-threatening pain and fatigue remain a challenge to treat, and are associated with high health care use. Understanding psychological and psychosocial contributing and coping factors, and working with patients to modify them, is one goal of management. An individual’s spirituality and/or religion may be one such factor that can influence the experience of chronicpain or fatigue. METHODS: The Canadian Community Health Survey (2002) obtained data from 37,000 individuals 15 years of age or older. From these data, four conditions with chronicpain and fatigue were analyzed together – fibromyalgia, back pain, migraine headaches and chronic fatigue syndrome. Additional data from the survey were used to determine how religion and spirituality affect psychological well-being, as well as the use of various coping methods. RESULTS: Religious persons were less likely to have chronicpain and fatigue, while those who were spiritual but not affiliated with regular worship attendance were more likely to have those conditions. Individuals with chronicpain and fatigue were more likely to use prayer and seek spiritual support as a coping method than the general population. Furthermore, chronicpain and fatigue sufferers who were both religious and spiritual were more likely to have better psychological well-being and use positive coping strategies. INTERPRETATION: Consideration of an individual’s spirituality and/or religion, and how it may be used in coping may be an additional component to the overall management of chronicpain and fatigue.
The dearth of theoretically driven research on the predictors of pediatric chronicpain may unwittingly contribute to needless suffering in children and adolescents by underinvestigating a potentially treatable condition. The objective of the present study was to investigate the hypothesized predictive effects of perceived stress on pediatric chronicpain intensity in 148 children and adolescents. Consistent with thea priori Biobehavioral
James W. Varni; Michael A. Rapoff; Stacy A. Waldron; Rod A. Gragg; Bram H. Bernstein; Carol B. Lindsley
Objective: We performed a pilot study to determine if patients with chronic pelvic pain have a consistent or unique sleep disorder by a polysomnographic sleep study.Methods: Overnight polysomnography was performed prospectively in 11 women with chronic pelvic pain (ages 33–44 years, mean 35). None of the women were taking sedating or psychoactive medications in the month prior to testing. Sleep
Kathleen T. Dunlap; Li Yu; Bruce J. Fisch; Thomas E. Nolan
Several theories about musculoskeletal pain syndromes such as whiplash-associated disorder (WAD) suggest that pain and muscle activity interact and may contribute to the chronicity of symptoms. Studies using surface electromyography (sEMG) have demonstrated abnormal muscle activation patterns of the upper trapezius muscles in the chronic stage of WAD (grade II). There are, however, no studies that confirm that these muscle
Marc J. Nederhand; Hermie J. Hermens; Maarten J. IJzerman; Dennis C. Turk; Gerrit Zilvold
Chronicpain is now recognized as a disease state that involves changes in brain function. This concept is reinforced by data that document structural and morphological remapping of brain circuitry under conditions of chronicpain. Evidence for aberrant neurophysiology in the brain further confirms neuroplasticity at cellular and molecular levels. Proper detection of pain-induced changes using emerging non-invasive and cost-effective technologies, such as analytical electroencephalography methods, could yield objective diagnostic measures and may guide therapeutic interventions targeting the brain for effective management of chronicpain. PMID:22684310
Service provision and access to pain services vary considerably in the UK, with only a small percentage of people with chronicpain accessing specialist services. Government policy supports giving patients more choice and control over their care. Empowerment involves ensuring patients have the knowledge, skills, attitudes and self-awareness to improve the quality of their lives. As most healthcare professionals provide care to people with chronicpain at some point, it is their responsibility to prepare patients to make informed decisions about their treatment. Empowering patients to self-manage their chronicpain can lead to improved person-centred outcomes. PMID:21560709
This study was designed to (1) provide information on the prevalence of pediatric pain as well as other pain related characteristics in a sample of schoolchildren, and (2) study the suitability of a system to grade the severity of chronicpain problems among children. Participants in this cross-sectional study included 561 schoolchildren between the ages of 8 and 16 years.
Two patients with severe thalamic pain and one patient with causalgia from the shoulder-hand syndrome are described whose pain was markedly improved or abolished by anticholinesterase drugs. Both short-acting parenteral and oral anticholinesterase preparations were employed. Anticholinesterase drugs are a new and potentially valuable approach to the treatment of chronicpain. PMID:6504553
Summary Lancinating pain, as described in tabes dorsalis, was noted in four patients with chronic sciatica after several months of laminectomy. The pain responded well to carbamezapine therapy. Abnormal or ephaptic neural transmission of impulses in the roots was considered to be the cause of such pain.
Background and aimsChronicpain patients often present with a host of psychological and somatic problems and are unable to work despite receiving traditional pain management. For example, it is common that patients with persistent pain also suffer from a variety of anxiety and depressive symptoms. Indeed, the regulation of emotions may be one important factor that is associated with the
The diagnosis of chronic pancreatitis in the UK largely rests on the combination of the clinical presentation which usually features pain which is often provoked by food and\\/or alcohol. There is usually a 30 to 40-min delay between the stimulus and the pain and, after exclusion of other causes of pain, an ERCP is performed. A minority of patients will
Glia have emerged as key contributors to pathological and chronicpain 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 chronicpain 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.
BACKGROUND: The aim of this study was to examine the relationship between chronic neuropathic pain after incomplete peripheral nerve lesion, chronic nociceptive pain due to osteoarthritis, and the excitability of the motor cortex assessed by transcranial magnetic stimulation (TMS). Hence in 26 patients with neuropathic pain resulting from an isolated incomplete lesion of the median or ulnar nerve (neuralgia), 20
Peter Schwenkreis; Andrea Scherens; Anne-Kathrin Rönnau; Oliver Höffken; Martin Tegenthoff; Christoph Maier
Adult patients with chronic ulnar wrist pain often seek medical advice. There are a number of diagnoses for chronic ulnar-sided wrist pain. A sound diagnostic strategy is therefore of paramount importance. Patient's history, clinical examination and high quality standard radiographs are the most important part of this strategy. Sophisticated investigations should only be performed to focus on solid clinical hypotheses. The palmar and dorsal aetiologies of ulnar wrist pain are considered as well as their treatment principles. PMID:22030264
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
Chronicpain is commonly treated by prescribing an opioid medication. For those suffering from both chronicpain and substance dependence, barriers to adequate pain management increase. This often causes both disorders to exacerbate one another. Effective treatment may also be hampered by opioid-induced hyperalgesia, tolerance, physical dependence, "chemical coping," and diminished physical and emotional functioning. This article reviews current research trends, potential problems stemming from prescription opioid use, and suggestions for clinical practice. PMID:22880539
The effect of interdisciplinary multimodal therapy of chronic back pain is well documented. With elapsing time changing diagnostic focuses, therapeutic strategies and objectives have to be considered. The chronicity leads to a modification of the relevance of structure-related diagnosis and therapy and changes the significance of the classic orthopedic instruments. The requirement of a rational causal therapy in chronic back pain still remains but the focal points shift to the consideration of somatic, psychological and social disposing and supporting factors.The aim of this paper is to reflect the necessary orthopedic expertise in the context of the pathomechanics of chronic back pain and the interdisciplinary teamwork. PMID:21523420
This article presents an overview of the neuroanatomical, neurochemical, and neurophysiological substrates of nociception relevant to the neurosurgical treatment of chronicpain. Consideration is given to the various procedures currently employed in the treatment of patients suffering from medically intractablechronicpain of both benign and malignant diseases, including their indications, techniques, and results. Particular attention is given to the modern neuroaugmentative methods, such as electrical stimulation and CNS drug infusion, that are progressively overshadowing the previously developed ablative procedures. PMID:1726524
Mechanisms underlying chronicpain differ from those underlying acute pain. In chronicpain states, central nervous system (CNS) factors appear to play particularly prominent roles. In the absence of anatomical causes of persistent pain, medical sub-specialties have historically applied wide-ranging labels (e.g. fibromyalgia -FM, irritable bowel syndrome, interstitial cystitis, somatization) for what now is emerging as a single common set of CNS processes. The hallmark of these “centrally-driven” pain conditions is a diffuse hyperalgesic state identifiable using experimental sensory testing, and corroborated by functional neuroimaging. The characteristic symptoms of these central pain conditions include multifocal pain, fatigue, insomnia, memory difficulties, and a higher rate of co-morbid mood disorders. In contrast to acute and “peripheral” pain states that are responsive to NSAIDs and opioids, central pain conditions respond best to CNS neuromodulating agents such as serotonin-norepinephrine re-uptake inhibitors (SNRIs) and anticonvulsants.
1.The management of chronicpain 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
Background\\/Aims: Pain in patients with chronic idiopathic axonal polyneuropathy (CIAP) has never been studied in detail. The aim of the study was to investigate the pain experienced by patients with CIAP, and to determine whether pain is associated with health-related quality of life (HRQoL). Methods: The McGill Pain Questionnaire (MPQ) and the RAND-36 were used in a cross-sectional study. Results:
Peter G. Erdmann; Frank R. van Genderen; Laurien L. Teunissen; Nicolette C. Notermans; Eline Lindeman; Albert J. M. van Wijck; Nico L. U. van Meeteren
Objective : Schoolchildren developing chronic musculoskeletal pain from carrying heavy backpacks (hereafter referred to as “pain”)\\u000a is a worldwide issue. The present study of two cohorts, consisting of 248 Indian and 103 American schoolchildren aged 9.0\\u000a to 20.6 years, using a semi-objective pain criteria, sought to answer the questions: Can pain be correlated with Body Mass\\u000a Index (BMI), Weight Carried,
Few validated instruments are available to assess beliefs and attitudes that patients have regarding pain, or ability to function despite discomfort. The Pain and Impairment Relationship Scale (PAIRS) was developed to tap these important beliefs and attitudes in chronicpain patients. Preliminary data indicate that the PAIRS is internally consistent and significantly related to impairment in a highly selected pain clinic sample of patients, including some chronic low back pain patients. The present study was designed to extend the validation of the PAIRS to a more general sample of chronic benign low back pain patients. Furthermore, additional tests supported the discriminant, convergent and divergent validity, as well as the reliability and relative independence from favorable self-report response bias of the PAIRS, by respectively demonstrating that: (1) the impairment beliefs assessed with the PAIRS were more prominent in chronic low back pain (CLBP) patients than in matched non-pain, healthy controls; (2) scores on the PAIRS were significantly related to measures of physical impairment, but not to physicians ratings of disease severity; (3) the impairment beliefs assessed with the PAIRS are readily distinguishable from cognitive distortions and emotional distress; (4) PAIRS scores for chronic low back pain patients are relatively consistent over time; and (5) PAIRS scores are not significantly associated with measures of favorable self-report response bias. We conclude that the PAIRS has demonstrated at least preliminary utility for applications by researchers and clinicians interested in chronicpain. PMID:1828111
Slater, M A; Hall, H F; Atkinson, J H; Garfin, S R
Objectives.? Over the past few years, there has been an increased reliance on the intrathecal delivery of drugs for patients suffering from intractablepain. We sought to demonstrate the effectiveness of the intrathecal pain pump by examining self-reported pre- and postimplantation pain levels. Methods.? Eighty-four patients who had elected to implant a Medtronic SynchroMed 1 or 2 system in order to control their pain were asked to complete a survey. The survey consisted of pain ratings before implantation, pain ratings postimplantation, medications used before and after implantation, and patient satisfaction with the procedure. Results.? Perceived success rate for implantation is 68%, when measured by the ability to reduce reliance on oral medication. When measured by willingness to undergo the procedure again, the success rate is 86%. Conclusions.? Overall, the implantation of an intrathecal pain pump is an effective way for most people to manage their intractablepain and reduce reliance on oral medications. PMID:22151041
Objective: The Pain Response Preference Questionnaire (PRPQ) assesses preferences regarding pain-related social support. The initial factor analytic study of the PRPQ conducted with a nonclinical sample identified scales labeled Solicitude, Management, Suppression, and Encouragement. The first aim of the current study was to evaluate whether these scales would be appropriate for use with chronicpain patients. The construct validity of
Lachlan A. McWilliams; Bruce D. Dick; Kristen Bailey; Michelle J. Verrier; John Kowal
Schematic representation of pain information was investigated in chronicpain patients, health professionals, and nonpatient controls. Under the guise of an English-language experiment, Ss were presented with 12 word stems to be completed with the first 2 English words that came to mind. Four of the stems could be completed with sensory pain words, 4 with affective, and 4 with
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
Background and objective: The aim of this study was to compare the effects of different paradoxical sleep deprivation methods on the pain threshold in rats submitted to inflammatory and neuropathic pain models. We also investigated whether changes in pain threshold could be reverted by sleep recovery period. Methods: Wistar rats were randomly assigned in arthritis-induced by adjuvant (AIA), chronic constrictive
Monica Levy Andersen; Regiane Kawakami; Sergio Tufik
Research investigating the presence of attentional bias in chronicpain has produced mixed results. The purpose of this review is to summarise former research using the visual-probe task to explore attentional bias in pain populations, and meta-analyse the results of controlled investigations comparing individuals with chronicpain to healthy controls. Ten eligible studies were included in this analysis (chronicpain
Daniel E. Schoth; Vanessa Delgado Nunes; Christina Liossi
A 45-year-old construction worker with a 7-year history of intermittent low back pain is seen by his family physician. The pain has gradually increased over the past 4 months, despite pain medications, physical therapy, and two epidural corticosteroid injections. The pain is described as a dull ache in the lumbosacral area with episodic aching in the posterior aspect of both
Brian M. Berman; Helene M. Langevin; Claudia M. Witt; Ronald Dubner
The paper develops a new theory of chronicpain and pain relief by extracorporeal shock wave treatment. Chronicpain without\\u000a underlying anatomical disorder is looked at as a pathological control function of memory. Conditioned reflexes are considered\\u000a to be engraved memory traces linking sensory input of afferent signals with motor response of efferent signals. This feature\\u000a can be described by
We report the rare occurrence of herpes zoster reactivation after facial trauma. Herpes zoster appeared in painful groups of distended vesicles containing clear fluid on an erythematous base within the secondary division of the trigeminal nerve. The patient was treated with acyclovir (intravenous, 250 mg, every 8 hours) combined with topical steroids and anti-neuropathic pain medication. The zoster-associated neuralgia subsided gradually 1.5 months after diagnosis. We illustrate this unique case to highlight the fact that reactivation of the varicella zoster virus from childhood chicken pox can reappear at a traumatic site in late adulthood. PMID:21686763
Chronic prostatitis\\/chronic pelvic pain syndrome (CP\\/CPPS) is a chronicpain syndrome identified by the presence of noninfectious\\u000a pelvic or perineal pain lasting longer than 3 months. Current diagnoses and treatments for the syndrome solely depend on and\\u000a target symptoms, respectively. Thus far, the mechanistic disturbances responsible for the pathogenesis of CP\\/CPPS have remained\\u000a largely elusive and treatments, and therefore, continue to
Brandon A. Mahal; Jeffrey M. Cohen; Stephen A. Allsop; John B. Moore; Salman F. Bhai; Gino Inverso; Jordan D. Dimitrakoff
Patients with chronicpain may have difficulties estimating their own physical activity level in daily life. Pain-related factors such as depression and pain intensity may affect a patients’ ability to estimate their own daily life activity level. This study evaluates whether patients with Chronic Low Back Pain (CLBP) who are more depressed and\\/or report more pain indeed have a lower
Ivan P. J. Huijnen; Jeanine A. Verbunt; Madelon L. Peters; Philippe Delespaul; Hanne P. J. Kindermans; Jeffrey Roelofs; Marielle Goossens; Henk A. M. Seelen
Background: A growing number of pa- tients suffer from severe low back pain of discogenic origin that is not responsive to conservative medical management. These patients must consider the option of surgi- cal spinal fusion or minimally-invasive in- tradiscal electrothermal therapy (IDET). Objective: To conduct a systemat- ic review of clinical outcomes in patients undergoing spinal fusion or the intradiscal
Gunnar B. J. Andersson; Nagy A. Mekhail; Jon E. Block
Degenerative disk disease is a strong etiologic risk factor of chronic low back pain (LBP). A multidisciplinary approach to treatment is often warranted. Patient education, medication, and cognitive behavioral therapies are essential in the treatment of chronic LBP sufferers. Surgical intervention with a rehabilitation regime is sometimes advocated. Prognostic factors related to the outcome of different treatments include maladaptive pain coping and genetics. The identification of pain genes may assist in determining individuals susceptible to pain and in patient selection for appropriate therapy. Biologic therapies show promise, but clinical trials are needed before advocating their use in humans. PMID:21944588
Karppinen, Jaro; Shen, Francis H; Luk, Keith D K; Andersson, Gunnar B J; Cheung, Kenneth M C; Samartzis, Dino
The urologic chronicpain conditions such as chronic prostatitis\\/chronic pelvic pain syndrome and interstitial cystitis are syndromes whose evaluation and management are controversial. Part of the difficulty in diagnosis and therapy is the heterogeneity of etiologies and symptoms. We propose a six-domain phenotype, which can classify these patients clinically and can direct the selection of therapy in the most evidence
D A Shoskes; J C Nickel; R R Rackley; M A Pontari; DA Shoskes
Misuse of opioids is associated with abnormalities of pituitary function. Patients with chronicpain frequently complain of fatigue and undergo endocrine testing. To test whether oral opioid treatment causes abnormal pituitary function we prospectively assessed pituitary function in 37 patients with chronicpain who were receiving either oral opioid analgesia or non-opioid analgesia. Oral opioid treatment was not associated with abnormal pituitary function although a few patients had abnormal results mainly related to obesity. Our results suggest that patients with chronicpain who have abnormal endocrine results should have a complete assessment, since abnormal test results cannot be attributed to their analgesia. PMID:12842375
Merza, Z; Edwards, N; Walters, S J; Newell-Price, J; Ross, R J M
Based on prior research demonstrating benefits of emotional disclosure for chronically ill individuals and evidence that anger is particularly problematic in chronicpain sufferers, outpatients from a chronicpain center (N=102) were randomly assigned to express their anger constructively or to write about their goals non-emotionally in a letter-writing format on two occasions. Letters were coded for degree of expressed anger and meaning-making (speculation and insight into conditions that precipitated anger). Over a 9 week period, participants in the anger-expression group (n=51) experienced greater improvement in control over pain and depressed mood, and marginally greater improvement in pain severity than the control group (n=51). Degree of expressed anger uniquely accounted for intervention effects and meaning-making mediated effects on depressed mood. These findings suggest that expressing anger may be helpful for chronicpain sufferers, particularly if it leads to meaning-making. PMID:18320302
Graham, Jennifer E; Lobel, Marci; Glass, Peter; Lokshina, Irina
Objective. Chronic musculoskeletal pain is a very common and costly health problem. Patients presenting to rheumatology clinics with chronicpain can be difficult to manage. We studied 354 patients referred to a rheumatology chronicpain clinic over 5 yrs to identify factors affecting their self-efficacy and intensity of pain. Methods. We collected data for each patient, covering demographic and psychosocial
A. Rahman; E. Reed; M. Underwood; M. E. Shipley; R. Z. Omar
Millions of Americans suffer from painful injuries and conditions, and many have some form of persistent pain. The successful\\u000a use of psychopharmacologic drugs to treat pain depends on careful clinical reasoning founded on knowledge of the phenomenology\\u000a and physiology of pain syndromes, the specific clinical actions of each drug, and the interactions of these drugs with other\\u000a medications and medical
\\u000a The International Association for the Study of Pain defines pain as “an unpleasant sensory and emotional experience,” which\\u000a recognizes both the physiological and psychological aspects of pain. According to the Biobehavioral Model of Pediatric Pain\\u000a (Varni 1989), biological factors (e.g., temperament, age, gender, cognitive development), family factors, cognitive perceptions,\\u000a coping styles, and perception of social support work together to influence
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
We are reporting two cases of chronic neuropathic pain after traumatism during regional anaesthesia (RA). Nerve injury is a rare complication of RA and it is the neurogical deficit, which is the most often quoted in medical literature. However, in both cases the neuropathic pain was the single departure point. The reunion of the clinical element, which incorporates possible traumatism during regional anaesthesia, characteristics of pain and unusual painful localization of surgery, should have allowed a more early diagnostic and treatment. In both cases, persistent neuropathic pain incapacitates the patient several years after the traumatism. PMID:21705179
The absence of consistent end organ abnormalities in many chronicpain 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
Research has largely ignored the systematic examination of physicians’ attitudes towards providing care for patients with chronic non-cancer pain. The objective of this study was to identify barriers and facilitators to opioid treatment of chronic non-cancer pain patients by office-based medical providers. We used a qualitative study design using individual and group interviews. Participants were twenty-three office-based physicians in New England. Interviews were audiotaped, transcribed, and systematically coded by a multidisciplinary team using the constant comparative method. Physician barriers included lack of expertise in the treatment of chronicpain and co-existing disorders, including addiction; lack of interest in pain management; patients’ aberrant behaviors; and physicians’ attitudes toward prescribing opioid analgesics. Physician facilitators included promoting continuity of patient care and the use of opioid agreements. Physicians’ perceptions of patient-related barriers included lack of physician responsiveness to patients’ pain reports, negative attitudes toward opioid analgesics, concerns about cost, and patients’ low motivation for pain treatment. Perceived logistical barriers included lack of appropriate pain management and addiction referral options, limited information regarding diagnostic workup, limited insurance coverage for pain management services, limited ancillary support for physicians, and insufficient time. Addressing these barriers to pain treatment will be crucial to improving pain management service delivery.
Barry, Declan T.; Irwin, Kevin S.; Jones, Emlyn S.; Becker, William C.; Tetrault, Jeanette M.; Sullivan, Lynn E.; Hansen, Helena; O'Connor, Patrick G.; Schottenfeld, Richard S.; Fiellin, David A.
Background. Chronic injury-related pain could be influenced by psychological symptoms such as depression, anxiety, and stress that also affect daily life. Methods. Patients with chronicpain caused by an injury (n = 86) aged 18–65 years referred to the Pain Rehabilitation Clinic at the Umeå University Hospital answered a set of questionnaires to assess pain intensity, depression, anxiety, posttraumatic stress, sleep disturbance, and fatigue. Results. A significantly higher proportion of women (47.5%) reported depression (Hospital Anxiety and Depression Scale (HAD)) than men (22.2%). In all patients anxiety (HAD) was reported by 39.5% and moderate/severe posttraumatic stress (Impact of Event Scale) by 30.2%. A majority reported sleep disturbance (84.9%) and fatigue (90.7%). Significant relationships were found between posttraumatic stress and depression and anxiety. Conclusion. These findings indicate the importance of assessing and treating psychological symptoms associated with chronicpain as the result of trauma.
Objective. The present study was conducted to determine if depressive symptoms were associated with variability in pain perception and quality of life among patients with nonalcohol-related chronic pancreatitis. Methods. The research design was cross-sectional, and self-report data was collected from 692 patients with nonalcohol-related, intractable pancreatitis. The mean age of the sample was 52.6 (SD = 14.7); 41% of the sample were male. Participants completed the MOS SF12 Quality of Life Measure, the Center for Epidemiological Studies 10-item Depression Scale (CESD), and a numeric rating scale measure of “pain on average” from the Brief Pain Inventory. Results. Depressive symptoms were significantly related to participants' reports of increased pain and decreased quality of life. The mean CESD score of the sample was 10.6 (SD = 6.5) and 52% of the sample scored above the clinical cutoff for the presence of significant depressive symptomology. Patients scoring above the clinical cutoff on the depression screening measure rated their pain as significantly higher than those below the cutoff (P < 0.0001) and had significantly lower physical quality of life (P < 0.0001) and lower mental quality of life (P < 0.0001). Conclusion. Although causality cannot be determined based on cross-sectional, correlational data, findings suggest that among patients with nonalcoholic pancreatitis, the presence of depressive symptoms is common and may be a risk factor associated with increased pain and decreased quality of life. Thus, routine screening for depressive symptomology among patients with nonalcoholic pancreatitis may be warranted.
Balliet, Wendy E.; Edwards-Hampton, Shenelle; Borckardt, Jeffery J.; Morgan, Katherine; Adams, David; Owczarski, Stefanie; Madan, Alok; Galloway, Sarah K.; Serber, Eva R.; Malcolm, Robert
Background Although acupuncture is widely used for chronicpain, there remains considerable controversy as to its value. We aimed to determine the effect size of acupuncture for four chronicpain conditions: back and neck pain, osteoarthritis, chronic headache, and shoulder pain. Methods We conducted a systematic review to identify randomized trials of acupuncture for chronicpain where allocation concealment was determined unambiguously to be adequate. Individual patient data meta-analyses were conducted using data from 29 of 31 eligible trials, with a total of 17,922 patients analyzed. Results In the primary analysis including all eligible trials, acupuncture was superior to both sham and no acupuncture control for each pain condition (all p<0.001). After exclusion of an outlying set of trials that strongly favored acupuncture, the effect sizes were similar across pain conditions. Patients receiving acupuncture had less pain, with scores 0.23 (95% C.I. 0.13, 0.33), 0.16 (95% C.I. 0.07, 0.25) and 0.15 (95% C.I. 0.07, 0.24) standard deviations lower than sham controls for back and neck pain, osteoarthritis, and chronic headache respectively; the effect sizes in comparison to no acupuncture controls were 0.55 (95% C.I. 0.51, 0.58), 0.57 (95% C.I. 0.50, 0.64) and 0.42 (95% C.I. 0.37, 0.46). These results were robust to a variety of sensitivity analyses, including those related to publication bias. Conclusions Acupuncture is effective for the treatment of chronicpain and is therefore a reasonable referral option. Significant differences between true and sham acupuncture indicate that acupuncture is more than a placebo. However, these differences are relatively modest, suggesting that factors in addition to the specific effects of needling are important contributors to the therapeutic effects of acupuncture.
Vickers, Andrew J.; Cronin, Angel M.; Maschino, Alexandra C.; Lewith, George; MacPherson, Hugh; Victor, Norbert; Foster, Nadine E.; Sherman, Karen J.; Witt, Claudia M.; Linde, Klaus
Individuals with “insecure” adult attachment styles have been shown to experience more pain than people with secure attachment, though results of previous studies have been inconsistent. We performed a cross-sectional study on a large population-based sample to investigate whether, compared to pain free individuals, subjects with chronic widespread pain were more likely to report insecure adult attachment style. Subjects in a population-based cross-sectional study completed a self-rated assessment of adult attachment style. Attachment style was categorised as secure (i.e., normal attachment style); or preoccupied, dismissing or fearful (insecure attachment styles). Subjects completed a pain questionnaire from which three groups were identified: pain free; chronic widespread pain; and other pain. Subjects rated their pain intensity and pain-related disability on an 11 point Likert scale. Subjects (2509) returned a completed questionnaire (median age 49.9 years (IQR 41.2–50.0); 59.2% female). Subjects with CWP were more likely to report a preoccupied (RRR 2.6; 95%CI 1.8–3.7), dismissing (RRR 1.9; 95%CI 1.2–3.1) or fearful attachment style (RRR 1.4; 95%CI 1.1–1.8) than those free of pain. Among CWP subjects, insecure attachment style was associated with number of pain sites (Dismissing: RRR 2.8; 95%CI 1.2–2.3, Preoccupied: RRR = 1.8, 95%CI 0.98–3.5) and degree of pain-related disability (Preoccupied: RRR = 2.1, 95%CI 1.0–4.1), but not pain intensity. These findings suggest that treatment strategies based on knowledge of attachment style, possibly using support and education, may alleviate distress and disability in people at risk of, or affected by, chronic widespread pain.
Davies, K.A.; Macfarlane, G.J.; McBeth, J.; Morriss, R.; Dickens, C.
Individuals with "insecure" adult attachment styles have been shown to experience more pain than people with secure attachment, though results of previous studies have been inconsistent. We performed a cross-sectional study on a large population-based sample to investigate whether, compared to pain free individuals, subjects with chronic widespread pain were more likely to report insecure adult attachment style. Subjects in a population-based cross-sectional study completed a self-rated assessment of adult attachment style. Attachment style was categorised as secure (i.e., normal attachment style); or preoccupied, dismissing or fearful (insecure attachment styles). Subjects completed a pain questionnaire from which three groups were identified: pain free; chronic widespread pain; and other pain. Subjects rated their pain intensity and pain-related disability on an 11 point Likert scale. Subjects (2509) returned a completed questionnaire (median age 49.9 years (IQR 41.2-50.0); 59.2% female). Subjects with CWP were more likely to report a preoccupied (RRR 2.6; 95%CI 1.8-3.7), dismissing (RRR 1.9; 95%CI 1.2-3.1) or fearful attachment style (RRR 1.4; 95%CI 1.1-1.8) than those free of pain. Among CWP subjects, insecure attachment style was associated with number of pain sites (Dismissing: RRR 2.8; 95%CI 1.2-2.3, Preoccupied: RRR=1.8, 95%CI 0.98-3.5) and degree of pain-related disability (Preoccupied: RRR=2.1, 95%CI 1.0-4.1), but not pain intensity. These findings suggest that treatment strategies based on knowledge of attachment style, possibly using support and education, may alleviate distress and disability in people at risk of, or affected by, chronic widespread pain. PMID:19345016
Davies, K A; Macfarlane, G J; McBeth, J; Morriss, R; Dickens, C
Ketamine has diverse effects that may be of relevance to chronicpain including: N-methyl-D-aspartic acid, alpha-amino-3-hydroxy-5-methyl-4-isoxazolepropionic acid, kainate, gamma-aminobutyric acid(A) receptors; inhibition of voltage gated Na(+) and K(+) channels and serotonin, dopamine re-uptake. Ketamine has been in clinical practice for over 30 yr; however, there has been little formal research on the effectiveness of ketamine for chronicpain management. In this review we evaluate the available clinical data as a basis for defining the potential use of ketamine for chronicpain. Literature referenced in this review was obtained from a computer search of EMBASE and MEDLINE from 1966 through August, 2002. Search terms included ketamine, ketalar, pain, painful, analgesic, and analgesia. Abstracts were screened for relevance and publications relating to chronicpain use were obtained. Levels of evidence were stratified according to accepted guidelines (level I-IV). For central pain, there is level II and level IV evidence of efficacy for parenteral and oral ketamine. For complex regional pain syndromes, there is only level IV evidence of efficacy of epidural ketamine. For fibromyalgia, there is level II evidence of pain relief, reduced tenderness at trigger points, and increased endurance. For ischemic pain, a level II study reported a potent dose-dependent analgesic effect, but with a narrow therapeutic window. For nonspecific neuropathic pain, level II and level IV studies reported divergent results with questionable long-term effects on pain. For phantom limb pain and postherpetic neuralgia, level II and level II studies provided objective evidence of reduced hyperpathia and pain relief was usually substantial either after parenteral or oral ketamine. Acute on chronic episodes of severe neuropathic pain represented the most frequent use of ketamine as a "third line analgesic," often by IV or subcutaneous infusion (level IV). In conclusion, the evidence for efficacy of ketamine for treatment of chronicpain is moderate to weak. However, in situations where standard analgesic options have failed ketamine is a reasonable "third line" option. Further controlled studies are needed. PMID:14633551
OBJECTIVE:To evaluate the Interstitial Cystitis Symptom Index and Problem Index as a screening tool for interstitial cystitis, and to estimate the prevalence and risk factors for interstitial cystitis in women with chronic pelvic pain.METHODS:Forty-five women scheduled to undergo laparoscopy for chronic pelvic pain were recruited. Women were questioned about lower urinary tract symptoms, administered the Interstitial Cystitis Symptom Index and
The following study examined the association between neurocognitive performance and emotional status in chronicpain patients. Seventy-three chronicpain patients recruited consecutively from services in a general medical hospital completed a battery of 10 neurocognitive measures and the Symptom Checklist-90-Revised (SCL-90-R; a gross measure of emotional distress). Cluster analytic procedures were used to identify a three-cluster group solution based on
Tony Iezzi; Yvonne Archibald; Peter Barnett; Ann Klinck; Melanie Duckworth
A vast body of literature supports the idea that exercise training is an important modality in the treatment and rehabilitation\\u000a of the chronicpain patient. Exercise testing and prescription should therefore be incorporated in the therapeutic armamentarium\\u000a of health care professionals working with chronicpain patients. In this chapter we present the scientific basis of the positive\\u000a effects regular exercise
The purpose of this study is to clarify the effects of repeated thermal therapy in patients with chronicpain. Forty-six chronicpain patients were assigned to group A (multidisciplinary treatment, n=24) or group B (combination of multidisciplinary treatment and repeated thermal therapy, n=22). Thermal therapy was performed with 60 °C far-infrared ray dry sauna for 15 min and was then
Magnetic resonance (MR) imaging for chronic wrist pain is challenging. Correct assessment of the triangular fibrocartilage,\\u000a hyaline cartilage, ligaments, and tendons has become mandatory for comprehensive decision making in wrist surgery. The MR\\u000a technique, potential and limits of MR imaging in patients with chronic wrist pain will be discussed. MR arthrography with\\u000a injection of gadolinium-containing contrast material into the distal
The clinical art of applying scientific knowledge to a patient’s circumstances of suffering is especially challenging when\\u000a practicing psychotherapy with people who are experiencing chronicpain. Health psychology has made substantial contributions\\u000a by showing that psychosocial factors are essential in explaining the phenomenon of pain and, particularly, its chronic progression\\u000a to debilitating degrees. In addition, clinical health psychology has developed
.\\u000a Objective: Inflammatory cytokines as well as nitric oxide (NO) play a key role in the pathogenesis of persistent and exaggerated pain\\u000a states. To document this, we investigated whether a range of cytokines and NO were detectable in the plasma of chronicpain\\u000a patients and whether cytokine and NO levels correlated with pain severity.\\u000a \\u000a \\u000a \\u000a Methods: Plasma samples of 94 chronicpain patients
A. Koch; K. Zacharowski; O. Boehm; M. Stevens; P. Lipfert; H. J. von Giesen; A. Wolf; R. Freynhagen
Introduction: There is some evidence to support the use of tramadol in chronic non-cancer pain, especially osteoarthritis pain, but modest analgesic activity is tempered by adverse effects. Combination of a lower dose of tramadol and acetaminophen is postulated to act synergistically, potentially reducing adverse effects without reduction in analgesic efficacy. Areas covered: This review discusses use of tramadol in chronic non-cancer pain and the pharmacokinetics/pharmacodynamics of tramadol and acetaminophen and when combined. Existing published controlled trial data for the effectiveness (efficacy and adverse effects) of tramadol/acetaminophen combination therapy in chronic non-cancer pain is critically appraised. Expert opinion: Combination therapy with tramadol and acetaminophen reduces pain outcomes in several types of chronic non-cancer pains. However, the effect is limited and is based on short duration trials and is associated with a significant adverse effect profile. There are few data comparing other pharmacological options and also sparse evidence to confirm benefits of the putative synergism of tramadol with acetaminophen. Nevertheless, other medications used for these chronicpains also have appreciable side effects and the combination may have a role to play. Increasing incidence of tramadol-associated deaths may lead to legislative changes that could alter prescription trends of tramadol-based medication. PMID:24067074
Inclusion of family members in the assessment of patients with chronicpain can improve outcomes. Family functioning can be assessed in four basic areas: boundaries, power, communication, and intimacy. Early recognition of maladaptive patterns in the family allows the family physician to consider a variety of interventions ranging from educating the spouse to referring the family for therapy or multidisciplinary pain management.
Margolis, Ronald B.; Merkel, William T.; Tait, Raymond C.; Richardson, William
Thalamic EEG recordings were made in 10 patients; the therapeutic goal of the implantation was the electrical stimulation treatment for pain. The patients' ages ranged from 37 to 72 years; seven patients had thalamic pain (Dejerine-Roussy syndrome), two had chronic spinal arachnoiditis and one had facial anaesthesia dolorosa.
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,
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
Objectives To examine associations between pain, functional outcomes, and sleep disturbances in children with chronicpain, specifically juvenile idiopathic arthritis ( JIA), sickle cell disease (SCD), and headache (HA). Sleep disturbances were tested as a risk factor for increased functional disability and decreased health-related quality of life (HRQOL). Methods One hundred children ( JIA n ¼ 30, SCD n ¼
Anna C. Long; Vidhya Krishnamurthy; Tonya M. Palermo
|This guide presents strategies used in Pain Management and Stress Reduction workshops for helping the elderly cope with stress and chronicpain. Client evaluations of the workshops are given along with an analysis of the clients' presenting problems. Coping strategies described include: the relaxation response, imagery, daily logs, journal…
BACKGROUND: Dexketoprofen, an NSAID used in the management of acute and chronicpains, is licensed in several countries but has not previously been the subjected of a systematic review. We used published and unpublished information from randomised clinical trials (RCTs) of dexketoprofen in painful conditions to assess evidence on efficacy and harm. METHODS: PubMed and Cochrane Central were searched for
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
The aim of this retrospective study is to evaluate the role of the implanted peripheral nerve stimulator in patients with pain in a peripheral nerve distribution. The current study is the largest in the literature that examines the role of the implantable peripheral nerve stimulator in the chronicpain patient. Our patient sample included 38 patients (with 41 nerve stimulators),
Background: Acupuncture is widely used by patients with low back pain, although its effectiveness is un- clear. We investigated the efficacy of acupuncture com- pared with minimal acupuncture and with no acupunc- ture in patients with chronic low back pain. Methods: Patients were randomized to treatment with acupuncture, minimal acupuncture (superficial needling at nonacupuncture points), or a waiting list control.
A Randomized Controlled Trial; Benno Brinkhaus; Claudia M. Witt; Susanne Jena; Klaus Linde; Andrea Streng; Stefan Wagenpfeil; Dominik Irnich; Heinz-Ulrich Walther; Dieter Melchart; Stefan N. Willich
Purpose: In this investigation, we evaluated a population of patients with chronic orofacial pain who sought treatment at a pain center in an academic institution. These patients were evaluated with respect to 1) the frequency and types of previous oral and maxillofacial surgery procedures, 2) the frequency of previous significant misdiagnoses, and 3) the number of patients who subsequently required
Howard A. Israel; John Desmond Ward; Brenda Horrell; Steven J. Scrivani
This guide presents strategies used in Pain Management and Stress Reduction workshops for helping the elderly cope with stress and chronicpain. Client evaluations of the workshops are given along with an analysis of the clients' presenting problems. Coping strategies described include: the relaxation response, imagery, daily logs, journal…
Two hundred patients with chronicpain were treated in an in-patient program in which behavior modification was the major therapeutic modality. The patients were characterized by having had pain of many years' duration, multiple operations, treatment failures, prolonged disability, compensation factors, and dependency on medication. At hospital dismissal, 59 % of the patients had achieved moderate improvement or better. At
DAVID W. SWANSON; TOSHIHIKO MARUTA; WENDELL M. SWENSON
Background: the practical issues confronting older people who suffer chronicpain may not be tackled in a pain clinic setting and little is known of their strategies for coping. They seem to have little or no information on how to improve the quality of their lives or on resources available to them. Aim: the aim of this study was to
B. Sofaer; A. P. MOORE; I. HOLLOWAY; J. M. LAMBERTY; T. A. S. THORP; J. O'DWYER
Electroconvulsive therapy (ECT) is used predominantly to treat major depressive illness but has also been used for chronic\\u000a pain. ECT causes a variety of neurochemical and neurophysiologic effects, some of which may interact with the pathophysiologic\\u000a mechanisms in complex pain states. An extensive literature on the use of ECT in pain patients identifies subgroups for whom\\u000a ECT may result in
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
Assessment of quality of life (QOL) is important in evaluating the well-being of patients suffering from chronicallypainful\\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
Chronic abdominal pain is a common feature of most functional gastrointestinal disorders in children, including functional\\u000a abdominal pain (FAP) and irritable bowel syndrome (IBS). FAP can impair a child’s life and often leads to significant school\\u000a absences. Although the underlying mechanism is likely multifactorial, early pain experiences during a vulnerable period in\\u000a the developing nervous system can cause longterm changes
The authors discuss the relationship between atypical facial pain and psychiatric disturbance. They present contemporary viewpoints and describe four cases that illustrate underlying psychodynamic mechanisms associated with pain in patients who had undergone various dental procedures and other treatments without success. They identify factors which might lead to the early detection of underlying psychological problems and discuss the role of learning, the family system and other factors in producing a chronicpain syndrome.
Background The extracellular matrix protein SPARC (Secreted Protein, Acidic, Rich in Cysteine) has been linked to degeneration of the intervertebral discs and chronic low back pain (LBP). In humans, SPARC protein expression is decreased as a function of age and disc degeneration. In mice, inactivation of the SPARC gene results in the development of accelerated age-dependent disc degeneration concurrent with age-dependent behavioral signs of chronic LBP. DNA methylation is the covalent modification of DNA by addition of methyl moieties to cytosines in DNA. DNA methylation plays an important role in programming of gene expression, including in the dynamic regulation of changes in gene expression in response to aging and environmental signals. We tested the hypothesis that DNA methylation down-regulates SPARC expression in chronic LBP in pre-clinical models and in patients with chronic LBP. Results Our data shows that aging mice develop anatomical and behavioral signs of disc degeneration and back pain, decreased SPARC expression and increased methylation of the SPARC promoter. In parallel, we show that human subjects with back pain exhibit signs of disc degeneration and increased methylation of the SPARC promoter. Methylation of either the human or mouse SPARC promoter silences its activity in transient transfection assays. Conclusions This study provides the first evidence that DNA methylation of a single gene plays a role in chronicpain in humans and animal models. This has important implications for understanding the mechanisms involved in chronicpain and for pain therapy.
Behavioural symptoms such as abnormal emotionality (including anxious and depressive episodes) and cognition (for instance weakened decision-making) are highly frequent in both chronicpain 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 chronicpain-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 chronicpain, 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 chronicpain. 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 chronicpain, expounding upon its validity and putative therapeutical impact as well as its current limitations and expected future developments. PMID:21741179
Objective Medicine lacks good models for understanding and treating chronic muscle pain. The aim of this study was to explore whether participation in a treatment group for women with chronic muscle pain can help the participants to develop strategies to handle their chronic muscle pain. Methods The study was carried out as a qualitative research project. Eight women completed a treatment programme consisting of movement training and group discussions. The qualitative data consisted of transcriptions from audio-taped individual interviews. The data material was analysed by systematic text condensation inspired by Giorgi. Results All the women describe participation in the treatment group as useful. Their experiences could be categorized as follows: To know oneself, to negotiate with oneself and others, to be able to choose, and to be able to act. Conclusion The participants developed strategies for handling their chronic muscle pain. Both the women's new understanding of their chronic muscle pain and increased confidence in themselves were important. These phenomena can help women in their encounters with their surroundings, for example when consulting doctors. The doctor's awareness of the women's resources and their own mastering strategies may contribute to a new understanding of the disposing, triggering, and maintaining factors, and of the curative and health-promoting forces at work in those with chronic muscle pain.
Although the etiology of chronicpain following trauma is not well understood, numerous retrospective studies have shown that a significant proportion of chronicpain patients have a history of traumatic injury. The present analysis examines the prevalence and early predictors of chronicpain in a cohort of prospectively followed severe lower extremity trauma patients. Chronicpain was measured using the
Renan C. Castillo; Ellen J. MacKenzie; Stephen T. Wegener; Michael J. Bosse
Chronicpain affects 75 million US citizens. A number of pharmacologic treatments are available for chronicpain that does not respond adequately to nonpharmacologic methods. Long the mainstay of chronicpain management, nonsteroidal anti-inflammatory drugs (NSAIDs) are known to be associated with gastrointestinal (GI) and renal toxicities, a particular problem for the elderly population, which commonly experiences chronicpain, such
Neural mechanisms mediating the transition from acute to chronicpain remain largely unknown. In a longitudinal brain imaging study, we followed up patients with a single sub-acute back pain (SBP) episode for more than 1year as their pain recovered (SBPr), or persisted (SBPp) representing a transition to chronicpain. We discovered brain white matter structural abnormalities (n=24 SBP patients; SBPp=12 and SBPr=12), as measured by diffusion tensor imaging (DTI), at entry into the study in SBPp in comparison to SBPr. These white matter fractional anisotropy (FA) differences accurately predicted pain persistence over the next year, which was validated in a second cohort (n=22 SBP patients; SBPp=11 and SBPr=11), and showed no further alterations over a 1-year period. Tractography analysis indicated that abnormal regional FA was linked to differential structural connectivity to medial vs lateral prefrontal cortex. Local FA was correlated with functional connectivity between medial prefrontal cortex and nucleus accumbens in SBPr. As we have earlier shown that the latter functional connectivity accurately predicts transition to chronicpain, we can conclude that brain structural differences, most likely existing before the back pain-inciting event and independent of the back pain, predispose subjects to pain chronification. PMID:24040975
Mansour, Ali R; Baliki, Marwan N; Huang, Lejian; Torbey, Souraya; Herrmann, Kristi M; Schnitzer, Thomas J; Apkarian, A Vania
Objectives In group interviews, we examined strategies used to manage chronicpain from the perspective of the individual. Methods Sixteen low income overweight Latino adults participated in two group interviews facilitated by a trained moderator who inquired about the type of chronicpain suffered by participants, followed by more specific questions about pain management. Interviews were audio-recorded, transcribed verbatim (Spanish), back-translated into English, and analyzed using thematic analysis. Results Participants’ pain varied in type, location, and intensity. Participants discussed pain-related changes in activities and social life, and difficulties with health care providers, and as a result, we discovered five major themes: Pain-related Life Alterations, Enduring the Pain, Trying Different Strategies, Emotional Suffering, and Encounters with Health Care System/Providers. Discussion Findings indicated that there are opportunities for providers to improve care for low income overweight Latinos with chronicpain by listening respectfully to how pain alters their daily lives and assisting them in feasible self management strategies.
Rutledge, Dana N; Cantero, Patricia J; Ruiz, Jeanette E
Chronic ischemic pain is a leading cause of pain in the lower extremities. A neuropathic component in ischemic pain has been shown. Neuropathic pain questionnaires are established as a common tool in pain research. The aim of this study was to analyze the clinical nature and the character of chronic ischemic pain in peripheral arterial disease (PAD). One hundred and
Linda J. Rüger; Dominik Irnich; Thomas N. Abahji; Alexander Crispin; Ulrich Hoffmann; Philip M. Lang
BACKGROUND: Chronicpain is a frequent cause of suffering and disability that negatively affects patients’ quality of life. There is\\u000a growing evidence that disparities in the treatment of pain occur because of differences in race.\\u000a \\u000a \\u000a OBJECTIVE: To determine whether race plays a role in treatment decisions involving patients with chronic nonmalignant pain in a primary\\u000a care population.\\u000a \\u000a \\u000a \\u000a \\u000a DESIGN, SETTING, AND
Ian Chen; James Kurz; Mark Pasanen; Charles Faselis; Mukta Panda; Lisa J. Staton; Jane O’Rorke; Madhusudan Menon; Inginia Genao; JoAnn Wood; Alex J. Mechaber; Eric Rosenberg; Tim Carey; Diane Calleson; Sam Cykert
It has proven difficult to use systemic administration of small molecules to selectively modulate nociception. Over the past decade, we and others have developed non-replicating herpes simplex virus (HSV)-based vectors to treat chronicpain. Subcutaneous inoculation of an HSV vector effectively transduces sensory neurons in the dorsal root ganglion; release of transgene-coded inhibitory neurotransmitters or anti-inflammatory peptides reduces pain-related behaviors in rodent models of chronic inflammatory and neuro-pathic pain. A phase 1 trial of this therapy in patients is set to begin soon.
This study pertains to the 71 patients who had received a diagnosis of cervico-brach ial pain syndrome after thorough clinical examination of a total series of 300 patients, who had been referred to the National Insurance Hospital in Tranas because of chronic neck pain that interfered with their ability to work. Changes in trapezius muscle blood flow and EMG were
R. Larsson; H. Cai; Q. Zhang; P. Å. Öberg; S. E. Larsson
This article reports the development of a pain and discomfort module (PDM) designed to assess the full impact of quality of life (QoL) relating to chronicpain, which could be used with the generic World Health Organisation Quality of Life Assessment (WHOQOL). First, cognitive interviewing was completed with nine participants with chronicpain, for 108 items representing 10 pain-specific facets
The aim of our study was to characterize brain dynamics of affective modulation of somatosensory processing in chronicpain. We hypothesized that chronicpain patients will show abnormal EEG activity under negative mood conditions compared to healthy controls. Nineteen patients with chronicpain and 21 healthy subjects participated in the experiment. Multiscale entropy, fractal dimension, event-related potentials, and fast Fourier
Carolina Sitges; Xavier Bornas; Jordi Llabrés; Miquel Noguera; Pedro Montoya
Applying cumulative inequality theory, this study examines the extent to which childhood socioeconomic disadvantage and maternal depression increase the risk of major depression and chronicpain in U.S. working-aged adults. Further, I assess whether low socioeconomic status amplifies the risk of adult depression and/or pain. Using data from the 2003 National Comorbidity Survey Replication (N=4339), I find that socioeconomic disadvantage and maternal depression during youth increases the risk of adult depression and/or chronicpain. The probability of having chronicpain increases in magnitude over the life course for adults whose parents have lower educational attainment relative to those with more highly educated parents. Childhood socioeconomic circumstances are not completely explained by adulthood socioeconomic status indicators. These findings help illustrate the far-reaching influence of childhood context on adult physical and mental health.
Individuals with chronic widespread pain, including those with fibromyalgia, pose a particular challenge to treatment, given the modest effectiveness of pharmacological agents for this condition. The growing consensus indicates that the best approach to treatment involves the combination of pharmacological and non-pharmacological interventions. Several non-pharmacological interventions, particularly exercise and cognitive-behavioural therapy (CBT), have garnered good evidence of effectiveness as stand-alone, adjunctive treatments for patients with chronicpain. In this article, evidenced-based, non-pharmacological management techniques for chronic widespread pain are described by using two broad categories, exercise and CBT. The evidence for decreasing pain, improving functioning and changing secondary symptoms is highlighted. Lastly, the methods by which exercise and CBT can be combined for a multi-component approach, which is consistent with the current evidence-based guidelines of several American and European medical societies, are addressed. PMID:22094203
OBJECTIVE To evaluate whether 6 months of raloxifene was effective in treatment of chronic pelvic pain in women with endometriosis. METHODS Women with chronic pelvic pain and no endometriosis treatment for 6 months underwent laparoscopy for excision of all lesions. Those with biopsy-proven endometriosis were randomly allocated to raloxifene (180 mg) or placebo daily. A second laparoscopy was performed at 2 years, or earlier, if pain returned. Return of pain was defined as 2 months of pain equal to or more severe than that at study entry. Menstrual cycles and adverse events were recorded. The log rank test was used to compare the time to return of pain by drug group. Analyses were done as intent-to-treat. RESULTS A total of 127 of 158 women underwent surgery. Of these, 93 had biopsy-confirmed endometriosis and were randomly assigned to study treatment. Menstrual cycle length, pelvic pain severity, quality of life, bone mineral density, and adverse events did not differ between treatment groups. The Data Safety Monitoring Committee terminated the study early when the raloxifene group experienced pain (P=.03) and had second surgery (P=.016) significantly sooner than the placebo group. Interestingly, biopsy-proven endometriosis was not associated with return of pain (P=.6). CONCLUSION Raloxifene significantly shortened the time to return of chronic pelvic pain. Because recurrence of endometriosis lesions did not correlate with return of pain, other factors are implicated in pelvic pain. CLINICAL TRIAL REGISTRATION ClinicalTrials.gov, www.cliicaltrials.gov, NCT00001848 (Obstet Gynecol 2008;111:88–96) LEVEL OF EVIDENCE I
Chronicpain 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 chronicpain 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 chronicpain 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 chronicpain 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 chronicpain. We conclude that, current controversies aside, utilization of ZIP as a tool to interrogate maintenance mechanisms of chronicpain 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 chronicpain. PMID:23433248
Chronicpain is a hallmark of osteoarthritis (OA), yet little is known about its properties and representation in the brain. Here we use fMRI combined with psychophysics to study knee pain in 14 OA patients and 9 healthy controls. Mechanical painful pressure stimuli were applied to the knee in both groups and ratings of evoked pain and related brain activity examined. We observe that psychophysical properties and brain activation patterns of evoked pain are essentially the same between OA patients and healthy subjects, and between worse and better OA knees. In OA patients, stimulus-related brain activity could be distinguished from brain activity associated with spontaneous pain. The former activated brain regions commonly observed for acute painful stimuli in healthy subjects, while the spontaneous pain of OA engaged prefrontal-limbic regions closely corresponding to areas observed for spontaneous pain in other chronicpain conditions, such as chronic back pain and post-herpetic neuralgia. Arthritis-related clinical characteristics of knee OA also mapped to prefrontal-limbic regions. In a subgroup of patients (n = 6) we examined brain activity changes for a 2-week, repeat measure, cyclooxygenase-2 inhibitor (valdecoxib) therapy. Treatment decreased spontaneous pain for the worse knee and clinical characteristics of OA, and increased blood and csf levels of the drug which correlated positively with prefrontal-limbic brain activity. These findings indicate dissociation between mechanically induced and spontaneous OA knee pain, the latter engaging brain regions involved in emotional assessment of the self, and challenge the standard clinical view regarding the nature of OA pain.
Parks, Elle L.; Geha, Paul Y.; Baliki, Marwan N.; Katz, Jeffrey; Schnitzer, Thomas J.; Apkarian, A. Vania
Chronicpain is a hallmark of osteoarthritis (OA), yet little is known about its properties and representation in the brain. Here we use fMRI combined with psychophysics to study knee pain in fourteen OA patients and nine healthy controls. Mechanical painful pressure stimuli were applied to the knee in both groups and ratings of evoked pain and related brain activity examined. We observe that psychophysical properties and brain activation patterns of evoked pain are essentially the same between OA patients and healthy subjects, and between worse and better OA knees. In OA patients, stimulus-related brain activity could be distinguished from brain activity associated with spontaneous pain. The former activated brain regions commonly observed for acute painful stimuli in healthy subjects, while the spontaneous pain of OA engaged prefrontal-limbic regions closely corresponding to areas observed for spontaneous pain in other chronicpain conditions, such as chronic back pain and post-herpetic neuralgia. Arthritis-related clinical characteristics of knee OA also mapped to prefrontal-limbic regions. In a subgroup of patients (n=6) we examined brain activity changes for a 2-week, repeat measure, cyclooxygenase-2 inhibitor (valdecoxib) therapy. Treatment decreased spontaneous pain for the worse knee and clinical characteristics of OA, and increased blood and csf levels of the drug which correlated positively with prefrontal-limbic brain activity. These findings indicate dissociation between mechanically induced and spontaneous OA knee pain, the latter engaging brain regions involved in emotional assessment of the self, and challenge the standard clinical view regarding the nature of OA pain. PMID:21315627
Parks, Elle L; Geha, Paul Y; Baliki, Marwan N; Katz, Jeffrey; Schnitzer, Thomas J; Apkarian, A Vania
Chronicpain 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 chronicpain using these models. Both pharmacological and interventional approaches are described, as well as a discussion of preventive strategies on the horizon.
McGreevy, Kai; Bottros, Michael M.; Raja, Srinivasa N.
Imperforate hymen in an adolescent usually presents with cyclic abdominal pain or with pelvic mass associated with primary amenorrhea. We present a 13-year-old girl with chronic lower back pain of 6 months' duration as the only complaint. On physical examination, multiple trigger points were detected in the quadratus lumborum and gluteus medius muscles bilaterally. Abdominal ultrasound revealed hematometrocolpos secondary to an imperforate hymen. Hymenectomy was performed, with complete resolution of the back pain. Myofascial pain syndrome with a viscerosomatic reflex is a possible explanation for the clinical presentation of our patient. PMID:23958769
Domany, Erel; Gilad, Oded; Shwarz, Michael; Vulfsons, Simon; Garty, Ben Zion
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
A major difficulty in the investigation of chronic facial pain has been a practical classification permitting the selection of appropriate diagnostic procedures to elucidate the etiology of the pain and to provide appropriate therapy. Categorization of facial pain syndromes into vascular, neuritic, muscular, rheumatic, traction and inflammatory and psychogenic groups provides a useful approach to the problem. Despite the utility of this method and advances in noninvasive diagnostic techniques, many pain syndromes remain refractory to full understanding and/or therapy and will test the physician's patience and perseverance. PMID:900012
Objectives. This study was done to evaluate three bedside tests in discriminating visceral pain from somatic pain among women with chronic pelvic pain. Study Design. The study was an exploratory cross-sectional evaluation of 81 women with chronic pelvic pain of 6 or more months' duration. Tests included abdominal cutaneous allodynia (aCA), perineal cutaneous allodynia (pCA), abdominal and perineal myofascial trigger points (aMFTP) and (pMFTP), and reduced pain thresholds (RPTs). Results. Eighty-one women were recruited, and all women provided informed consent. There were 62 women with apparent visceral pain and 19 with apparent somatic sources of pain. The positive predictive values for pelvic visceral disease were aCA-93%, pCA-91%, aMFTP-93%, pMFTP-81%, and RPT-79%. The likelihood ratio (+) and 95% C.I. for the detection of visceral sources of pain were aCA-4.19 (1.46, 12.0), pCA-2.91 (1.19, 7.11), aMTRP-4.19 (1.46, 12.0), pMFTP-1.35 (0.86, 2.13), and RPT-1.14 (0.85, 1.52), respectively. Conclusions. Tests of cutaneous allodynia, myofascial trigger points, and reduced pain thresholds are easily applied and well tolerated. The tests for cutaneous allodynia appear to have the greatest likelihood of identifying a visceral source of pain compared to somatic sources of pain.
Jarrell, John; Giamberardino, Maria Adele; Robert, Magali; Nasr-Esfahani, Maryam
Here we review recent research into the mechanisms of chronicpain that has focused on neuronal sodium channels, a target of classic analgesic agents. We first discuss evidence that specific sodium channel isoforms are essential for the detection and conduction of normal acutely painful stimuli from nociceptors. We then review findings that show changes in sodium channel expression and localization in chronic inflammation and nerve injury in animal and human tissues. We conclude by discussing the role that myelination plays in organizing and maintaining sodium channel clusters at nodes of Ranvier in normal development and how inflammatory processes or nerve injury alter the characteristics of such clusters. Based on these findings, we suggest that chronicpain may in part result from partial demyelination of axons during chronic injury, which creates aberrant sodium channel clusters that serve as sites of ectopic sensitivity or spontaneous activity.
Levinson, Simon R.; Luo, Songjiang; Henry, Michael A.
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 chronicpain 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 chronicpain 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
AIM: To prove the hypothesis that patients with chronic pancreatitis would show increased theta activity during painful visceral stimulation. METHODS: Eight patients and 12 healthy controls underwent an experiment where the esophagus was electrically stimulated at the pain threshold using a nasal endoscope. The electroencephalogram (EEG) was recorded from 64 surface electrodes and \\
Asbjørn M Drewes; Maciej Gratkowski; Saber AK Sami; Georg Dimcevski; Peter Funch-Jensen; Lars Arendt-Nielsen
Cognitive–behavioural therapy and maintenance of exercise have emerged as major tools in the treatment of patients with chronic low back pain. Patients' beliefs about their problem may influence their uptake of and responses to particular treatment modalities. In particular, we hypothesised that patients' beliefs about the cause and treatment of pain may mediate changes in physical disability following participation in
Psychosocial treatments for chronicpain 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 laboratory-based studies suggest that acceptance-oriented strategies significantly enhance pain tolerance and behavioral persistence, compared
Kevin E. Vowles; Daniel W. McNeil; Richard T. Gross; Michael L. McDaniel; Angela Mouse; Mick Bates; Paula Gallimore; Cindy McCall
Background Modern theories define chronicpain 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 chronicpain 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 chronicpain 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 chronicpain 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.
Spinal cord stimulation (SCS) suppresses visceral response to colon distension in an animal model. In humans, it may be an effective therapy for chronicpain of pelvic origin, irritable bowel syndrome, and persistent unspecified abdominal pain. Described here is the case of SCS for 38-year-old woman with visceral pain secondary to chronic pancreatitis. Previous therapies included numerous endoscopic retrograde cholangiopancreatographies, multiple pancreatic duct stenting, chemical and surgical sympathectomies with short-lasting pain relief. After the initial evaluation, the patient underwent retrograde epidural differential block to determine possible source of pain. Delay in pain recurrence after block suggested that the origin of her pain was visceral. After the psychologic evaluation, the patient underwent SCS trial over 14 days. She had 2 trial leads placed epidurally via T9-T10 paramedian entry with the tips of both leads positioned at T6 vertebral body. During the trial, visual analog scale pain score decreased from 8 to 1 cm, Pain Disability Index from 62 to 14, and opioid use from 150 to 0 mg of morphine sulfate equivalent a day. After the completion of successful SCS trial, she was implanted with dual octrode leads and rechargeable pulse generator. Median pain scores decreased from 8 to 1 at 3 months after the implant. Pain Disability Index changed from 62 to 15. Opiate use decreased to none. It seems that SCS may have a significant therapeutic potential for the treatment of visceral pain secondary to chronic pancreatitis. PMID:18496389
Objective To review the epigenetic modifications involved in the transition from acute to chronicpain 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 chronicpain. 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 chronicpain. Conclusions Epigenetic analysis may identify mechanisms critical to the development of chronicpain after injury, and may provide new pathways and target mechanisms for future drug development and individualized medicine.
Buchheit, Thomas; Van de Ven, Thomas; Shaw, Andrew
Chronic noncancer pain includes a heterogeneous group of disorders and is often refractory to treatment. Cannabis products have historically been used for chronicpain and are attracting renewed pharmaceutical interest. Nabilone is a synthetic cannabinoid licensed in Canada for the treatment of severe nausea and vomiting associated with cancer chemotherapy. We have used nabilone off-label for the treatment of chronic noncancer pain since 1999. In this article, we review our clinical experience of 20 adult patients with chronic noncancer pain who had been treated with nabilone and followed up for an average of 1.5 years. Prior to nabilone therapy, patients had used a wide range of therapies, including 11 who had used cannabis. Fifteen patients reported subjective overall improvement with nabilone, and nine reported reduced pain intensity. Beneficial effects on sleep and nausea were the main reasons for continuing use. Intolerable side effects were experienced in three patients (palpitations, urinary retention, dry mouth). Nabilone may be a useful addition to pain management and should be further evaluated in randomized controlled trials. PMID:16533193
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
This project continues to be a biomarker discovery program focusing on the causes of persistent pain after traumatic amputation in the combat setting. In the second year we have: (1) maintained the necessary regulatory approval at WRMC and Duke University...
Text Version... There is moderate evidence that NSAIDs are not more effective than paracetamol for acute low back pain, but paracetamol had fewer side effects” ... More results from www.fda.gov/downloads/advisorycommittees/committeesmeetingmaterials
Text Version... applications and licenses, for technology innovations in pain management. He's also received ... scientific fashion. Firstly, my disclosures. ... More results from www.fda.gov/downloads/drugs/newsevents
Background The sickness certification and return to work (RTW) of people with chronicpain are important health and economic issues for employees, employers, taxpayers and the UK government. The 'fit note' and a national educational programme promoting RTW were introduced in 2010 to curb rising rates of sickness absence. Aims To investigate employers' and employees' experiences of managing RTW when someone has taken sick leave for chronicpain and to explore the perceived efficacy of the fit note. Methods A qualitative study, comprising semi-structured interviews with employers who had managed sick leave cases and employees who had experienced sick leave for chronicpain. Interviews were recorded, transcribed and the data analysed using constructivist grounded theory principles. Results Five themes were elicited. Firstly, frequent enquiry after health status was seen as intrusive by some employees but part of good practice by employers and acknowledging this difference was useful. Secondly, being able to trust employees due to their performance track record was helpful for employers when dealing with complex chronicpain conditions. Thirdly, feeling valued increased employees' motivation to RTW. Fourthly, guidelines about maintaining contact with absent employees were useful if used flexibly. Finally, both parties valued the fit note for its positive language, interrogative format and biomedical authority. Conclusions The fit note was perceived to be helpful if used in combination with other strategies for managing sick leave and RTW for people with chronicpain. These strategies may be applicable to other fluctuating, long-term conditions with medically unexplained elements. PMID:24027219
Wainwright, E; Wainwright, D; Keogh, E; Eccleston, C
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.
Bruce, J; Thornton, A J; Scott, N W; Marfizo, S; Powell, R; Johnston, M; Wells, M; Heys, S D; Thompson, A M
Trigeminal neuralgia (TN) is supposedly caused by an ectatic blood vessel affecting the trigeminal nerve at the root entry zone of the brain stem. Recent evidence suggests an additional central component within trigeminal pain-processing in the pathophysiology of TN. Therefore, we aimed to identify specific brain regions possibly associated with the development or maintenance of TN using magnetic resonance imaging (MRI) voxel-based morphometry (VBM). Sixty patients with classical TN were compared to 49 healthy controls. Eighteen patients had TN with concomitant constant facial pain, a condition previously described as a predictor of worse treatment outcome. We found gray matter (GM) volume reduction in TN patients compared to healthy controls in the primary somatosensory and orbitofrontal cortices, as well as the in the secondary somatosensory cortex, thalamus, insula, anterior cingulate cortex (ACC), cerebellum, and dorsolateral prefrontal cortex. GM volume decrease within the ACC, parahippocampus, and temporal lobe correlated with increasing disease duration in TN. There were no differences comparing patients with and without concomitant constant facial pain. No GM increase was found comparing patient subgroups with each other and with healthy controls. The observed changes probably reflect the impact of multiple, daily attacks of trigeminal pain in these patients similar to what was previously described in other chronicpain conditions and may be interpreted as adaptation mechanism to chronicpain in regard to neuronal plasticity. The ACC, parahippocampus and temporal lobe volume reduction in parallel with disease duration may point to a pivotal role of these structures in chronicpain. PMID:23485849
Background: Chronic intestinal schistosomiasis is rare in the United Kingdom. The symptoms are nonspecific and may mimic several other gastrointestinal conditions. We present a case of chronic intestinal schistosomiasis in a West Indian woman presenting to a genitourinary clinic. Case: The patient presented with chronic lower abdominal pain and dysuria. A sexually transmitted disease (STD) screen was negative and midstream urine cultures were sterile. A rectal biopsy revealed a non-necrotizing granulomatous reaction around the ova of Schistosoma. Her symptoms resolved with anti-schistosomiasis therapy. Conclusion: This case illustrates that physicians should be aware of chronic schistosomiasis in the differential diagnosis of chronic lower abdominal pain in women who have come from or visited areas where schistosomiasis is endemic.
Both chronic cough and chronicpain are critical clinical issues in which a large number of patients remain unsatisfied with available treatments. These conditions have considerable effects on sufferers' quality of life, who often show co-morbidities such as anxiety and depression. There is therefore a pressing need to find new effective therapies. The basic neurobiological mechanisms and pathologies of these two conditions show substantial homologies. However, whilst chronicpain has received a great deal of attention over the last few decades, the same cannot be said for the neurological underpinnings of chronic cough. There is a substantial literature around mechanisms of chronicpain which is likely to be useful in advancing knowledge about the pathologies of chronic cough. Here we compare the basic pain and cough pathways, in addition to the clinical features and possible pathophysiologies of each; including mechanisms of peripheral and central sensitisation which may underlie symptoms such as hyperalgesia and allodynia, and hypertussitvity and allotussivity. Due to the substantial overlap that emerges, it is likely that therapies may be effective over both areas. PMID:23831712
O'Neill, Jessica; McMahon, Stephen B; Undem, Bradley J
Pain is the most frequently reported symptom in the health care industry today. Chronicpain in the United States costs millions of dollars annually, and its financial impact is mounting. For individuals living in the United States, chronicpain affects nearly all normal activities and often leaves the person feeling helpless and hopeless. Literature supports the idea that chronicpain
Chronicpain is a debilitating problem for many Americans. It affects physical, social, and emotional health. This study addresses the potential differential effects of chronicpain cross-culturally in younger Americans. A retrospective analysis of persons younger than 50 years of age presenting for chronicpain management in a multidisciplinary pain center was done. White and black American adults aged 18
Carmen Reneé Green; Tamara A Baker; Yuka Sato; Tamika L Washington; Edna M Smith
|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 chronicpain population. Sixty-three women with chronic pelvic pain completed measures of sexual function, sexual abuse, and pain. Using an index…
Chronicpain has a considerable impact on patient-reported outcomes such as quality of life (QoL). To assess QoL in people\\u000a with chronicpain, a pain and discomfort module (PDM) was developed for use with the WHOQOL-100 and its psychometric properties\\u000a assessed. Sixteen items covered four facets on pain relief; anger and frustration; vulnerability, fear and worry; and uncertainty.\\u000a Chronic low
Adequate sleep is essential for health across the lifespan and is likely to be influenced by different factors among those\\u000a with chronicpain than among others. Questionnaires were administered to 362 college students, some of whom reported chronic\\u000a pain from varied sources. Among chronicpain sufferers (n = 108), pain severity was uniquely associated with sleep quality after controlling for gender, BMI,
Jennifer E. GrahamKatherine; Katherine L. Streitel
Pain is the most common reason patients with inflammatory arthritis see a rheumatologist. Patients consistently rate pain as one of their highest priorities, and pain is the single most important determinant of patient global assessment of disease activity. Although pain is commonly interpreted as a marker of inflammation, the correlation between pain intensity and measures of peripheral inflammation is imperfect. The prevalence of chronic, non-inflammatory pain syndromes such as fibromyalgia is higher among patients with inflammatory arthritis than in the general population. Inflammatory arthritis patients with fibromyalgia have higher measures of disease activity and lower quality of life than inflammatory patients who do not have fibromyalgia. This review article focuses on current literature involving the effects of pain on disease assessment and quality of life for patients with inflammatory arthritis. It also reviews non-pharmacologic and pharmacologic options for treatment of pain for patients with inflammatory arthritis, focusing on the implications of comorbidities and concurrent disease-modifying antirheumatic drug therapy. Although several studies have examined the effects of reducing inflammation for patients with inflammatory arthritis, very few clinical trials have examined the safety and efficacy of treatment directed specifically towards pain pathways. Most studies have been small, have focused on rheumatoid arthritis or mixed populations (e.g., rheumatoid arthritis plus osteoarthritis), and have been at high risk of bias. Larger, longitudinal studies are needed to examine the mechanisms of pain in inflammatory arthritis and to determine the safety and efficacy of analgesic medications in this specific patient population. PMID:23292816
The sympathetic blocks are useful in many ways for relief of chronicpain. The sympathetic block can be caused at pre- and paravertebral sympathetic ganglia eg, stellate ganglia, coeliac plexus and lumbar sympathetic ganglia. Indications for sympathetic blockade are: Complex regional pain syndrome, phantom limb pain, central pain, acute pancreatitis, pancreatic cancer and cancer pain from upper abdominal viscera. Stellate ganglion blockade is required for the diagnosis, prognosis and therapy for painful and other conditions associated with sympathetic dysfunctions of head, neck and upper extremity. Coeliac plexus block is indicated in pain due to intra-abdominal cancer, stemming from organs innervated by coeliac plexus. Lumbar sympathetic block is indicated for diagnosis, prognosis and therapy for painful and other conditions associated with sympathetic dysfunctions like complex regional pain syndrome I and II, herpes zoster, amputation stump pain and inoperable peripheral vascular vasospastic diseases of the lower limb. Indications for superior hypogastric block are the prognostic and therapeutic purposes of cancer pelvic organs--uterus, cervix, bladder, prostate, urethra, testes and ovaries. PMID:12022220
A few studies of long-term outcomes for pediatric functional abdominal pain (FAP) have assessed acute non-abdominal pain at follow-up, but none has assessed chronicpain. We followed a cohort of pediatric patients with FAP (n = 155) and a well control group (n = 45) prospectively for up to 15 years. Participants ranged in age from 18 to 32 years at a follow-up telephone interview. FAP patients were classified as Resolved (n = 101) versus Unresolved (n = 54) at follow-up, based on whether they reported symptoms consistent with the adult Rome III criteria for a functional gastrointestinal disorder. Headache symptoms and reports of chronic non-abdominal pain also were assessed at follow-up. In the Unresolved group, 48.1% reported one or more sites of chronic non-abdominal pain at follow-up, compared to 24.7% in the Resolved group and 13.3% in the control group, p < 0.01. More than half (57.4%) of the Unresolved group endorsed symptoms consistent with International Headache Society criteria for headache, compared to 44.6% of the Resolved group and 31% of controls, p < 0.05. One-third of the Unresolved group reported both headache and one or more sites of chronic non-abdominal pain at follow-up, compared to 17.8% of the Resolved group and 4.4% of controls. Youth with FAP that persists into adulthood may be at increased risk for chronicpain and headache. Examination of central mechanisms that are common across chronicpain disorders may enhance understanding of this subgroup of FAP.
Walker, Lynn S.; Dengler-Crish, Christine M.; Rippel, Sara; Bruehl, Stephen
Chronic neuropathic pain (CNP) is common after peripheral nerve injuries (PNI), but is rather refractory to available anti-pain medication. Advances in neuropathic pain research have identified cellular and molecular cues triggering the onset of neuropathic pain, but the mechanisms responsible for maintenance of chronicpain states are largely unknown. Structural changes such as sprouting of injured A-fibres into the substantia
Robby J. P. Jaken; Elbert A. J. Joosten; Martin Knüwer; Rianne Miller; Inge van der Meulen; Marco A. E. Marcus; Ronald Deumens
Background. Chronic back pain (CBP) disability results from the complex interaction of psychosocial variables in the presence of back pain. It is believed that personality plays an important role in pain perception; however, the link between personality and chronicpain has been extensively challenged and has received little empirical support. Trait approaches to personality have historically dominated pain research but
This study evaluated a theoretically and empirically based model of the progression of acute neck and back pain to chronicpain and disability, developed from the literature in chronicpain, cognition, and stress and trauma. Clinical information and standardized psychosocial measures of cumulative traumatic events exposure (TLEQ), depressed mood (CES-D), pain (DDS), physical disability (PDI), and pain beliefs (PBPI) were
Corinna Young Casey; Melanie A. Greenberg; Perry M. Nicassio; R. Edward Harpin; David Hubbard
Chronicpain is a highly prevalent condition that impacts adversely on individual quality of life, imposes substantial costs on the healthcare system and a considerable burden on society. Advances in the understanding of pain mechanisms have opened the way for the development of new treatment strategies. The continuous delivery of short-lived potent bioactive molecules to sensory nerves, spinal cord or meninges - achieved by directed gene transfer - offers the possibility to selectively interrupt nociceptive neurotransmission or to interfere with the plastic changes in the nervous system underlying the development or persistence of chronicpain. In this review we describe advances in the use of non-viral and viral vector-based gene transfer for the treatment of pain, with a special focus on the use of recombinant non-replicating herpes simplex virus-based vectors and the prospects for clinical trials.
Two patients with severe chronicpain of pancreatic origin are described. In both there was severe back pain and an area of erythema ab igne lay directly over the portion of the pancreas giving rise to the pain. In both patients therapy directed at these areas of diseased pancreas resulted in relief of symptoms. The presence of erythema ab igne on a patient's back at the level of T12-L2 should arouse suspicion of underlying pancreatic pathology, and this may be valuable in a disease with remarkably little to find on clinical examination. In one patient early obstruction of the pancreatic duct by pancreatic carcinoma caused distal chronic pancreatitis and back pain many months before the onset of obstructive jaundice. Images Figure 1. A Figure 1. B Figure 2. A Figure 2. B
Thirty-three patients with undiagnosed chronic knee pain had features of autonomic disturbance. Thermography is a useful imaging technique for demonstrating this abnormality. The patients lacked the thermographic symmetry observed in 16 normal controls but this returned with resolution of the pain. Recognized radiological and scintigraphic features of algodystrophy were found. The long duration of symptoms, high proportion of young females and the severity of the associated disability were notable. It is suggested that algodystrophy is a more frequent cause of chronic knee pain than previously recognized. Autonomic abnormalities may be less intense in disease at this site, particularly in young females and may be overlooked. This characteristic of algodystrophy of the knee may contribute to chronicity and subsequent disability. PMID:2440509
Coughlan, R J; Hazleman, B L; Thomas, D P; Sattelle, L; Crisp, A J; Jenner, J R; Dandy, D J
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
In adults, chronicpain is by most people involved considered to be a serious disorder. Although\\u000achronic pain in adults is in general not life-threatening, a considerable amount of\\u000aliterature elucidates the large number of sufferers, the high cost to the person in question\\u000aand to the society as a whole, and the often crushing effects it has on personal
Eighty-eight patients (58 women and 30 men; mean age 53.4 years) with chronic non-cancer pain present on average for 9.8 years were evaluated following treatment with intrathecal opioids for an average duration of 36.2 months. Outcome measures were global pain relief, physical activity levels, medication consumption, work status, intrathecal opioid side-effects, proportion of patients who ceased therapy and patient satisfaction.
Lindy J. Roberts; Phillip M. Finch; C. Roger Goucke; Leanne M. Price
Dudgeon BJ, Gerrard BC, Jensen MP, Rhodes LA, Tyler EJ. Physical disability and the experience of chronicpain. Arch Phys Med Rehabil 2002;83:229-35. Objectives: To obtain an insider's view about disability-related pain to help rehabilitation clinicians understand the experience and to show how people with disability manage daily living and encounters with other people. Design: Qualitative methods by using open-ended
Brian J. Dudgeon; Beth C. Gerrard; Mark P. Jensen; Lorna A. Rhodes; Erica J. Tyler
Chronic back pain is among the most common patient complaints. Its prevalence and impact have spawned a rapidly expanding range of tests and treatments. Some of these have become widely used for indications that are not well-validated, leading to uncertainty about efficacy and safety, increasing complication rates, and marketing abuses. Recent studies document – over approximately a decade - a 629% increase in Medicare expenditures for epidural steroid injections; a 423% increase in expenditures for opioids for back pain; a 307% increase in the number of lumbar MRIs among Medicare beneficiaries; and a 220% increase in spinal fusion surgery rates. The limited studies available suggest that these increases have not been accompanied by population-level improvements in patient outcomes or disability rates. We suggest a need for a better understanding of the basic science of pain mechanisms; more rigorous and independent trials of many treatments; a stronger regulatory stance toward approval and post-marketing surveillance of new drugs and devices for chronicpain; and a chronic disease model for managing chronic back pain.
Deyo, Richard A.; Mirza, Sohail K.; Turner, Judith A.; Martin, Brook I.
Chronic back pain is among the most common patient complaints. Its prevalence and impact have spawned a rapidly expanding range of tests and treatments. Some of these have become widely used for indications that are not well validated, leading to uncertainty about efficacy and safety, increasing complication rates, and marketing abuses. Recent studies document a 629% increase in Medicare expenditures for epidural steroid injections; a 423% increase in expenditures for opioids for back pain; a 307% increase in the number of lumbar magnetic resonance images among Medicare beneficiaries; and a 220% increase in spinal fusion surgery rates. The limited studies available suggest that these increases have not been accompanied by population-level improvements in patient outcomes or disability rates. We suggest a need for a better understanding of the basic science of pain mechanisms, more rigorous and independent trials of many treatments, a stronger regulatory stance toward approval and post-marketing surveillance of new drugs and devices for chronicpain, and a chronic disease model for managing chronic back pain. PMID:19124635
Deyo, Richard A; Mirza, Sohail K; Turner, Judith A; Martin, Brook I
Study design:?Systematic reviewObjective:?To compare the safety and effectiveness of fusion versus denervation for chronic sacroiliac joint pain after failed conservative management.Summary of background:?Methods of confirming the sacroiliac joint as a pain source have been extensively studied and reported in the literature. After confirmation of the origin of the pain by positive local anesthetic blocks, chronic sacroiliac joint pain is usually managed with a combination of medication, physical therapies, and injections. We have chosen to compare two alternative treatments for sacroiliac pain that was refractory to conservative therapies.Methods:?A systematic review of the English-language literature was undertaken for articles published between 1970 and June 2010. Electronic databases and reference lists of key articles were searched to identify studies evaluating fusion or denervation for chronic sacroiliac joint pain after failed conservative management. Studies involving only conservative treatment or traumatic onset of injury were excluded. Two independent reviewers assessed the level of evidence quality using the grading of recommendations assessment, development and evaluation (GRADE) system, and disagreements were resolved by consensus.Results:?We identified eleven articles (six fusion, five denervation) meeting our inclusion criteria. The majority of patients report satisfaction after both treatments. Both treatments reported mean improvements in pain and functional outcome. Rates of complications were higher among fusion studies (13.7%) compared to denervation studies (7.3%). Only fusion studies reported infections (5.3%). No infections were reported among denervation patients. The evidence for all findings were very low to low; therefore, the relative efficacy or safety of one treatment over another cannot be established.Conclusions:?Sacroiliac joint fusion or denervation can reduce pain for many patients. Whether a true arthrodesis of the joint is achieved by percutaneous techniques is open to question and whether denervation of the joint gives durable pain relief is not clear. Further comparative studies of these two techniques may provide the answers. PMID:22956926
Ashman, Bryan; Norvell, Daniel C; Hermsmeyer, Jeffrey T
Study design:?Systematic review Objective:?To compare the safety and effectiveness of fusion versus denervation for chronic sacroiliac joint pain after failed conservative management. Summary of background:?Methods of confirming the sacroiliac joint as a pain source have been extensively studied and reported in the literature. After confirmation of the origin of the pain by positive local anesthetic blocks, chronic sacroiliac joint pain is usually managed with a combination of medication, physical therapies, and injections. We have chosen to compare two alternative treatments for sacroiliac pain that was refractory to conservative therapies. Methods:?A systematic review of the English-language literature was undertaken for articles published between 1970 and June 2010. Electronic databases and reference lists of key articles were searched to identify studies evaluating fusion or denervation for chronic sacroiliac joint pain after failed conservative management. Studies involving only conservative treatment or traumatic onset of injury were excluded. Two independent reviewers assessed the level of evidence quality using the grading of recommendations assessment, development and evaluation (GRADE) system, and disagreements were resolved by consensus. Results:?We identified eleven articles (six fusion, five denervation) meeting our inclusion criteria. The majority of patients report satisfaction after both treatments. Both treatments reported mean improvements in pain and functional outcome. Rates of complications were higher among fusion studies (13.7%) compared to denervation studies (7.3%). Only fusion studies reported infections (5.3%). No infections were reported among denervation patients. The evidence for all findings were very low to low; therefore, the relative efficacy or safety of one treatment over another cannot be established. Conclusions:?Sacroiliac joint fusion or denervation can reduce pain for many patients. Whether a true arthrodesis of the joint is achieved by percutaneous techniques is open to question and whether denervation of the joint gives durable pain relief is not clear. Further comparative studies of these two techniques may provide the answers.
Ashman, Bryan; Norvell, Daniel C.; Hermsmeyer, Jeffrey T.
Background Chronic groin pain, especially in professional sportsmen, is a difficult clinical problem.\\u000a \\u000a \\u000a \\u000a Methods From January 1999 to August 2005, 55 professional and semiprofessional sportsmen (53 males; mean age, 25 ± 4.5 years; range,\\u000a 17–36 years) with undiagnosed chronic groin pain were followed prospectively. All the patients underwent an endoscopic total\\u000a extraperitoneal (TEP) mesh placement.\\u000a \\u000a \\u000a \\u000a Results Incipient hernia was diagnosed in the study
R. N. van Veen; P. de Baat; M. P. Heijboer; G. Kazemier; B. J. Punt; R. S. Dwarkasing; H. J. Bonjer; C. H. J. van Eijck
Pain resulting from chronic pancreatitis is often debilitating and difficult to manage. Many approaches have been used to treat these patients, including narcotic analgesia, antidepressants, pancreatic enzymes, octreotide, denervation procedures, such as celiac plexus block, and various palliative, decompression, or drainage procedures. Many of these procedures can be performed endoscopically, while others require a more invasive, surgical approach. The effectiveness of these therapies is not only highly variable but also often controversial. This review will discuss the endoscopic options for pain management in patients with chronic pancreatitis and their utility in treating this difficult disease.
Evidence suggests that effective conservative treatment is available for chronic low back pain. The effectiveness of conservative treatment has recently received attention following publication of several randomized controlled trials (RCTs) that reported similar improvements in outcomes from cognitive intervention with exercise as from spinal fusion surgery. This paper will explore the conservative treatment arms of these RCTs with the goal of educating the reader about the principles of cognitive intervention with exercise. These principles can be incorporated into the care of chronic low back pain patients both as primary treatment and as a means of augmenting surgical outcomes.
Patients high in alientation and distrust may be poor compliers. Because only the somatic concern dimension predicted outcome, a single scale that measures this characteristic may be sufficient for effective identification of the potential good v poor responders to conservative treatment of low back pain. (Author)
Chronicpain is known as a complex and subjective phenomenon that challenges healthcare professionals who coach and support clients with chronicpain. The aim of this study was to explore how persons with chronicpain experienced their occupational performance. Eight persons suffering from chronicpain were interviewed and the data was analysed with the constant comparative method. Three themes were identified: "Performing is an ongoing attraction", "Getting used to taking breaks is not easy", and "The challenge to finish performing". "Performing is an ongoing attraction" illustrates the innate need of every human being to be active and also how pleasurable occupations do not influence pain. The ongoing thoughts and emotions while participants stop their performance are described in "Getting used to taking breaks is not easy". This stop and go during every occupation is discussed in the perspective of temporality and occupational performance. In "The challenge to finish performing" the participants describe how they complete certain occupations despite pain. This is discussed with the focus on distraction and flow experience. PMID:18982527
Evaluation of lower back pain (LBP) in terms of legal assessment is important since pain, as the most frequent symptom of diseases of the human musculoskeletal system, is a subjective sensation. Frequently, medical findings are not consistent with the subjective pain sensation. Because of multi-dimensional causes of (chronic) LBP and a high impact of psychosomatic comorbidity, the assessor has to prove all complaints of a test subject in terms of consistency with the (objective) findings. Therefore, it is often necessary to include psychosomatic aspects into the evaluation of multi-dimensional origins of LBP. PMID:23926699
Widespread pain and pain hypersensitivity are the hallmark of fibromyalgia, a complex pain condition linked to central sensitization. In this study the painDETECT questionnaire (PDQ), validated to identify neuropathic pain and based on pain quality items, was applied in a cross-sectional sample of patients with chronic widespread pain (CWP). The aims of the study were to assess the patient-reported sensory
Clinical observations suggest that many patients with chronicpain have difficulty forgiving persons they perceive as having unjustly offended them in some way. By using a sample of 61 patients with chronic low back pain, this study sought to determine the reliability and variability of forgiveness assessments in patients and to examine the relationship of forgiveness to pain, anger, and
James W. Carson; Francis J. Keefe; Veeraindar Goli; Anne Marie Fras; Thomas R. Lynch; Steven R. Thorp; Jennifer L. Buechler
Objective: Acceptance of pain and values-based action appear important in the emotional, physical, and social functioning of individuals with chronicpain. The purpose of the current study was to prospectively investigate these combined processes. Method: 115 patients attending an assessment and treatment course for chronicpain in the U.K. completed a standard set of measures on two occasions separated by
Preliminary evidence from a study using a modified Stroop paradigm suggests that individuals with chronicpain selectively attend to pain-related information. The current study was conducted in an attempt to replicate and extend this finding. Nineteen patients with chronicpain stemming from musculoskeletal injury and 22 healthy control subjects participated. All participants completed a computerised task designed to evaluate attentional
Gordon J. G Asmundson; Jenora L Kuperos; G Ron Norton
Interstitial cystitis and chronic prostatitis\\/chronic pelvic pain syndrome are clinical syndromes characterized by pelvic\\u000a pain with or without voiding symptoms such as urgency and frequency. There are many similarities in their epidemiology, adverse\\u000a effect on quality of life, etiology\\/pathophysiology, natural history, and response to similar treatments. However, overlapping\\u000a clinical definitions and similar entrance criteria for large-scale cohort studies make comparisons
Chronic low back pain (LBP) is an extremely common problem in practice, where it is often labeled idiopathic. No sufficient\\u000a studies have been conducted to analyze the contribution of hypovitaminosis D to the etiology of chronic LBP in populations\\u000a wherein vitamin D deficiency is endemic. The present study was, therefore, carried out to examine hypovitaminosis D and its\\u000a determinants in
Ahmed Lotfi; Ahmed M. Abdel-Nasser; Ahmed Hamdy; Ahmed A. Omran; Mahmoud A. El-Rehany
Chronic abdominal pain is a common feature of most functional gastrointestinal disorders in children, including functional abdominal pain (FAP) and irritable bowel syndrome (IBS). FAP can impair a child's life and often leads to significant school absences. Although the underlying mechanism is likely multifactorial, early pain experiences during a vulnerable period in the developing nervous system can cause long-term changes in the brain-gut axis and ultimately may result in altered pain pathways and visceral hyperalgesia. Care providers often feel uncomfortable managing patients with chronic abdominal pain, as the pathophysiology is poorly understood, and limited data exist regarding safety and efficacy of therapeutic options in children. The primary goal of therapy in FAP is to alleviate pain symptoms and to help the child return to normal daily activities. Treatment should be individualized and chosen based on the severity of symptoms, the existence of comorbid psychological disorders, and the impact the disorder has on the child's school attendance and normal functioning. Various psychological interventions, such as cognitive-behavioral therapy, hypnosis, and guided imagery, have been successfully used in children with chronic abdominal pain. Pharmacologic therapies such as H(2) blockers, proton-pump inhibitors, tricyclic antidepressants, and various serotonergic drugs have been used, but good controlled trials are lacking. More studies are clearly needed to investigate the benefits and safety of pharmacologic therapy in children. Newer pharmacologic agents that target specific receptors involved in nociception, stress, and neurogenic inflammation currently are being developed. Future targets for visceral hyperalgesia should not only be aimed at alleviating symptoms but also should include prevention, particularly in cases with a suspected sensitizing event such as neonatal pain and postinfectious IBS. PMID:16942666
Chronic tendon pain from overuse is a common condition, with limited options for ongoing pain management. Two cases are presented in which pulsed radio frequency energy (PRFE) therapy was used for pain relief following surgical intervention for chronic tendinopathy-associated pain, unresponsive to conventional therapies. Both patients showed a dramatic reduction in pain following PRFE therapy after 2 to 3 weeks of treatment, and at the 7-month (case 1) and 6-month (case 2) follow-up visits, both patients reported that pain had not returned. Recent molecular evidence suggests a possible mechanism underlying PRFE-mediated pain relief. Further study into this promising technology is warranted. PMID:23764157
As key players in multidisciplinary health care systems, geriatric social workers must understand the dynamics of pain management among older adults with chronicpain. This study identified perceived barriers to, and facilitators for, utilizing nonpharmacological pain management through face-to-face interviews with 44 ethnically diverse community-dwelling older adults. Constant comparative analysis identified barriers not recognized in prior studies: (a) embarrassment/self-consciousness, (b) unavailability of certain treatments, and (c) lack of faith in effectiveness of nonpharmacological treatments. Most frequently reported facilitators were (a) social support, (b) positive attitude, and (c) available resources. Social workers can provide counseling to motivate older adults to exercise to manage chronicpain and refer them to exercise programs tailored for older adults. To resolve the most frequently reported barrier-transportation-social workers can link older adults with transportation services offered by senior centers or other nonprofit agencies. PMID:23822640
Park, Juyoung; Hirz, Christina E; Manotas, Karen; Hooyman, Nancy
Objectives. This study was done to evaluate three bedside tests in discriminating visceral pain from somatic pain among women with chronic pelvic pain. Study Design. The study was an exploratory cross-sectional evaluation of 81 women with chronic pelvic pain of 6 or more months' duration. Tests included abdominal cutaneous allodynia (aCA), perineal cutaneous allodynia (pCA), abdominal and perineal myofascial trigger points (aMFTP) and (pMFTP), and reduced pain thresholds (RPTs). Results. Eighty-one women were recruited, and all women provided informed consent. There were 62 women with apparent visceral pain and 19 with apparent somatic sources of pain. The positive predictive values for pelvic visceral disease were aCA-93%, pCA-91%, aMFTP-93%, pMFTP-81%, and RPT-79%. The likelihood ratio (+) and 95% C.I. for the detection of visceral sources of pain were aCA-4.19 (1.46, 12.0), pCA-2.91 (1.19, 7.11), aMTRP-4.19 (1.46, 12.0), pMFTP-1.35 (0.86, 2.13), and RPT-1.14 (0.85, 1.52), respectively. Conclusions. Tests of cutaneous allodynia, myofascial trigger points, and reduced pain thresholds are easily applied and well tolerated. The tests for cutaneous allodynia appear to have the greatest likelihood of identifying a visceral source of pain compared to somatic sources of pain. PMID:22135736
Jarrell, John; Giamberardino, Maria Adele; Robert, Magali; Nasr-Esfahani, Maryam
There is increasing clinical evidence that reflex therapies such as massage, Gua Sha, cupping, wet packs, acupuncture etc. are helpful in reducing symptoms of chronicpain. However, the neurobiological basis of these effects has rarely been investigated even though the increasing knowledge of the pathophysiology of chronicpain syndromes allows for specific hypotheses. Reflex therapies are likely able to influence chronicpain at the level of the nociceptor and the spinal cord. Moreover, it can be speculated that these therapies have a strong impact on relaxation and maybe understood as a social, comforting interaction. Since it is well accepted that the positive effect of grooming has a neurobiological basis in non-human primates, its biosocial impact on wellbeing and pain processing in humans may be underestimated. A synopsis of the neurobiological foundations of pain perception, from the nociceptor up the spinal cord to brain mechanisms provides the basis for the investigation of the 'way of action' of reflex therapies. Specific hypotheses on their neurobiological bases and methods suitable for their investigation are outlined. Further clarification of the mechanisms of action of reflex therapies will support their clinical evidence and add to our understanding of the neurobiology of complementary medicine. PMID:18496023
One in five Canadians suffers from some form of persistent or chronicpain. The impact on individual lives, families and friends, the health services sector and the economy is huge. Reliable evidence is available that the burden of persistent pain can be markedly reduced when available knowledge is applied. Bridging the quality chasm between chronicpain and the care process will require a unique confluence of opinion from all stakeholders committed within a focused community of practice to address the impact of pain. Various levels of success in this regard have been demonstrated when there is exchange, synthesis and ethically sound application of research findings within a complex set of interactions among researchers and knowledge users. It is now critical to accelerate the capture of the benefits of research for Canadians through improved health, more effective and responsive services and products, and a strengthened health care system to bring about health reform and health care reform across Canada as it pertains to the one in five Canadians living with chronic, disabling pain. The overarching outcome of such an initiative needs to be promoted to sustain a balanced portfolio of curiosity-and needs-based research, which along with existing knowledge, can be mobilized and applied for the benefit of Canadians, the health care system and the economy.
Objective To evaluate factors predisposing women to chronic and recurrent pelvic pain. Design, data sources, and methods Systematic review of relevant studies without language restrictions identified through Medline, Embase, PsycINFO, Cochrane Library, SCISEARCH, conference papers, and bibliographies of retrieved primary and review articles. Two reviewers independently extracted data on study characteristics, quality, and results. Exposure to risk factors was compared
Pallavi Latthe; Luciano Mignini; Richard Gray; Robert Hills; Khalid Khan
|This commentary reviews the case of GH, a survivor of a road traffic collision, who has chronicpain and posttraumatic stress disorder (PTSD). The case formulation, assessment strategy, and treatment plan are informed by the relevant experimental literature and empirically supported treatments using a cognitive behavioral perspective. Given this…
There is considerable controversy in the literature regarding the extent to which chronicpain and depression are associated and the possible causal relationship of such an association. The present study examines these issues with a sample of 243 patients diagnosed with rheumatoid arthritis (RA) who were mailed questionnaires for six waves of data collection. The results indicated that RA patients
Sex differences in 351 patients with chronic low back pain were examined. Biological, psychological, and psychosocial factors were considered. Sex differences in adaptive functioning were consistent with traditional gender roles. Significant interactions were found for sex and employment status, and sex and marital status. Retired women reported…
Sheffer, Christine E.; Cassisi, Jeffrey E.; Ferraresi, Laurette M.; Lofland, Kenneth R.; McCracken, Lance M.
Behavioural symptoms such as abnormal emotionality (including anxious and depressive episodes) and cognition (for instance weakened decision-making) are highly frequent in both chronicpain 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
Recent research has indicated that depressed chronic low back pain (CLBP) patients exhibit high levels of cognitive distortion. Among CLBP patients, elevated depression scores can occur in the presence of either a somatizing presentation or a pattern of general dysphoria. The present study of 138 CLBP patients indicated that cognitive distortion was associated with high scores on the Minnesota Multiphasic
Timothy W. Smith; Edward W. Aberger; Michael J. Follick; David K. Ahern
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
Objectives: The objectives of this study were to provide estimates of the prevalence and strength of association between major depression and chronicpain 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
Chronic pelvic pain is a common problem presenting a major challenge to healthcare professionals. This is partly due to the lack of understanding of the aetiology and natural history of the disease. This condition is best managed using a multidisciplinary approach. In recent years, the emphasis in the clinical management has tended towards psychosocial or psychosexual involvement after organic disease
The aim of this study was to investigate the relationship between demographic, mood, physical and coping factors, and alcohol use in people experiencing chronicpain. It was hypothesised that a combined model would be more effective in explaining the variance in alcohol use than any single block of predictors individually. The study was cross-sectional in nature. Self-report measures of demographic
A clinical study tested the therapeutic efficacy of Botulinum toxin A (BTXA) when injected into symptomatic neck muscles after one injection session. Patients with chronic neck pain were randomly assigned to receive either a high dose of an active treatment or an injection of the same volume of normal saline. Patients were compared for 4 months using a comprehensive set
Anthony H. Wheeler; Paula Goolkasian; Stephanie S. Gretz
For those of us who have read the 2 recently published articles by a Danish - British research group, it might appear that we are observing an impending paradigm shift on the origins of chronic low back pain. The results of this research indicate, that chronic low back pain associated with bone marrow edema in vertebral endplates that are adjacent to herniated intervertebral discs may be caused by infections with anaerobic bacteria of low virulence. According to these articles, treatment with certain antibiotics is significantly more effective than placebo against this low back pain. If these findings are to hold true in repeat studies by other researchers, they stand to fundamentally change our concepts of low back pain, degenerative disc disease and in consequence the suitable therapies for these entities. It may in fact require pain specialists to become familiarized with the details of antibiotic treatments and their specific risks in order to be able to properly counsel their patients. While this seems hard to believe at first glance, bacteria have been implicated in the pathogenesis of other conditions that do not primarily impose as infectious diseases such as gastric ulcers. While the authors refer to a few previous studies pointing into the same direction, the relevant research is really only from one group of collaborating scientists. Therefore, before we start prescribing antibiotics for chronic low back pain, it is imperative that other researchers in different institutions confirm these results.
Transient receptor potential vanilloid type 1 (TRPV1) receptor is a non selective ligand-gated cation channel activated by capsaicin, heat, protons and endogenous lipids termed endovanilloids. As well as peripheral primary afferent neurons and dorsal root ganglia, TRPV1 receptor is also expressed in spinal and supraspinal structures such as those belonging to the endogenous antinociceptive descending pathway which is a circuitry of the supraspinal central nervous system whose task is to counteract pain. It includes periaqueductal grey (PAG) and rostral ventromedial medulla (RVM) whose activation leads to analgesia. Such an effect is associated with a glutamate increase and the activation of OFF and inhibition of ON cell population in the rostral ventromedial medulla (RVM). Activation of the antinociceptive descending pathway via TPRV1 receptor stimulation in the PAG may be a novel strategy for producing analgesia in chronicpain. This review will summarize the more recent insights into the role of TRPV1 receptor within the antinociceptive descending pathway and its possible exploitation as a target for new pain-killer agents in chronicpain conditions, with particular emphasis on the most untreatable pain state: neuropathic pain.
There currently is a clinical need for an objective technique to assess muscle dysfunction associated with chronic lower back pain. A Back Analysis System for objectively measuring local fatigue in the back extensor muscles is presented. The reliability and validity of this technique was evaluated by testing chronic low-back pain patients and control subjects without back pain. Concurrent surface electromyograms (EMG) were detected from multiple back muscles during sustained isometric contractions at different force levels of trunk extension. Median frequency parameters of the EMG power density spectrum were monitored to quantify localized muscle fatigue. Results indicated: 1) high reliability estimates for repeated trials; 2) significant differences (P less than 0.05) in median frequency parameters between lower back pain patients and control subjects for specific combinations of contractile force level and muscle site tested; 3) Median Frequency parameters correctly classified lower back pain and control subjects using a two-group discriminant analysis procedure. The applicability of this technique as a treatment outcome measure and diagnostic screening method for lower back pain patients is discussed. PMID:2528828
Neuropathic pain, as a chronicintractablepain, is well known to be difficult in prevention, diagnosis and treatment. Especially, neuropathic pain from different causes has each characteristics for prevention, diagnosis and treatment. These include post-herpetic pain, persistent chronicpain following traffic accident, pain after peripheral nerve injury in venipuncture, phantom limb pain originating from dysfunction of the primary motor cortex, pain from failed back surgery syndrome, and diabetic neuropathy, and are helpful for understanding prevention, diagnosis and treatment of neuropathic pain. PMID:21077299
Prolonged, chronicpain after surgery is a very common phenomenon that has been underrecognized until recently. A number of risk factors and predictors (including the surgical procedure, age, gender, pre- and postoperative pain, psychosocial factors, genes and pain modulation variables) have been identified in the past years. Together with an increased knowledge about the pathophysiology of chronicpain after surgery, we may be able to develop successful drugs or interventions modifying the disease in subgroups of patients in the near future. However to date there is only little information about successful drugs or approaches which can be recommended to prevent chronicpain after surgery successfully. One of the reasons is the inadequacy of trial design and lack of prospective studies. Single RTCs show for example positive results with perioperative pregabalin for 30 days after total knee arthroplasty or short-term ketamine intravenously after open colon surgery. However, others have failed to show an effect after other procedures with similar drugs and treatment approaches. Positive results are consistently shown with regional anesthesia techniques perioperatively (for example epidural analgesia after thoracic surgery of paravertebral block after mastectomy). However, again, convincing evidence for certain treatment protocols (start and duration of regional anesthesia techniques) to get optimal results are limited at most. Thus, we are left with speculative effects after certain surgeries and may rely--at least to date--more on analgesic rather than disease related treatment approaches. Future studies with a standardized study design recognizing patient characteristics are highly needed to make progress and find drugs, strategies and approaches which can be applied to certain groups of patients to prevent the development of chronicpain after surgery successfully. PMID:20665361
Objective To evaluate factors predisposing women to chronic and recurrent pelvic pain. Design, data sources, and methods Systematic review of relevant studies without language restrictions identified through Medline, Embase, PsycINFO, Cochrane Library. SCISEARCH, conference papers, and bibliographies of retrieved primary and review articles. Two reviewers independently extracted data on study characteristics, quality, and results. Exposure to risk factors was compared between women with and without pelvic pain. Results were pooled within subgroups defined by type of pain and risk factors. Results There were 122 studies (in 111 articles) of which 63 (in 64 286 women) evaluated 54 risk factors for dysmenorrhoea, 19 (in 18 601 women) evaluated 14 risk factors for dyspareunia, and 40 (in 12 040 women) evaluated 48 factors for non-cyclical pelvic pain. Age < 30 years, low body mass index, smoking, earlier menarche (< 12 years), longer cycles, heavy menstrual flow, nulliparity, premenstrual syndrome, sterilisation, clinically suspected pelvic inflammatory disease, sexual abuse, and psychological symptoms were associated with dysmenorrhoea. Younger age at first childbirth, exercise, and oral contraceptives were negatively associated with dysmenorrhoea. Menopause, pelvic inflammatory disease, sexual abuse, anxiety, and depression were associated with dyspareunia. Drug or alcohol abuse, miscarriage, heavy menstrual flow, pelvic inflammatory disease, previous caesarean section, pelvic pathology, abuse, and psychological comorbidity were associated with an increased risk of non-cyclical pelvic pain. Conclusion Several gynaecological and psychosocial factors are strongly associated with chronic pelvic pain. Randomised controlled trials of interventions targeting these potentially modifiable factors are needed to assess their clinical relevance in chronic pelvic pain.
Latthe, Pallavi; Mignini, Luciano; Gray, Richard; Hills, Robert; Khan, Khalid
Background The intersection of pain, addiction and mental health has not been adequately described. We describe the roles of these three conditions in a chronicpain patient population using opioid analgesics. Aims were to improve our understanding of this population as well as to explore ways of identifying different types of patients. Methods We conducted a retrospective cohort study in a large integrated group medical practice in Washington State with persons using opioids chronically (n=704). Patient classes were derived with latent class analysis using factors representing DSM-IV opioid abuse and dependence, opioid misuse, pain, anxiety and depression. Regression analyses explored the utility of automated and interview data to distinguish the empirically-derived patient groups. Results Three classes were identified: a Typical group, the substantial majority that had persistent, moderate mental health and pain symptoms; an Addictive Behaviors group with elevated mental health symptoms and opioid problems, but pain similar to the Typical class; and a Pain Dysfunction class with significantly higher pain interference as well as elevated mental health and opioid problems. Prescribed average daily dose of opioids was three times higher for those in the two atypical groups and was strongly associated with class membership after adjusting for other variables. Conclusion We describe three distinct types of patient classes as well as data elements that could help identify the two atypical types. Further research is needed to confirm these findings and determine the utility of this approach in other clinical settings.
Banta-Green, Caleb J.; Merrill, Joseph O.; Doyle, Suzanne R.; Boudreau, Denise M.; Calsyn, Donald A.
Emerging evidence suggests that some individuals with regional pain disorders go on to develop chronic widespread pain (CWP). However, the mechanism behind this transition and nature of risk factors that predispose a person to develop CWP remain to be elucidated. The purpose of this study was to describe the frequency with which participants with chronic back or neck pain develop CWP and to determine the risk factors associated with this development. In a sample of 512 individuals, we found that nearly a quarter (22.6%) of subjects who presented with regional back or neck pain in 2001/2002 had developed CWP by 2007. Logistic regression indicated that seven factors were associated with the transition to CWP: moderate or severe pain intensity, female gender, history of abuse, family history of CWP, severe interference with general activity, having one or more central sensitivity syndromes, and using more pain management strategies. History of abuse was not significant in multivariate analysis. Notably number of depressive symptoms endorsed, pain duration, age, body mass index, number of medication classes used, and receipt of disability benefits were not significantly associated with this transition.
Kindler, Lindsay L.; Jones, Kim D.; Perrin, Nancy; Bennett, Robert M.
Objective: To examine the factorial structure of the Chinese translation of the Pain Self-Efficacy Questionnaire in a sample of Chinese patients with chronicpain.Setting: Outpatient physiotherapy department in a local hospital and a local rehabilitation clinic.Participants: One hundred and twenty patients with chronicpain in physiotherapy treatment.Methods: Each participant was asked to complete the Chinese version of the Pain Self-Efficacy
This study tested for alpha-2 adrenergic mediation of the inverse relationship between resting blood pressure and acute pain\\u000a sensitivity in healthy individuals. It also replicated limited prior work suggesting this inverse blood pressure\\/pain association\\u000a is altered in chronicpain, and provided the first test of whether chronicpain-related changes in alpha-2 adrenergic function\\u000a contribute to these alterations. Resting blood pressure
Stephen Bruehl; Ok Y. Chung; Laura Diedrich; André Diedrich; David Robertson
Chronic perineal pain is the anorectal and perineal pain without underlying organic disease, anorectal or endopelvic, which has been excluded by careful physical examination, radiological and endoscopic investigations. A variety of neuromuscular disorders of the pelvic floor lead to the different pathological conditions such as anorectal incontinence, urinary incontinence and constipation of obstructed defecation, sexual dysfunction and pain syndromes. The most common functional disorders of the pelvic floor muscles, accompanied by perineal pain are levator ani syndrome, proctalgia fugax, myofascial syndrome and coccygodynia. In the diagnosis of these syndromes, contributing to a thorough history, physical examination, selected specialized investigations and the exclusion of organic disease with proctalgia is carried out. Accurate diagnosis of the syndromes helps in choosing an appropriate treatment and in avoiding unnecessary and ineffective surgical procedures, which often are performed in an attempt to alleviate the patient's symptoms. PMID:21079515
Background Prevalence of pain as a recurrent symptom in children is known to be high, but little is known about children with high impairment from chronicpain seeking specialized treatment. The purpose of this study was the precise description of children with high impairment from chronicpain referred to the German Paediatric Pain Centre over a 5-year period. Methods Demographic variables, pain characteristics and psychometric measures were assessed at the first evaluation. Subgroup analysis for sex, age and pain location was conducted and multivariate logistic regression applied to identify parameters associated with extremely high impairment. Results The retrospective study consisted of 2249 children assessed at the first evaluation. Tension type headache (48%), migraine (43%) and functional abdominal pain (11%) were the most common diagnoses with a high rate of co-occurrence; 18% had some form of musculoskeletal pain disease. Irrespective of pain location, chronicpain disorder with somatic and psychological factors was diagnosed frequently (43%). 55% of the children suffered from more than one distinct pain diagnosis. Clinically significant depression and general anxiety scores were expressed by 24% and 19% of the patients, respectively. Girls over the age of 13 were more likely to seek tertiary treatment compared to boys. Nearly half of children suffered from daily or constant pain with a mean pain value of 6/10. Extremely high pain-related impairment, operationalized as a comprehensive measure of pain duration, frequency, intensity, pain-related school absence and disability, was associated with older age, multiple locations of pain, increased depression and prior hospital stays. 43% of the children taking analgesics had no indication for pharmacological treatment. Conclusion Children with chronicpain are a diagnostic and therapeutic challenge as they often have two or more different pain diagnoses, are prone to misuse of analgesics and are severely impaired. They are at increased risk for developmental stagnation. Adequate treatment and referral are essential to interrupt progression of the chronicpain process into adulthood.
Avoidance of painful activities has been proposed to be an important n'sk factor for the initiation and maintenance of chronic low back suffering, whereas exposure to these activities has been suggested to be beneficial for recovery. In a cross-sectional study, the differences between chronic patients with avoidant and confrontational styles were investigated using self-report measures and a behavioral test. Participants
Geert Crombez; Leen Vervaet; Roland Lysens; Frank Baeyens; Paul Eelen
Opioids have been regarded for millennia as among the most effective drugs for the treatment of pain. Their use in the management of acute severe pain and chronicpain related to advanced medical illness is considered the standard of care in most of the world. In contrast, the long-term administration of an opioid for the treatment of chronic noncancer pain
Andrew Rosenblum; Lisa A. Marsch; Herman Joseph; Russell K. Portenoy
Do patients with chronicpain selectively process pain- and illness-related stimuli? The evidence with regard to attention, interpretation, and recall biases is critically reviewed. A model is proposed to account for the findings in which it is suggested that biases in information processing in chronicpain are the result of overlap between 3 schemas: pain, illness, and self. With frequent
OBJECTIVES:Chronic pancreatic pain is difficult to treat. Surgical and medical therapies directed at reducing pain have met with little long-term success. In addition, there are no reliable predictors of response including pancreatic duct diameter. A differential neuroaxial blockade allows characterization of chronic abdominal pain into visceral and nonvisceral pain origins and may be useful as a guide to the treatment.
Darwin L. Conwell; John J. Vargo; Gregory Zuccaro; Teresa E. Dews; Nagy Mekhail; Judith Scheman; R. Matthew Walsh; Sharon F. Grundfest-Broniatowski; John A. Dumot; Steven S. Shay
Aim: To examine the nature, prevalence and impact of chronicpain 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: Chronicpain was reported in 13% of the sample (n = 21), 6.3% had pain in two sites and 2% had pain in…
Background: It has been reported that local thermal therapy with a hot pack or paraffin relieves pain. We hypothesized that systemic warming may decrease pain and improve the outcomes in patients with chronicpain. The purpose of this study was to clarify the effects of systemic thermal therapy in patients with chronicpain. Methods: Group A (n = 24) patients
There has been a need for a brief assessment tool for providers who treat chronicpain patients to determine potential risk of abuse when prescribed opioids for pain. The purpose of this study was to develop and begin the validation of a self-administered screening tool (Screener and Opioid Assessment for Patients with Pain, SOAPP) for chronicpain patients considered for
Stephen F. Butler; Simon H. Budman; Kathrine Fernandez; Robert N. Jamison
This literature review explores the potential of genomics to explain, or at least contribute to the discussion about, heterogeneity in chronicpain in sickle-cell disease (SCD). Background: Adults with SCD, a single-gene disorder, are living longer than in years past, yet report being burdened by chronicpain. With only a few studies on chronicpain in this population, the epidemiology
A preliminary study was undertaken to determine both the efficacy and cost effectiveness of the Feldenkrais Method for treatment of Medicaid recipients with chronicpain at the Santa Barbara Regional Health Authority (SBRHA). SBRHA staff wished to offer treatment for chronicpain patients beyond what is provided for in the Medicaid scope of benefits. Conventional intensive chronicpain treatment programs
Racial and ethnic minorities, older people, and women are differentially affected by chronicpain. This study aimed to identify the experiences of adult African Americans and whites with chronicpain while identifying patient clusters on the basis of clinical characteristics as well as race, age, and gender influences within and between clusters. Three clusters of patients with chronicpain were
Carmen R Green; S. Khady Ndao-Brumblay; Andrew M Nagrant; Tamara A Baker; Edward Rothman
Acceptance of chronicpain has become an important concept in understanding and predicting that chronicpain sufferers can remain engaged with meaningful aspects of life. Assessment of acceptance has been facilitated by the development of ChronicPain Acceptance Questionnaire (CPAQ). In this study, we aimed to test the reliability and validity of translated Chinese version of CPAQ to use this
Michelle Cheung Ning; Tony Wong Chi Ming; Jacqueline Yap Chooi Mae; Chen Phoon Ping
Chronic osteoarthritis (OA) pain of the knee is often not effectively managed with current non-pharmacological or pharmacological treatments. Radiofrequency (RF) neurotomy is a therapeutic alternative for chronicpain. We investigated whether RF neurotomy applied to articular nerve branches (genicular nerves) was effective in relieving chronic OA knee joint pain. The study involved 38 elderly patients with (a) severe knee OA
Discusses psychological and behavioral interventions used to help clients deal with chronicpain from the standpoint of clients' relationship to the physiology of chronicpain. Claims when both mental health counselor and client have good understanding of physiology of chronicpain, the shared knowledge can be effectively applied to maximize…
OBJECTIVE: This study examined medical resource consumption by patients with chronic and breakthrough pain (BTP) who were using transdermally-delivered fentanyl for the management of chronicpain. Patients were participants in a broader survey designed to collect clini- cal and economic information regarding their pain. METHODS: Surveys were administered to cancer and non-cancer patients with chronic and BTP to assess medical
Aims: To describe and quantify impairment in an outpatient population of children with chronicpain 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.
Konijnenberg, A; Uiterwaal, C; Kimpen, J; van der Hoeven, J; Buitelaar, J; de Graeff-Meeder, E R
There are still many things to be found out about interstitial cystitis/painful bladder syndrome (IC/PBS) because the pathological processes underlying the condition are not yet elucidated, biological markers of the condition are not yet available, and the type and severity of symptoms can vary, so, clearly defining the condition is not yet possible. For example, it is not clearly understood whether IC/PBS represents a systemic disease, if it is localized in the bladder, or if it was initially localized in the bladder and it later evolved into a systemic disease. This condition is best managed by using a multidisciplinary approach. Management requires a good integration and knowledge of all pelvic organ systems and other systems including musculoskeletal, neurologic, and psychiatric systems.
Cauni, V; Gutue, S; Blaj, I; Jinga, V; Geavlete, P
There are still many things to be found out about interstitial cystitis/painful bladder syndrome (IC/PBS) because the pathological processes underlying the condition are not yet elucidated, biological markers of the condition are not yet available, and the type and severity of symptoms can vary, so, clearly defining the condition is not yet possible. For example, it is not clearly understood whether IC/PBS represents a systemic disease, if it is localized in the bladder, or if it was initially localized in the bladder and it later evolved into a systemic disease. This condition is best managed by using a multidisciplinary approach. Management requires a good integration and knowledge of all pelvic organ systems and other systems including musculoskeletal, neurologic, and psychiatric systems. PMID:20968203
An elderly gentleman presented to hospital with recurrent blackout episodes consistent with syncope and a 3-month history of right ear pain. Significant postural hypotension was recorded. White cell count and C reactive protein were elevated. MRI of the head and neck revealed a soft tissue abnormality in the right nasopharynx and base of skull. Tissue biopsies were obtained and microbiology specimens revealed a mixed growth of pseudomonas and diphtheroids. There was no histological evidence of malignancy. A diagnosis of skull base infection was made. Infective involvement of the carotid sinus was considered to be the cause of the recurrent syncope and postural hypotension. The patient responded well to a 12-week course of intravenous meropenem. Inflammatory markers returned to normal and a repeat MRI after 3 months of treatment showed significant resolution of infection. The syncopal episodes and orthostatic hypotension resolved in parallel with treatment of infection.
Clegg, Andrew; Daverede, Luis; Wong, Winson; Loney, Elizabeth; Young, John
Chronic, noncancer pain such as that associated with osteoarthritis of the hip and knee is typically managed according to American College of Rheumatology guidelines. Patients unresponsive to first-line treatment with acetaminophen receive nonsteroidal antiinflammatory drugs (NSAIDs), including cyclooxygenase-2 (COX-2) inhibitors. However, many patients may have chronicpain that is refractory to these agents, or they may be at risk for the gastrointestinal, renal, and cardiovascular complications associated with their use. Tramadol, a mild opioid agonist and norepinephrine and serotonin reuptake inhibitor, is recommended by current guidelines for the treatment of moderate to moderately severe pain in patients who have not responded to previous oral therapy, or in patients who have contraindications to COX-2 inhibitors and nonselective NSAIDs. An extended-release (ER) formulation of tramadol was approved by the US Food and Drug Administration in September 2005. In contrast with immediate-release (IR) tramadol, this ER formulation allows once-daily dosing, providing around-the-clock analgesia. In clinical studies, tramadol ER has demonstrated a lower incidence of adverse events than that reported for IR tramadol. Unlike nonselective NSAIDs and COX-2 inhibitors, tramadol ER is not associated with gastrointestinal, renal, or cardiovascular complications. Although tramadol is an opioid agonist, significant abuse has not been demonstrated after long-term therapy. It is concluded that tramadol ER has an efficacy and safety profile that warrants its early use for the management of chronicpain, either alone or in conjunction with nonselective NSAIDs and COX-2 inhibitors.
This study pertains to the 71 patients who had received a diagnosis of cervico-brachial pain syndrome after thorough clinical examination of a total series of 300 patients, who had been referred to the National Insurance Hospital in Tranås because of chronic neck pain that interfered with their ability to work. Changes in trapezius muscle blood flow and EMG were examined and related to the anamnesis and physical findings. The microcirculation in the upper part of the right and left trapezius muscles was examined simultaneously by using optical laser-Doppler single-fibres after insertion into the muscle directly via the skin. Continuous recordings were made during stepwise increased static contraction determined electro-myographically. Signal processing was performed on-line by computer. MRT of the cervical spine was performed in 12 patients. None showed nerve root affliction. Ten showed a bulging intervertebral disc and two, a narrowed nerve hole (lateral stenosis). The muscle blood flow (LDF) was significantly lower in the most painful side compared with the opposite side in the group of 41 patients with predominantly unilateral pain (21 women and 20 men). A lowered blood flow was also found when the 21 females in this group was compared with a normal control group of 20 healthy women. The patients had lower rms-EMG and EMG mean power frequency (MPF) in the painful side compared with the opposite side. A further lowering of the MPF was observed with induced fatigue. It was concluded that the chronic neck pain in cervico-brachial syndrome can become visualized by the finding of lowered blood flow of the trapezius muscle which seems to be an expression of the chronic neck pain. PMID:9659729
Larsson, R; Cai, H; Zhang, Q; Oberg, P A; Larsson, S E
Assessing chronic widespread pain (CWP) and its impact on physical, emotional and social function requires multidimensional qualitative and health-related quality of life (HRQL) instruments. The recommendations of the Initiative on Methods, Measurement, and Pain Assessment in Clinical Trials (IMMPACT) concerning outcome measurements for pain trials are useful for making routine assessments, the most significant of which include pain, fatigue, disturbed sleep, physical functioning, emotional functioning, patient global ratings of satisfaction and HRQL. However, despite the growing spread of instruments and theoretical publications devoted to measuring the various aspects of chronicpain, there is little widespread agreement, and no unified approach has yet been devised. There is therefore still considerable scope for the development of consensus around a core set of measures and response criteria, as well as for the development and refinement of the related instruments, standardised assessor training, the cross-cultural adaptation of health status questionnaires, electronic data capture and the introduction of valid, reliable and responsive standardised quantitative measurements into routine clinical care. Clinicians need to be aware of the psychometric properties of the instruments used, including their levels of imprecision and minimum clinically important differences (those indicating a meaningful change in clinical status). This article reviews a selection of the instruments used to assess CWP patients, including validated newly developed and well-established screening instruments, and discusses their advantages and limitations. PMID:22094200
Direct central nervous system (CNS) analgesic delivery is a useful option when more traditional means of dealing with chronicpain fail. Solutions containing local anesthetic have been effective in certain disease states, particularly in patients suffering from intractable head and neck pain. This review discusses historical aspects of CNS drug delivery and the role of intrathecal bupivacaine-containing solutions in refractory head and neck pain patients.
Belverud, Shawn A; Mogilner, Alon Y; Schulder, Michael
control of the persistent, baseline component of chronicpain, are char- acterized by a slow onset of action and a pharmacokinetic profile with minimal peaks and valleys that result in stable blood levels over the dose period. 1 This class of opioids includes transdermal fentanyl; methadone; morphine controlled-release (CR), sustained-release, and extended- release (ER); oxycodone CR; tramadol ER; and oxymorphone
We are one-year into the three-years of our research program into the immunogenetic and drug exposure factors that contribute to chronicpain following spinal cord injury. Owing to the planned data collection timeline of the 2 studies in this program we h...
J. Clark J. Coller J. Middleton M. Hutchinson R. Marshall
Psychosocial treatments for chronicpain 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
Evidence that patients with chronicpain selectively attend to pain-related stimuli presented in modified Stroop and dot-probe paradigms is mixed. The pain-related stimuli used in these studies have been primarily verbal in nature (i.e., words depicting themes of pain). The purpose of the present study was to determine whether patients with chronicpain, relative to healthy controls, show selective attention for pictures depicting painful faces. To do so, 170 patients with chronicpain and 40 age- and education-matched healthy control participants were tested using a dot-probe task in which painful, happy, and neutral facial expressions were presented. Selective attention was denoted using the mean reaction time and the bias index. Results indicated that, while both groups shifted attention away from happy faces (and towards neutral faces), only the control group shifted attention away from painful faces. Additional analyses were conducted on chronicpain participants after dividing them into groups on the basis of fear of pain/(re)injury. The results of these analyses revealed that while chronicpain patients with high and low levels of fear both shifted attention away from happy faces, those with low fear shifted attention away from painful faces, whereas those with high fear shifted attention towards painful faces. These results suggest that patients with chronicpain selectively attend to facial expressions of pain and, importantly, that the tendency to shift attention towards such stimuli is positively influenced by high fear of pain/(re)injury. Implications of the findings and future research directions are discussed. PMID:19201094
Somatic focus refers to the tendency to notice and report physical symptoms, and has been investigated in relation to chronicallypainful conditions. This study investigated the relationship between somatic focus, as measured by the Pennebaker Inventory of Limbic Languidness (PILL), negative affect and pain. A secondary purpose of the present study was to examine sex differences in these relationships. Participants included 280 chronicpain patients (69.6% females, 88.9% Caucasian), who completed a battery of self-report measures on somatic focus, pain, negative affect, coping, and dysfunction. Results for the overall sample revealed that the PILL shares considerable variance with measures of negative affect, particularly with the physiological components of anxiety and depression. When the results were analyzed separately for male and female patients, it was found that several components of negative affect and cognitive factors play a stronger role in predicting somatic focus among men compared to women. Additional analyses then examined whether somatic focus was predictive of male and female patients’ pain reports. Results indicated that somatic focus explained a small, but unique amount of variance in female patients’ pain reports, which differed from the relationship observed among male patients.
O'Brien, Erin M.; Atchison, James W.; Gremillion, Henry A.; Waxenberg, Lori B.; Robinson, Michael E.
Somatic focus refers to the tendency to notice and report physical symptoms, and has been investigated in relation to chronicallypainful conditions. This study investigated the relationship between somatic focus, as measured by the Pennebaker Inventory of Limbic Languidness (PILL), negative affect and pain. A secondary purpose of the present study was to examine sex differences in these relationships. Participants included 280 chronicpain patients (69.6% females, 88.9% Caucasian), who completed a battery of self-report measures on somatic focus, pain, negative affect, coping, and dysfunction. Results for the overall sample revealed that the PILL shares considerable variance with measures of negative affect, particularly with the physiological components of anxiety and depression. When the results were analyzed separately for male and female patients, it was found that several components of negative affect and cognitive factors play a stronger role in predicting somatic focus among men compared to women. Additional analyses then examined whether somatic focus was predictive of male and female patients' pain reports. Results indicated that somatic focus explained a small, but unique amount of variance in female patients' pain reports, which differed from the relationship observed among male patients. PMID:17524684
O'Brien, Erin M; Atchison, James W; Gremillion, Henry A; Waxenberg, Lori B; Robinson, Michael E
Chronic pelvic pain is a common gynecologic complaint, affecting about 5% of American women. The differential diagnosis is broad, including many medical diseases, surgical indications, musculoskeletal problems, and somatic dysfunction. Women are more affected than men by pelvic pain because their bodies are subject to more changes. These changes include a cyclic hormonal milieu, major alterations in biomechanics during pregnancy, psychosocial stress, and other modifications during childrearing, and more adjustments during menopause. Both medical and surgical approaches to management exist, but integrative modes of therapy address the body-mind-spirit continuum. Osteopathic manipulative treatment is a valuable option for many affected women from childbirth to menopause. PMID:16249362
Acute ankle and hindfoot injuries are common in athletes and typically are treated conservatively. Persistent pain that has not responded to appropriate conservative treatment and prevents the patient from returning to play is more problematic for the athlete and the treating sports clinician. Making a specific clinical and imaging diagnosis in these patients can be quite challenging. This article discusses the imaging evaluation of chronic ankle and hindfoot pain related to osseous and soft-tissue injuries in athletes. MR imaging is the preferred imaging modality in most of the presented cases. PMID:18440477
Background In animal models, the impact of social and environmental manipulations on chronicpain 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 chronicpain patients well after the establishment of chronicpain. Enrichment is a potentially inexpensive, safe and easily implemented non-pharmacological intervention for the treatment of chronicpain.
The present investigation sought to examine the relation between specific types of chronic musculoskeletal pain and cigarette smoking among a large representative sample of adolescents and adults residing in Canada. Specifically, we examined the relations between chronic back pain, arthritis, and daily smoking status. As predicted, individuals with chronic back pain were more likely to smoke than those without chronic back pain or arthritis; this association remained significant after controlling for sociodemographics and any lifetime anxiety or mood disorder. An opposite, albeit less robust, association was evident for the prescence of lifetime arthritis and smoking. Future work is needed to better understand the mechainisms underlying the association between chronicpain and smoking.
Zvolensky, Michael J.; McMillan, Katherine A.; Gonzalez, Adam; Asmundson, Gordon J. G.
Parent perceptions of and responses to pain have been identified as important factors in understanding pain-related disability among children and adolescents with chronicpain. The ability to accept chronicpain rather than focus on ways to avoid or control it has been linked to positive outcomes in chronicpain research. To examine parent beliefs about child acceptance of pain, the ChronicPain Acceptance Questionnaire, parent report (CPAQ-P), was developed and administered to 195 parents of children with persistent pain evaluated in a multidisciplinary pain clinic. Analyses support the internal consistency of the CPAQ-P (?=.89) and 1-month stability estimates were acceptable for the total scale score (?=.72), and results suggest some responsivity to change. Exploratory factor analysis identified a 2-factor model with 4 items removed from the original 20-item measure. Confirmatory factor analysis strongly supported the modified version. For construct validity, parent beliefs about child acceptance were negatively correlated with parent pain catastrophizing and parent fear of pain. Greater acceptance was also negatively associated with protective parent responses to pain. These results support the CPAQ-P as a promising measure for assessing parent beliefs about child acceptance of pain and reinforce the importance of the social context and parental influence on child functioning. PMID:21783324
Simons, Laura E; Sieberg, Christine B; Kaczynski, Karen J
The management of chronicpain in sportsmen and women requires consideration of a wide differential diagnosis. A syndrome caused by a distension of the posterior inguinal wall is described, effectively an early direct inguinal hernia. The diagnosis can be made from certain aspects of the history and examination, which are described. The results of surgical repair to the posterior inguinal wall are excellent. The procedure was carried out on 14 sportsmen and one woman. There is an 87% return to full sporting activity, with a follow-up of 18 months to 5 years. The remaining 13% were improved by the repair. Many of the athletes had received other treatments without success. The sports hernia should be high on the list of differential diagnoses in chronic groin pain.
OBJECTIVE To estimate the relationship between the presence of vulvodynia, fibromyalgia, interstitial cystitis, and irritable bowel syndrome. METHODS Validated questionnaire-based screening tests for the four pain conditions were completed by women with and without vulvodynia who were participating in the Michigan Woman to Woman Health Study -- a longitudinal population-based survey in southeastern Michigan. Weighted population-based estimates of the prevalence and characteristics of participants with these chronic comorbid pain conditions were calculated using regression analyses. RESULTS Of 1,940 women who completed the survey containing all four screening tests, 1,890 (97.4%) answered all screening questions and were included. The prevalences of the screening-based diagnoses ranged from 7.5% (95% CI 6.2, 9.0) for interstitial cystitis, 8.7% (95% CI 7.3, 10.4) for vulvodynia, 9.4% (95% CI 8.1, 11.0) for irritable bowel syndrome, to 11.8% (95% CI 10.1, 13.7) for fibromyalgia, with 27.1% screening positive for multiple conditions. The presence of vulvodynia was associated with the presence of each of the other comorbid pain conditions (p<0.001, OR = 2.3 to 3.3). Demographic risk factors for each condition varied. Increasing age was not associated with greater numbers of comorbid conditions, and only low socioeconomic status was associated with having multiple comorbid conditions concurrently. CONCLUSIONS Chronicpain conditions are common, and a subgroup of women with vulvodynia is more likely than those without vulvodynia to have one or more of the three other chronicpain conditions evaluated.
Reed, Barbara D.; Harlow, Sioban D.; Sen, Ananda; Edwards, Rayna M.; Chen, Di; Haefner, Hope K.
Underlying ischaemic disease should be excluded in patients with delayed wound healing. Contrast angiography is a useful imaging method for assessing the specific cause of wound chronicity and may also be helpful in assessing the aetiology of unexplained pain symptoms. Angioplasty provides a practical alternative to more invasive techniques in addressing peripheral ischaemia. Our patient suffered claudication-type pain in his thigh and a non-healing stump wound following below-knee amputation. Magnetic resonance angiography confirmed the presence of arterial stenoses and an angioplasty was successfully performed to improve patency of the profunda femoris vessel. Following the operation, the claudication pain symptoms were significantly reduced and the stump wound went on to heal. PMID:24112482
Warner, B E; Richards, A J; Biswas, M; Chick, C; Lewis, P; Harding, K G