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1

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

PubMed Central

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

Monsivais, Diane Burn

2014-01-01

2

An Unusual Cause of Intractable Heel Pain  

Microsoft Academic Search

We report a case of severe heel pain that did not respond to noninvasive measures. Magnetic resonance imaging scans revealed a soft tissue mass that after complete surgical excision was found to be an epidermal cyst. The patient experienced full resolution of the symptoms after excision of the epidermal cyst. To our knowledge, intractable heel pain due to an epidermal

Samuel Ghani; Muhammad Ali Fazal

2011-01-01

3

Chronic Pain  

MedlinePLUS

MENU Return to Web version Chronic Pain Overview What is chronic pain? There are 2 types of pain: acute and chronic. Acute pain lets you know that your ... It should go away as your body heals. Chronic pain lasts much longer. Chronic pain may last months ...

4

Chronic Pain  

MedlinePLUS

... a problem you need to take care of. Chronic pain is different. The pain signals go on for ... there is no clear cause. Problems that cause chronic pain include Headache Low back strain Cancer Arthritis Pain ...

5

Chronic Pain  

MedlinePLUS

NINDS Chronic Pain Information Page Synonym(s): Pain - Chronic Condensed from Pain: Hope Through Research Table of Contents (click to jump ... Trials Organizations Additional resources from MedlinePlus What is Chronic Pain? While acute pain is a normal sensation triggered ...

6

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

SciTech Connect

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

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

1999-09-15

7

Chronic Pain  

Microsoft Academic Search

\\u000a \\u000a \\u000a \\u000a \\u000a 1. \\u000a \\u000a Non-cancer-related pain that lasts longer than 3 months is considered chronic pain.\\u000a \\u000a \\u000a \\u000a 2. \\u000a \\u000a According to the National Institutes of Health, chronic pain is the third largest health problem in the world.\\u000a \\u000a \\u000a \\u000a 3. \\u000a \\u000a Approximately 25 million Americans are affected by chronic pain.\\u000a \\u000a \\u000a \\u000a 4. \\u000a \\u000a Chronic pain is one of the most common problems seen in primary care clinics. Pain-related problems account

Jim Nuovo

8

Low back pain - chronic  

MedlinePLUS

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

9

Oral bismuth for chronic intractable diarrheal conditions?  

PubMed Central

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

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

2013-01-01

10

Chronic Pelvic Pain  

MedlinePLUS

... Family > Conditions & Treatments > Pain Disorders > Chronic Pelvic Pain Chronic Pelvic Pain Page Content Pelvic pain is an uncommon but ... and can be injured or weakened causing pain Chronic pain can continue long after tissue injury has healed, ...

11

Thalamotomy for Alleviation of Intractable Pain  

Microsoft Academic Search

17 patients had thalamotomies for alleviation of pain due to malignancy since January, 1970. In 12 of them, thalamic electrodes were implanted through occipital burr holes for subsequent radiofrequency thalamotomies. In 4 cases, the lesions were made by the bifrontal approach and 1 case was approached from the left occipital and right frontal. In 13 cases, the thalamic lesions were

S. Uematsu; B. Konigsmark; A. E. Walker

1974-01-01

12

Chronic Pain and Adherence  

Microsoft Academic Search

\\u000a Chronic pain of non-malignant etiology is a significant problem. Chronic non-malignant pain is typically defined as pain that\\u000a persists for 3 months or longer and that is non-life threatening [1, 2]. Among the most common chronic pain conditions are\\u000a chronic back pain, migraine headaches, and tension headaches. Chronic pain is very common. In the United States, 17% of patients\\u000a seen

Rebecca A. Shelby; Francis J. Keefe

13

Managing Chronic Pain  

MedlinePLUS

... perform household chores. What can a person with chronic pain do? ? Develop and practice a lifestyle based on ... mind and reduce tensions that aggravate pain. Managing Chronic Pain ® Tips for Living Occupational Therapy: Skills for the ...

14

Fighting Chronic Pain  

MedlinePLUS

... Navigation Bar Home Current Issue Past Issues Fighting Chronic Pain Past Issues / Fall 2007 Table of Contents For ... diagnose, health care professionals and scientists know that chronic pain is very complex. Below are some of the ...

15

Tips for Chronic Pain  

MedlinePLUS

Chronic pain is defined as “persistent pain” and is a common complaint in Sjögren’s syndrome. For example, Sjögren’s ... mental well-being. Some tips for dealing with chronic pain: Continue caring for the condition causing your pain. • ...

16

American Chronic Pain Association  

MedlinePLUS

... of their pain. To raise awareness among the health care community, policy makers, and the public at large about issues of living with chronic pain. Recent News View All News OTC ... Verify here Certified by: Independent Charities of ...

17

Psychology and chronic pain  

Microsoft Academic Search

This article will explore some specific psychological responses to pain and outline the historical developments that have led to current treatments. The recognition and treatment of maladaptive psychological responses to pain can lessen distress and the progression of chronic pain states.

Jennifer K. Dietrich

2011-01-01

18

Treating Intractable Phantom Limb Pain with Ambulatory Continuous Peripheral Nerve Blocks: A Pilot Study  

PubMed Central

Background There is currently no reliable treatment for phantom limb pain (PLP). Chronic PLP and associated cortical abnormalities may be maintained from abnormal peripheral input, raising the possibility that a continuous peripheral nerve block (CPNB) of extended duration may permanently reorganize cortical pain mapping, thus providing lasting relief. Methods Three men with below-the-knee (2) or -elbow (1) amputations and intractable PLP received femoral/sciatic or infraclavicular perineural catheter(s), respectively. Subjects were randomized in a double-masked fashion to receive perineural ropivacaine (0.5%) or normal saline for over 6 days as outpatients using portable electronic infusion. Four months later, subjects returned for repeated perineural catheter insertion (“crossover”), and received an ambulatory infusion with the alternate solution. Subjects were followed for up to one year. Results By chance, all 3 subjects received saline during their initial infusion and reported little change in their PLP. One subject did not receive crossover treatment; but, the remaining 2 subjects reported complete resolution of their PLP during and immediately following treatment with ropivacaine. One subject experienced no PLP recurrence through the 52-week follow-up period; and, the other reported mild PLP occurring once each week of just a small fraction of his original pain (pre-treatment: continuous PLP rated 10/10; post-treatment: no PLP at baseline with average of 1 PLP episode each week rated 2/10) for 12 weeks (lost to follow-up thereafter). Conclusions A prolonged ambulatory CPNB may be a reliable treatment for intractable PLP. The results of this pilot study suggest that a large, randomized clinical trial is warranted. PMID:23489466

Ilfeld, Brian M.; Moeller-Bertram, Tobias; Hanling, Steven R.; Tokarz, Kyle; Mariano, Edward R.; Loland, Vanessa J.; Madison, Sarah J.; Ferguson, Eliza J.; Morgan, Anya C.; Wallace, Mark S.

2013-01-01

19

Employees with Chronic Pain  

MedlinePLUS

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

20

Psychology and chronic pain  

Microsoft Academic Search

Unfortunately for many sufferers, medical management alone is often not successful in alleviating chronic pain or in improving the emotional impacts and disability that come with it. The patients’ psychological experience of pain, the behaviour patterns they adopt, and the emotional, social, and cognitive influences on those behaviour patterns are critical in the management of many, if not most, cases.

Lance M. McCracken

2008-01-01

21

Acceptance of chronic pain  

Microsoft Academic Search

The experience of chronic pain can be associated with significant distress and disability; however, this is not always the\\u000a case. Although attempts to control or reduce pain can be helpful for many pain sufferers, on some occasions this is not an\\u000a effective option and a different response is required. This different response can include a fiexible mix of control and

Lance M. McCracken; Kevin E. Vowles

2006-01-01

22

Gene Therapy for Chronic Pain  

Microsoft Academic Search

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

William R. Lariviere; Doris K. Cope

23

[Chronic pain and depression].  

PubMed

Chronic pain and depression are frequently associated. Links between them are numerous and well documented. It is known for example that depression is associated with a greater number and higher intensity of pain symptoms. Similarly the presence of pain complicates the diagnostic evaluation and aggravates the prognosis of depression. The question of the causality link has no clear answer. Taking care of these patients implies to acknowledge the different aspects of their suffering in a holistic bio-psycho-social model. Treatment or medication, for instance antidepressants, should be a post-scriptum to the construction of a therapeutic relationship. PMID:19626761

Rentsch, D; Piguet, V; Cedraschi, C; Desmeules, J; Luthy, C; Andreoli, A; Allaz, A F

2009-06-17

24

Managing chronic pain in adults.  

PubMed

The management of chronic pain is complex. Services and support for people living with chronic pain are variable despite the publication of a number of reports highlighting the problem. Due to the epidemiology of pain, nurses deliver care to patients with persistent pain in a variety of settings. It is important that nurses have the knowledge, skills and correct attitude to deliver compassionate, person-centred care, in line with best practice in chronic pain management. PMID:25315569

Barrie, Janette; Loughlin, Diane

2014-10-15

25

The consequences of chronic pain.  

PubMed

Questions from patients about analgesic pharmacotherapy and responses from authors are presented to help educate patients and make them more effective self-advocates. The topic addressed in this issue is untreated/undertreated chronic pain and the physical, emotional, and social consequences that can profoundly affect a patient's quality of life. Chronic pain is no longer considered a symptom; it is a disease entity itself. Anxiety and depression often coexist with chronic pain. Chronic pain is the enemy of happiness. Further, chronic pain can activate the sympathetic nervous system, leading to the fight-or-flight response. PMID:22448948

Greenberg, Eric N

2012-01-01

26

Peripheral Pain Mechanisms in Chronic Widespread Pain  

PubMed Central

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

Staud, Roland

2011-01-01

27

Chronic pain in elderly people  

Microsoft Academic Search

Chronic pain 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

Lucy Gagliese; Ronald Melzack

1997-01-01

28

Chronic noncancer pain  

PubMed Central

Abstract Objective To describe the characteristics of patients with chronic noncancer pain (CNCP) prescribed opioids by community physicians and referred to a tertiary pain clinic. Design Cross-sectional, descriptive study. Setting A tertiary care, hospital-based pain clinic in Toronto, Ont. Participants A total of 455 consecutive patients newly referred to the pain clinic by community physicians. Main outcome measures Data on demographic characteristics, pain ratings, and medication intake were obtained using standardized collection forms and retrospective chart review. Patients were classified by diagnosis: group 1 patients had biomedical disorders only, group 2 patients had biomedical disorders and psychological factors, and group 3 patients had psychological factors only. Patients were also categorized based on opioid use: no opioid use (NOU); low opioid use (LOU), with a daily morphine-equivalent dosage (MED) of 200 mg or less; or high opioid use (HOU), with a daily MED of more than 200 mg. Results In the general study population, 63% of patients were taking opioids, with 1 in 5 exceeding an MED of 200 mg daily. In group 1, 59% of patients used opioids and 10% had HOU; 66% of patients in groups 2 and 3 were taking opioids, with 21% and 26% classified as having HOU. The mean (SD) daily MED for groups 2 and 3 HOU patients combined was significantly higher than that of group 1 HOU patients: 575.7 (472.9) mg/d versus 284.9 (74.6) mg/d, respectively. Men were twice as likely as women to have HOU; Canadian-born patients were 3 times as likely as foreign-born patients to have HOU. Psychoactive drugs were coprescribed in 61% of LOU patients and 76% of HOU patients. Greater opioid use was associated with group 2 and 3 diagnoses, male sex, Canadian-born origin, and high pain scores. Conclusion Our results indicate that male, Canadian-born CNCP patients presenting with psychological morbidity or comorbidity and reporting higher pain severity ratings were more likely to receive opioids. Additionally, many CNCP patients referred to our tertiary care pain clinic were receiving opioids in excess of a 200-mg/d MED. More studies are needed to determine which factors lead to high-dose opioid prescribing in a subset of this CNCP population. PMID:21402957

Mailis-Gagnon, Angela; Lakha, S. Fatima; Ou, Ting; Louffat, Ada; Yegneswaran, Balaji; Umana, Margarita; Cohodarevic, Tea; Nicholson, Keith; Deshpande, Amol

2011-01-01

29

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

PubMed Central

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

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

2011-01-01

30

Occipital nerve stimulation for intractable chronic cluster headache: new hope for a dreadful disease?  

PubMed

Chronic cluster headache (CCH) is one of the most painful primary headaches. A small percentage of CCH become intractable (iCCH) and is refractory to the majority of preventing drugs. Various invasive and sometimes destructive procedures have been tempted to help these patients, but none gave satisfactory results for the long term. Hypothalamic deep-brain stimulation (hDBS) has recently raised expectations with an average improvement of 50 to 70%, but is not a riskless procedure. Harmless methods were therefore warranted, and in this perspective occipital nerve stimulation (ONS) trials were undertaken. Up to now, nearly 38 iCCH patients benefited from ONS in the available literature and the technique appears to give results similar to hDBS, having the advantage to have much milder side effects. The mechanism by which ONS is efficient in iCCH remains unknown but preliminary results of neurophysiological and imaging studies suggest ONS is just a symptomatic treatment which does not act on the disease generator. We would however advocate ONS as first choice alternative therapy in iCCH. PMID:21510228

Magis, Delphine; Schoenen, Jean

2011-03-01

31

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

PubMed Central

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

Zaporowska-Stachowiak, Iwona; Kowalski, Grzegorz; Luczak, Jacek; Kosicka, Katarzyna; Kotlinska-Lemieszek, Aleksandra; Sopata, Maciej; Glowka, Franciszek

2014-01-01

32

Spinal cord stimulation: Current applications for treatment of chronic pain  

PubMed Central

Spinal cord stimulation (SCS) is thought to relieve chronic intractable pain by stimulating nerve fibers in the spinal cord. The resulting impulses in the fibers may inhibit the conduction of pain signals to the brain, according to the pain gate theory proposed by Melzack and Wall in 1965 and the sensation of pain is thus blocked. Although SCS may reduce pain, it will not eliminate it. After a period of concern about safety and efficacy, SCS is now regaining popularity among pain specialists for the treatment of chronic pain. The sympatholytic effect of SCS is one of its most interesting therapeutic properties. This effect is considered responsible for the effectiveness of SCS in peripheral ischemia, and at least some cases of complex regional pain syndrome. The sympatholytic effect has also been considered part of the management of other chronic pain states such as failed back surgery syndrome, phantom pain, diabetic neuropathy, and postherpetic neuralgia. In general, SCS is part of an overall treatment strategy and is used only after the more conservative treatments have failed. The concept of SCS has evolved rapidly following the technological advances that have produced leads with multiple contact electrodes and battery systems. The current prevalence of patients with chronic pain requiring treatment other than conventional medical management has significantly increased and so has been the need for SCS. With the cost benefit analysis showing significant support for SCS, it may be appropriate to offer this as an effective alternative treatment for these patients.

Vannemreddy, Prasad; Slavin, Konstantin V.

2011-01-01

33

Omacetaxine mepesuccinate in the treatment of intractable chronic myeloid leukemia  

PubMed Central

In a significant proportion of patients with chronic myeloid leukemia, resistance to BCR-ABL tyrosine kinase inhibitors develops due to acquisition of BCR-ABL kinase domain mutations and insensitivity of leukemia stem cells to tyrosine kinase inhibitors. Omacetaxine mepesuccinate (formerly called homoharringtonine) is a natural alkaloid that inhibits protein synthesis and induces cell death. Omacetaxine mepesuccinate has been recently approved by the US Food and Drug Administration to treat patients with chronic myeloid leukemia who failed to respond to multiple tyrosine kinase inhibitors and/or acquired the BCR-ABL-T315I mutation. In this review, we discuss the use and effectiveness of omacetaxine mepesuccinate in the treatment of chronic myeloid leukemia, with coverage of its pharmacology, mode of action, and pharmacokinetics. We believe that omacetaxine mepesuccinate will be beneficial to many patients with chronic myeloid leukemia who do not respond well to tyrosine kinase inhibitors. PMID:24516334

Chen, Yaoyu; Li, Shaoguang

2014-01-01

34

Low back pain (chronic)  

PubMed Central

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). PMID:19445791

2008-01-01

35

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

PubMed

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

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

2014-05-01

36

Low back pain (chronic)  

PubMed Central

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

2010-01-01

37

Chronic Pain and Exercise Therapy.  

ERIC Educational Resources Information Center

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

Raithel, Kathryn Simmons

1989-01-01

38

Easing Chronic Pain: Better Treatments and Medications  

MedlinePLUS

... Navigation Bar Home Current Issue Past Issues Easing Chronic Pain: Better Treatments and Medications Past Issues / Fall 2007 ... In some rare instances, it can become chronic. Chronic pain is widely believed to represent disease itself. It ...

39

Chronic Pain Medicines  

MedlinePLUS

... acetaminophen pills a day, tell your doctor. Nonsteroidal Anti-Inflammatory Drugs (NSAIDs) Other drugs that help with pain are called nonsteroidal anti-inflammatory drugs, or NSAIDs. Examples include aspirin, ibuprofen (two brand names: Motrin, ...

40

Epidemiology of chronic musculoskeletal pain.  

PubMed

Chronic widespread pain (CWP) due to musculoskeletal conditions is a major social burden. The case definition of CWP relies on pain, chronicity (more than 3 months' duration) and widespread distribution (both sides of the body including the axial skeleton). Health Interview Survey (HIS) and Health Examination Survey (HES) have been used to assess the frequency of CWP in the general population. Unfortunately, both techniques are poorly standardised, which hampers comparison of data pertaining to different populations and countries. A major effort in the European Union (EU) is the development of common strategies to investigate musculoskeletal pain through HIS. Issues to be addressed include: (1) loss of daily life functions due to pain; (2) pain duration and rhythm; (3) affected sites; and (4) type of pain. We know that musculoskeletal pain affects between 13.5% and 47% of the general population, with CWP prevalence varying between 11.4% and 24%. Risk factors for musculoskeletal pain include age, gender, smoking, low education, low physical activity, poor social interaction, low family income, depression, anxiety and sleep disorders, as well as performing manual work, being a recent immigrant, non-Caucasian and widowed, separated or divorced. PMID:22094194

Cimmino, Marco A; Ferrone, Carmela; Cutolo, Maurizio

2011-04-01

41

Intractable Chronic Vulval Ulceration Presenting as Immune Reconstitution Inflammatory Syndrome in a Treatment-Failure Patient: A Case Observation  

PubMed Central

HIV-1 treatment-failure patients are increasingly being initiated on second-line antiretroviral therapy. The case we describe is of a treatment-failure patient who developed intractable chronic vulval ulceration presenting as immune reconstitution inflammatory syndrome (IRIS), following complete viral suppression with second-line highly active antiretroviral treatment (HAART). To the best of our knowledge, this is the first reported case of intractable vulval ulceration IRIS in an HIV-1 treatment-failure patient. PMID:22567519

Katusiime, Christine; Ocama, Ponsiano; Kambugu, Andrew

2011-01-01

42

Psychosocial aspects of chronic pain.  

PubMed

ABSTRACT Chronic pain is a complex phenomenon that does not fit well within the normal conceptions of health and illness. Pain Management Programs are commonly used to train and support people to self-manage, however, the long-term impact of this biopsychosocial approach remains poorly understood. The social domain can impact on patients' quality of life more than any other aspect of chronic pain; however, it is rarely addressed by health services. This report is adapted from paineurope 2014; Issue 2, ©Haymarket Medical Publications Ltd, and is presented with permission. paineurope is provided as a service to pain management by Mundipharma International, LTD and is distributed free of charge to healthcare professionals in Europe. Archival issues can be accessed via the website: http://www.paineurope.com at which European health professionals can register online to receive copies of the quarterly publication. PMID:25348224

Hill, Patrick

2014-12-01

43

Medical management for intractable pain arising from primary sjögren syndrome involving both brain and spinal cord: a case report.  

PubMed

Primary Sjögren syndrome, which involves lesions in both the brain and spinal cord, is rarely reported. Related symptoms, such as intractable pain due to central nervous system involvement, are very rare. A 73-year-old woman diagnosed with primary Sjögren syndrome manifested with subacute encephalopathy and extensive transverse myelitis. She complained of severe whole body neuropathic pain. Magnetic resonance imaging demonstrated a non-enhancing ill-defined high intensity signal involving the posterior limb of the both internal capsule and right thalamus on a T2 fluid-attenuated inversion recovery image. Additionally, multifocal intramedullary ill-defined contrast-enhancing lesion with cord swelling from the C-spine to L-spine was also visible on the T2-weighted image. Her intractable pain remarkably improved after administration of concomitant oral doses of gabapentin, venlafaxine, and carbamazepine. PMID:25229038

Lee, Kyoung Moo; Han, Kyu Yong; Kwon, Oh Pum

2014-08-01

44

Experimental therapies for chronic pain  

Microsoft Academic Search

Chronic pain, 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

Nikolai G. Rainov; V. Heidecke

45

Accepting Pain Management or Seeking Pain Cure: An Exploration of Patients’ Attitudes to Chronic Pain  

Microsoft Academic Search

This article explores the differing attitudes of patients toward chronic pain. Because pain is a subjective experience, individuals react to living with chronic pain in varying ways. Some patients successfully manage their chronic pain, whereas others continue to seek a pain cure. A convenience sample (n = 8) was generated from a district general hospital’s nurse-led pain clinic. The sample

Kathryn A. Clarke; Ron Iphofen

2007-01-01

46

Chronic pain and voluntary euthanasia  

Microsoft Academic Search

Emotional status and its brain bases change in a chronic pain patient and this change affects his\\/her decision making ability. Moreover, it is accepted that a mentally disturbed individual is not competent to make critical decisions. According to these bases, this article demonstrates that such patients are not entitled to request voluntary euthanasia.

Mojtaba Rismanchi

2008-01-01

47

Evidence Based Practice of Chronic Pain  

PubMed Central

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

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

2012-01-01

48

Comprehensive management of chronic pain in haemophilia.  

PubMed

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

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

2014-03-01

49

Halt the Hurt! Dealing with Chronic Pain  

MedlinePLUS

... exit disclaimer . Subscribe Halt the Hurt! Dealing with Chronic Pain Pain—it’s something we’ve all experienced. From ... for months or even years, then it’s called chronic pain, and it can be tricky to treat. Chronic ...

50

Presentation and management of chronic pain.  

PubMed

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

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

2014-05-01

51

Treating Chronic Pain with Opioids: Comparing Effectiveness and Cost  

MedlinePLUS

Treating Chronic Pain with Opioids: Comparing Effectiveness and Cost What are opioids? Opioids are very strong prescription pain medicines. They ... used to treat some kinds of long-term, chronic pain. This includes back pain, nerve pain, and pain ...

52

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

PubMed

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

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

2013-01-01

53

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

PubMed Central

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

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

2013-01-01

54

University receives grant for chronic pain research  

E-print Network

and the brain cause pain. Researchers are trying to inhibit chronic pain, associated with physical conditions of nerves -- and stop pain signals from reaching the brain. Then the patients feel no pain. According://www.theshorthorn.com/index2.php?option=com_content&task=view&id=14643&pop=1... #12;Close Window lives with the constant pain

Chiao, Jung-Chih

55

Genetics of chronic pain states.  

PubMed

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

Buskila, Dan

2007-06-01

56

A dynamic network perspective of chronic pain.  

PubMed

We briefly summarize recent advances regarding brain functional representation of chronic pain, reorganization of resting state brain activity, and of brain anatomy with chronic pain. Based on these observations and recent theoretical advances regarding network architecture properties, we develop a general concept of the dynamic interplay between anatomy and function as the brain progresses into persistent pain, and outline the role of mesolimbic learning mechanisms that are likely involved in maintenance of chronic pain. PMID:22579823

Farmer, Melissa A; Baliki, Marwan N; Apkarian, A Vania

2012-06-29

57

Towards a theory of chronic pain  

PubMed Central

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

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

2009-01-01

58

Surgical Treatment of Chronic Orofacial Pain  

PubMed Central

There are many conditions in which chronic orofacial pain is a major diagnostic and therapeutic problem. It is generally accepted that surgical treatment for these chronic pain problems should be resorted to only when more conservative treatments have been ineffective. Literature concerning selected orofacial pain problems is reviewed and the indications for surgical management are discussed. PMID:6370045

Sisk, Allen L.

1983-01-01

59

Chronic Pelvic Pain in Women (Beyond the Basics)  

MedlinePLUS

... Searches Chronic pelvic pain Patient information Patient information: Chronic pelvic pain in women (Beyond the Basics) Author Fred Howard, ... pain and is not a common cause of chronic pain. (See "Patient information: Diverticular disease (Beyond the Basics)" .) ...

60

Safely Managing Chronic Pain | NIH MedlinePlus the Magazine  

MedlinePLUS

... of this page please turn Javascript on. Feature: Chronic Pain Safely Managing Chronic Pain Past Issues / Spring 2011 Table of Contents Helping ... all health professionals. But assisting people in managing chronic pain is tough. Strong medicines that relieve the pain ...

61

Chronic postsurgical pain: still a neglected topic?  

PubMed Central

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

Kissin, Igor; Gelman, Simon

2012-01-01

62

[Experience of successful treatment for a case of intractable chronic empyema with a bronchopleural fistula].  

PubMed

We report an experience of successful treatment for a case of intractable chronic empyema complicated by bronchopleural fistula (BPF). A 75-year-old woman who had severe diabetes mellitus complained of general fatigue and anorexia. A lung abscess in the right upper lobe was diagnosed and treated with antibiotics. Regrettably, it ruptured into a pyopneumothorax. The BPF was closed primarily and covered with intercostal muscle, but the procedure was not effective. The pyopneumothorax led to the development of chronic empyema with BPF. The patient was admitted to our hospital for treatment and the BPF was managed with a Dumon stent and endobronchial Watanabe spigot (EWS) but failed to heal. Therefore, open drainage was chosen as a 1st stage treatment. After healing the infected space, closure of the BPF and a bronchial embolization by EWS was performed with a closeire of space by pediculed omentum and muscle flap and with a thoracoplasty as a 2nd stage treatment. The postoperative course was uneventful, and the patient was discharged on post-operative day 51. PMID:20214353

Nagata, Toshiyuki; Nakamura, Yoshihiro; Kariatsumari, Kouta; Fukumori, Kazuhiko

2010-03-01

63

Chronic low back pain: Progress in therapy  

Microsoft Academic Search

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

Jerry D. Joines

2006-01-01

64

Chronic pain: clinical features, assessment and treatment.  

PubMed

A significant number of people in the UK experience chronic pain, resulting in high levels of suffering and reduced quality of life. Management of chronic pain is complex, time consuming and not always successful. Good communication between patients and healthcare professionals is essential to ensure realistic treatment plans and outcomes can be negotiated. Accurate assessment is also key, and nurses play a fundamental role in ensuring patients with chronic pain receive the most appropriate care. PMID:18947083

Mackintosh, Carolyn; Elson, Sue

65

[Post-operative pain therapy of a chronic pain patient].  

PubMed

Post-operative pain therapy of chronic pain patients poses a challenge. Here we report the perioperative management of a 39-year-old male under chronic therapy with oxycodon, gabapentin and tolperison. Particular the pharmacointeractions regarding premedication and postoperative dose finding of opioids with intravenous PCIA are discussed. PMID:17151986

Pawlik, Michael T; Ittner, Karl Peter

2006-11-01

66

Pharmacological pain management in chronic pancreatitis.  

PubMed

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

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

2013-11-14

67

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

ERIC Educational Resources Information Center

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

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

2007-01-01

68

Atlanto-axial subluxation syndrome and management of intractable headache, neck pain and shoulder pain with auricular stimulation: a clinical case report.  

PubMed

Atlanto-axial subluxation syndrome is a condition that is easily overlooked, misdiagnosed and mismanaged. Anatomy, neurovascular involvement and description of clinical manifestations are reviewed. Bi-Digital O-Ring Test is employed to establish an accurate diagnosis and its value and accuracy described briefly. Bi-Digital O-Ring Test has been an important diagnosis confirmation method (reconfirmed by CT or MRI in over 95% of more than 850 clinical cases) in this author's practice of spinal disorder and intractable pain management. A newly described device, the KIM-STIM, offers auricular stimulation of multiple points, using electrical microcurrent. Each unit is individually custom-molded to the patient's ear, and fitted with multiple electrodes. It was found to be very effective in managing the majority of intractable pain, especially pain requiring multiple daily treatments in order for the patient to live and function normally. The KIM-STIM device allows the patient to self-manage the pain, by day or night, thus allowing for a reduction or elimination of medication intake and diminishing the necessity for frequent doctor visits. PMID:11841111

Kim, K H

2001-01-01

69

Counseling Adult Clients Experiencing Chronic Pain  

ERIC Educational Resources Information Center

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

Burns, Stephanie T.

2010-01-01

70

Chronic Pain Patients: Implications for Rehabilitation Counseling.  

ERIC Educational Resources Information Center

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

Scott, Lori T.

71

Pathogenesis of Pain in Chronic Pancreatitis  

Microsoft Academic Search

The pathophysiology of pain in chronic pancreatitis (CP) is incompletely understood. Several hypotheses have been advanced, including pancreatic and extrapancreatic causes. The existence of different hypotheses to explain the genesis of pain in CP also reflects the different therapeutic approaches to pain in these patients. Increased intraductal pressure as a result of single or multiple strictures and\\/or calculi is believed

Pierluigi Di Sebastiano; Fabio F. di Mola; Markus W. Büchler; Helmut Friess

2004-01-01

72

Opioids and Chronic Pain | NIH MedlinePlus the Magazine  

MedlinePLUS

... of this page please turn Javascript on. Feature: Chronic Pain Opioids and Chronic Pain Past Issues / Spring 2011 Table of Contents Opioids ... and similar drugs have been used to treat chronic pain not caused by cancer. For many people, they ...

73

Pain characteristic differences between subacute and chronic back pain  

PubMed Central

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. PMID:21497139

Chanda, Mona Lisa; Alvin, Matthew D.; Schnitzer, Thomas J; Apkarian, A. Vania

2011-01-01

74

[Chronic pain and regional anesthesia in children].  

PubMed

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

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

2013-10-01

75

Neurolytic block of ganglion of Walther for the management of chronic pelvic pain  

PubMed Central

Here we report on the use of neurolytic block of ganglion impar (ganglion of Walther) for the management of intractable chronic pelvic pain, which is common enough to be recognized as a problem by gynecologists, likely to be difficult to diagnose and even more challenging to manage. Following failure in controlling the symptoms with pharmacological management, nine women underwent neurolysis of the ganglion impar in our Pain Clinic from 2009 to March 2013. The indication for the procedure was chronic pelvic pain (CPP) of either malignancy-related (4) or other origin (5). The Numeric Rating Scale (NRS) and duration of pain relief were employed to assess effectiveness of the procedure. Neurolysis was efficacious in patients with both malignancy-related CPP and CPP of non-malignant origin. Reported relief time varied from 4 weeks to 3 years, while in 4 cases complete and permanent cessation of pain was achieved. No complications were noted. PMID:25337174

Horosz, Bartosz; Koleda, Iwona; Sekowska, Agnieszka; Kucia, Hanna; Kosson, Dariusz; Jakiel, Grzegorz

2014-01-01

76

Veterinarians' attitudes to chronic pain in dogs.  

PubMed

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

Bell, A; Helm, J; Reid, J

2014-11-01

77

[Nondermatomal somatosensory deficits in chronic pain patients].  

PubMed

Nondermatomal somatosensory deficits (NDSDs) are frequently found in chronic pain patients and allude to pain sensitization and pain centralization. In the clinical examination NDSDs are as a rule accompanied by hyposensitivity to touch and heat perception often with a quadrantal or hemibody distribution. The majority of NDSD patients show a trigger episode with a somatic nociceptive trauma in the case history. These somatic findings, however, never fully explain the pain disorder, analogue to the complex regional pain syndrome (CRPS). Most patients with chronic pain disorders as well as those with NDSD often report an antecedent period of high psychobiological stress. The data from functional imaging reveal a complex pattern of a central nervous dysregulation. PMID:22120917

Egloff, N; Maecker, F; Landmann, G; von Känel, R

2011-12-01

78

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

PubMed

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

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

2014-08-01

79

Gene Therapy for the Treatment of Chronic Peripheral Nervous System Pain  

PubMed Central

Chronic pain 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. Chronic pain 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 chronic pain. 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 intractable pain 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 chronic pain. PMID:22668775

Goins, William F.; Cohen, Justus B.; Glorioso, Joseph C.

2012-01-01

80

Chronic neck pain and masticatory dysfunction  

Microsoft Academic Search

Chronic nonspecific neck pain is a common problem in rheumatology and may resist conventional treatment. Pathophysiological links exist between the cervical spine and masticatory system. Occlusal disorders may cause neck pain and may respond to dental treatment. The estimated prevalence of occlusal disorders is about 45%, with half the cases being due to functional factors. Minor repeated masticatory dysfunction (MD)

Jean-François Catanzariti; Thierry Debuse; Bernard Duquesnoy

2005-01-01

81

Normal Personality Correlates of Chronic Pain Subgroups  

Microsoft Academic Search

A heterogeneous sample of chronic pain patients was first classified into one of three previously identified subgroups (i.e., dysfunctional, interpersonally distressed, adaptive) using the Multidimensional Pain Inventory (R. D. Kerns, D. C. Turk, & T. E. Rudy, 1985). Multiple differences at the domain and facet levels of the Revised NEO PI-R Personality Inventory (P. T. Costa, Jr. & R. R.

Stephen R. Nitch; Kyle B. Boone

2004-01-01

82

The Neurobiology of Chronic Pelvic Pain  

Microsoft Academic Search

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

Jennifer Gunter

83

[Hypnosis for chronic pain of children].  

PubMed

A child or adolescent can suffer from chronic pain. Whatever the causes, it can trap the child in a specific process whereby they focus on the pain, fearing that it will appear and experiencing anxiety. Hypno-analgesia and hypnotherapy enable them to escape this process and find within themselves the capacity to face up to the pain. Moreover, these techniques offer them an autonomy which they can use in all areas of their life. PMID:24779171

Célestin-Lhopiteau, Isabelle

2014-01-01

84

The Personality Assessment Inventory With Chronic Pain Patients  

E-print Network

the significant role of psychological factors in the experience and expression of chronic pain (Gatchel, 1996 as pain. Personality measures that can help practitioners target psychological factors that mayThe Personality Assessment Inventory With Chronic Pain Patients: Psychometric Properties

Meagher, Mary

85

[Evaluation of chronic pain in geriatric patients].  

PubMed

This retrospective study considers the influence of chronological age on the perception and consequential effects of chronic non-cancer pain in 203 patients referred to an ambulatory pain clinic. One patient in four (50) was 65 years or older. Pain had existed for more than a year in 66%. It was referred to an "unbearable" by 54% of elderly adults vs 44% (NS) of the younger adult population, and as "intense" by 61% vs 44% (p < 0.05). A higher proportion of neurogenic pain (54% vs 26%, p < 0.05) could explain this significant difference. Cognitive factors could also have amplified the painful syndrome since 59% (vs 54%) of the elderly considered they had received insufficient information on the potential consequences of their painful condition. However, despite a higher occurrence of other severe illnesses in the elderly (52% vs 35%, p < 0.05), they appear to worry less about their health problems (58% vs 78%, p < 0.01). Finally, in spite of increased severity of pain in the elderly, depression scores and consequential effects are similar in the two populations. In conclusion, the intensity of chronic pain appears to be more severe in the elderly, perhaps due to its more frequent neuropathic origin. Nonetheless, its repercussions on daily life activity seem no worse than for younger adults, and could reflect better coping strategies towards chronic pain. PMID:7973524

Desmeules, J; Allaz, A F; Binyet, S; Piguet, V; Vogt, N; Dayer, P

1994-11-01

86

Etiologic theories of chronic prostatitis\\/chronic pelvic pain syndrome  

Microsoft Academic Search

The etiology of chronic prostatitis\\/chronic pelvic pain syndrome is unknown. Whereas infection causes category I and II prostatitis,\\u000a the evidence for an ongoing infection in category III patients is lacking. Immunologic, neurologic, and psychologic factors\\u000a likely play a role in the development and maintenance of symptoms in these men. The traditional concept of pain as a simple\\u000a response to a

Michel A. Pontari

2006-01-01

87

Pharmacogenetics of Chronic Pain and Its Treatment  

PubMed Central

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

Svetlik, Svatopluk; Hronova, Karolina; Bakhouche, Hana; Matouskova, Olga; Slanar, Ondrej

2013-01-01

88

Transcranial magnetic stimulation for chronic pain.  

PubMed

Current data suggest that transcranial magnetic stimulation (TMS) has the potential to be an effective and complimentary treatment modality for patients with chronic neuropathic pain syndromes. The success of TMS for pain relief depends on the parameters of the stimulation delivered, the location of neural target, and duration of treatment. TMS can be used to excite or inhibit underlying neural tissue that depends on long-term potentiation and long-term depression, respectively. Long-term randomized controlled studies are warranted to establish the efficacy of repetitive TMS in patients with various chronic pain syndromes. PMID:25240669

Young, Nicole A; Sharma, Mayur; Deogaonkar, Milind

2014-10-01

89

Chronic Pain and Mortality: A Systematic Review  

PubMed Central

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

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

2014-01-01

90

Cortical plasticity as a new endpoint measurement for chronic pain  

Microsoft Academic Search

Animal models of chronic pain are widely used to investigate basic mechanisms of chronic pain and to evaluate potential novel\\u000a drugs for treating chronic pain. Among the different criteria used to measure chronic pain, behavioral responses are commonly\\u000a used as the end point measurements. However, not all chronic pain conditions can be easily measured by behavioral responses\\u000a such as the

Min Zhuo

2011-01-01

91

Astrocytes--multitaskers in chronic pain.  

PubMed

Treatment of chronic pain remains a clinical challenge and sufficient pharmacological management is difficult to achieve without concurrent adverse drug effects. Recently the concept of chronic pain as a solely neuron-mediated phenomenon has evolved and it is now appreciated that also glial cells are of critical importance in pain generation and modulation. Astrocytes are macroglial cells that have close structural relationships with neurons; they contact neuronal somata and dendrites and enwrap synapses, where small astrocytic processes have been shown to be highly motile. This organization allows astrocytes to directly influence and coordinate neurons located within their structural domains. Moreover, astrocytes form astroglial networks and calcium wave propagations can spread through neighbouring astrocytes. ATP, which is released from astrocytes in response to elevated intracellular calcium concentrations, can contribute to the central mechanisms in chronic pain via purinergic receptors. In this review we highlight the structural organization and the functionalities of astrocytes that allow them to undertake critical roles in pain processing and we stress the possibility that astrocytes contribute to chronic pain not via a single pathway, but by undertaking various roles depending on the pain condition. PMID:23528354

Hansen, Rikke Rie; Malcangio, Marzia

2013-09-15

92

Medical Management for Intractable Pain Arising From Primary Sj?gren Syndrome Involving Both Brain and Spinal Cord: A Case Report  

PubMed Central

Primary Sjögren syndrome, which involves lesions in both the brain and spinal cord, is rarely reported. Related symptoms, such as intractable pain due to central nervous system involvement, are very rare. A 73-year-old woman diagnosed with primary Sjögren syndrome manifested with subacute encephalopathy and extensive transverse myelitis. She complained of severe whole body neuropathic pain. Magnetic resonance imaging demonstrated a non-enhancing ill-defined high intensity signal involving the posterior limb of the both internal capsule and right thalamus on a T2 fluid-attenuated inversion recovery image. Additionally, multifocal intramedullary ill-defined contrast-enhancing lesion with cord swelling from the C-spine to L-spine was also visible on the T2-weighted image. Her intractable pain remarkably improved after administration of concomitant oral doses of gabapentin, venlafaxine, and carbamazepine.

Lee, Kyoung Moo; Han, Kyu Yong

2014-01-01

93

Opioids, sensory systems and chronic pain.  

PubMed

Opioids are the oldest and most potent drugs for the treatment of severe pain. Their clinical application is undisputed in acute pain (e.g. associated with trauma or surgery) but their long-term use in chronic pain has met increasing scrutiny. Therefore, this article will review sensory mechanisms related to opioid analgesia and side effects with a special emphasis on chronic pain. Central and peripheral sites of analgesic actions and side effects, as well as conventional and novel opioid compounds will be discussed. Since pain is a complex bio-psycho-social phenomenon, non-pharmacological considerations important for the understanding of opioid analgesic efficacy are also included. Finally, examples of challenging clinical situations such as the perioperative management of patients receiving long-term opioid treatment are illustrated. PMID:23500206

Stein, Christoph

2013-09-15

94

Chronic pain in torture survivors  

Microsoft Academic Search

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

2000-01-01

95

Pregabalin in Chronic Post-thoracotomy Pain  

PubMed Central

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

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

2013-01-01

96

Transition to Chronic Pain in Men With Low Back Pain: Predictive Relationships Among Pain Intensity, Disability, and Depressive Symptoms  

Microsoft Academic Search

Pain intensity, disability, and depressive symptoms are hallmarks of chronic pain conditions, but little is known about the relationships among these symptoms in the transition from acute to chronic pain. 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

1998-01-01

97

Surgical Treatment for Chronic Pelvic Pain  

PubMed Central

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

1998-01-01

98

Chronic Lower Leg Pain in Athletes  

PubMed Central

Context: Chronic lower leg pain in athletes can be a frustrating problem for patients and a difficult diagnosis for clinicians. Myriad approaches have been suggested to evaluate these conditions. With the continued evolution of diagnostic studies, evidence-based guidance for a standard approach is unfortunately sparse. Evidence Acquisition: PubMed was searched from January 1980 to May 2011 to identify publications regarding chronic lower leg pain in athletes (excluding conditions related to the foot), including differential diagnosis, clinical presentation, physical examination, history, diagnostic workup, and treatment. Results: Leg pain in athletes can be caused by many conditions, with the most frequent being medial tibial stress syndrome; chronic exertional compartment syndrome, stress fracture, nerve entrapment, and popliteal artery entrapment syndrome are also considerations. Conservative management is the mainstay of care for the majority of causes of chronic lower leg pain; however, surgical intervention may be necessary. Conclusion: Chronic lower extremity pain in athletes includes a wide differential and can pose diagnostic dilemmas for clinicians. PMID:23016078

Brewer, Rachel Biber; Gregory, Andrew J. M.

2012-01-01

99

Characteristics of Methadone Maintenance Patients with Chronic Pain  

Microsoft Academic Search

Chronic pain 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 chronic pain. The aim of this study was to survey individuals at methadone maintenance centers in order to determine the prevalence of chronic pain and

Robert N. Jamison; Janice Kauffman; Nathaniel P. Katz

2000-01-01

100

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

PubMed Central

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

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

2013-01-01

101

Psychological Factors in Chronic Pain: An Introduction to Psychosomatic Pain Management  

Microsoft Academic Search

Most pain treating physicians have a vague notion, that there may be a psychological component contributing to the severity of chronic pain. The International Association for the Study of Pain defined pain as \\

Dietrich Klinghardt

102

[Etiology and diagnosis of chronic shoulder pain].  

PubMed

Shoulder pain of more than three months' duration is regarded as chronic. Activity with an elevated arm is a risk factor, due to reduced local flow of blood to the supraspinatus muscle. Knowledge about normal shoulder biomechanics and dysfunctional behaviour patterns is essential when treating patients with chronic pain. It is necessary to consider psychosocial factors in addition to local pathology. The clinical examination should enable the physician to distinguish between referred and true shoulder pain and between restricted and free passive range of movement. Diagnoses may be classified into eight groups. The association between pain and degenerative changes has yet to be solved. This emphasizes the danger of deciding treatment without matching findings from radiological examinations with clinical signs and symptoms. PMID:1412343

Brox, J I

1992-09-30

103

The Epidemiology of Pediatric Chronic Pain  

Microsoft Academic Search

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

Thomas R. Vetter

104

Complementary and Alternative Approaches for Chronic Pain  

Microsoft Academic Search

\\u000a Chronic pain 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

Subhadra Evans; Lonnie K. Zeltzer

105

The pharmacotherapy of chronic pain: A review  

PubMed Central

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

Lynch, Mary E; Watson, C Peter N

2006-01-01

106

Intrathecal allograft of chromaffin cells for intractable pain treatment: A model for understanding CNS tolerance mechanisms in humans  

Microsoft Academic Search

GRAFTS of adrenal medulla tissue or chromaffin cells have been proposed for the treatment of Parkinson's disease and chronic pain.1,2 It has been shown that transplanted chromaffin cells can release analgesic neuroactive substances, including catecholamines, opioid peptides, metenkephalin, somatostatin, and so on.3,4 The subarachnoid space is a favored site for the allograft since the phenomenon of immunologic privilege is classically

J. Tkaczuk; J. C. Bes; H. de Bouet du Portal; M. Tafani; H. Duplan; M. Abbal; Y. Lazorthes; E. Ohayon

1997-01-01

107

Beyond pain: modeling decision-making deficits in chronic pain  

PubMed Central

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

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

2014-01-01

108

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

PubMed

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

Keppel Hesselink, Jan M; Kopsky, David J

2013-01-01

109

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

PubMed Central

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

Keppel Hesselink, Jan M; Kopsky, David J

2013-01-01

110

Acupuncture for patients with chronic neck pain.  

PubMed

Acupuncture is widely used by patients with neck pain, but there is a lack of information about its effectiveness in routine medical care. The aim was to investigate the effectiveness of acupuncture in addition to routine care in patients with chronic neck pain compared to treatment with routine care alone. We performed a randomized controlled multicentre trial plus non-randomized cohort in general practices in Germany. 14,161 patients with chronic neck pain (duration >6 months). Patients were randomly allocated to an acupuncture group or a control group receiving no acupuncture. Patients in the acupuncture group received up to 15 acupuncture sessions over three months. Patients who did not consent to randomization received acupuncture treatment. All subjects were allowed to receive usual medical care in addition to study treatment. Neck pain and disability (NPAD Scale by Wheeler) after three months. Of 14,161 patients (mean age 50.9+/-13.1 years, 68% female) 1880 were randomized to acupuncture and 1886 to control, and 10,395 included into the non-randomized acupuncture group. At three months, neck pain and disability improved by 16.2 (SE: 0.4) to 38.3 (SE: 0.4); and by 3.9 (SE: 0.4) to 50.5 (SE: 0.4), difference 12.3 (p<0.001) in the acupuncture and control group, respectively. Treatment success was essentially maintained through six months. Non-randomized patients had more severe symptoms at baseline and showed higher neck pain and disability improvement compared to randomized patients. Treatment with acupuncture added to routine care in patients with chronic neck pain was associated with improvements in neck pain and disability compared to treatment with routine care alone. PMID:16781068

Witt, Claudia M; Jena, Susanne; Brinkhaus, Benno; Liecker, Bodo; Wegscheider, Karl; Willich, Stefan N

2006-11-01

111

Experimental pain responses in children with chronic pain and in healthy children: How do they differ?  

PubMed Central

BACKGROUND: Extant research comparing laboratory pain responses of children with chronic pain 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 chronic pain 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 chronic pain and controls for the unspecified trials. For the specified cold pressor trial, 92% of children with chronic pain completed the entire trial compared with only 61.5% of controls. Children with chronic pain 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 chronic pain relative to controls. Children with chronic pain demonstrated a tendency toward increased arousal in anticipation of and following pain induction compared with controls. PMID:22518373

Tsao, Jennie CI; Evans, Subhadra; Seidman, Laura C; Zeltzer, Lonnie K

2012-01-01

112

Pain, Catastrophizing, and Depression in Chronic Prostatitis/Chronic Pelvic Pain Syndrome  

PubMed Central

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. PMID:23869268

Kwon, Jong Kyou

2013-01-01

113

Chronic neck pain and masticatory dysfunction.  

PubMed

Chronic nonspecific neck pain is a common problem in rheumatology and may resist conventional treatment. Pathophysiological links exist between the cervical spine and masticatory system. Occlusal disorders may cause neck pain and may respond to dental treatment. The estimated prevalence of occlusal disorders is about 45%, with half the cases being due to functional factors. Minor repeated masticatory dysfunction (MD) with craniocervical asymmetry is the most common clinical picture. The pain is usually located in the suboccipital region and refractory to conventional treatment. The time pattern may be suggestive, with nocturnal arousals or triggering by temporomandibular movements. MD should be strongly suspected in patients with at least two of the following: history of treated or untreated MD, unilateral temporomandibular joint pain and clicking, lateral deviation during mouth opening, and limitation of mouth opening (less than three fingerbreadths). Rheumatologists should consider MD among causes of neck pain, most notably in patients with abnormal craniocervical posture, signs linking the neck pain to mastication, and clinical manifestations of MD. Evidence suggesting that MD may cause neck pain has been published. However, studies are needed to determine whether treatment of MD can relieve neck pain. PMID:16226475

Catanzariti, Jean-François; Debuse, Thierry; Duquesnoy, Bernard

2005-12-01

114

Chronic musculoskeletal pain in young athletes.  

PubMed

Chronic musculoskeletal pain is becoming increasingly common in young athletes. When these athletes do not respond well to standard treatments, for example physical theraphy and anti-inflammatories, other diagnoses must be considered, such as reflex sympathetic dystrophy, fibromyalgia, and/or overtraining syndrome. PMID:12119870

Small, Eric

2002-06-01

115

Spinal Cord Stimulation for Chronic Pain Management  

Microsoft Academic Search

This article outlines the role of spinal cord stimulation in contemporary chronic pain management. The anatomical and neurophysiological correlates of stimulation of the intraspinal structures are discussed. The most common indications are presented, including failed back syndrome, reflex sympathetic dystrophy, neurogenic thoracic outlet syndrome, and spinal cord injury, etc. The most common complications are presented, including paralysis, infection, electrode migration,

Giancarlo Barolat

2000-01-01

116

Percutaneous drilling for chronic heel pain  

Microsoft Academic Search

The authors report a retrospective study involving 25 feet in 21 patients who underwent percutaneous drilling for chronic heel pain. Patients with increased activity of the heel were considered for surgical treatment if there was increased uptake on the delayed bone scans. The average follow-up was 21 months (range, 6 to 30 months). All patients were treated in day surgery

Stefano Santini; Arturo Rebeccato; Roberto Schiavon; Livio Nogarin

2003-01-01

117

Art Therapy for Chronic Pain: Applications and Future Directions  

ERIC Educational Resources Information Center

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

Angheluta, Anne-Marie; Lee, Bonnie K.

2011-01-01

118

Social, Psychological, and Medical Aspects of Chronic Pain.  

ERIC Educational Resources Information Center

Discusses certain factors that contribute to the development of chronic pain. Psychosocial factors are explored with a summary of their implications for treatment. Medical treatment for chronic pain is reviewed and holistic treatment is surveyed. (Author)

Sparks, Jayne A.; Clark, Donald W.

1981-01-01

119

Opioid use and depression in chronic pelvic pain.  

PubMed

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

Steele, Andrew

2014-09-01

120

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

PubMed Central

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

Staud, Roland

2009-01-01

121

Chronic pain in neuromuscular disease: pain site and intensity differentially impacts function.  

PubMed

The importance of pain extent (ie, number of body areas with pain) and pain site as factors contributing to dysfunction in persons with chronic, slowly progressive neuromuscular disease (NMD), remains poorly understood. This article discusses the importance of assessing pain site in addition to global pain intensity in patients with chronic, slowly progressive NMD. The importance of addressing pain at multiple sites will have a major impact on future studies assessing interventions to treat pain in this patient population. PMID:23137744

Miró, Jordi; Gertz, Kevin J; Carter, Gregory T; Jensen, Mark P

2012-11-01

122

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

PubMed Central

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

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

2014-01-01

123

Pain management discussion forum: prevention of chronic postoperative pain.  

PubMed

ABSTRACT A case of a 35-year-old woman scheduled for removal of a painful breast tumor is discussed. Ways to reduce risk of chronic pain developing postoperatively are described. Preoperative medications, nerve blocks, local anesthetics, and postoperative epidural pharmacotherapy are described. This report is adapted from paineurope 2014; Issue 1, Haymarket Medical Publications Ltd., and is presented with permission. paineurope is provided as a service to pain management by Mundipharma International, Ltd., and is distributed free of charge to health care professionals in Europe. Archival issues can be accessed via the Web site: http://www.paineurope.com, at which European health professionals can register online to receive copies of the quarterly publication. PMID:25166777

Breivik, Harald

2014-09-01

124

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

PubMed

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

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

2011-06-01

125

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

PubMed Central

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

Staud, Roland

2012-01-01

126

Chronic Pain: Treatment Barriers and Strategies for Clinical Practice  

Microsoft Academic Search

Background: Chronic pain 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

Myra Glajchen

127

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

Microsoft Academic Search

Adolescents with chronic pain frequently report sleep disturbances, particularly short sleep duration, night wakings, and poor sleep quality. Prior research has been limited by assessment of subjectively reported sleep only and lack of data on daily relationships between sleep and pain. The current study utilized multilevel modeling to compare daily associations between sleep and pain in adolescents with chronic pain

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

2010-01-01

128

[Chronic pain in elderly people: psychosocial dimension].  

PubMed

Chronic pain in elderly people requires to take into account somatic co-morbidities as well as its psychosocial dimensions. Chronic pain often represents a distress signal addressed to the environment and the care providers. Psychological suffering or mood disorders can be presented in the form of somatic complaints often associated with functional impairments, sometimes severe. Therapeutic care has to address functionality through an image-enhancing approach aiming to summon the patients' resources. The treatment of a concomitant depressive state necessitates a true commitment from the therapist. Its benefits are documented in elderly patients. Analgesic treatment as a whole will seek in particular to restore feelings of self-esteem and help the patient recover a good quality of life. PMID:21815497

Allaz, A F; Cedraschi, C; Rentsch, D; Canuto, A

2011-06-29

129

Cannabinoid–Opioid Interaction in Chronic Pain  

Microsoft Academic Search

Cannabinoids and opioids share several pharmacologic properties and may act synergistically. The potential pharmacokinetics and the safety of the combination in humans are unknown. We therefore undertook a study to answer these questions. Twenty-one individuals with chronic pain, on a regimen of twice-daily doses of sustained-release morphine or oxycodone were enrolled in the study and admitted for a 5-day inpatient

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

2011-01-01

130

Minimally Invasive Therapies for Chronic Pelvic Pain Syndrome  

Microsoft Academic Search

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

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

2010-01-01

131

Perceived Stereotyping and Seeking Care for Chronic Vulvar Pain  

PubMed Central

Objectives We examined stereotyping of chronic pain sufferers among women aged 18 – 40 years and determined whether perceived stereotyping affects seeking care for women with chronic vulvar pain. Design Cross-sectional study using a community-based survey of vulvodynia asking if “Doctors think that people with chronic pain exaggerate their pain”, and if “People believe that vulvar pain is used as an excuse to avoid having sex”. Setting and Participants 12,834 women aged 18 – 40 years in metropolitan Minneapolis/St. Paul, Minnesota. Paul, Minnesota. Outcome Measures Women were considered to have a history of chronic vulvar pain if they reported vulvar burning lasting more than 3 months or vulvar pain on contact. Results 4,987 (38.9%) women reported a chronic pain condition; 1,651 had chronic vulvar pain. Women experiencing chronic pain were more likely than those without to perceive stereotyping from both doctors and others; a dose-response with the number of pain conditions existed. Women with chronic vulvar pain were more likely to believe that people think vulvar pain is an excuse to avoid intercourse. Half of the women with chronic vulvar pain did not seek medical care for it; of these, 40.4% perceived stereotyping from doctors. However, it was women who actually sought care (45.1%) who were more likely to feel stigmatized by doctors (adj. relative risk=1.11, 95% CI: 1.01-1.23). Conclusions Perceived negative stereotyping among chronic pain sufferers is common, particularly negative perceptions about physicians. In fact, chronic vulvar pain sufferers who felt stigmatized were more likely to have sought care than those who didn't feel stigmatized. PMID:23742116

Nguyen, Ruby H.N.; Turner, Rachael M.; Rydell, Sarah A.; MacLehose, Richard F.; Harlow, Bernard L.

2014-01-01

132

Chronic Pelvic Pain in Endometriosis: An Overview  

PubMed Central

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

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

2013-01-01

133

Cortical plasticity as a new endpoint measurement for chronic pain  

PubMed Central

Animal models of chronic pain are widely used to investigate basic mechanisms of chronic pain and to evaluate potential novel drugs for treating chronic pain. Among the different criteria used to measure chronic pain, behavioral responses are commonly used as the end point measurements. However, not all chronic pain conditions can be easily measured by behavioral responses such as the headache, phantom pain and pain related to spinal cord injury. Here I propose that cortical indexes, that indicate neuronal plastic changes in pain-related cortical areas, can be used as endpoint measurements for chronic pain. Such cortical indexes are not only useful for those chronic pain conditions where a suitable animal model is lacking, but also serve as additional screening methods for potential drugs to treat chronic pain in humans. These cortical indexes are activity-dependent immediate early genes, electrophysiological identified plastic changes and biochemical assays of signaling proteins. It can be used to evaluate novel analgesic compounds that may act at peripheral or spinal sites. I hope that these new cortical endpoint measurements will facilitate our search for new, and more effective, pain medicines, and help to reduce false lead drug targets. PMID:21798042

2011-01-01

134

Naturopathic Care for Chronic Low Back Pain: A Randomized Trial  

Microsoft Academic Search

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

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

2007-01-01

135

Naturopathic Care for Chronic Low Back Pain: A Randomized Trial  

Microsoft Academic Search

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

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

2007-01-01

136

Acupuncture treatment for chronic knee pain: a systematic review  

Microsoft Academic Search

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

A. White; N. E. Foster; M. Cummings; P. Barlas

2007-01-01

137

Classification of chronic pain associated with spinal cord injuries  

Microsoft Academic Search

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

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

2002-01-01

138

Pain-Associated Adaptive Cortical Reorganisation in Chronic Pancreatitis  

Microsoft Academic Search

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

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

2010-01-01

139

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

PubMed Central

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

2014-01-01

140

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

MedlinePLUS

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

141

Chronic Pain: Symptoms, Diagnosis, & Treatment | NIH MedlinePlus the Magazine  

MedlinePLUS

... of this page please turn Javascript on. Feature: Chronic Pain Chronic Pain: Symptoms, Diagnosis, & Treatment Past Issues / Spring 2011 Table of Contents Symptoms Chronic pain is often defined as any pain lasting more ...

142

Intractable Pruritus After Traumatic Spinal Cord Injury  

PubMed Central

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 chronic pain or pruritic syndromes, sympatholysis via such techniques as stellate ganglion block might be effective. PMID:19777867

Crane, Deborah A; Jaffee, Kenneth M; Kundu, Anjana

2009-01-01

143

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

PubMed Central

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

Pujar, Thejeswi; Spinello, Irene M

2009-01-01

144

Role of the Immune system in chronic pain  

Microsoft Academic Search

During the past two decades, an important focus of pain research has been the study of chronic pain mechanisms, particularly the processes that lead to the abnormal sensitivity — spontaneous pain and hyperalgesia — that is associated with these states. For some time it has been recognized that inflammatory mediators released from immune cells can contribute to these persistent pain

Fabien Marchand; Mauro Perretti; Stephen B. McMahon

2005-01-01

145

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

ERIC Educational Resources Information Center

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

Strong, Jenny; And Others

1994-01-01

146

Cyberhugs: creating a voice for chronic pain sufferers through technology.  

PubMed

Chronic pain is a pervasive and expensive public health problem affecting roughly one-third of the American population. The inability of language to accurately convey pain expressions combined with the social stigmas associated with discussing pain persuade many sufferers to remain silent about their pain. Gender politics and fear of professional repercussions further encourage silence. This article explores the need for a safe and secure place for chronic pain sufferers to talk of their pain experiences. The extent to which digital communication technology can fulfill this need is examined. This descriptive study examines the use of one online chronic pain management workshop for its ability to create an engaged community of choice. Workshop admittance was based on participants having a qualifying chronic pain condition. A thematic discourse analysis is conducted of all entries chronic pain participants posted. In addition to goal setting, participants discuss the ways in which pain affects them on a daily basis. Two themes emerge: validation and encouragement. This study suggests that chronic pain users need a discursive space to legitimate their chronic pain identity. It confirms that online websites and virtual audiences facilitate disclosure and allow for authentic communication. The benefits of computer-mediated discussion as well as its limitations are examined. PMID:23276258

Becker, Karin L

2013-02-01

147

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

PubMed Central

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

Wilkes, Denise

2014-01-01

148

Duloxetine in the management of chronic musculoskeletal pain  

PubMed Central

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

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

2012-01-01

149

Long-term Use of Opioids for Complex Chronic Pain  

PubMed Central

Increased opioid prescribing for back pain and other chronic musculoskeletal pain conditions has been accompanied by dramatic increases in prescription opioid addiction and fatal overdose. Opioid-related risks appear to increase with dose. While short-term randomized trials of opioids for chronic pain have found modest analgesic benefits (a one-third reduction in pain intensity on average), the long-term safety and effectiveness of opioids for chronic musculoskeletal pain is unknown. Given the lack of large, long-term randomized trials, recent epidemiologic data suggests the need for caution when considering long-term use of opioids to manage chronic musculoskeletal pain, particularly at higher dosage levels. Principles for achieving more selective and cautious use of opioids for chronic musculoskeletal pain are proposed. PMID:24315147

Von Korff, Michael R.

2014-01-01

150

Medical marijuana use for chronic pain: risks and benefits.  

PubMed

Questions from patients about medical marijuana use for chronic pain 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

Greenwell, Garth T

2012-01-01

151

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

PubMed

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

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

2011-01-01

152

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

Microsoft Academic Search

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

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

2011-01-01

153

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

PubMed

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

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

2013-02-19

154

Effects of Anger Suppression on Pain Severity and Pain Behaviors Among Chronic Pain Patients: Evaluation of an Ironic Process Model  

Microsoft Academic Search

Objective: Evidence for links between anger inhibition or suppression and chronic pain 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

2008-01-01

155

Treatment for Chronic Pain in Patients With Advanced Cancer  

ClinicalTrials.gov

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

2010-11-07

156

Chronic low back pain and inaccurate predictions of pain: Is being too tough a risk factor for the development and maintenance of chronic pain?  

Microsoft Academic Search

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

Arnoud Arntz; Madelon Peters

1995-01-01

157

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

ERIC Educational Resources Information Center

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

Anderson, Louis P.; Rehm, Lynn P.

1984-01-01

158

The risk of suicide mortality in chronic pain patients.  

PubMed

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

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

2014-08-01

159

Interpersonal Psychotherapy for Co-occurring Depression and Chronic Pain  

PubMed Central

Up to 37% of individuals experience chronic pain during their lifetimes. Approximately one-fourth of primary care patients with chronic pain also meet criteria for major depression. Many of these individuals fail to receive psychotherapy or other treatment for their depression; moreover when they do, physical pain is often not addressed directly. Women, socioeconomically disadvantaged individuals, African Americans and Latinos all report higher rates of pain and depression compared to other groups. This article describes a version of Interpersonal Psychotherapy tailored for patients with comorbid depression and chronic pain, Interpersonal Psychotherapy for Depression and Pain (IPT-P). While IPT-P potentially could be delivered to many different patient populations in a range of clinical settings, this article focuses on its delivery within primary care settings for socioeconomically disadvantaged women. Adaptations include a brief 8-session protocol that incorporates strategies for anticipating barriers to psychotherapy, accepting patients’ conceptualization of their difficulties, encouraging patients to consider the impact of their pain on their roles and relationships, emphasizing self-care, incorporating pain management techniques, and flexible scheduling. In addition, IPT-P is designed as an adjunct to usual medical pain treatment, and seeks to engage non-treatment seeking patients in psychotherapy by focusing on accessibility and relevance of the intervention to concerns common among patients with pain. Identifying patients with comorbid depression and chronic pain and offering IPT-P as a treatment option has the potential to improve clinical outcomes for individuals with depression and chronic pain. PMID:21191470

Poleshuck, Ellen L.; Gamble, Stephanie A.; Cort, Natalie; Hoffman-King, Debra; Cerrito, Beth; Rosario-McCabe, Luis A.; Giles, Donna E.

2010-01-01

160

An ethnography of chronic pain in veteran enlisted women.  

PubMed

Enlisted women are an essential subpopulation within the United States (U.S.) Armed Services, yet little is known about their chronic pain experiences. The purpose of this study was to describe veteran enlisted women's chronic pain experiences, both while on active duty and since active duty ended. A total of 15 enlisted women were interviewed. This ethnographic approach produced stories of their beliefs, attitudes, and behaviors regarding their chronic pain and the care they have received both while serving and after discharge or retirement. The findings show that U.S. military culture and training have a major impact on enlisted women's chronic pain experiences. Enlisted women learn to ignore or deny acute pain because it would hamper their ability to complete their military mission. Even when they admit to themselves that they are in pain, they may mask the pain from others for fear of being called weak or fear of discrimination and ostracism. When the pain can no longer be ignored and they seek health care, they are frustrated when their pain reports are not believed by supervisors and health care providers. Chronic pain eventually leads to discharge or retirement when they can no longer do their job. Health care providers must understand both U.S. military culture and enlisted women's strategies concerning pain if they are to accurately diagnose and sufficiently treat enlisted women in pain. PMID:24315272

Denke, Linda; Barnes, Donelle M

2013-12-01

161

Outcome measures in chronic low back pain.  

PubMed

The purpose of this prospective, single site cohort quasi-experimental study was to determine the responsiveness of the numerical rating scale (NRS), Roland-Morris disability questionnaire (RMDQ), Oswestry disability index (ODI), pain self-efficacy questionnaire (PSEQ) and the patient-specific functional scale (PSFS) in order to determine which would best measure clinically meaningful change in a chronic low back pain (LBP) population. Several patient-based outcome instruments are currently used to measure treatment effect in the chronic LBP population. However, there is a lack of consensus on what constitutes a "successful" outcome, how an important improvement/deterioration has been defined and which outcome measure(s) best captures the effectiveness of therapeutic interventions for the chronic LBP population. Sixty-three consecutive patients with chronic LBP referred to a back exercise and education class participated in this study; 48 of the 63 patients had complete data. Five questionnaires were administered initially and after the 5-week back class intervention. Also at 5 weeks, patients completed a global impression of change as a reflection of meaningful change in patient status. Score changes in the five different questionnaires were subjected to both distribution- and anchor-based methods: standard error of measurement (SEM) and receiver operating characteristic (ROC) curves to define clinical improvement. From these methods, the minimal clinically important difference (MCID) defined as the smallest difference that patients and clinicians perceive to be worthwhile is presented for each instrument. Based on the SEM, a point score change of 2.4 in the NRS, 5 in the RMDQ, 17 in the ODI, 11 on the PSEQ, and 1.4 on the PSFS corresponded to the MCID. Based on ROC curve analysis, a point score change of 4 points for both the NRS and RMDQ, 8 points for the ODI, 9 points for the PSEQ and 2 points for the PSFS corresponded to the MCID. The ROC analysis demonstrated that both the PSEQ and PSFS are responsive to clinically important change over time. The NRS was found to be least responsive. The exact value of the MCID is not a fixed value and is dependent on the assessment method used to calculate the score change. Based on ROC curve analysis the PSFS and PSEQ were more responsive than the other scales in measuring change in patients with chronic LBP following participation in a back class programme. However, due to the small sample size, the lack of observed worsening of symptoms over time, the single centre and intervention studied these results which need to be interpreted with caution. PMID:20397032

Maughan, Elaine F; Lewis, Jeremy S

2010-09-01

162

Pain and chronic pancreatitis: A complex interplay of multiple mechanisms  

PubMed Central

Despite multiple theories on the pathogenesis of pain in chronic pancreatitis, no uniform and consistently successful treatment strategy exists and abdominal pain still remains the dominating symptom for most patients and a major challenge for clinicians. Traditional theories focussed on a mechanical cause of pain related to anatomical changes and evidence of increased ductal and interstitial pressures. These observations form the basis for surgical and endoscopic drainage procedures, but the outcome is variable and often unsatisfactory. This underscores the fact that other factors must contribute to pathogenesis of pain, and has shifted the focus towards a more complex neurobiological understanding of pain generation. Amongst other explanations for pain, experimental and human studies have provided evidence that pain perception at the peripheral level and central pain processing of the nociceptive information is altered in patients with chronic pancreatitis, and resembles that seen in neuropathic and chronic pain disorders. However, pain due to e.g., complications to the disease and adverse effects to treatment must not be overlooked as an additional source of pain. This review outlines the current theories on pain generation in chronic pancreatitis which is crucial in order to understand the complexity and limitations of current therapeutic approaches. Furthermore, it may also serve as an inspiration for further research and development of methods that can evaluate the relative contribution and interplay of different pain mechanisms in the individual patients, before they are subjected to more or less empirical treatment. PMID:24259959

Poulsen, Jakob Lykke; Olesen, Søren Schou; Malver, Lasse Paludan; Frøkjær, Jens Brøndum; Drewes, Asbjørn Mohr

2013-01-01

163

The appendix as the cause of chronic lower abdominal pain  

Microsoft Academic Search

The records of 63 patients who had appendectomy for chronic lower abdominal pain were reviewed. Histologically 92% of the removed appendices revealed abnormality, and 95% of these patients were completely cured. It is concluded that appendicopathy does exist and could be the cause of chronic lower abdominal pain.

Jamil A. Fayez; Nancy J. Toy; Tiffany M. Flanagan

1995-01-01

164

Mazes, conflict, and paradox: tools for understanding chronic pain.  

PubMed

This article presents an argument for framing chronic pain within a complex adaptive systems (CAS) paradigm. The first aim of this article is to demonstrate how chronic pain can be framed as a CAS and how paradox, one of the core characteristics of a CAS, exists within the chronic pain experience. The second aim is to illustrate how paradox exists at multiple levels within the health care encounter and ongoing experience of chronic pain. Finally, the article will use the example of interactions at the patient/clinician level to illustrate how health care workers' efforts to deal with issues emergent from the range of paradoxes have for the most part been ineffective, and at times harmful, to persons experiencing chronic pain. This article uses the example of chronic pain to explore how the manner in which health care providers and patients recognize and deal with paradoxes can either worsen the pain experience or help generate creative new ways to manage the chronic pain condition. The CAS principles discussed in this article hold application across a range of chronic conditions for which a traditional biomedical paradigm proves insufficient. PMID:19298361

Brown, Cary A

2009-01-01

165

An ethnography of chronic pain in veteran enlisted women  

Microsoft Academic Search

Enlisted women are an essential sub-population within the United States (U.S.) Armed Services, yet little is known about their chronic pain experiences. The purpose of this study was to describe veteran enlisted women's chronic pain experiences, both while on active duty and since active duty ended. A total of fifteen enlisted women were interviewed. This ethnographic approach produced stories of

Linda Denke; Donelle M. Barnes

166

Impact of chronic pain on everyday physical activity  

Microsoft Academic Search

Although patients with chronic pain are often considered to have reduced levels of everyday physical activity, data on their activity levels are scarce and inconclusive. Therefore, this study explored whether patients with chronic pain have reduced activity levels, as objectively measured with an activity monitor. The activity monitor is based on long-term ambulatory monitoring of signals from body-fixed accelerometers during

Rita J. van den Berg-Emons; Fabiënne C. Schasfoort; Leonard A. de Vos; Johannes B. Bussmann; Henk J. Stam

2007-01-01

167

Deep brain stimulation for chronic pain investigated with magnetoencephalography  

E-print Network

Deep brain stimulation for chronic pain investigated with magnetoencephalography Morten L of Surgery, John Radcli¡e Hospital,Oxford, d Department of Psychology, Newcastle University, Newcastle and e remarkable potential in alleviat- ing otherwise treatment-resistant chronic pain, but little is currently

Hansen, Peter

168

Is Self-Concealment Associated With Acute and Chronic Pain?  

Microsoft Academic Search

Objective: Self-concealment is the predisposition to hide negative personal information. The present research examined whether self-concealment was associated with acute and chronic pain. Methods: In Study 1, undergraduate students (N = 44) completed an online questionnaire packet and then completed a cold-pressor task in the laboratory. In Study 2, individuals with chronic pain (N = 85) completed an online survey.

Ahmet Uysal; Qian Lu

2011-01-01

169

Impairment of pain inhibition in chronic tension-type headache  

Microsoft Academic Search

Evidence has been accumulated suggesting that a dysfunction in pain inhibitory systems, i.e. in ‘diffuse noxious inhibitory controls‘ (DNIC)-like mechanisms, might be—amongst other factors—responsible for the development of anatomically generalized chronic pain like fibromyalgia. The aim of the present study was to look for similar impairments in chronic tension-type headache (CTTH) as a regionally specific pain syndrome. Twenty-nine CTTH patients

Anke Pielsticker; Gunther Haag; Michael Zaudig; Stefan Lautenbacher

2005-01-01

170

Ketamine for chronic pain: risks and benefits.  

PubMed

The anaesthetic ketamine is used to treat various chronic pain syndromes, especially those that have a neuropathic component. Low dose ketamine produces strong analgesia in neuropathic pain states, presumably by inhibition of the N-methyl-D-aspartate receptor although other mechanisms are possibly involved, including enhancement of descending inhibition and anti-inflammatory effects at central sites. Current data on short term infusions indicate that ketamine produces potent analgesia during administration only, while three studies on the effect of prolonged infusion (4-14 days) show long-term analgesic effects up to 3 months following infusion. The side effects of ketamine noted in clinical studies include psychedelic symptoms (hallucinations, memory defects, panic attacks), nausea/vomiting, somnolence, cardiovascular stimulation and, in a minority of patients, hepatoxicity. The recreational use of ketamine is increasing and comes with a variety of additional risks ranging from bladder and renal complications to persistent psychotypical behaviour and memory defects. Blind extrapolation of these risks to clinical patients is difficult because of the variable, high and recurrent exposure to the drug in ketamine abusers and the high frequency of abuse of other illicit substances in this population. In clinical settings, ketamine is well tolerated, especially when benzodiazepines are used to tame the psychotropic side effects. Irrespective, close monitoring of patients receiving ketamine is mandatory, particularly aimed at CNS, haemodynamic, renal and hepatic symptoms as well as abuse. Further research is required to assess whether the benefits outweigh the risks and costs. Until definite proof is obtained ketamine administration should be restricted to patients with therapy-resistant severe neuropathic pain. PMID:23432384

Niesters, Marieke; Martini, Christian; Dahan, Albert

2014-02-01

171

Psychological distress in chronic craniomandibular and cervical spinal pain patients.  

PubMed

Recent studies to chronic pain have shown that the number of painful body areas is related to the level of psychological distress. Therefore, the first aim of this study was to analyse differences in level of psychological distress between craniomandibular pain patients with or without cervical spinal pain. In this analysis, the number of painful body areas below the cervical spine was also taken into account. The second aim was to determine psychological differences between subgroups of craniomandibular pain patients. In this study, 103 out of 250 persons with or without craniomandibular pain were included in the final analyses. Patients who suffered from both craniomandibular and cervical spinal pain showed higher levels of psychological distress, as measured with the Symptom Checklist 90 (SCL-90) than patients with local craniomandibular pain and persons without pain. Further, a positive relationship was found between the number of painful body areas below the cervical spine, as measured on a body drawing, and the SCL-90 scores. No psychological differences were found between myogenous and arthrogenous craniomandibular pain patients. In conclusion, chronic craniomandibular pain patients with a coexistent cervical spinal pain showed more psychological distress compared to patients with only a local craniomandibular pain and asymptomatic persons. PMID:11456346

Visscher, C M; Lobbezoo, F; de Boer, W; van der Meulen, M; Naeije, M

2001-06-01

172

Pain assessment and management of patients with chronic renal failure  

Microsoft Academic Search

ABSTRACT Background.Chronic renal failure is a worldwide,public health concern with increasing incidence and prevalence, poor patient outcomes and high cost. Patients with renal failure often experience pain. Optimal pain assessment and management,are key clinical activities yet inadequate pain control by health professionals persists. The presence of renal failure compounds,this problem. Very little research has been conducted on pain control in

Allison Williams; Elizabeth Manias

173

Connecting parents of children with chronic pain through art therapy  

PubMed Central

Objectives To help address the unique needs of parents of children with chronic pain, a four module, parent-only, group art therapy curriculum was designed and implemented within an interdisciplinary pain rehabilitation treatment program. We evaluated perceived satisfaction and helpfulness of the group intervention. Methods Fifty-three parents of children experiencing chronic pain enrolled in a day hospital interdisciplinary pain rehabilitation program participated. The voluntary parent art therapy group was offered one time per week for one hour. Participants completed a measure of satisfaction, helpfulness, and perceived social support at the end of each group session. Results Parents enjoyed participating in the group, agreed that they would try art therapy again, and found it to be a helpful, supportive, and validating experience. Conclusions Initial results are promising that group art therapy is an appropriate and helpful means of supporting parents of children with chronic pain during interdisciplinary pain rehabilitation. PMID:24563827

Pielech, Melissa; Sieberg, Christine B.; Simons, Laura E.

2014-01-01

174

THE EFFECTS OF SLEEP DEPRIVATION AND SLEEP RECOVERY ON PAIN THRESHOLDS OF RATS WITH CHRONIC PAIN  

Microsoft Academic Search

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

175

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

PubMed Central

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

Pastore, Elizabeth Anne; Katzman, Wendy B.

2012-01-01

176

Pathways of Chronic Pain in Survivors of Intimate Partner Violence  

PubMed Central

Abstract Objective To examine the roles of lifetime abuse-related injury, posttraumatic stress disorder (PTSD) symptom severity, and depressive symptom severity in mediating the effects of severity of assaultive intimate partner violence (IPV), psychological IPV, and child abuse on chronic pain severity in women survivors of IPV. Methods Structural equation modeling of data from a community sample of 309 women survivors of IPV was used to test partial and full theoretical models of the relationships among the variables of interest. Results The full model had good fit and accounted for 40.2% of the variance in chronic pain severity. Abuse-related injury, PTSD symptom severity, and depressive symptom severity significantly mediated the relationship between child abuse severity and chronic pain severity, but only abuse-related injury significantly mediated the relationship between assaultive IPV severity and chronic pain severity. Psychological IPV severity was the only abuse variable with significant direct effects on chronic pain severity but had no significant indirect effects. Conclusions These findings can inform clinical care of women with chronic pain in all areas of healthcare delivery by reinforcing the importance of assessing for a history of child abuse and IPV. Moreover, they highlight the relevance of routinely assessing for abuse-related injury and PTSD and depressive symptom severity when working with women who report chronic pain. PMID:20718626

Ford-Gilboe, Marilyn; Merritt-Gray, Marilyn; Wilk, Piotr; Campbell, Jacquelyn C.; Lent, Barbara; Varcoe, Colleen; Smye, Victoria

2010-01-01

177

Effects of mood on pain responses and pain tolerance: An experimental study in chronic back pain patients  

Microsoft Academic Search

Although chronic pain and depression commonly co-occur, causal relationships have yet to be established. A reciprocal relationship, with depression increasing pain and vice versa, is most frequently suggested, but experimental evidence is needed to validate such a view. The most straightforward approach would be a demonstration that increasing or decreasing depressed mood predictably modifies pain responses. The current experiment tested

Nicole K. Y. Tang; Paul M. Salkovskis; Amy Hodges; Kelly J. Wright; Magdi Hanna; Joan Hester

2008-01-01

178

Acupuncture for Chronic Low Back Pain  

Microsoft Academic Search

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

2010-01-01

179

Hippocampal subfields differentially correlate with chronic pain in older adults.  

PubMed

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

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

2014-07-21

180

Patients with chronic pain and abnormal pituitary function require investigation.  

PubMed

Misuse of opioids is associated with abnormalities of pituitary function. Patients with chronic pain 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 chronic pain 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 chronic pain 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

2003-06-28

181

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

PubMed Central

This study aimed to identify clinically meaningful profiles of pain coping strategies used by youth with chronic abdominal pain (CAP). Participants (n = 699) were pediatric patients (ages 8–18 years) and their parents. Patients completed the Pain Response Inventory (PRI) and measures of somatic and depressive symptoms, disability, pain severity and pain efficacy, and perceived competence. Parents rated their children’s pain severity and coping efficacy. Hierarchical cluster analysis based on the 13 PRI subscales identified pain coping profiles in Sample 1 (n = 311) that replicated in Sample 2 (n = 388). Evidence was found of external validity and distinctiveness of the profiles. The findings support a typology of pain coping that reflects the quality of patients’ pain mastery efforts and interpersonal relationships associated with pain coping. Results are discussed in relation to developmental processes, attachment styles, and treatment implications. PMID:17928144

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

2009-01-01

182

Opioids, Chronic Pain, and Addiction in Primary Care  

PubMed Central

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 chronic pain 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. PMID:20627817

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.

2010-01-01

183

Alterations in Endogenous Opioid Functional Measures in Chronic Back Pain  

PubMed Central

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

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

2013-01-01

184

Emerging targets in neuroinflammation-driven chronic pain  

PubMed Central

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

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

2014-01-01

185

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

PubMed Central

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

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

2014-01-01

186

Intercostal nerve block with 5% tetracaine for chronic pain syndromes  

Microsoft Academic Search

Treating chronic pain syndromes is always challenging. We describe an effective use of an intercostal nerve block using 5% tetracaine in three patients with postherpetic intercostal neuralgia or postoperative intercostal neuralgia.

Katsushi Doi; Tetsuro Nikai; Shinichi Sakura; Yoji Saito

2002-01-01

187

Complementary Health Approaches for Chronic Pain: What the Science Says  

MedlinePLUS

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

188

Chronic precentral stimulation in trigeminal neuropathic pain  

Microsoft Academic Search

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

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

1996-01-01

189

Variations in Brain Gray Matter Associated with Chronic Pain  

Microsoft Academic Search

Variations in brain gray matter volume and density have been reported in association with a variety of disorders characterized\\u000a by chronic pain, including chronic low back pain, fibromyalgia, and irritable bowel syndrome. Correlation analyses have demonstrated\\u000a relationships between morphometric and clinical variables. However, conclusions regarding the nature of these relationships\\u000a are problematic given that currently available data are derived exclusively

Patrick B. Wood

2010-01-01

190

Exercise Testing and Training in Patients with (Chronic) Pain  

Microsoft Academic Search

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

Harriët Wittink; Tim Takken

191

Management of chronic pain with chronic opioid therapy in patients with substance use disorders  

PubMed Central

Substance use disorders (SUDs), whether active or in remission, are often encountered in patients with chronic nonmalignant pain. Clinicians are challenged when managing chronic pain while facing substance abuse issues during the course of chronic opioid therapy (COT). Further, the interrelated behavioral symptomatology of addiction and chronic pain suggests that if one disorder is untreated, effective treatment of the other in not possible. Incomplete understanding of the overlapping presentations of the two disorders, coupled with insufficient management of both conditions, leads to undertreated pain and premature discharge of SUD patients from pain treatment. In order to achieve pain relief and optimal functionality, both conditions need to be carefully managed. This paper reviews the prevalence of SUDs in chronic pain patents; the overlapping presentation of the two disorders; risk factors and stratification for addiction; identification of addiction in the chronic pain population; and suggestions for treating patients with COT, with an emphasis on relapse prevention. With appropriate assessment and treatment, COT for chronic pain patients with a history of SUD can be successful, leading to improved functionality and quality of life. PMID:24341916

2013-01-01

192

Celiac plexus block in the management of chronic abdominal pain.  

PubMed

Chronic abdominal pain is a devastating problem for patients and providers, due to the difficulty of effectively treating the entity. Both benign and malignant conditions can lead to chronic abdominal pain. Precision in diagnosis is required before effective treatment can be instituted. Celiac Plexus Block is an interventional technique utilized for diagnostic and therapeutic purposes in the treatment of abdominovisceral pain. The richly innervated plexus provides sensory input about pathologic processes in the liver, pancreas, spleen, omentum, alimentary tract to the mid-transverse colon, adrenal glands, and kidney. Chronic pancreatitis and chronic pain from pancreatic cancer have been treated with celiac plexus block to theoretically decrease the side effects of opioid medications and to enhance analgesia from medications. Historically, the block was performed by palpation and identification of bony and soft tissue anatomy; currently, various imaging modalities are at the disposal of the interventionalist for the treatment of pain. Fluoroscopy, computed tomography (CT) guidance and endoscopic ultrasound assistance may be utilized to aid the practitioner in performing the blockade of the celiac plexus. The choice of radiographic technology depends on the specialty of the interventionalist, with gastroenterologists favoring endoscopic ultrasound and interventional pain physicians and radiologists preferring CT guidance. A review is presented describing the indications, technical aspects, and agents utilized to block the celiac plexus in patients suffering from chronic abdominal pain. PMID:24414338

Rana, Maunak V; Candido, Kenneth D; Raja, Omar; Knezevic, Nebojsa Nick

2014-02-01

193

Positron emission tomography study of a chronic pain patient successfully treated with somatosensory thalamic stimulation  

Microsoft Academic Search

Previous neuroimaging studies suggested that the neuronal network underlying the perception of chronic pain may differ from that underlying acute pain. To further map the neural network associated with chronic pain, we used positron emission tomography (PET) to determine significant regional cerebral blood flow (rCBF) changes in a patient with chronic facial pain. The patient is implanted with a chronic

Ron C. Kupers; Jan M. Gybels; Albert Gjedde

2000-01-01

194

Understanding cultural constructions of chronic pain in Mexican-American women  

Microsoft Academic Search

Background. Non-malignant chronic pain is a national health problem. Cultural constructions of chronic pain, such as expression of symptoms and decision making, may interfere with treatment. ^ Purpose. To describe the cultural constructions of chronic pain held by Mexican-American women. ^ Methods. This qualitative, focused ethnographic study examined the shared cultural experiences of women with non-malignant chronic pain. Field work

Diane B Monsivais

2008-01-01

195

Effect of Iyengar yoga therapy for chronic low back pain  

Microsoft Academic Search

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

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

2005-01-01

196

Effect of Iyengar yoga therapy for chronic low back pain  

Microsoft Academic Search

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

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

197

Strategies for Coping with Stress and Chronic Pain.  

ERIC Educational Resources Information Center

This guide presents strategies used in Pain Management and Stress Reduction workshops for helping the elderly cope with stress and chronic pain. 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…

Meyer, Genevieve Rogge

198

Sleep Disturbances in School-age Children with Chronic Pain  

Microsoft Academic Search

Objectives To examine associations between pain, functional outcomes, and sleep disturbances in children with chronic pain, specifically juvenile idiopathic arthritis ( JIA), sickle cell disease (SCD), and headache (HA). Sleep disturbances were tested as a risk factor for increased functional disability and decreased health-related quality of life (HRQOL). Methods One hundred children ( JIA n ¼ 30, SCD n ¼

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

2008-01-01

199

Spinal cord stimulation and the relief of chronic pain  

Microsoft Academic Search

Twenty six patients who had received spinal cord stimulation for chronic pain were evaluated by videotaped structured interviews with staff not directly involved in the patients' care. In addition estimates of pain relief were obtained from clinicians involved in the patients' care and from close relatives and friends. Information about lifestyles and drug usage was also collected and correlated with

T H Koeze; A C Williams; S Reiman

1987-01-01

200

Acupuncture in Patients With Chronic Low Back Pain  

Microsoft Academic Search

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

2006-01-01

201

Sleep and Quality of Life in Chronic Pain  

Microsoft Academic Search

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

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

202

Treatment options for chronic abdominal pain in children and adolescents  

Microsoft Academic Search

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

Adrian Miranda; Manu Sood

2006-01-01

203

Parents' Initial Perceptions of Multidisciplinary Care for Pediatric Chronic Pain  

PubMed Central

Chronic and recurrent pain is experienced by many children and adolescents. Treatment of chronic pain using a multidisciplinary approach has been found to be effective for treatment of chronic pain. Parent satisfaction with treatment and treatment providers highly correlates to children's treatment adherence. Parents of children treated at a multidisciplinary chronic pain clinic were interviewed following their initial appointment. Parents reported high satisfaction with treatment team members and with the treatment plan. Parents also reported appreciation of multidisciplinary structure, the high level of expertise of the team members, and the team members' genuine interest in treating their children. This increase in satisfaction when compared to previous treatment is important since increases in satisfaction may correlate with a reduction in experiences of chronic pain. Parents reported high satisfaction with interactions with treatment team members and with the treatment plan provided for their children. Parents had appreciation of multidisciplinary team structure and the high level of expertise of the team members. This increase in satisfaction when compared to treatment from previous providers is important since increases in satisfaction may correlate with an increase in children's treatment adherence and a reduction in experiences of chronic pain. PMID:22966428

Gorodzinsky, Ayala Y.; Tran, Susan T.; Medrano, Gustavo R.; Fleischman, Katie M.; Anderson-Khan, Kimberly J.; Ladwig, Renee J.; Weisman, Steven J.

2012-01-01

204

Chronic pain management strategies used by low income overweight Latinos  

PubMed Central

Objectives In group interviews, we examined strategies used to manage chronic pain 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 chronic pain 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 chronic pain by listening respectfully to how pain alters their daily lives and assisting them in feasible self management strategies. PMID:23129787

Rutledge, Dana N; Cantero, Patricia J; Ruiz, Jeanette E

2013-01-01

205

Brain white matter structural properties predict transition to chronic pain  

PubMed Central

Neural mechanisms mediating the transition from acute to chronic pain remain largely unknown. In a longitudinal brain imaging study, we followed patients with a single subacute back pain (SBP) episode for over one year as their pain subsided (SBPr), or persisted (SBPp) representing a transition to chronic pain. We discovered brain white-matter structural abnormalities (in n=24 SBP; 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 (in n=22 SBP; SBPp=11 and SBPr=11), and showed no further alterations over a one-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 to 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 chronic pain, we can conclude that brain structural differences, most likely existing prior to the back pain inciting event and independent of the back pain, predisposes subjects to pain chronification. PMID:24040975

Mansour, Ali; Baliki, Marwan N.; Huang, Lejian; Torbey, Souraya; Herrmann, K.; Schnitzer, Thomas J.; Apkarian, A. Vania

2013-01-01

206

Chronic Pain and the Emotional Brain: Specific Brain Activity Associated with Spontaneous Fluctuations of Intensity of Chronic Back Pain  

PubMed Central

Living with unrelenting pain (chronic pain) is maladaptive and is thought to be associated with physiological and psychological modifications, yet there is a lack of knowledge regarding brain elements involved in such conditions. Here, we identify brain regions involved in spontaneous pain of chronic back pain (CBP) in two separate groups of patients (n = 13 and n = 11), and contrast brain activity between spontaneous pain and thermal pain (CBP and healthy subjects, n = 11 each). Continuous ratings of fluctuations of spontaneous pain during functional magnetic resonance imaging were separated into two components: high sustained pain and increasing pain. Sustained high pain of CBP resulted in increased activity in the medial prefrontal cortex (mPFC; including rostral anterior cingulate). This mPFC activity was strongly related to intensity of CBP, and the region is known to be involved in negative emotions, response conflict, and detection of unfavorable outcomes, especially in relation to the self. In contrast, the increasing phase of CBP transiently activated brain regions commonly observed for acute pain, best exemplified by the insula, which tightly reflected duration of CBP. When spontaneous pain of CBP was contrasted to thermal stimulation, we observe a double-dissociation between mPFC and insula with the former correlating only to intensity of spontaneous pain and the latter correlating only to pain intensity for thermal stimulation. These findings suggest that subjective spontaneous pain of CBP involves specific spatiotemporal neuronal mechanisms, distinct from those observed for acute experimental pain, implicating a salient role for emotional brain concerning the self. PMID:17122041

Baliki, Marwan N.; Chialvo, Dante R.; Geha, Paul Y.; Levy, Robert M.; Harden, R. Norman; Parrish, Todd B.; Apkarian, A. Vania

2014-01-01

207

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

PubMed Central

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

2013-01-01

208

Conceptualizing and Treating Comorbid Chronic Pain and PTSD  

PubMed Central

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

Gallinati, Jessica L.; Clark, Michael E.

2013-01-01

209

Retained foetal bones: an intrauterine cause of chronic pelvic pain.  

PubMed

Intrauterine retention of foetal bones is an uncommon but recognised complication of late termination of pregnancy. Secondary subfertility, abnormal uterine bleeding and vaginal discharge are the usual presenting complaints. We report a case of prolonged retention of foetal bones for 14 years in a woman who presented with chronic pelvic pain. Hysteroscopic examination was diagnostic and therapeutic. Retained foetal bones are an uncommon intrauterine cause of chronic pelvic pain that should be considered particularly when a woman with a history of late termination presents with pelvic pain. Hysteroscopic evacuation is curative. PMID:18506460

Kalu, Emmanuel; Richardson, Robert

2009-02-01

210

A new paradigm in chronic bladder pain.  

PubMed

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

Wesselmann, Ursula

2014-12-01

211

Mental motor imagery and chronic pain: the foot laterality task.  

PubMed

Several lines of evidence suggest that mental motor imagery is subserved by the same cognitive operations and brain structures that underlie action. Additionally, motor imagery is informed by the anticipated sensory consequences of action, including pain. We reasoned that motor imagery could provide a useful measure of chronic leg or foot pain. Forty subjects with leg pain (19 bilateral, 11 right, and 10 left leg pain), 42 subjects with chronic pain not involving the legs, and 38 controls were shown 12 different line drawings of the right or left foot and asked to indicate which foot was depicted. Previous work suggests that subjects perform this task by mentally rotating their foot to match the visually presented stimulus. All groups of subjects were slower and less accurate with stimuli that required a greater degree of mental rotation of their foot. Subjects with leg pain were both slower and less accurate than normal and pain control subjects in responding to drawings of a painful extremity. Furthermore, subjects with leg pain exhibited a significantly greater decrement in performance for stimuli that required larger amplitude mental rotations. These data suggest that motor imagery may provide important insights into the nature of the pain experience. PMID:20380787

Coslett, H Branch; Medina, Jared; Kliot, Dasha; Burkey, Adam

2010-07-01

212

The effects of motivational interviewing on marital and pain adjustment in chronic pain patients and their spouses  

Microsoft Academic Search

Chronic pain is a costly health condition that is estimated to affect 150 million Americans. Numerous studies have shown that chronic pain affects a variety of aspects of life including mood, daily activities, and relationships. Not only does the individual with chronic pain suffer, spouses often do as well. The purpose of this study was to develop and test an

Lisa Renee Miller

2012-01-01

213

Multidisciplinary and interdisciplinary management of chronic pain.  

PubMed

Multidisciplinary and interdisciplinary pain management programs incorporate a biopsychosocial model in assessing and treating pain and result in pain reduction, improved quality of life, and psychosocial functioning. Additionally, return-to-work and vocational outcomes may be seen in selected patients. Treatment teams may include a physiatrist, a physical or occupational therapist,a pain psychologist, a relaxation (biofeedback) therapist, vocational and therapeutic recreational therapists, social workers, and nurses. The key component to program success is collaborative ongoing communication among team members, the patient, and the case manager. PMID:16616276

Stanos, Steven; Houle, Timothy T

2006-05-01

214

Locus of control patterns in headaches and chronic pain  

PubMed Central

BACKGROUND: Locus of control (LOC) is related to the impact of headaches and chronic pain; however, literature evidence regarding LOC is not always consistent. Several authors consider this to be due, in part, to the separate interpretation of LOC factors, during which the interaction among them is ignored. In 1982, Wallston and Wallston proposed eight possible LOC health patterns depending on whether the individual scored high or low in each of three dimensions. OBJECTIVE: To identify these LOC patterns in patients with headaches and chronic pain, and to validate them in terms of their association with a selection of the main pain indicators. METHODS: A total of 228 individuals were recruited at three public centres in Seville, Spain. Participants completed a semistructured clinical interview and several questionnaires assessing psychological variables related to pain. The main statistical analyses used were two-step cluster analysis and ANCOVA. RESULTS: The six-cluster solution was optimal. The patterns observed coincided with: the believer in control; the yea-sayer; the pure chance; the pure internal; the pure professional; and the nay-sayer clusters. The double external or type VI clusters were not observed. Clusters could be classified from the best to the worst adjustment to chronic pain. CONCLUSIONS: These results support the empirical validity of the theoretical model of LOC patterns proposed in 1982 by Wallston and Wallston among a chronic pain population. The analysis of patterns provides more accurate information regarding the adjustment to pain compared with analysis of the LOC factors separately. PMID:23936894

Cano-Garcia, Francisco Javier; Rodriguez-Franco, Luis; Lopez-Jimenez, Ana Maria

2013-01-01

215

Psychological therapies for the management of chronic pain.  

PubMed

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

Sturgeon, John A

2014-01-01

216

Neuromodulatory treatments for chronic pain: efficacy and mechanisms.  

PubMed

Chronic pain is common, and the available treatments do not provide adequate relief for most patients. Neuromodulatory interventions that modify brain processes underlying the experience of pain have the potential to provide substantial relief for some of these patients. The purpose of this Review is to summarize the state of knowledge regarding the efficacy and mechanisms of noninvasive neuromodulatory treatments for chronic pain. The findings provide support for the efficacy and positive side-effect profile of hypnosis, and limited evidence for the potential efficacy of meditation training, noninvasive electrical stimulation procedures, and neurofeedback procedures. Mechanisms research indicates that hypnosis influences multiple neurophysiological processes involved in the experience of pain. Evidence also indicates that mindfulness meditation has both immediate and long-term effects on cortical structures and activity involved in attention, emotional responding and pain. Less is known about the mechanisms of other neuromodulatory treatments. On the basis of the data discussed in this Review, training in the use of self-hypnosis might be considered a viable 'first-line' approach to treat chronic pain. More-definitive research regarding the benefits and costs of meditation training, noninvasive brain stimulation and neurofeedback is needed before these treatments can be recommended for the treatment of chronic pain. PMID:24535464

Jensen, Mark P; Day, Melissa A; Miró, Jordi

2014-03-01

217

Psychological therapies for the management of chronic pain  

PubMed Central

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

Sturgeon, John A

2014-01-01

218

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

PubMed Central

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

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

2014-01-01

219

Non-pharmacological treatment of chronic widespread musculoskeletal pain.  

PubMed

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 chronic pain. 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

Hassett, Afton L; Williams, David A

2011-04-01

220

Laparoscopic Inguinal Exploration and Mesh Placement for Chronic Pelvic Pain  

PubMed Central

Background and Objective: Chronic pelvic pain affects 15% of women. Our objective was to evaluate empiric laparoscopic inguinal exploration and mesh placement in this population. Methods: Retrospective cohort with follow-up questionnaire of women with lateralizing chronic pelvic pain (right or left), ipsilateral inguinal tenderness on pelvic examination, no clinical hernia on abdominal examination, and ipsilateral empiric laparoscopic inguinal exploration with mesh placement (2003–2009). Primary outcome was pain level at the last postoperative visit. Secondary outcomes were pain level and SF-36 scores from the follow-up questionnaire. Results: Forty-eight cases met the study criteria. Surgery was done empirically for all patients, with only 7 patients (15%) found to have an ipsilateral patent processus vaginalis (shallow peritoneal dimple or a deeper defect (occult hernia)). Of 43 cases informative for the primary outcome, there was pain improvement in 15 patients (35%); pain improvement then return of the pain in 18 patients (42%); and pain unchanged in 9 patients (21%) and worse in 1 patient (2%). Improvement in pain was associated with a positive Carnett's test in the ipsilateral abdominal lower quadrant (P = .024). Thirteen patients returned the questionnaire (27%), and the pain was now described as improved in 9 patients (69%), unchanged in 4 patients (31%), and worse in none. Three SF-36 subscales showed improvement (physical functioning, social functioning, and pain). Conclusion: In select women with chronic pelvic pain, empiric laparoscopic inguinal exploration and mesh placement results in moderate improvement in outcome. A positive Carnett's test in the ipsilateral abdominal lower quadrant is a predictor of better outcome. PMID:23743375

Williams, Christina; Allaire, Catherine

2013-01-01

221

Return of Chronic Pelvic Pain From Endometriosis After Raloxifene Treatment  

PubMed Central

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 PMID:18165396

Stratton, Pamela; Sinaii, Ninet; Segars, James; Koziol, Deloris; Wesley, Robert; Zimmer, Carolyn; Winkel, Craig; Nieman, Lynnette K.

2009-01-01

222

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

PubMed Central

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

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

2013-01-01

223

[Psychological components of chronic pain in the elderly].  

PubMed

Chronic pain is a complex multidimensional phenomenon. Pain complaints in the elderly are modulated by several psychosocial factors. They can be understood as a way to indicate suffering or to get attention and sometimes as a mean to regain self-esteem. There is little quantitative change in pain associated psychopathology and coping mechanisms in the elderly as compared to younger patients. However, qualitative changes are identified. The high degree of association between chronic pain and depression remains throughout the age span. However, age variations in the expression of psychological distress are to be noted. Elderly patients have a tendency to make a greater use of somatic complaints and avoid the expression of the emotional dimension of distress. This clinical particularity is discussed. Special attention should be paid to the multidimensional aspects of pain complaints in the elderly in order not to underestimate its affective components. PMID:16753583

Allaz, Anne-Françoise

2006-06-01

224

[Treatment of hand surgery patients in chronic pain].  

PubMed

The treatment of hand surgery patients suffering from chronic pain requires an interdisciplinary procedure. An imbalance between nociception and antinociception can be seen as a reason for the chronification of pain. The complexity of the problem of chronic pain patients is marked by a wide variety of symptoms. Full diagnostic assessment to detect or to exclude other organic diseases is required. Rehabilitation to improve function and reduce pain intensity has priority. Our therapeutic strategy consists of intensive physiotherapy and analgesic drugs as well as a series of blockades with buprenorphine (Temgesic) of the ganglion stellatum (GLOA). This specific therapy achieved an improvement of the function of the upper extremity and a reduction of pain intensity. The majority of patients were satisfied with the outcome. PMID:12743693

Eiche, J; Krimmer, H; Lanz, U; Müller-Zimmermann, A; Reichl, M

2003-05-01

225

Acceptance and related processes in adjustment to chronic pain.  

PubMed

Chronic pain poses significant challenges in the lives of many people. At the root of many of these challenges are the behavior patterns pain naturally coordinates. For example, in some cases, attempts to control, reduce, or cure pain through medication, medical procedures, or lifestyle changes can prove unsuccessful, and can dominate all other potential goals. The experience of chronic pain also includes other discouraging, painful, or unwanted psychological experiences, such as thoughts, feelings, and memories. Attempts to control or reduce some of these psychological experiences also can prove unsuccessful and even harmful, further reducing quality of life. This review highlights recent evidence for the utility of acceptance as an alternative when control-based methods are unsuccessful. It describes evidence from experimental, clinical, and treatment outcome studies. The review also notes how work in this area is drawing attention to the wider concept of "psychological flexibility," an overarching process that includes other component processes, such as mindfulness and values. PMID:21222244

Thompson, Miles; McCracken, Lance M

2011-04-01

226

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

PubMed Central

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

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

2011-01-01

227

Toll-like receptors in chronic pain  

Microsoft Academic Search

Proinflammatory central immune signaling contributes significantly to the initiation and maintenance of heightened pain states. Recent discoveries have implicated the innate immune system, pattern recognition Toll-like receptors in triggering these proinflammatory central immune signaling events. These exciting developments have been complemented by the discovery of neuronal expression of Toll-like receptors, suggesting pain pathways can be activated directly by the detection

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

228

Toll-Like Receptors in Chronic Pain  

PubMed Central

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

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

2011-01-01

229

Pain beliefs and perceived physical disability of patients with chronic low back pain  

Microsoft Academic Search

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

David Andrew Walsh; Jenny Clare Radcliffe

2002-01-01

230

Improving the quality of pain treatment by a tailored pain education programme for cancer patients in chronic pain.  

PubMed

Educational interventions, aiming to increase patients' knowledge and attitude regarding pain, can affect pain treatment. The purpose of this study was to evaluate the effects of a Pain Education Programme (PEP), on adequacy of pain treatment, and to describe characteristics predicting change in adequacy. The PEP consists of a multi-method approach in which patients are educated about the basic principles regarding pain, instructed how to report pain in a pain diary, how to communicate about pain, and how to contact healthcare providers. The effects of the PEP were evaluated taking into consideration the lack of well-established outcome measures to evaluate adequacy of pain treatment, the lack of long-term follow-up, and the influence of missing data.A prospective, randomized study was utilized in which 313 chronic cancer patients were followed-up until 8 weeks postdischarge. Adequacy of pain treatment was evaluated by means of the Amsterdam Pain Management Index (APMI), consisting of an integrated score of patients' Present Pain Intensity, Average Pain Intensity, and Worst Pain Intensity, corrected for patients' Tolerable Present Pain, with the analgesics used by the patient. At pretest, 60% of the patients in the hospital were treated inadequately for their pain. Postdischarge, the control group patients were significantly more inadequately treated at 2 weeks after discharge (56% vs 41%), at 4 weeks after discharge (62% vs 42%) and at 8 weeks after discharge (57% vs 51%) than the intervention group patients. While the level of inadequacy in the control groups remained relatively stable at all assessment points, a slight increase in the percentage of patients being treated inadequately was found in the intervention group patients over time. A beneficial effect of the PEP was found for patients both with and without district nursing. Variables predicting an improvement in adequacy of pain treatment consisted of the PEP, the APMI score at baseline, patients' level of physical functioning, patients' level of social functioning, the extent of adherence to pain medication, patients' pain knowledge, and the amount of analgesics used. These findings suggest that quality of pain treatment in cancer patients with chronic pain can be enhanced by educating patients about pain and improving active participation in their own pain treatment. The benefit from the PEP, however, decreases slightly over time, pointing at a need for ongoing education. PMID:11558980

de Wit, R; van Dam, F; Loonstra, S; Zandbelt, L; van Buuren, A; van der Heijden, K; Leenhouts, G; Duivenvoorden, H; Huijer Abu-Saad, H

2001-01-01

231

Analgesic and psychoactive drugs in the chronic pain patient.  

PubMed

In contrast to the management of pain in patients with malignant disease, where manipulation of analgesic and psychoactive drugs may be necessary and effective, the elimination of drug use is a primary goal in programs for patients with chronic pain of benign rig in.; Drug use is often a significant component of pain behavior and, therefore, it is important to alter the use of drugs in freeing the patient of the chronic pain syndrome. Elimination of the unwanted side effects and medical complications of drug use may contribute significantly to the patient's physical and psychological well-being. Also, because many of these drugs are associated with physiological or psychological dependency, it also becomes important to identify and treat drug abuse and chemical dependency, which is a primary problem in a subgroup of chronic pain patients. This discussion will focus on the relationship of drug use to chronic pain behavior and methods of medication withdrawal. In addition, the problems of chemical dependency and its identification and management will be discussed.J Orthop Sports Phys Ther 1984;5(6):315-317. PMID:18806389

Davis, J C

1984-01-01

232

Epigenetics and the Transition from Acute to Chronic Pain  

PubMed Central

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

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

2012-01-01

233

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

PubMed

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

Pinals, Robert S; Hassett, Afton L

2013-01-01

234

Pain and Opioid Use in Chronic Liver Disease  

PubMed Central

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

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

2013-01-01

235

Sleep quality and acute pain severity among young adults with and without chronic pain: the role of biobehavioral factors.  

PubMed

Adequate sleep is essential for health across the lifespan and is likely to be influenced by different factors among those with chronic pain than among others. Questionnaires were administered to 362 college students, some of whom reported chronic pain from varied sources. Among chronic pain sufferers (n = 108), pain severity was uniquely associated with sleep quality after controlling for gender, BMI, perceived health, health behaviors, depressed mood, perceived stress, and scholastic/interpersonal self-esteem. For these participants, perceived health, alcohol use, pain medication use, and depressed mood were also associated with sleep quality, whereas for participants with non-chronic recent pain (n = 129) only perceived health and depressed mood predicted sleep. Individuals with both chronic pain and high stress had the worst sleep. Stress, alcohol use, pain, and mood may contribute to poor sleep among young adults with pain, which could lead to a cycle of long-term health problems. PMID:20464629

Graham, Jennifer E; Streitel, Katherine L

2010-10-01

236

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

PubMed Central

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

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

2012-01-01

237

siRNA relieves chronic neuropathic pain  

Microsoft Academic Search

Double stranded, short interfering RNAs (siRNA) of 21-22 nt length initiate a sequence-specific, post- trancriptional gene silencing in animals and plants known as RNA interference (RNAi). Here we show that RNAi can block a pathophysiological pain response and provide relief from neuropathic pain in a rat disease model by down regulating an endo- genous, neuronally expressed gene. Rats, intrathe- cally

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

2004-01-01

238

Category III chronic prostatitis/chronic pelvic pain syndrome: insights from the National Institutes of Health Chronic Prostatitis Collaborative Research Network studies.  

PubMed

Chronic prostatitis/chronic pelvic pain syndrome remains an enigmatic medical condition. Creation of the National Institutes of Health-funded Chronic Prostatitis Collaborative Research Network (CPCRN) has stimulated a renewed interest in research on and clinical aspects of chronic prostatitis/chronic pelvic pain syndrome. Landmark publications of the CPCRN document a decade of progress. Insights from these CPCRN studies have improved our management of chronic prostatitis/chronic pelvic pain syndrome and offer hope for continued progress. PMID:18765132

Nickel, J Curtis; Alexander, Richard B; Anderson, Rodney; Berger, Richard; Comiter, Craig V; Datta, Nand S; Fowler, Jackson E; Krieger, John N; Landis, J Richard; Litwin, Mark S; McNaughton-Collins, Mary; O'Leary, Michael P; Pontari, Michel A; Schaeffer, Anthony J; Shoskes, Daniel A; White, Paige; Kusek, John; Nyberg, Leroy

2008-07-01

239

Sexual Abuse and Sexual Functioning in a Chronic Pelvic Pain Sample  

ERIC Educational Resources Information Center

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

Randolph, Mary E.; Reddy, Diane M.

2006-01-01

240

Structural evaluation of the contemporary psychological models of chronic pain: does fear of pain work for all?  

PubMed

The aim of the present study was to test Turk and Okifuji's (2002) model of chronic pain and in particular the moderating role of self-efficacy. We assessed 207 consecutive chronic pain patients (53.1% female) on a range of relevant measures and tested the model using structured equation modelling. The model was supported. These results support Turk and Okifuji's model of chronic pain and suggest that it can account for the relationships between variables in chronic pain patients. In particular, the results support the central role of fear-based avoidance and self-efficacy in chronic pain. Future research should be aimed at testing the alternative contemporary models of chronic pain at different stages of the development and maintenance of chronic pain and over time. PMID:20127541

Dehghani, Mohsen; Sharpe, Louise; Nicholas, Michael K

2010-01-01

241

Chronic cough and pain: Janus faces in sensory neurobiology?  

PubMed

Both chronic cough and chronic pain 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 chronic pain 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 chronic pain 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

2013-10-01

242

Treatment Preferences for CAM in Children with Chronic Pain  

PubMed Central

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

Meldrum, Marcia; Kim, Su C.; Jacob, Margaret C.; Zeltzer, Lonnie K.

2007-01-01

243

Precordial chest pain in patients with chronic Chagas disease.  

PubMed

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

Bestetti, Reinaldo B; Restini, Carolina Baraldi A

2014-09-20

244

Essure(®) and chronic pelvic pain: A population-based cohort.  

PubMed

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

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

2014-11-01

245

Overtreating Chronic Back Pain: Time to Back Off?  

PubMed Central

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

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

2009-01-01

246

Sagittal spino-pelvic alignment in chronic low back pain  

Microsoft Academic Search

Introduction  The differences in sagittal spino-pelvic alignment between adults with chronic low back pain (LBP) and the normal population\\u000a are still poorly understood. In particular, it is still unknown if particular patterns of sagittal spino-pelvic alignment\\u000a are more prevalent in chronic LBP. The current study helps to better understand the relationship between sagittal alignment\\u000a and low back pain.\\u000a \\u000a \\u000a \\u000a \\u000a Materials and methods  To

Emmanuelle Chaléat-Valayer; Jean-Marc Mac-Thiong; Jérôme Paquet; Eric Berthonnaud; Fabienne Siani; Pierre Roussouly

247

Effective Conservative Treatment for Chronic Low Back Pain  

PubMed Central

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. PMID:20161564

Rainville, James; Nguyen, Rosalyn; Suri, Pradeep

2009-01-01

248

Effects of coping statements on experimental pain in chronic pain patients  

PubMed Central

The present study measured the effects of catastrophizing self-statements and positive coping self-statements on cold pressor-induced pain. Participants were 58 adult chronic pain patients with current facial pain. It was hypothesized that catastrophizing would lead to a decrease in pain endurance whereas positive coping would lead to an increase in pain endurance. It was also hypothesized that catastrophizing would lead to an increase in peak pain intensity whereas positive coping would lead to a decrease in peak pain intensity. At pretest, participants submerged their nondominant hand in the cold pressor. Pain sensitivity ranges (PSR) were subsequently determined by calculating the difference between tolerance and threshold times. Ratings of peak pain intensity were measured using a pressure sensitive bladder/transducer. Participants underwent random assignment to either a catastrophizing group or a positive coping self-statement group. ANCOVA results revealed that on average, participants employing catastrophizing statements as a coping strategy experienced significantly lower PSR (M = 35.53, SD = 39.71) compared to participants employing positive coping self-statements (M = 73.70, SD = 86.14) when controlling for pretest PSR. Group assignment had no significant influence on peak pain intensity ratings. Thus, our results reveal that manipulation of coping causes changes in pain endurance. PMID:21197299

Roditi, Daniela; Robinson, Michael E; Litwins, Nola

2009-01-01

249

Perioperative pain management in the opioid-tolerant patient with chronic pain: an evidence-based practice project.  

PubMed

According to the Institute of Medicine (IOM) report on pain, chronic pain affects an estimated 116 million American adults and costs the nation more than $600 billion each year in medical treatment and lost worker productivity. Many individuals with chronic pain undergo surgical procedures. Safe and effective treatment of their postoperative pain can present a significant challenge to the health care team but is essential to their optimal recovery. Administrators in a community hospital in central Pennsylvania identified a need to improve the care of their patients with chronic pain and supported a hospital-wide initiative to address various aspects of this population's hospital experience. This article presents the first phase of an evidence-based practice project that focused on improving the perioperative pain management in patients with chronic pain who receive long-acting opioids for the treatment of chronic pain before admission for surgery. PMID:23164203

Dykstra, Karen M

2012-12-01

250

Psychosocial perspectives in the treatment of pediatric chronic pain  

PubMed Central

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

2012-01-01

251

Tapentadol. Acute or chronic pain: no therapeutic advance.  

PubMed

The standard opioids for relieving moderate to severe pain are: codeine as a step 2 analgesic and morphine for step 3. Tapentadol is an opioid similar to tramadol. An immediate-release form has been authorised in France for moderate to severe acute pain in adults and a sustained-release form for severe chronic pain in adults. It has been evaluated in comparative trials in several types of acute pain: pain following orthopaedic or gynaecological surgery or tooth extraction, and joint pain. These trials were principally designed to show its analgesic effect versus placebo.They did not establish the equianalgesic dose ratios of tapentadol to codeine, morphine or oxycodone. In chronic pain, one trial compared sustained-release tapentadol versus sustained-release morphine, but only unconvincing preliminary results are available.The results of other trials versus sustained-release oxycodone are unconvincing, because half of the patients were lost to follow-up. The known adverse effects of tapentadolare mainly those associated with all opioids, including neuropsychiatric disorders and addiction. Aggression and serotonin syndrome are possible reactions that require further investigation. Gastrointestinal disorders appeared less common with tapentadol than with oxycodone, but the data could well be biased due to the use of a relative overdose of oxycodone in the trials. In practice, the evaluation of tapentadol was not designed to show whether this drug represents a therapeutic advance. Its analgesic efficacy remains unclear, and it provokes the adverse effects common to all opioids. PMID:24926510

2014-05-01

252

Emotional Disturbance and Chronic Low Back Pain.  

ERIC Educational Resources Information Center

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

McCreary, Charles P.; And Others

1980-01-01

253

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

PubMed Central

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

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

2014-01-01

254

Gabapentin for chronic neuropathic pain and fibromyalgia in adults  

PubMed Central

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

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

2014-01-01

255

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

PubMed Central

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

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

2012-01-01

256

Duloxetine treatment adherence across mental health and chronic pain conditions  

PubMed Central

Purpose This study applied a uniform methodology for measuring and comparing duloxetine adherence in the treatment of multiple chronic medical conditions. Materials and methods Study patients 18–64 years of age initiating duloxetine therapy during 2008 were identified from a large managed care database. The study was restricted to patients with continuous health plan eligibility for 12 months pre- and post-duloxetine initiation. Study patients had ?1 medical claim with an inpatient or outpatient diagnosis of one (and only one) of the following conditions: major depressive disorder (MDD); generalized anxiety disorder (GAD); fibromyalgia, diabetic peripheral neuropathic pain; or chronic musculoskeletal pain, as established in studies in patients with osteoarthritis and chronic lower back pain (CLBP). Patients initiating duloxetine who had two or more of the six studied conditions were not included in this study, thereby avoiding the need to differentiate between primary and secondary diagnoses from the claims records. Adherence rate was defined as the percentage of patients with a 365-day medication possession ratio ?0.8. Results A total of 20,490 patients initiated duloxetine treatment during 2008 with a diagnosis of one of the studied conditions during the study period. The adherence rate in our sample was 34.6% and was highest among patients with MDD (37.3%) and lowest for patients with CLBP (29.9%). In general, adherence among patients with MDD and GAD was greater than among those with a chronic pain condition. Conclusion Adherence among newly initiated duloxetine patients varied modestly across the medical conditions for which it was used. After adjusting for potential confounders, differences between the mental conditions (MDD and GAD) and the chronic pain conditions (CLBP, osteoarthritis, and diabetic peripheral neuropathic pain) were statistically significant. These results may be useful in the determination of expectations of adherence, and how it may differ for each of the conditions studied. PMID:24596469

Able, Stephen L; Cui, Zhanglin; Shen, Wei

2014-01-01

257

Treatment options for chronic abdominal pain in children and adolescents.  

PubMed

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

Miranda, Adrian; Sood, Manu

2006-09-01

258

Understanding Help Seeking for Chronic Joint Pain  

PubMed Central

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

Jinks, Clare; Ong, Bie Nio

2014-01-01

259

The need for knowledge translation in chronic pain  

PubMed Central

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

Henry, James L

2008-01-01

260

The Opioid Contract in the Management of Chronic Pain  

Microsoft Academic Search

Although the “opioid contract” is widely used in the administration of chronic opioid therapy, its use has not been well defined and there are few guidelines for developing or revising such tools. We reviewed opioid contracts from 39 major academic pain centers and analyzed every statement for its core meaning. These statements were grouped into general categories and then into

Scott M Fishman; Tara B Bandman; Annabel Edwards; David Borsook

1999-01-01

261

Topical analgesics for acute and chronic pain in adults  

PubMed Central

This is the protocol for a review and there is no abstract. The objectives are as follows: To provide an overview of the analgesic efficacy and associated adverse events of topical analgesics (primarily NSAIDs, rubefacients, capsaicin, lidocaine, and opioids) for the treatment of acute and chronic pain in adults.

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

2014-01-01

262

RESEARCH ARTICLE Open Access Chronic pain associated with the Chikungunya  

E-print Network

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

Paris-Sud XI, Université de

263

Chronic Pain Rehabilitation with a Serious Game using Multimodal Input  

E-print Network

to translate the skills learned in therapy to every day life. Serious games are hypothesized to support cost motion capture system (Microsoft Kinect) and biosignal acquisition devices to a game engine a system, which enables chronic pain patients to train their motor skills in a serious game, where body

264

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

ERIC Educational Resources Information Center

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

Romano, Joan M.; Turner, Judith A.

1985-01-01

265

Response Phases in Methadone Treatment for Chronic Nonmalignant Pain  

Microsoft Academic Search

Although studies on the beliefs of persons with chronic nonmalignant pain (CNMP) are still scarce, methadone is increasingly prescribed for the treatment of CNMP. This qualitative case study uses semistructured interviews to explore the beliefs of 11 patients with CNMP and the challenges they faced coming to terms with and integrating methadone treatment into their lives. The study identifies a

Antonia Arnaert; Gina Ciccotosto

2006-01-01

266

Treatment of a Case Example with PTSD and Chronic Pain  

ERIC Educational Resources Information Center

This commentary reviews the case of GH, a survivor of a road traffic collision, who has chronic pain 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…

Shipherd, Jillian C.

2006-01-01

267

Coping Constructs Related to College Students with Chronic Pain  

ERIC Educational Resources Information Center

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

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

2011-01-01

268

Sex Differences in the Presentation of Chronic Low Back Pain  

ERIC Educational Resources Information Center

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

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

2002-01-01

269

Acupuncture versus Sham Acupuncture for Chronic Prostatitis\\/Chronic Pelvic Pain  

Microsoft Academic Search

BackgroundChronic prostatitis\\/chronic pelvic pain syndrome (CP\\/CPPS) afflicts 2%-10% of adult men. Available therapies offer little or no proven benefit. Because acupuncture represents an attractive “natural” therapy, we compared the efficacy of acupuncture to sham acupuncture for CP\\/CPPS.

Shaun Wen Huey Lee; Men Long Liong; Kah Hay Yuen; Wing Seng Leong; Christopher Chee; Phaik Yeong Cheah; Weng Pho Choong; Yue Wu; Nurzalina Khan; Wooi Long Choong; Hin Wai Yap; John N. Krieger

2008-01-01

270

Bedside Testing for Chronic Pelvic Pain: Discriminating Visceral from Somatic Pain  

PubMed Central

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

2011-01-01

271

Multiple 60-Minute Massages per Week Offer Relief for Chronic Neck Pain  

MedlinePLUS

... 60-Minute Massages per Week Offer Relief for Chronic Neck Pain Results of an NCCAM-funded study found that ... than fewer or shorter sessions for people with chronic neck pain, suggesting that several hour-long massages per week ...

272

Implantable Intrathecal Pumps for Chronic Pain: Highlights and Updates  

PubMed Central

Management of chronic pain by intrathecal delivery is gaining increasing use. The aim of this article is to review the literature pertinent to implantable devices used for treatment of chronic pain, and to highlight what is known. Articles were obtained from Medline database and reviewed. Practical patient selection criteria, trial management, and surgical technique are described. Expert consensus guidelines for intrathecal medication use are also reviewed. Finally, an exhaustive description of known complications and future implications is discussed. We concluded that intrathecal pump seems to be overused, while there is still weak evidence to support its outcome. It is also recommended that future research focus on the outcome, measured by functional parameters rather than commonly used pain scores. PMID:17309136

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

2007-01-01

273

Interview: Management of chronic pain requires a multidisciplinary approach.  

PubMed

Sridhar V Vasudevan(*) speaks to Roshaine Gunawardana, Commissioning Editor: Sridhar V Vasudevan, MD is clinical professor of Physical Medicine and Rehabilitation (PM&R) at the Medical College of Wisconsin in Milwaukee, WI, USA. He is Board certified in PM&R and Pain Medicine (American Board of PM&R/American Board of Anesthesiology exam). He also has Board certification in Electro-diagnostic Medicine and Independent Medical Examination. He has been involved in the evaluation and rehabilitation of individuals with sub-acute and chronic pain using a whole-person multidisciplinary approach since 1977. He is Past President of the Midwest Pain Society, the American Academy of Pain Medicine, the Wisconsin Society of Physical Medicine and Rehabilitation and the Waukesha County Medical Society, as well as Founding President of the American College of Pain Medicine (now the American Board of Pain Medicine). He has presented on the topics of Pain Rehabilitation at several national meetings and international meetings in Scotland, Denmark, Peoples Republic of China, USSR, Germany, France, Turkey, South Africa, Canada, Aruba, Mexico and India. He has authored several chapters in text books on topics of a multidisciplinary approach to pain rehabilitation and evaluation of disability in individuals with pain. He is currently associated with the Center for Pain and Work Rehabilitation in Sheboygan, WI, USA, and is the Medical Director for the Center for Pain Rehabilitation at Community Memorial Hospital in Menomonee Falls, WI, USA. He also works at the Medical College of Wisconsin clinic in Menomonee Falls, WI, USA. He currently serves as a member of the Medical Examining Board of the State of Wisconsin, WI, USA. PMID:24654718

Vasudevan, Sridhar V

2012-07-01

274

Ecological system influences in the treatment of pediatric chronic pain  

PubMed Central

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

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

2012-01-01

275

Should We Start Treating Chronic Low Back Pain with Antibiotics Rather than with Pain Medications?  

PubMed Central

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. PMID:24155998

2013-01-01

276

Effective physical treatment for chronic low back pain.  

PubMed

It is now feasible to adopt an evidence-based approach when providing physical treatment for patients with chronic LBP. A summary of the efficacy of a range of physical treatments is provided in Table 1. The evidence-based primary care options are exercise, laser, massage, and spinal manipulation; however, the latter three have small or transient effects that limit their value as therapies for chronic LBP. In contrast, exercise produces large reductions in pain and disability, a feature that suggests that exercise should play a major role in the management of chronic LBP. Physical treatments, such as acupuncture, backschool, hydrotherapy, lumbar supports, magnets, TENS, traction, ultrasound, Pilates therapy, Feldenkrais therapy, Alexander technique, and craniosacral therapy are either of unknown value or ineffective and so should not be considered. Outside of primary care, multidisciplinary treatment or functional restoration is effective; however, the high cost probably means that these programs should be reserved for patients who do not respond to cheaper treatment options for chronic LBP. Although there are now effective treatment options for chronic LBP, it needs to be acknowledged that the problem of chronic LBP is far from solved. Though treatments can provide marked improvements in the patient's condition, the available evidence suggests that the typical chronic LBP patient is left with some residual pain and disability. Developing new, more powerful treatments and refining the current group of known effective treatments is the challenge for the future. PMID:15062718

Maher, C G

2004-01-01

277

Extracorporeal shock wave treatment for chronic plantar fasciitis (heel pain).  

PubMed

(1) Electrohydraulic, electromagnetic, or piezoelectric devices are used to translate energy into acoustic waves during extracorporeal shock wave treatment (ESWT) for chronic plantar fasciitis (or heel pain). These waves may help to accelerate the healing process via an unknown mechanism. (2) ESWT, which is performed as an outpatient procedure, is intended to alleviate the pain due to chronic plantar fasciitis. (3) Results from randomized controlled trials have been conflicting. Six trials reported data that favour ESWT over placebo or conservative treatment for efficacy outcomes, while three trials showed no significant difference between the ESWT group and the placebo group. (4) The lack of convergent findings from randomized trials of ESWT for chronic plantar fasciitis suggests uncertainty about its effectiveness. The evidence reviewed in this bulletin does not support the use of this technology for this condition. PMID:17302019

Ho, C

2007-01-01

278

The Prevalence of Fibromyalgia in Other Chronic Pain Conditions  

PubMed Central

Central sensitivity syndromes (CSS) include fibromyalgia syndrome (FMS), irritable bowel syndrome, temporomandibular disorder, restless legs syndrome, chronic fatigue syndrome, and other similar chronic painful conditions that are based on central sensitization (CS). CSS are mutually associated. In this paper, prevalence of FMS among other members of CSS has been described. An important recent recognition is an increased prevalence of FMS in other chronic pain conditions with structural pathology, for example, rheumatoid arthritis, systemic lupus, ankylosing spondylitis, osteoarthritis, diabetes mellitus, and inflammatory bowel disease. Diagnosis and proper management of FMS among these diseases are of crucial importance so that unwarranted use of such medications as corticosteroids can be avoided, since FMS often occurs when RA or SLE is relatively mild. PMID:22191024

Yunus, Muhammad B.

2012-01-01

279

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

PubMed

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

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

2014-09-01

280

Validation of the Spanish version of the Chronic Pain Acceptance Questionnaire (CPAQ) for the assessment of acceptance in fibromyalgia  

Microsoft Academic Search

BACKGROUND: The aim of this study was to validate a Spanish version of the Chronic Pain Acceptance Questionnaire (CPAQ). Pain acceptance is the process of giving up the struggle with pain and learning to live a worthwhile life despite it. The Chronic Pain Acceptance Questionnaire (CPAQ) is the questionnaire most often used to measure pain acceptance in chronic pain populations.

Baltasar Rodero; Javier García-Campayo; Benigno Casanueva; Yolanda Lopez del Hoyo; Antoni Serrano-Blanco; Juan V Luciano

2010-01-01

281

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

PubMed Central

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

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

2010-01-01

282

Opioids and the Treatment of Chronic Pain: Controversies, Current Status, and Future Directions  

Microsoft Academic Search

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 chronic pain 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

2008-01-01

283

The Effects of Repeated Thermal Therapy for Patients with Chronic Pain  

Microsoft Academic Search

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 chronic pain. The purpose of this study was to clarify the effects of systemic thermal therapy in patients with chronic pain. Methods: Group A (n = 24) patients

Akinori Masuda; Yasuyuki Koga; Masato Hattanmaru; Shinichi Minagoe; Chuwa Tei

2005-01-01

284

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

ERIC Educational Resources Information Center

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

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

2010-01-01

285

Religious and Spiritual Beliefs and Practices of Persons with Chronic Pain  

ERIC Educational Resources Information Center

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

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

2007-01-01

286

Partners with Bad Temper: Reject or Cure? A Study of Chronic Pain and Aggression in Horses  

Microsoft Academic Search

BackgroundExperiencing acute pain can affect the social behaviour of both humans and animals and can increase the risk that they exhibit aggressive or violent behaviour. However, studies have focused mainly on the impact of acute rather than chronic painful experiences. As recent results suggest that chronic pain or chronic discomfort could increase aggressiveness in humans and other mammals, we tested

Carole Fureix; Hervé Menguy; Martine Hausberger; Martin Giurfa

2010-01-01

287

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

E-print Network

The Biopsychosocial Approach to Chronic Pain: Scientific Advances and Future Directions Robert J The prevalence and cost of chronic pain is a major physical and mental health care problem in the United States today. As a result, there has been a recent explosion of research on chronic pain, with significant

Meagher, Mary

288

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

Microsoft Academic Search

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

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

2008-01-01

289

Chronic pain in land mine accident survivors in Cambodia and Kurdistan  

Microsoft Academic Search

The aims of the study were to study chronic pain in land mine accident survivors, and to study the impact of trauma and trauma care parameters on chronic pain. The level of chronic pain was registered (patient-rated and by clinical examination) in 57 severely injured adult land mine accident survivors in Cambodia and Northern Iraq more than one year after

Hans Husum; Kirsten Resell; Gyri Vorren; Yang Van Heng; Mudhafar Murad; Mads Gilbert; Torben Wisborg

2002-01-01

290

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

PubMed

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

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

2002-12-01

291

Children with unexplained chronic pain: substantial impairment in everyday life  

PubMed Central

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

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

2005-01-01

292

Pregabalin for acute and chronic pain in adults  

PubMed Central

Background Antiepileptic drugs have been used in pain management since the 1960s. Pregabalin is a recently developed antiepileptic drug also used in management of chronic neuropathic pain conditions. Objectives To assess analgesic efficacy and associated adverse events of pregabalin in acute and chronic pain. Search methods We searched MEDLINE, EMBASE, and CENTRAL to May 2009 for randomised controlled trials (RCTs). Additional studies were identified from the reference lists of retrieved papers and on-line clinical trial databases. Selection criteria Randomised, double blind trials reporting on the analgesic effect of pregabalin, with subjective pain assessment by the patient as either the primary or a secondary outcome. Data collection and analysis Two independent review authors extracted data and assessed trial quality. Numbers-needed-to-treat-to-benefit (NNTs) were calculated, where possible, from dichotomous data for effectiveness, adverse events and study withdrawals. Main results There was no clear evidence of beneficial effects of pregabalin in established acute postoperative pain. No studies evaluated pregabalin in chronic nociceptive pain, like arthritis. Pregabalin at doses of 300 mg, 450 mg, and 600 mg daily was effective in patients with postherpetic neuralgia, painful diabetic neuropathy, central neuropathic pain, and fibromyalgia (19 studies, 7003 participants). Pregabalin at 150 mg daily was generally ineffective. Efficacy was demonstrated for dichotomous outcomes equating to moderate or substantial pain relief, alongside lower rates for lack of efficacy discontinuations with increasing dose. The best (lowest) NNT for each condition for at least 50% pain relief over baseline (substantial benefit) for 600 mg pregabalin daily compared with placebo were 3.9 (95% confidence interval 3.1 to 5.1) for postherpetic neuralgia, 5.0 (4.0 to 6.6) for painful diabetic neuropathy, 5.6 (3.5 to 14) for central neuropathic pain, and 11 (7.1 to 21) for fibromyalgia. With 600 mg pregabalin daily somnolence typically occurred in 15% to 25% and dizziness occurred in 27% to 46%. Treatment was discontinued due to adverse events in 18 to 28%. The proportion of participants reporting at least one adverse event was not affected by dose, nor was the number with a serious adverse event, which was not more than with placebo. Higher rates of substantial benefit were found in postherpetic neuralgia and painful diabetic neuropathy than in central neuropathic pain and fibromyalgia. For moderate and substantial benefit on any outcome NNTs for the former were generally six and below for 300 mg and 600 mg daily; for fibromyalgia NNTs were much higher, and generally seven and above. Authors’ conclusions Pregabalin has proven efficacy in neuropathic pain conditions and fibromyalgia. A minority of patients will have substantial benefit with pregabalin, and more will have moderate benefit. Many will have no or trivial benefit, or will discontinue because of adverse events. Individualisation of treatment is needed to maximise pain relief and minimise adverse events. There is no evidence to support the use of pregabalin in acute pain scenarios. PMID:19588419

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

2014-01-01

293

Intimacy and family relationships of women with chronic pain.  

PubMed

This study explored family relationships and intimacy of women experiencing chronic pain from the perspective of the women and their family members. A narrative ethnographic qualitative research design was used. Narrative and field data were analyzed using the coding procedure outlined by Strauss aided by the QSR NUD*IST 4 qualitative computer software program. Twenty-five women self-identified as experiencing chronic pain, and 13 family members including 7 husbands, 1 father, 1 stepmother, and 4 children living in the home were interviewed. Three patterns of behavior emerged regarding family relationships: cycle of close involvement compensated with isolation, focus directed toward others, and loss of physical sexual intimacy. Findings of this study indicate that family members' perception is that chronic pain affects important basic relationships and both emotional and physical intimacy. A need exists to relieve some of the suffering that accompanies pain in these women and their families. Based on the study's findings, several treatment strategies are recommended. PMID:14566711

Smith, A Ann

2003-09-01

294

Tramadol extended-release in the management of chronic pain  

PubMed Central

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 chronic pain 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 chronic pain, either alone or in conjunction with nonselective NSAIDs and COX-2 inhibitors. PMID:18488071

McCarberg, Bill

2007-01-01

295

Clinimetric evaluations of patients with chronic widespread pain.  

PubMed

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 chronic pain, 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

Salaffi, Fausto; Sarzi-Puttini, Piercarlo; Ciapetti, Alessandro; Atzeni, Fabiola

2011-04-01

296

Exercise Alters Pain Sensitivity in Gulf War Veterans With Chronic Musculoskeletal Pain  

Microsoft Academic Search

Since returning from the Persian Gulf, nearly 100,000 veterans of the first Gulf War (GVs) have reported numerous symptoms with no apparent medical explanation. A primary complaint of these individuals is chronic musculoskeletal pain (CMP). CMP symptoms in GVs are similar to those reported by patients with fibromyalgia (FM), but have not received equivalent scientific attention. Exercise research in CMP

Dane B. Cook; Aaron J. Stegner; Laura D. Ellingson

2010-01-01

297

Carbamazepine for acute and chronic pain in adults  

PubMed Central

Background Carbamazepine is used to treat chronic neuropathic pain. Objectives Evaluation of analgesic efficacy and adverse effects of carbamazepine for acute and chronic pain management (except headaches). Search methods Randomised controlled trials (RCTs) of carbamazepine in acute, chronic or cancer pain were identified, searching MEDLINE, EMBASE, SIGLE and Cochrane CENTRAL to June 2010, reference lists of retrieved papers, and reviews. Selection criteria RCTs reporting the analgesic effects of carbamazepine. Data collection and analysis Two authors independently extracted results and scored for quality. Numbers needed to treat to benefit (NNT) or harm (NNH) with 95% confidence intervals (CI) were calculated from dichotomous data for effectiveness, adverse effects and adverse event withdrawal. Issues of study quality, size, duration, and outcomes were examined. Main results Fifteen included studies (12 cross-over design; three parallel-group) with 629 participants. Carbamazepine was less effective than prednisolone in preventing postherpetic neuralgia following acute herpes zoster (1 study, 40 participants). No studies examined acute postoperative pain. Fourteen studies investigated chronic neuropathic pain: two lasted eight weeks, others were four weeks or less (mean 3 weeks, median 2 weeks). Five had low reporting quality. Ten involved fewer than 50 participants; mean and median maximum treatment group sizes were 34 and 29. Outcome reporting was inconsistent. Most placebo controlled studies indicated that carbamazepine was better than placebo. Five studies with 298 participants provided dichotomous results; 70% improved with carbamazepine and 12% with placebo. Carbamazepine at any dose, using any definition of improvement was significantly better than placebo (70% versus 12% improved; 5 studies, 298 participants); relative benefit 6.1 (3.9 to 9.7), NNT 1.7 (1.5 to 2.0). Four studies (188 participants) reporting outcomes equivalent to 50% pain reduction or more over baseline had a similar NNT. With carbamazepine, 66% of participants experienced at least one adverse event, and 27% with placebo; relative risk 2.4 (1.9 to 3.1), NNH 2.6 (2.1 to 3.5). Adverse event withdrawals occurred in12 of 323 participants (4%) with carbamazepine and 0 of 310 with placebo. Serious adverse events were not reported consistently; rashes were associated with carbamazepine. Five deaths occurred in patients on carbamazepine, with no obvious drug association. Authors’ conclusions Carbamazepine is effective in chronic neuropathic pain, with caveats. No trial was longer than four weeks, of good reporting quality, using outcomes equivalent to at least moderate clinical benefit. In these circumstances, caution is needed in interpretation, and meaningful comparison with other interventions is not possible. PMID:21249671

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

2014-01-01

298

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

PubMed Central

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

2013-01-01

299

Imaging evaluation of chronic ankle and hindfoot pain in athletes.  

PubMed

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

Collins, Mark S

2008-02-01

300

Complementary and alternative medications for chronic pelvic pain.  

PubMed

Chronic pelvic pain is common, but rarely cured, thus patients seek both second opinions and alternative means of controlling their pain. Complementary and alternative medicine accounts for 11.2% of out-of-pocket medical expenditures for adults for all conditions in the United States. Although there are many treatments, rigorous testing and well-done randomized studies are lacking. Dietary changes and physical modalities such as physical therapy have often been included in the category of alternative medicine, but their use is now considered mainstream. This article concentrates on other sources of alternative and complementary medicine, such as dietary supplementation and acupuncture. PMID:25155128

Leong, Fah Che

2014-09-01

301

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

ERIC Educational Resources Information Center

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

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

2007-01-01

302

HSV vector-mediated modification of primary nociceptor afferents: an approach to inhibit chronic pain  

PubMed Central

Chronic pain is a serious medical condition with millions of sufferers for whom long-term therapies are either lacking or inadequate. Here we review the use of herpes simplex virus vectors as therapeutic tools to treat chronic pain by gene therapy. We describe an approach to inhibit chronic pain signaling whereby vector-mediated genes transferred to sensory nerves will modify the primary afferent nociceptor to prevent pain signaling to second-order nerves in the spinal cord. This approach may be used to reverse the chronic pain state of the nociceptor and could affect downstream pain-related changes in the central nervous system. PMID:19357694

Goss, JR; Gold, MS; Glorioso, JC

2009-01-01

303

Chronic pain management in the active-duty military  

NASA Astrophysics Data System (ADS)

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

Jamison, David; Cohen, Steven P.

2012-06-01

304

Successful management of chronic postsurgical pain following total knee replacement.  

PubMed

We report reversal of chronic postsurgical pain (CPSP) along with functional restoration after total knee replacement (TKR) in two patients, using a combination therapy that included ultrasonography-guided pulsed radiofrequency (PRF) of nerves supplying the knee to provide pain relief, along with dry needling (DN) to relax myofascial triggers/bands that caused painful stiffness and restricted movement of muscles acting across the knee. Both patients showed demonstrable pain relief, as evidenced by changes in pain as assessed on the Numeric Rating Scale (patient 1: 4-9/10 [pre-treatment] to 0-3/10 [6 months post-treatment]; patient 2: 5-9/10 to 0-4/10), Oxford Knee Score (patient 1: 17 to 40; patient 2: 12 to 39), Self-Administered Leeds Assessment of Neuropathic Symptoms and Signs score (patient 1: 16 to 0; patient 2: 18 to 0), and Patient Health Questionnaire-9 score (patient 1: 17 to 2; patient 2: 20 to 2). The selection of the PRF-and-DN combination for treating post-TKR CPSP was based on a new idea that CPSP is a neuromyopathic phenomenon involving both sensory and motor neuropathy. It has evolved from our experience of 8 years. Physiotherapy worked synergistically with DN, optimizing muscle performance and pain relief. PMID:25132412

Vas, Lakshmi; Khandagale, Nishigandha; Pai, Renuka

2014-10-01

305

Chronic spinal infusion of loperamide alleviates postsurgical pain in rats.  

PubMed

Plantar incision in rat generates spontaneous pain behaviour. The opioid drug, morphine used to treat postsurgical pain produces tolerance after long-term administration. Loperamide, a potent mu-opioid agonist, has documented analgesic action in various pain conditions. However, loperamide analgesia and associated tolerance following continuous spinal administration in postsurgical pain has not been reported. Chronic spinal infusion of drugs was achieved using intrathecal catheters connected to osmotic minipump. Coinciding with the onset of spinal infusion of loperamide or morphine, rats were subjected to plantar incision. Pain-related behaviour was assessed by Hargreaves apparatus (thermal hyperalgesia) and von Frey filaments (mechanical allodynia). Morphine and loperamide (0.5, 1 and 2 microL/h) induced analgesia was observed until 7th day post-plantar incision in Sprague-Dawley rats. Morphine and loperamide produced dose-dependent analgesia. Loperamide, in the highest dose, produced analgesia till 7th day. However, the highest dose of morphine produced inhibition of thermal hyperalgesia till 5th day and mechanical allodynia only till 3rd day post-plantar incision. Morphine and loperamide produced analgesia in postsurgical pain, which may be mediated through different mechanisms. Longer duration of analgesia with loperamide could probably be due sustained blockade of calcium channels. PMID:24772934

Kumar, Rakesh; Reeta, K H; Ray, Subrata Basu

2014-04-01

306

IVIG Shown to Relieve Complex Regional Pain Syndrome But Study Has Limitations, Experts Say  

E-print Network

4A small study found IVIG effective for alleviating chronic regional pain syndrome, providing evidence that modulating the immune system could help with managing pain. Asmall but intriguing study found that intravenous immunoglobulin (IVIG) can provide relief for people suffering from complex regional pain syndrome, or CRPS, which causes chronic and often intractable pain, usually in an arm or leg, long after recovery from an illness or injury.

Tom Valeo

307

Chorea in a Chronic Pain Patient Using Gabapentin  

PubMed Central

Background Gabapentin increasingly is being used to treat chronic pain in addition to seizures, anxiety, and bipolar disorder. Chorea has been reported as a potential side effect of gabapentin. Case Report We report the case of a patient with chronic low back pain who was treated with a host of modalities, including gabapentin. After she increased her dose of gabapentin, she developed chorea of the upper extremities, neck, and head. With cessation of gabapentin, the bulk of her symptoms resolved within 24 hours, and symptoms completely resolved in the following months. Conclusions Chorea is thought to appear when the basal ganglia are deregulated. Gabapentin interferes with gamma-aminobutyric acid, the primary inhibitory neurotransmitter in the motor pathway. Chorea associated with gabapentin has been reported in several case studies, but not at a dose as low as the patient took in this case. PMID:24940142

Souzdalnitski, Dmitri; Chang, Anita Kumar; Guirguis, Maged

2014-01-01

308

Psychologic and Psychosocial Factors Contributing to Chronic Pain  

Microsoft Academic Search

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

Janice M. Livengood

1999-01-01

309

Personality disorders and response to outpatient treatment of chronic pain  

Microsoft Academic Search

As part of a comprehensive interdisciplinary evaluation conducted prior to participation in an outpatient chronic pain treatment program, the psychological status of 101 persons was assessed. The majority of participants was found to have a form of personality disorder, determined by conservative cutoff scores applied to their Millon Clinical Multiaxial Inventory (MCMI) profiles. DSM-III-R Cluster C disorders (i.e., Avoidant, Dependent,

Timothy R. Elliott; Warren T. Jackson; Molly Layfield; Debra Kendall

1996-01-01

310

Incidence of chronic pain following traumatic brain injury  

Microsoft Academic Search

Objective: To index the frequency of reported chronic pain in patients with traumatic brain injury (TBI).Design: A case series study was conducted on consecutive patients with TBI.Setting: TBI patients were recruited from an adult tertiary care center brain injury clinic.Patients: A consecutive sample of 132 patients who attended a brain injury rehabilitation center after TBI. The sample included 53 mild

Sophia Lahz; Richard A Bryant

1996-01-01

311

Pain complaints in patients with fibromyalgia versus chronic fatigue syndrome  

Microsoft Academic Search

Individuals with fibromyalgia (FM) and\\/or chronic fatigue syndrome (CFS) report arthralgias and myalgias. However, only persons\\u000a with FM alone exhibit abnormal pain responses to mild levels of stimulation, or allodynia. We identify the abnormalities in\\u000a the neuroendocrine axes that are common to FM and CFS as well as the abnormalities in central neuropeptide levels and functional\\u000a brain activity that differentiate

Laurence A. Bradley; Nancy L. McKendree-Smith; Graciela S. Alarcón

2000-01-01

312

Potential Role of Fascia in Chronic Musculoskeletal Pain  

Microsoft Academic Search

Many empirically developed physical therapy techniques as well as alternative manual therapies (e.g., Rolfing, myofascial\\u000a release) are aimed at treating fascia and other “unspecialized” connective tissues; however, compared with muscles, joints,\\u000a and the nervous system, very little research has been devoted to the role of fascia in chronic musculoskeletal pain. One possible\\u000a reason for this discrepancy is the lack of

Helene M. Langevin

313

LACK OF CORRELATION BETWEEN OPIOID DOSE ADJUSTMENT AND PAIN SCORE CHANGE IN A GROUP OF CHRONIC PAIN PATIENTS  

PubMed Central

Despite the increasing use of opioid analgesics for chronic pain management, it is unclear whether opioid dose escalation leads to better pain relief during chronic opioid therapy. In this study, we retrospectively analyzed clinical data collected from the Massachusetts General Hospital (MGH) Center for Pain Medicine over a 7-year period. We examined 1) the impact of opioid dose adjustment (increase or decrease) on clinical pain score, 2) gender and age differences in response to opioid therapy, and 3) the influence of clinical pain conditions on the opioid analgesic efficacy. A total of 109 subjects met the criteria for data collection. We found that neither opioid dose increase, nor decrease, correlated with point changes in clinical pain score in a subset of chronic pain patients over a prolonged course of opioid therapy (an average of 704 days). This lack of correlation was consistent regardless of the type of chronic pain including neuropathic, nociceptive, or mixed pain conditions. Neither gender nor age differences showed a significant influence on the clinical response to opioid therapy in these subjects. These results suggest that dose adjustment during opioid therapy may not necessarily alter long-term clinical pain score in a group of chronic pain patients and that individualized opioid therapy based on the clinical effectiveness should be considered to optimize the treatment outcome. Perspectives The study reports a relationship, or lack thereof, between opioid dose change and clinical pain score in a group of chronic pain patients. The study also calls for further investigation into the effectiveness of opioid therapy in the management of chronic non-malignant pain conditions. PMID:23452826

Chen, Lucy; Vo, Trang; Seefeld, Lindsey; Malarick, Charlene; Houghton, Mary; Ahmed, Shihab; Zhang, Yi; Cohen, Abigail; Retamozo, Cynthia; Hilaire, Kristen St.; Zhang, Vivian; Mao, Jianren

2013-01-01

314

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

PubMed

This study explored the impact of group singing on mood, coping, and perceived pain in chronic pain patients attending a multidisciplinary pain clinic. Singers participated in nine 30-minute sessions of small group singing, while comparisons listened to music while exercising. A short form of The Profile of Mood States (POMS) was administered before and after selected singing sessions to assess whether singing produced short-term elevations in mood. Results indicated that pre to post difference scores were significantly different between singing and control groups for only one of the 15 mood variables (i.e., uneasy). To test the longer term impacts of singing the Profile of Mood States, Zung Depression Inventory, Pain Self-Efficacy Questionnaire, Pain Rating Self-Statement, and Pain Disability Questionnaire were administered immediately before and after the singing sessions. All inventories other than the POMS were re-administered 6 months later. One-way ANCOVAs indicated that participants who attended the singing sessions showed evidence of postintervention improvements in active coping, relative to those who failed to attend, when preintervention differences in active coping were controlled for. While the singing group showed marked improvements from pre to postintervention on all mood, coping, and perceived pain variables, these improvements were also observed among comparison participants. The results of this study suggest that active singing may have some benefits, in terms of enhancing active coping, though the limitations of the study and small effect sizes observed suggest that further research is required to fully explore such effects. PMID:15327342

Kenny, Dianna T; Faunce, Gavin

2004-01-01

315

Exercise in the Management of Chronic Back Pain  

PubMed Central

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

Dreisinger, Thomas E.

2014-01-01

316

Effect of Ilioinguinal Neurectomy on Chronic Pain following Herniorrhaphy  

PubMed Central

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

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

2012-01-01

317

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

ERIC Educational Resources Information Center

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

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

2009-01-01

318

Phantom headache: pain-memory-emotion hypothesis for chronic daily headache?  

Microsoft Academic Search

The neurobiology of chronic pain, including chronic daily headache (CDH) is not completely understood. “Pain memory” hypothesis\\u000a is one of the mechanisms for phantom limb pain. We reviewed the literature to delineate a relation of “pain memory” for the\\u000a development of CDH. There is a direct relation of pain to memory. Patients with poor memory have less chance to develop

Sanjay Prakash; Purva Golwala

2011-01-01

319

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

PubMed Central

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

2013-01-01

320

Pain-coping strategies in chronic pain patients: psychometric characteristics of the pain-coping inventory (PCI).  

PubMed

This article presents a series of studies aimed at validating a comprehensive pain-coping inventory (PCI) that is applicable to various types of patients with chronic pain. Item and scale analyses were performed for patients with rheumatoid arthritis (RA), patients with chronic headache, and pain clinic outpatients. The following 6 scales were derived from a simultaneous component analysis: Pain Transformation, Distraction, Reducing Demands, Retreating, Worrying, and Resting, all of which were internally reliable. A higher order factor analysis grouped the PCI scales into active (transformation, distraction, reducing demands) and passive (retreating, worrying, resting) pain-coping dimensions. Differences in use of strategy found between RA patients and headache patients indicated that the PCI scales were sufficiently sensitive to measure differences between groups. Concurrent validity was assessed for patients with RA and patients with fibromyalgia and predictive validity was assessed for patients with recently diagnosed RA after 1 and 3 years. In both analyses the validity of the scales was supported, in particular the predictive validity of passive coping scales for future outcomes. PMID:14734263

Kraaimaat, Floris W; Evers, Andrea W M

2003-01-01

321

[Midocalm in complex therapy of chronic low back pain syndrome].  

PubMed

The aim of the study was to determine whether application of midocalm is appropriate in patients with chronic low back pain (LBP) from the point of view of quality of life (QL), efficacy and tolerance. The subjects were 50 patients with chronic LBP associated with spinal osteochondrosis, who underwent clinical examination and were questioned using four QL questionnaires: Health Assessment Questionnaire (HAQ), Womac osteoarthritis index Womac osteoarthritis index, Oswestry Low Back Pain Disability Questionnaire, and The 36-Item Short-Form Health Survey (SF-36). The subjects were divided into two groups. The 25 patients of Group I were administered nise in a dose of 100 mg twice a day during 10 days, the 25 patients of Group II--nise in a dose of 100 mg twice a day plus midocalm in a dose of 150 mg per day during the first two days and 450 mg per day from the third day through the tenth day. The study showed high efficacy of midocalm in complex therapy of patients with chronic LBP, as well as low rate of adverse reactions and high treatment tolerance. QL of the patients improved. Combining midocalm therapy with nise allows quicker positive effect in patients with chronic LBP and lowers need for long application of non-steroid antiinflammatory drugs. PMID:16404939

Chernysheva, T V; Bagirova, G G

2005-01-01

322

Pain in chronic pancreatitis: Managing beyond the pancreatic duct  

PubMed Central

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

Talukdar, Rupjyoti; Reddy, D Nageshwar

2013-01-01

323

Negotiating the maze: risk factors for suicidal behavior in chronic pain patients.  

PubMed

Chronic pain disorders can exert major negative effects on virtually every aspect of an individual's life. It is not surprising then that many chronic pain sufferers find themselves at a point of emotional fragility where they experience thoughts of ending their life. Suicidal behavior encompasses a spectrum of experience, from "life weariness" or passive suicidal ideation, to more active suicidal intent and suicide completion. A range of risk factors for suicidal behavior in the general population have been identified, and these apply equally to the chronic pain population: a family history of mental illness, past history of suicide attempts, and the presence of comorbid depression. With regard specifically to chronic pain patients, elevated suicide risk is also associated with severe or recurrent headache, ambiguous diagnoses (psychogenic pain, abdominal pain), and medicolegal issues related to the pain. A number of suggestions for clinicians managing chronic pain patients with regards to managing suicide risk are given. PMID:25091131

Newton-John, Toby R O

2014-09-01

324

Occurrence, characteristics, and impact of chronic pain in formerly abused women.  

PubMed

The purposes of this study were to describe the occurrence of chronic pain and to evaluate for differences in pain characteristics and intimate partner violence between women who reported mild compared with moderate to severe chronic pain. A convenience sample of community-based women (N = 84) was recruited. The 77% of women who reported chronic pain were dichotomized into two groups. Women with moderate to severe pain (n = 49) were significantly more likely to be unemployed, to be in the abusive relationship longer, to report more minor injuries and threats of violence, and to report pain in multiple locations that significantly interfered with every aspect of their lives. PMID:22071093

Humphreys, Janice; Cooper, Bruce A; Miaskowski, Christine

2011-10-01

325

Trigger point acupuncture treatment of chronic low back pain in elderly patients – a blinded RCT  

Microsoft Academic Search

Objective There is some evidence for the efficacy of acupuncture in chronic low back pain, but it remains unclear which acupuncture modes are most effective. Our objective was to evaluate the effects of two different modes of trigger point acupuncture on pain and quality of life in chronic low back pain patients compared to standard acupuncture treatment.Methods Thirty five consecutive

Kazunori Itoh; Yasukazu Katsumi; Hiroshi Kitakoji

2004-01-01

326

Risk Factor Assessment for Problematic Use of Opioids for Chronic Pain  

Microsoft Academic Search

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

Robert N. Jamison; Robert R. Edwards

2012-01-01

327

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

ERIC Educational Resources Information Center

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

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

2008-01-01

328

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

ERIC Educational Resources Information Center

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

Lewis, Sarah; Bell, Dorothy; Gillanders, David

2007-01-01

329

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

E-print Network

Behavioral/Systems/Cognitive Chronic Pain and the Emotional Brain: Specific Brain Activity of Chicago, Lurie Cancer Center, Northwestern University, Feinberg School of Medicine, Chicago, Illinois,yetthereisalackofknowledgeregardingbrainelementsinvolvedinsuchconditions.Here,weidentifybrainregionsinvolvedin spontaneous pain of chronic back pain (CBP) in two separate groups of patients (n 13 and n 11), and contrast

Apkarian, A. Vania

330

Therapeutic effects of antidepressants and Kampo medicines on chronic pelvic pain in women  

Microsoft Academic Search

Chronic pelvic pain is a common and significant disorder among women. However, its etiology is not clear, and effective treatments remain inconclusive. The present study was designed to investigate the efficacy of antidepressants and Kampo medicines, which have been applied for other pain disorders, to treat chronic pelvic pain in women. Twenty-nine gynecological outpatients received pharmacological treatments. None of the

Mina Morimura; Kouzo Hirai; Chiho Yoshimura; Tamaki Matsumoto; Kei Tsumura; Osamu Ishiko

2006-01-01

331

Effectiveness of nucleoplasty applied for chronic radicular pain  

PubMed Central

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

Karaman, Haktan; Tufek, Adnan; Kavak, Gonul Olmez; Yildirim, Zeynep Baysal; Temel, Vildan; Celik, Feyzi; Akdemir, Mehmet Salim; Kaya, Sedat

2011-01-01

332

Botulinum toxin-type A: could it be an effective treatment option in intractable trigeminal neuralgia?  

PubMed Central

Background Botulinum toxin type A (BTX-A) has been reported to have analgesic effects independent of its action on muscle tone, mostly by acting on neurogenic inflammatory mediators and controlling the neurotransmitter release of sensory and autonomic nerve terminals that are involved in many chronic painful conditions as chronic intractable trigeminal neuralgia (TN). The aim of our work was evaluating the efficacy, safety, and tolerability of BTX-A for the treatment of intractable idiopathic TN. Methods This was a randomized, single-blinded, placebo-control study carried out on 20 Egyptian patients with intractable TN. Patients received a one-time subcutaneous administration of BTX-A using “follow the pain” method. The primary efficacy measure was reduction in pain severity on the 10-cm VAS score as well as in paroxysms frequency from the baseline to week 12 (endpoint last observation carried forward [LOCF]). Secondary efficacy measures included QoL assessment and number of acute medications received from baseline to the endpoint. Results Pain reduction at the 12-week endpoint was significant in BTX-A group (p<0.0001); VAS scores at endpoint LOCF relative to baseline for BTX-A group showed a decrease of 6.5 compared with a decrease of 0.3 for placebo, also there was a significant decrease in the number of acute medications and an increase in QoL functioning scale. Conclusion These results indicate that BTX-A has a direct analgesic effect in patients with TN and can represent a therapeutic option for intractable cases. PMID:24251833

2013-01-01

333

Occipital peripheral nerve stimulation in the management of chronic intractable occipital neuralgia in a patient with neurofibromatosis type 1: a case report  

Microsoft Academic Search

Introduction  Occipital peripheral nerve stimulation is an interventional pain management therapy that provides beneficial results in the\\u000a treatment of refractory chronic occipital neuralgia. Herein we present a first-of-its-kind case study of a patient with neurofibromatosis\\u000a type 1 and bilateral occipital neuralgia treated with occipital peripheral nerve stimulation.\\u000a \\u000a \\u000a \\u000a \\u000a Case presentation  A 42-year-old Caucasian woman presented with bilateral occipital neuralgia refractory to various conventional

Ioannis Skaribas; Octavio Calvillo; Evangelia Delikanaki-Skaribas

2011-01-01

334

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

PubMed Central

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

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

2010-01-01

335

The place of oxycodone/naloxone in chronic pain management  

PubMed Central

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

2013-01-01

336

Perspectives on Yoga Inputs in the Management of Chronic Pain  

PubMed Central

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

Vallath, Nandini

2010-01-01

337

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

ERIC Educational Resources Information Center

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

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

2007-01-01

338

Personal Control in Chronic Pain Sufferers During Acute Interpersonal Stress  

PubMed Central

Among individuals with Rheumatoid Arthritis (RA), pain-associated stress can severely impact wellbeing. Psychological attributes, such as a sense of personal mastery, may attenuate the effects of chronic pain on life quality. We tested the hypothesis that a high sense of mastery would predict lower pain, perceived stress, fatigue, and mean arterial pressure (MAP) than would a low sense of mastery during an acute, interpersonal stressor. Seventy-four individuals with RA completed a psychophysiological laboratory session involving MAP measurements, as well as self-ratings of stress, joint pain, and fatigue. Measurements were collected before, during, and after an interpersonal stressor. To assess personal mastery, exploratory and confirmatory factor analyses were conducted on the Pearlin Mastery Scale based on recommendations by Reich and Zautra (1991) The Pearlin Mastery Scale yielded two distinct factors: fatalism and control. Both fatalism and control were significant predictors of the wellbeing variables. Individuals with a highly fatalistic style demonstrated higher general levels of mean arterial pressure (F(1) = 3.41, p<.1) and reported greater joint pain (F(1) = 4.72, p<.05) across all periods. Individuals with a high sense of control also evidenced lower MAP (F(1) = 3.73, p<.1) and reported less stress (F(1) = 7.44, p<.01) and fatigue (F(1) = 5.16, p<.05). Neither fatalism nor control were related to objective measures of disease severity (r's = ?.10, p=NS and ?.02, p=NS, respectively). RA patients with a high level of personal mastery, as evidenced by scores on two distinct indices, experience lower MAP, and report less pain, stress and fatigue. Although fatalism and control were not related to objective disease state, they seem to play an important role in the experience of wellbeing for people with RA. PMID:21132065

Younger, Jarred; Finan, Patrick; Zautra, Alex; Reich, John; Davis, Mary

2008-01-01

339

Pain Sensitivity and Recovery From Mild Chronic Sleep Loss  

PubMed Central

Study Objectives: To determine whether an extended bedtime in sleepy and otherwise healthy volunteers would increase alertness and thereby also reduce pain sensitivity. Setting: Outpatient with sleep laboratory assessments. Participants and Interventions: Healthy volunteers (n = 18), defined as having an average daily sleep latency on the Multiple Sleep Latency Test (MSLT) < 8 min, were randomized to 4 nights of extended bedtime (10 hr) (EXT) or 4 nights of their diary-reported habitual bedtimes (HAB). On day 1 and day 4 they received a standard MSLT (10:00, 12:00, 14:00, and 16:00 hr) and finger withdrawal latency pain testing to a radiant heat stimulus (10:30 and 14:30 hr). Results: During the four experimental nights the EXT group slept 1.8 hr per night more than the HAB group and average daily sleep latency on the MSLT increased in the EXT group, but not the HAB group. Similarly, finger withdrawal latency was increased (pain sensitivity was reduced) in the EXT group but not the HAB group. The nightly increase in sleep time during the four experimental nights was correlated with the improvement in MSLT, which in turn was correlated with reduced pain sensitivity. Conclusions: These are the first data to show that an extended bedtime in mildly sleepy healthy adults, which resulted in increased sleep time and reduced sleepiness, reduces pain sensitivity. Citation: Roehrs TA; Harris E; Randall S; Roth T. Pain sensitivity and recovery from mild chronic sleep loss. SLEEP 2012;35(12):1667-1672. PMID:23204609

Roehrs, Timothy A.; Harris, Erica; Randall, Surilla; Roth, Thomas

2012-01-01

340

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

PubMed Central

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

Winger, Anette; Kvarstein, Gunnvald; Wyller, Vegard Bruun; Sulheim, Dag; Fagermoen, Even; Smastuen, Milada Cvancarova; Helseth, S?lvi

2014-01-01

341

A biopsychosocial-spiritual model of chronic pain in adults with sickle cell disease.  

PubMed

Chronic pain in adults with sickle cell disease (SCD) is a complex multidimensional experience that includes biologic, psychologic, sociologic, and spiritual factors. To date, three models of pain associated with SCD (i.e., biomedical model, biopsychosocial model for SCD pain, and Health Beliefs Model) have been published. The biopsychosocial multidimensional approach to chronic pain developed by Turk and Gatchel is a widely used model of chronic pain. However, this model has not been applied to chronic pain associated with SCD. In addition, a spiritual/religious dimension is not included in this model. Because spirituality/religion is central to persons affected by SCD, that dimension needs to be added to any model of chronic pain in adults with SCD. In fact, data from one study suggest that spirituality/religiosity is associated with decreased pain intensity in adults with chronic pain from SCD. A biopsychosocial-spiritual model is proposed for adults with chronic pain from SCD, because it embraces the whole person. This model includes the biologic, psychologic, sociologic, and spiritual factors relevant to adults with SCD based on past and current research. The purpose of this paper is to describe an adaptation of Turk and Gatchel's model of chronic pain for adults with SCD and to summarize research findings that support each component of the revised model (i.e., biologic, psychologic, sociologic, spiritual). The paper concludes with a discussion of implications for the use of this model in research. PMID:24315252

Taylor, Lou Ella V; Stotts, Nancy A; Humphreys, Janice; Treadwell, Marsha J; Miaskowski, Christine

2013-12-01

342

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

Microsoft Academic Search

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

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

1988-01-01

343

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

PubMed Central

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

Bishop, Mark D.

2011-01-01

344

Current Smoking as a Predictor of Chronic Musculoskeletal Pain in Young Adult Twins  

PubMed Central

Chronic pain is common during adolescence and young adulthood and is associated with poor quality of life, depression, and functional disability. Recognizing that chronic pain has significant consequences it is important to identify modifiable health behaviors that may place young adults at-risk for chronic pain. This study examines associations among chronic musculoskeltetal pain and smoking in young adult twins (n=1588, ages 18–30) participating in a statewide twin registry. Twins completed questionnaires assessing smoking, mood (anxiety, depressive symptoms, stress), and chronic musculoskeletal pain. Analyses examined associations among chronic pain and smoking, particularly the role of genetics/shared familial factors and psychological symptoms. As predicted, results revealed a near two-fold increased risk for chronic musculoskeletal pain in twins who currently smoked compared to non-smokers, even when accounting for psychological factors. Results of within-pair analyses were only minimally attenuated suggesting associations among smoking and chronic musculoskeletal pain are better accounted for by non-shared factors than shared familial factors/genetic effects. Future twin research is needed to identify what non-shared factors (e.g., attitudes, direct effects of smoking on pain) contribute to these associations to further understand comorbidity. Longitudinal studies and recruitment of participants prior to smoking initiation and chronic pain onset will better identify causal associations. PMID:23810151

Holley, Amy Lewandowski; Law, Emily F.; Tham, See Wan; Myaing, Mon; Noonan, Carolyn; Strachan, Eric; Palermo, Tonya

2013-01-01

345

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

PubMed Central

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

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

2012-01-01

346

Ectopic uterine tissue as a chronic pain generator  

PubMed Central

While chronic pain is a main symptom in endometriosis, the underlying mechanisms and effective therapy remain elusive. We developed an animal model enabling exploration of ectopic endometrium as a source of endometriosis pain. Rats were surgically implanted with autologous uterus in the gastrocnemius muscle. Within two weeks, visual inspection revealed the presence of a reddish-brown fluid filled cystic structure at the implant site. Histology demonstrated cystic glandular structures with stromal invasion of the muscle. Immunohistochemical studies of these lesions revealed the presence of markers for nociceptor nerve fibers and neuronal sprouting. Fourteen days after surgery rats exhibited persistent mechanical hyperalgesia at the site of the ectopic endometrial lesion. Intralesional, but not contralateral, injection of progesterone was dose-dependently antihyperalgesic. Systemic administration of leuprolide also produced antihyperalgesia. In vivo electrophysiological recordings from sensory neurons innervating the lesion revealed a significant increase in their response to sustained mechanical stimulation. These results are consistent with clinical and pathologic findings observed in patients with endometriosis, compatible with the ectopic endometrium as a source of pain. This model of endometriosis allows mechanistic exploration at the lesion site facilitating our understanding of endometriosis pain. PMID:22922120

Alvarez, Pedro; Chen, Xiaojie; Hendrich, Jan; Irwin, Juan C.; Green, Paul G.; Giudice, Linda C.; Levine, Jon D.

2012-01-01

347

Ectopic uterine tissue as a chronic pain generator.  

PubMed

While chronic pain is a main symptom in endometriosis, the underlying mechanisms and effective therapy remain elusive. We developed an animal model enabling the exploration of ectopic endometrium as a source of endometriosis pain. Rats were surgically implanted with autologous uterus in the gastrocnemius muscle. Within two weeks, visual inspection revealed the presence of a reddish-brown fluid-filled cystic structure at the implant site. Histology demonstrated cystic glandular structures with stromal invasion of the muscle. Immunohistochemical studies of these lesions revealed the presence of markers for nociceptor nerve fibers and neuronal sprouting. Fourteen days after surgery rats exhibited persistent mechanical hyperalgesia at the site of the ectopic endometrial lesion. Intralesional, but not contralateral, injection of progesterone was dose-dependently antihyperalgesic. Systemic administration of leuprolide also produced antihyperalgesia. In vivo electrophysiological recordings from sensory neurons innervating the lesion revealed a significant increase in their response to sustained mechanical stimulation. These results are consistent with clinical and pathological findings observed in patients with endometriosis, compatible with the ectopic endometrium as a source of pain. This model of endometriosis allows mechanistic exploration at the lesion site facilitating our understanding of endometriosis pain. PMID:22922120

Alvarez, P; Chen, X; Hendrich, J; Irwin, J C; Green, P G; Giudice, L C; Levine, J D

2012-12-01

348

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

PubMed Central

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

Fashler, Samantha R; Katz, Joel

2014-01-01

349

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

PubMed Central

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

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

2014-01-01

350

Chronic Back Pain: Assessing the Patient at Risk  

PubMed Central

Pain in the lower back is a growing and costly problem. A simple, effective diagnosis can usually be provided by the family physician, based on a clinical history, especially regarding the circumstances surrounding an injury, and physical examination. Work-related risk factors implicated in the cause of the disorder are also important. Spinal X-ray examinations are of little value in diagnosis during the acute stage of low back pain. Chronic cases can be avoided by appropriate early treatment: a short period of analgesia and rest, followed by education about the back, a graduated exercise program, and if the clinical condition is stable or improving, early return to a modified level of work, even in the presence of symptoms. PMID:21233988

Koelink, Anthony F.C.

1990-01-01

351

MECHANISMS IN PROSTATITIS/CHRONIC PELVIC PAIN SYNDROME  

PubMed Central

Purpose We reviewed the current literature on mechanisms involved in the pathogenesis of prostatitis/chronic pelvic pain syndrome (CPPS). Materials and Methods A literature review for the years 1966 to 2003 was performed using the MEDLINE database of the United States National Library of Medicine. Results National Institutes of Health categories I and II prostatitis result from identifiable prostatic infections, whereas patients with category IV are asymptomatic. The majority of symptomatic cases are category III or chronic prostatitis (CP)/CPPS. The etiology of CP/CPPS is unknown. The traditional marker of inflammation, namely white blood cells in prostatic fluids, does not correlate with the predominant symptom of pelvic pain. An imbalance toward increased proinflammatory and decreased anti-inflammatory cytokines has been implicated and a few studies have shown some correlation of this with pelvic pain. The imbalance in some men may result from polymorphisms at the cytokine loci. An autoimmune process may be involved and experimental evidence indicates that this can be under hormonal influence. Recent findings include possible defects in the androgen receptor. The prostate may not even be the source of the symptoms. Pelvic pain also correlates with the neurotrophin nerve growth factor implicated in neurogenic inflammation and central sensitization. Finally, psychological stress may produce measurable biochemical changes and influence the other processes. The role of normal prostatic bacterial flora in inciting the inflammatory response has also been reconsidered. Conclusions The symptoms of CP/CPPS appear to result from an interplay between psychological factors and dysfunction in the immune, neurological and endocrine systems. PMID:15310980

PONTARI, MICHEL A.; RUGGIERI, MICHAEL R.

2013-01-01

352

Scientific evidence for the effectiveness of virtual reality for pain reduction in adults with acute or chronic pain.  

PubMed

The objective of this systematic review was to determine the level of scientific evidence for the effectiveness of VR for pain management in adults with pain. A comprehensive systematic search involving major health care databases was undertaken to identify randomized clinical trials (RCTs) and descriptive studies. Twenty-seven studies were identified that fulfilled the inclusion criteria. There was strong (Level 1a) evidence of a greater benefit from immersive VR and limited evidence (Level 2a) for the effectiveness of non-immersive VR in reducing acute pain. Moreover, there is limited evidence (Level 2a) of effectiveness of immersive VR compared to no VR for reducing chronic pain. There is currently no published study that has explored the effectiveness of non-immersive VR for chronic pain (level 5). It is concluded that VR can be recommended as a standard or adjunct clinical intervention for pain management at least in the management of acute pain. PMID:19592727

Shahrbanian, Shahnaz; Ma, Xiaoli; Korner-Bitensky, Nicol; Simmonds, Maureen J

2009-01-01

353

Searching for Hidden, Painful Osteochondral Lesions of the Ankle in Patients with Chronic Lower Limb Pain - Two Case Reports -  

PubMed Central

It is easy to overlook osteochondral lesions (OCLs) of the ankle in patients with chronic lower limb pain, such as complex regional pain syndrome (CRPS) or thromboangiitis obliterans (TAO, Buerger's disease). A 57-year-old woman diagnosed with type 1 CRPS, and a 58-year-old man, diagnosed with TAO, complained of tactile and cold allodynia in their lower legs. After neurolytic lumbar sympathethic ganglion block and titration of medications for neuropathic pain, each subject could walk without the aid of crutches. However, they both complained of constant pain on the left ankle during walking. Focal tenderness was noted; subsequent imaging studies revealed OCLs of her talus and his distal tibia, respectively. Immediately after percutaneous osteoplasties, the patients could walk without ankle pain. It is important to consider the presence of a hidden OCL in chronic pain patients that develop weight-bearing pain and complain of localized tenderness on the ankle. PMID:23614079

Ri, Hyun Su; Lee, Dong Heon

2013-01-01

354

Alfuzosin and Symptoms of Chronic Prostatitis-Chronic Pelvic Pain Syndrome  

PubMed Central

Background In men with chronic prostatitis–chronic pelvic pain syndrome, treatment with alpha-adrenergic receptor blockers early in the course of the disorder has been reported to be effective in some, but not all, relatively small randomized trials. Methods We conducted a multicenter, randomized, double-blind, placebo-controlled trial to evaluate the efficacy of alfuzosin, an alpha-adrenergic receptor blocker, in reducing symptoms in men with chronic prostatitis–chronic pelvic pain syndrome. Participation in the study required diagnosis of the condition within the preceding 2 years and no previous treatment with an alpha-adrenergic receptor blocker. Men were randomly assigned to treatment for 12 weeks with either 10 mg of alfuzosin per day or placebo. The primary outcome was a reduction of at least 4 points (from baseline to 12 weeks) in the score on the National Institutes of Health Chronic Prostatitis Symptom Index (NIH-CPSI) (range, 0 to 43; higher scores indicate more severe symptoms). A 4-point decrease is the minimal clinically significant difference in the score. Results A total of 272 eligible participants underwent randomization, and in both study groups, 49.3% of participants had a decrease of at least 4 points in their total NIH-CPSI score (rate difference associated with alfuzosin, 0.1%; 95% confidence interval, ?11.2 to 11.0; P = 0.99). In addition, a global response assessment showed similar response rates at 12 weeks: 33.6% in the placebo group and 34.8% in the alfuzosin group (P = 0.90). The rates of adverse events in the two groups were also similar. Conclusions Our findings do not support the use of alfuzosin to reduce the symptoms of chronic prostatitis–chronic pelvic pain syndrome in men who have not received prior treatment with an alpha-blocker. PMID:19092152

Nickel, J. Curtis; Krieger, John N.; McNaughton-Collins, Mary; Anderson, Rodney U.; Pontari, Michel; Shoskes, Daniel A.; Litwin, Mark S.; Alexander, Richard B.; White, Paige C.; Berger, Richard; Nadler, Robert; O'Leary, Michael; Liong, Men Long; Zeitlin, Scott; Chuai, Shannon; Landis, J. Richard; Kusek, John W.; Nyberg, Leroy M.; Schaeffer, Anthony J.

2009-01-01

355

Communicating the Experience of Chronic Pain and Illness Through Blogging  

PubMed Central

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

2012-01-01

356

[Absence from work and illness behavior in patients with chronic pain].  

PubMed

Factors relating to working status, i.e. whether the subject is still at work or on workmen's compensation, have been studied in chronic pain patients. Sociodemographic and pain variables were not correlated with absence from work, nor was diagnosis. However, beliefs and attitudes concerning pain differed between patients still working and those on workmen's compensation. In chronic pain patients medical attention should focus not only on description of symptoms but also on the "illness behaviour" dimension. PMID:7973536

Allaz, A F; Binyet, S; Desmeules, J; Piguet, V; Dayer, P

1994-11-12

357

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

Microsoft Academic Search

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

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

2006-01-01

358

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

Microsoft Academic Search

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

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

359

Acupuncture for chronic low back pain: protocol for a multicenter, randomized, sham-controlled trial  

Microsoft Academic Search

BACKGROUND: Use of acupuncture has widely increased in patients with chronic low back pain. However, the evidence supporting its efficacy remains unclear. In this article, we report the design and the protocol of a multi-center randomized sham-controlled trial to treat chronic low back pain. Our goal is to verify the effect of acupuncture on chronic low back pain. METHODS\\/DESIGN: This

Jun-Hwan Lee; Hi-Joon Park; Hyangsook Lee; Im Hee Shin; Mi-Yeon Song

2010-01-01

360

A pilot study of pain-related anxiety and smoking-dependence motives among persons with chronic pain.  

PubMed

Complex interactions between pain and tobacco smoking have been of increasing interest to researchers and clinicians from a variety of disciplines. There is also recent evidence to suggest that pain-related anxiety may play an important role in the maintenance of tobacco dependence among persons with comorbid pain disorders. The goal of the current study was to evaluate the explanatory relevance of pain-related anxiety in relation to tobacco dependence among a sample of daily smokers with current chronic pain. Participants were recruited from the general population to complete an online survey that was developed to examine interrelations between chronic pain and tobacco smoking. Fifty-six of 129 (43%) daily smoking respondents met criteria for current chronic pain. Results indicated that pain-related anxiety accounted for a significant portion of the unique variance in total smoking dependence scores, and both primary and secondary dependence composite scores (as measured by the Wisconsin Inventory of Smoking Dependence Motives; Piper et al., 2004). It is noteworthy that these effects were observed above and beyond the variance accounted for by relevant sociodemographic factors, generalized anxiety, and pain severity. Pain-related anxiety was observed to be strongly associated with secondary dependence motives, which is consistent with a conceptualization of pain-related anxiety as an instrumental or situational motivator of smoking. These results suggest that tobacco smokers with comorbid pain disorders may be at risk for maintaining or exacerbating their dependence on tobacco, possibly due to individual differences in pain-related anxiety. These findings may help inform the development of tailored interventions for smokers with comorbid chronic pain. PMID:24080021

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

2013-12-01

361

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

PubMed

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

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

2011-04-01

362

Behavioural Change Techniques For Chronic Low Back Pain: A Physiotherapy Practice Study.  

E-print Network

??Chronic non-specific low back pain (CNSLBP) is prevalent in the Canadian Forces. Physiotherapists use behavioural change techniques (BCT) to challenge maladaptive cognitions and behaviours in… (more)

MacRae, Marsha

2011-01-01

363

An Examination of the CoMorbidity Between Chronic Pain and Posttraumatic Stress Disorder on U.S. Veterans  

Microsoft Academic Search

The purpose of this study was to assess the comorbidity between chronic pain and posttraumatic stress disorder (PTSD) and examine the extent to which PTSD is associated with changes in the multidimensional experience of pain in a sample of Veterans with chronic pain. It was hypothesized that Veterans with comorbid chronic pain and PTSD would report significantly higher scores on

John D. Otis; Kristin Gregor; Christina Hardway; Jay Morrison; Erica Scioli; Kristen Sanderson

2010-01-01

364

The development of chronic pain: physiological CHANGE necessitates a multidisciplinary approach to treatment  

PubMed Central

Chronic pain is currently under-diagnosed and under-treated, partly because doctors’ training in pain management is often inadequate. This situation looks certain to become worse with the rapidly increasing elderly population unless there is a wider adoption of best pain management practice. This paper reviews current knowledge of the development of chronic pain and the multidisciplinary team approach to pain therapy. The individual topics covered include nociceptive and neuropathic pain, peripheral sensitization, central sensitization, the definition and diagnosis of chronic pain, the biopsychosocial model of pain and the multidisciplinary approach to pain management. This last section includes an example of the implementation of a multidisciplinary approach in Belgium and describes the various benefits it offers; for example, the early multidimensional diagnosis of chronic pain and rapid initiation of evidence-based therapy based on an individual treatment plan. The patient also receives continuity of care, while pain relief is accompanied by improvements in physical functioning, quality of life and emotional stress. Other benefits include decreases in catastrophizing, self-reported patient disability, and depression. Improved training in pain management is clearly needed, starting with the undergraduate medical curriculum, and this review is intended to encourage further study by those who manage patients with chronic pain. PMID:23786498

Ahlbeck, Karsten; Aldington, Dominic; Alon, Eli; Coluzzi, Flaminia; Dahan, Albert; Huygen, Frank; Kocot-K?pska, Magdalena; Mangas, Ana Cristina; Mavrocordatos, Philippe; Morlion, Bart; Müller-Schwefe, Gerhard; Nicolaou, Andrew; Pérez Hernández, Concepción; Sichère, Patrick; Schäfer, Michael; Varrassi, Giustino

2013-01-01

365

Presence of Mental Imagery Associated with Chronic Pelvic Pain: A Pilot Study  

PubMed Central

Objective To ascertain whether a small sample of patients with chronic pelvic pain experienced any pain-related cognitions in the form of mental images. Patients Ten women with chronic pelvic pain consecutively referred from a tertiary referral center by the physicians in charge of their treatment. Outcome measures An interview was used to determine the presence, emotional valence, content, and impact of cognitions about pain in the form of mental images and verbal thoughts. The Brief Pain Inventory (BPI), Pain Catastrophizing Scale (PCS), Spontaneous Use of Imagery Scale (SUIS), and Hospital Anxiety and Depression Scale (HADS) were completed. Results In a population of patients with a prolonged duration of pain and high distress, all patients reported experiencing cognitions about pain in the form of mental images. For each patient, the most significant image was both negative in valence and intrusive. The associated emotional-behavioral pattern could be described within a cognitive behavioral therapy framework. Eight patients also reported coping imagery. Conclusion Negative pain-related cognitions in the form of intrusive mental imagery were reported by women with chronic pelvic pain. Targeting such imagery has led to interesting treatment innovation in the emotional disorders. Thus, imagery, hitherto neglected in pain phenomenology, could provide a novel target for cognitive behavioral therapy in chronic pain. These exciting yet preliminary results require replication and extension in a broader population of patients with chronic pain. PMID:21668746

Berna, Chantal; Vincent, Katy; Moore, Jane; Tracey, Irene; Goodwin, Guy M; Holmes, Emily A

2011-01-01

366

The assessment of sleep in pediatric chronic pain sufferers.  

PubMed

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

de la Vega, Rocío; Miró, Jordi

2013-06-01

367

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

PubMed Central

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

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

2014-01-01

368

Brain resting state is disrupted in chronic back pain patients.  

PubMed

Recent brain functional magnetic resonance imaging (fMRI) studies have shown that chronic back pain (CBP) alters brain dynamics beyond the feeling of pain. In particular, the response of the brain default mode network (DMN) during an attention task was found abnormal. In the present work similar alterations are demonstrated for spontaneous resting patterns of fMRI brain activity over a population of CBP patients (n=12, 29-67 years old, mean=51.2). Results show abnormal correlations of three out of four highly connected sites of the DMN with bilateral insular cortex and regions in the middle frontal gyrus (p<0.05), in comparison with a control group of healthy subjects (n=20, 21-60 years old, mean=38.4). The alterations were confirmed by the calculation of triggered averages, which demonstrated increased coactivation of the DMN and the former regions. These findings demonstrate that CBP disrupts normal activity in the DMN even during the brain resting state, highlighting the impact of enduring pain over brain structure and function. PMID:20800649

Tagliazucchi, Enzo; Balenzuela, Pablo; Fraiman, Daniel; Chialvo, Dante R

2010-11-12

369

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

PubMed

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

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

2014-03-01

370

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

PubMed Central

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

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

2011-01-01

371

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

PubMed Central

Previous reviews of massage therapy for chronic, non-malignant pain have focused on discrete pain conditions. This article aims to provide a broad overview of the literature on the effectiveness of massage for a variety of chronic, non-malignant pain complaints to identify gaps in the research and to inform future clinical trials. Computerized databases were searched for relevant studies including prior reviews and primary trials of massage therapy for chronic, non-malignant pain. Existing research provides fairly robust support for the analgesic effects of massage for non-specific low back pain, but only moderate support for such effects on shoulder pain and headache pain. There is only modest, preliminary support for massage in the treatment of fibromyalgia, mixed chronic pain conditions, neck pain and carpal tunnel syndrome. Thus, research to date provides varying levels of evidence for the benefits of massage therapy for different chronic pain conditions. Future studies should employ rigorous study designs and include follow-up assessments for additional quantification of the longer-term effects of massage on chronic pain. PMID:17549233

2007-01-01

372

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

PubMed Central

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

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

2013-01-01

373

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

PubMed Central

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

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

2012-01-01

374

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

PubMed Central

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

Roditi, Daniela; Robinson, Michael E

2011-01-01

375

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

ERIC Educational Resources Information Center

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

Lackner, Jeffrey M.; And Others

1996-01-01

376

Does aerobic exercise improve pain perception and mood? A review of the evidence related to healthy and chronic pain subjects  

Microsoft Academic Search

Aerobic exercise can cause an acute improvement in mood as well as a reduction in the perception of pain from a painful stimulus.\\u000a Regular exercise training also may offer some protection from depression, is clinically useful in treating certain psychiatric\\u000a and chronic pain conditions, and may allow for an enhancement of the acute improvements in mood from a single exercise

Martin D. Hoffman; Debi Rufi Hoffman

2007-01-01

377

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

PubMed Central

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

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

2014-01-01

378

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

PubMed Central

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

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

2011-01-01

379

Using electronic health records data to identify patients with chronic pain in a primary care setting  

PubMed Central

Objective To develop and validate an accurate method to identify patients with chronic pain using electronic health records (EHR) data at a multisite community health center. Materials and methods We identified patients with chronic pain in our EHR system using readily available data elements pertaining to pain: diagnostic codes (International Classification of Disease, revision 9; ICD-9), patient-reported pain scores, and opioid prescription medications. Medical chart reviews were used to evaluate the accuracy of these data elements in all of their combinations. We developed an algorithm to identify chronic pain patients more accurately based on these evaluations. The algorithm's results were validated for accuracy by comparing them with the documentation of chronic pain by the patient's treating clinician in 381 random patient charts. Results The new algorithm, which combines pain scores, prescription medications, and ICD-9 codes, has a sensitivity and specificity of 84.8% and 97.7%, respectively. The algorithm was more accurate (95.0%) than pain scores (88.7%) or ICD-9 codes (93.2%) alone. The receiver operating characteristic was 0.981. Discussion A straightforward method for identifying chronic pain patients solely using structured electronic data does not exist because individual data elements, such as pain scores or ICD-9 codes, are not sufficiently accurate. We developed and validated an algorithm that uses a combination of elements to identify chronic pain patients accurately. Conclusions We derived a useful method that combines readily available elements from an EHR to identify chronic pain with high accuracy. This method should prove useful to those interested in identifying chronic pain patients in large datasets for research, evaluation or quality improvement purposes. PMID:23904323

Tian, Terrence Y; Zlateva, Ianita; Anderson, Daren R

2013-01-01

380

Executive and attentional functions in chronic pain: Does performance decrease with increasing task load?  

PubMed Central

BACKGROUND: Diminished executive function and attentional control has been reported in chronic pain patients. However, the precise pattern of impairment in these aspects of cognition in chronic pain remains unclear. Moreover, a decline in psychomotor speed could potentially influence executive and attentional control performance in pain patients. OBJECTIVE: To examine different aspects of executive and attentional control in chronic pain together with the confounding role of psychomotor slowing. METHODS: Neuropsychological tests of sustained attention, planning ability, inhibition and mental flexibility were administered to 34 participants with chronic pain and 32 control participants. RESULTS: Compared with the controls, participants with chronic pain took longer to complete tests of sustained attention and mental flexibility, but did not perform worse on inhibition or planning tasks. The decreased performance on the mental flexibility task likely reflects a reduction in psychomotor speed. The pattern of performance on the sustained attention task reveals a specific decline in attention, indicated by a disproportionate decline in performance with an increase in task duration and by increased fluctuations in attention during task performance. No additional effect was noted of pain intensity, pain duration, pain catastrophizing, depressive symptoms, reduced sleep because of the pain or opioid use. CONCLUSIONS: Executive and attention functions are not uniformly affected in chronic pain. At least part of the previously reported decline in executive function in this group may reflect psychomotor slowing. Overall, limited evidence was found that executive and attention performance is indeed lower in chronic pain. Therefore, it can be concluded that in chronic pain sustained attention performance is diminished while mental flexibility, planning and inhibition appear to be intact. PMID:22606680

Oosterman, Joukje M; Derksen, Laura C; van Wijck, Albert JM; Kessels, Roy PC; Veldhuijzen, Dieuwke S

2012-01-01

381

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

PubMed Central

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

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

2014-01-01

382

A Practical Approach for the Differential Diagnosis of Chronic Leg Pain in the Athlete  

Microsoft Academic Search

Chronic lower leg pain results from various conditions, most commonly, medial tibial stress syndrome, stress fracture, chronic exertional compartment syndrome, nerve entrapment, and popliteal artery entrapment syndrome. Symptoms associated with these conditions often overlap, making a definitive diagnosis difficult. As a result, an algorithmic approach was created to aid in the evaluation of patients with complaints of lower leg pain

Peter H. Edwards; Michelle L. Wright; Jodi F. Hartman

2005-01-01

383

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

Microsoft Academic Search

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

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

2006-01-01

384

Disuse and deconditioning in chronic low back pain: concepts and hypotheses on contributing mechanisms  

Microsoft Academic Search

For years enhancement of a patient’s level of physical fitness has been an important goal in rehabilitation treatment in chronic low back pain (CLBP), based on the hypothesis that physical deconditioning contributes to the chronicity of low back pain. However, whether this hypothesis in CLBP holds is not clear. In this paper, possible mechanisms that contribute to the development of

Jeanine A Verbunt; Henk A Seelen; Johan W Vlaeyen; Geert J van de Heijden; Peter H Heuts; Kees Pons; J Andre Knottnerus

2003-01-01

385

The Use of Psychotropic Drugs in the Treatment of Chronic, Severe Pains  

Microsoft Academic Search

The results of long experience in the treatment of chronic and severe pains resistant to ordinary therapy with psychotropic drugs are reported. Out of 103 inpatients with chronic and severe pains caused by neurological conditions, who were treated with a combination of thymoleptics and neuroleptics, 82 (approx. 82 %) showed marked improvement. These encouraging results are compared with others published

R. Kocher

1976-01-01

386

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

Microsoft Academic Search

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

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

2008-01-01

387

Comorbid Chronic Pain and Posttraumatic Stress Disorder Across the Lifespan: A Review of Theoretical Models  

Microsoft Academic Search

Chronic pain is often associated with functional, psychological, and social problems that can have a significant negative impact on a person’s quality of life. Substantial literature currently exists documenting the relationship between chronic pain and commonly co-occurring disorders such as substance abuse (Brown et al., 1996), depression (Banks & Kerns, 1996), and anxiety disorders (Asmundson et al., 1996). Importantly, interest

John D. Otis; Donna B. Pincus; Terence M. Keane

388

Physiotherapy for sleep disturbance in chronic low back pain: a feasibility randomised controlled trial  

Microsoft Academic Search

BACKGROUND: Sleep disturbance is becoming increasingly recognised as a clinically important symptom in people with chronic low back pain (CLBP, low back pain >12 weeks), associated with physical inactivity and depression. Current research and international clinical guidelines recommend people with CLBP assume a physically active role in their recovery to prevent chronicity, but the high prevalence of sleep disturbance in

Deirdre A Hurley; Jennifer Eadie; Grainne O'Donoghue; Clare Kelly; Chris Lonsdale; Suzanne Guerin; Mark A Tully; Willem van Mechelen; Suzanne M McDonough; Colin AG Boreham; Conor Heneghan; Leslie Daly

2010-01-01

389

Mechanical and thermal allodynia in chronic central pain following spinal cord injury  

Microsoft Academic Search

Spinal cord injury (SCI) results in variable motor recoveries and chronic central pain syndromes develop in the majority of SCI patients. To provide a basis for further studies, we report a new rodent model of chronic central pain following spinal cord trauma. Male Sprague-Dawley rats (N = 10) were hemisectioned at T13 and were tested both preoperatively and postoperatively and

Marc D Christensen; Alex W Everhart; Jason T Pickelman; Claire E Hulsebosch

1996-01-01

390

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

PubMed Central

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

Gregoire, Marie-Claude; Finley, G Allen

2013-01-01

391

Early maladaptive schemas in Finnish adult chronic male and female pain patients  

Microsoft Academic Search

Background and aims of the studyThe connection between chronic pain and traumatic experiences in childhood has been established in several studies. The association of emotional maltreatment with chronic pain has been studied, but to a lesser degree. Schema therapy [24] is an extension of cognitive therapy and presents the early maladaptive schema (EMS) concept. EMSs reflect early, mainly emotional maltreatment.

Tom H. J. Saariaho; Anita S. I. Saariaho; Irma A. Karila; Matti I. Joukamaa

2010-01-01

392

Opioids and the Treatment of Chronic Pain in a Primary Care Sample  

Microsoft Academic Search

Chronic pain is a widespread, difficult problem facing clinicians. This study assessed the current medical management of a general population of patients with chronic pain in 12 family medicine practices located throughout the state of Wisconsin. Medical record audits were conducted on a sample of 209 adults. Sixty-seven percent were female with an average age of 53 years. The most

Nancy J Adams; Mary Beth Plane; Michael F Fleming; Marlon P Mundt; Laura A Saunders; Ellyn A Stauffacher

2001-01-01

393

Is chronic pelvic pain a comfortable diagnosis for primary care practitioners: a qualitative study  

Microsoft Academic Search

BACKGROUND: Chronic pelvic pain (CPP) has a prevalence similar to asthma and chronic back pain, but little is known about how general practitioners (GPs) and practice nurses manage women with this problem. A clearer understanding of current management is necessary to develop appropriate strategies, in keeping with current health care policy, for the supported self-management of patients with long term

Linda McGowan; Diane Escott; Karen Luker; Francis Creed; Carolyn Chew-Graham

2010-01-01

394

Sexual functioning in women with chronic pelvic pain: The impact of depression, support, and abuse  

Microsoft Academic Search

Many studies have documented associations among sexual functioning, depression, experiences of childhood sexual abuse, relationship support, and chronic pelvic pain, but none have addressed the interrelationships among all of these variables in a unified model. The aim of this preliminary study was to construct an integrative model predicting sexual functioning for women with chronic pelvic pain. Women (n = 63)

Mary E. Randolph; Diane M. Reddy

2006-01-01

395

Gender differences in associations between trauma history and adjustment among chronic pain patients  

Microsoft Academic Search

This study examines the relationship between a trauma history and emotional functioning in response to a chronic pain condition. We broadened the traditional study of trauma in chronic pain from sexual and physical abuse to include a variety of traumatic events and experiences that occurred not only during childhood, but during adulthood as well. Seventy-three (51% female, 60% lower back)

Ilyse L Spertus; John Burns; Beth Glenn; Kenneth Lofland; Lance McCracken

1999-01-01

396

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

ERIC Educational Resources Information Center

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

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

2010-01-01

397

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

ERIC Educational Resources Information Center

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

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

2007-01-01

398

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

MedlinePLUS

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

399

Child Abuse and Chronic Pain in a Community Survey of Women  

ERIC Educational Resources Information Center

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

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

2007-01-01

400

Cost-effectiveness of acupuncture treatment in patients with chronic neck pain  

Microsoft Academic Search

Acupuncture is increasingly used in patients with chronic pain, but there is a lack of evidence on the cost–benefit relationship of this treatment strategy. The objective of this study was to assess costs and cost-effectiveness of additional acupuncture treatment in patients with chronic neck pain compared to patients receiving routine care alone. A randomized controlled trial including patients (?18 years

Stefan N. Willich; Thomas Reinhold; Dagmar Selim; Susanne Jena; Benno Brinkhaus; Claudia M. Witt

2006-01-01

401

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

PubMed

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

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

2012-12-01

402

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

Microsoft Academic Search

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

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

2007-01-01

403

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

Microsoft Academic Search

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

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

2003-01-01

404

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

PubMed Central

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

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

2013-01-01

405

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

Microsoft Academic Search

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

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

2008-01-01

406

PSYCHOLOGY, PSYCHIATRY AND BRAIN NEUROSCIENCE SECTION Original Research Article Exercise Performance and Chronic Pain in Chronic Fatigue Syndrome: The Role of Pain Catastrophizing  

Microsoft Academic Search

Medical Sociology, Faculty of Medicine and Pharmacy, Vrije Universiteit, Brussels ABSTRACT Objectives. This study aimed to examine the associations between bodily pain, pain catastrophizing, depression, activity limitations\\/participation restrictions, employment status, and exercise perfor- mance in female patients with chronic fatigue syndrome (CFS) who experience widespread pain. Design. Cross-sectional observational study. Setting. A university-based clinic. Patients. Thirty-six female CFS patients who

Jo Nijs; Karen Van de Putte; Fred Louckx; Steven Truijen; Kenny De Meirleir

407

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

PubMed Central

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

Yagci, Nesrin; Duymaz, Tomris; Cavlak, Ugur

2014-01-01

408

Chronic pain effect on body schema and neuropsychological performance in athletes: a pilot study.  

PubMed

The ability to recognize the body parts blindfolded is called body schema. Chronic pain disrupts cognitive function and could lead to an altered body schema. Commonly competitive athletes have chronic pain, but still train and compete. The goal of this study was to assess the body schema of competitive athletes with chronic pain. Pain was measured with the McGill Pain Questionnaire. To assess the body schema, the Image Marking Procedure was used to assess the capacity of the participants to project their bodies in space. Neuropsychological performance was assessed with the Grooved Pegboard Test. There was no difference in body schema between groups; neuropsychological performance indicated better scores in the athlete group. This study showed that despite chronic pain, the athlete group presented unaltered body schema and better neuropsychological performance, perhaps explained by self-selection. PMID:24032329

Thurm, Bianca E; Matoso, Amanda; Diaz, Ana C; Paschoalini, Carolina; Neves, Elayne; Tuunelis, Raquel; Kiyomoto, Henry Dan; Gama, Eliane F

2013-04-01

409

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

PubMed

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

A Forgeron, Paula; Stinson, Jennifer

2014-10-01

410

Tapentadol extended-release for treatment of chronic pain: a review  

PubMed Central

Tapentadol is a centrally acting analgesic with a dual mechanism of action of mu receptor agonism and norepinephrine reuptake inhibition. Tapentadol immediate-release is approved by the US Food and Drug Administration for the management of moderate-to-severe acute pain. It was developed to decrease the intolerability issue associated with opioids. Tapentadol extended-release has a 12-hour duration of effect, and has recently been evaluated for pain in patients with chronic osteoarthritis, low back pain, and pain associated with diabetic peripheral neuropathy. Tapentadol extended-release was found to provide safe and highly effective analgesia for the treatment of chronic pain conditions, including moderate-to-severe chronic osteoarthritis pain and low back pain. Initial trials demonstrating efficacy in neuropathic pain suggest that tapentadol has comparable analgesic effectiveness and better gastrointestinal tolerability than opioid comparators, and demonstrates effectiveness in settings of inflammatory, somatic, and neuropathic pain. Gastrointestinal intolerance and central nervous system effects were the major adverse events noted. Tapentadol will need to be rigorously tested in chronic neuropathic pain, cancer-related pain, and cancer-related neuropathic pain. PMID:21887118

Vadivelu, Nalini; Timchenko, Alexander; Huang, Yili; Sinatra, Raymond

2011-01-01

411

The association among neighborhood socioeconomic status, race and chronic pain in black and white older adults.  

PubMed Central

The association among race, neighborhood socioeconomic status (SES), and chronic pain has not been well examined in older people. Clinical data was obtained from older adults (>50 years old) presenting to a tertiary care pain center. The relative roles of race and neighborhood SES on the chronic pain experienced in older black and white adults were assessed. Older blacks experienced more affective pain, pain-related disability and mood disorder symptoms than older whites. Confirmatory factor analysis confirmed previously hypothesized factors for the McGill Pain Questionnaire pain dimensions and the Pain Disability Index. Exploratory and confirmatory factor analyses also identified factors in the Brief Symptom Inventory and neighborhood SES. Structural equation modeling showed black race was associated with lower neighborhood SES and also with increased affective pain, obligatory disability and mood disorders mediationally through neighborhood SES. It was indirectly associated with increased sensory and miscellaneous pain, and voluntary disability through low neighborhood SES. Racial interaction examination showed that neighborhood SES had the same relationship to outcomes by race. We found increasing neighborhood SES is associated with decreasing negative chronic pain outcomes for older blacks and whites. Our data provide evidence that both race and neighborhood SES are important factors to consider when examining the chronic pain experience among older Americans. PMID:17987920

Fuentes, Molly; Hart-Johnson, Tamera; Green, Carmen R.

2007-01-01

412

Cognitive-Behavioural Therapy versus EMG Biofeedback in the treatment of chronic low back pain  

Microsoft Academic Search

Forty-four chronic, but relatively well functioning, low back pain patients were assigned to either Cognitive Behaviour Therapy (CBT), Electromyographic Biofeedback (EMGBF) or Wait List Control (WLC). Both treatments were conducted over eight sessions in groups of four subjects. Results at post-treatment indicated significant improvements in functioning on measures of pain intensity, perceived level of disability, adaptive beliefs about pain and

Toby R. O. Newton-John; Susan H. Spence; David Schotte

1995-01-01

413

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

E-print Network

of the low sugar count until it may be life­threatening, so they must contin­ uously monitor their sugar methods to get rid of the pain. Easing Chronic Pain: a Brief History Since pain signals are simply

Kreinovich, Vladik

414

The Body Has a History: An Educational Intervention Programme for People with Generalised Chronic Musculoskeletal Pain.  

ERIC Educational Resources Information Center

Studies the effects of a 12-session educational group intervention program for people with generalized chronic musculoskeletal pain. Results reveal that participants came out significantly better than the control group with respect to pain and pain coping, taking care of themselves, life satisfaction, and health care consumption. (Contains 69…

Steen, Eldri; Haugli, Liv

2000-01-01

415