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Sample records for adequate pain treatment

  1. Improving access to adequate pain management in Taiwan.

    PubMed

    Scholten, Willem

    2015-06-01

    There is a global crisis in access to pain management in the world. WHO estimates that 4.65 billion people live in countries where medical opioid consumption is near to zero. For 2010, WHO considered a per capita consumption of 216.7 mg morphine equivalents adequate, while Taiwan had a per capita consumption of 0.05 mg morphine equivalents in 2007. In Asia, the use of opioids is sensitive because of the Opium Wars in the 19th century and for this reason, the focus of controlled substances policies has been on the prevention of diversion and dependence. However, an optimal public health outcome requires that also the beneficial aspects of these substances are acknowledged. Therefore, WHO recommends a policy based on the Principle of Balance: ensuring access for medical and scientific purposes while preventing diversion, harmful use and dependence. Furthermore, international law requires that countries ensure access to opioid analgesics for medical and scientific purposes. There is evidence that opioid analgesics for chronic pain are not associated with a major risk for developing dependence. Barriers for access can be classified in the categories of overly restrictive laws and regulations; insufficient medical training on pain management and problems related to assessment of medical needs; attitudes like an excessive fear for dependence or diversion; and economic and logistical problems. The GOPI project found many examples of such barriers in Asia. Access to opioid medicines in Taiwan can be improved by analysing the national situation and drafting a plan. The WHO policy guidelines Ensuring Balance in National Policies on Controlled Substances can be helpful for achieving this purpose, as well as international guidelines for pain treatment. PMID:26068436

  2. Treatment of Neck Pain

    PubMed Central

    Hurwitz, Eric L.; Cheng, Ivan; Carroll, Linda J.; Nordin, Margareta; Guzman, Jaime; Peloso, Paul; Holm, Lena W.; Côthé, Pierre; Hogg-Johnson, Sheilah; van der Velde, Gabrielle; Cassidy, J. David; Haldeman, Scott

    2008-01-01

    Study Design Best evidence synthesis. Objective To identify, critically appraise, and synthesize literature from 1980 through 2006 on surgical interventions for neck pain alone or with radicular pain in the absence of serious pathologic disease. Summary of Background Data There have been no comprehensive systematic literature or evidence-based reviews published on this topic. Methods We systematically searched Medline for literature published from 1980 to 2006 on percutaneous and open surgical interventions for neck pain. Publications on the topic were also solicited from experts in the field. Consensus decisions were made about the scientific merit of each article; those judged to have adequate internal validity were included in our Best Evidence Synthesis. Results Of the 31,878 articles screened, 1203 studies were relevant to the Neck Pain Task Force mandate and of these, 31 regarding treatment by surgery or injections were accepted as scientifically admissible. Radiofrequency neurotomy, cervical facet injections, cervical fusion and cervical arthroplasty for neck pain without radiculopathy are not supported by current evidence. We found there is support for short-term symptomatic improvement of radicular symptoms with epidural corticosteroids. It is not clear from the evidence that long-term out comes are improved with the surgical treatment of cervical radiculopathy compared to non operative measures. However, relatively rapid and substantial symptomatic relief after surgical treatment seems to be reliably achieved. It is not evident that one open surgical technique is clearly superior to others for radiculopathy. Cervical foramenal or epidural injections are associated with relatively frequent minor adverse events (5%–20%); however, serious adverse events are very uncommon (<1%). After open surgical procedures on the cervical spine, potentially serious acute complications are seen in approximately 4% of patients. Conclusion Surgical treatment and limited

  3. Advances in the Treatment of Neuropathic Pain.

    PubMed

    Xu, Li; Zhang, Yuguan; Huang, Yuguang

    2016-01-01

    Neuropathic pain is pain that arises as a direct consequence of a lesion or diseases affecting the somatosensory system. Treatments for neuropathic pain include pharmacological, nonpharmacological, and interventional therapies. Currently recommended first-line pharmacological treatments include antidepressants and anticonvulsants (gabapentin and pregabalin). However, in some cases, pharmacological therapy alone fails to give adequate control of the chronic pain. New techniques have been invented and have been proved effective on neuropathic pain, such as behavioral, cognitive, integrative, and physical therapies. In this review, we focused on the advances in the treatment of central neuropathic pain, diabetic peripheral neuropathy, postherpetic neuralgia, and cancer pain. PMID:26900067

  4. Treatment of myofascial pain.

    PubMed

    Desai, Mehul J; Bean, Matthew C; Heckman, Thomas W; Jayaseelan, Dhinu; Moats, Nick; Nava, Andrew

    2013-01-01

    SUMMARY The objective of this article was to perform a narrative review regarding the treatment of myofascial pain syndrome and to provide clinicians with treatment recommendations. This paper reviews the efficacy of various myofascial pain syndrome treatment modalities, including pharmacological therapy, injection-based therapies and physical therapy interventions. Outcomes evaluated included pain (visual analog scale), pain pressure threshold and range of motion. The evidence found significant benefit with multiple treatments, including diclofenac patch, thiocolchicoside and lidocaine patches. Trigger point injections, ischemic compression therapy, transcutaneous electrical nerve stimulation, spray and stretch, and myofascial release were also efficacious. The authors recommend focusing on treating underlying pathologies, including spinal conditions, postural abnormalities and underlying behavioral issues. To achieve maximum pain reduction and improve function, we recommend physicians approach myofascial pain syndrome with a multimodal plan, which includes a combination of pharmacologic therapies, various physical therapeutic modalities and injection therapies. PMID:24645933

  5. Myofascial pain syndrome treatments.

    PubMed

    Borg-Stein, Joanne; Iaccarino, Mary Alexis

    2014-05-01

    Myofascial pain syndrome (MPS) is a regional pain disorder caused by taut bands of muscle fibers in skeletal muscles called myofascial trigger points. MPS is a common disorder, often diagnosed and treated by physiatrists. Treatment strategies for MPS include exercises, patient education, and trigger point injection. Pharmacologic interventions are also common, and a variety of analgesics, antiinflammatories, antidepressants, and other medications are used in clinical practice. This review explores the various treatment options for MPS, including those therapies that target myofascial trigger points and common secondary symptoms. PMID:24787338

  6. Cancer treatment: dealing with pain

    MedlinePlus

    ... ency/patientinstructions/000827.htm Cancer treatment: dealing with pain To use the sharing features on this page, ... health care provider about your options. What Causes Pain The pain from cancer can have a few ...

  7. Increasing nursing treatment for pediatric procedural pain.

    PubMed

    Bice, April A; Gunther, Mary; Wyatt, Tami

    2014-03-01

    Procedural pain management is an underused practice in children. Despite the availability of efficacious treatments, many nurses do not provide adequate analgesia for painful interventions. Complementary therapies and nonpharmacologic interventions are additionally essential to managing pain. Owing to the increasing awareness of inadequate nursing utilization of pharmacologic measures for procedural pain, this paper focuses only on analgesic treatments. The aim of this review was to examine how varying degrees of quality improvement affect nursing utilization of treatments for routine pediatric procedural pain. A comprehensive search of databases including Cinahl, Medline/Pubmed, Web of Science, Google Scholar, Psycinfo, and Cochrane Library was performed. Sixty-two peer-reviewed research articles were examined. Ten articles focusing on quality improvement in pediatric pain management published in English from 2001 to 2011 were included. Three themes emerged: 1) increasing nursing knowledge; 2) nursing empowerment; and 3) protocol implementation. Research critique was completed with the use of guidelines and recommendations from Creswell (2009) and Garrard (2011). The literature reveals that nurses still think that pediatric pain management is essential. Quality improvement increases nursing utilization of procedural pain treatments. Although increasing nursing knowledge improves pediatric pain management, it appears that nursing empowerment and protocol implementation increase nursing compliance more than just education alone. Nurses providing pain management can enhance their individual practice with quality improvement measures that may increase nursing adherence to institutional and nationally recommended pediatric procedural pain management guidelines. PMID:24602440

  8. Cancer treatment: dealing with pain

    MedlinePlus

    ... You have a right to receive treatment for cancer pain. There are many medicines and other treatments that ... There are three main types of medicines for cancer pain. Your provider will work with you to find ...

  9. Neuropathic pain after dental treatment.

    PubMed

    Tınastepe, Neslihan; Oral, Koray

    2013-01-01

    The head and neck regions are the most common sites of the human body to be involved in chronic pain conditions. Neuropathic pain is a chronic pain condition, and refers to all pain initiated or caused by a primary lesion or dysfunction or transitory perturbation in the peripheral or central nervous system (CNS). Trigeminal neuralgia, atypical odontalgia (phantom tooth pain), burning mouth syndrome, traumatic neuropathies, postherpetic neuralgias and complex regional pain syndrome are neuropathic pain conditions in the orofacial region that can be encountered in pain and dental clinics. The majority of the time this problem is misdiagnosed by the dentist, which can lead to unnecessary treatments. These treatments may include endodontic treatment and extraction of the tooth or teeth in the region. In this review, only post-traumatic peripheral pain neuropathies seen after dental treatments will be discussed. PMID:23588863

  10. Adequate peritoneal dialysis: theoretical model and patient treatment.

    PubMed

    Tast, C

    1998-01-01

    The objective of this study was to evaluate the relationship between adequate PD with sufficient weekly Kt/V (2.0) and Creatinine clearance (CCR) (60l) and necessary daily dialysate volume. This recommended parameter was the result of a recent multi-centre study (CANUSA). For this there were 40 patients in our hospital examined and compared in 1996, who carried out PD for at least 8 weeks and up to 6 years. These goals (CANUSA) are easily attainable in the early treatment of many individuals with a low body surface area (BSA). With higher BSA or missing RRF (Residual Renal Function) the daily dose of dialysis must be adjusted. We found it difficult to obtain the recommended parameters and tried to find a solution to this problem. The simplest method is to increase the volume or exchange rate. The most expensive method is to change from CAPD to APD with the possibility of higher volume or exchange rates. Selection of therapy must take into consideration: 1. patient preference, 2. body mass, 3. peritoneal transport rates, 4. ability to perform therapy, 5. cost of therapy and 6. risk of peritonitis. With this information in mind, an individual prescription can be formulated and matched to the appropriate modality of PD. PMID:10392062

  11. [Neurosurgical treatment of chronic pain].

    PubMed

    Fontaine, Denys

    2013-06-01

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

  12. Myofascial low back pain treatment.

    PubMed

    Sharan, Deepak; Rajkumar, Joshua Samuel; Mohandoss, Mathankumar; Ranganathan, Rameshkumar

    2014-09-01

    Myofascial pain is a common musculoskeletal problem, with the low back being one of the commonest affected regions. Several treatments have been used for myofascial low back pain through physical therapies, pharmacologic agents, injections, and other such therapies. This review will provide an update based on recently published literature in the field of myofascial low back pain along with a brief description of a sequenced, multidisciplinary treatment protocol called Skilled Hands-on Approach for the Release of myofascia, Articular, Neural and Soft tissue mobilization (SHARANS) protocol. A comprehensive multidisciplinary approach is recommended for the successful management of individuals with myofascial low back pain. PMID:25091133

  13. [Neurosurgical treatment of chronic pain].

    PubMed

    Fontaine, D; Blond, S; Mertens, P; Lanteri-Minet, M

    2015-02-01

    Neurosurgical treatment of pain used two kind of techniques: 1) Lesional techniques interrupt the transmission of nociceptive neural input by lesionning the nociceptive pathways (drezotomy, cordotomy, tractotomy…). They are indicated to treat morphine-resistant cancer pain and few cases of selected neuropathic pain. 2) Neuromodulation techniques try to decrease pain by reinforcing inhibitory and/or to limit activatory mechanisms. Chronic electrical stimulation of the nervous system (peripheral nerve stimulation, spinal cord stimulation, motor cortex stimulation…) is used to treat chronic neuropathic pain. Intrathecal infusion of analgesics (morphine, ziconotide…), using implantable pumps, allows to increase their efficacy and to reduce their side effects. These techniques can improve, sometimes dramatically, selected patients with severe and chronic pain, refractory to all other treatments. The quality of the analgesic outcome depends on the relevance of the indications. PMID:25681114

  14. Treatments for Managing Pain

    MedlinePlus

    ... muscle massage. Electrical stimulation - Transcutaneous electrical nerve stimulation (TENS) is the most common form of electrical stimulation ... painful and does not require needles or medicine. TENS consists of a small, battery-operated device that ...

  15. Reducing Cancer Patients' Painful Treatment

    NASA Video Gallery

    A NASA light technology originally developed to aid plant growth experiments in space has proved to reduce the painful side effects resulting from chemotherapy and radiation treatment in bone marro...

  16. Treatment of painful diabetic neuropathy.

    PubMed

    Javed, Saad; Petropoulos, Ioannis N; Alam, Uazman; Malik, Rayaz A

    2015-01-01

    Painful diabetic neuropathy (PDN) is a debilitating consequence of diabetes that may be present in as many as one in five patients with diabetes. The objective assessment of PDN is difficult, making it challenging to diagnose and assess in both clinical practice and clinical trials. No single treatment exists to prevent or reverse neuropathic changes or to provide total pain relief. Treatment of PDN is based on three major approaches: intensive glycaemic control and risk factor management, treatments based on pathogenetic mechanisms, and symptomatic pain management. Clinical guidelines recommend pain relief in PDN through the use of antidepressants such as amitriptyline and duloxetine, the γ-aminobutyric acid analogues gabapentin and pregabalin, opioids and topical agents such as capsaicin. Of these medications, duloxetine and pregabalin were approved by the US Food and Drug Administration (FDA) in 2004 and tapentadol extended release was approved in 2012 for the treatment of PDN. Proposed pathogenetic treatments include α-lipoic acid (stems reactive oxygen species formation), benfotiamine (prevents vascular damage in diabetes) and aldose-reductase inhibitors (reduces flux through the polyol pathway). There is a growing need for studies to evaluate the most potent drugs or combinations for the management of PDN to maximize pain relief and improve quality of life. A number of agents are potential candidates for future use in PDN therapy, including Nav 1.7 antagonists, N-type calcium channel blockers, NGF antibodies and angiotensin II type 2 receptor antagonists. PMID:25553239

  17. Treatment of painful diabetic neuropathy

    PubMed Central

    Petropoulos, Ioannis N.; Alam, Uazman; Malik, Rayaz A.

    2015-01-01

    Painful diabetic neuropathy (PDN) is a debilitating consequence of diabetes that may be present in as many as one in five patients with diabetes. The objective assessment of PDN is difficult, making it challenging to diagnose and assess in both clinical practice and clinical trials. No single treatment exists to prevent or reverse neuropathic changes or to provide total pain relief. Treatment of PDN is based on three major approaches: intensive glycaemic control and risk factor management, treatments based on pathogenetic mechanisms, and symptomatic pain management. Clinical guidelines recommend pain relief in PDN through the use of antidepressants such as amitriptyline and duloxetine, the γ-aminobutyric acid analogues gabapentin and pregabalin, opioids and topical agents such as capsaicin. Of these medications, duloxetine and pregabalin were approved by the US Food and Drug Administration (FDA) in 2004 and tapentadol extended release was approved in 2012 for the treatment of PDN. Proposed pathogenetic treatments include α-lipoic acid (stems reactive oxygen species formation), benfotiamine (prevents vascular damage in diabetes) and aldose-reductase inhibitors (reduces flux through the polyol pathway). There is a growing need for studies to evaluate the most potent drugs or combinations for the management of PDN to maximize pain relief and improve quality of life. A number of agents are potential candidates for future use in PDN therapy, including Nav 1.7 antagonists, N-type calcium channel blockers, NGF antibodies and angiotensin II type 2 receptor antagonists. PMID:25553239

  18. Sacroiliac Joint Pain and Its Treatment.

    PubMed

    Rashbaum, Ralph F; Ohnmeiss, Donna D; Lindley, Emily M; Kitchel, Scott H; Patel, Vikas V

    2016-03-01

    The sacroiliac joint (SIJ) as a source of symptoms has been controversial; however, as knowledge about the joint increased, its role as a pain generator in patients complaining of symptoms that are often attributed to spinal pathology has become better appreciated. The literature reports that the SIJ is the pain origin in as many as 30% of patients presenting with low back pain. Clinically, the SIJ can be challenging to evaluate; however, assessing pain location, patient posture/movement, and provocative manual testing are useful in making the presumptive diagnosis of SIJ disruption. The most definitive evaluation is image-guided injection of anesthetic solutions into the joint which is diagnostic if there is at least 75% symptom relief acutely. Treatment begins with nonoperative intervention including physical therapy and/or chiropractic care. If these fail, the next option is generally radiofrequency denervation (rhizotomy) of the joint. If this does not provide adequate relief, surgical intervention, in the form of minimally invasive SIJ fusion may be considered. The literature increasingly supports favorable results of SIJ fusion in appropriately selected patients. The purpose of this review is to provide an overview of the current literature on the SIJ, with focus on its surgical treatment. PMID:26889985

  19. New Labor Pain Treatment Options.

    PubMed

    Koyyalamudi, Veerandra; Sidhu, Gurleen; Cornett, Elyse M; Nguyen, Viet; Labrie-Brown, Carmen; Fox, Charles J; Kaye, Alan D

    2016-02-01

    Presently, the gold standard for pain control in laboring patients is neuraxial blockade, which includes a spinal, epidural, or a combined spinal-epidural technique. In conjunction with neuraxial blockade or by itself, some of the other agents employed related to labor pain include opioids, non-opioids, nitrous oxide, patient-controlled analgesia (PCA), and distraction therapy. Alternative treatments include acupuncture, hypnotism, yoga, exercise during pregnancy, hydrotherapy, transcutaneous electronic nerve stimulation, massage, and relaxation techniques. This review will focus on current updates and recent trends in labor pain management. Neuraxial management, pharmacotherapy, and newer alternative methods to mitigate labor pain are reviewed. Newer techniques in epidural analgesia include the dural puncture epidural technique, which needs further evaluation. There are limited published data on the use of acupuncture, hypnotism, yoga, exercise during pregnancy, hydrotherapy, transcutaneous electronic nerve stimulation, massage, and relaxation techniques in the alleviation of labor pain. These alternative therapies maybe considered as an adjuvant as the analgesic efficiency is inferior to that provided by typical standard pharmacotherapy. Future studies are warranted to evaluate the role of immersion virtual reality in alleviating labor pain. PMID:26780039

  20. Surgical Treatment of Upper Extremity Pain.

    PubMed

    Dellon, Arnold Lee

    2016-02-01

    If the patient with hand pain remains without significant relief and without recovery of function after appropriate pharmaceutical and physical modality treatments, it is appropriate to consider a surgical approach to the pain. Categories of pain amenable to a surgical approach are pain caused by nerve compression, pain caused by a neuroma, and joint pain of neural origin. Compressed nerve should be decompressed and depending on the intraoperative findings a neurolysis also should be performed. Painful neuroma must be resected to stop the pain generator. For a painful joint, the biomechanics of that joint must first be stable before denervation. PMID:26611391

  1. Can Chronic Pain Patients Be Adequately Treated Using Generic Pain Medications to the Exclusion of Brand-Name Ones?

    PubMed

    Candido, Kenneth D; Chiweshe, Joseph; Anantamongkol, Utchariya; Knezevic, Nebojsa Nick

    2016-01-01

    According to the Food and Drug Administration (FDA) reports, approximately 8 in 10 prescriptions filled in the United States are for generic medications, with an expectation that this number will increase over the next few years. The impetus for this emphasis on generics is the cost disparity between them and brand-name products. The use of FDA-approved generic drugs saved 158 billion dollars in 2010 alone. In the current health care climate, there is continually increasing pressure for prescribers to write for generic alternative medications, occasionally at the expense of best clinical practices. This creates a conflict wherein both physicians and patients may find brand-name medications clinically superior but nevertheless choose generic ones. The issue of generic versus brand medications is a key component of the discussion of health payers, physicians and their patients. This review evaluates some of the important medications in the armamentarium of pain physicians that are frequently used in the management of chronic pain, and that are currently at the forefront of this issue, including Opana (oxymorphone; Endo Pharmaceuticals, Inc., Malvern, PA), Gralise (gabapentin; Depomed, Newark, CA), and Horizant (gabapentin enacarbil; XenoPort, Santa Clara, CA) that are each available in generic forms as well. We also discuss the use of Lyrica (pregabalin; Pfizer, New York, NY), which is currently unavailable as generic medication, and Cymbalta (duloxetine; Eli Lilly, Indianapolis, IN), which has been recently FDA approved to be available in a generic form. It is clear that the use of generic medications results in large financial savings for the cost of prescriptions on a national scale. However, cost-analysis is only part of the equation when treating chronic pain patients and undervalues the relationships of enhanced compliance due to single-daily dosing and stable and reliable pharmacokinetics associated with extended-duration preparations using either retentive

  2. Emerging Treatments for Neuropathic Pain.

    PubMed

    Pessoa, Bruno L; Escudeiro, Gabriel; Nascimento, Osvaldo J M

    2015-12-01

    Neuropathic pain is a series of well-known conditions caused by diseases or lesions to the somatosensory system. Due to the better understanding of the pathophysiology of neuropathic pain, previously unexplored therapies have been used with encouraging results. As such, Acetyl-L-carnitine (ALC), Alpha-lipoic-acid (ALA), cannabinoids, Clonidine, EMA401, Botulinum Toxin type A, and new voltage-gated sodium channel blockers, can be cited. Furthermore, new modalities in neuromodulation such as high-frequency spinal cord stimulation, burst stimulation, dorsal root ganglion stimulation, transcranial direct current stimulation, and many others have been showing exciting results. Besides, changing paradigms may occur with the advent of optogenetics and a better understanding of epigenetic regulation. This article reviews the published literature on the treatment of NP. Despite the interesting results, randomized controlled trials are demanded for the majority of the therapies previously mentioned. PMID:26530058

  3. Post surgical pain treatment - adults

    MedlinePlus

    Postoperative pain relief ... Pain that occurs after surgery is an important concern. Before your surgery, you and your surgeon may have discussed how much pain you should expect and how it will be ...

  4. Prevention: The Best Treatment for Back Pain

    MedlinePlus

    ... DO Video Library Prevention: The Best Treatment for Back Pain Page Content A n estimated 50 million Americans ... natural tendency toward self-healing. Tips to Minimize Back Pain Here are some tips for preventing or minimizing ...

  5. Easing Chronic Pain: Better Treatments and Medications

    MedlinePlus

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

  6. Pain Treatment in Arthritis-Related Pain: Beyond NSAIDs

    PubMed Central

    van Laar, Mart; Pergolizzi, Joseph V; Mellinghoff, Hans-Ulrich; Merchante, Ignacio Morón; Nalamachu, Srinivas; O'Brien, Joanne; Perrot, Serge; Raffa, Robert B

    2012-01-01

    Managing pain from chronic conditions, such as, but not limited to, osteoarthritis and rheumatoid arthritis, requires the clinician to balance the need for effective analgesia against safety risks associated with analgesic agents. Osteoarthritis and rheumatoid arthritis pain is incompletely understood but involves both nociceptive and non-nociceptive mechanisms, including neuropathic mechanisms. Prevailing guidelines for arthritis-related pain do not differentiate between nociceptive and non-nociceptive pain, sometimes leading to recommendations that do not fully address the nature of pain. NSAIDs are effective in treating the nociceptive arthritis-related pain. However, safety concerns of NSAIDs may cause clinicians to undertreat arthritis-related pain. In this context, combination therapy may be more appropriate to manage the different pain mechanisms involved. A panel convened in November 2010 found that among the currently recommended analgesic products for arthritis-related pain, fixed-low-dose combination products hold promise for pain control because such products allow lower doses of individual agents resulting in decreased toxicity and acceptable efficacy due to synergy between the individual drugs. Better evidence and recommendations are required to improve treatment of chronic arthritis-related pain. PMID:23264838

  7. Pain

    MedlinePlus

    ... realize you have a medical problem that needs treatment. Once you take care of the problem, pain ... Fortunately, there are many ways to treat pain. Treatment varies depending on the cause of pain. Pain ...

  8. The neurosurgical treatment of neuropathic facial pain.

    PubMed

    Brown, Jeffrey A

    2014-04-01

    This article reviews the definition, etiology and evaluation, and medical and neurosurgical treatment of neuropathic facial pain. A neuropathic origin for facial pain should be considered when evaluating a patient for rhinologic surgery because of complaints of facial pain. Neuropathic facial pain is caused by vascular compression of the trigeminal nerve in the prepontine cistern and is characterized by an intermittent prickling or stabbing component or a constant burning, searing pain. Medical treatment consists of anticonvulsant medication. Neurosurgical treatment may require microvascular decompression of the trigeminal nerve. PMID:24680498

  9. Expectations predict chronic pain treatment outcomes.

    PubMed

    Cormier, Stéphanie; Lavigne, Geneviève L; Choinière, Manon; Rainville, Pierre

    2016-02-01

    Accumulating evidence suggests an association between patient pretreatment expectations and numerous health outcomes. However, it remains unclear if and how expectations relate to outcomes after treatments in multidisciplinary pain programs. The present study aims at investigating the predictive association between expectations and clinical outcomes in a large database of chronic pain patients. In this observational cohort study, participants were 2272 patients treated in one of 3 university-affiliated multidisciplinary pain treatment centers. All patients received personalized care, including medical, psychological, and/or physical interventions. Patient expectations regarding pain relief and improvements in quality of life and functioning were measured before the first visit to the pain centers and served as predictor variables. Changes in pain intensity, depressive symptoms, pain interference, and tendency to catastrophize, as well as satisfaction with pain treatment and global impressions of change at 6-month follow-up, were considered as treatment outcomes. Structural equation modeling analyses showed significant positive relationships between expectations and most clinical outcomes, and this association was largely mediated by patients' global impressions of change. Similar patterns of relationships between variables were also observed in various subgroups of patients based on sex, age, pain duration, and pain classification. Such results emphasize the relevance of patient expectations as a determinant of outcomes in multimodal pain treatment programs. Furthermore, the results suggest that superior clinical outcomes are observed in individuals who expect high positive outcomes as a result of treatment. PMID:26447703

  10. Greater trochanteric pain syndrome diagnosis and treatment.

    PubMed

    Mallow, Michael; Nazarian, Levon N

    2014-05-01

    Lateral hip pain, or greater trochanteric pain syndrome, is a commonly seen condition; in this article, the relevant anatomy, epidemiology, and evaluation strategies of greater trochanteric pain syndrome are reviewed. Specific attention is focused on imaging of this syndrome and treatment techniques, including ultrasound-guided interventions. PMID:24787333

  11. Post surgical pain treatment - adults

    MedlinePlus

    ... of Anesthesiologists Task Force on Acute Pain Management. Anesthesiology . 2012;116:248-73. PMID: 22227789 www.ncbi. ... chap 18. Sherwood ER, Williams CG, Prough DS. Anesthesiology principles, pain management, and conscious sedation. In: Townsend ...

  12. Efficacy of dry needling for treatment of myofascial pain syndrome.

    PubMed

    Fogelman, Yacov; Kent, John

    2015-01-01

    Myofascial pain is a major cause of musculoskeletal regional pain. Myofascial pain, which is a high-prevalence but eminently treatable condition, is almost universally underdiagnosed by physicians and undertreated by physical therapy modalities. Large numbers of patients can be left suffering in chronic pain for years. Dry needling, also referred to as Intramuscular Stimulation, is a method in the arsenal of pain management which has been known for almost 200 years in Western medicine, yet has been almost completely ignored. With the increase in research in this field over the past two decades, there are many high-quality studies that demonstrate dry needling to be an effective and safe method for the treatment of myofascial pain when diagnosed and treated by adequately-trained physicians or physical therapists. This article provides an overview of recent literature regarding the treatment of myofascial pain syndrome, evidence for the efficacy of dry needling as a central component of its management, and a glimpse at developments in recent imaging methods to aid in the treatment of these problems. PMID:25322743

  13. [Phantom limb pain. Psychological treatment strategies].

    PubMed

    Diers, M; Flor, H

    2013-04-01

    Similar to other pain syndromes phantom limb pain is characterized by learning and memory processes that maintain the pain and increase maladaptive plastic changes of the brain: therefore, psychological interventions that change maladaptive memory processes are useful. In addition to traditional psychological interventions, such as pain management training and biofeedback, more recent developments that involve sensory discrimination training, mirror treatment, graded motor imagery, prosthesis training and training in virtual reality are interesting. These interventions not only reduce phantom limb pain but also reverse the associated maladaptive brain changes. PMID:23588803

  14. Hypnosis for treatment of pain in children

    PubMed Central

    Rogovik, Alex L.; Goldman, Ran D.

    2007-01-01

    QUESTION Many children suffer from chronic and painful illnesses. Hypnosis was found to be effective for analgesia in adults. Is it effective for managing pain in children? ANSWER Children can be easier to hypnotize than adults. Studies have shown clinical hypnosis and self-hypnosis to be effective as adjunct treatments for children in pain. Examples include painful medical procedures, such as bone marrow aspiration and lumbar puncture in pediatric cancer patients, postoperative pain and anxiety in children undergoing surgery, and chronic headache. PMID:17872743

  15. Bone pain: current and future treatments.

    PubMed

    Frost, Charlotte Ørsted; Hansen, Rikke Rie; Heegaard, Anne-Marie

    2016-06-01

    Skeletal conditions are common causes of chronic pain and there is an unmet medical need for improved treatment options. Bone pain is currently managed with disease modifying agents and/or analgesics depending on the condition. Disease modifying agents affect the underlying pathophysiology of the disease and reduce as a secondary effect bone pain. Antiresorptive and anabolic agents, such as bisphosphonates and intermittent parathyroid hormone (1-34), respectively, have proven effective as pain relieving agents. Cathepsin K inhibitors and anti-sclerostin antibodies hold, due to their disease modifying effects, promise of a pain relieving effect. NSAIDs and opioids are widely employed in the treatment of bone pain. However, recent preclinical findings demonstrating a unique neuronal innervation of bone tissue and sprouting of sensory nerve fibers open for new treatment possibilities. PMID:26940053

  16. Phantom Limb Pain: Mechanisms and Treatment Approaches

    PubMed Central

    Subedi, Bishnu; Grossberg, George T.

    2011-01-01

    The vast amount of research over the past decades has significantly added to our knowledge of phantom limb pain. Multiple factors including site of amputation or presence of preamputation pain have been found to have a positive correlation with the development of phantom limb pain. The paradigms of proposed mechanisms have shifted over the past years from the psychogenic theory to peripheral and central neural changes involving cortical reorganization. More recently, the role of mirror neurons in the brain has been proposed in the generation of phantom pain. A wide variety of treatment approaches have been employed, but mechanism-based specific treatment guidelines are yet to evolve. Phantom limb pain is considered a neuropathic pain, and most treatment recommendations are based on recommendations for neuropathic pain syndromes. Mirror therapy, a relatively recently proposed therapy for phantom limb pain, has mixed results in randomized controlled trials. Most successful treatment outcomes include multidisciplinary measures. This paper attempts to review and summarize recent research relative to the proposed mechanisms of and treatments for phantom limb pain. PMID:22110933

  17. Phantom limb pain: mechanisms and treatment approaches.

    PubMed

    Subedi, Bishnu; Grossberg, George T

    2011-01-01

    The vast amount of research over the past decades has significantly added to our knowledge of phantom limb pain. Multiple factors including site of amputation or presence of preamputation pain have been found to have a positive correlation with the development of phantom limb pain. The paradigms of proposed mechanisms have shifted over the past years from the psychogenic theory to peripheral and central neural changes involving cortical reorganization. More recently, the role of mirror neurons in the brain has been proposed in the generation of phantom pain. A wide variety of treatment approaches have been employed, but mechanism-based specific treatment guidelines are yet to evolve. Phantom limb pain is considered a neuropathic pain, and most treatment recommendations are based on recommendations for neuropathic pain syndromes. Mirror therapy, a relatively recently proposed therapy for phantom limb pain, has mixed results in randomized controlled trials. Most successful treatment outcomes include multidisciplinary measures. This paper attempts to review and summarize recent research relative to the proposed mechanisms of and treatments for phantom limb pain. PMID:22110933

  18. Interventional Treatments of Cancer Pain.

    PubMed

    Sindt, Jill E; Brogan, Shane E

    2016-06-01

    Pain is a significant burden for patients with cancer and is particularly prevalent among those with advanced cancer. Appropriate interventional cancer pain therapies complement conventional pain management by reducing the need for systemic opioid therapy and its associated toxicity; however, these therapies are often underutilized. This article reviews techniques, indications, complications, and outcomes of the most common interventional approaches for the management of cancer-related pain. These approaches include intrathecal drug delivery, vertebral augmentation, neurolysis of the celiac, superior hypogastric and ganglion impar plexus', image-guided tumor ablation, and other less commonly performed but potentially beneficial interventions. PMID:27208713

  19. Treatment of neuropathic pain in Sierra Leone.

    PubMed

    Lacoux, Phillipe; Ford, Nathan

    2002-07-01

    During Sierra Leone's violent decade-long war, the warring parties used amputation, especially of arms, as a means of terror. In a camp for amputees in the capital city Freetown, Médecins Sans Frontières established a clinic and a treatment programme for neuropathic pain. Insecurity and cultural and language barriers have complicated this work, but medical and humanitarian benefits have been demonstrated. Pain services are virtually non-existent in less-developed countries. There have recently been no major treatment advances for neuropathic or phantom pain; however, the general body of knowledge about amputation pain can be increased by observations from these difficult settings. PMID:12849488

  20. Hypnosis for the treatment of burn pain.

    PubMed

    Patterson, D R; Everett, J J; Burns, G L; Marvin, J A

    1992-10-01

    The clinical utility of hypnosis for controlling pain during burn wound debridement was investigated. Thirty hospitalized burn patients and their nurses submitted visual analog scales (VAS) for pain during 2 consecutive daily wound debridements. On the 1st day, patients and nurses submitted baseline VAS ratings. Before the next day's would debridement, Ss received hypnosis, attention and information, or no treatment. Only hypnotized Ss reported significant pain reductions relative to pretreatment baseline. This result was corroborated by nurse VAS ratings. Findings indicate that hypnosis is a viable adjunct treatment for burn pain. Theoretical and practical implications and future research directions are discussed. PMID:1383302

  1. Assessment and treatment of pain in thalassemia.

    PubMed

    Lal, Ashutosh

    2016-03-01

    Pain is a subjective symptom whose prevalence can be grossly underestimated. The high proportion of adults with thalassemia who experience chronic pain is evident from recent surveys. However, pain has not received enough attention in the overall management of thalassemia. The association of pain with the type and treatment of thalassemia or with its comorbidities is unclear. Abnormal spine imaging is seen in patients reporting pain, although the role of osteopenia has not been established. Pain becomes more frequent with age. The lower back is the most common site and can be particularly disabling and difficult to treat. Treatable causes, such as extramedullary masses or disc herniation or fractures, must be ruled out. Some adults experience increasing pain when the hemoglobin drops at the end of transfusion cycles. Interdisciplinary management of pain is necessary, while overreliance on medications can be counterproductive. The impact of chronic pain on the quality of life must be acknowledged. Physical therapy, psychological counseling, and vocational rehabilitation are vital to management. I recommend a proactive approach for prevention of pain by maintaining optimal bone density and an active lifestyle. I further propose that a universal tool be adopted to document and characterize pain at routine clinic visits. PMID:27124110

  2. Assessment and Treatment of Pain during Treatment of Buruli Ulcer

    PubMed Central

    Barogui, Yves T.; Sopoh, Ghislain; Phillips, Richard O.; van der Werf, Tjip S.; Loth, Susanne; Molenbuur, Bouwe; Plantinga, Mirjam; Ranchor, Adelita V.; Stienstra, Ymkje

    2015-01-01

    Background Buruli ulcer (BU) is described as a relatively painless condition; however clinical observations reveal that patients do experience pain during their treatment. Knowledge on current pain assessment and treatment in BU is necessary to develop and implement a future guideline on pain management in BU. Methodology A mixed methods approach was used, consisting of information retrieved from medical records on prescribed pain medication from Ghana and Benin, and semi-structured interviews with health care personnel (HCP) from Ghana on pain perceptions, assessment and treatment. Medical records (n = 149) of patients treated between 2008 and 2012 were collected between November 2012 and August 2013. Interviews (n = 11) were audio-taped, transcribed verbatim and qualitatively analyzed. Principal Findings In 113 (84%) of the 135 included records, pain medication, mostly simple analgesics, was prescribed. In 48% of the prescriptions, an indication was not documented. HCP reported that advanced BU could be painful, especially after wound care and after a skin graft. They reported not be trained in the assessment of mild pain. Pain recognition was perceived as difficult, as patients were said to suppress or to exaggerate pain, and to have different expectations regarding acceptable pain levels. HCP reported a fear of side effects of pain medication, shortage and irregularities in the supply of pain medication, and time constraints among medical doctors for pain management. Conclusions Professionals perceived BU disease as potentially painful, and predominantly focused on severe pain. Our study suggests that pain in BU deserves attention and should be integrated in current treatment. PMID:26402069

  3. [Local invasive treatment of chronic pain].

    PubMed

    Medvedeva, L A; Zagorul'ko, O I; Gnezdilov, A V

    2014-01-01

    The literature on methods of invasive local treatment of chronic pain was analyzed. We reviewed 14 publications including meta-analyses and systematic reviews. The use of regional anesthesia conducted by anesthesiologists in pain clinics demonstrated the evidence based efficacy of different types of peridural injections of local anesthetics with steroids in patients with root pain syndromes at cervical and lumbar levels. Therapeutic blockades of the occipital nerve is effective method of treatment of cervicogenic and cluster headache as well as occipital nerve neuralgia. There are clear indications of the efficacy of local injections in primary chronic cephalgia (migraine and headache of tension). The possibility of the abortion of the pain information flow in peripheral nociceptive pathways and, as a consequence, breaking the vicious circle is emphasized. Issues on the efficacy of local injections at trigger points in the treatment of chronic pain are highlighted. PMID:24874319

  4. Botulinum Toxin Treatment of Neuropathic Pain.

    PubMed

    Mittal, Shivam Om; Safarpour, Delaram; Jabbari, Bahman

    2016-02-01

    Neuropathic pain (NP), a common form of human pain, often poorly responds to analgesic medications. In this review the authors discuss the pathophysiology and conventional treatment of neuropathic pain and provide evidenced-based statements on the efficacy of botulinum neurotoxins (BoNTs) in this form of pain. The level of efficacy for BoNT treatment in each category of NP is defined according to the published guidelines of the American Academy of Neurology. The data indicate that BoNT treatment (most of the literature is with onabotulinumtoxinA) is effective (level A evidence) in postherpetic neuralgia and trigeminal neuralgia. It is probably effective (level B) in posttraumatic neuralgia and painful diabetic neuropathy. The data on complex regional pain syndrome, carpal tunnel syndrome, occipital neuralgia, and phantom limb pain are preliminary and await conduction of randomized, blinded clinical trials. Much remains to be learned about the most-effective dosage and technique of injection, optimum dilutions, and differences among BoNTs in the treatment of neuropathic pain. PMID:26866499

  5. [Non pharmacologic treatment of neuropathic pain].

    PubMed

    Guastella, Virginie; Mick, Gérard; Laurent, Bernard

    2008-02-01

    Nondrug treatments of neuropathic pain should always begin at the same time as pharmacologic treatment. There are three types of nondrug treatment for neuropathic pain: physical, surgical, and "psychocorporal" and psychotherapeutic treatment. Transcutaneous electrical nerve stimulation (TENS) is a simple physical treatment that strengthens local inhibitory controls and is indicated in focal neuropathic pain when upstream stimulation is possible for a superficial sensitive nerve trunk. Destructive surgery is represented today by "DREZotomy", destruction of nociceptive fibers and their dorsal root entry zones. It is indicated essentially in intractable pain due to plexus avulsion. Functional surgery is implanted electric stimulation--either spinal or central (encephalic)--of structures that exert inhibitory control on the pain pathways. Spinal stimulation is performed at the level of the posterior spinal cord and is indicated essentially in segmental mononeuropathies refractory to drug treatment. Central stimulation is performed at the motor cortex and is indicated for refractory central pain. "Psychocorporal" techniques (relaxation, sophrology, hypnosis) are useful to reduce anxiety and neurovegetative hypertonicity, both factors that aggravate neuropathic pain. PMID:18191370

  6. [Drug treatment and interventional pain therapy in back pain patients].

    PubMed

    Sprott, Haiko; Klauke, Wolfgang

    2013-09-01

    The treatment of chronic, non-malignant low-back pain is based on the patients' history and the clinical examination. It can be assumed that half of the cases present with a neuropathic pain component which needs to be treated with antidepressive and antiepileptic drugs instead of "pure" analgesics. Opioids should be considered with extreme caution because of their toxicity. Chronic non-malignant back pain is the prototype for interdisciplinary treatment approaches and multi-modal interdisciplinary settings, including pain programmes. However, a personalised strategy has to be preferred in most cases. A quick relief of pain is important in order to improve function as well as to re-integrate the patient into professional life. Spinal infiltrations can be of both diagnostic as well as therapeutic benefits. Their indication must be considered carefully, especially if the invasive diagnostic intervention has no therapeutic consequences. The interventional procedures should only be used as part of a multimodal approach in patients without any psychological problem. The sole use of interventions supports the purely somatic orientation of many patients and thus leads us in the wrong direction. PMID:23985154

  7. Supraspinal stimulation for treatment of refractory pain.

    PubMed

    Parmar, V K; Gee, L; Smith, H; Pilitsis, J G

    2014-08-01

    Refractory pain syndromes often have far reaching effects and are quite a challenge for primary care providers and specialists alike to treat. With the help of site-specific neuromodulation and appropriate patient selection these difficult to treat pain syndromes may be managed. In this article, we focus on supraspinal stimulation (SSS) for treatment of intractable pain and discuss off-label uses of deep brain stimulation (DBS) and motor cortex stimulation (MCS) in context to emerging indications in neuromodulation. Consideration for neuromodulatory treatment begins with rigorous patient selection based on exhaustive conservative management, elimination of secondary gains, and a proper psychology evaluation. Trial stimulation prior to DBS is nearly always performed while trial stimulation prior to MCS surgery is symptom dependent. Overall, a review of the literature demonstrates that DBS should be considered for refractory conditions including nociceptive/neuropathic pain, phantom limb pain, and chronic cluster headache (CCH). MCS should be considered primarily for trigeminal neuropathic pain (TNP) and central pain. DBS outcome studies for post-stroke pain as well as MCS studies for complex regional pain syndrome (CRPS) show more modest results and are also discussed in detail. PMID:24956545

  8. [Review of current pharmacologic treatment of pain].

    PubMed

    Brasseur, L

    1997-01-01

    Pain is the main reason prompting patients to consult their physicians. In acute conditions, pain has a very particular significance as a warning sign, enabling the physician to attempt a diagnosis. Nevertheless, its detrimental effect upon the individual (even in the case of acute pain) and its cost to society are now widely acknowledged. There can be no doubt about the physical component of pain, but the psychological and social aspects should not be ignored, particularly in the case of chronic pain. There is no single therapeutic approach to pain and, more often than not, successful treatment comprises a combination of several. Pharmacological treatments are undeniably the most common approach. In clinical practice, recent advances have been based upon an improved understanding of 'old' substances such as morphine and, at the same time, research continues in the hope of finding the 'ideal' analgesic-effective in most situations but without adverse effects: this appears to be a somewhat utopian arm at present, considering the number of different causes of pain. An improved understanding of the physiological mechanisms of pain has led, within the field of clinical practice, to several methods of differentiating pain. These depend on whether or not pain responds to morphine, or on the type of pain: pain due to an excess of nociception, pain resulting from deafferentation (caused by damage to nerve pathways) in the central or peripheral nervous system and psychogenic (idiopathic) pain. Likewise, there are several different ways of classifying analgesic treatments: according to the intensity of pain, as with use of the WHO ladder (which is based on the notion of steps) for the treatment of cancer pain; according to the presumed physiopathological mechanism and, in particular, the response to morphine, and according to the presumed central or peripheral mechanism of the drugs. In reality, peripherally acting drugs can also have a central mechanism of action, just as

  9. Hypnosis treatment for chronic low back pain.

    PubMed

    Tan, Gabriel; Fukui, Tenley; Jensen, Mark P; Thornby, John; Waldman, Karen L

    2010-01-01

    Chronic low back pain (CLBP) is a significant healthcare problem, and many individuals with CLBP remain unresponsive to available interventions. Previous research suggests that hypnosis is effective for many chronic pain conditions; however, data to support its efficacy for CLBP are outdated and have been limited primarily to case studies. This pilot study indicated that a brief, 4-session standardized self-hypnosis protocol, combined with psycho-education, significantly and substantially reduced pain intensity and pain interference. Significant session-to-session improvements were also noted on pain ratings and mood states; however, follow-up data suggest that these benefits may not have been maintained across time in this sample. These findings need to be replicated and confirmed in a larger clinical trial, which could also assess the long-term effects of this treatment. PMID:20183738

  10. [Adequate attention is required to the diagnosis and treatment of mild-symptom erectile dysfunction].

    PubMed

    Deng, Chun-hua; Zhang, Ya-dong; Chen, Xin

    2015-01-01

    Mild-symptom erectile dysfunction (MSED) is commonly seen in clinical practice, but receives inadequate attention from both the patients and clinicians. Increasing researches have indicated that MSED is associated with not only unhealthy living habits and psychological factors but also the early progression of endothelial, metabolic and endocrine diseases. The diagnosis and treatment of MSED should be based on the relevant guidelines, with consideration of both its specific and common features. The therapeutic principle is a combination of integrated and individual solutions aimed at the causes of the disease. Drug intervention should be initiated if psychological therapy fails. Negligence of MSED may affect the quality of life of the patients and their partners, and what's more, might delay the management of some other severe underlying diseases. Adequate attention to the early diagnosis and treatment for MSED is of great significance for a deeper insight into the etiology of ED, the prevention of potential cardiovascular and metabolic diseases, and the improvement of the overall health of males. PMID:25707132

  11. Inadequate treatment of pain: time for the South African courts to redress this human rights violation?

    PubMed

    Jansen, Rita-Marié

    2010-12-01

    In the case of 90 per cent of patients, pain can be relieved adequately, but in 80 per cent of these cases this is not done, despite the fact that effective pain medication is available. More than three decades ago, the under-treatment of pain had already been identified as a major global problem. Human dignity requires that treatable pain be relieved. Although attempts have been made to address this unnecessary human suffering, there are a number of reasons why little progress has been made. Fear of the regulatory authority has been mentioned, but in South Africa this is not the case. A lack of knowledge and archaic views have resulted in the standard practice of mismanaging pain. Diverging views on whether the health care system's failure to treat patient pain adequately needs corrective action by the judiciary will be discussed. An argument will be made out that the courts should reconsider the standard practice and the question of what is reasonable in regard to pain treatment. The "failure to treat pain adequately" should be recognised as a separate and independent form of medical negligence. Other possible causes of action will also be discussed. Improvements in pain management require simultaneous initiatives in medicine, law and ethics. PMID:22145547

  12. Postamputation pain: epidemiology, mechanisms, and treatment.

    PubMed

    Hsu, Eugene; Cohen, Steven P

    2013-01-01

    Postamputation pain (PAP) is highly prevalent after limb amputation but remains an extremely challenging pain condition to treat. A large part of its intractability stems from the myriad pathophysiological mechanisms. A state-of-art understanding of the pathophysiologic basis underlying postamputation phenomena can be broadly categorized in terms of supraspinal, spinal, and peripheral mechanisms. Supraspinal mechanisms involve somatosensory cortical reorganization of the area representing the deafferentated limb and are predominant in phantom limb pain and phantom sensations. Spinal reorganization in the dorsal horn occurs after deafferentataion from a peripheral nerve injury. Peripherally, axonal nerve damage initiates inflammation, regenerative sprouting, and increased "ectopic" afferent input which is thought by many to be the predominant mechanism involved in residual limb pain or neuroma pain, but may also contribute to phantom phenomena. To optimize treatment outcomes, therapy should be individually tailored and mechanism based. Treatment modalities include injection therapy, pharmacotherapy, complementary and alternative therapy, surgical therapy, and interventions aimed at prevention. Unfortunately, there is a lack of high quality clinical trials to support most of these treatments. Most of the randomized controlled trials in PAP have evaluated medications, with a trend for short-term Efficacy noted for ketamine and opioids. Evidence for peripheral injection therapy with botulinum toxin and pulsed radiofrequency for residual limb pain is limited to very small trials and case series. Mirror therapy is a safe and cost-effective alternative treatment modality for PAP. Neuromodulation using implanted motor cortex stimulation has shown a trend toward effectiveness for refractory phantom limb pain, though the evidence is largely anecdotal. Studies that aim to prevent PA P using epidural and perineural catheters have yielded inconsistent results, though there may

  13. Successful Treatment of Chronic Donor Site Pain

    PubMed Central

    Yanow, Jennifer H; Lorenzo, Luigi Di; Worosilo, Sharon C; Pappagallo, Marco

    2015-01-01

    Introduction: This is a case presentation of a 45-year-old male with chronic donor site pain following autologous iliac crest bone harvest successfully treated with superior cluneal nerve blockade. Donor site pain following autologous bone harvest is a common postoperative complication of lumbar fusion procedures that can cause significant morbidity and diminish quality of life, even in the context of an otherwise successful surgery. Dysfunction of the superior cluneal nerves is an etiology of this chronic pain. The patient’s medical history, attempted treatments, and literature were reviewed. Case Presentation: A 45-year-old male with a six year history of severe pain over the right iliac crest following an otherwise successful lumbar laminectomy and fusion underwent two sets of superior cluneal nerve blocks, with sustained relief of more than 80% at seven months follow up. Conclusions: Donor site pain following autologous iliac crest bone harvest is a common surgical complication that is often resistant to conservative treatments such as physical therapy and oral medications. Blockade of the superior cluneal nerves is a safe and technically simple procedure that may result in long-term pain relief, obviating the need to consider more invasive options. PMID:26587399

  14. Diagnosis and treatment of chronic ankle pain.

    PubMed

    Wukich, Dane K; Tuason, Dominick A

    2011-01-01

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

  15. [Low dose naltrexone for treatment of pain].

    PubMed

    Plesner, Karin Bruun; Vægter, Henrik Bjarke; Handberg, Gitte

    2015-10-01

    Recent years have seen an increasing interest in the use of low dose naltrexone (LDN) for off-label treatment of pain in diseases as fibromyalgia, multiple sclerosis and morbus Crohn. The evidence is poor, with only few randomized double-blind placebo-controlled studies. The studies currently available are reviewed in this paper. LDN could be a potentially useful drug in the future for the treatment of pain in fibromyalgia, but more studies are needed to verify that it is superior to placebo, and currently it cannot be recommended as first-line therapy. PMID:26509454

  16. [Optimal treatment of urolithiasis pain].

    PubMed

    Tozawa, Keiichi; Yasui, Takahiro; Okada, Atsushi; Yoshimura, Mugi; Hirose, Masahito; Endo, Sumio; Ito, Yasunori; Kohri, Kenjiro

    2004-08-01

    Many drugs have been used in the treatment of renal colic, but the safest and most effective drug has not yet been clearly defined. A questionnaire was used to collate the types of treatment for renal colic used by Japanese urologists. The main treatments were nonsteroidal analgesic (suppository) and anticholinergic agent. A new protocol was developed on the basis of this result, and its effect on renal colic was verified. The combination of an injection of a local anesthetic and pointillage was found to be superior to non-steroidal analgesic anti-inflammatory drugs and anticholinergic agent in terms of both duration of action and effectiveness. PMID:15471078

  17. [PECULIARITIES OF TREATMENT VERTEBROGENIC PAIN SYNDROMES].

    PubMed

    Klymenko, O; Belska, I

    2015-01-01

    The results of studying the pathogenetic features of back pain at vertebrogenic of Spine, and disorders of life of patients in relation to it. Application of therapy with the standard treatment and the complex medicine of the vitamins B. PMID:27089720

  18. [Capsaicin in treatment of neuropathic pain].

    PubMed

    Kamchatnov, P R; Evzelman, M A; Abusueva, B A; Volkov, A I

    2014-01-01

    Treatment of neuropathic pain (NP) is a serious medical problem. Antiepileptic drugs and antidepressants, used to relief pain, act on the central pain mechanisms and cause several side-effects, thus substantially restricting possibilities of their clinical application.At the same time, NP often has a peripheral component. Ligand-associated channels, including vanilloid receptors TRPV1, play a key role in the development of regional NP syndromes. Capsaicin, a component of chili pepper and several other plants, is a highly selective ligand of TRPV1 receptors and has long been used in treatment of pain syndromes. However, its using is limited by short-term action and relatively low efficacy. Recently it has been shown that the local use of single high doses of capsaicin during 30-60 min causes a marked stable(> 12 weeks) effect. The decrease in NP (>50%) is seen in about half of patients. Current studies will allow to single out groups of patients with the maximal treatment effect of capsaicin. PMID:25629137

  19. Treatment Considerations for Cancer Pain: A Global Perspective.

    PubMed

    Pergolizzi, Joseph V; Gharibo, Christopher; Ho, Kok-Yuen

    2015-11-01

    Cancer pain is prevalent, undertreated, and feared by patients with cancer. In April 2013, a panel of pain experts convened in Singapore to address the treatment of cancer pain. They discussed the various types of cancer pain, including breakthrough pain, which is sometimes clinically confused with analgesic gaps. Reasons for undertreating cancer pain include attitudes of patients, clinicians, and factors associated with healthcare systems. The consequences of not treating cancer pain may include reduced quality of life for patients with cancer (who now live longer than ever), functional decline, and increased psychological stress. Early analgesic intervention for cancer pain may reduce the risk of central sensitization and chronification of pain. To manage pain in oncology patients, clinicians should assess pain during regular follow-up visits using validated pain measurement tools and follow prescribing guidelines, if necessary referring patients with cancer to pain specialists. Many patients with cancer require opioids for pain relief. Pain associated with cancer may also relate to cancer treatments, such as chemotherapy-induced peripheral neuropathy. Many patients with cancer are what might be considered "special populations," in that they may be elderly, frail, comorbid, or have end-stage organ failure. Specific pain therapy guidelines for those populations are reviewed. Patients with cancer with a history of or active substance abuse disorder deserve pain control but may require close medical supervision. While much "treatment inertia" exists in cancer pain control, cancer pain can be safely and effectively managed and should be carried out to alleviate suffering and improve outcomes. PMID:25469726

  20. [Acute pain in children and its treatment].

    PubMed

    Dalens, B

    1991-01-01

    Pain in paediatrics has long been underestimated. The numerous scientific studies carried out during the last decade show that its existence can no longer be doubted: in fact, pain already exists during the neonatal period, and probably throughout the last trimester of gestation as well. Pain pathways mature during the embryonic period and peripheral receptors develop between the 7th and 20th week. A-delta and C fibers, as well as spinal roots and nerves, are completely differentiated before the end of the second month. The development of specific neurotransmitters and thalamic and cortical dendritic branching occurs later on; it is well enough developed to allow perception of painful stimuli (slow or protopathic component) from the beginning of the foetal period onwards. The discriminative rapid component develops in parallel to myelinisation, and the psycho-affective component, which requires a long and complex learning process, will not be fully operative until the end of puberty. Assessing pain, already a difficult task in the adult, is all the more so in children because of lesser verbal communicative capabilities, difficulty in handling abstract concepts, lack of experience of painful stimuli to make comparisons, and ignorance of their body image. In the very young child, diagnosing pain relies on suggestive circumstances, and an altered behaviour, knowing that no one symptom in pathognomonic. As the child grows up, methods for self-assessment of pain become usable, such as coloured scales and simplified verbal scales. However, behavioural tests remain the mainstay until the prepubertal period. The treatment of acute pain requires a reasoned approach which takes into account the state of the child, that of the aetiological investigations, the likely course of the lesions, as well as the patient's analgesic requirements. Therapeutic means do not differ from those for adult patients; however, the differences of distribution of body water, the small

  1. Postamputation pain: epidemiology, mechanisms, and treatment

    PubMed Central

    Hsu, Eugene; Cohen, Steven P

    2013-01-01

    Postamputation pain (PAP) is highly prevalent after limb amputation but remains an extremely challenging pain condition to treat. A large part of its intractability stems from the myriad pathophysiological mechanisms. A state-of-art understanding of the pathophysiologic basis underlying postamputation phenomena can be broadly categorized in terms of supraspinal, spinal, and peripheral mechanisms. Supraspinal mechanisms involve somatosensory cortical reorganization of the area representing the deafferentated limb and are predominant in phantom limb pain and phantom sensations. Spinal reorganization in the dorsal horn occurs after deafferentataion from a peripheral nerve injury. Peripherally, axonal nerve damage initiates inflammation, regenerative sprouting, and increased “ectopic” afferent input which is thought by many to be the predominant mechanism involved in residual limb pain or neuroma pain, but may also contribute to phantom phenomena. To optimize treatment outcomes, therapy should be individually tailored and mechanism based. Treatment modalities include injection therapy, pharmacotherapy, complementary and alternative therapy, surgical therapy, and interventions aimed at prevention. Unfortunately, there is a lack of high quality clinical trials to support most of these treatments. Most of the randomized controlled trials in PAP have evaluated medications, with a trend for short-term Efficacy noted for ketamine and opioids. Evidence for peripheral injection therapy with botulinum toxin and pulsed radiofrequency for residual limb pain is limited to very small trials and case series. Mirror therapy is a safe and cost-effective alternative treatment modality for PAP. Neuromodulation using implanted motor cortex stimulation has shown a trend toward effectiveness for refractory phantom limb pain, though the evidence is largely anecdotal. Studies that aim to prevent PA P using epidural and perineural catheters have yielded inconsistent results, though there

  2. Pain Management in the Elderly: Transdermal Fentanyl for the Treatment of Pain Caused by Osteoarthritis of the Knee and Hip

    PubMed Central

    2014-01-01

    This study was designed to evaluate the utility of transdermal fentanyl (transdermal fentanyl, TDF) for the treatment of pain due to osteoarthritis (osteoarthritis, OA) of the knee and hip, which was not adequately controlled by nonopioid analgesics or weak opioids. WOMAC is a reliable, valid, and responsive multidimensional, self-administrated outcome measure designed specifically to evaluate patients with OA of the knee or hip. TDF significantly increased pain control and improved functioning and quality of life. Metoclopramide appeared to be of limited value in preventing nausea and vomiting. PMID:24527441

  3. Differential Diagnoses for Persistent Pain Following Root Canal Treatment: A Study in the National Dental PBRN

    PubMed Central

    Nixdorf, Donald R.; Law, Alan S.; John, Mike T.; Sobieh, Radwa M.; Kohli, Richie; Nguyen, Ruby H.N.

    2015-01-01

    Introduction Pain present 6 months following root canal treatment (RCT) may be either of odontogenic or nonodontogenic origin. This is importance because treatments and prognoses are different; therefore the aim of this study was to provide specific diagnoses of patients reporting pain 6 months after receiving initial orthograde RCT. Methods We enrolled patients from the Midwest region of an existing prospective observational study of pain after RCT. Pain at 6 months was defined as ≥1 day of pain and average pain intensity of at least 1/10 over the preceding month. An Endodontist and an Orofacial Pain practitioner independently performed clinical evaluations, which included periapical and cone-beam CT radiographs, to determine diagnoses. Results Thirty-eight out of the 354 eligible patients in the geographic area (11%) met the pain criteria, with 19 (50%) consenting to be clinically evaluated. As the sole reason for pain, 7 patients (37%) were given odontogenic diagnoses (4 involving the RCT tooth, 3 involving an adjacent tooth). Eight patients (42%) were given nonodontogenic pain diagnoses (7 from referred temporomandibular disorder (TMD) pain, 1 from persistent dentoalveolar pain disorder (PDAP)). Two patients (11%) had both odontogenic and nonodontogenic diagnoses, while 2 (11%) no longer fit the pain criteria at the time of the clinical evaluation. Conclusion Patients reporting “tooth” pain 6 months following RCT had a nonodontogenic pain diagnosis accounting for some of this pain, with TMD being the most frequent nonodonotgenic diagnosis. Dentists should have the necessary knowledge to differentiate between these diagnoses to adequately manage their patients. PMID:25732400

  4. Rectal cancer delivery of radiotherapy in adequate time and with adequate dose is influenced by treatment center, treatment schedule, and gender and is prognostic parameter for local control: Results of study CAO/ARO/AIO-94

    SciTech Connect

    Fietkau, Rainer . E-mail: rainer.fietkau@med.uni-rostock.de; Roedel, Claus; Hohenberger, Werner; Raab, Rudolf; Hess, Clemens; Liersch, Torsten; Becker, Heinz; Wittekind, Christian; Hutter, Matthias; Hager, Eva; Karstens, Johann; Ewald, Hermann; Christen, Norbert; Jagoditsch, Michael; Martus, Peter; Sauer, Rolf

    2007-03-15

    Purpose: The impact of the delivery of radiotherapy (RT) on treatment results in rectal cancer patients is unknown. Methods and Materials: The data from 788 patients with rectal cancer treated within the German CAO/AIO/ARO-94 phase III trial were analyzed concerning the impact of the delivery of RT (adequate RT: minimal radiation RT dose delivered, 4300 cGy for neoadjuvant RT or 4700 cGy for adjuvant RT; completion of RT in <44 days for neoadjuvant RT or <49 days for adjuvant RT) in different centers on the locoregional recurrence rate (LRR) and disease-free survival (DFS) at 5 years. The LRR, DFS, and delivery of RT were analyzed as endpoints in multivariate analysis. Results: A significant difference was found between the centers and the delivery of RT. The overall delivery of RT was a prognostic factor for the LRR (no RT, 29.6% {+-} 7.8%; inadequate RT, 21.2% {+-} 5.6%; adequate RT, 6.8% {+-} 1.4%; p = 0.0001) and DFS (no RT, 55.1% {+-} 9.1%; inadequate RT, 57.4% {+-} 6.3%; adequate RT, 69.1% {+-} 2.3%; p = 0.02). Postoperatively, delivery of RT was a prognostic factor for LRR on multivariate analysis (together with pathologic stage) but not for DFS (independent parameters, pathologic stage and age). Preoperatively, on multivariate analysis, pathologic stage, but not delivery of RT, was an independent prognostic parameter for LRR and DFS (together with adequate chemotherapy). On multivariate analysis, the treatment center, treatment schedule (neoadjuvant vs. adjuvant RT), and gender were prognostic parameters for adequate RT. Conclusion: Delivery of RT should be regarded as a prognostic factor for LRR in rectal cancer and is influenced by the treatment center, treatment schedule, and patient gender.

  5. Pain volatility and prescription opioid addiction treatment outcomes in patients with chronic pain.

    PubMed

    Worley, Matthew J; Heinzerling, Keith G; Shoptaw, Steven; Ling, Walter

    2015-12-01

    The combination of prescription opioid dependence and chronic pain is increasingly prevalent and hazardous to public health. Variability in pain may explain poor prescription opioid addiction treatment outcomes in persons with chronic pain. This study examined pain trajectories and pain volatility in patients with chronic pain receiving treatment for prescription opioid addiction. We conducted secondary analyses of adults with chronic pain (n = 149) who received buprenorphine/naloxone (BUP/NLX) and counseling for 12 weeks in an outpatient, multisite clinical trial. Good treatment outcome was defined as urine-verified abstinence from opioids at treatment endpoint (Week 12) and during at least 2 of the previous 3 weeks. Pain severity significantly declined over time during treatment (b = -0.36, p < .001). Patients with greater pain volatility were less likely to have a good treatment outcome (odds ratio = 0.55, p < .05), controlling for baseline pain severity and rate of change in pain over time. A 1 standard deviation increase in pain volatility was associated with a 44% reduction in the probability of endpoint abstinence. The significant reduction in subjective pain during treatment provides observational support for the analgesic effects of BUP/NLX in patients with chronic pain and opioid dependence. Patients with greater volatility in subjective pain during treatment have increased risk of returning to opioid use by the conclusion of an intensive treatment with BUP/NLX and counseling. Future research should examine underlying mechanisms of pain volatility and identify related therapeutic targets to optimize interventions for prescription opioid addiction and co-occurring chronic pain. PMID:26302337

  6. [Diagnostic and treatment measures in patients with sympathetically maintained pain].

    PubMed

    Maier, C; Gleim, M

    1998-08-27

    The term "sympathetically maintained pain" (SMP) describes a symptom that might accompany a variety of diseases (CRPS, (post-) herpetic and post-injury neuralgia), which might transform into sympathetically independent pain (SIP) after some time. Patients with SMP present a bunch of disorders of the autonomic and sensory system, but the only reliable way to diagnose a pain as SMP is a positive response to an intervention at the sympathetic nervous system. Three ways of influencing the sympathetic system are commonly used: (a) local anesthetic sympathetic blockade (SB), (b) intravenous regional sympathectomy (IVRS) and (c) ganglionic local opioid application (GLOA). A review of current literature shows that SB has certain advantages in diagnostic sensitivity, whereas GLOA might be slightly superior in therapy of some diseases with longstanding pain history. Obviously, the therapeutic benefit of all interventions is complete independent of the accompanying autonomic disorder and of a blockade of efferent fibers. A new heuristic model of the SMP mechanism is presented, including both experimental and clinical data. For reducing the risks of false positive or negative diagnosis of SMP and SIP, a diagnostic algorithm is proposed. This includes optimizing the technique, changes of interventional measures, and adequate monitoring both of analgesia and as well of the extend of efferent sympathetic blockade (e.g. measurement of sympathetic reflexes). The treatment recommendations in patients with SMP vary in dependence of the kind of disease. In SMP, invasive measures play an important, but only limited role within the comprehensive treatment concept. As an example a three-stage, symptom-adapted treatment algorithm is demonstrated for CRPS, including also drug therapy, psychologic and physiotherapeutic approaches. PMID:12799969

  7. Chronic leg ulcer: does a patient always get a correct diagnosis and adequate treatment?

    PubMed

    Mooij, Michael C; Huisman, Laurens C

    2016-03-01

    Patients with chronic leg ulcers have severely impaired quality of life and account for a high percentage of annual healthcare costs. To establish the cause of a chronic leg ulcer, referral to a center with a multidisciplinary team of professionals is often necessary. Treating the underlying cause diminishes healing time and reduces costs. In venous leg ulcers adequate compression therapy is still a problem. It can be improved by training the professionals with pressure measuring devices. A perfect fitting of elastic stockings is important to prevent venous leg ulcer recurrence. In most cases, custom-made stockings are the best choice for this purpose. PMID:26916772

  8. Prevalence and Correlates of Pain and Pain Treatment in a Western Kenya Referral Hospital

    PubMed Central

    Owino, Claudio; Gramelspacher, Gregory P.; Monahan, Patrick O.; Tabbey, Rebeka; Hagembe, Mildred; Strother, Robert M.; Njuguna, Festus; Vreeman, Rachel C.

    2013-01-01

    Abstract Background Pain is often inadequately evaluated and treated in sub-Saharan Africa (SSA). Objective We sought to assess pain levels and pain treatment in 400 hospitalized patients at a national referral hospital in western Kenya, and to identify factors associated with pain and pain treatment. Design Using face-validated Kiswahili versions of two single-item pain assessment tools, the Numerical Rating Scale (NRS) and the Faces Pain Scale–Revised (FPS-R), we determined patients' pain levels. Additional data collected included patient demographics, prescribed analgesics, and administered analgesics. We calculated mean pain ratings and pain management index (PMI) scores. Results Averaged between the NRS and FPS-R, 80.5% of patients endorsed a nonzero level of pain and 30% of patients reported moderate to severe pain. Older patients, patients with HIV, and cancer patients had higher pain ratings. Sixty-six percent of patients had been prescribed analgesics at some point during their hospitalization, the majority of which were nonopioids. A majority of patients (66%) had undertreated pain (negative scores on the PMI). Conclusion This study shows that hospitalized patients in Kenya are experiencing pain and that this pain is often undertreated. PMID:24032753

  9. Treatment of Morbidity with Atypical Chest Pain

    PubMed Central

    Cott, Arthur

    1987-01-01

    The appropriate management of atypical chest pain requires an integration of medical and behavioural treatments. Unnecessary medicalization can increase morbidity. A sensitivity to the behavioural factors contributing to symptoms and disability may reduce both. The purpose of this paper is to provide physicians with a cognitive-behavioural perspective of the nature of morbidity and disability associated with chronic chest discomfort; some strategies for detecting heretofore unsuspected disability associated with chronic chest pain and related discomfort in patients with organic findings (both cardiac and non-cardiac), as well those with no identifiable disease process or organic cause; and some simple behavioural and cognitive-behavioural therapeutic techniques for treating and preventing such problems. PMID:21263912

  10. Neuropathic Pain Treatment: Still a Challenge

    PubMed Central

    Nascimento, Osvaldo J.M.; Pessoa, Bruno L.; Orsini, Marco; Ribeiro, Pedro; Davidovich, Eduardo; Pupe, Camila; Filho, Pedro Moreira; Dornas, Ricardo Menezes; Masiero, Lucas; Bittencourt, Juliana; Bastos, Victor Hugo

    2016-01-01

    Neuropathic pain (NP) is the result of a series of conditions caused by diseases or lesions to the somatosensory system. Due to the better understanding of NP pathophysiology previously unexplored therapies have been used with encouraging results. In this group, acetyl-L-carnitine, alpha-lipoic-acid, cannabinoids, clonidine, EMA401, botulinum toxin type A and new voltage-gated sodium channel blockers, can be included. Besides, changing paradigms may occur with the advent of optogenetics and a better understanding of epigenetic regulation. We reviewed the published literature on the pharmacological treatment of NP. Despite the interesting results, randomized controlled trials are demanded the majority of the therapies previously mentioned. In spite of several studies for the relief of NP, pain control continues being a challenge. PMID:27441065

  11. Identifying the Best Treatment Among Common Nonsurgical Neck Pain Treatments

    PubMed Central

    Hogg-Johnson, Sheilah; Bayoumi, Ahmed M.; Cassidy, J. David; Côté, Pierre; Boyle, Eleanor; Llewellyn-Thomas, Hilary; Chan, Stella; Subrata, Peter; Hoving, Jan Lucas; Hurwitz, Eric; Bombardier, Claire; Krahn, Murray

    2008-01-01

    Study Design Decision analysis. Objective To identify the best treatment for nonspecific neck pain. Summary of Background Data In Canada and the United States, the most commonly prescribed neck pain treatments are nonsteroidal anti-inflammatory drugs (NSAIDs), exercise, and manual therapy. Deciding which treatment is best is difficult because of the trade-offs between beneficial and harmful effects, and because of the uncertainty of these effects. Methods (Quality-adjusted) life expectancy associated with standard NSAIDs, Cox-2 NSAIDs, exercise, mobilization, and manipulation were compared in a decision-analytic model. Estimates of the course of neck pain, background risk of adverse events in the general population, treatment effectiveness and risk, and patient-preferences were input into the model. Assuming equal effectiveness, we conducted a baseline analysis using risk of harm only. We assessed the stability of the baseline results by conducting a second analysis that incorporated effectiveness data from a high-quality randomized trial. Results There were no important differences across treatments. The difference between the highest and lowest ranked treatments predicted by the baseline model was 4.5 days of life expectancy and 3.4 quality-adjusted life-days. The difference between the highest and lowest ranked treatments predicted by the second model was 7.3 quality-adjusted life-days. Conclusion When the objective is to maximize life expectancy and quality-adjusted life expectancy, none of the treatments in our analysis were clearly superior.

  12. Mastalgia. Tailoring treatment to type of breast pain.

    PubMed

    Steinbrunn, B S; Zera, R T; Rodriguez, J L

    1997-11-01

    Breast pain is a common, often distressing problem among women. After significant disease is ruled out, most patients respond to simple reassurance. Others, however, require treatment because symptoms interfere with their lifestyle. The authors offer practical suggestions for tailoring treatment for these patients according to type of pain--cyclical mastalgia, non-cyclical mastalgia, or chest wall pain. PMID:9385340

  13. Treatment of complex regional pain syndrome

    PubMed Central

    Resmini, Giuseppina; Ratti, Chiara; Canton, Gianluca; Murena, Luigi; Moretti, Antimo; Iolascon, Giovanni

    2015-01-01

    Summary Complex Regional Pain Syndrome (CRPS) is a multifactorial and disabling disorder with complex etiology and pathogenesis. Goals of therapy in CRPS should be pain relief, functional restoration, and psychological stabilization, but early interventions are needed in order to achieve these objectives. Several drugs have been used to reduce pain and to improve functional status in CRPS, despite the lack of scientific evidence supporting their use in this scenario. They include anti-inflammatory drugs, analgesics, anesthetics, anticonvulsants, antidepressants, oral muscle relaxants, corticosteroids, calcitonin, bisphosphonates, calcium channel blockers and topical agents. NSAIDs showed no value in treating CRPS. Glucocorticoids are the only anti-inflammatory drugs for which there is direct clinical trial evidence in early stage of CRPS. Opioids are a reasonable second or third-line treatment option, but tolerance and long term toxicity are unresolved issues. The use of anticonvulsants and tricyclic antidepressants has not been well investigated for pain management in CRPS. During the last years, bisphosphonates have been the mostly studied pharmacologic agents in CRPS treatment and there are good evidence to support their use in this condition. Recently, the efficacy of intravenous (IV) administration of neridronate has been reported in a randomized controlled trial. Significant improvements in VAS score and other indices of pain and quality of life in patients who received four 100 mg IV doses of neridronate versus placebo were reported. These findings were confirmed in the open-extension phase of the study, when patients formerly enrolled in the placebo group received neridronate at the same dosage, and these results were maintained at 1 year follow-up. The current literature concerning sympathetic blocks and sympathectomy techniques lacks evidence of efficacy. Low evidence was recorded for a free radical scavenger, dimethylsulphoxide (DMSO) cream (50%). The

  14. Treatment of complex regional pain syndrome.

    PubMed

    Resmini, Giuseppina; Ratti, Chiara; Canton, Gianluca; Murena, Luigi; Moretti, Antimo; Iolascon, Giovanni

    2015-01-01

    Complex Regional Pain Syndrome (CRPS) is a multifactorial and disabling disorder with complex etiology and pathogenesis. Goals of therapy in CRPS should be pain relief, functional restoration, and psychological stabilization, but early interventions are needed in order to achieve these objectives. Several drugs have been used to reduce pain and to improve functional status in CRPS, despite the lack of scientific evidence supporting their use in this scenario. They include anti-inflammatory drugs, analgesics, anesthetics, anticonvulsants, antidepressants, oral muscle relaxants, corticosteroids, calcitonin, bisphosphonates, calcium channel blockers and topical agents. NSAIDs showed no value in treating CRPS. Glucocorticoids are the only anti-inflammatory drugs for which there is direct clinical trial evidence in early stage of CRPS. Opioids are a reasonable second or third-line treatment option, but tolerance and long term toxicity are unresolved issues. The use of anticonvulsants and tricyclic antidepressants has not been well investigated for pain management in CRPS. During the last years, bisphosphonates have been the mostly studied pharmacologic agents in CRPS treatment and there are good evidence to support their use in this condition. Recently, the efficacy of intravenous (IV) administration of neridronate has been reported in a randomized controlled trial. Significant improvements in VAS score and other indices of pain and quality of life in patients who received four 100 mg IV doses of neridronate versus placebo were reported. These findings were confirmed in the open-extension phase of the study, when patients formerly enrolled in the placebo group received neridronate at the same dosage, and these results were maintained at 1 year follow-up. The current literature concerning sympathetic blocks and sympathectomy techniques lacks evidence of efficacy. Low evidence was recorded for a free radical scavenger, dimethylsulphoxide (DMSO) cream (50%). The same level

  15. Are treatment guides and rational drug use policies adequately exploited in combating respiratory system diseases?

    PubMed

    Dogan, Mustafa; Mutlu, Levent C; Yilmaz, İbrahim; Bilir, Bulent; Varol Saracoglu, Gamze; Yildirim Guzelant, Aliye

    2016-01-01

    The aim of the present study was to increase awareness regarding the rational use of medicines. The data were obtained via the Material Resources Management System Module of the Ministry of Health. For the appropriateness of treatments, the Global Initiative for Asthma, the Global Initiative for Chronic Obstructive Lung Disease, and the guidelines for the rational use of medicines were used. We also investigated whether any de-escalation method or physical exercise was performed. Statistical analyses were performed using descriptive statistics to determine the mean, standard deviation, and frequency. The results showed that healthcare providers ignored potential drug reactions or adverse interactions, and reflecting the lack of adherence to the current treatment guides, 35.8% irrational use of medicines was recorded. Thus, de-escalation methods should be used to decrease costs or narrow the antibiotic spectrum, antibiotic selection should consider the resistance patterns, culturing methods should be analyzed, and monotherapy should be preferred over combination treatments. PMID:26166817

  16. [Hypnosis as an alternative treatment for pain in palliative medicine].

    PubMed

    Peintinger, Christa; Hartmann, Wolfgang

    2008-01-01

    Pain--which can have a variety of causes--constitutes a severe problem for patients in need of palliative care, because this pain usually dramatically impairs their quality of life. Thus, the more advanced a terminal illness has become, the more hospital staff should focus on holistic treatment, encompassing body, mind and soul of the patient. Apart from conventional medication-based pain therapy, there is also a variety of non-medicinal treatments for pain. One of these methods is hypnosis, an imaginative treatment that activates available resources; it is not only an effective way of alleviating pain, but it also can ease psychological problems at the same time. PMID:19165446

  17. Barriers to help-seeking, detection, and adequate treatment for anxiety and mood disorders: implications for health care policy.

    PubMed

    Mechanic, David

    2007-01-01

    Recently, the focus of health policies and initiatives has been directed toward mental health. More precisely, depressive and anxiety disorders have received particular attention because of their disabling outcomes and prevalence among most populations. Despite this increased interest, numerous issues regarding patients' willingness to seek treatment and the adequate recognition and treatment of these disorders by clinicians remain to be addressed. This article considers the factors that influence patients and physicians in their reticence to acknowledge and adequately treat depression and anxiety disorders. It also reviews the impact of society and the media, together with other factors relating to health care organization and administration that affect the treatment of depression and anxiety. In view of the multifaceted challenge involved, efforts to achieve a consensus in determining treatment for those with depressive and anxiety disorders are essential. A consensus will require easy, measurable, and reliable disability indicators; evidence that treatment of patients with varying levels of need is cost effective; and that persons who most need and would benefit from care can be reliably identified among the highly prevalent population of persons with more transient symptoms. Governments and other policymakers should be encouraged to provide appropriate coverage for access to primary and secondary care, the treatments required, and sufficient resources so that care is available when necessary. An important aspect of the challenge is to incorporate these efforts within the realistic constraints of primary care. PMID:17288503

  18. Recent advances in the treatment of pain

    PubMed Central

    2010-01-01

    Cancer pain and chronic non-malignant pain can be difficult to manage and may not respond satisfactorily to standard analgesics. Sequential empiric analgesic trials are usually done to manage individual patients. Experimental human pain models have helped to clarify mechanisms of opioid and adjuvant analgesic actions. Combinations of opioids and adjuvant analgesics better relieve pain than either opioids or adjuvant analgesics alone, as demonstrated in randomized controlled trials. The analgesic activity of antidepressants is largely dependent upon norepinephrine reuptake and activation of alpha 2 adrenergic receptors. Corticosteroids reduce postoperative orthopedic incident pain, which may allow patients to ambulate earlier and with less pain. Spinal corticosteroids reduce lower hemibody pain. Gabapentinoids as single high doses reduce postoperative pain and certain acute pain syndromes. Individuals who experience flares of pain while on spinal opioids benefit from intrathecal boluses of levobupivicaine or sublingual ketamine. Interventional approaches to pain management are often necessary due to the limitations of systemic analgesics. Electronics stimulators (peripheral, spinal and motor cortex) improve difficult to manage chronic pain syndromes. Pulsed radiofrequency reduces pain without tissue damage, which could be an advantage over chemical or radiofrequency neurotomy. Botulinum toxin A reduces focal neuropathic pain that is durable. Interventional related successes in relieving pain are operator dependent. Most reported benefits of systemic and regional analgesics and interventional approaches to pain relief are not based on randomized trials and are subject to selection bias, sampling error, and placebo responses, which may over-inflate reported benefits. Randomized controlled trials are needed to confirm reported benefits. PMID:21173850

  19. Combine or Separate Future Pain? The Impact of Current Pain on Decisions about Future Dental Treatments

    PubMed Central

    Andrade, Eduardo B.; Bianchini, Marco Aurélio; Lucchiari, Newton

    2013-01-01

    Patients are often given the option of undergoing future painful treatments in one or multiple sessions (e.g., extracting two wisdom teeth on one or two different days). In a randomized controlled field experiment, we investigated the impact of transient pain on patients’ decision to combine or separate future periodontal treatments. The main results show that most patients preferred to have the future treatments take place in one session when they made their choice after a painless examination (i.e., general clinical exam). However, the patients’ preference for combining the future treatments did not differ from chance when the choice was made immediately following a painful examination (i.e., pocketing and bleeding on probing exam). The impact of pain on decision making is observed within and between participants. Current pain seems to lead patients to question their ability to endure future painful treatments in one session. PMID:23704972

  20. Diagnosis and Treatment of Pain in Small Fiber Neuropathy

    PubMed Central

    Hovaguimian, Alexandra

    2011-01-01

    Small fiber neuropathy manifests in a variety of different diseases and often results in symptoms of burning pain, shooting pain, allodynia, and hyperesthesia. Diagnosis of small fiber neuropathy is determined primarily by the history and physical exam, but functional neurophysiologic testing and skin biopsy evaluation of intraepidermal nerve fiber density can provide diagnostic confirmation. Management of small fiber neuropathy depends on the underlying etiology with concurrent treatment of associated neuropathic pain. A variety of recent guidelines propose the use of antidepressants, anticonvulsants, opioids, topical therapies, and nonpharmacologic treatments as part of the overall management of neuropathic pain. Unfortunately, little data about the treatment of pain specifically in small fiber neuropathy exist because most studies combine mixed neuropathic pain syndromes in the analysis. Additional studies targeting the treatment of pain in small fiber neuropathy are needed to guide decision making. PMID:21286866

  1. Pharmacological Treatment of Alzheimer’s Disease: Is it Progressing Adequately?

    PubMed Central

    Robles, Alfredo

    2009-01-01

    Introduction: Between 1993 and 2000 four acetylcholinesterase inhibitors were marketed as a symptomatic treatment for Alzheimer’s disease (AD), as well as memantine in 2003. Current research is focused on finding drugs that favorably modify the course of the disease. However, their entrance into the market does not seem to be imminent. Research Development: The aim of AD research is to find substances that inhibit certain elements of the AD pathogenic chain (beta- and gamma-secretase inhibitors, alpha-secretase stimulants, beta-amyloid aggregability reducers or disaggregation and elimination inductors, as well as tau-hyperphosphorylation, glutamate excitotoxicity, oxidative stress and mitochondrial damage reducers, among other action mechanisms). Demonstrating a disease’s retarding effect demands longer trials than those necessary to ascertain symptomatic improvement. Besides, a high number of patients (thousands of them) is necessary, all of which turns out to be difficult and costly. Furthermore, it would be necessary to count on diagnosis and progression markers in the disease’s pre-clinical stage, markers for specific phenotypes, as well as high-selectivity molecules acting only where necessary. In order to compensate these difficulties, drugs acting on several defects of the pathogenic chain or showing both symptomatic and neuroprotective action simultaneously are being researched. Conclusions: There are multiple molecules used in research to modify AD progression. Although it turns out to be difficult to obtain drugs with sufficient efficacy so that their marketing is approved, if they were achieved they would lead to a reduction of AD prevalence. PMID:19461897

  2. Nonpharmacologic Treatment of Pain in Rheumatic Diseases and Other Musculoskeletal Pain Conditions

    PubMed Central

    Cunningham, Natoshia Raishevich; Kashikar-Zuck, Susmita

    2013-01-01

    Pain is a complex phenomenon influenced by a number of biological, psychological, and social factors. The treatment of pain is most effective when using a multidisciplinary approach consisting of a careful selection of pharmacologic and non-pharmacologic interventions based upon disease factors, pain characteristics, psychological coping abilities and lifestyle factors. In this review we focus on research-based evidence for non-pharmacologic interventions including psychological interventions, physical exercise, patient education, and complementary approaches for pain management in patients with rheumatic diseases and common musculoskeletal pain conditions, such as low back pain. The vast proportion of research studies is on adults with chronically painful conditions but pediatric studies are also reviewed wherever possible to give the reader a more inclusive view of non-pharmacological approaches for pain management across the lifespan. PMID:23307578

  3. Pain in the cancer patient: different pain characteristics CHANGE pharmacological treatment requirements.

    PubMed

    Müller-Schwefe, Gerhard; Ahlbeck, Karsten; Aldington, Dominic; Alon, Eli; Coaccioli, Stefano; Coluzzi, Flaminia; Huygen, Frank; Jaksch, Wolfgang; Kalso, Eija; Kocot-Kępska, Magdalena; Kress, Hans-Georg; Mangas, Ana Cristina; Ferri, Cesar Margarit; Morlion, Bart; Nicolaou, Andrew; Hernández, Concepción Pérez; Pergolizzi, Joseph; Schäfer, Michael; Sichère, Patrick

    2014-09-01

    Twenty years ago, the main barriers to successful cancer pain management were poor assessment by physicians, and patients' reluctance to report pain and take opioids. Those barriers are almost exactly the same today. Cancer pain remains under-treated; in Europe, almost three-quarters of cancer patients experience pain, and almost a quarter of those with moderate to severe pain do not receive any analgesic medication. Yet it has been suggested that pain management could be improved simply by ensuring that every consultation includes the patient's rating of pain, that the physician pays attention to this rating, and a plan is agreed to increase analgesia when it is inadequate. After outlining current concepts of carcinogenesis in some detail, this paper describes different methods of classifying and diagnosing cancer pain and the extent of current under-treatment. Key points are made regarding cancer pain management. Firstly, the pain may be caused by multiple different mechanisms and therapy should reflect those underlying mechanisms - rather than being simply based on pain intensity as recommended by the WHO three-step ladder. Secondly, a multidisciplinary approach is required which combines both pharmacological and non-pharmacological treatment, such as psychotherapy, exercise therapy and electrostimulation. The choice of analgesic agent and its route of administration are considered, along with various interventional procedures and the requirements of palliative care. Special attention is paid to the treatment of breakthrough pain (particularly with fast-acting fentanyl formulations, which have pharmacokinetic profiles that closely match those of breakthrough pain episodes) and chemotherapy-induced neuropathic pain, which affects around one third of patients who receive chemotherapy. Finally, the point is made that medical education should place a greater emphasis on pain therapy, both at undergraduate and postgraduate level. PMID:24841174

  4. The assessment and treatment of wound pain.

    PubMed

    Brown, Annemarie

    This article is the third in a series on wound management. Poor pain management leads to distress and can impede the healing process. This article describes the different types of pain and the psychological aspects of pain that should be taken into account when deciding on a wound-management strategy. It discusses assessment tools, along with pharmacological and non-pharmacological interventions for pain management. PMID:26721090

  5. Acute low back pain: diagnostics and treatment.

    PubMed

    Becker, F C

    2001-03-01

    How many times have you heard from a patient or groaned yourself "Oh, my aching back?" Innocuous movements such as reaching, stooping, or leaning are halted mid-performance as you sense "something" give, catch, snap, grab, or slide in your lower back. Such subjective complaints may also include sensations of discomfort described as stabbing, sharp, dull, hot/burning, tingling, or numbing. In practice, you will be required to assess these subjective symptoms, effectively document objective data, formulate a diagnosis, and plan appropriate treatment for your patients. Careful attention to history, associated symptoms, and following a systematic approach to back pain can make the rule-in/out differentials less taxing on both the practitioner and the patient. PMID:11329554

  6. Diagnosis and medical treatment of neuropathic pain in leprosy 1

    PubMed Central

    Arco, Rogerio Del; Nardi, Susilene Maria Tonelli; Bassi, Thiago Gasperini; Paschoal, Vania Del Arco

    2016-01-01

    ABSTRACT Objective: to identify the difficulties in diagnosing and treating neuropathic pain caused by leprosy and to understand the main characteristics of this situation. Methods: 85 patients were treated in outpatient units with reference to leprosy and the accompanying pain. We used a questionnaire known as the Douleur Neuropathic 4 test and we conducted detailed neurological exams. As a result, 42 patients were excluded from the study for not having proved their pain. Results: Out of the 37 patients that experienced pain, 22 (59.5%) had neuropathic pain (or a mixture of this pain and their existing pain) and of these 90.8% considered this pain to be moderate or severe. 81.8% of the sample suffered with this pain for more than 6 months. Only 12 (54.5%) of the patients had been diagnosed with neuropathic pain and in almost half of these cases, this pain had not been diagnosed. With reference to medical treatment (n=12) for neuropathic pain, 5 (41.6%) responded that they became better. For the other 7 (58.4%) there were no changes in relation to the pain or in some cases the pain worsened in comparison to their previous state. Statistical analysis comparing improvements in relation to the pain amongst the patients that were treated (n=12) and those that were not, showed significant differences (value p=0.020). Conclusion: we noted difficulties in diagnosing neuropathic pain for leprosy in that almost half of the patients that were studied had not had their pain diagnosed. We attributed this to some factors such as the non-adoption of the appropriate protocols which led to inadequate diagnosis and treatment that overlooked the true picture. PMID:27508904

  7. Effectiveness of an interdisciplinary pain management program for the treatment of chronic pelvic pain.

    PubMed

    Kames, L D; Rapkin, A J; Naliboff, B D; Afifi, S; Ferrer-Brechner, T

    1990-04-01

    Chronic pelvic pain has rarely been discussed in the pain management literature, although it is extremely common in general gynecological practice and often refractory to traditional medical and surgical therapy. A chronic pelvic pain program was developed to offer an alternative treatment approach for women for whom standard gynecological procedures were inappropriate or unsuccessful. Sixteen subjects completed the full 6-8 week interdisciplinary program, which included both somatic and behavioral therapies. Compared to a waiting list control the results showed a dramatic decrease in reported levels of pain following treatment. Anxiety and depression also decreased and psychosocial functioning improved, including return to work, increased social activities, and improved sexual activity. The outcome suggests that the interdisciplinary pain management approach is effective for the treatment of chronic pelvic pain. PMID:2352765

  8. The Role of Positive Affect in Pain and its Treatment

    PubMed Central

    Finan, Patrick H.; Garland, Eric L.

    2014-01-01

    This narrative review summarizes and integrates the available literature on PA and pain to: 1) Provide a brief overview of PA and summarize the key findings that have emerged in the study of PA and chronic pain; 2) Provide a theoretical foundation from which to understand how PA operates in the context of chronic pain; and 3) Highlight how the prevailing psychosocial treatments for chronic pain address PA in the therapeutic context, and offer suggestions for how future treatment development research can maximize the benefit of PA for patients with chronic pain. To that end, we review experimental studies that have assessed the association of evoked PA and pain sensitivity, as well as clinical studies that have assessed the association of naturally occurring PA and clinical pain in the context of chronic pain. The evidence suggests PA influences pain, over and above the influence of NA. We offer an “upward spiral” model of positive affect, resilience and pain self-management, which makes specific predictions that PA will buffer maladaptive cognitive and affective responses to pain, and promote active engagement in valued goals that enhance chronic pain self-management. PMID:24751543

  9. Systematic Review of Multidisciplinary Chronic Pain Treatment Facilities.

    PubMed

    Fashler, Samantha R; Cooper, Lynn K; Oosenbrug, Eric D; Burns, Lindsay C; Razavi, Shima; Goldberg, Lauren; Katz, Joel

    2016-01-01

    This study reviewed the published literature evaluating multidisciplinary chronic pain treatment facilities to provide an overview of their availability, caseload, wait times, and facility characteristics. A systematic literature review was conducted using PRISMA guidelines following a search of MEDLINE, PsycINFO, and CINAHL databases. Inclusion criteria stipulated that studies be original research, survey more than one pain treatment facility directly, and describe a range of available treatments. Fourteen articles satisfied inclusion criteria. Results showed little consistency in the research design used to describe pain treatment facilities. Availability of pain treatment facilities was scarce and the reported caseloads and wait times were generally high. A wide range of medical, physical, and psychological pain treatments were available. Most studies reported findings on the percentage of practitioners in different health care professions employed. Future studies should consider using more comprehensive search strategies to survey facilities, improving clarity on what is considered to be a pain treatment facility, and reporting on a consistent set of variables to provide a clear summary of the status of pain treatment facilities. This review highlights important information for policymakers on the scope, demand, and accessibility of pain treatment facilities. PMID:27445618

  10. Systematic Review of Multidisciplinary Chronic Pain Treatment Facilities

    PubMed Central

    Fashler, Samantha R.; Cooper, Lynn K.; Oosenbrug, Eric D.; Burns, Lindsay C.; Razavi, Shima; Goldberg, Lauren; Katz, Joel

    2016-01-01

    This study reviewed the published literature evaluating multidisciplinary chronic pain treatment facilities to provide an overview of their availability, caseload, wait times, and facility characteristics. A systematic literature review was conducted using PRISMA guidelines following a search of MEDLINE, PsycINFO, and CINAHL databases. Inclusion criteria stipulated that studies be original research, survey more than one pain treatment facility directly, and describe a range of available treatments. Fourteen articles satisfied inclusion criteria. Results showed little consistency in the research design used to describe pain treatment facilities. Availability of pain treatment facilities was scarce and the reported caseloads and wait times were generally high. A wide range of medical, physical, and psychological pain treatments were available. Most studies reported findings on the percentage of practitioners in different health care professions employed. Future studies should consider using more comprehensive search strategies to survey facilities, improving clarity on what is considered to be a pain treatment facility, and reporting on a consistent set of variables to provide a clear summary of the status of pain treatment facilities. This review highlights important information for policymakers on the scope, demand, and accessibility of pain treatment facilities. PMID:27445618

  11. Botulinum neurotoxins in the treatment of refractory pain.

    PubMed

    Jabbari, Bahman

    2008-12-01

    The proper management of pain is a critical issue in the practice of medicine. Despite the availability of a large number of analgesic medications, management of pain that is refractory to conventional treatments remains a challenge for both clinicians and surgeons. Botulinum neurotoxin (BoNT) has recently emerged as a potential novel approach to control pain. Animal studies have revealed a number of mechanisms by which BoNTs can influence and alleviate chronic pain, including inhibition of pain peptide release from nerve terminals and sensory ganglia, anti-inflammatory and antiglutaminergic effects, reduction of sympathetic neural discharge, and inhibition of muscle spindle discharge. In humans, prospective, placebo-controlled, double-blind studies have also provided evidence for effectiveness of BoNT therapy in a number of painful disorders. These include cervical dystonia, pelvic pain, low back pain, plantar fasciitis, postsurgical painful spasms, myofascial pain syndromes, migraine, and chronic daily headaches. Long-term studies on cervical dystonia and low back pain have demonstrated safety and sustained efficacy after repeated injections. This Review focuses on the analgesic effects of BoNT and the mechanisms of its pain control as revealed by animal models, and provides evidence-based data on the efficacy of BoNT therapy in various pain syndromes in humans. PMID:19043424

  12. Use of opioids for treatment of osteoporotic pain

    PubMed Central

    Vellucci, Renato; Mediati, Rocco Domenico; Ballerini, Giovanna

    2014-01-01

    Summary The prevalence of osteoporosis increases markedly with age: currently it is estimated that over 200 million people suffer from osteoporosis worldwide. One of the most feared and more frequent complications of osteoporosis is pain, which affects 85% of patients. Commonly in the treatment of chronic pain the therapeutic strategy is based on a three-ladder approach, involving opioids for moderate and severe pain. As proposed by the World Health Organization (WHO), according to the intensity of chronic pain, analgesic treatment can be established. Despite the debate and updates to the analgesic ladder for pain published in 1986 by the WHO, the benefits resulting from its worldwide use are uncontested. In case the pain was not responsive to drugs of pain ladder, is necessary to resort to specialized practices (e.g. subarachnoid infusion of drugs). The oral route for administering analgesics should be preferred, provided that the patients are able to use it. About 50% of all opioid users experience at least one side effect, and more than 20% discontinued treatment due to a serious adverse event. Despite published guidelines and WHO’s pain ladder for the management of chronic pain, the treatment of this condition remains suboptimal. Given the physiopsychopathology and complexity of the problems of chronic osteoporotic pain, a multimodal and multidisciplinary approach is still considered the best way to diagnose and treat this disease. PMID:25568648

  13. Spinal cord injury-induced pain: mechanisms and treatments.

    PubMed

    Siddall, Philip J; Middleton, James W

    2015-01-01

    Pain is a common consequence of a spinal cord injury (SCI) and has a major impact on quality of life through its impact on physical function, mood and participation in work, recreational and social activities. Several types of pain typically present following SCI with central neuropathic pain being a frequent and difficult to manage occurrence. Despite advances in our understanding of the mechanisms contributing to this type of pain and an increasing number of trials examining treatment efficacy, our ability to relieve neuropathic SCI pain is still very limited. Optimal management relies upon an integrated approach that uses a combination of pharmacological and nonpharmacological options. PMID:26402151

  14. Self-Treatment of Pain in a Rural Area

    ERIC Educational Resources Information Center

    Vallerand, April Hazard; Fouladbakhsh, Judith M.; Templin, Thomas

    2004-01-01

    In the United States, 42% of adults say they experience pain daily, the majority often relying on self-treatment. In addition, an increasing number of people are seeking complementary/alternative therapies, often without informing their health care providers. Purpose: To explore the occurrence of pain and the modalities of self-treatment used by…

  15. Assessment and treatment of abuse risk in opioid prescribing for chronic pain.

    PubMed

    Jamison, Robert N; Serraillier, Juliana; Michna, Edward

    2011-01-01

    Opioid analgesics provide effective treatment for noncancer pain, but many physicians have concerns about adverse effects, tolerance, and addiction. Misuse of opioids is prominent in patients with chronic back pain and early recognition of misuse risk could help physicians offer adequate patient care while implementing appropriate levels of monitoring to reduce aberrant drug-related behaviors. In this review, we discuss opioid abuse and misuse issues that often arise in the treatment of patients with chronic back pain and present an overview of assessment and treatment strategies that can be effective in improving compliance with the use of prescription opioids for pain. Many persons with chronic back pain have significant medical, psychiatric and substance use comorbidities that affect treatment decisions and a comprehensive evaluation that includes a detailed history, physical, and mental health evaluation is essential. Although there is no "gold standard" for opioid misuse risk assessment, several validated measures have been shown to be useful. Controlled substance agreements, regular urine drug screens, and interventions such as motivational counseling have been shown to help improve patient compliance with opioids and to minimize aberrant drug-related behavior. Finally, we discuss the future of abuse-deterrent opioids and other potential strategies for back pain management. PMID:22110936

  16. Assessment and Treatment of Abuse Risk in Opioid Prescribing for Chronic Pain

    PubMed Central

    Jamison, Robert N.; Serraillier, Juliana; Michna, Edward

    2011-01-01

    Opioid analgesics provide effective treatment for noncancer pain, but many physicians have concerns about adverse effects, tolerance, and addiction. Misuse of opioids is prominent in patients with chronic back pain and early recognition of misuse risk could help physicians offer adequate patient care while implementing appropriate levels of monitoring to reduce aberrant drug-related behaviors. In this review, we discuss opioid abuse and misuse issues that often arise in the treatment of patients with chronic back pain and present an overview of assessment and treatment strategies that can be effective in improving compliance with the use of prescription opioids for pain. Many persons with chronic back pain have significant medical, psychiatric and substance use comorbidities that affect treatment decisions and a comprehensive evaluation that includes a detailed history, physical, and mental health evaluation is essential. Although there is no “gold standard” for opioid misuse risk assessment, several validated measures have been shown to be useful. Controlled substance agreements, regular urine drug screens, and interventions such as motivational counseling have been shown to help improve patient compliance with opioids and to minimize aberrant drug-related behavior. Finally, we discuss the future of abuse-deterrent opioids and other potential strategies for back pain management. PMID:22110936

  17. Evaluation and treatment of shoulder pain.

    PubMed

    Greenberg, Deborah L

    2014-05-01

    Shoulder pain is a common symptom in the adult population. The most common cause of shoulder pain is SIS, reflecting a problem with the rotator cuff or subacromial bursa. Determining the cause of a patient’s pain is usually a clinical diagnosis based on careful history taking and physical examination. Limited use of imaging studies will be needed in the setting of trauma, possible glenohumeral arthritis, or when a complete tendon tear is suspected. Therapy is based on pain control and therapeutic exercises in almost all cases. Despite the prevalence of shoulder pain, there is no consensus on the best way to achieve pain control or on the type of exercise most likely to achieve speedy recovery. PMID:24758957

  18. [Pharmacological treatment strategy and mirror visual feedback treatment for neuropathic pain].

    PubMed

    Sumitani, Masahiko; Miyauchi, Satoru; Yamada, Yoshitsugu

    2012-11-01

    Neuropathic pain is a debilitating condition, and pharmacotherapy is the most established treatment strategy. A variety of pharmacotherapies is used for neuropathic pain management: however, pharmacotherapies with evidence for analgesic potency are less common. Several pharmacotherapeutic treatment guidelines for neuropathic pain treatment recommend the first- to third-line drugs on the basis of evidence-based medicine; however, neuropathic pain is often resistant to pharmacotherapies. We have treated pharmacotherapy-resistant neuropathic pain with neurorehabilitation techniques such as mirror visual feedback (MVF) treatment. Further to our clinical experience using MVF, we discuss the cerebral mechanism associated with neuropathic pain in this study. PMID:23131739

  19. Nipple Pain in Breastfeeding Mothers: Incidence, Causes and Treatments

    PubMed Central

    Kent, Jacqueline C.; Ashton, Elizabeth; Hardwick, Catherine M.; Rowan, Marnie K.; Chia, Elisa S.; Fairclough, Kyle A.; Menon, Lalitha L.; Scott, Courtney; Mather-McCaw, Georgia; Navarro, Katherine; Geddes, Donna T.

    2015-01-01

    Background: Persistent nipple pain is one of the most common reasons given by mothers for ceasing exclusive breastfeeding. We aimed to determine the frequency of nipple pain as a reason for consultation, the most common attributed aetiologies, and the effectiveness of the advice and treatment given. Methods: All consultations at the Breast Feeding Centre of Western Australia (WA) were audited over two six-month periods in 2011 (n = 469) and 2014 (n = 708). Attributed cause(s) of nipple pain, microbiology results, treatment(s) advised, and resolution of pain were recorded. Results: Nipple pain was one of the reasons for consultation in 36% of cases. The most common attributed cause of nipple pain was incorrect positioning and attachment, followed by tongue tie, infection, palatal anomaly, flat or inverted nipples, mastitis, and vasospasm. Advice included correction of positioning and attachment, use of a nipple shield, resting the nipples and expressing breastmilk, frenotomy, oral antibiotics, topical treatments, and cold or warm compresses. Pain was resolving or resolved in 57% of cases after 18 days (range 2–110). Conclusion: The multiple attributed causes of nipple pain, possibly as a result of a cascade of events, suggests that effective early lactation management for prevention of nipple pain and early diagnosis and effective treatment are crucial to avoid early weaning. PMID:26426034

  20. Diabetic neuropathic pain: Physiopathology and treatment

    PubMed Central

    Schreiber, Anne K; Nones, Carina FM; Reis, Renata C; Chichorro, Juliana G; Cunha, Joice M

    2015-01-01

    Diabetic neuropathy is a common complication of both type 1 and type 2 diabetes, which affects over 90% of the diabetic patients. Although pain is one of the main symptoms of diabetic neuropathy, its pathophysiological mechanisms are not yet fully known. It is widely accepted that the toxic effects of hyperglycemia play an important role in the development of this complication, but several other hypotheses have been postulated. The management of diabetic neuropathic pain consists basically in excluding other causes of painful peripheral neuropathy, improving glycemic control as a prophylactic therapy and using medications to alleviate pain. First line drugs for pain relief include anticonvulsants, such as pregabalin and gabapentin and antidepressants, especially those that act to inhibit the reuptake of serotonin and noradrenaline. In addition, there is experimental and clinical evidence that opioids can be helpful in pain control, mainly if associated with first line drugs. Other agents, including for topical application, such as capsaicin cream and lidocaine patches, have also been proposed to be useful as adjuvants in the control of diabetic neuropathic pain, but the clinical evidence is insufficient to support their use. In conclusion, a better understanding of the mechanisms underlying diabetic neuropathic pain will contribute to the search of new therapies, but also to the improvement of the guidelines to optimize pain control with the drugs currently available. PMID:25897354

  1. Repression predicts outcome following multidisciplinary treatment of chronic pain.

    PubMed

    Burns, J W

    2000-01-01

    This study examined whether repression predicts outcome following multidisciplinary treatment for chronic pain and whether links between anxiety and outcome are obscured by repressors. Ninety-three chronic pain patients completed a 4-week pain program. Lifting capacity, walking endurance, depression, pain severity, and activity were measured at pre- and posttreatment. Low-anxious, repressor, high-anxious, and defensive/high-anxious groups were formed from median splits of Anxiety Content (ACS) and Lie scales of the Minnesota Multiphasic Personality Inventory-2 (MMPI-2; Butcher, Dahlstrom, Graham, Tellegen, & Kaemmer, 1989). Significant ACS x Lie interactions were found for lifting capacity, depression, and pain severity changes. Planned comparisons showed that both repressors and high-anxious patients performed poorly on lifting capacity; repressors alone recovered poorly on depression and pain severity. Results imply that repression may interfere with the process and outcome of pain programs. PMID:10711590

  2. Treatment of Cancer Pain by Targeting Cytokines

    PubMed Central

    Vendrell, I.; Macedo, D.; Alho, I.; Dionísio, M. R.; Costa, L.

    2015-01-01

    Inflammation is one of the most important causes of the majority of cancer symptoms, including pain, fatigue, cachexia, and anorexia. Cancer pain affects 17 million people worldwide and can be caused by different mediators which act in primary efferent neurons directly or indirectly. Cytokines can be aberrantly produced by cancer and immune system cells and are of particular relevance in pain. Currently, there are very few strategies to control the release of cytokines that seems to be related to cancer pain. Nevertheless, in some cases, targeted drugs are available and in use for other diseases. In this paper, we aim to review the importance of cytokines in cancer pain and targeted strategies that can have an impact on controlling this symptom. PMID:26538839

  3. [An overview of conservative treatment for low back pain].

    PubMed

    Gnjidić, Zoja

    2011-01-01

    Low back pain is the most frequent musculoskeletal complaint worldwide and leading cause of chronic disability. In this review we discuss knowledge about the role of management of non-invasive, conservative therapy for the nonspecific low back pain. Initial therapy includes modification of activity, pharmacological analgesic therapy and education of patients. In patients with sub acute or chronic low back pain, multimodal and interdisciplinary treatment approach is necessary with personalized and individual healthcare combined with different modality of therapy. PMID:22232958

  4. Baseline Brain Activity Predicts Response to Neuromodulatory Pain Treatment

    PubMed Central

    Jensen, Mark P.; Sherlin, Leslie H.; Fregni, Felipe; Gianas, Ann; Howe, Jon D.; Hakimian, Shahin

    2015-01-01

    Objectives The objective of this study was to examine the associations between baseline electroencephalogram (EEG)-assessed brain oscillations and subsequent response to four neuromodulatory treatments. Based on available research, we hypothesized that baseline theta oscillations would prospectively predict response to hypnotic analgesia. Analyses involving other oscillations and the other treatments (meditation, neurofeedback, and both active and sham transcranial direct current stimulation) were viewed as exploratory, given the lack of previous research examining brain oscillations as predictors of response to these other treatments. Design Randomized controlled study of single sessions of four neuromodulatory pain treatments and a control procedure. Methods Thirty individuals with spinal cord injury and chronic pain had their EEG recorded before each session of four active treatments (hypnosis, meditation, EEG biofeedback, transcranial direct current stimulation) and a control procedure (sham transcranial direct stimulation). Results As hypothesized, more presession theta power was associated with greater response to hypnotic analgesia. In exploratory analyses, we found that less baseline alpha power predicted pain reduction with meditation. Conclusions The findings support the idea that different patients respond to different pain treatments and that between-person treatment response differences are related to brain states as measured by EEG. The results have implications for the possibility of enhancing pain treatment response by either 1) better patient/treatment matching or 2) influencing brain activity before treatment is initiated in order to prepare patients to respond. Research is needed to replicate and confirm the findings in additional samples of individuals with chronic pain. PMID:25287554

  5. Central sensitization: Implications for the diagnosis and treatment of pain

    PubMed Central

    Woolf, Clifford J

    2010-01-01

    Nociceptor inputs can trigger a prolonged but reversible increase in the excitability and synaptic efficacy of neurons in central nociceptive pathways, the phenomenon of central sensitization. Central sensitization manifests as pain hypersensitivity, particularly dynamic tactile allodynia, secondary punctate or pressure hyperalgesia, aftersensations, and enhanced temporal summation. It can be readily and rapidly elicited in human volunteers by diverse experimental noxious conditioning stimuli to skin, muscles or viscera, and in addition to producing pain hypersensitivity, results in secondary changes in brain activity that can be detected by electrophysiological or imaging techniques. Studies in clinical cohorts reveal changes in pain sensitivity that have been interpreted as revealing an important contribution of central sensitization to the pain phenotype in patients with fibromyalgia, osteoarthritis, musculoskeletal disorders with generalized pain hypersensitivity, headache, temporomandibular joint disorders, dental pain, neuropathic pain, visceral pain hypersensitivity disorders and postsurgical pain. The comorbidity of those pain hypersensitivity syndromes that present in the absence of inflammation or a neural lesion, their similar pattern of clinical presentation and response to centrally acting analgesics, may reflect a commonality of central sensitization to their pathophysiology. An important question that still needs to be determined is whether there are individuals with a higher inherited propensity for developing central sensitization than others, and if so, whether this conveys an increased risk both of developing conditions with pain hypersensitivity, and their chronification. Diagnostic criteria to establish the presence of central sensitization in patients will greatly assist the phenotyping of patients for choosing treatments that produce analgesia by normalizing hyperexcitable central neural activity. We have certainly come a long way since the

  6. Current aproach to cancer pain management: Availability and implications of different treatment options

    PubMed Central

    Nersesyan, Hrachya; Slavin, Konstantin V

    2007-01-01

    Despite tremendous progress in medicine during last couple of decades, cancer still remains the most horrifying diagnosis for anybody due to its almost inevitable futility. According to American Cancer Society Statistics, it is estimated that only in the United States more than half a million people will die from cancer in 2006. For those who survive, probably the most fearsome symptom regardless of cancer type will be the pain. Although most pain specialists and oncologists worldwide are well aware of the importance to adequately treat the pain, it was yet established that more than half of cancer patients have insufficient pain control, and about quarter of them actually die in pain. Therefore, in this review article we attempted to provide the comprehensive information about different options available nowadays for treating cancer pain focusing on most widely used pharmacologic agents, surgical modalities for intractable pain control, their potential for adverse effects, and ways to increase the effectiveness of treatment maximally optimizing analgesic regimen and improving compliance. PMID:18488078

  7. Clinical values of control over pain and pain coping strategies in surgical treatment for patients with lumbar spinal stenosis

    PubMed Central

    2016-01-01

    Background Control over pain and pain coping strategies are associated with pain intensity as well as psychological status and subjective disability in patients experiencing pain. The present study assessed the clinical values of control over pain and pain coping strategies in surgical treatment for patients with lumbar spinal stenosis using mediation analysis. Methods Sixty-two patients with lumbar spinal stenosis (median age, 70 years; 34 men, 28 women) were evaluated before surgery. The pain intensity and area, psychological status/subjective disability (Japanese Orthopaedic Association Back Pain Evaluation Questionnaire), and control over pain/pain coping strategies (Coping Strategies Questionnaire) were assessed. Mediation analysis, which consisted of serial regression analyses, mainly tested whether (1) control over pain/pain coping strategies were predicted by pain characteristics and (2) control over pain/pain coping strategies predicted psychological status/subjective disability after controlling for pain characteristics. Results Control over pain was predicted by pain intensity (regression coefficient, -0.33; p = 0.01); moreover, it predicted walking ability (standardized partial regression coefficient, 0.31; p = 0.01) and social function (0.38; p = 0.00) after controlling for pain intensity. Although increasing activity level, one pain coping strategy, was predicted by pain intensity (regression coefficient, -0.30; p = 0.02), it did not predict walking ability (standardized partial regression coefficient, 0.07; p = 0.53) or social function (0.13; p = 0.33) when considering pain intensity. Conclusions In this cohort, mediation analysis demonstrated that pain intensity did not directly affect perceived walking ability or social function, but did affect control over pain; moreover, control over pain affected walking ability and social function. Clinical relevance These findings are useful for a deep understanding of the relationships between pain and

  8. Clinical Approach to the Treatment of Painful Diabetic Neuropathy

    PubMed Central

    Hovaguimian, Alexandra; Gibbons, Christopher H.

    2011-01-01

    Painful neuropathy is a common and often progressive complication of diabetes. Patients frequently report symptoms of tingling, burning, lancinating pain, hyperesthesia, and allodynia. The natural history of the disease may vary from intermittent mild symptoms to severe chronic daily pain; the latter is often associated with diminished quality of life. There are a variety of pharmaceutical agents from different medicinal categories available for the symptomatic treatment of painful diabetic neuropathy, however selecting an agent is often challenging given the breadth of choices and lack of consistent guidelines. As a result, many patients remain untreated or undertreated. This article presents a practical clinical approach to the treatment of pain in diabetic neuropathy. Recommendations for first-, second-, and third-line medications are based on specific evidence for the treatment of painful diabetic neuropathy as well as safety, tolerability, drug interactions, and cost. Additional topics of discussion include breakthrough pain, opioid use, and topical therapies. This review does not comprehensively discuss all possible treatments for painful neuropathy, but provides a systematic approach designed to guide clinicians in tailoring therapies to the individual patient. PMID:21709806

  9. Easing Chronic Pain: Better Treatments and Medications

    MedlinePlus

    ... can be made much worse by environmental and psychological factors. Chronic pain persists over a longer period ... flow and oxygen to muscles and relieve stress. Psychological methods These include counseling, hypnosis, and cognitive-behavioral ...

  10. Carbamazepine in Bipolar Disorder With Pain: Reviewing Treatment Guidelines

    PubMed Central

    Campbell, Austin; O’Connell, Christopher R.; Nallapula, Kishan

    2014-01-01

    Objective: To determine if any monotherapy drug treatment has robust efficacy to treat comorbid bipolar disorder and chronic pain. Data Sources: The American Psychiatric Association (APA) treatment guidelines for bipolar mood disorder and the 2012 Cochrane database for pain disorders. Study Selection: We relied on the treatment guides to determine if the drugs that are APA guideline–supported to treat bipolar disorder have supporting data from the Cochrane database for chronic pain. Data Synthesis: No single drug was mentioned by either guideline to treat this comorbidity. However, carbamazepine was the only drug that has guideline-supported robust efficacy in the management of each condition separately. Conclusions: Carbamazepine was found to have strong preclinical data for the treatment of comorbid bipolar mood disorder and chronic pain disorders. While requiring more studies in this population, we propose that this treatment modality may benefit patients. PMID:25667814

  11. Treatment of persistent painful nodules of hidradenitis suppurativa with cryotherapy.

    PubMed

    Bong, J L; Shalders, K; Saihan, E

    2003-05-01

    We report outcomes for 10 patients with persistent painful nodules of hidradenitis suppurativa treated with cryotherapy. Eight patients reported improvement and to date have had no recurrence of lesions at the treated sites. Most patients had significant pain during and after treatment. Eight patients had post-treatment ulceration, infection or both. The average number of days for the treatment areas to heal was 25. Seven patients rated cryotherapy as better than oral antibiotics and eight patients would consider this treatment again in the future. Cryotherapy can be an effective treatment for patients who have limited but persistent painful nodules. However, patients must be warned about pain, prolonged healing time and risk of infection after the procedure. PMID:12780702

  12. Resiniferatoxin for Pain Treatment: An Interventional Approach to Personalized Pain Medicine

    PubMed Central

    Iadarola, Michael J.; Gonnella, Gian Luigi

    2015-01-01

    This review examines existing preclinical and clinical studies related to resiniferatoxin (RTX) and its potential uses in pain treatment. Like capsaicin, RTX is a vanilloid receptor (TRPV1) agonist, only more potent. This increased potency confers both quantitative and qualitative advantages in terms of drug action on the TRPV1 containing nerve terminal, which result in an increased efficacy and a long duration of action. RTX can be delivered by a central route of administration through injection into the subarachnoid space around the lumbosacral spinal cord. It can also be administered peripherally into a region of skin or deep tissue where primary afferents nerves terminate, or directly into a nerve trunk or a dorsal root ganglion. The central route is currently being evaluated as a treatment for intractable pain in patients with advanced cancer. Peripheral administration offers the possibility to treat a wide diversity of pain problems because of the ability to bring the treatment to the site of the pain (the peripheral generator). While not all pain disorders are appropriate for RTX, tailoring treatment to an individual patient's needs via a selective and local intervention that chemically targets a specific population of nerve terminals provides a new capability for pain therapy and a simplified and effective approach to personalized pain medicine. PMID:26779292

  13. [Topical pharmacologic approach with 5% lidocaine medicated plaster in the treatment of localized neuropathic pain].

    PubMed

    Provinciali, L; Lattanzi, S; Chiarlone, R; Fogliardi, A; Intelligente, F; Irace, C; Lanzilotta, M; Palomba, R; Storelli, E; Zampi, M

    2014-12-01

    The treatment of neuropathic pain is a medical challenge. The responsiveness to the different classes of drugs is often unsatisfactory and frequently associated to a wide range of side effects. International guidelines suggest for the "localized" neuropathic pain the topical treatment with 5% lidocaine medicated plaster, alone or associated to systemic drugs, as the first choice since its favorable efficacy and tolerability profile. Many clinical experiences support the rationale for using 5% lidocaine medicated plaster in different kinds of localized neuropathic pain, such as postherpetic and trigeminal neuralgia, compressive syndromes, painful diabetic polyneuropathy and pain secondary to trauma or surgical interventions. This paper reports a series of clinical cases whose heterogeneity suggests the wide burden of applicability of the topical 5% lidocaine, either alone and associated to systemic drugs. All the described conditions were characterized by a highly intense pain, not adequately controlled by actual medications, which improved after the use of topical lidocaine. The good response to lidocaine allowed the reduction, of even the withdrawal, of concurrent drugs and improved the patients' quality of life. PMID:25392960

  14. Ghosts in the Machine. Interoceptive Modeling for Chronic Pain Treatment.

    PubMed

    Di Lernia, Daniele; Serino, Silvia; Cipresso, Pietro; Riva, Giuseppe

    2016-01-01

    Pain is a complex and multidimensional perception, embodied in our daily experiences through interoceptive appraisal processes. The article reviews the recent literature about interoception along with predictive coding theories and tries to explain a missing link between the sense of the physiological condition of the entire body and the perception of pain in chronic conditions, which are characterized by interoceptive deficits. Understanding chronic pain from an interoceptive point of view allows us to better comprehend the multidimensional nature of this specific organic information, integrating the input of several sources from Gifford's Mature Organism Model to Melzack's neuromatrix. The article proposes the concept of residual interoceptive images (ghosts), to explain the diffuse multilevel nature of chronic pain perceptions. Lastly, we introduce a treatment concept, forged upon the possibility to modify the interoceptive chronic representation of pain through external input in a process that we call interoceptive modeling, with the ultimate goal of reducing pain in chronic subjects. PMID:27445681

  15. [Low Back Pain in Pregnancy: Diagnosis, Treatment Options and Outcomes].

    PubMed

    Mühlemann, Daniel; Mühlemann, Malin B

    2015-05-20

    Low back pain in pregnancy is a common occurrence and is mainly caused by hormonal and biomechanical changes. Patients with pregnancy-induced low back pain (PILBP) frequently complain of moderate to severe and disabling pain often restricting their daily activities. In these cases, a “watch and wait” approach cannot be the best solution. On the basis of anamnesis and examination PILBP can be divided into three subgroups: pregnancy-related low back pain (PLBP), pelvic girdle pain (PGP) and the combination of PLBP and PGP. The three entities ask for different diagnostic workups and therapeutic modalities. There are many possible treatments for PLBP, however, only a few are based on sound evidence. Information and advice, exercise and training programs, acupuncture, stabilizing belts and analgesic medication can have a positive impact on pain and disability. PGP und PLBP respond well to chiropractic interventions. PMID:26098153

  16. Lower back pain in the athlete: common conditions and treatment.

    PubMed

    Baker, Robert J; Patel, Dilip

    2005-03-01

    Athletes younger than 12 years of age commonly have pathology related to the lower back pain. Spondylolysis is the most common condition in these athletes. Other conditions, including lumbar Scheuermann's disease,scoliosis, disc herniation, fractures, and muscular stains, can occur. Most of the mature general population experiences low back at some time in life. Athletes may be at increased risk, but outcomes are good. The majority of low back pain in mature athletes is mechanical in nature. Herniated discs,spinal stenosis, sacoilitis, and sacral stress fractures can also cause low back pain in these athletes. Low back conditions mentioned above may be treated with rest, specific exercise programs, and medication. Surgery is indicated for severe spinal stenosis, pain with evidence of neurological compromise,and some painful deformities. Newer treatments for back pain are emerging,but few controlled clinical trials are available. PMID:15831319

  17. Ghosts in the Machine. Interoceptive Modeling for Chronic Pain Treatment

    PubMed Central

    Di Lernia, Daniele; Serino, Silvia; Cipresso, Pietro; Riva, Giuseppe

    2016-01-01

    Pain is a complex and multidimensional perception, embodied in our daily experiences through interoceptive appraisal processes. The article reviews the recent literature about interoception along with predictive coding theories and tries to explain a missing link between the sense of the physiological condition of the entire body and the perception of pain in chronic conditions, which are characterized by interoceptive deficits. Understanding chronic pain from an interoceptive point of view allows us to better comprehend the multidimensional nature of this specific organic information, integrating the input of several sources from Gifford's Mature Organism Model to Melzack's neuromatrix. The article proposes the concept of residual interoceptive images (ghosts), to explain the diffuse multilevel nature of chronic pain perceptions. Lastly, we introduce a treatment concept, forged upon the possibility to modify the interoceptive chronic representation of pain through external input in a process that we call interoceptive modeling, with the ultimate goal of reducing pain in chronic subjects. PMID:27445681

  18. Craniosacral Therapy for the Treatment of Chronic Neck Pain

    PubMed Central

    Lauche, Romy; Cramer, Holger; Rampp, Thomas; Saha, Felix J.; Ostermann, Thomas; Dobos, Gustav

    2016-01-01

    Objectives: With growing evidence for the effectiveness of craniosacral therapy (CST) for pain management, the efficacy of CST remains unclear. This study therefore aimed at investigating CST in comparison with sham treatment in chronic nonspecific neck pain patients. Materials and Methods: A total of 54 blinded patients were randomized into either 8 weekly units of CST or light-touch sham treatment. Outcomes were assessed before and after treatment (week 8) and again 3 months later (week 20). The primary outcome was the pain intensity on a visual analog scale at week 8; secondary outcomes included pain on movement, pressure pain sensitivity, functional disability, health-related quality of life, well-being, anxiety, depression, stress perception, pain acceptance, body awareness, patients’ global impression of improvement, and safety. Results: In comparison with sham, CST patients reported significant and clinically relevant effects on pain intensity at week 8 (−21 mm group difference; 95% confidence interval, −32.6 to −9.4; P=0.001; d=1.02) and at week 20 (−16.8 mm group difference; 95% confidence interval, −27.5 to −6.1; P=0.003; d=0.88). Minimal clinically important differences in pain intensity at week 20 were reported by 78% within the CST group, whereas 48% even had substantial clinical benefit. Significant between-group differences at week 20 were also found for pain on movement, functional disability, physical quality of life, anxiety and patients’ global improvement. Pressure pain sensitivity and body awareness were significantly improved only at week 8. No serious adverse events were reported. Discussion: CST was both specifically effective and safe in reducing neck pain intensity and may improve functional disability and the quality of life up to 3 months after intervention. PMID:26340656

  19. Psychosocial perspectives in the treatment of pediatric chronic pain

    PubMed Central

    2012-01-01

    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

  20. Reversible and irreversible painful pulpitides: diagnosis and treatment.

    PubMed

    Bender, I B

    2000-04-01

    The foregoing clinical evidence indicates that when pain is severe, or when mild to moderate pain is present with a previous history of pain in the aching tooth, with or without periapical radiolucency, the tooth is in the IRPP category. Treatment dictates endodontic therapy or extraction. On the other hand, when clinical evidence indicates that the pain is mild or moderate with no previous history of pain, normal pulp vitality, and there is no positive percussion sign, the pulp is in the RPP category. Treatment dictates indirect or direct pulp capping in teeth with or without periapical radiolucency. The success rate favours teeth with no periapical radiolucency, 98%; in teeth with periapical radiolucency the success rate is less favorable, 43%. Efforts should be made to maintain pulp vitality. Endodontic therapy can always be done, if in time the pulp develops necrosis. PMID:11359291

  1. Phantom limb pain after lower limb trauma: origins and treatments.

    PubMed

    Foell, Jens; Bekrater-Bodmann, Robin; Flor, Herta; Cole, Jonathan

    2011-12-01

    Phantom sensations, that is, sensations perceived in a body part that has been lost, are a common consequence of accidental or clinical extremity amputations. Most amputation patients report a continuing presence of the limb, with some describing additional sensations such as numbness, tickling, or cramping of the phantom limb. The type, frequency, and stability of these phantom sensations can vary immensely. The phenomenon of painful phantom sensations, that is, phantom limb pain, presents a challenge for practitioners and researchers and is often detrimental to the patient's quality of life. In addition to the use of conventional therapies for chronic pain disorders, recent years have seen the development of novel treatments for phantom limb pain, based on an increasing body of research on neurophysiological changes after amputation. This article describes the current state of research in regard to the demographics, causal factors, and treatments of phantom limb pain. PMID:22184752

  2. Psychosocial perspectives in the treatment of pediatric chronic pain.

    PubMed

    Carter, Bryan D; Threlkeld, Brooke M

    2012-01-01

    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

  3. Many Patients with Cancer Need Better Treatments for Pain

    Cancer.gov

    Inadequate pain treatment in patients with cancer remains a significant problem and appears to be more frequent among minorities, according to a new study published online April 16, 2012, in the Journal of Clinical Oncology.

  4. New Guidelines Issued for Cancer Patients' Post-Treatment Pain

    MedlinePlus

    ... treatments for pain. These include hypnosis, meditation and medical marijuana where it's legal. ASCO also cautioned doctors to ... said. In states where allowed, doctors can prescribe medical marijuana. But they should first consider the potential benefits ...

  5. Treatment Options for Low Back Pain in Athletes

    PubMed Central

    Petering, Ryan C.; Webb, Charles

    2011-01-01

    Context: Low back pain is one of the most common medical presentations in the general population. It is a common source of pain in athletes, leading to significant time missed and disability. The general categories of treatment for low back pain are medications and therapies. Evidence acquisition: Relevant studies were identified through a literature search of MEDLINE and the Cochrane Database from 1990 to 2010. A manual review of reference lists of identified sources was also performed. Results: It is not clear whether athletes experience low back pain more often than the general public. Because of a aucity of trials with athlete-specific populations, recommendations on treatments must be made from reviews of treatments for the general population. Several large systemic reviews and Cochrane reviews have compiled evidence on different modalities for low back pain. Superficial heat, spinal manipulation, nonsteroidal anti-inflammatory medications, and skeletal muscle relaxants have the strongest evidence of benefit. Conclusions: Despite the high prevalence of low back pain and the significant burden to the athletes, there are few clearly superior treatment modalities. Superficial heat and spinal manipulation therapy are the most strongly supported evidence-based therapies. Nonsteroidal anti-inflammatory medications and skeletal muscle relaxants have benefit in the initial management of low back pain; however, both have considerable side effects that must be considered. Athletes can return to play once they have recovered full range of motion and have the strength to prevent further injury. PMID:23016058

  6. Medication Treatment Efficacy and Chronic Orofacial Pain.

    PubMed

    Clark, Glenn T; Padilla, Mariela; Dionne, Raymond

    2016-08-01

    Chronic pain in the orofacial region has always been a vexing problem for dentists to diagnose and treat effectively. For trigeminal neuropathic pain, there are 3 medications (gabapentinoids, tricyclic antidepressants, and serotonin-norepinephrine reuptake inhibitors) to use plus topical anesthetics that have therapeutic efficacy. For chronic daily headaches (often migraine in origin), 3 prophylactic medications have reasonable therapeutic efficacy (β-blockers, tricyclic antidepressants, and antiepileptic drugs). The 3 Food and Drug Administration-approved drugs for fibromyalgia (pregabalin, duloxetine, and milnacipran) are not robust, with poor efficacy. For osteroarthritis, nonsteroidal anti-inflammatory drugs have therapeutic efficacy and when gastritis contraindicates them, corticosteriod injections are helpful. PMID:27475515

  7. Treatment of temporomandibular myofascial pain with deep dry needling

    PubMed Central

    Gonzalez-Perez, Luis M.; Granados-Nuñez, Mercedes; Urresti-Lopez, Francisco J.

    2012-01-01

    Objectives: The present study was designed to evaluate the usefulness of deep dry needling in the treatment of temporomandibular myofascial pain. Study Design: We selected 36 patients with myofascial pain located in the external pterygoid muscle (30 women/6 men, mean age=27 years with SD±6,5). We studied differences in pain with a visual analog scale and range of mandibular movements before and after intervention. Results: We found a statistically significant relationship (p<0,01) between therapeutic intervention and the improvement of pain and jaw movements, which continued up to 6 months after treatment. Pain reduction was greater the higher was the intensity of pain at baseline. Conclusions: Although further studies are needed, our findings suggest that deep dry needling in the trigger point in the external pterygoid muscle can be effective in the management of patients with myofascial pain located in that muscle. Key words:Temporomandibular joint, myofascial pain, external pterygoid muscle, trigger point, deep dry needling. PMID:22549679

  8. Treatment Preferences for CAM in Children with Chronic Pain

    PubMed Central

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

    2007-01-01

    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

  9. Treatment Preferences for CAM in children with chronic pain.

    PubMed

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

    2007-09-01

    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

  10. EMDR: a new treatment for trauma and chronic pain.

    PubMed

    Grant, M

    2000-05-01

    EMDR (eye movement desensitization and reprocessing) is a new psychological treatment for trauma that is capable of facilitating rapid and permanent reduction in distressing thoughts and feelings (Carlson et al. 1998,Wilson et al. 1995). In addition to reduction of psychological distress, the method leads to more adaptive attitudes and functioning. The utility of the method also appears to extend beyond trauma with positive results reported in the treatment of addictions, phobias, and pain (Henry 1996, Goldstein & Feske 1994, Grant 1986). As a treatment for pain EMDR offers a method of facilitating permanent changes in how pain is experienced somatically and emotionally. Knowledge and understanding of the principles underlying EMDR can also provide a guide for more effective interventions by pain specialists. PMID:10844748

  11. Change in Suicidal Ideation Following Interdisciplinary Treatment of Chronic Pain

    PubMed Central

    Kowal, John; Wilson, Keith G.; Henderson, Peter R.; McWilliams, Lachlan A.

    2014-01-01

    Objectives To examine suicidal ideation in individuals with chronic pain, especially change in suicidal thinking following interdisciplinary treatment. Methods Consecutive patients (n = 250) admitted to a 4-week, group-based chronic pain management program completed measures of pain intensity, functional limitations, depressive symptoms, overall distress, pain catastrophizing, self-perceived burden, and suicidal ideation at pre- and post-treatment. Results Before treatment, 30 (12.0%) participants were classified as having a high level of suicidal ideation, 56 (22.4%) had a low level of suicidal ideation, and 164 (65.6%) reported none. Following treatment, there was a significant reduction in suicidal ideation and improvements in all other outcomes, but there were still some individuals with high (n = 22, 8.8%) or low (n = 28, 11.2%) levels at discharge. Patients with high suicidal ideation at baseline differed from those with no suicidal thinking on pre- and post-treatment measures of depression, distress, catastrophizing, and self-perceived burden, but not on pain intensity or functional limitations. Patients high in suicidal ideation endorsed greater pain catastrophizing and self-perceived burden than those low in suicidal thinking. Sustained suicidal ideation after treatment was associated with higher baseline levels of suicidal thinking and self-perceived burden to others, as well as a more limited overall response to treatment. Discussion Suicidal ideation was common in individuals with chronic pain, although mostly at a low level. Interdisciplinary treatment may result in reduced suicidal thinking; however, some patients continue to express thoughts of self-harm. Future studies could examine processes of change and interventions for treatment-resistant suicidal concerns. PMID:24281291

  12. Treatment Considerations for Elderly and Frail Patients With Neuropathic Pain

    PubMed Central

    Schmader, Kenneth E.; Baron, Ralf; Haanpää, Maija L.; Mayer, John; O'Connor, Alec B.; Rice, Andrew S. C.; Stacey, Brett

    2010-01-01

    Currently, an estimated 38 million individuals 65 years or older live in the United States, and more than 11 million of these individuals are 80 years or older. Older people are at high risk of neuropathic pain because many diseases that cause neuropathic pain increase in incidence with age. Depending on their underlying health, older adults with neuropathic pain may have to cope with multiple coexisting diseases, polypharmacy, and impaired functional ability. The objective of this article is to review how aging and frailty affect the treatment of older adults with neuropathic pain. Specific topics reviewed include the complexity of treatment decisions in older patients due to aged heterogeneity, multimorbidity, and polypharmacy; selection of treatment in an effort to maximize patients' functional abilities in addition to relieving their pain; more careful dosing (usually lower) and monitoring of pharmacotherapy relative to younger patients due to age-related changes in pharmacokinetics and pharmacodynamics; and underrepresentation of older adults in clinical trials of neuropathic pain treatments, which further compromises physicians' ability to make informed treatment decisions. PMID:20194145

  13. Pharmacology of opioids in the treatment of chronic pain syndromes.

    PubMed

    Vallejo, Ricardo; Barkin, Robert L; Wang, Victor C

    2011-01-01

    The perpetual pursuit of pain elimination has been constant throughout human history and pervades human cultures. In some ways it is as old as medicine itself. Cultures throughout history have practiced the art of pain management through remedies such as oral ingestion of herbs or techniques believed to have special properties. In fact, even Hippocrates wrote about the practice of trepanation, the cutting of holes in the body to release pain. Current therapies for management of pain include the pervasive utilization of opioids, which have an extensive history, spanning centuries. There is general agreement about the appropriateness of opioids for the treatment of acute and cancer pain, but the long-term use of these drugs for treatment of chronic non-malignant pain remains controversial. The pros and cons regarding these issues are beyond the scope of this review. Instead, the purpose of this review will be directed towards the pharmacology of commonly prescribed opioids in the treatment of various chronic pain syndromes. Opium, derived from the Greek word for "juice," is extracted from the latex sap of the opium poppy (Papaverum somniferum). The juice of the poppy is the source of some 20 different alkaloids of opium. These alkaloids of opioids can be divided into 2 chemical classes: phenanthrenes (morphine, codeine, and thebaine) and benzylisoquinolines (agents that do not interact with opioid receptors). PMID:21785485

  14. Invasive stimulation therapies for the treatment of refractory pain.

    PubMed

    Nizard, Julien; Raoul, Sylvie; Nguyen, Jean-Paul; Lefaucheur, Jean-Pascal

    2012-10-01

    Invasive neurostimulation therapies may be proposed to patients with neuropathic pain refractory to conventional medical management, in order to improve pain relief, functional capacity, and quality of life. In this review, the respective mechanisms of action and efficacy of peripheral nerve stimulation (PNS), nerve root stimulation (NRS), spinal cord stimulation (SCS), deep brain stimulation (DBS), and motor cortex stimulation (MCS) are discussed. PNS appears to be useful in various refractory neuropathic pain indications (as long as there is some preservation of sensation in the painful area), such as intractable chronic headache, pelvic and perineal pain, and low back pain, but evidence for its efficacy is not strongly conclusive, and large-scale randomized controlled studies are necessary to confirm the efficacy in the long term. Spinal cord stimulation (SCS) has been validated for the treatment of selected types of chronic pain syndromes, such as Failed Back Surgery Syndrome, and Complex Regional Pain Syndrome type I. When neuropathic pain is secondary to a brain lesion (especially following stroke) or a trigeminal lesion, stimulation of brain structures is required. Deep brain stimulation (DBS), which can be proposed with targets like the periventricular/periaqueductal gray matter or the sensory thalamus, is increasingly replaced by motor cortex stimulation (MCS), mainly because it is safer, more easily performed, and probably more effective in a wider range of indications (including central post-stroke pain). The respective places of DBS and MCS in some selected indications, such as peripheral neuropathic pain and phantom limb pain, have yet to be clearly delineated. Controlled trials, with the stimulator switched ON or OFF in a double-blind procedure, have demonstrated the efficacy of MCS in the treatment of peripheral and central neuropathic pain, although these trials included a limited number of patients and need to be confirmed by large, controlled

  15. Pathogenesis and treatment of pain in patients with chronic wounds.

    PubMed

    Freedman, Gordon; Cean, Conrad; Duron, Vincent; Tarnovskaya, Alina; Brem, Harold

    2003-01-01

    Pain must be managed during treatment of a patient with a chronic wound. Failure to do so will impair the patient's ability to heal significantly. Understanding the wound's etiology is essential for designing the wound-healing protocol and implementing its pain management regimen, of which a critical part is the chronic-wound patient's self-assessed scores of pain and functionality. In this report we present a paradigm for treating all chronic wounds, which was subsequently applied to 32 consecutive patients. Our integrated-team approach to managing the treatment of wounds includes accurate evaluation of the progression of patients' pain. Directors of the pain-management team and wound team have jointly managed hundreds of patients--either hospitalized or seen in both outpatient clinical practices. The three general categories for etiologies of the 10 most common types of chronic wounds are: ischemia, neuropathy, and direct tissue damage (e.g. pressure ulcers and venous stasis ulcers). Each of these are treated with unique analgesic regimens focused on surgical/medical management of the wound: oral and parenteral medications in combinations designed to facilitate specific additive analgesic effects and nerve blocks and implantable devices for correcting underlying wound pathophysiology. Successful treatment of pain generally results in increased functional independence and improvement of the patient's quality of life. We integrated wound-care pain-management team established guidelines that delineate the causes of chronic wounds and categorize treatment options for practical clinical use. The expectation is that all pain should be resolved in all patients if both the wound-healing and pain-healthcare providers use current technologies and drugs. PMID:12931299

  16. Intracerebroventricular Pain Treatment with Analgesic Mixtures including Ziconotide for Intractable Pain.

    PubMed

    Staquet, Héléne; Dupoiron, Denis; Nader, Edmond; Menei, Philippe

    2016-07-01

    Intracerebroventricular (ICV) administration of opioids for control of intractable cancer pain has been used since 1982. We present here our experience of intracerebroventricular administration of pain treatments including ziconotide associated with morphine and ropivacaine for patients resistant to a conventional approach, with nociceptive, neuropathic, or mixed pain. These clinical cases were conducted with patients suffering from refractory pain, more than 6/10 on a numerical pain rating scale (NPRS) while on high-dose medical treatment and/or intolerance with significant side effects from oral medication. The baseline study visit included a physical examination and an assessment of pain intensity on a NPRS. Under general anesthesia, a neuronavigation device was used to place the catheter on the floor of the third ventricle, supported by an endoscope. Then, drugs were injected in the cerebroventricular system, through a pump (external or subcutaneous). The primary objective was to measure pain evaluation with ICV treatment after a complete withdrawal of other medications.Four patients were enrolled: 3 with intractable cancer pain and one with central neuropathic pain. The median NPRS at baseline was 9.5 [8.5; 19]. The mean NPRS after one month was 3.5 [3; 4.5]. Ziconotide was initiated at 0.48 µg/d and up to a median of 1.2 µg/d [1.0; 1.56]. The median dose of morphine and ropivacaine used initially was respectively 0.36 mg/d [0.24; 0.66] up to 0.6 mg/d [0.45; 4.63] and 1.2 mg/d [0; 2.4] up to 2.23 mg/d [1.2; 3.35]. Minor side effects were initially observed but transiently. One psychiatric agitation required discontinuation of ziconotide infusion. For intractable pain, using ziconotide by intracerebroventricular infusion seems safe and efficient, specifically for chronic neoplastic pain of cervicocephalic, thoracic, or diffuse origin and also for pain arising from a central neuropathic mechanism. PMID:27454282

  17. [Botulinum toxin for the treatment of pain syndromes].

    PubMed

    Ferreira, Joaquim J; Couto, Marina; Costa, João; Coelho, Miguel; Rosa, Mário M; Sampaio, Cristina

    2006-01-01

    Although botulinum toxin (BoNT) is being used for therapeutic purposes for more than 20 years, the list of potential new indications continues to increase and includes various pain syndromes. The pain relief experienced by patients with dystonia and spasticity from intramuscular BoNT injections suggested that other chronic skeletal-muscles pain conditions may also benefit. BoNT inhibits the release of acetylcholine at the neuromuscular junction thereby reducing striatal muscle contractions and the proposed analgesic property was initially attributed to muscular relaxation. A specific analgesic BoNT effect is difficult to conclude from studies where pain is conditioned by other associated symptoms like dystonia, muscle contraction or spasticity. One alternative is to critically appraise clinical trials where BoNT was studied as the active intervention and pain evaluated as an outcome. From this analysis there is convincing evidence for the effectiveness of BoNT in the treatment of pain associated with cervical dystonia. For all other pain syndromes there have been relatively few, small sized, placebo-controlled studies (myofascial pain syndrome, chronic neck and low back pain, piriformis syndrome and fibromyalgia) and the results of these studies have been contradictory or non conclusive. To establish the analgesic properties of BoNT there is a need for appropriately designed, exploratory randomized controlled studies in well accepted human models of nociceptive or neuropathic pain. This does not exclude the subsequent need to conduct pragmatic trials to evaluate the effectiveness of BoNT in conditions where the improvement of pain or any associated clinical sign or symptom may be of clinical relevance. PMID:17058384

  18. Adequate Selection of a Therapeutic Site Enables Efficient Development of Collateral Vessels in Angiogenic Treatment With Bone Marrow Mononuclear Cells

    PubMed Central

    Nemoto, Masaru; Koyama, Hiroyuki; Nishiyama, Ayako; Shigematsu, Kunihiro; Miyata, Tetsuro; Watanabe, Toshiaki

    2015-01-01

    Background Induction of angiogenic mechanisms to promote development of collateral vessels is considered promising for the treatment of peripheral arterial diseases. Collateral vessels generally develop from preexisting arteriolar connections, bypassing the diseased artery. We speculated that induction of angiogenic mechanisms should be directed to such arteriolar connections to achieve efficient collateral development. The aim of this study was to verify this hypothesis using autologous transplantation of bone marrow mononuclear cells in the rabbit model of chronic limb ischemia. Methods and Results The left femoral artery was excised to induce limb ischemia in male rabbits. In this model, arteriolar connections in the left coccygeofemoral muscle tend to develop into collateral vessels, although this transformation is insufficient to alleviate the limb ischemia. In contrast, arteriolar connections in the closely located adductor muscle do not readily develop into collateral vessels. At 21 days after ischemia initiation, a sufficient number of automononuclear cells were selectively injected in the left coccygeofemoral muscle (coccygeo group) or left adductor muscle (adductor group). Evaluation of calf blood pressure ratios, blood flow in the left internal iliac artery, and angiographic scores at day 28 after injection revealed that collateral development and improvement of limb ischemia were significantly more efficient in the coccygeo group than in the adductor group. Morphometric analysis of the coccygeofemoral muscle at day 14 showed similar results. Conclusions Specific delivery of mononuclear cells to the coccygeofemoral but not the adductor muscle effectively improves collateral circulation in the rabbit model of limb ischemia and suggests that adequate site selection can facilitate therapeutic angiogenesis. PMID:26370447

  19. Pain intensity and smoking behavior among treatment seeking smokers.

    PubMed

    Bakhshaie, Jafar; Ditre, Joseph W; Langdon, Kirsten J; Asmundson, Gordon J G; Paulus, Daniel J; Zvolensky, Michael J

    2016-03-30

    Empirical evidence supporting the interplay between pain intensity and tobacco smoking has been growing. The current investigation advances this work in three important ways: (1) controlling for negative affectivity and gender; (2) examining pain intensity in smokers from a community sample, rather than specialized pain treatment centers; and, (3) studying smokers who are highly motivated to quit. Participants were adult smokers (N=112; 35% female; Mage=41.4, SD=13.1) participating in a larger study examining barriers to cessation during a self-guided quit attempt. At baseline, participants completed self-report measures on pain intensity and smoking severity outcomes. As hypothesized, more intense pain was significantly associated with all four smoking severity variables: years as a daily smoker, current cigarettes per day, cigarettes per day during the heaviest lifetime smoking period, and current level of nicotine dependence. These associations remained when taking into account the variance accounted for by gender and negative affectivity. These data provide evidence that more intense pain is related to more severe smoking behavior and nicotine dependence. Pain reduction could be an important target in regard to smokers with chronic pain. PMID:26921054

  20. Pain in Breast Cancer Treatment: Aggravating Factors and Coping Mechanisms

    PubMed Central

    Guerreiro Godoy, Maria de Fatima; Pereira de Godoy, Livia Maria; Barufi, Stelamarys; de Godoy, José Maria Pereira

    2014-01-01

    The objective of this study was to evaluate pain in women with breast cancer-related lymphedema and the characteristics of aggravating factors and coping mechanisms. The study was conducted in the Clinica Godoy, São Jose do Rio Preto, with a group of 46 women who had undergone surgery for the treatment of breast cancer. The following variables were evaluated: type and length of surgery; number of radiotherapy and chemotherapy sessions; continued feeling of the removed breast (phantom limb), infection, intensity of pain, and factors that improve and worsen the pain. The percentage of events was used for statistical analysis. About half the participants (52.1%) performed modified radical surgery, with 91.3% removing only one breast; 82.6% of the participants did not perform breast reconstruction surgery. Insignificant pain was reported by 32.60% of the women and 67.3% said they suffered pain; it was mild in 28.8% of the cases (scale 1–5), moderate in 34.8% (scale 6–9), and severe in 4.3%. The main mechanisms used to cope with pain were painkillers in 41.30% of participants, rest in 21.73%, religious ceremonies in 17.39%, and chatting with friends in 8.69%. In conclusion, many mastectomized patients with lymphedema complain of pain, but pain is often underrecognized and undertreated. PMID:25349741

  1. Chronic pain: the burden of disease and treatment innovations.

    PubMed

    Monti, S; Caporali, R

    2015-01-01

    Musculoskeletal conditions are the most frequent cause of chronic pain and affect around 1 in 5 adults in Europe. When chronic pain occurs, it becomes disease itself, with substantial clinical, social and economic impact. Efficacy and tolerability problems are encountered with all therapeutic strategies available to treat musculoskeletal pain. This often limits effective analgesia and patients' long term compliance, with the result that chronic pain is persistently underestimated and undertreated. Tapentadol is a novel, centrally acting analgesic that has been recently commercialized for the treatment of chronic pain. This new molecule, by combining two distinct mechanisms of action, μ-opioid receptor agonism (MOR) and noradrenaline reuptake inhibition (NRI), introduces a new pharmacological class called MOR-NRI. Several studies demonstrated promising results in the management of both nociceptive and neuropathic pain and good tolerability profile, particularly concerning side effects, compared to traditional opioids. This novel analgesic represents a possible therapeutic option also in the rheumatologic field, particularly in the treatment of osteoarthritis and low back pain. PMID:26492961

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

    PubMed Central

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

    2011-01-01

    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

  3. Topical medications as treatment of neuropathic orofacial pain.

    PubMed

    Nasri-Heir, Cibele; Khan, Junad; Heir, Gary M

    2013-07-01

    Understanding mechanisms of neuropathic orofacial pain, targets of treatment, and basic pharmacology and working with informed compounding pharmacists may result in significant benefit for patients. The clinical significance of topical medications is improvement of quality of life for patients by providing a unique medication delivery system for neuropathic orofacial pain and other dental and extraoral conditions. The use of this route of administration has decreased or minimized side effects compared with other methods and is especially useful in medically compromised and elderly patients. These innovations, supported and improved by ongoing research, will augment the armamentarium of the clinician treating orofacial pain disorders. PMID:23809308

  4. Total thyroidectomy without prophylactic central neck dissection in clinically node-negative papillary thyroid cancer: is it an adequate treatment?

    PubMed Central

    2014-01-01

    Background Cervical lymph node metastases in papillary thyroid cancer are common. Although central neck dissection is indicated in clinically nodal-positive disease, it remains controversial in patients with no clinical evidence of nodal metastasis. The aim of this retrospective study was to determine the outcomes of clinically lymph node-negative patients with papillary thyroid cancer who underwent total thyroidectomy without a central neck dissection, in order to determine the rates of recurrence and reoperation in these patients compared with a group of patients submitted to total thyroidectomy with central neck dissection. Methods Two-hundred and eighty-five patients undergoing total thyroidectomy with preoperative diagnosis of papillary thyroid cancer, in the absence of suspicious nodes, were divided in two groups: those who underwent a thyroidectomy only (group A; n = 220) and those who also received a central neck dissection (group B; n = 65). Results Six cases (2.1%) of nodal recurrence were observed: 4 in group A and 2 in group B. Tumor histology was associated with risk of recurrence: Hürthle cell-variant and tall cell-variant carcinomas were associated with a high risk of recurrence. Multifocality and extrathyroidal invasion also presented a higher risk, while smaller tumors were at lower risk. Conclusions The role of prophylactic central lymph node dissection in the management of papillary thyroid cancer remains controversial. Total thyroidectomy appears to be an adequate treatment for clinically node-negative papillary thyroid cancer. Prophylactic central neck dissection could be considered for the more appropriate selection of patients for radioiodine treatment and should be reserved for high-risk patients only. No clinical or pathological factors are able to predict with any certainty the presence of nodal metastasis. In our experience, tumor size, some histological types, multifocality, and locoregional infiltration are related to an

  5. Can treatment success with 5% lidocaine medicated plaster be predicted in cancer pain with neuropathic components or trigeminal neuropathic pain?

    PubMed Central

    Kern, Kai-Uwe; Nalamachu, Srinivas; Brasseur, Louis; Zakrzewska, Joanna M

    2013-01-01

    An expert group of 40 pain specialists from 16 countries performed a first assessment of the value of predictors for treatment success with 5% lidocaine-medicated plaster in the management of cancer pain with neuropathic components and trigeminal neuropathic pain. Results were based on the retrospective analysis of 68 case reports (sent in by participants in the 4 weeks prior to the conference) and the practical experience of the experts. Lidocaine plaster treatment was mostly successful for surgery or chemotherapy-related cancer pain with neuropathic components. A dose reduction of systemic pain treatment was observed in at least 50% of all cancer pain patients using the plaster as adjunct treatment; the presence of allodynia, hyperalgesia or pain quality provided a potential but not definitively clear indication of treatment success. In trigeminal neuropathic pain, continuous pain, severe allodynia, hyperalgesia, or postherpetic neuralgia or trauma as the cause of orofacial neuropathic pain were perceived as potential predictors of treatment success with lidocaine plaster. In conclusion, these findings provide a first assessment of the likelihood of treatment benefits with 5% lidocaine-medicated plaster in the management of cancer pain with neuropathic components and trigeminal neuropathic pain and support conducting large, well-designed multicenter studies. PMID:23630431

  6. [Current topics in prevention, diagnosis and treatment of neuropathic pain from different causes: preface and comments].

    PubMed

    Hanaoka, Kazuo

    2010-11-01

    Neuropathic pain, as a chronic intractable pain, is well known to be difficult in prevention, diagnosis and treatment. Especially, neuropathic pain from different causes has each characteristics for prevention, diagnosis and treatment. These include post-herpetic pain, persistent chronic pain following traffic accident, pain after peripheral nerve injury in venipuncture, phantom limb pain originating from dysfunction of the primary motor cortex, pain from failed back surgery syndrome, and diabetic neuropathy, and are helpful for understanding prevention, diagnosis and treatment of neuropathic pain. PMID:21077299

  7. Treatment of a Case Example with PTSD and Chronic Pain

    ERIC Educational Resources Information Center

    Shipherd, Jillian C.

    2006-01-01

    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…

  8. Cognitive Mediators of Treatment Outcomes in Pediatric Functional Abdominal Pain

    PubMed Central

    Levy, Rona L.; Langer, Shelby L.; Romano, Joan M.; Labus, Jennifer; Walker, Lynn S.; Murphy, Tasha B.; Van Tilburg, Miranda; Feld, Lauren D.; Christie, Dennis L.; Whitehead, William E.

    2014-01-01

    Objectives Cognitive-behavioral interventions improve outcomes for many pediatric health conditions, but little is known about which mechanisms mediate these outcomes. The goal of this study was to identify whether changes in targeted process variables from baseline to one week post-treatment mediate improvement in outcomes in a randomized controlled trial of a brief cognitive-behavioral intervention for idiopathic childhood abdominal pain. Methods Two-hundred children with persistent functional abdominal pain and their parents were randomly assigned to one of two conditions: a 3-session social learning and cognitive-behavioral treatment (SLCBT) (N=100), or a 3-session educational intervention controlling for time and attention (N=100). Outcomes were assessed at 3, 6 and 12 month follow-ups. The intervention focused on altering parental responses to pain and on increasing adaptive cognitions and coping strategies related to pain in both parents and children. Results Multiple mediation analyses were applied to examine the extent to which the effects of the SLCBT condition on child GI symptom severity and pain as reported by children and their parents were mediated by changes in targeted cognitive process variables and parents’ solicitous responses to their child’s pain symptoms. Reductions in parents’ perceived threat regarding their child’s pain mediated reductions in both parent- and child-reported GI symptom severity and pain. Reductions in children’s catastrophic cognitions mediated reductions in child-reported GI symptom severity but no other outcomes. Reductions in parental solicitousness did not mediate outcomes. Discussion Results suggest that reductions in reports of children’s pain and GI symptoms following a social learning and cognitive-behavioral intervention were mediated at least in part by decreasing maladaptive parent and child cognitions. PMID:24469611

  9. Pathophysiology, diagnosis, and treatment of discogenic low back pain

    PubMed Central

    Peng, Bao-Gan

    2013-01-01

    Discogenic low back pain is a serious medical and social problem, and accounts for 26%-42% of the patients with chronic low back pain. Recent studies found that the pathologic features of discs obtained from the patients with discogenic low back pain were the formation of the zones of vascularized granulation tissue, with extensive innervation in fissures extending from the outer part of the annulus into the nucleus pulposus. Studies suggested that the degeneration of the painful disc might originate from the injury and subsequent repair of annulus fibrosus. Growth factors such as basic fibroblast growth factor, transforming growth factor β1, and connective tissue growth factor, macrophages and mast cells might play a key role in the repair of the injured annulus fibrosus and subsequent disc degeneration. Although there exist controversies about the role of discography as a diagnostic test, provocation discography still is the only available means by which to identify a painful disc. A recent study has classified discogenic low back pain into two types that were annular disruption-induced low back pain and internal endplate disruption-induced low back pain, which have been fully supported by clinical and theoretical bases. Current treatment options for discogenic back pain range from medicinal anti-inflammation strategy to invasive procedures including spine fusion and recently spinal arthroplasty. However, these treatments are limited to relieving symptoms, with no attempt to restore the disc’s structure. Recently, there has been a growing interest in developing strategies that aim to repair or regenerate the degenerated disc biologically. PMID:23610750

  10. Differential changes in functional disability and pain intensity over the course of psychological treatment for children with chronic pain

    PubMed Central

    Lynch-Jordan, Anne M.; Sil, Soumitri; Peugh, James; Cunningham, Natoshia; Kashikar-Zuck, Susmita; Goldschneider, Kenneth R.

    2015-01-01

    Patients presenting for treatment of chronic pain often believe that pain reduction must be achieved before returning to normal functioning. However, treatment programs for chronic pain typically take a rehabilitative approach, emphasizing decreasing pain-related disability first with the expectation that pain reduction will follow. This information is routinely provided to patients, yet no studies have systematically examined the actual trajectories of pain and disability in a clinical care setting. In this study of youth with chronic pain (N = 94, 8 to 18 years), it was hypothesized that 1) functional disability and pain would decrease over the course of psychological treatment for chronic pain and 2) functional disability would decrease more quickly than pain intensity. Participants received cognitive behavioral therapy (CBT) for pain management (M = 5.6 sessions) plus standard medical care. The Functional Disability Inventory and a Numeric Rating Scale of average pain intensity were completed by the child at every CBT session. Hierarchical linear modeling was conducted to examine the longitudinal trajectories of disability and pain. Standardized estimates of the slopes of change were obtained to test differences in rates of change between pain and disability. Results showed an overall significant decline in functional disability over time. Although pain scores reduced slightly from pretreatment to posttreatment, the longitudinal decline over treatment was not statistically significant. As expected, the rate of change of disability was significantly more rapid than pain. Evidence for variability in treatment response was noted, suggesting the need for additional research into individual trajectories of change in pediatric pain treatment. PMID:24954165

  11. How to Use PAP (Pain-Avoidance Principle) to Make AYP (Adequate Yearly Progress) under NCLB (No Child Left Behind Act)

    ERIC Educational Resources Information Center

    Popham, W. James

    2005-01-01

    Today's educators live in fear of the draconian consequences of failing to make adequate yearly progress under the No Child Left Behind Act. In this article, the author offers sage advice on how to "comply" with the law and not get hurt. In this analysis, the author also offers guidance to his public school colleagues who, yearning to dodge the…

  12. Pain Relief in Cervical Dystonia with Botulinum Toxin Treatment

    PubMed Central

    Camargo, Carlos Henrique Ferreira; Cattai, Lígia; Teive, Hélio Afonso Ghizoni

    2015-01-01

    Dystonia is a neurological disorder characterized by intermittent or sustained muscle contractions that cause abnormal, usually repetitive, movements and postures. Dystonic movements can be tremulous and twisting and often follow a pattern. They are frequently associated with overflow muscle activation and may be triggered or worsened by voluntary action. Most voluntary muscles can be affected and, in the case of the neck muscles, the condition is referred to as cervical dystonia (CD), the most common form of dystonia. The high incidence of pain distinguishes CD from other focal dystonias and contributes significantly to patient disability and low quality of life. Different degrees of pain in the cervical region are reported by more than 60% of patients, and pain intensity is directly related to disease severity. Botulinum toxin (BoNT) is currently considered the treatment of choice for CD and can lead to an improvement in pain and dystonic symptoms in up to 90% of patients. The results for BoNT/A and BoNT/B are similar. The complex relationship between pain and dystonia has resulted in a large number of studies and more comprehensive assessments of dystonic patients. When planning the application of BoNT, pain should be a key factor in the choice of muscles and doses. In conclusion, BoNT is highly effective in controlling pain, and its analgesic effect is sustained for a long time in most CD patients. PMID:26110508

  13. The efficacy of intrathecal morphine and clonidine in the treatment of pain after spinal cord injury.

    PubMed

    Siddall, P J; Molloy, A R; Walker, S; Mather, L E; Rutkowski, S B; Cousins, M J

    2000-12-01

    We performed a double-blinded, randomized, controlled trial in 15 patients to determine the efficacy of intrathecal morphine or clonidine, alone or combined, in the treatment of neuropathic pain after spinal cord injury. The combination of morphine and clonidine produced significantly more pain relief than placebo 4 h after administration; either morphine or clonidine alone did not produce as much pain relief. In addition, lumbar and cervical cerebrospinal fluid (CSF) concentrations, sampled at these levels at different times after administration were examined for a relationship between pain relief and CSF drug concentration. Lumbar CSF drug concentrations were initially several orders of magnitude larger than those in cervical CSF. After 1-2 h, the concentrations of morphine in cervical CSF markedly exceeded those of clonidine. The concentration of morphine in the cervical CSF and the degree of pain relief correlated significantly. We conclude that intrathecal administration of a mixture of clonidine and morphine is more effective than either drug administered alone and is related to the CSF-borne drug concentration above the level of spinal cord injury. If there is pathology that may restrict CSF flow, consideration should be given to intrathecal administration above the level of spinal cord damage to provide an adequate drug concentration in this region. PMID:11094007

  14. Four treatment strategies for complex regional pain syndrome type 1.

    PubMed

    Lee, Sang Ki; Yang, Dae Suk; Lee, Jae Won; Choy, Won Sik

    2012-06-01

    Complex regional pain syndrome (CRPS) poses a dilemma for many clinicians due to its unknown etiology and largely unsuccessful treatment modalities. The purpose of this study was to compare the clinical results of 4 treatment modalities for CRPS type 1. A total of 59 patients were divided into 4 groups based on treatment modality: group A, an oral nonsteroidal anti-inflammatory drug (NSAID) (n=10); group B, oral gabapentin (n=12); group C, intravenous (IV) 10% mannitol and steroid (n=11); group D, a combination of IV 20% mannitol and steroid with oral gabapentin (n=26). The patients remained under medical supervision after discharge and were evaluated either once a month or once every 2 months until final follow-up at a mean of 8 months. Patients in group A showed improvement in pain level, finger range of motion, swelling, and grip strength, without statistical significance (P=.076, P=.062, P=.312, and P=.804, respectively). Patients in group B showed significant improvement in pain level (P<.001), and patients in group C showed improvement in pain, finger range of motion, and swelling (P=.127), which rendered functional impairment unchanged. In comparison, patients in group D showed recovery of grip strength and improvement in pain level, finger range of motion, and (P<.001, P=.016, P=.031, and P=.047, respectively). Based on these results, a protocol including a combination of IV 20% mannitol and steroid with oral gabapentin is an acceptable and effective treatment for CRPS type 1. PMID:22691654

  15. Surgical treatment of painful lesions of the inferior alveolar nerve.

    PubMed

    Biglioli, Federico; Allevi, Fabiana; Lozza, Alessandro

    2015-10-01

    Nerve-related complications are being reported with increasing frequency following oral and dental surgery, and typically involve the inferior alveolar nerve (IAN). We assess herein the etiology of neuropathic pain related to IAN injuries, and describe the various surgical treatment techniques available. Between 2007 and 2013, 19 patients were referred to the Maxillofacial Surgery Department of San Paolo Hospital (Milan, Italy) with pain in the area supplied by the IAN, which developed following endodontic treatment, oral surgery and maxillofacial surgery. All patients underwent IAN surgery by several different microsurgical procedures. Most of the patients affected by pain before surgery experienced complete or partial amelioration of symptoms. All patients receiving sural nerve grafts were pain-free 12 months after surgery. In five patients the operation was unsuccessful. In 78.94% of cases, a significant increase in nerve function was observed. Pain following IAN surgical damage may be addressed by microsurgery; nerve substitution with a sural nerve interpositional graft appears to represent the most efficacious procedure. Scar releasing, nerve decompression and nerve substitution using vein grafts are less effective. Removal of endodontic material extravasated into the mandibular canal is mandatory and effective in patients experiencing severe pain. Surgery should be performed within 12 months postoperatively, ideally during the first few weeks after symptoms onset. PMID:26315275

  16. Multiwave low-laser therapy in the pain treatment

    NASA Astrophysics Data System (ADS)

    Moldovan, Corneliu I.; Antipa, Ciprian; Bratila, Florin; Brukner, Ion; Vasiliu, Virgil V.

    1995-03-01

    Sixteen patients with knee pain, 17 patients with low back pain and 23 patients with vertebral pain were randomly allocated to multiwave laser therapy (MWL). The MWL was performed through an original method by a special designed laser system. The stimulation parameters adaptably optimized in a closed loop by measuring the reflected laser radiation. A control group of 11 patients was conventionally treated with a single infrared laser system. All patients were assessed by single observer using a visual analogue scale in a controlled trial. Our results indicate that the treatment with different laser wavelengths, different output power and frequencies, simultaneously applied through optic-fibers, has significant effects on the pain when compared with the common low laser therapy.

  17. The value of SPECT/CT in localizing pain site and prediction of treatment response in patients with chronic low back pain.

    PubMed

    Lee, Inki; Budiawan, Hendra; Moon, Jee Youn; Cheon, Gi Jeong; Kim, Yong Chul; Paeng, Jin Chul; Kang, Keon Wook; Chung, June-Key; Lee, Dong Soo

    2014-12-01

    In many circumstances, causing sites of low back pain (LBP) cannot be determined only by anatomical imaging. Combined functional and morphological imaging such as bone scan with single-photon emission computed tomography/computed tomography (SPECT/CT) may be helpful in identifying active lesions. The purpose of this study was to evaluate the usefulness of bone SPECT/CT in localizing the pain site and the treatment of chronic LBP. One hundred seventy-five patients suffering from chronic LBP who underwent SPECT/CT were included, retrospectively. All of the patients received multiple general treatments according to the symptoms, and some of them underwent additional target-specific treatment based on SPECT/CT. Numerical rating scale (NRS) pain score was used to assess the pain intensity. Of 175 patients, 127 showed good response to the given therapies, while the rest did not. Overall, 79.4% of patients with definite active lesions showed good response. Patients with mild active or no lesions on SPECT/CT had relatively lower response rate of 63.0%. Good response was observed by the treatment with the guidance of active lesions identified on SPECT/CT. SPECT/CT could be useful in identifying active lesions in patients with chronic LBP and guiding the clinicians to use adequate treatment. PMID:25469075

  18. Medical Treatments for Endometriosis-Associated Pelvic Pain

    PubMed Central

    Luppi, Stefania; Ricci, Giuseppe

    2014-01-01

    The main sequelae of endometriosis are represented by infertility and chronic pelvic pain. Chronic pelvic pain causes disability and distress with a very high economic impact. In the last decades, an impressive amount of pharmacological agents have been tested for the treatment of endometriosis-associated pelvic pain. However, only a few of these have been introduced into clinical practice. Following the results of the controlled studies available, to date, the first-line treatment for endometriosis associated pain is still represented by oral contraceptives used continuously. Progestins represent an acceptable alternative. In women with rectovaginal lesions or colorectal endometriosis, norethisterone acetate at low dosage should be preferred. GnRH analogues may be used as second-line treatment, but significant side effects should be taken into account. Nonsteroidal anti-inflammatory drugs are widely used, but there is inconclusive evidence for their efficacy in relieving endometriosis-associated pelvic pain. Other agents such as GnRH antagonist, aromatase inhibitors, immunomodulators, selective progesterone receptor modulators, and histone deacetylase inhibitors seem to be very promising, but there is not enough evidence to support their introduction into routine clinical practice. Some other agents, such as peroxisome proliferator activated receptors-γ ligands, antiangiogenic agents, and melatonin have been proven to be efficacious in animal studies, but they have not yet been tested in clinical studies. PMID:25165691

  19. Is acupuncture effective in the treatment of pain in endometriosis?

    PubMed Central

    Lund, Iréne; Lundeberg, Thomas

    2016-01-01

    Introduction Endometriosis is a multifactorial, estrogen-dependent, inflammatory gynecological condition – often with long-lasting visceral pelvic pain of different origin, and infertility among women. Current management options for patients’ are often inadequate, with side effects for many for whom acupuncture techniques could be an alternative. Earlier studies have discussed the efficacy of acupuncture, but not its methodological aspects. Objectives To summarize the documented clinical effects of acupuncture on rated visceral pelvic endometriosis-related pain, and associated variables among individuals, within and between studied groups, and to discuss the methodological treatment aspects. Methods Published full text clinical studies, case reports, and observational studies with abstracts written in English were searched by using the keywords “Acupuncture and Endometriosis” in databases such as PubMed, Web of Science, and CINAHL. The reporting guidelines, Standards for Reporting Interventions in Clinical Trials of Acupuncture was used for the methodological report. Results Three studies were found including 99 women, 13–40 years old, with diagnosed endometriosis. The studies were different in research design, needle stimulation techniques, and evaluation instruments. Methodological similarities were seven to12 needle insertions per subject/session, and 15–25 minutes of needle retention time. The needles were placed in lower back/pelvic-abdominal area, in the shank, feet, and hands. Treatment numbers varied from nine to 16 and patients received one to two treatments per week. Similarity in reported treatment effects in the quoted studies, irrespective of research design or treatment technique, was reported decrease of rated pain intensity. Discussion Meta-analysis is the standard procedure for the evaluation of evidence of treatment effects, ie, on a group level, usually without analysis of the individual responses even with obvious spread in the

  20. Acupuncture Treatment of Lateral Elbow Pain: A Nonrandomized Pilot Study

    PubMed Central

    Liu, Yan-Song; Gadau, Marcus; Zhang, Guo-Xue; Liu, Hao; Wang, Fu-Chun; Zaslawski, Christopher; Li, Tie; Tan, Yuan-Sheng; Berle, Christine; Li, Wei-Hong; Bangrazi, Sergio; Liguori, Stefano; Zhang, Shi-Ping

    2016-01-01

    In planning for a large-scale multicenter trial to evaluate the effect of acupuncture for the treatment of lateral elbow pain, a pilot study was conducted. This was a prospective, investigator- and patient-blinded, nonrandomized, placebo controlled trial. Subjects were evaluated at baseline, before fourth, seventh, and ninth treatment, and at a two-week posttreatment follow-up. The treatment group received unilateral acupuncture at LI 10 and LI 11 at the affected side with manual needle manipulation; the control group received sham-laser acupuncture at the same acupoints. Measures included (i) disabilities of the arm, shoulder, and hand (DASH) questionnaire, (ii) pain-free grip strength (PFGS), and (iii) a visual analogue scale (VAS) for pain. Significant differences in DASH score, PFGS, and VAS between treatment and control group were found at the ninth treatment (n = 20 for each group, P < 0.05). Only DASH showed significant differences compared to the control for all the measurement time points after treatment commenced and appears to be a sensitive and appropriate primary outcome measure for the future multisite trial. Results from this pilot study provided relevant information about treatment efficacy, credibility of control treatment, and sensitivity of different outcome measures for the planning of the future trial. PMID:27006679

  1. Use of conventional, complementary, and alternative treatments for pain among individuals seeking primary care treatment with buprenorphine-naloxone

    PubMed Central

    Barry, Declan T.; Savant, Jonathan D.; Beitel, Mark; Cutter, Christopher J.; Moore, Brent A.; Schottenfeld, Richard S.; Fiellin, David A.

    2012-01-01

    Previous studies have not examined patterns of pain treatment use among patients seeking office-based buprenorphine-naloxone treatment (BNT) for opioid dependence. Objectives To examine, among individuals with pain seeking BNT for opioid dependence, the use of pain treatment modalities, perceived efficacy of prior pain treatment, and interest in pursuing pain treatment while in BNT. Methods 244 patients seeking office-based BNT for opioid dependence completed measures of demographics, pain status (i.e. “chronic pain (CP)” [pain lasting at least 3 months] vs. “some pain (SP)” [pain in the past week not meeting the duration criteria for chronic pain]), pain treatment use, perceived efficacy of prior pain treatment, and interest in receiving pain treatment while in BNT. Results In comparison to the SP group (N = 87), the CP group (N = 88) was more likely to report past-week medical use of opioid medication (AOR 3.2, 95% CI 1.2–8.4), lifetime medical use of non-opioid prescribed medication (AOR 2.2, 95% CI 1.1–4.7), and lifetime use of prayer (AOR 2.8, 95% CI 1.2–6.5), and was less likely to report lifetime use of yoga (AOR 0.2, 95% CI 0.1–0.7) to treat pain. While the two pain groups did not differ on levels of perceived efficacy of prior lifetime pain treatments, in comparison to the SP group, the CP group was more likely to report interest in receiving pain treatment while in BNT (P < 0.001). Conclusions Individuals with pain seeking BNT for opioid dependence report a wide range of conventional, complementary, and alternative pain-related treatments and are interested (especially those with CP) in receiving pain management services along with BNT. PMID:23041680

  2. Role of intraseptal anesthesia for pain-free dental treatment

    PubMed Central

    Gazal, G; Fareed, WM; Zafar, MS

    2016-01-01

    Pain control during the dental procedure is essentials and challenging. A complete efficacious pulp anesthesia has not been attained yet. The regional anesthesia such as inferior alveolar nerve block (IANB) only does not guarantee the effective anesthesia with patients suffering from irreversible pulpitis. This main aim of this review was to discuss various aspects of intraseptal dental anesthesia and its role significance in pain-free treatment in the dental office. In addition, reasons of failure and limitations of this technique have been highlighted. Literature search was conducted for peer-reviewed articles published in English language in last 30 years. Search words such as dental anesthesia, pain control, intraseptal, and nerve block were entered using a web of knowledge and Google scholar databases. Various dental local anesthesia techniques were reviewed. A combination of block anesthesia, buccal infiltration and intraligamentary injection resulted in deep anesthesia (P = 0.003), and higher success rate compared to IANB. For pain-free management of conditions such as irreversible pulpitis, buccal infiltration (4% articaine), and intraosseous injection (2% lidocaine) are better than intraligamentary and IANB injections. Similarly, nerve block is not always effective for pain-free root canal treatment hence, needing supplemental anesthesia. Intraseptal anesthesia is an efficient and effective technique that can be used in maxillary and mandibular adult dentition. This technique is also beneficial when used in conjunction to the regional block or local dental anesthesia. PMID:26955316

  3. Role of intraseptal anesthesia for pain-free dental treatment.

    PubMed

    Gazal, G; Fareed, W M; Zafar, M S

    2016-01-01

    Pain control during the dental procedure is essentials and challenging. A complete efficacious pulp anesthesia has not been attained yet. The regional anesthesia such as inferior alveolar nerve block (IANB) only does not guarantee the effective anesthesia with patients suffering from irreversible pulpitis. This main aim of this review was to discuss various aspects of intraseptal dental anesthesia and its role significance in pain-free treatment in the dental office. In addition, reasons of failure and limitations of this technique have been highlighted. Literature search was conducted for peer-reviewed articles published in English language in last 30 years. Search words such as dental anesthesia, pain control, intraseptal, and nerve block were entered using a web of knowledge and Google scholar databases. Various dental local anesthesia techniques were reviewed. A combination of block anesthesia, buccal infiltration and intraligamentary injection resulted in deep anesthesia (P = 0.003), and higher success rate compared to IANB. For pain-free management of conditions such as irreversible pulpitis, buccal infiltration (4% articaine), and intraosseous injection (2% lidocaine) are better than intraligamentary and IANB injections. Similarly, nerve block is not always effective for pain-free root canal treatment hence, needing supplemental anesthesia. Intraseptal anesthesia is an efficient and effective technique that can be used in maxillary and mandibular adult dentition. This technique is also beneficial when used in conjunction to the regional block or local dental anesthesia. PMID:26955316

  4. [Cervical myofascial pain syndrome. Narrative review of physiotherapeutic treatment].

    PubMed

    Capó-Juan, M A

    2015-01-01

    Pain is a complex and multifactorial phenomenon that depends on the interaction of biopsychosocial factors. Between 15-25% of adults suffer from chronic pain at some point in their lives. Cervical chronic pain is considered a public health problem affecting 9.6% men and 21.9% women, according to the latest National Health Survey 2011-12. A high percentage of medical consultations due to muscle pain turn out to be myofascial pain syndrome (MPS). Its existence implies the presence of myofascial trigger points which can be latent or active throughout the whole population. The aim of this review is to update knowledge in the various therapies applied by the physiotherapist in the treatment of this syndrome at cervical level. From the review it appears that some of the most used techniques that may be useful in the short or medium term are: ischemic compression and/or trigger point pressure release and dry needling. Furthermore, various combinations of treatment modalities are used to treat this syndrome, taking other aspects into account, such as education. PMID:25963463

  5. Capsaicinoids in the treatment of neuropathic pain: a review

    PubMed Central

    Pappagallo, Marco

    2014-01-01

    The treatment of neuropathic pain is difficult. Oral pharmaceuticals have significant side effects, and treatment efficacy tends to be modest. The use of topical analgesics reduces the potential for systemic side effects and allows direct application of medications to the area of pain. The natural spicy substance, capsaicin, has historically been known for its topical use. Capsaicin, once applied to the skin, causes a brief initial sensitization followed by a prolonged desensitization of the local pain nerves. This occurs through stimulation of the transient receptor potential vanilloid-1 (TRPV1) expressing pain nerve fibers. While low-dose capsaicin has not resulted in good efficacy, the larger dose 8% topical capsaicin has had some of the best data currently available in the treatment of post-herpetic neuralgia (PHN) and other neuropathic conditions. This paper discusses the data currently existing for capsaicin 8% in the treatment of PHN. It further reviews data for the low-dose capsaicin products and the current status in the development of other capsaicinoids, e.g. resiniferotoxin, and high-concentration liquid capsaicin. PMID:24409200

  6. Phentolamine as a treatment for poor mixing in transposition of the great arteries with adequate intraatrial communication.

    PubMed

    Galal, M O; El-Naggar, W I; Sharfi, M H

    2005-01-01

    Patients with transposition of the great arteries often show poor mixing for different reasons, even after adequate balloon atrial septostomy. We present a patient with such a lesion whose clinical status improved dramatically after phentolamine was applied. We believe this improvement is due to reduction in afterload caused by the alpha(2) blocker and also possibly as a response to a presumptive effect of the drug on the diastolic function of the right ventricle, allowing more left-to-right shunt across the atrial septal defect. Both phenomena can improve cardiac output in such a situation. PMID:16374695

  7. [Treatment of postoperative pain by balanced spinal analgesia].

    PubMed

    Polati, E; Finco, G; Bartoloni, A; Rigo, V; Gottin, L; Pinaroli, A M; Barzoi, G

    1995-01-01

    Postoperative pain relief has the aim to provide patient subjective comfort, to inhibit neuroendocrine and metabolic responses to surgical injury and to enhance restoration of function by allowing the patient to breathe, cough, move more easily and to begin enteral nutrition. Opioid analgesics, independently from the route of administration, are unable to provide all this. In addition to spinal opioids other drugs, such as local anesthetics, alpha 2-agonists and cholinergic drugs, may produce an antinociceptive effect when administered by spinal route. All these drugs may be administered in combination between them, realising the so called "balanced spinal analgesia". The aim of this study is to analyse the available methods for the evaluation of pharmacological interactions, the types of interaction among different spinal antinociceptive drugs and the role of balanced spinal analgesia in the treatment of postoperative pain. Analysis of the presented data shows that the spinal synergism between opioids-local anesthetics and opioids-alpha 2-agonists can be useful in the treatment of postoperative pain, because these drug combinations are able to provide a satisfactory pain control at low doses with a reduction of the adverse effects. Furthermore, the combined use of opioids-local anesthetics proved to be effective also in abolishing postoperative incident pain and in inhibiting neuroendocrine and metabolic responses to surgical injury. Especially in high risk patients this is related to a better outcome. Finally, even if the synergism between cholinergic drugs with opioids or a2-agonists have been proved, at the moment their use in man by spinal route in the treatment of postoperative pain is not advisable. PMID:9480192

  8. Evaluation of stress and pain during rapid maxillary expansion treatments.

    PubMed

    Gecgelen, M; Aksoy, A; Kirdemir, P; Doguc, D K; Cesur, G; Koskan, O; Ozorak, O

    2012-10-01

    The purpose of this study was to use salivary cortisol levels, pressure pain threshold (PPT) and Spielberger's State-Trait Anxiety Inventory for Children (STAIC) to assess stress, anxiety and pain during the expansion and retention phase of rapid maxillary expansion (RME) in children and investigate to whether this parameters are associated with gender or skeletal maturity stages. STAIC was used to assess the anxiety levels of the children. Salivary samples were collected for stress hormone determination. Visual Analog Scale was used for pain determination. Pressure pain threshold (PPT) was measured by using algometer. Data collection was performed a week before RME treatment (T0), at the day of the expansion appliance was bonded (T1), at the days of 1st, 4th, 7th, 14th, 25th, 36th activations of expansion screw (T2, T3, T4, T5, T6, T7) and after the retention period of 3 months (T8). The results of this study showed that the differences were statistically significant within-day (P < 0·001) and within-hours (P < 0·001) in cortisol levels during treatment. PPT levels were statistically significant within sex differences and skeletal maturity stages (P < 0·05). State-trait anxiety scale scores were similar with respect to gender (P > 0·05). There were statistically significant differences of state-trait anxiety levels between pre and post-treatment stages (P < 0·05). The maximum number of patients reporting pain were days at T3 and T4. From day T5 the percentage of patients reporting pain then gradually reduced. Based on the findings of this study, it has been shown that RME leads to changes in patients' state-trait anxiety and cortisol levels. PMID:22783926

  9. Artemether–lumefantrine treatment failure despite adequate lumefantrine day 7 concentration in a traveller with Plasmodium falciparum malaria after returning from Tanzania

    PubMed Central

    2012-01-01

    Artemether-lumefantrine is currently first-line therapy of Plasmodium falciparum malaria in many countries. This report describes a treatment failure despite adequate drug concentrations in a traveller returning from sub-Saharan Africa. Genotyping confirmed recrudescence and suggested reduced sensitivity. Potential sub-optimal effect of artemether-lumefantrine highlights the need to follow non-immune individuals the weeks after treatment. PMID:22632033

  10. New Chronic Pain Treatments in the Outpatient Setting: Review Article.

    PubMed

    Grandhe, R; Souzdalnitski, D; Gritsenko, K

    2016-05-01

    Chronic pain is an issue encountered by many health care providers in their routine clinical practice. In addition to generalized patient suffering, this condition has significant clinical, psychological, and socioeconomic impact due to its widespread occurrence. The landscape of chronic pain management has been changing rapidly with an array of treatment innovations, better understanding of established therapies, and care coordination across specialties. In this article, we have reviewed emerging new modalities as well as transformation of established therapies by interventional, pharmacologic, rehabilitative, psychological, complimentary, and interdisciplinary approaches. PMID:27038972

  11. Treatment of Non Pain-Related Symptoms

    PubMed Central

    von Gunten, Charles F.; Gafford, Ellin

    2013-01-01

    Relieving the suffering associated with cancer and its treatment in the physical, emotional, practical and spiritual domains is impossible without impeccable symptom control. This review summarizes key features essential to the management of: anorexia/cachexia, bowel obstruction, diarrhea, fatigue, mucositis, and nausea/vomiting. Taken together, these are some of the most vexing symptoms for cancer patients. Well-managed symptoms enable the course of overall cancer care to be unimpeded. PMID:24051612

  12. Updating postoperative pain management: from multimodal to context-sensitive treatment.

    PubMed

    Fanelli, G; Berti, M; Baciarello, M

    2008-09-01

    Although a wealth of evidence exists on effective postoperative pain (POP) treatment, surgical patients still suffer from inadequate analgesic regimens, and outcomes have been shown to improve only within the context of tightly controlled, randomized trials. The pathophysiology of pain seems to suggest that analgesic regimens aimed at inhibition of neurotransmission and neuroplastic phenomena should be instituted immediately before the painful stimuli are applied. Several protocols have been proposed, but the final choice should be made according to patients' needs, surgical indications, and institutional resources. Optimal POP management may succeed in improving outcomes only when combined with hospital-wide protocols for early rehabilitation and recovery; in the absence of adequate monitoring, equipment, motivation and coordination, even state-of-the-art techniques may fail to show results in terms of returning to daily life. Analgesic efficacy should always be balanced against safety and the ability to monitor patients in order to reduce complications that may actually impair recovery. A ''context-sensitive'' approach to POP, therefore, is suggested. Context-sensitive analgesia should be instituted as early as deemed necessary to avoid persistent pain, and it should be continued, with different modalities, until full recovery from surgery. In this way, it should constitute a ''bridge'' therapy from surgery to full healing. The use of neuroprotective agents to reduce the risk of postoperative hyperalgesia and other sensory disturbances should be considered in the context of specific surgical interventions. PMID:18762755

  13. Vitamin D for the treatment of painful diabetic neuropathy

    PubMed Central

    Basit, Abdul; Basit, Khalid Abdul; Fawwad, Asher; Shaheen, Fariha; Fatima, Nimra; Petropoulos, Ioannis N; Alam, Uazman; Malik, Rayaz A

    2016-01-01

    Objective To assess the effect of high-dose vitamin D in patients with painful diabetic neuropathy. Methods A single intramuscular dose of 600 000 IU vitamin D was administered, and the effects on metabolic parameters and neuropathic pain assessed over 20 weeks. Results 143 participants with predominantly type 2 diabetes, aged 52.31±11.48 years, with a Douleur Neuropathique 4 (DN4) score (3.0±1.8), total McGill pain score (21.2±14.9), and Short Form McGill Pain Questionnaire (SFMPQ) score (2.1±0.9), were enrolled. The baseline 25-hydroxyvitamin D (25(OH)D) level was 31.7±23.3 ng/mL and 58 (40.5%) patients showed evidence of vitamin D deficiency (25(OH)D<20 ng/mL). Intramuscular administration of vitamin D resulted in a significant increase in 25(OH)D (46.2±10.2 ng/mL, p<0.0001) and a reduction in positive symptoms on the DN4 (p<0.0001), total pain score (p<0.0001), and SFMPQ (p<0.0001). Conclusions Treatment with a single intramuscular dose of 600 000 IU of vitamin D in patients with painful diabetic neuropathy is associated with a significant decrease in the symptoms of painful diabetic neuropathy. Trial registration number BIDE-12/2014. PMID:27026808

  14. Treatment of abdominal pain in irritable bowel syndrome.

    PubMed

    Vanuytsel, Tim; Tack, Jan F; Boeckxstaens, Guy E

    2014-08-01

    Functional abdominal pain in the context of irritable bowel syndrome (IBS) is a challenging problem for primary care physicians, gastroenterologists and pain specialists. We review the evidence for the current and future non-pharmacological and pharmacological treatment options targeting the central nervous system and the gastrointestinal tract. Cognitive interventions such as cognitive behavioral therapy and hypnotherapy have demonstrated excellent results in IBS patients, but the limited availability and labor-intensive nature limit their routine use in daily practice. In patients who are refractory to first-line therapy, tricyclic antidepressants (TCA) and selective serotonin reuptake inhibitors are both effective to obtain symptomatic relief, but only TCAs have been shown to improve abdominal pain in meta-analyses. A diet low in fermentable carbohydrates and polyols (FODMAP) seems effective in subgroups of patients to reduce abdominal pain, bloating, and to improve the stool pattern. The evidence for fiber is limited and only isphagula may be somewhat beneficial. The efficacy of probiotics is difficult to interpret since several strains in different quantities have been used across studies. Antispasmodics, including peppermint oil, are still considered the first-line treatment for abdominal pain in IBS. Second-line therapies for diarrhea-predominant IBS include the non-absorbable antibiotic rifaximin and the 5HT3 antagonists alosetron and ramosetron, although the use of the former is restricted because of the rare risk of ischemic colitis. In laxative-resistant, constipation-predominant IBS, the chloride-secretion stimulating drugs lubiprostone and linaclotide, a guanylate cyclase C agonist that also has direct analgesic effects, reduce abdominal pain and improve the stool pattern. PMID:24845149

  15. Know pain know gain: proposing a treatment approach for phantom limb pain.

    PubMed

    Le Feuvre, Peter; Aldington, D

    2014-03-01

    Phantom limb pain affects between 50 and 80% of amputees. With an increasing number of battle casualties having had an amputation after combat trauma, it is inevitable that both primary and secondary care clinicians will come into contact with a patient with phantom limb pain (PLP). It is widely acknowledged that its complex aetiology means that this condition is often poorly understood and difficult to manage. A growing pathophysiological understanding is shedding new light on the mechanisms which underlie PLP. Knowledge of these mechanisms will inform treatment and enable clinicians to plan and implement solutions which make a difference to those individuals with this condition. This paper seeks to outline current research into this condition and proposes an approach to treatment. This approach has been formulated from an amalgamation of clinical experience working with battle casualties at the Defence Medical Rehabilitation Centre, Headley Court. PMID:24109117

  16. Effective physical treatment for chronic low back pain.

    PubMed

    Maher, C G

    2004-01-01

    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

  17. Guideline for diagnosis and treatment of subacromial pain syndrome

    PubMed Central

    Diercks, Ron; Bron, Carel; Dorrestijn, Oscar; Meskers, Carel; Naber, René; de Ruiter, Tjerk; Willems, Jaap; Winters, Jan; van der Woude, Henk Jan

    2014-01-01

    Treatment of “subacromial impingement syndrome” of the shoulder has changed drastically in the past decade. The anatomical explanation as “impingement” of the rotator cuff is not sufficient to cover the pathology. “Subacromial pain syndrome”, SAPS, describes the condition better. A working group formed from a number of Dutch specialist societies, joined by the Dutch Orthopedic Association, has produced a guideline based on the available scientific evidence. This resulted in a new outlook for the treatment of subacromial pain syndrome. The important conclusions and advice from this work are as follows: (1) The diagnosis SAPS can only be made using a combination of clinical tests. (2) SAPS should preferably be treated non-operatively. (3) Acute pain should be treated with analgetics if necessary. (4) Subacromial injection with corticosteroids is indicated for persistent or recurrent symptoms. (5) Diagnostic imaging is useful after 6 weeks of symptoms. Ultrasound examination is the recommended imaging, to exclude a rotator cuff rupture. (6) Occupational interventions are useful when complaints persist for longer than 6 weeks. (7) Exercise therapy should be specific and should be of low intensity and high frequency, combining eccentric training, attention to relaxation and posture, and treatment of myofascial trigger points (including stretching of the muscles) may be considered. (8) Strict immobilization and mobilization techniques are not recommended. (9) Tendinosis calcarea can be treated by shockwave (ESWT) or needling under ultrasound guidance (barbotage). (10) Rehabilitation in a specialized unit can be considered in chronic, treatment resistant SAPS, with pain perpetuating behavior. (11) There is no convincing evidence that surgical treatment for SAPS is more effective than conservature management. (12) There is no indication for the surgical treatment of asymptomatic rotator cuff tears. PMID:24847788

  18. Predicting response to physiotherapy treatment for musculoskeletal shoulder pain: a systematic review

    PubMed Central

    2013-01-01

    demonstrated no association (p > 0.05). Conclusion Associations between prognostic factors and outcome were often inconsistent between studies. This may be due to clinical heterogeneity or type II errors. Only two baseline prognostic factors demonstrated a consistent association with outcome in two or more studies; duration of shoulder pain and baseline function. Prior to developing a predictive model for the outcome of physiotherapy treatment for shoulder pain, a large adequately powered prospective cohort study is required in which a broad range of prognostic factors are incorporated. PMID:23834747

  19. Postoperative Pain after Root Canal Treatment: A Prospective Cohort Study

    PubMed Central

    Gotler, M.; Bar-Gil, B.; Ashkenazi, M.

    2012-01-01

    Aim. To evaluate the incidence and severity of postendodontic treatment pain (PEP) subsequent to root canal treatment (RCT) in vital and necrotic pulps and after retreatment. Methodology. A prospective study. Participants were all patients (n = 274) who underwent RCT in teeth with vital pulp, necrotic pulp, or vital pulp that had been treated for symptomatic irreversible pulpitis or who received root canal retreatment, by one clinician, during an eight-month period. Exclusion criteria were swelling, purulence, and antibiotic use during initial treatment. A structured questionnaire accessed age, gender, tooth location, and pulpal diagnosis. Within 24 h of treatment, patients were asked to grade their pain at 6 and 18 hours posttreatment, using a 1–5 point scale. Results. RCT of teeth with vital pulp induced a significantly higher incidence and severity of PEP (63.8%; 2.46 ± 1.4, resp.) than RCT of teeth with necrotic pulp (38.5%; 1.78 ± 1.2, resp.) or of retreated teeth (48.8%; 1.89 ± 1.1, resp.). No statistical relation was found between type of pain (spontaneous or stimulated) and pulp condition. Conclusion. RCT of teeth with vital pulp induced a significantly higher incidence and intensity of PEP compared to teeth with necrotic pulp or retreated teeth. PMID:22505897

  20. [Balanced spinal analgesia in the treatment of oncologic pain. Review of the literature].

    PubMed

    Polati, E; Pinaroli, A M; Ischia, S

    1996-11-01

    Certain types of cancer pain fail to respond well either to systemic drug therapy or to spinal opioids because of the occurrence of intolerable adverse effects. In addition to spinal opioids other drugs may produce an antinociceptive effect when administered by the spinal route, such as local anesthetics, NSAID, alpha 2-agonists, calcium-channel blockers, NMDA antagonists, cholinergic drugs, peptides such as somatostatin, octreotide or calcitonin, adenosine agonists, benzodiazepines, neurokinin and cholecystokinin antagonists, nitric oxide synthase inhibitors, corticosteroids, and enkephalinase inhibitors. All these drugs may be administered in combination between them, realising the so called balanced spinal analgesia. The aim of this study is to analyse: the available methods for the evaluation of pharmacological interactions, the types of interaction between different spinal antinociceptive drugs and the role of balanced spinal analgesia in the treatment of cancer pain. Analysis of the presented data shows that the spinal synergism between opioids-local anesthetics and opioids-alpha 2-agonists can be useful in the treatment of opioid refractory cancer pain. Furthermore, the use of cholinergic drugs combined with opioids and alpha 2-agonists may be promising. Finally, even if the synergism between NSAID or NMDA antagonists with opioids or alpha 2-agonists have been proved, at the moment their use in man by the spinal route is not advisable because of the absence of adequate studies on their neurotoxicity and adverse effects. PMID:9102586

  1. REASSESSMENT OF PAINFUL SHOULDERS AMONG BASEBALL PLAYERS AFTER CONSERVATIVE TREATMENT

    PubMed Central

    Miyazaki, Alberto Naoki; Fregoneze, Marcelo; Santos, Pedro Doneux; da Silva, Luciana Andrade; do Val Sella, Guilherme; Ishioka, Fábio Eduardo; Rosa, João Roberto Polydoro; Estelles, José Renato Depari; Checchia, Sérgio Luiz

    2015-01-01

    Objective: The objective of this study was to evaluate the rehabilitation results among baseball players who presented pain and medial rotation deficit in their shoulders. Methods: Out of 55 baseball players assessed between April and June 2009, it was observed that 20 presented pain at some instant during throwing movements. They were advised to undergo a rehabilitation program with exercises to stretch the posterior capsule and reinforce the muscles of the scapular belt, especially the lateral rotators. Eighteen patients followed the advice, while two were lost from the follow-up. The parameters evaluated were: pain, range of motion, strength before the program and strength after the end of the program. Results: Comparing the initial and final assessments, we observed mean increases as follows: 10° of elevation (p = 0.001); three vertebral levels of medial rotation (p < 0.001); 20° of medial rotation at 90° abduction (p < 0.001); and 26° of range of motion (p < 0.001). Regarding strength, elevation force increased by 3 kgf (p = 0.002) and lateral rotation force increased by 1 kgf (p = 0.020). Out of the 18 baseball players studied, the pain level improved in 16, while two continued to present pain and underwent magnetic resonance imaging, which showed lesions for surgical treatment. Conclusion: The rehabilitation program conducted among the baseball players was effective and enabled increases in medial rotation, elevation, range of motion and strength of elevation and lateral rotation, consequently producing pain improvements in most of the players. PMID:27042626

  2. [Multidisciplinary practice guideline 'Invasive treatment of spine related low back pain'].

    PubMed

    Itz, Coen J; Willems, Paul C; Zeilstra, Dick J; Huygen, Frank J P M

    2013-01-01

    The practice guideline 'Invasive treatment of spine related low back pain' describes the state of the art regarding the diagnosis and value of invasive treatment after failure of conservative treatment in patients with pain symptoms of facet joint pain, pain in the sacroiliac joint, coccygodynia, discogenic pain and the 'failed back surgery syndrome'. There is no consensus on definitions and a classification system for chronic low back pain symptoms. The classification in specific and nonspecific low back pain provides insufficient insight and is unable to show which therapy is effective for which disorder. The guideline working group advises a new classification system for chronic low back pain in degenerative and non-degenerative disorders. After failure of conservative treatment, several specific invasive treatments are recommended; some of these treatments should only be performed in study related settings. Some of the treatments that are currently used in daily practice are inadvisable. PMID:23920233

  3. Do ethnic differences still exist in pain assessment and treatment in the emergency department?

    PubMed

    Ware, Laurie Jowers; Epps, Cynthia D; Clark, Julie; Chatterjee, Ayona

    2012-12-01

    Although the provision of timely and appropriate analgesia is a primary goal of Emergency Department (ED) staff, pain continues to be undertreated and some evidence supports the existence of pain treatment disparities. Despite strong incentives from accreditation organizations, pain management in the ED may still be inconsistent and problematic. The purpose of this research study was to conduct a retrospective chart review to investigate pain assessment and treatment for 200 adults (≥18 years old) admitted to the ED suffering from long-bone fractures. An additional purpose was to investigate demographic variables, including ethnicity, to determine if they influenced pain assessment, pain treatment, and wait times in the ED. Although assessment and treatment of pain is universally recognized as being important and necessary to provide optimal patient care, only 52% of patients in this study were assessed using a pain intensity scale, with 43% of those assessed reporting pain as ≥5 on a 0-10 pain intensity instrument. Pain medication was administered to 75% of the patients, but 25% of the patients received no medication. Only 24% of those receiving a pain medication were reassessed to determine pain relief. Compounding these problems were wait times for analgesia of >1 hour. Although the influence on pain management related to ethnicity was not a factor in this study, other findings revealed that undertreatment of pain, inadequate assessment, lack of documentation of pain, and lengthy wait times persist in the ED. PMID:23158701

  4. Pain Management in Intellectually Disabled Children: Assessment, Treatment, and Translational Research

    ERIC Educational Resources Information Center

    Valkenburg, Abraham J.; van Dijk, Monique; de Klein, Annelies; van den Anker, Johannes N.; Tibboel, Dick

    2010-01-01

    The primary focus of pain research in intellectually disabled individuals is still on pain assessment. Several observational pain assessment scales are available, each with its own characteristics, its own target group and its own validated use. Observational studies report differences in the treatment of intra- and postoperative pain of…

  5. Reducing racial disparities in pain treatment: the role of empathy and perspective-taking.

    PubMed

    Drwecki, Brian B; Moore, Colleen F; Ward, Sandra E; Prkachin, Kenneth M

    2011-05-01

    Epidemiological evidence indicates that African Americans receive lower quality pain treatment than European Americans. However, the factors causing these disparities remain unidentified, and solutions to this problem remain elusive. Across three laboratory experiments, we examined the hypotheses that empathy is not only causing pain treatment disparities but that empathy-inducing interventions can reduce these disparities. Undergraduates (Experiments 1 and 2) and nursing professionals (Experiment 3) watched videos of real Black and White patients' genuine facial expressions of pain, provided pain treatment decisions, and reported their feelings of empathy for each patient. The efficacy of an empathy-inducing, perspective-taking intervention at reducing pain treatment disparities was also examined (Experiments 2 and 3). When instructed to attempt to provide patients with the best care, participants exhibited significant pro-White pain treatment biases. However, participants engaged in an empathy-inducing, perspective-taking intervention that instructed them to imagine how patients' pain affected patients' lives exhibited upwards of a 55% reduction in pain treatment bias in comparison to controls. Furthermore, Pro-White empathy biases were highly predictive of pro-White pain treatment biases. The magnitude of the empathy bias experienced predicted the magnitude of the treatment bias exhibited. These findings suggest that empathy plays a crucial role in racial pain treatment disparities in that it appears not only to be one likely cause of pain treatment disparities but also is an important means for reducing racial disparities in pain treatment. PMID:21277087

  6. No evidence of real progress in treatment of acute pain, 1993–2012: scientometric analysis

    PubMed Central

    Correll, Darin J; Vlassakov, Kamen V; Kissin, Igor

    2014-01-01

    Over the past 2 decades, many new techniques and drugs for the treatment of acute pain have achieved widespread use. The main aim of this study was to assess the progress in their implementation using scientometric analysis. The following scientometric indices were used: 1) popularity index, representing the share of articles on a specific technique (or a drug) relative to all articles in the field of acute pain; 2) index of change, representing the degree of growth in publications on a topic compared to the previous period; and 3) index of expectations, representing the ratio of the number of articles on a topic in the top 20 journals relative to the number of articles in all (>5,000) biomedical journals covered by PubMed. Publications on specific topics (ten techniques and 21 drugs) were assessed during four time periods (1993–1997, 1998–2002, 2003–2007, and 2008–2012). In addition, to determine whether the status of routine acute pain management has improved over the past 20 years, we analyzed surveys designed to be representative of the national population that reflected direct responses of patients reporting pain scores. By the 2008–2012 period, popularity index had reached a substantial level (≥5%) only with techniques or drugs that were introduced 30–50 years ago or more (epidural analgesia, patient-controlled analgesia, nerve blocks, epidural analgesia for labor or delivery, bupivacaine, and acetaminophen). In 2008–2012, promising (although modest) changes of index of change and index of expectations were found only with dexamethasone. Six national surveys conducted for the past 20 years demonstrated an unacceptably high percentage of patients experiencing moderate or severe pain with not even a trend toward outcome improvement. Thus, techniques or drugs that were introduced and achieved widespread use for acute pain management within the past 20 years have produced no changes in scientometric indices that would indicate real progress and

  7. Comparing Chronic Pain Treatment Seekers in Primary Care versus Tertiary Care Settings

    PubMed Central

    Fink-Miller, Erin L.; Long, Dustin M.; Gross, Richard T.

    2015-01-01

    Background Patients frequently seek treatment for chronic nonmalignant pain in primary care settings. Compared with physicians who have completed extensive specialization (eg, fellowships) in pain management, primary care physicians receive much less formal training in managing chronic pain. While chronic pain represents a complicated condition in its own right, the recent increase in opioid prescriptions further muddles treatment. It is unknown whether patients with chronic pain seeking treatment in primary care differ from those seeking treatment in tertiary care settings. This study sought to determine whether patients with chronic pain in primary care reported less pain, fewer psychological variables related to pain, and lower risk of medication misuse/abuse compared with those in tertiary care. Methods Data collected from patients with chronic pain in primary care settings and tertiary care settings were analyzed for significant differences using Wilcoxon rank sum tests, Fisher exact tests, and linear regression. A host of variables among populations, including demographics, self-reported pain severity, psychological variables related to pain, and risk for opioid misuse and abuse, were compared. Results Findings suggest that primary care patients with chronic pain were similar to those in tertiary care on a host of indices and reported more severe pain. There were no significant group differences for risk of medication misuse or abuse. Conclusion It seems that primary care physicians care for a complicated group of patients with chronic pain that rivals the complexity of those seen in specialized tertiary care pain management facilities. PMID:25201929

  8. Transdermal opioid patches for pain treatment in ancient Greece.

    PubMed

    Harrison, Adrian P; Hansen, Steen H; Bartels, Else M

    2012-11-01

    Pain treatment in ancient Greece, and through the middle ages in Europe, was to a great extent based on the expertise of the Greek physician Galen (c. 129-200 A.D.). Galen makes particular reference to "Olympic Victor's Dark Ointment" (OVDO), which is listed with a number of collyria. Galen states that OVDO can be useful for treating extreme pain and swellings, forming one of the best eye salves. Olympic Victor's Dark Ointment, an opium-based treatment, forms a "patch" when applied externally as an ointment, because it quickly dries to cover a localized region but still retains its elastic properties. This study has recreated OVDO and applied the ointment to abdominal mouse skin, in vitro. To assess the efficacy of OVDO, the transdermal transfer of morphine was measured when given as OVDO and compared to morphine administered in the form of a solution of Opium + PBS (ringer). Olympic Victor's Dark Ointment showed a transdermal transfer of morphine over time comparable to 25% of the most efficient modern transdermal opioid patches, while hardly any morphine was able to penetrate the skin when applied mixed in PBS. We conclude that OVDO is very efficient in its composition and may carry some forgotten abilities in terms of drug delivery, which could be transferred to modern medicine. Indeed, this may lead to a better choice of morphine use and controlled management in individual patient cases, taking both pain relief and anti-inflammatory aspects into account. PMID:22448887

  9. Diagnosis and treatment of acute low back pain.

    PubMed

    Casazza, Brian A

    2012-02-15

    Acute low back pain is one of the most common reasons for adults to see a family physician. Although most patients recover quickly with minimal treatment, proper evaluation is imperative to identify rare cases of serious underlying pathology. Certain red flags should prompt aggressive treatment or referral to a spine specialist, whereas others are less concerning. Serious red flags include significant trauma related to age (i.e., injury related to a fall from a height or motor vehicle crash in a young patient, or from a minor fall or heavy lifting in a patient with osteoporosis or possible osteoporosis), major or progressive motor or sensory deficit, new-onset bowel or bladder incontinence or urinary retention, loss of anal sphincter tone, saddle anesthesia, history of cancer metastatic to bone, and suspected spinal infection. Without clinical signs of serious pathology, diagnostic imaging and laboratory testing often are not required. Although there are numerous treatments for nonspecific acute low back pain, most have little evidence of benefit. Patient education and medications such as nonsteroidal anti-inflammatory drugs, acetaminophen, and muscle relaxants are beneficial. Bed rest should be avoided if possible. Exercises directed by a physical therapist, such as the McKenzie method and spine stabilization exercises, may decrease recurrent pain and need for health care services. Spinal manipulation and chiropractic techniques are no more effective than established medical treatments, and adding them to established treatments does not improve outcomes. No substantial benefit has been shown with oral steroids, acupuncture, massage, traction, lumbar supports, or regular exercise programs. PMID:22335313

  10. Pain Reduction in Myofascial Pain Syndrome by Anodal Transcranial Direct Current Stimulation Combined with Standard Treatment: A Randomized Controlled Study

    PubMed Central

    Sakrajai, Piyaraid; Janyacharoen, Taweesak; Jensen, Mark P.; Sawanyawisuth, Kittisak; Auvichayapat, Narong; Tunkamnerdthai, Orathai; Keeratitanont, Keattichai; Auvichayapat, Paradee

    2014-01-01

    Background Myofascial pain syndrome (MPS) in the shoulder is among the most prevalent pain problems in the middle-aged population worldwide. Evidence suggests that peripheral and central sensitization may play an important role in the development and maintenance of shoulder MPS. Given previous research supporting the potential efficacy of anodal transcranial direct current stimulation (tDCS) for modulating pain-related brain activity in individuals with refractory central pain, we hypothesized that anodal tDCS when applied over the primary motor cortex (M1) combined with standard treatment will be more effective for reducing pain in patients with MPS than standard treatment alone. Method Study participants were randomized to receive either (1) standard treatment with 5-consecutive days of 1 mA anodal tDCS over M1 for 20 min or (2) standard treatment plus sham tDCS. Measures of pain intensity, shoulder passive range of motion, analgesic medication use, and self-reported physical functioning were administered before treatment and again at post-treatment and 1-, 2-, 3-and 4-week follow-up. Results Thirty-one patients with MPS were enrolled. Participants assigned to the active tDCS condition reported significantly more pre- to post-treatment reductions in pain intensity that were maintained at 1-week post-treatment, and significant improvement in shoulder adduction PROM at 1-week follow-up than participants assigned to the sham tDCS condition. Conclusion 5 consecutive days of anodal tDCS over M1 combined with standard treatment appears to reduce pain intensity, and may improve PROM, faster than standard treatment alone. Further tests of the efficacy and duration of effects of tDCS in the treatment of MPS are warranted. PMID:25373724

  11. Process evaluation of podiatric treatment of patients with forefoot pain

    PubMed Central

    2013-01-01

    Background Foot pain is a common problem for people aged 50 and over and occurs more often in women than in men. About 60% of the foot problems are forefoot problems and slightly more than half of these patients seek medical help, mainly in the form of podiatric care. Podiatric treatment of forefoot problems is known to be heterogeneous. The aims of the present study are to describe the podiatric treatment of patients with forefoot pain and to evaluate the podiatric examination and treatment using an expert panel. Method We invited twenty-five randomly selected subjects with forefoot problems who had received podiatric treatment in a pragmatic randomised clinical trial to participate in an analysis of their treatment by an expert panel. The panel retrospectively established the cause of the foot problem as well as the therapeutic goals and evaluated the treatment. These findings were compared to those reported by the treating podiatrist. Results Two fundamentally different approaches were found in approach of podiatric examination; a functional approach (n =13) and a non-functional approach (n =12). In nine cases the expert panel agreed with the cause recorded by the podiatrist. In five other cases the expert panel concluded that the treatment of the podiatrist was not consistent with the cause of the problem recorded by the podiatrist. Of the 10 patients for whom the podiatrist had recorded to have given shoe advice, only two were able to recollect the proper advice. Three patients did not remember receiving advice at all. Conclusion In this study almost half of the podiatrists worked according to a non-functional approach where the other half (like the expert panel) chose a functional strategy that analyses the underlying problem. Fundamental differences in treatment plans and thus heterogeneous treatments could be a consequence. PMID:23919765

  12. The Quality of Pain Treatment in Community-Dwelling Persons with Dementia

    PubMed Central

    Li, Jiwen; Snow, A. Lynn; Wilson, Nancy; Stanley, Melinda A.; Morgan, Robert O.; Sansgiry, Shubhada; Kunik, Mark E.

    2015-01-01

    Background/Aims Despite pervasive and debilitating pain among elders, it is underassessed and undertreated; and cognitive impairment can add challenges. We assessed the quality of pain care for community-dwelling elderly patients with dementia. Methods We phone interviewed 203 Veterans Affairs primary care outpatients with dementia and pain and reviewed medical records to score 15 quality indicators of pain assessment and management. Results Pain assessment was documented for 98%, and a standard pain scale was used for 94%. Modified pain scales were rarely used. Though 70% self-reported pain of ‘quite bad’ or worse, charts documented no pain in 64%. When pain was identified, treatment was offered to 80%; but only 59% had a follow-up assessment within 6 months. Nonpharmacological interventions were underused. Conclusion Community-dwelling elders with dementia are underdiagnosed and undertreated for pain.

  13. Ulnar-sided wrist pain. II. Clinical imaging and treatment

    PubMed Central

    Watanabe, Atsuya; Souza, Felipe; Vezeridis, Peter S.; Blazar, Philip

    2009-01-01

    Pain at the ulnar aspect of the wrist is a diagnostic challenge for hand surgeons and radiologists due to the small and complex anatomical structures involved. In this article, imaging modalities including radiography, arthrography, ultrasound (US), computed tomography (CT), CT arthrography, magnetic resonance (MR) imaging, and MR arthrography are compared with regard to differential diagnosis. Clinical imaging findings are reviewed for a more comprehensive understanding of this disorder. Treatments for the common diseases that cause the ulnar-sided wrist pain including extensor carpi ulnaris (ECU) tendonitis, flexor carpi ulnaris (FCU) tendonitis, pisotriquetral arthritis, triangular fibrocartilage complex (TFCC) lesions, ulnar impaction, lunotriquetral (LT) instability, and distal radioulnar joint (DRUJ) instability are reviewed. PMID:20012039

  14. Update on neuropathic pain treatment for trigeminal neuralgia

    PubMed Central

    Al-Quliti, Khalid W.

    2015-01-01

    Trigeminal neuralgia is a syndrome of unilateral, paroxysmal, stabbing facial pain, originating from the trigeminal nerve. Careful history of typical symptoms is crucial for diagnosis. Most cases are caused by vascular compression of the trigeminal root adjacent to the pons leading to focal demyelination and ephaptic axonal transmission. Brain imaging is required to exclude secondary causes. Many medical and surgical treatments are available. Most patients respond well to pharmacotherapy; carbamazepine and oxcarbazepine are first line therapy, while lamotrigine and baclofen are considered second line treatments. Other drugs such as topiramate, levetiracetam, gabapentin, pregabalin, and botulinum toxin-A are alternative treatments. Surgical options are available if medications are no longer effective or tolerated. Microvascular decompression, gamma knife radiosurgery, and percutaneous rhizotomies are most promising surgical alternatives. This paper reviews the medical and surgical therapeutic options for the treatment of trigeminal neuralgia, based on available evidence and guidelines. PMID:25864062

  15. Massage Impact on Pain in Opioid-dependent Patients in Substance Use Treatment

    PubMed Central

    Wiest, Katharina L.; Asphaug, Victoria J.; Carr, Kathryn E.; Gowen, Emily A.; Hartnett, Timothy T.

    2015-01-01

    Background: Chronic pain is a common cause of health care utilization and high levels of pain are pronounced in individuals engaged in methadone maintenance treatment. Although massage has been demonstrated to alleviate chronic pain symptoms, its use as an adjunctive therapy to modify pain during opioid-replacement treatment is absent from the literature. Purpose: To consider the efficacy of Swedish massage in reducing pain in opioid-dependent patients with chronic pain receiving methadone treatment. Setting: Trial was conducted at a nonprofit methadone treatment center serving low-income patients. Research Design: A randomized clinical trial with randomized to either 1) massage plus treatment-as-usual (TAU) (n = 27) or 2) TAU (n = 24). Durability of treatment effect was evaluated at Week 12. Intervention: Eight weekly 50-minute Swedish massage sessions plus TAU or TAU alone. Main Outcome Measures: Pain, anxiety, depression, physical functioning, decreased substance use, and improvement in treatment engagement. Results: Randomized participants were comparable at Baseline for demographic, pain, physical, and emotional variables. Massage group reported improved pain scores; worst pain had a clinically significant 2-point improvement while the other pain scores did not. Overall improvements were not observed in treatment engagement or levels of anxiety, depression, or physical functioning. A subgroup of the participants, who felt they could be pain-free, consistently reported improvements in pain from Baseline to Week 8, and this was most pronounced and clinically significant in the massage group. Conclusions: These preliminary findings do not support an overall clinically significant positive effect of Swedish massage on reduction in pain ratings or improvement in anxiety, depression, or treatment engagement in a substance-using, opioid-dependent population with chronic pain. Future nonpharmacologic pain research in marginalized substance-using populations may wish

  16. Pulsed Radiofrequency Application for the Treatment of Pain Secondary to Sacroiliac Joint Metastases

    PubMed Central

    Lee, Na Rea; Kwon, Young Suk; Jang, Ji Su; Lim, So Young

    2016-01-01

    Sacroiliac (SI) joint pain can result from degeneration, infection, malignancy, and trauma. Patients with metastatic bone pain who do not respond to conventional treatment may need more aggressive neuroinvasive approaches. Recently, pulsed radiofrequency (PRF) neuromodulation has emerged as a promising treatment alternative for refractory cases of SI joint pain. Nevertheless, there is no report on the treatment of pain arising from SI joint metastases with PRF. We are reporting about a 63-year-old woman suffering from buttock pain due to breast cancer metastases in the SI joint. We treated this patient with PRF neuromodulation of the L4-S3 primary dorsal rami and lateral branches using a rotating curved needle technique. The patient tolerated the procedures well, without any complications. She experienced about 70% reduction in pain, and pain relief was sustained for 10 months. This result suggests that PRF neuromodulation is a safe, effective treatment for pain from SI joint metastases. PMID:26839672

  17. Burning through the pain: treatments for diabetic neuropathy.

    PubMed

    Javed, S; Alam, U; Malik, R A

    2015-12-01

    The rise in the global burden of diabetes is spurring an increase in the prevalence of its complications. Diabetic peripheral neuropathy (DPN) is a common and devastating complication of diabetes, with multiple clinical manifestations. The most common is a symmetrical length-dependent dysfunction and damage of peripheral nerves. The management of DPN rests on three tenets: intensive glycaemic control, even though the evidence of benefit is questionable in people with type 2 diabetes; pathogenetic therapies; and symptomatic treatment. A number of pathogenetic treatments have been evaluated in phase III clinical trials, including α-lipoic acid (stems reactive oxygen species formation), benfotiamine (prevents vascular damage) and aldose-reductase inhibitors (reduce flux through the polyol pathway), protein kinase C inhibitors (prevent hyperglycaemia-induced activation of protein kinase C), nerve growth factors (stimulate nerve regeneration) and Actovegin® (improves tissue glucose and oxygen uptake). However, none have gained US Food and Drug Administration or European Medicines Agency (EMA) approval, questioning the validity of current trial designs and the endpoints deployed to define efficacy. For painful diabetic neuropathy, clinical guidelines recommend: atypical analgesics for pain relief, including duloxetine and amitriptyline; the γ-aminobutyric acid analogues gabapentin and pregabalin; opioids, including Tapentadol; and topical agents such as lidocaine and capsaicin. No single effective treatment exists for painful DPN, highlighting a growing need for studies to evaluate more potent and targeted drugs, as well as combinations. A number of novel potential candidates, including erythropoietin analogues and angiotensin II type 2 receptor anatagonists are currently being evaluated in phase II clinical trials. PMID:26179288

  18. [Femoral nerve block as pain relief in hip fracture. A good alternative in perioperative treatment proved by a prospective study].

    PubMed

    Kullenberg, Björn; Ysberg, Benita; Heilman, Martin; Resch, Sylvia

    2004-06-10

    Almost 25% of all patients with hip fracture experience temporary confusion pre- and directly postoperatively due to trauma, advanced age, transport between units, and the use of analgesics, 35-50% of the patients suffer temporary or chronic decubitus. Analgesics often lead to nausea. A femoral nerve block can interrupt sensory impulses from the hip joint and provide complete pain relief without affecting the CNS, thus making preoperative care easier and postoperative rehabilitation can be started earlier. 80 consecutive patients with hip fracture were randomized to femoral nerve block or pharmacological treatment only. Paracetamol and tramadol were the standard analgesics used. All patients were followed up with regard to pain, duration of the block, number of analgesics doses, temporary confusion and time for postoperative mobilization. Pain was estimated by the patients using the visual analogue scale (VAS). A nerve block was performed to block the femoral nerve, the lateral femoral cutaneous nerve and the obturator nerve with 30 ml of ropivacaine 7.5 mg/ml. Mental status was evaluated with Pfeiffer-test. All patients experienced relatively intense pain on admission with an average VAS of 6. After nerve block the VAS was 2. Pain relief was the same in the control group. Pain relief was sustained for 15 hours. The time for mobilization after surgery was significantly lower, 23 hours compared to 36 for the control group. There was a lower number of patients temporarily confused in the block group compared to the control group, however no significant differences were seen. Femoral nerve block provides adequate pain relief, equivalent to pharmacological treatment in most patients. The time for postoperative mobilization was shorter and less temporary confusion was seen. There were no complications in this group, making nerve block a good alternative to traditional pharmacological preoperative treatment for patients with hip fractures. PMID:15282985

  19. Virtual Reality Hypnosis In The Treatment Of Chronic Neuropathic Pain: A Case Report

    PubMed Central

    Oneal, Brent J.; Patterson, David R.; Soltani, Maryam; Teeley, Aubriana; Jensen, Mark P.

    2009-01-01

    This case report evaluates virtual reality hypnosis (VRH) in treating chronic neuropathic pain in a patient with a 5-year history of failed treatments. The patient participated in a 6-month trial of VRH, and her pain ratings of intensity and unpleasantness dropped on average 36% and 33%, respectively, over the course of 33 sessions. In addition, she reported both no pain and a reduction of pain for an average of 3.86 and 12.21 hours, respectively, after treatment sessions throughout the course of the VRH treatment. These reductions and the duration of treatment effects following VRH treatment were superior to those following a trial of standard hypnosis (non-VR) treatment. However, the pain reductions with VRH did not persist over long periods of time. The findings support the potential of VRH treatment for helping individuals with refractory chronic pain conditions. PMID:18726807

  20. Virtual reality hypnosis in the treatment of chronic neuropathic pain: a case report.

    PubMed

    Oneal, Brent J; Patterson, David R; Soltani, Maryam; Teeley, Aubriana; Jensen, Mark P

    2008-10-01

    This case report evaluates virtual reality hypnosis (VRH) in treating chronic neuropathic pain in a patient with a 5-year history of failed treatments. The patient participated in a 6-month trial of VRH, and her pain ratings of intensity and unpleasantness dropped on average 36% and 33%, respectively, over the course of 33 sessions. In addition, she reported both no pain and a reduction of pain for an average of 3.86 and 12.21 hours, respectively, after treatment sessions throughout the course of the VRH treatment. These reductions and the duration of treatment effects following VRH treatment were superior to those following a trial of standard hypnosis (non-VR) treatment. However, the pain reductions with VRH did not persist over long periods of time. The findings support the potential of VRH treatment for helping individuals with refractory chronic pain conditions. PMID:18726807

  1. [Atraumatic restorative treatment in relation to pain, discomfort and dental treatment anxiety].

    PubMed

    Frencken, J E F M; Flohil, K A; de Baat, C

    2014-01-01

    Dental treatment anxiety usually develops during childhood due to a bad experience and the dental drill as well as the injection needle are the most common causes. The Atraumatic Restorative Treatment provides the opportunity to provoke little or no dental treatment anxiety because only hand instruments are used and local anaesthesia is seldom required. Several scientific studies have indicated that the Atraumatic Restorative Treatment causes less pain, discomfort and anxiety by comparison with conventional treatments. Therefore, the Atraumatic Restorative Treatment is considered to be promising for the treatment of carious lesions in anxious children and adults, and potentially also for patients suffering from dental treatment phobia. Furthermore, the Atraumatic Restorative Treatment may be indicated as the primary treatment method in children to prevent dental treatment anxiety and treatment under general anaesthesia. These conclusions must still be confirmed with responsible scientific research. PMID:25174188

  2. Allopathic, complementary, and alternative medical treatment utilization for pain among methadone-maintained patients: An exploratory study1

    PubMed Central

    Barry, Declan T.; Beitel, Mark; Cutter, Christopher J.; Garnet, Brian; Joshi, Dipa; Schottenfeld, Richard S.; Rounsaville, Bruce J.

    2009-01-01

    We surveyed 150 methadone maintenance treatment program (MMTP) patients about pain, pain treatment utilization, perceived efficacy of prior pain treatment, and interest in pursuing pain treatment at the MMTP. Respondents with chronic severe pain (CSP) (i.e., pain lasting at least 6 months with moderate to severe pain intensity or significant pain interference) and “some pain” (i.e., pain reported in the previous week but not CSP) endorsed similar rates of past-week and lifetime allopathic or standard medical (with the exception of lifetime medical use of non-opiate medication) and complementary and alternative medicine (CAM) utilization for pain reduction. Prior pain treatments were perceived to be less effective by CSP than SP patients but both groups had equivalent high rates of interest in pain treatment associated with the MMTP. These findings may have implications for resource and program planning in MMT programs. PMID:19874157

  3. Various Strategies for Pain-Free Root Canal Treatment

    PubMed Central

    Parirokh, Masoud; V. Abbott, Paul

    2014-01-01

    Introduction: Achieving successful anesthesia and performing pain-free root canal treatment are important aims in dentistry. This is not always achievable and therefore, practitioners are constantly seeking newer techniques, equipments, and anesthetic solutions for this very purpose. The aim of this review is to introduce strategies to achieve profound anesthesia particularly in difficult cases. Materials and Methods: A review of the literature was performed by electronic and hand searching methods for anesthetic agents, techniques, and equipment. The highest level of evidence based investigations with rigorous methods and materials were selected for discussion. Results: Numerous studies investigated to pain management during root canal treatment; however, there is still no single technique that will predictably provide profound pulp anesthesia. One of the most challenging issues in endodontic practice is achieving a profound anesthesia for teeth with irreversible pulpitis especially in mandibular posterior region. Conclusion: According to most investigations, achieving a successful anesthesia is not always possible with a single technique and practitioners should be aware of all possible alternatives for profound anesthesia. PMID:24396370

  4. Does adherence to treatment mediate the relationship between patients' treatment outcome expectancies and the outcomes of pain intensity and recovery from acute low back pain?

    PubMed

    Haanstra, Tsjitske M; Kamper, Steven J; Williams, Christopher M; Spriensma, Alette S; Lin, Chung-Wei Christine; Maher, Christopher G; de Vet, Henrica C W; Ostelo, Raymond W J G

    2015-08-01

    It is believed that patients' expectancies about the effectiveness of treatment influence their treatment outcomes, but the working mechanism is rarely studied in patients with low back pain. Theoretical models suggest that adherence to treatment may be an important pathway. The aim of this study was to assess the mediating role of adherence to treatment in the relationship between expectancies and the outcomes of recovery and pain intensity in patients with acute low back pain. This study used data from a randomized placebo-controlled trial of paracetamol for acute low back pain. Expectancies were measured with the Credibility Expectancy Questionnaire. Adherence was measured with a medication diary. Pain intensity was recorded daily in a diary on a 0 to 10 pain scale, and recovery was defined as the first of 7 consecutive days scoring 0 or 1 on a 6-point pain scale. Cox regression (dependent variable: recovery) and linear mixed-model analyses (dependent variable: daily pain intensity scores) were performed. The "difference in coefficients" approach was used to establish mediation. A total of 1573 participants were included in current analyses. There was a small but highly significant relationship between expectancies and outcomes; 3.3% of the relationship between expectancies and recovery and 14.2% of the relationship between expectancies and pain intensity were mediated by adherence to treatment. This study does not convincingly support the theory that adherence is a key pathway in the relationship between treatment outcome expectancies and recovery and pain intensity in this acute low back pain population. PMID:25906348

  5. Chronic pain relief after the exposure of nitrous oxide during dental treatment: longitudinal retrospective study.

    PubMed

    Mattos Júnior, Francisco Moreira; Mattos, Rafael Villanova; Teixeira, Manoel Jacobsen; Siqueira, Silvia Regina Dowgan Tesseroli de; Siqueira, Jose Tadeu Tesseroli de

    2015-07-01

    The objective was to investigate the effect of nitrous/oxygen in chronic pain. Seventy-seven chronic pain patients referred to dental treatment with conscious sedation with nitrous oxide/oxygen had their records included in this research. Data were collected regarding the location and intensity of pain by the visual analogue scale before and after the treatment. Statistical analysis was performed comparing pre- and post-treatment findings. It was observed a remarkable decrease in the prevalence of pain in this sample (only 18 patients still had chronic pain, p < 0.001) and in its intensity (p < 0.001). Patients that needed fewer sessions received higher proportions of nitrous oxide/oxygen. Nitrous oxide may be a tool to be used in the treatment of chronic pain, and future prospective studies are necessary to understand the underlying mechanisms and the effect of nitrous oxide/oxygen in patients according to the pain diagnosis and other characteristics. PMID:26200051

  6. Do minimally invasive procedures have a place in the treatment of chronic low back pain?

    PubMed

    Cahana, Alex; Mavrocordatos, Philippe; Geurts, Jos W M; Groen, Gerbrand J

    2004-05-01

    Chronic low back pain is the leading cause of disability in the industrialized world. Medical and surgical treatments remain costly despite limited efficacy. The field of 'interventional pain' has grown enormously and evidence-based practice guidelines are systematically developed. In this article, the vast, complex and contradictory literature regarding the treatment of chronic low back pain is reviewed. Interventional pain literature suggests that there is moderate evidence (small randomized, nonrandomized, single group or matched-case controlled studies) for medial branch neurotomy and limited evidence (nonexperimental one or more center studies) for intradiscal treatments in mechanical low back pain. There is moderate evidence for the use of transforaminal epidural steroid injections, lumbar percutaneous adhesiolysis and spinal endoscopy for painful lumbar radiculopathy, and spinal cord stimulation and intrathecal pumps mostly after spinal surgery. In reality, there is no gold standard for the treatment of chronic low back pain, but these results appear promising. PMID:15853544

  7. Predictive factors for the outcome of multidisciplinary treatments in chronic low back pain at the first multidisciplinary pain center of Japan.

    PubMed

    Hayashi, Kazuhiro; Arai, Young-Chang P; Ikemoto, Tatsunori; Nishihara, Makoto; Suzuki, Shigeyuki; Hirakawa, Tomoe; Matsuo, Shingo; Kobayashi, Mami; Haruta, Midori; Kawabata, Yuka; Togo, Hiroki; Noguchi, Taiji; Hase, Toshiyuki; Hatano, Genki; Ushida, Takahiro

    2015-09-01

    [Purpose] Multidisciplinary treatments are recommended for treatment of chronic low back pain. The aim of this study was to show the associations among multidisciplinary treatment outcomes, pretreatment psychological factors, self-reported pain levels, and history of pain in chronic low back pain patients. [Subjects and Methods] A total of 221 chronic low back pain patients were chosen for the study. The pretreatment scores for the 10-cm Visual Analogue Scale, Hospital Anxiety and Depression Scale, Pain Catastrophizing Scale, Short-Form McGill Pain Questionnaire, Pain Disability Assessment Scale, pain drawings, and history of pain were collected. The patients were divided into two treatment outcome groups a year later: a good outcome group and a poor outcome group. [Results] One-hundred eighteen patients were allocated to the good outcome group. The scores for the Visual Analogue Scale, Pain Disability Assessment Scale, and affective subscale of the Short-Form McGill Pain Questionnaire and number of nonorganic pain drawings in the good outcome group were significantly lower than those in the poor outcome group. Duration of pain in the good outcome group was significantly shorter than in the poor outcome group. [Conclusion] These findings help better predict the efficacy of multidisciplinary treatments in chronic low back pain patients. PMID:26504321

  8. Predictive factors for the outcome of multidisciplinary treatments in chronic low back pain at the first multidisciplinary pain center of Japan

    PubMed Central

    Hayashi, Kazuhiro; Arai, Young-Chang P.; Ikemoto, Tatsunori; Nishihara, Makoto; Suzuki, Shigeyuki; Hirakawa, Tomoe; Matsuo, Shingo; Kobayashi, Mami; Haruta, Midori; Kawabata, Yuka; Togo, Hiroki; Noguchi, Taiji; Hase, Toshiyuki; Hatano, Genki; Ushida, Takahiro

    2015-01-01

    [Purpose] Multidisciplinary treatments are recommended for treatment of chronic low back pain. The aim of this study was to show the associations among multidisciplinary treatment outcomes, pretreatment psychological factors, self-reported pain levels, and history of pain in chronic low back pain patients. [Subjects and Methods] A total of 221 chronic low back pain patients were chosen for the study. The pretreatment scores for the 10-cm Visual Analogue Scale, Hospital Anxiety and Depression Scale, Pain Catastrophizing Scale, Short-Form McGill Pain Questionnaire, Pain Disability Assessment Scale, pain drawings, and history of pain were collected. The patients were divided into two treatment outcome groups a year later: a good outcome group and a poor outcome group. [Results] One-hundred eighteen patients were allocated to the good outcome group. The scores for the Visual Analogue Scale, Pain Disability Assessment Scale, and affective subscale of the Short-Form McGill Pain Questionnaire and number of nonorganic pain drawings in the good outcome group were significantly lower than those in the poor outcome group. Duration of pain in the good outcome group was significantly shorter than in the poor outcome group. [Conclusion] These findings help better predict the efficacy of multidisciplinary treatments in chronic low back pain patients. PMID:26504321

  9. Analyzing multiple endpoints in clinical trials of pain treatments: IMMPACT recommendations. Initiative on Methods, Measurement, and Pain Assessment in Clinical Trials.

    PubMed

    Turk, Dennis C; Dworkin, Robert H; McDermott, Michael P; Bellamy, Nicholas; Burke, Laurie B; Chandler, Julie M; Cleeland, Charles S; Cowan, Penney; Dimitrova, Rozalina; Farrar, John T; Hertz, Sharon; Heyse, Joseph F; Iyengar, Smriti; Jadad, Alejandro R; Jay, Gary W; Jermano, John A; Katz, Nathaniel P; Manning, Donald C; Martin, Susan; Max, Mitchell B; McGrath, Patrick; McQuay, Henry J; Quessy, Steve; Rappaport, Bob A; Revicki, Dennis A; Rothman, Margaret; Stauffer, Joseph W; Svensson, Ola; White, Richard E; Witter, James

    2008-10-31

    The increasing complexity of randomized clinical trials and the practice of obtaining a wide variety of measurements from study participants have made the consideration of multiple endpoints a critically important issue in the design, analysis, and interpretation of clinical trials. Failure to consider important outcomes can limit the validity and utility of clinical trials; specifying multiple endpoints for the evaluation of treatment efficacy, however, can increase the rate of false positive conclusions about the efficacy of a treatment. We describe the use of multiple endpoints in the design, analysis, and interpretation of pain clinical trials, and review available strategies and methods for addressing multiplicity. To decrease the probability of a Type I error (i.e., the likelihood of obtaining statistically significant results by chance) in pain clinical trials, the use of gatekeeping procedures and other methods that correct for multiple analyses is recommended when a single primary endpoint does not adequately reflect the overall benefits of treatment. We emphasize the importance of specifying in advance the outcomes and clinical decision rule that will serve as the basis for determining that a treatment is efficacious and the methods that will be used to control the overall Type I error rate. PMID:18706763

  10. [Structure of pain management facilities in Germany : Classification of medical and psychological pain treatment services-Consensus of the Joint Commission of the Professional Societies and Organizations for Quality in Pain Medicine].

    PubMed

    Müller-Schwefe, G H H; Nadstawek, J; Tölle, T; Nilges, P; Überall, M A; Laubenthal, H J; Bock, F; Arnold, B; Casser, H R; Cegla, T H; Emrich, O M D; Graf-Baumann, T; Henning, J; Horlemann, J; Kayser, H; Kletzko, H; Koppert, W; Längler, K H; Locher, H; Ludwig, J; Maurer, S; Pfingsten, M; Schäfer, M; Schenk, M; Willweber-Strumpf, A

    2016-06-01

    On behalf of the Medical/Psychological Pain Associations, Pain Patients Alliance and the Professional Association of Pain Physicians and Psychologists, the Joint Commission of Professional Societies and Organizations for Quality in Pain Medicine, working in close collaboration with the respective presidents, has developed verifiable structural and process-related criteria for the classification of medical and psychological pain treatment facilities in Germany. Based on the established system of graded care in Germany and on existing qualifications, these criteria also argue for the introduction of a basic qualification in pain medicine. In addition to the first-ever comprehensive description of psychological pain facilities, the criteria presented can be used to classify five different levels of pain facilities, from basic pain management facilities, to specialized institutions, to the Centre for Interdisciplinary Pain Medicine. The recommendations offer binding and verifiable criteria for quality assurance in pain medicine and improved pain treatment. PMID:27221745

  11. It's Not Your Heart: Group Treatment for Non-Cardiac Chest Pain

    ERIC Educational Resources Information Center

    Hess, Sherry M.

    2011-01-01

    This article presents a brief group psychoeducational treatment for non-cardiac chest pain, supplemented with a composite case study. Patients present to emergency rooms for chest pain they believe is a heart attack symptom. When cardiac testing is negative, this pain is usually a panic symptom, often occurring with a cluster of other panic…

  12. Changes of Pain Perception, Autonomic Function, and Endocrine Parameters during Treatment of Anorectic Adolescents

    ERIC Educational Resources Information Center

    Bar, Karl-Jurgen; Boettger, Silke; Wagner, Gerd; Wilsdorf, Christine; Gerhard, Uwe Jens; Boettger, Michael K.; Blanz, Bernhard; Sauer, Heinrich

    2006-01-01

    Objectives: The underlying mechanisms of reduced pain perception in anorexia nervosa (AN) are unknown. To gain more insight into the pathology, the authors investigated pain perception, autonomic function, and endocrine parameters before and during successful treatment of adolescent AN patients. Method: Heat pain perception was assessed in 15…

  13. Effect of Behavioral Activation Treatment on Fibromyalgia-Related Pain Anxiety Cognition

    ERIC Educational Resources Information Center

    Lundervold, Duane A.; Talley, Chris; Buermann, Michael

    2006-01-01

    Effects of Behavioral Activation Treatment (BAT) on pain anxiety, depression, and pain interference on a 43-year-old female with an 11-year history of chronic fibromyalgia pain are described. Analgesic, anxyiolytic, and antidepressant medications were stabilized prior to participation. Dependent measures were the Behavioral Relaxation Scale, a…

  14. Treating Chronic Pain in Veterans Presenting to an Addictions Treatment Program

    ERIC Educational Resources Information Center

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

    2011-01-01

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

  15. The Pain and Opioids IN Treatment study: characteristics of a cohort using opioids to manage chronic non-cancer pain.

    PubMed

    Campbell, Gabrielle; Nielsen, Suzanne; Bruno, Raimondo; Lintzeris, Nicholas; Cohen, Milton; Hall, Wayne; Larance, Briony; Mattick, Richard P; Degenhardt, Louisa

    2015-02-01

    There has been a recent increase in public and professional concern about the prescription of strong prescription opioids for pain. Despite this concern, research to date has been limited because of a number of factors such as small sample sizes, exclusion of people with complex comorbidities, and studies of short duration. The Pain and Opioids IN Treatment is a 2-year prospective cohort study of 1500 people prescribed with pharmaceutical opioids for their chronic pain. This article provides an overview of the demographic and clinical characteristics of the cohort using the baseline data of 1514 community-based people across Australia. Participants had been in pain for a period of 10 years and had been on prescription opioids for approximately 4 years. One in 10 was on a daily morphine equivalent dose of ≥200 mg. Employment and income levels were low, and two-thirds of the sample reported that their pain had impacted on their employment status. Approximately 50% screened positive for current moderate-to-severe depression, and 1 in 5 had made a lifetime suicide attempt. There were a number of age-related differences. The younger groups experienced higher levels of pain and pain interference, more mental health and substance use issues, and barriers to treatment, compared with the older group. This study found that the people who have been prescribed strong opioids for chronic pain have very complex demographic and clinical profiles. Major age-related differences in the experiences of pain, coping, mental health, and substance use suggest the necessity of differential approaches to treatment. PMID:25599444

  16. Novel Treatment of Chronic Bladder Pain Syndrome and Other Pelvic Pain Disorders by OnabotulinumtoxinA Injection

    PubMed Central

    Jhang, Jia-Fong; Kuo, Hann-Chorng

    2015-01-01

    Chronic pelvic pain (CPP) is defined as pain in the pelvic organs and related structures of at least 6 months’ duration. The pathophysiology of CPP is uncertain, and its treatment presents challenges. Botulinum toxin A (BoNT-A), known for its antinociceptive, anti-inflammatory, and muscle relaxant activity, has been used recently to treat refractory CPP with promising results. In patients with interstitial cystitis/bladder pain syndrome, most studies suggest intravesical BoNT-A injection reduces bladder pain and increases bladder capacity. Repeated BoNT-A injection is also effective and reduces inflammation in the bladder. Intraprostatic BoNT-A injection could significantly improve prostate pain and urinary frequency in the patients with chronic prostatitis/chronic pelvic pain syndrome. Animal studies also suggest BoNT-A injection in the prostate decreases inflammation in the prostate. Patients with CPP due to pelvic muscle pain and spasm also benefit from localized BoNT-A injections. BoNT-A injection in the pelvic floor muscle improves dyspareunia and decreases pelvic floor pressure. Preliminary studies show intravesical BoNT-A injection is useful in inflammatory bladder diseases such as chemical cystitis, radiation cystitis, and ketamine related cystitis. Dysuria is the most common adverse effect after BoNT-A injection. Very few patients develop acute urinary retention after treatment. PMID:26094697

  17. Pain issues and treatment of the person with an amputation.

    PubMed

    Uustal, Heikki; Meier, Robert H

    2014-02-01

    Most people with amputations should not experience pain that interferes with their quality of life or requires regular medication more than 6 months following the amputation surgery. In fact, most people with amputations do not experience significant pain more than 3 months following the amputation. However, the clinician must specifically define what these patients mean when they relate that they have pain. The pain must be carefully differentiated to treat it properly. Most problematic pain that is present more than 6 months after amputation is related to a poorly fitting prosthesis and should be labeled as residual limb pain. PMID:24287239

  18. Auricular point acupressure for chronic pain: a feasibility study of a 4-week treatment protocol.

    PubMed

    Yeh, Chao Hsing; Chien, Lung-Chang; Huang, Li Chun; Suen, Lorna Kwai-Ping

    2014-01-01

    This 1-group, 4-week observational study aimed to (1) assess the feasibility of recruiting, retention, and completion of a 4-week auricular point acupressure (APA) treatment protocol for chronic pain in adult patients and (2) assess the effects of APA in pain reduction (pain severity and pain interference) among these patients. The participants received a 4-week APA treatment protocol in weekly cycles. Each weekly cycle included 5 days with APA seeds taped onto the ear and 2 days without. Each participant was called every day to monitor adherence to the treatment protocol (the actual times the participant pressed the seeds each day and the duration of applied pressure), to answer analgesic use, and to answer the pain intensity questionnaire. Thirty participants were initially enrolled in this study, but 5 did not continue. The retention rate was 83% (n = 25). Approximately 60% of the participants (n = 15) adhered to the 4-week APA and completed all data assessments. At baseline assessment, only 40% of all participants (n = 12 of 30) were confident that APA would reduce and eliminate pain; nonetheless, all participants reported fewer episodes of pain occurrences and pain intensity with the APA treatment. For the participants who completed the 4-week APA protocol (n = 15), 96% (n = 14) decreased analgesic medication intake and 88% (n = 13) felt "much better" after the APA treatment. Participants reported an average reduction of 63% in the worst pain intensity at day 7. By the end of the 4-week APA protocol, an even greater reduction in pain intensity was reported (66%, n = 10, at day 28). The participants who did not complete the treatment protocol reported an average pain reduction of 29%, which fluctuated to 22% before they dropped out. Auricular point acupressure is feasible for patients with chronic pain. The preliminary findings of this feasibility study show a reduction in pain intensity and improvement in physical function, which demonstrate the potential for

  19. Virtual reality hypnosis pain control in the treatment of multiple fractures: a case series.

    PubMed

    Teeley, Aubriana M; Soltani, Maryam; Wiechman, Shelley A; Jensen, Mark P; Sharar, Sam R; Patterson, David R

    2012-01-01

    This case series evaluated the use of virtual reality hypnosis (VRH) for the treatment of pain associated with multiple fractures from traumatic injuries. VRH treatment was administered on 2 consecutive days, and pain and anxiety were assessed each day before and after VRH treatment as well as on Day 3, which was 24 hours after the second treatment session. Pain reduction from baseline to Day 3 was from 70% to 30%, despite opioid analgesic use remaining stable. The subjective pain reduction reported by patients was encouraging, and the results of this case series suggest the importance of further study of VRH with larger samples using randomized controlled trials. PMID:22443021

  20. Morphine for the Treatment of Pain in Sickle Cell Disease

    PubMed Central

    Ballas, Samir K.

    2015-01-01

    Pain is a hallmark of sickle cell disease (SCD) and its treatment remains challenging. Opioids are the major family of analgesics that are commonly used for treating severe pain. However, these are not always effective and are associated with the liabilities of their own. The pharmacology and multiorgan side effects of opioids are rapidly emerging areas of investigation, but there remains a scarcity of clinical studies. Due to opioid-induced endothelial-, mast cell-, renal mesangial-, and epithelial-cell-specific effects and proinflammatory as well as growth influencing signaling, it is likely that when used for analgesia, opioids may have organ specific pathological effects. Experimental and clinical studies, even though extremely few, suggest that opioids may exacerbate existent organ damage and also stimulate pathologies of their own. Because of the recurrent and/or chronic use of large doses of opioids in SCD, it is critical to evaluate the role and contribution of opioids in many complications of SCD. The aim of this review is to initiate inquiry to develop strategies that may prevent the inadvertent effect of opioids on organ function in SCD, should it occur, without compromising analgesia. PMID:25654130

  1. Alpha9 nicotinic acetylcholine receptors and the treatment of pain.

    PubMed

    McIntosh, J Michael; Absalom, Nathan; Chebib, Mary; Elgoyhen, Ana Belén; Vincler, Michelle

    2009-10-01

    Chronic pain is a vexing worldwide problem that causes substantial disability and consumes significant medical resources. Although there are numerous analgesic medications, these work through a small set of molecular mechanisms. Even when these medications are used in combination, substantial amounts of pain often remain. It is therefore highly desirable to develop treatments that work through distinct mechanisms of action. While agonists of nicotinic acetylcholine receptors (nAChRs) have been intensively studied, new data suggest a role for selective antagonists of nAChRs. alpha-Conotoxins are small peptides used offensively by carnivorous marine snails known as Conus. A subset of these peptides known as alpha-conotoxins RgIA and Vc1.1 produces both acute and long lasting analgesia. In addition, these peptides appear to accelerate the recovery of function after nerve injury, possibly through immune mediated mechanisms. Pharmacological analysis indicates that RgIA and Vc1.1 are selective antagonists of alpha9alpha10 nAChRs. A recent study also reported that these alpha9alpha10 antagonists are also potent GABA-B agonists. In the current study, we were unable to detect RgIA or Vc1.1 binding to or action on cloned GABA-B receptors expressed in HEK cells or Xenopus oocytes. We review the background, findings and implications of use of compounds that act on alpha9* nAChRs.(1). PMID:19477168

  2. The usefulness of ozone treatment in spinal pain

    PubMed Central

    Bocci, Velio; Borrelli, Emma; Zanardi, Iacopo; Travagli, Valter

    2015-01-01

    Objective The aim of this review is to elucidate the biochemical, molecular, immunological, and pharmaceutical mechanisms of action of ozone dissolved in biological fluids. Studies performed during the last two decades allow the drawing of a comprehensive framework for understanding and recommending the integration of ozone therapy for spinal pain. Methods An in-depth screening of primary sources of information online – via SciFinder Scholar, Google Scholar, and Scopus databases as well as Embase, PubMed, and the Cochrane Database of Systemic Reviews – was performed. In this review, the most significant papers of the last 25 years are presented and their proposals critically evaluated, regardless of the bibliometric impact of the journals. Results The efficacy of standard treatments combined with the unique capacity of ozone therapy to reactivate the innate antioxidant system is the key to correcting the oxidative stress typical of chronic inflammatory diseases. Pain pathways and control systems of algesic signals after ozone administration are described. Conclusion This paper finds favors the full insertion of ozone therapy into pharmaceutical sciences, rather than as either an alternative or an esoteric approach. PMID:26028964

  3. Associations Between Pain, Current Tobacco Smoking, Depression, and Fibromyalgia Status Among Treatment-Seeking Chronic Pain Patients

    PubMed Central

    Goesling, Jenna; Brummett, Chad M.; Meraj, Taha S.; Moser, Stephanie E.; Hassett, Afton L.; Ditre, Joseph W.

    2016-01-01

    Objective As smoking impacts physiological pathways in the central nervous system, it is important to consider the association between smoking and fibromyalgia, a pain condition caused predominantly by central nervous system dysfunction. The objectives were to assess the prevalence of current smoking among treatment-seeking chronic pain patients with (FM+) and without (FM−) a fibromyalgia-like phenotype; test the individual and combined influence of smoking and fibromyalgia on pain severity and interference; and examine depression as a mediator of these processes. Methods Questionnaire data from 1566 patients evaluated for a range of conditions at an outpatient pain clinic were used. The 2011 Survey Criteria for Fibromyalgia were used to assess the presence of symptoms associated with fibromyalgia. Results Current smoking was reported by 38.7% of FM+ patients compared to 24.7% of FM− patients. FM+ smokers reported higher pain and greater interference compared to FM+ nonsmokers, FM− smokers, and FM− nonsmokers. There was no interaction between smoking and fibromyalgia. Significant indirect effects of fibromyalgia and smoking via greater depression were observed for pain severity and interference. Conclusions Current smoking and positive fibromyalgia status were associated with greater pain and impairment among chronic pain patients, possibly as a function of depression. Although FM+ smokers report the most negative clinical symptomatology (i.e., high pain, greater interference) smoking does not appear to have a unique association with pain or functioning in FM+ patients, rather the effect is additive. The 38.7% smoking rate in FM+ patients is high, suggesting FM+ smokers present a significant clinical challenge. PMID:25801019

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

    PubMed Central

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

    2014-01-01

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

  5. Genetic Variants in Cyclooxygenase- 2 Contribute to Post-treatment Pain among Endodontic Patients

    PubMed Central

    Applebaum, Elizabeth; Nackley, Andrea G.; Bair, Eric; Maixner, William; Khan, Asma A.

    2015-01-01

    Introduction Non-steroidal anti-inflammatory drugs (NSAIDs) have a well-established analgesic efficacy for inflammatory pain. These drugs exert their effect by inhibiting the enzyme cyclooxygenase (COX) and are commonly used for the management of pain following endodontic treatment. There are two distinct isoforms of COX: COX-1, which is constitutively expressed; and COX-2, which is primarily induced by inflammation. Previous studies have shown that functional human genetic variants of the COX-2 gene may explain individual variations in acute pain. The present study extends this work by examining the potential contribution of the two COX isoforms to pain after endodontic treatment. Methods Ninety-four patients treated by endodontic residents at the University of North Carolina School of Dentistry were enrolled into a prospective cohort study. Data on potential predictors of post-treatment pain was collected and all patients submitted saliva samples for genetic analysis. Non-surgical root canal therapy was performed and participants recorded pain levels for five days following. Results In this study, 63% of patients experienced at least mild pain after root canal therapy and 24% experienced moderate to severe pain. Presence of pretreatment pain was correlated with higher post-treatment pain (p=0.01). Elevated heart rate (p=0.02) and higher diastolic blood pressure (p=0.024) were also correlated with decreased post-treatment pain. Finally, we identified genetic variants in COX-2 (haplotype composed of rs2383515 G, rs5277 G, rs5275 T, and rs2206593 A) associated with post-treatment pain following endodontic treatment (p= 0.025). Conclusion Understanding the genetic basis of pain following endodontic treatment will advance its prevention and management. PMID:26081267

  6. Racial differences in pain treatment and empathy in a Canadian sample

    PubMed Central

    Kaseweter, Kimberley A; Drwecki, Brian B; Prkachin, Kenneth M

    2012-01-01

    BACKGROUND: Evidence of inadequate pain treatment as a result of patient race has been extensively documented, yet remains poorly understood. Previous research has indicated that nonwhite patients are significantly more likely to be undertreated for pain. OBJECTIVE: To determine whether previous findings of racial biases in pain treatment recommendations and empathy are generalizable to a sample of Canadian observers and, if so, to determine whether empathy biases mediate the pain treatment disparity. METHODS: Fifty Canadian undergraduate students (24 men and 26 women) watched videos of black and white patients exhibiting facial expressions of pain. Participants provided pain treatment decisions and reported their feelings of empathy for each patient. RESULTS: Participants demonstrated both a prowhite treatment bias and a prowhite empathy bias, reporting more empathy for white patients than black patients and prescribing more pain treatment for white patients than black patients. Empathy was found to mediate the effect of race on pain treatment. CONCLUSIONS: The results of the present study closely replicate those from a previous study of American observers, providing evidence that a prowhite bias is not a peculiar feature of the American population. These results also add support to the claim that empathy plays a crucial role in racial pain treatment disparity. PMID:23248809

  7. Chronic lumbar spine and radicular pain: pathophysiology and treatment.

    PubMed

    Wheeler, Anthony H; Murrey, Daniel B

    2002-04-01

    The lumbar spine forms the foundation and infrastructure of an organic skyscraper equipped with the physiologic capacity to act as a crane for lifting and a crankshaft for walking. Subjected to aging like other "human machinery," the lumbar spine adapts to the wear and tear of gravity and biomechanical loading through structural and neurochemical changes. Many of the changes are maladaptive, resulting in pain, physical and functional disability, and altered neurophysiologic circuitry. Some compensatory reactions are constructive, but others cause more interference with the organism's capacity to cope. A conceptional understanding of the multifaceted structural, biomechanical, biochemical, medical, and psychosocial influences that compose this mix elucidates the complexity of applying effective treatments. PMID:11872180

  8. Facial Pain Update: Advances in Neurostimulation for the Treatment of Facial Pain.

    PubMed

    Maniam, Rajivan; Kaye, Alan David; Vadivelu, Nalini; Urman, Richard D

    2016-04-01

    Craniofacial pain, including trigeminal neuralgia, trigeminal neuropathic pain, and persistent idiopathic facial pain, is difficult to treat and can have severe implications for suffering in patients afflicted with these conditions. In recent years, clinicians have moved beyond treating solely with pharmacological therapies, which are generally not very effective, and focused on new interventional pain procedures. These procedures have evolved as technology has advanced, and thus far, early results have demonstrated efficacy in small patient cohorts with a variety of craniofacial pain states. Some of the most promising interventional pain procedures include peripheral nerve field stimulation, high-frequency spinal cord stimulation, sphenopalatine ganglion stimulation, and deep brain stimulation. This review focuses on a better understanding of craniofacial pain and emerging interventional pain therapies. With the advent of newer miniature wireless devices and less invasive implantation techniques, this should allow for more widespread use of neurostimulation as a therapeutic modality for treating craniofacial pain. Larger studies should assist in best practice strategies vis-à-vis traditional pharmacological therapies and emerging interventional pain techniques. PMID:26896948

  9. Pain and discomfort perceived during the initial stage of active fixed orthodontic treatment

    PubMed Central

    Rakhshan, Hamid; Rakhshan, Vahid

    2015-01-01

    Background and objectives As the most common complication of orthodontic treatment, pain can negatively impact quality of life and cause patients to discontinue treatment. However, few studies have evaluated pain during orthodontic treatment, with controversial findings. This study assessed the intensity and duration of pain and discomfort caused by active orthodontic treatment. Methods This descriptive cross-sectional study examined 67 patients (22 men, 45 females; age range: 18–32 years) undergoing fixed orthodontic treatment. Patients were interviewed after the active treatment stage to assess their perceived pain and discomfort at different sites during different activities by a visual analogue scale. Frequency and duration of pain in different areas were analyzed by the chi-squared and chi-squared goodness-of-fit tests (α = 0.05). Results Among the 67 patients, 65.7% experienced general dentogingival pain or discomfort and 34.3% had localized dentogingival pain or discomfort (p = 0.010, chi-squared goodness-of-fit test). Masticating soft foods reduced discomfort (p = 0.000, chi-squared) in the tongue, cheeks, and in or around the teeth and gingivae. Pain and discomfort were mostly moderate while masticating sticky, fibrous, and firm foods. Mild pains were mostly reported during tooth brushing and while consuming soft foods (p < 0.05, chi-squared). Pain and discomfort tended to last for more than 4 weeks, except in the tongue, where pain and discomfort lasted less than 4 weeks (p < 0.05, chi-squared goodness-of-fit test). Conclusions Pain and discomfort occur for more than 4 weeks after beginning fixed orthodontic treatment. Changing diets to incorporate softer foods is recommended to alleviate pain. PMID:26082574

  10. The successful treatment of pain associated with scar tissue using acupuncture.

    PubMed

    Fang, Sheng

    2014-10-01

    In this case report, a 48-year-old female who had suffered severe scar pain for 3 months was treated with acupuncture using the Wei Ci technique (surrounding the dragon). Scar tissue usually forms after deep trauma, such as piercings, burns, and surgery, to the dermis. In Chinese Medicine, scar tissue causes local Qi and blood stagnation which lead to pain. The Wei Ci technique (surrounding the dragon) and distal points Hegu-LI-4, Taichong-LIV-3, Zusanli-ST-36 were used. The patient received a total of eight treatments in 5 weeks. The scar pain decreased from 7 to 1 or 2 on a Likert scale of 0-10, with 0 being no pain and 10 being the worst pain. Acupuncture may have a good short-term pain-relieving effect on scar pain but its long-term scar-pain-relieving effects are still unclear. PMID:25441952

  11. Treatment of interstitial cystitis/painful bladder syndrome as a neuropathic pain condition

    PubMed Central

    Vas, Lakshmi; Pattanik, Manorama; Titarmore, Vaishali

    2014-01-01

    A lady of 52 years with painful bladder syndrome/interstitial cystitis (PBS/IC) presented with chronic pelvic pain, irritative voiding with sphincter dominance on urodynamics. 3 yrs of oral analgesics, antispasmodics and intravesical therapy was ineffective. We surmised her pain, and irritative voiding to be secondary to constant straining against a dysfunctional pelvic floor. We treated PBS/IC as a neuropathic phenomenon with a combination of neuromodulator medications and continuous caudal epidural analgesia to reduce the pain induced peripheral and central sensitisation. Botulinum toxin type A injection into pelvic floor muscles appeared to address their dysfuction. Clinical and urodynamics response was encouraging. PMID:25097327

  12. Targeting cortical representations in the treatment of chronic pain: a review.

    PubMed

    Moseley, G Lorimer; Flor, Herta

    2012-01-01

    Recent neuroscientific evidence has confirmed the important role of cognitive and behavioral factors in the development and treatment of chronic pain. Neuropathic and musculoskeletal pain are associated with substantial reorganization of the primary somatosensory and motor cortices as well as regions such as the anterior cingulate cortex and insula. What is more, in patients with chronic low back pain and fibromyalgia, the amount of reorganizational change increases with chronicity; in phantom limb pain and other neuropathic pain syndromes, cortical reorganization correlates with the magnitude of pain. These findings have implications for both our understanding of chronic pain and its prevention and treatment. For example, central alterations may be viewed as pain memories that modulate the processing of both noxious and nonnoxious input to the somatosensory system and outputs of the motor and other response systems. The cortical plasticity that is clearly important in chronic pain states also offers potential targets for rehabilitation. The authors review the cortical changes that are associated with chronic pain and the therapeutic approaches that have been shown to normalize representational changes and decrease pain and discuss future directions to train the brain to reduce chronic pain. PMID:22331213

  13. Peripheral Nerve Stimulation for Treatment of Post-Amputation Pain – A Case Report

    PubMed Central

    Rauck, Richard L.; Kapural, Leonardo; Cohen, Steven P.; North, James M.; Gilmore, Christopher A.; Zang, Rosemary H.; Boggs, Joseph W.

    2012-01-01

    Many amputees suffer from post-amputation pain, which can be extremely debilitating, decrease quality of life, increase the risk of depression, and negatively affect interpersonal relationships and the ability to work. Present methods of treatment, including medications, are often unsatisfactory in reducing post-amputation pain. Electrical stimulation of the nerve innervating the painful area could reduce the pain, but peripheral nerve stimulation is rarely used to treat post-amputation pain because present methods require invasive surgical access and precise placement of the leads in close proximity (≤ 2 mm) with the nerve. The present study investigated a novel approach to peripheral nerve stimulation in which a lead was placed percutaneously a remote distance (> 1 cm) away from the femoral nerve in a patient with severe residual limb pain 33 years following a below-knee amputation. Electrical stimulation generated ≥ 75% paresthesia coverage, reduced residual limb pain by > 60%, and improved quality of life outcomes as measured by the pain interference scale of the Brief Pain Inventory-Short Form (100% reduction in pain interference), Pain Disability Index (74% reduction in disability), and the Patient Global Impression of Change (Very Much Improved) during a 2-week home trial. There were no adverse events. The ability to generate significant paresthesia coverage and pain relief with a single lead inserted percutaneously and remotely from the target nerve holds promise for providing relief of post-amputation pain. PMID:22548686

  14. Depression in patients with chronic pain attending a specialised pain treatment centre: prevalence and impact on health care costs.

    PubMed

    Rayner, Lauren; Hotopf, Matthew; Petkova, Hristina; Matcham, Faith; Simpson, Anna; McCracken, Lance M

    2016-07-01

    This cross-sectional study aimed to determine the prevalence and impact of depression on health care costs in patients with complex chronic pain. The sample included 1204 patients attending a tertiary pain management service for people with chronic disabling pain, unresponsive to medical treatment. As part of routine care, patients completed a web-based questionnaire assessing mental and physical health, functioning, and service use in the preceding 3 months. Depression was assessed using the 9-item Patient Health Questionnaire. Self-report health care utilisation was measured across 4 domains: general practitioner contacts, contacts with secondary/tertiary care doctors, accident and emergency department visits, and days hospitalised. The participation rate was 89%. Seven hundred and thirty-two patients (60.8%; 95% CI 58.0-63.6) met criteria for probable depression, and 407 (33.8%) met the threshold for severe depression. Patients with depression were more likely to be unable to work because of ill health and reported greater work absence, greater pain-related interference with functioning, lower pain acceptance, and more generalised pain. Mean total health care costs per 3-month period were £731 (95% CI £646-£817) for patients with depression, compared with £448 (95% CI £366-£530) for patients without depression. A positive association between severe depression and total health care costs persisted after controlling for key demographic, functional, and clinical covariates using multiple linear regression models. These findings reveal the extent, severity, and impact of depression in patients with chronic pain and make evident a need for action. Effective treatment of depression may improve patient health and functioning and reduce the burden of chronic pain on health care services. PMID:26963849

  15. Depression in patients with chronic pain attending a specialised pain treatment centre: prevalence and impact on health care costs

    PubMed Central

    Rayner, Lauren; Hotopf, Matthew; Petkova, Hristina; Matcham, Faith; Simpson, Anna; McCracken, Lance M.

    2016-01-01

    Abstract This cross-sectional study aimed to determine the prevalence and impact of depression on health care costs in patients with complex chronic pain. The sample included 1204 patients attending a tertiary pain management service for people with chronic disabling pain, unresponsive to medical treatment. As part of routine care, patients completed a web-based questionnaire assessing mental and physical health, functioning, and service use in the preceding 3 months. Depression was assessed using the 9-item Patient Health Questionnaire. Self-report health care utilisation was measured across 4 domains: general practitioner contacts, contacts with secondary/tertiary care doctors, accident and emergency department visits, and days hospitalised. The participation rate was 89%. Seven hundred and thirty-two patients (60.8%; 95% CI 58.0-63.6) met criteria for probable depression, and 407 (33.8%) met the threshold for severe depression. Patients with depression were more likely to be unable to work because of ill health and reported greater work absence, greater pain-related interference with functioning, lower pain acceptance, and more generalised pain. Mean total health care costs per 3-month period were £731 (95% CI £646-£817) for patients with depression, compared with £448 (95% CI £366-£530) for patients without depression. A positive association between severe depression and total health care costs persisted after controlling for key demographic, functional, and clinical covariates using multiple linear regression models. These findings reveal the extent, severity, and impact of depression in patients with chronic pain and make evident a need for action. Effective treatment of depression may improve patient health and functioning and reduce the burden of chronic pain on health care services. PMID:26963849

  16. Vertebral augmentation treatment of painful osteoporotic compression fractures with the Kiva VCF Treatment System

    PubMed Central

    Olivarez, Luis M. Rosales; Dipp, Juan M.; Escamilla, Ricardo Flores; Bajares, Guillermo; Perez, Alejandro; Stubbs, Harrison A.; Block, Jon E.

    2011-01-01

    Background Vertebral compression fractures (VCFs) can cause significant pain and functional impairment, and their cumulative effect can lead to progressive morbidity. This single-arm, prospective feasibility trial, conducted at 4 clinical sites, was undertaken to evaluate the clinical outcomes associated with the use of an innovative vertebral augmentation device, the Kiva VCF Treatment System (Benvenue Medical, Santa Clara, California), in the management of symptomatic VCFs associated with osteoporosis. Methods Vertebral augmentation treatment was performed for persistent back pain symptoms in 57 patients (mean age, 71.9 ± 10.4 years), including 46 women, with radiologically confirmed VCFs; 36 of these patients (63%) had reached 12 months of follow-up at this data analysis. There were 51 one-level cases, 5 two-level cases, and 1 three-level case, representing 64 treated levels. Back pain severity and condition-specific functional impairment were evaluated with a standard 100-mm visual analog scale and the Oswestry Disability Index (ODI), respectively, before device implantation as well as at 6 weeks, 3 months, and 12 months. Results Marked clinical improvements were realized in back pain severity and functional impairment through 12 months of follow-up. The mean back pain score on the visual analog scale improved from 79.3 ± 17.2 before treatment to 21.9 ± 21.3, 21.9 ± 24.6, and 23.2 ± 23.3 at 6 weeks, 3 months, and 12 months, respectively. The mean decrease at 12 months was 49.9 ± 30.3 mm, or approximately 66% (P < .0001). Similarly, the mean ODI score improved from 68.1% ± 16.9% before treatment to 27.4% ± 17.2%, 23.8% ± 18.7%, and 23.3% ± 15.5% at 6 weeks, 3 months, and 12 months, respectively, representing a mean change of 39.2 ± 19.6 percentage points, or approximately 63%, at 12 months. Overall clinical success rates based on a 30% improvement in pain severity or greater and maintenance or improvement in the ODI were 91%, 88%, and 89% at 6 weeks

  17. Dosing considerations with transdermal formulations of fentanyl and buprenorphine for the treatment of cancer pain

    PubMed Central

    Skaer, Tracy L

    2014-01-01

    Opioids continue to be first-line pharmacotherapy for patients suffering from cancer pain. Unfortunately, subtherapeutic dosage prescribing of pain medications remains common, and many cancer patients continue to suffer and experience diminished quality of life. A large variety of therapeutic options are available for cancer pain patients. Analgesic pharmacotherapy is based on the patient’s self-report of pain intensity and should be tailored to meet the requirements of each individual. Most, if not all, cancer pain patients will ultimately require modifications in their opioid pharmacotherapy. When changes in a patient’s medication regimen are needed, adequate pain control is best maintained through appropriate dosage conversion, scheduling immediate release medication for withdrawal prevention, and providing as needed dosing for breakthrough pain. Transdermal opioids are noninvasive, cause less constipation and sedation when compared to oral opioids, and may improve patient compliance. A relative potency of 100:1 is recommended when converting the patient from oral morphine to transdermal fentanyl. Based on the limited data available, there is significant interpatient variability with transdermal buprenorphine and equipotency recommendations from oral morphine of 75:1–110:1 have been suggested. Cancer patients may require larger transdermal buprenorphine doses to control their pain and may respond better to a more aggressive 75–100:1 potency ratio. This review outlines the prescribing of transdermal fentanyl and transdermal buprenorphine including how to safely and effectively convert to and use them for those with cancer pain. PMID:25170278

  18. Atypical odontalgia misdiagnosed as odontogenic pain: a case report and discussion of treatment.

    PubMed

    Lilly, J P; Law, A S

    1997-05-01

    Atypical odontalgia is characterized by prolonged periods of throbbing or burning pain in the teeth or alveolar process, which occurs in the absence of any identifiable odontogenic etiology. The pain may be bilateral and change in location. This article presents two cases of atypical odontalgia that were misdiagnosed and initially treated as pain of odontogenic origin. A therapeutic regimen of tricyclic antidepressants alleviated the pain in one patient and was unsuccessful in the second. These two cases demonstrate the importance of having a thorough knowledge of both odontogenic and nonodontogenic causes of orofacial pain as well as the need for careful diagnosis before undertaking any treatment. PMID:9545940

  19. [Treatment of implant-induced pain conditions in the maxillofacial area].

    PubMed

    Ehrenfeld, M; Riediger, D; Schwenzer, N; Eichhorst, U

    1990-01-01

    The implantation of dental implants may lead to severe pain syndromes (not reckoning postoperative pain and discomfort). Pain in the upper jaw is usually caused by inflammations like sinusitis, often in combination with an oroantral communication, rhinitis and osteitis, whereas pain in the lower jaw is often caused by injuries of sensitive branches of the mandibular nerve, mostly the inferior alveolar nerve. In these cases the therapy of pain should be causal, which means removal of the implant and treatment of the pathologic consequences of implantation. Especially the possibilities of micronerval surgery are emphasized within this article. PMID:2257804

  20. Attitudes of Italian general practitioners in the treatment of cancer pain. The Committee of the Associazione Italiana di Oncologia Medica (AIOM).

    PubMed

    Minotti, V; Betti, M

    1997-01-01

    The attitude of Italian general practitioners in prescribing practices for patients with cancer pain was assessed by means of a questionnaire. The results indicated that among most of the doctors who completed the questionnaire the basic principles of pain treatment in cancer patients are largely understood. Oral morphine emerged as the most commonly used opioid (60%) and controlled-release morphine as the preferred preparation. Non-steroidal anti-inflammatory drugs were the most commonly used minor analgesics. Fear of side effects and restrictive prescribing regulations emerged as the most important barrier against adequate pain management. The survey emphasised the need for continued efforts in implementing specific educational programming for improvement in cancer pain management. PMID:9349310

  1. Complementary and alternative treatment for neck pain: chiropractic, acupuncture, TENS, massage, yoga, Tai Chi, and Feldenkrais.

    PubMed

    Plastaras, Christopher T; Schran, Seth; Kim, Natasha; Sorosky, Susan; Darr, Deborah; Chen, Mary Susan; Lansky, Rebecca

    2011-08-01

    Of the multitude of treatment options for the management of neck pain, no obvious single treatment modality has been shown to be most efficacious. As such, the clinician should consider alternative treatment modalities if a modality is engaging, available, financially feasible, potentially efficacious, and is low risk for the patient. As evidence-based medicine for neck pain develops, the clinician is faced with the challenge of which treatments to encourage patients to pursue. Treatment modalities explored in this article, including chiropractic, acupuncture, TENS, massage, yoga, Tai Chi, and Feldenkrais, represent reasonable complementary and alternative medicine methods for patients with neck pain. PMID:21824591

  2. The Pain System in Oesophageal Disorders: Mechanisms, Clinical Characteristics, and Treatment

    PubMed Central

    Lottrup, Christian; Olesen, Søren Schou; Drewes, Asbjørn Mohr

    2011-01-01

    Pain is common in gastroenterology. This review aims at giving an overview of pain mechanisms, clinical features, and treatment options in oesophageal disorders. The oesophagus has sensory receptors specific for different stimuli. Painful stimuli are encoded by nociceptors and communicated via afferent nerves to the central nervous system. The pain stimulus is further processed and modulated in specific pain centres in the brain, which may undergo plastic alterations. Hence, tissue inflammation and long-term exposure to pain can cause sensitisation and hypersensitivity. Oesophageal sensitivity can be evaluated ,for example, with the oesophageal multimodal probe. Treatment should target the cause of the patient's symptoms. In gastro-oesophageal reflux diseases, proton pump inhibitors are the primary treatment option, surgery being reserved for patients with severe disease resistant to drug therapy. Functional oesophageal disorders are treated with analgesics, antidepressants, and psychological therapy. Lifestyle changes are another option with less documentation. PMID:21826137

  3. Chronic facial pain in the female patient: treatment updates.

    PubMed

    Stavropoulos, Franci; Hastie, Barbara A

    2007-05-01

    Over the past decade, gender-related differences in pain and analgesia have been examined in experimental settings with conflicting evidence on whether men and women differ in their response to pain. New advances in research have begun to investigate the influence of genetic factors in moderating sex differences in analgesic response. This article provides oral and maxillofacial surgeons with evidence-based data on the issues of chronic pain between the sexes to suggest alternative approaches to the management of pain in their male and female patients. PMID:18088882

  4. Treatment for Chronic Pain in Patients With Advanced Cancer

    ClinicalTrials.gov

    2010-11-07

    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

  5. Peripheral nerve stimulation for the treatment of postamputation pain--a case report.

    PubMed

    Rauck, Richard L; Kapural, Leonardo; Cohen, Steven P; North, James M; Gilmore, Christopher A; Zang, Rosemary H; Boggs, Joseph W

    2012-11-01

    Many amputees suffer from postamputation pain, which can be extremely debilitating, decrease quality of life, increase the risk of depression, and negatively affect interpersonal relationships and the ability to work. Present methods of treatment, including medications, are often unsatisfactory in reducing postamputation pain. Electrical stimulation of the nerve innervating the painful area could reduce the pain, but peripheral nerve stimulation is rarely used to treat postamputation pain because present methods require invasive surgical access and precise placement of the leads in close proximity (≤ 2 mm) with the nerve. The present study investigated a novel approach to peripheral nerve stimulation in which a lead was placed percutaneously a remote distance (> 1 cm) away from the femoral nerve in a patient with severe residual limb pain (RLP) 33 years following a below-knee amputation. Electrical stimulation generated ≥ 75% paresthesia coverage, reduced RLP by > 60%, and improved quality of life outcomes as measured by the pain interference scale of the Brief Pain Inventory-Short Form (100% reduction in pain interference), Pain Disability Index (74% reduction in disability), and the Patient Global Impression of Change (very much improved) during a 2-week home trial. There were no adverse events. The ability to generate significant paresthesia coverage and pain relief with a single lead inserted percutaneously and remotely from the target nerve holds promise for providing relief of postamputation pain. PMID:22548686

  6. Frequency, impact, and predictors of persistent pain after root canal treatment: a national dental PBRN study.

    PubMed

    Nixdorf, Donald R; Law, Alan S; Lindquist, Kimberly; Reams, Gregory J; Cole, Emery; Kanter, Keith; Nguyen, Ruby H N; Harris, D Robert

    2016-01-01

    Root canal treatment (RCT) is commonly performed surgery and persistent pain is known to occur, but little is known about how these patients are affected by this pain. Although biopsychosocial mechanisms are thought to be associated with the development of such pain, similar to persistent pain after surgery in other body sites, little is known about the baseline predictors for persistent pain. We assessed the frequency of persistent pain 6 months after RCT, measured the impact this pain had on patients, and determined predictive factors for persistent tooth pain in a multicenter prospective cohort study conducted within the National Dental Practice-Based Research Network. Of 708 patients enrolled, 651 (91.9%) provided follow-up data, with 65 (10.0%) meeting criteria for pain 6 months after RCT. On average, these patients reported their pain as mild to moderate in intensity, present for approximately 10 days in the preceding month, and minimally interfered with daily activities. After adjusting for the type of dental practitioner and patient age, gender, and household income, pain duration over the week before RCT significantly increased the risk of developing persistent pain (odds ratio = 1.19 per 1 day increase in pain duration, 95% confidence interval: 1.07-1.33), whereas optimism about the procedure reduced the risk (odds ratio = 0.39, 95% confidence interval: 0.22-0.67). Our data suggest that persistent pain 6 months after RCT is fairly common, but generally does not have a large impact on those experiencing it. Furthermore, patient age and gender did not predict persistent pain, whereas preoperative pain duration and the patient's expectation did. PMID:26335907

  7. TRPV1-FAAH-COX: The Couples Game in Pain Treatment.

    PubMed

    Aiello, Francesca; Carullo, Gabriele; Badolato, Mariateresa; Brizzi, Antonella

    2016-08-19

    Pain is a complex sensation involving the perception and transduction of diverse environmental pain stimuli with cognitive and emotional processing by the central nervous system. It can manifest as acute or chronic pain. Pain is controlled by a series of enzymes and receptors, implicated in a variety of interconnected mechanisms and pathways. In fact, several studies have shown the cannabinoid receptor 1 and the transient receptor potential vanilloid channel 1 to be new players in modulating the sophisticated pain transduction system at the central level. At the peripheral level, the perception of pain involves cyclooxygenases and fatty acid amide hydrolase, as recent studies demonstrate. This Minireview describes the physiological aspects of the receptors and enzymes mentioned above and focuses on the consideration of dual mechanisms as a new therapeutic approach in the treatment of pain. PMID:27240888

  8. Pulsed radiofrequency treatment of complex regional pain syndrome: A case series

    PubMed Central

    Djuric, Vlad

    2014-01-01

    BACKGROUND: Various forms of sympathetic chain neurolysis (sympathectomy) have, at one time or another, held promise as effective treatment options for complex regional pain syndrome (CRPS). Complications, such as worsening pain and the development of new pain syndromes, have prevented sympathectomy from emerging as a standard intervention. In an effort to avoid poor outcomes associated with neurolysis, pulsed radiofrequency (PRF) has been proposed as a potential treatment alternative for a number of chronic neuropathic pain states, including some forms of CRPS. METHODS: The present report describes three cases in which patients diagnosed with lower extremity CRPS type I obtained substantial and lasting intervals of pain relief following PRF of the lumbar sympathetic chain. Over a period of four years, 14 fluoroscopically guided procedures using PRF lesioning of the lumbar sympathetic chain at L2, L3 and L4 were performed in three individuals with CRPS type I of the lower limb. Outcome measures included pre- and post-treatment self-reported pain and medication requirements. RESULTS: Substantial pain relief (>50%) was achieved in 91.7% of PRF applications at three months and 83.3% at six months, with some treatments resulting in persistent relief well beyond 12 months. Medication use decreased to a comparable degree, with discontinuation of opiates after all but three treatments. CONCLUSIONS: PRF lesioning of the lumbar sympathetic chain can be an effective treatment for patients with CRPS type I of the lower extremity, with the potential to provide ≥6 months of substantial pain relief. PMID:24945285

  9. Future directions in the treatment of neuropathic pain: a review on various therapeutic targets.

    PubMed

    Gangadhar, Matharasala; Mishra, Ram Kumar; Sriram, Dharmarajan; Yogeeswari, Perumal

    2014-02-01

    Neuropathic pain is caused by structural lesion leading to functional abnormalities in central and peripheral nervous system. Neuropathic pain in itself is not always a disease, as it arises due to consequences of other diseases like diabetes, spinal cord injury, degenerative neuronal diseases and cancer. Current strategies of neuropathic pain treatment have provided relief to the patients to some extent, but complete cure is still a distant dream. In the future, it is hoped that a combination of new and improved pharmaceutical developments combined with careful clinical trials and increased understanding of neuroplasticity will lead to improved and effective pain management strategies leading to improved quality of life. In this review we have discussed various therapeutic targets of neuropathic pain and their pathophysiological mechanisms. Current status of drugs used for treatment of neuropathic pain have also been discussed in the review. PMID:24152326

  10. Multipotent Mesenchymal Stem Cell Treatment for Discogenic Low Back Pain and Disc Degeneration

    PubMed Central

    Zeckser, Jeffrey; Wolff, Michael; Tucker, Jason; Goodwin, Josh

    2016-01-01

    Low back pain with resultant loss of function, decreased productivity, and high economic costs is burdensome for both the individual and the society. Evidence suggests that intervertebral disc pathology is a major contributor to spine-related pain and degeneration. When commonly used conservative therapies fail, traditional percutaneous or surgical options may be beneficial for pain relief but are suboptimal because of their inability to alter disc microenvironment catabolism, restore disc tissue, and/or preserve native spine biomechanics. Percutaneously injected Multipotent Mesenchymal Stem Cell (MSC) therapy has recently gained clinical interest for its potential to revolutionarily treat disc-generated (discogenic) pain and associated disc degeneration. Unlike previous therapies to date, MSCs may uniquely offer the ability to improve discogenic pain and provide more sustained improvement by reducing disc microenvironment catabolism and regenerating disc tissue. Consistent treatment success has the potential to create a paradigm shift with regards to the treatment of discogenic pain and disc degeneration. PMID:26880958

  11. Diagnosis and Treatment of Low Back Pain in the Pediatric Population

    PubMed Central

    Taxter, Alysha J.; Chauvin, Nancy A.; Weiss, Pamela F.

    2014-01-01

    Back pain in the pediatric population is a common complaint presenting to sports medicine clinic. There is a wide differential that should be considered, including mechanical, infectious, neoplastic, inflammatory, and amplified musculoskeletal pain. The history, pain quality, and examination are key components to help distinguish the etiologies of the pain and direct further evaluation. Laboratory investigations, including blood counts and inflammatory markers, can provide insight into the diagnosis. The HLA-B27 antigen can be helpful if a spondyloarthropathy is suspected. Imaging as clinically indicated typically begins with radiographs, and the use of MRI, CT, or bone scan can provide additional information. Proper diagnosis of back pain is important because prognosis and treatments are significantly different. This paper will review the pertinent evaluation, differential diagnoses, and treatment of low back pain in the pediatric population. PMID:24565826

  12. Breakthrough pain and its treatment: critical review and recommendations of IOPS (Italian Oncologic Pain Survey) expert group.

    PubMed

    Mercadante, Sebastiano; Marchetti, Paolo; Cuomo, Arturo; Mammucari, Massimo; Caraceni, Augusto

    2016-02-01

    Controversies exist about the definition and epidemiology of breakthrough cancer pain (BTcP), the pharmacological treatment options, drug dosing, and how to select the medications for BTcP among the new fentanyl products. Existing data were critically evaluated to provide recommendations by an expert group. An algorithm to diagnose BTcP should be used followed by a careful assessment. Fentanyl products provide efficacy and rapidity of action to counteract the temporal pattern of BTcP. The doses of opioids used for background pain should guide the choice of the doses of fentanyl products. The choice of fentanyl products should be based on individual clinical conditions. PMID:26438145

  13. Fighting Chronic Pain

    MedlinePlus

    ... pain, bone pain from spread of cancer, fibromyalgia, chronic fatigue syndrome Neurologic: "Phantom limb" pain after amputation, nerve pain from diabetes Read More "Chronic Pain" Articles Easing Chronic Pain: Better Treatments and ...

  14. Extended-release morphine sulfate in treatment of severe acute and chronic pain

    PubMed Central

    Balch, Robert J; Trescot, Andrea

    2010-01-01

    Morphine is the archetypal opioid analgesic. Because it is a short-acting opioid, its use has been limited to the management of acute pain. The development of extended-release formulations have resulted in the increased utilization of morphine in chronic pain conditions. This review documents the history of morphine use in pain treatment, and describes the metabolism, pharmacodynamics, formulations, and efficacy of the currently available extended-release morphine medications. PMID:21197323

  15. Treatment of chronic non-malignant pain in the elderly: safety considerations.

    PubMed

    Barber, Jonathan Bruce; Gibson, Stephen J

    2009-01-01

    Non-malignant pain in the elderly is frequently under-treated, with physicians appearing to be uncertain concerning how best to achieve optimum management of this common problem in individual cases. The aim of this review is to provide a brief overview and discuss the variety of interacting factors that contribute to the continuing under-treatment of chronic non-malignant pain in the older population. The central objective is to encourage safer and more effective pain management in a population that is highly vulnerable to painful conditions and to the consequences of poorly treated pain. Under-treatment of pain as experienced by the elderly is largely a consequence of uncertainties that arise within a complex environment that is underscored and exacerbated by the progressive and rapid aging of the global population. Uncertainties include the optimum management of pain in geriatric syndromes, frailty and dementia, and their impact on diagnosis, pain assessment and choices of treatment modalities. There is an inadequate evidence base for pharmacological interventions in older persons with respect to pharmacokinetic and pharmacodynamic changes that occur with aging. In this review, the prevalence of chronic pain and the incidence of adverse drug reactions are identified as factors that encourage conservatism in prescribing, as are major predictors of adverse drug reactions, i.e. aging, inappropriate combinations of medications and polypharmacy. The major classes of analgesic drugs are summarized with reference to their mechanisms of action, analgesic properties and known adverse effects. Although all medications have associated risks, the use of analgesics in managing persistent pain in elderly people is widely supported and guided on the basis of clinical experience and consensus among specialists in geriatrics and pain management. It is concluded that the absence of trial data, specific to the elderly, is substantially offset by information based on clinical

  16. Sensory abnormalities and pain in Parkinson disease and its modulation by treatment of motor symptoms.

    PubMed

    Cury, R G; Galhardoni, R; Fonoff, E T; Perez Lloret, S; Dos Santos Ghilardi, M G; Barbosa, E R; Teixeira, M J; Ciampi de Andrade, D

    2016-02-01

    Pain and sensory abnormalities are present in a large proportion of Parkinson disease (PD) patients and have a significant negative impact in quality of life. It remains undetermined whether pain occurs secondary to motor impairment and to which extent it can be relieved by improvement of motor symptoms. The aim of this review was to examine the current knowledge on the mechanisms behind sensory changes and pain in PD and to assess the modulatory effects of motor treatment on these sensory abnormalities. A comprehensive literature search was performed. We selected studies investigating sensory changes and pain in PD and the effects of levodopa administration and deep brain stimulation (DBS) on these symptoms. PD patients have altered sensory and pain thresholds in the off-medication state. Both levodopa and DBS improve motor symptoms (i.e.: bradykinesia, tremor) and change sensory abnormalities towards normal levels. However, there is no direct correlation between sensory/pain changes and motor improvement, suggesting that motor and non-motor symptoms do not necessarily share the same mechanisms. Whether dopamine and DBS have a real antinociceptive effect or simply a modulatory effect in pain perception remain uncertain. These data may provide useful insights into a mechanism-based approach to pain in PD, pointing out the role of the dopaminergic system in pain perception and the importance of the characterization of different pain syndromes related to PD before specific treatment can be instituted. PMID:26147660

  17. Trajectories of Change During a Randomized Controlled Trial of Internet-delivered Psychological Treatment for Adolescent Chronic Pain: How does Change in Pain and Function Relate?

    PubMed Central

    Palermo, Tonya M.; Law, Emily F.; Zhou, Chuan; Holley, Amy Lewandowski; Logan, Deirdre; Tai, Gabrielle

    2014-01-01

    Although pain and function improve at immediate post-treatment for youth receiving cognitive-behavioral therapy for chronic pain, limited data are available to understand changes that youth make during psychological treatment. We sought to characterize distinct trajectory patterns of change in pain and function in order to understand the temporal association of these changes during internet-delivered cognitive-behavioral treatment. Weekly repeated assessments of pain and function were conducted during eight weeks of treatment among 135 adolescents, ages 11 to 17 years, with chronic pain who were randomized to the cognitive-behavioral intervention (CBT) arm of an ongoing trial of internet-delivered CBT (Web-Based Management of Adolescent Pain; Web-MAP2). Using random effects growth mixture models we characterized pain and functional disability trajectories finding distinct trajectory groups indicating patterns of both linear as well as quadratic effects. Trajectories of change showed that some patients’ pain and functional disability was improving, others worsened, or changed minimally. Paired t-tests compared the within-subject relative change rate in pain and function demonstrating similar change range for pain and function during the treatment period. There was no support for improvements in either pain or function to precede changes in the other domain. Findings may be useful in informing future studies of psychosocial treatments for pediatric chronic pain to consider how to target treatment strategies to distinct patient response profiles. This may lead to the development of intervention strategies that can both more effectively target children’s pain and function during treatment, and lead to sustained changes following treatment. PMID:25775441

  18. Non-invasive transcranial direct current stimulation for the study and treatment of neuropathic pain.

    PubMed

    Knotkova, Helena; Cruciani, Ricardo A

    2010-01-01

    In the last decade, radiological neuroimaging techniques have enhanced the study of mechanisms involved in the development and maintenance of neuropathic pain. Recent findings suggest that neuropathic pain in certain pain syndromes (e.g., complex regional pain syndrome/reflex sympathic dystrophy, phantom-limb pain) is associated with a functional reorganization and hyperexitability of the somatosensory and motor cortex. Studies showing that the reversal of cortical reorganization in patients with spontaneous or provoked pain is accompanied by pain relief stimulated the search for novel alternatives how to modulate the cortical excitability as a strategy to relieve pain. Recently, non-invasive brain stimulation techniques such as transcranial magnetic stimulation (TMS) and transcranial direct current stimulation (tDCS) were proposed as suitable methods for modulation of cortical excitability. Both techniques (TMS and tDCS) have been clinically investigated in healthy volunteers as well as in patients with various clinical pathologies and variety of pain syndromes. Although there is less evidence on tDCS as compared with TMS, the findings on tDCS in patients with pain are promising, showing an analgesic effect of tDCS, and observations up to date justify the use of tDCS for the treatment of pain in selected patient populations. tDCS has been shown to be very safe if utilized within the current protocols. In addition, tDCS has been proven to be easy to apply, portable and not expensive, which further enhances great clinical potential of this technique. PMID:20336445

  19. The Responsive Amygdala: Treatment-induced Alterations in Functional Connectivity in Pediatric Complex Regional Pain Syndrome

    PubMed Central

    Simons, LE; Pielech, M; Erpelding, N; Linnman, C; Moulton, E; Sava, S; Lebel, A; Serrano, P; Sethna, N; Berde, C; Becerra, L; Borsook, D

    2014-01-01

    The amygdala is a key brain region with efferent and afferent neural connections that involve complex behaviors such as pain, reward, fear and anxiety. This study evaluated resting state functional connectivity of the amygdala with cortical and subcortical regions in a group of chronic pain patients (pediatric complex regional pain syndrome) with age-gender matched controls before and after intensive physical-biobehavioral pain treatment. Our main findings include (1) enhanced functional connectivity from the amygdala to multiple cortical, subcortical, and cerebellar regions in patients compared to controls, with differences predominantly in the left amygdala in the pre-treated condition (disease state); (2) dampened hyperconnectivity from the left amygdala to the motor cortex, parietal lobe, and cingulate cortex after intensive pain rehabilitation treatment within patients with nominal differences observed among healthy controls from Time 1 to Time 2 (treatment effects); (3) functional connectivity to several regions key to fear circuitry (prefrontal cortex, bilateral middle temporal lobe, bilateral cingulate, hippocampus) correlated with higher pain-related fear scores and (4) decreases in pain-related fear associated with decreased connectivity between the amygdala and the motor and somatosensory cortex, cingulate, and frontal areas. Our data suggest that there are rapid changes in amygdala connectivity following an aggressive treatment program in children with chronic pain and intrinsic amygdala functional connectivity activity serving as a potential indicator of treatment response. PMID:24861582

  20. The responsive amygdala: treatment-induced alterations in functional connectivity in pediatric complex regional pain syndrome.

    PubMed

    Simons, L E; Pielech, M; Erpelding, N; Linnman, C; Moulton, E; Sava, S; Lebel, A; Serrano, P; Sethna, N; Berde, C; Becerra, L; Borsook, D

    2014-09-01

    The amygdala is a key brain region with efferent and afferent neural connections that involve complex behaviors such as pain, reward, fear, and anxiety. This study evaluated resting state functional connectivity of the amygdala with cortical and subcortical regions in a group of chronic pain patients (pediatric complex regional pain syndrome) with age-sex matched control subjects before and after intensive physical-biobehavioral pain treatment. Our main findings include (1) enhanced functional connectivity from the amygdala to multiple cortical, subcortical, and cerebellar regions in patients compared with control subjects, with differences predominantly in the left amygdala in the pretreated condition (disease state); (2) dampened hyperconnectivity from the left amygdala to the motor cortex, parietal lobe, and cingulate cortex after intensive pain rehabilitation treatment within patients with nominal differences observed among healthy control subjects from time 1 to time 2 (treatment effects); (3) functional connectivity to several regions key to fear circuitry (prefrontal cortex, bilateral middle temporal lobe, bilateral cingulate, hippocampus) correlated with higher pain-related fear scores; and (4) decreases in pain-related fear associated with decreased connectivity between the amygdala and the motor and somatosensory cortex, cingulate, and frontal areas. Our data suggest that there are rapid changes in amygdala connectivity after an aggressive treatment program in children with chronic pain and intrinsic amygdala functional connectivity activity serving as a potential indicator of treatment response. PMID:24861582

  1. Topical amitriptyline and ketamine for the treatment of neuropathic pain.

    PubMed

    Mercadante, Sebastiano

    2015-01-01

    A neuropathy is a disturbance of function or pathological change in nerves. In some cases, peripheral neuropathic pain may occur due to a lesion or disease of the peripheral somatosensory nervous system. Efficacy of different agents for peripheral neuropathic pain conditions is less than optimal. The administration of topical analgesics might be an option, due to the potential of reduced adverse effects and increased patient compliance. There is major interest in compounding topical analgesics for peripheral neuropathic pain, but several challenges remain for this approach. Topical analgesics have the potential to be a valuable additional approach for the management of peripheral neuropathic pain. Topical amitriptyline-ketamine combination (AK) is a promising agent for peripheral neuropathic pain conditions. Some studies have shown its efficacy in neuropathic pain conditions. However, this data was not uniformely obtained and its role remains still controversial. Efficacy may depend on many factors, including the choice of the vehicle, the concentration, the pain site, and specific diseases. More studies are necessary to support the use of AK in clinical practice. PMID:26488799

  2. Evaluation of Transcutaneous Electrical Nerve Stimulation as a Treatment of Neck Pain due to Musculoskeletal Disorders

    PubMed Central

    Maayah, Mikhled; Al-Jarrah, Mohammed

    2010-01-01

    Background This study was designed to evaluate transcutaneous electrical nerve stimulation (TENS) as a treatment for neck pain due to musculoskeletal disorders within the context of a physiotherapy treatment. Methods Thirty subjects with neck pain were randomly allocated to two groups, treated with either TENS (n = 15) or placebo (n = 15). Each subject received one session for one hour. All subjects were evaluated before, during treatment, after switch off and again a week after by using Myometer machine. All subjects completed the follow-up assessment. Subjects referred for out-subjects' physiotherapy department, fulfilling the inclusion and exclusion criteria, took part in the study. Results The assessments were compared and used to measure outcome treatment. Improvement in their condition was measured in terms of a reduction in the individual's level of pain during the week after the end of the first session. At the end of the first session, the study showed that 11 subjects (73%) in the treatment and 7 subjects (43%) in the control groups had gained marked improvement. These results are statistically highly significant, (P = 0.01) at the end of the follow-up assessment. Conclusions A conclusion could be drawn that a single intense TENS treatment is an effective treatment for neck pain due to musculoskeletal disorders. On the other hand, TENS showed an effective pain relief with subjects who have a mild neck pain rather than those with severe symptoms. Keywords Musculoskeletal disorders; Transcutaneous electrical nerve stimulation; Neck pain PMID:21629525

  3. Pain exposure physical therapy (PEPT) compared to conventional treatment in complex regional pain syndrome type 1: a randomised controlled trial

    PubMed Central

    Barnhoorn, Karlijn J; van de Meent, Henk; van Dongen, Robert T M; Klomp, Frank P; Groenewoud, Hans; Samwel, Han; Nijhuis-van der Sanden, Maria W G; Frölke, Jan Paul M; Staal, J Bart

    2015-01-01

    Objective To compare the effectiveness of pain exposure physical therapy (PEPT) with conventional treatment in patients with complex regional pain syndrome type 1 (CRPS-1) in a randomised controlled trial with a blinded assessor. Setting The study was conducted at a level 1 trauma centre in the Netherlands. Participants 56 adult patients with CRPS-1 participated. Three patients were lost to follow-up. Interventions Patients received either PEPT in a maximum of five treatment sessions, or conventional treatment following the Dutch multidisciplinary guideline. Measurements Outcomes were assessed at baseline and at 3, 6 and 9 months after randomisation. The primary outcome measure was the Impairment level Sum Score—Restricted Version (ISS-RV), consisting of visual analogue scale for pain (VAS-pain), McGill Pain Questionnaire, active range of motion (AROM) and skin temperature. Secondary outcome measures included Pain Disability Index (PDI); muscle strength; Short Form 36 (SF-36); disability of arm, shoulder and hand; Lower Limb Tasks Questionnaire (LLTQ); 10 m walk test; timed up-and-go test (TUG) and EuroQol-5D. Results The intention-to-treat analysis showed a clinically relevant decrease in ISS-RV (6.7 points for PEPT and 6.2 points for conventional treatment), but the between-group difference was not significant (0.96, 95% CI −1.56 to 3.48). Participants allocated to PEPT experienced a greater improvement in AROM (between-group difference 0.51, 95% CI 0.07 to 0.94; p=0.02). The per protocol analysis showed larger and significant between-group effects on ISS-RV, VAS-pain, AROM, PDI, SF-36, LLTQ and TUG. Conclusions We cannot conclude that PEPT is superior to conventional treatment for patients with CRPS-1. Further high-quality research on the effects of PEPT is warranted given the potential effects as indicated by the per protocol analysis. Trial registration numbers NCT00817128 and NTR 2090. PMID:26628523

  4. Pain after earthquake

    PubMed Central

    2012-01-01

    Introduction On 6 April 2009, at 03:32 local time, an Mw 6.3 earthquake hit the Abruzzi region of central Italy causing widespread damage in the City of L Aquila and its nearby villages. The earthquake caused 308 casualties and over 1,500 injuries, displaced more than 25,000 people and induced significant damage to more than 10,000 buildings in the L'Aquila region. Objectives This observational retrospective study evaluated the prevalence and drug treatment of pain in the five weeks following the L'Aquila earthquake (April 6, 2009). Methods 958 triage documents were analysed for patients pain severity, pain type, and treatment efficacy. Results A third of pain patients reported pain with a prevalence of 34.6%. More than half of pain patients reported severe pain (58.8%). Analgesic agents were limited to available drugs: anti-inflammatory agents, paracetamol, and weak opioids. Reduction in verbal numerical pain scores within the first 24 hours after treatment was achieved with the medications at hand. Pain prevalence and characterization exhibited a biphasic pattern with acute pain syndromes owing to trauma occurring in the first 15 days after the earthquake; traumatic pain then decreased and re-surged at around week five, owing to rebuilding efforts. In the second through fourth week, reports of pain occurred mainly owing to relapses of chronic conditions. Conclusions This study indicates that pain is prevalent during natural disasters, may exhibit a discernible pattern over the weeks following the event, and current drug treatments in this region may be adequate for emergency situations. PMID:22747796

  5. Predictors of outcome of multidisciplinary treatment in chronic widespread pain: an observational study

    PubMed Central

    2013-01-01

    Background The effectiveness of multidisciplinary treatment in chronic widespread pain (CWP) is limited. The considerable heterogeneity among patients is a likely explanation. Knowledge on predictors of the outcome of multidisciplinary treatment can help to optimize treatment effectiveness. The purpose of this study was to identify predictors of multidisciplinary treatment outcome in patients with CWP. Methods Data were used from baseline and 6 months follow-up measurements of a prospective cohort study of 120 CWP. Regression models were used to assess whether baseline variables predicted treatment outcome. Outcome domains included: pain, pain interference, depression, and global perceived effect (GPE). Potential predictors included: psychological distress, illness and self-efficacy beliefs, fear-avoidance beliefs and behaviour, symptoms, disability, and socio-demographic factors. Results Greater improvement in pain was predicted by more pain at baseline and male gender. Greater improvement in interference of pain in daily life was predicted by more interference of pain in daily life at baseline, lower levels of anxiety, a stronger belief in personal control, less belief in consequences, male gender, and a higher level of education. Greater improvement in depression was predicted by higher baseline values of depression, stronger beliefs in personal control, and a higher level of education. Better outcome on GPE was predicted by less pain, less fatigue, and a higher level of education. Conclusion Less anxiety, stronger beliefs in personal control, less belief in consequences, less pain, less fatigue, higher level of education, and male gender are predictors of better outcome of multidisciplinary treatment in CWP. Tailoring treatment to these specific patient characteristics or selecting eligible patients for multidisciplinary treatment may further improve treatment outcome. PMID:23577981

  6. Successful Treatment of Lower Limb Complex Regional Pain Syndrome following Three Weeks of Hyperbaric Oxygen Therapy.

    PubMed

    Katznelson, Rita; Segal, Shira C; Clarke, Hance

    2016-01-01

    Hyperbaric oxygen therapy (HBOT) is a treatment that delivers 100% oxygen at increased atmospheric pressures. The efficacy of HBOT for treating pain has been described in various animal pain models and may have clinical efficacy in the treatment of human chronic pain syndromes. We present our experience with posttraumatic Complex Regional Pain Syndrome (CRPS) type 2 in a patient who underwent 15 sessions of HBOT. A 41-year-old male with one-year history of CRPS of left foot followed by left ankle fracture demonstrated less pain, decreased swelling, less allodynia, and improvement in skin color and range of motion of the lower limb after 3 weeks of HBOT. Patient was back to work for the first time in over a year. HBOT may be considered as a valuable therapeutic tool in the treatment of long-standing CRPS. PMID:27445607

  7. Successful Treatment of Lower Limb Complex Regional Pain Syndrome following Three Weeks of Hyperbaric Oxygen Therapy

    PubMed Central

    Katznelson, Rita; Segal, Shira C.; Clarke, Hance

    2016-01-01

    Hyperbaric oxygen therapy (HBOT) is a treatment that delivers 100% oxygen at increased atmospheric pressures. The efficacy of HBOT for treating pain has been described in various animal pain models and may have clinical efficacy in the treatment of human chronic pain syndromes. We present our experience with posttraumatic Complex Regional Pain Syndrome (CRPS) type 2 in a patient who underwent 15 sessions of HBOT. A 41-year-old male with one-year history of CRPS of left foot followed by left ankle fracture demonstrated less pain, decreased swelling, less allodynia, and improvement in skin color and range of motion of the lower limb after 3 weeks of HBOT. Patient was back to work for the first time in over a year. HBOT may be considered as a valuable therapeutic tool in the treatment of long-standing CRPS. PMID:27445607

  8. Evaluation and Treatment of Low Back Pain: A Clinically Focused Review for Primary Care Specialists.

    PubMed

    Hooten, W Michael; Cohen, Steven P

    2015-12-01

    Low back pain (LBP) is a leading cause of disability worldwide. In the absence of a classification system for pain syndromes, classification of LBP on the basis of the distribution of pain as axial (pain generally localized to the low back) or radicular neuropathic (pain radiating to the lower extremities) is relevant to clinical practice because the distribution of pain is often a corollary of frequently occurring disease processes involving the lumbar spine. Common sources of axial LBP include the intervertebral disc, facet joint, sacroiliac joint, and paraspinal musculature, whereas common sources of radicular pain include a herniated intervertebral disc and spinal stenosis. The accuracy of historical and physical examination findings has been established for sacroiliac joint pain, radiculopathy, and lumbar spinal stenosis. However, the accuracy of similar data, so-called red flags, for identifying the underlying medical sources of LBP has been overstated. Diagnostic imaging studies can be useful, and adherence to established guidelines can protect against overuse. Multiple pharmacological trials exist for the management of LBP; however, the long-term outcomes of commonly used drugs are mixed. For carefully selected patients with axial LBP, radiofrequency denervation techniques can provide sustained pain relief. In patients with radicular pain, transforaminal epidural steroid injections may provide short-term pain relief, but neurostimulation may confer more enduring benefits of refractory symptoms. Pain-related indications for commonly performed operations include spinal decompression for radicular symptoms as well as spinal fusion or disc prosthesis for discogenic LBP. Physical modalities and psychological treatments can improve pain and functioning, but patient preferences may influence treatment adherence. PMID:26653300

  9. Targeting temporomandibular disorder pain treatment to hormonal fluctuations: a randomized clinical trial.

    PubMed

    Turner, Judith A; Mancl, Lloyd; Huggins, Kimberly Hanson; Sherman, Jeffrey J; Lentz, Gretchen; LeResche, Linda

    2011-09-01

    Mounting evidence supports the importance of hormonal fluctuations in temporomandibular disorder (TMD) pain among women. Stabilizing influential hormones or having a plan and skills for coping with hormonally related increases in TMD pain, therefore, may be beneficial for women with TMD pain. This randomized clinical trial evaluated the short- and long-term efficacy of 3 interventions for women with TMD pain: (1) dental hygienist-delivered pain self-management training (SMT; n=59); (2) the same dental hygienist-delivered pain self-management training, but with a focus on menstrual cycle-related changes in pain and other symptoms (targeted SMT, or TSMT; n=55); and (3) continuous oral contraceptive therapy (6-month trial) aimed at stabilizing hormones believed to be influential in TMD pain (COCT; n=57). Study participants completed outcome (pain, activity interference, depression) and process (pain beliefs, catastrophizing, coping effectiveness) measures before randomization, and 6 and 12months later. Intent-to-treat analyses supported the benefits of the SMT and TSMT interventions relative to COCT. Targeting the self-management treatment to menstrual cycle-related symptoms did not increase the treatment's efficacy. The benefits of the self-management interventions relative to COCT for pain and activity interference were statistically significant at 12 months, but not at 6 months, whereas the benefits for the process measures generally were apparent at both time points. COCT was associated with multiple adverse events (none serious). The study provides further support for long-term benefits of a safe, low-intensity (2 in-person sessions and 6 brief telephone contacts), dental hygienist-delivered self-management treatment for TMD pain. PMID:21680092

  10. Efficacy of a single-formula acupuncture treatment for horses with palmar heel pain.

    PubMed

    Robinson, Katherine A; Manning, Stephen T

    2015-12-01

    Acupuncture is used without strong scientific evidence to treat many diseases of the horse, including palmar heel pain. Research is needed to provide evidence for the application of these treatments. Within the confines of our study, acupuncture did not reliably modulate palmar heel pain in horses. PMID:26663921

  11. Efficacy of a single-formula acupuncture treatment for horses with palmar heel pain

    PubMed Central

    Robinson, Katherine A.; Manning, Stephen T.

    2015-01-01

    Acupuncture is used without strong scientific evidence to treat many diseases of the horse, including palmar heel pain. Research is needed to provide evidence for the application of these treatments. Within the confines of our study, acupuncture did not reliably modulate palmar heel pain in horses. PMID:26663921

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

    MedlinePlus

    ... great promise as a treatment approach. In self-management programs, the individual patient becomes an active participant in his or her pain treatment—engaging in problem-solving, pacing, decision-making, and taking actions to manage their pain. ...

  13. Citalopram Treatment of Pediatric Recurrent Abdominal Pain and Comorbid Internalizing Disorders: An Exploratory Study

    ERIC Educational Resources Information Center

    Campo, John V.; Perel, James; Lucas, Amanda; Bridge, Jeff; Ehmann, Mary; Kalas, Catherine; Monk, Kelly; Axelson, David; Birmaher, Boris; Ryan, Neal; Di Lorenzo, Carlo; Brent, David A.

    2004-01-01

    Objective: To assess the potential efficacy, tolerability, and safety of citalopram in the treatment of functional pediatric recurrent abdominal pain and comorbid internalizing disorders. Method: Twenty-five clinically referred children and adolescents with recurrent abdominal pain aged 7 to 18 years, inclusive, participated in a 12-week,…

  14. [Influence of psychologic attitude to efficiency of pain treatment in vibration disease].

    PubMed

    Kir'yakov, V A; Sukhova, A V

    2016-01-01

    The article presents results of study concerning influence of desadaptive psychologic attitudes on formation and perception of pain syndrome in 148 vibration disease patients. The authors determined clinical and psychologic predictors of efficiency of pain syndrome treatment in vibration disease patients. PMID:27265941

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

    ERIC Educational Resources Information Center

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

    2012-01-01

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

  16. Effect of Behavioral Activation Treatment on Chronic Fibromyalgia Pain: Replication and Extension

    ERIC Educational Resources Information Center

    Lundervold, Duane A.; Talley, Chris; Buermann, Michael

    2008-01-01

    A multiple-baseline-across two behavior sets and positions (reclined, upright) was used to experimentally examine the effect of Behavioral Activation Treatment for Pain (BAT-P) on pain-related behavior of a 44-year-old woman with a 22-year history of fibromyalgia (FM). BAT-P, based on the matching law, is comprised of Behavioral Relaxation…

  17. Ultrasound-guided pulsed radiofrequency treatment of the pudendal nerve in chronic pelvic pain.

    PubMed

    Ozkan, D; Akkaya, T; Yildiz, S; Comert, A

    2016-02-01

    Chronic pelvic pain is a condition that can be caused by pudendal neuralgia, interstitial cystitis, piriformis syndrome and neuropathy of the ilioinguinal, iliohypogastric and genitofemoral nerves. Based on three case reports this article discusses the clinical effectiveness of pulsed high-frequency radiofrequency (PRF) treatment applied to the pudendal nerve under ultrasound guidance in medicinally treated patients with chronic pelvic pain. PMID:26811947

  18. Use of hypnosis in the treatment of pain.

    PubMed

    Lee, Jin-Seong; Pyun, Young Don

    2012-04-01

    Hypnosis is an altered state of consciousness that comprises of heightened absorption in focal attention, dissociation of peripheral awareness, and enhanced responsiveness to social cues. Hypnosis has a long tradition of effectiveness in controlling somatic symptoms, such as pain. Pain, the most common symptom in clinical practice, is a multi-dimensional experience, which includes sensory-discriminative, affective-emotional, cognitive and behavioral components. There is a growing recognition for hypnosis and related techniques in pain management. Psychological approaches to pain control, such as hypnosis, can be highly effective analgesics, but are underused in Korea. In this article, we would like to review the basic concepts of hypnosis, the mechanism, and the outcome data of the analgesic effects of hypnosis, and also, its limitations. PMID:22514773

  19. Use of Hypnosis in the Treatment of Pain

    PubMed Central

    Pyun, Young Don

    2012-01-01

    Hypnosis is an altered state of consciousness that comprises of heightened absorption in focal attention, dissociation of peripheral awareness, and enhanced responsiveness to social cues. Hypnosis has a long tradition of effectiveness in controlling somatic symptoms, such as pain. Pain, the most common symptom in clinical practice, is a multi-dimensional experience, which includes sensory-discriminative, affective-emotional, cognitive and behavioral components. There is a growing recognition for hypnosis and related techniques in pain management. Psychological approaches to pain control, such as hypnosis, can be highly effective analgesics, but are underused in Korea. In this article, we would like to review the basic concepts of hypnosis, the mechanism, and the outcome data of the analgesic effects of hypnosis, and also, its limitations. PMID:22514773

  20. Efficacy of treatments and pain management for trapeziometacarpal (thumb base) osteoarthritis: protocol for a systematic review

    PubMed Central

    Hamasaki, Tokiko; Lalonde, Lyne; Harris, Patrick; Bureau, Nathalie J; Gaudreault, Nathaly; Ziegler, Daniela; Choinière, Manon

    2015-01-01

    Introduction The thumb is essential for daily activities. Unfortunately, this digit is commonly affected by trapeziometacarpal osteoarthritis (TMO), handicapping a large number of individuals. TMO constitutes an increasing human and economic burden for our society whose population is ageing. Limited access to adequate treatment is among the most important obstacles to optimal TMO management. Poor understanding of TMO characteristics, lack of knowledge about evidence-based treatments, simplistic pain management plans based solely on the patient's physical condition, absence of interprofessional communication and lack of multidisciplinary treatment guidelines contribute to inadequate TMO management. On the long term, our research project aims at improving the quality of care and services offered to patients with TMO by developing a patient-centred, evidence-based multidisciplinary management clinical pathway coordinated across the healthcare system. This proposed systematic review is a prerequisite to ensuring evidence-based practices and aims to document the efficacy of all the existing modalities for TMO management. Methods and analysis The protocol of the systematic review is registered with PROSPERO and will be conducted using the guidelines Cochrane Handbook for Systematic Reviews of Interventions. We will identify studies in English and French concerning TMO treatments through searches in Cochrane Central, EMBASE, MEDLINE, PsychINFO, CINHAL, PubMed, OT Seekers, PEDRO and the grey literature. 2 reviewers will independently screen study eligibility, extract data and appraise studies using published assessment tools. Meta-analyses will be undertaken where feasible; otherwise, narrative syntheses will be carried out. The robustness of evidence will be assessed using the GRADE system. Ethics and dissemination Ethics approval is not required for this study. A comprehensive knowledge exchange and transfer plan incorporating effective strategies will be used to

  1. The role of ketamine in the treatment of chronic cancer pain

    PubMed Central

    ZGAIA, ARMEANA OLIMPIA; IRIMIE, ALEXANDRU; SANDESC, DOREL; VLAD, CATALIN; LISENCU, COSMIN; ROGOBETE, ALEXANDRU; ACHIMAS-CADARIU, PATRICIU

    2015-01-01

    Background and aim Ketamine is a drug used for the induction and maintenance of general anesthesia, for the treatment of postoperative and posttraumatic acute pain, and more recently, for the reduction of postoperative opioid requirements. The main mechanism of action of ketamine is the antagonization of N-methyl-D-aspartate (NMDA) receptors that are associated with central sensitization. In the pathogenesis of chronic pain and particularly in neuropathic pain, an important role is played by the activation of NMDA receptors. Although ketamine is indicated and used for the treatment of chronic cancer pain as an adjuvant to opioids, there are few clinical studies that clearly demonstrate the effectiveness of ketamine in this type of pain. The aim of this study is to analyze evidence-based clinical data on the effectiveness and safety of ketamine administration in the treatment of chronic neoplastic pain, and to summarize the evidence-based recommendations for the use of ketamine in the treatment of chronic cancer pain. Method We reviewed the literature from the electronic databases of MEDLINE, COCHRANE, PUBMED, MEDSCAPE (1998–2014), as well as chapters of specialized books (palliative care, pain management, anesthesia). Results A number of studies support the effectiveness of ketamine in the treatment of chronic cancer pain, one study does not evidence clear clinical benefits for the use of ketamine, and some studies included too few patients to be conclusive. Conclusions Ketamine represents an option for neoplasic pain that no longer responds to conventional opioid treatment, but this drug should be used with caution, and the development of potential side effects should be carefully monitored. PMID:26733743

  2. Infrared laser in the treatment of craniomandibular disorders, arthrogenous pain

    SciTech Connect

    Hansson, T.L.

    1989-05-01

    The fast removal of intra-articular inflammation of the temporomandibular joint in five different patients after infrared laser application is described. Parameters of clinical evaluation was maximum mouth opening and subjective pain. The application of infrared laser of 700 Hz frequency for 3 minutes during five consecutive days at the skin over the painful area of the temporomandibular joint was used. However, the importance of concomitant mandibular stabilization is stressed to achieve optimal result.

  3. AMBULATORY DIAGNOSIS AND TREATMENT OF NON-MALIGNANT PAIN IN THE UNITED STATES, 2000–2010

    PubMed Central

    Daubresse, Matthew; Chang, Hsien-Yen; Yu, Yuping; Viswanathan, Shilpa; Shah, Nilay D.; Stafford, Randall S.; Kruszewski, Stefan P.; Alexander, G. Caleb

    2013-01-01

    Background Escalating rates of prescription opioid use and abuse have occurred in the context of efforts to improve the treatment of non-malignant pain. Objectives To characterize the diagnosis and management of non-malignant pain in ambulatory, office-based settings in the United States between 2000 and 2010. Design, setting, and participants Serial cross-sectional and multivariate regression analyses of the National Ambulatory Medical Care Survey (NAMCS), a nationally representative audit of office-based physician visits. Measures (1) Annual visits volume among adults with primary pain symptom or diagnosis; (2) receipt of any pain treatment; and (3) receipt of prescription opioid or non-opioid pharmacologic therapy in visits for new musculoskeletal pain. Results Primary symptoms or diagnoses of pain consistently represented one-fifth of visits, varying little from 2000 through 2010. Among all pain visits, opioid prescribing nearly doubled from 11.3% to 19.6%, whereas non-opioid analgesic prescribing remained unchanged (26%–29% of visits). One-half of new musculoskeletal pain visits resulted in pharmacologic treatment, though the prescribing of non-opioid pharmacotherapies decreased from 38% of visits (2000) to 29% of visits (2010). After adjusting for potentially confounding covariates, few patient, physician or practice characteristics were associated with a prescription opioid rather than a non-opioid analgesic for new musculoskeletal pain, and increases in opioid prescribing generally occurred non-selectively over time. Conclusions Increased opioid prescribing has not been accompanied by similar increases in non-opioid analgesics or the proportion of ambulatory pain patients receiving pharmacologic treatment. Clinical alternatives to prescription opioids may be underutilized as a means of treating ambulatory non-malignant pain. PMID:24025657

  4. Tramadol/paracetamol fixed-dose combination in the treatment of moderate to severe pain

    PubMed Central

    Pergolizzi, Joseph V; van de Laar, Mart; Langford, Richard; Mellinghoff, Hans-Ulrich; Merchante, Ignacio Morón; Nalamachu, Srinivas; O’Brien, Joanne; Perrot, Serge; Raffa, Robert B

    2012-01-01

    Pain is the most common reason patients seek medical attention and pain relief has been put forward as an ethical obligation of clinicians and a fundamental human right. However, pain management is challenging because the pathophysiology of pain is complex and not completely understood. Widely used analgesics such as nonsteroidal anti-inflammatory drugs (NSAIDs) and paracetamol (acetaminophen) have been associated with adverse events. Adverse event rates are of concern, especially in long-term treatment or at high doses. Paracetamol and NSAIDs are available by prescription, over the counter, and in combination preparations. Patients may be unaware of the risk associated with high dosages or long-term use of paracetamol and NSAIDs. Clinicians should encourage patients to disclose all medications they take in a “do ask, do tell” approach that includes patient education about the risks and benefits of common pain relievers. The ideal pain reliever would have few risks and enhanced analgesic efficacy. Fixed-dose combination analgesics with two or more agents may offer additive or synergistic benefits to treat the multiple mechanisms of pain. Therefore, pain may be effectively treated while toxicity is reduced due to lower doses. One recent fixed-dose combination analgesic product combines tramadol, a centrally acting weak opioid analgesic, with low-dose paracetamol. Evidence-based guidelines recognize the potential value of combination analgesics in specific situations. The current guideline-based paradigm for pain treatment recommends NSAIDs for ongoing use with analgesics such as opioids to manage flares. However, the treatment model should evolve how to use low-dose combination products to manage pain with occasional use of NSAIDs for flares to avoid long-term and high-dose treatment with these analgesics. A next step in pain management guidelines should be targeted therapy when possible, or low-dose combination therapy or both, to achieve maximal efficacy with

  5. Cervical pain in the athlete: common conditions and treatment.

    PubMed

    Dorshimer, Gary W; Kelly, Michael

    2005-03-01

    In summary, it is important for physicians dealing with neck pain in an athletic population to understand the differences between serious and mild cervical injuries. This is best facilitated by a thorough understanding of the signs and symptoms of serious cervical injury, familiarity with the basic anatomy of the neck and its structures, and a working knowledge of common causes of neck pain and mechanisms of injury. All unconscious athletes should be assumed to have a serious cervical injury until proven otherwise, and preventive measures should be taken to ensure the safety of the athlete. This includes airway management with a jaw thrust only, neck stabilization, and preventing helmet removal. In the conscious athlete who has neck pain, serious cervical injury can often be ruled out with an accurate history and physical examination. In all cases of neck pain, it is imperative that the athlete be protected. This may involve removing the athlete from competition, or transporting him or her to the local emergency room. Often, this decision falls on the shoulders of the doctor in the stands. Thus, a basic understanding of the evaluation and management of neck pain in athletes is an asset for all physicians who frequent athletic events or see athletes in the office. The physician responsible for patients who have Down syndrome or rheumatoid arthritis needs to consider the increased incidence of cervical instability in these patients when evaluating for athletic participation or neck pain. PMID:15831320

  6. Celiac plexus neurolysis for the treatment of upper abdominal cancer pain

    PubMed Central

    Teixeira, Manoel Jacobsen; Neto, Eloy Rusafa; da Nóbrega, José Cláudio Marinho; dos Ângelos, Jairo Silva; Martin, Miguel San; de Monaco, Bernardo Assumpção; Fonoff, Erich Talamoni

    2013-01-01

    Optimal treatment of oncologic pain is a challenge to all professionals who deal with cancer and its complications. The management of upper abdominal pain is usually difficult and it is often refractory to conservative therapies. In this context, celiac plexus neurolysis (CPN) appears to be an important and indispensable tool because it alleviates pain, gives comfort to patients and is a safe procedure. In this study, the importance of CPN is reviewed by a retrospective study of 74 patients with pain due to upper abdominal cancer. Almost all cases evaluated (94.6%) had an excellent result after CPN and the majority of side effects were transitory. PMID:23983470

  7. [Combined surgical and physical treatment in traumatic painful syndromes of the cervical spine].

    PubMed

    Stachowski, B; Kaczmarek, J; Nosek, A; Kocur, L

    1976-01-01

    Clinical observations suggest the need for changing therapeutic management to a more active one in cases of cervical spine injury with damage to the spinal cord and nerve roots or brachial plexus. In 248 patients with these injuries treated initially conservatively the incidence of cervicobrachial pain was analysed. Neuralgic pains were present in 31.5% of cases, causalgic pains in 2.4% and sympathalgic pains in 2%. Conservative treatment conducted in these patients (89 cases) during many months after trauma had no effect on return of mobility. Long-term application of physioterapy prevented only temporarily the development of trophic changes and only partially relieved pains. Only surgical decompression of the spinal cord or spinal nerves with stabilization of damaged vertebrae caused disappearance of painful syndromes and improvement in the motor activity of the extremities. These observations show that early surgical intervention for decompression of the spinal cord, roots or brachial plexus should be advocated in these cases. PMID:980212

  8. Successful Treatment of Severe Sympathetically Maintained Pain Following Anterior Spine Surgery

    PubMed Central

    Woo, Jae Hee

    2014-01-01

    Sympathetic dysfunction is one of the possible complications of anterior spine surgery; however, it has been underestimated as a cause of complications. We report two successful experiences of treating severe dysesthetic pain occurring after anterior spine surgery, by performing a sympathetic block. The first patient experienced a burning and stabbing pain in the contralateral upper extremity of approach side used in anterior cervical discectomy and fusion, and underwent a stellate ganglion block with a significant relief of his pain. The second patient complained of a cold sensation and severe unexpected pain in the lower extremity of the contralateral side after anterior lumbar interbody fusion and was treated with lumbar sympathetic block. We aimed to describe sympathetically maintained pain as one of the important causes of early postoperative pain and the treatment option chosen for these cases in detail. PMID:25289130

  9. Effectiveness of therapeutic physical exercise in the treatment of patellofemoral pain syndrome: a systematic review

    PubMed Central

    Alba-Martín, Pablo; Gallego-Izquierdo, T; Plaza-Manzano, Gustavo; Romero-Franco, Natalia; Núñez-Nagy, Susana; Pecos-Martín, Daniel

    2015-01-01

    [Purpose] The aim of this study was to analyze the effectiveness of conservative treatment of patellofemoral pain syndrome with physical exercise. [Subjects and Methods] A computer-based review conducted of four databases (PubMed, the Cochrane Library, PEDro, and the University Library) was completed based on the inclusion criteria of patellofemoral pain syndrome patients treated with physical exercise methods and examination with self-reported pain and/or functional questionnaires. [Results] The findings of ten clinical trials of moderate to high quality were evaluated to determine the effectiveness of physical exercise as conservative management for patellofemoral pain syndrome. [Conclusion] The intervention programs that were most effective in relieving pain and improving function in patellofemoral pain syndrome included proprioceptive neuromuscular facilitation stretching and strengthening exercises for the hip external rotator and abductor muscles and knee extensor muscles. PMID:26311988

  10. [Mirror feed-back - a new method for the treatment of neuropathic pain].

    PubMed

    Schwarzer, A; Glaudo, S; Zenz, M; Maier, C

    2007-10-01

    The mirror feedback therapy is a method for treatment of neuropathic pain syndromes that are associated with a missing or disordered afferent sensory input. That concerns especially the phantom limb pain, the pain after plexus or spinal nerve root injury and the complex regional pain syndrome. This therapeutic method has been increasingly implemented in the past few years. Its theoretical background rest upon recent pain research findings that refer to changes in the cortical organization and the influence of sensory and motor training effects on the pain experience. During the therapy the patients are instructed to use the mirror in a way that the image of the mirrored healthy limb seems to appear in the place of the missing or affected extremity. The mirror image produces an illusion of two "healthy" limbs. An ergotherapeutic training program with sensory and motor training elements based on the visual impressions is performed additionally. PMID:17924298

  11. Phase I Trial of Vertebral Intracavitary Cement and Samarium (VICS): Novel Technique for Treatment of Painful Vertebral Metastasis

    SciTech Connect

    Ashamalla, Hani; Cardoso, Erico; Macedon, Mark; Guirguis, Adel; Weng Lijun; Ali, Shamsah; Mokhtar, Bahaa; Ashamalla, Michael; Panigrahi, Nokul

    2009-11-01

    Purpose: Kyphoplasty is an effective procedure to alleviate pain in vertebral metastases. However, it has no proven anticancer activity. Samarium-153-ethylene diamine tetramethylene phosphonate ({sup 153}Sm-EDTMP) is used for palliative treatment of bone metastases. A standard dose of 1 mCi/kg is administrated intravenously. The present study was conducted to determine the feasibility of intravertebral administration of {sup 153}Sm with kyphoplasty. Methods and Materials: A total of 33 procedures were performed in 26 patients. Of these 26 patients, 7 underwent procedures performed at two vertebral levels. The mean age of the cohort was 64 years (range, 33-86). The kyphoplasty procedure was performed using a known protocol; 1-4 mCi of {sup 153}Sm was admixed with the bone cement and administered under tight radiation safety measures. Serial nuclear body scans were obtained. Pain assessment was evaluated using a visual analog pain score. Results: All patients tolerated the procedure well. No procedure-related morbidities were noted. No significant change had occurred in the blood counts at 1 month after the procedure. One case was not technically satisfactory. Nuclear scans revealed clear radiotracer uptake in the other 32 vertebrae injected. Except for the first patient, no radiation leakage was encountered. The mean pain score using the visual analog scale improved from 8.6 before to 2.8 after the procedure (p < .0001). Follow-up bone scans demonstrated a 43% decrease in the tracer uptake. Conclusion: The results of our study have shown that the combination of intravertebral administration of {sup 153}Sm and kyphoplasty is well tolerated with adequate pain control. No hematologic adverse effects were found. A reduction of the bone scan tracer uptake was observed in the injected vertebrae. Longer follow-up is needed to study the antineoplastic effect of the procedure.

  12. Comprehensive multidisciplinary pain center approach to the treatment of low back pain.

    PubMed

    Rosomoff, H L; Rosomoff, R S

    1991-10-01

    The primary objective of our program is full function. Other objectives include relief or decrease in pain with the abolition of pain medication, elimination of assistive devices, low or zero disability rating, job satisfaction with return to work and leisure activities without limitations, independence from the health care system, prevention of reinjury, and optimum wellness. The intense, multidisciplinary program described involves a full-time multidisciplinary staff, complete patient involvement, weight control, physical restoration and conditioning, home program maintenance, pacing, body mechanics, energy-saving techniques, reinjury prevention education, pain control and elimination, drug detoxification, behavioral modification, biofeedback, relaxation, imagery, individual and group therapy, family therapy, assertiveness training, stress management, coping skills, vocational counseling, job planning/development/simulation, achievement of maximal function, immediate return to work at discharge, and follow-up care. It is possible to return 86% of these patients to full function and work; they may have some residual pain, which should eventually remit. The 14% who fail are hardcore patients with major behavioral problems, although, to be fair, there are still unanswered questions to resolve. These people have problems that cannot be eliminated within the limit of time with which we have to work with the patient. Lastly, these patients can be disturbed and dangerous, as evidenced by the headline of "A Former Patient Shoots, Kills, New York Neurosurgeon, Self, Wife." PMID:1840392

  13. Targeting Temporomandibular Disorder Pain Treatment to Hormonal Fluctuations: A Randomized Clinical Trial

    PubMed Central

    Turner, Judith A.; Mancl, Lloyd; Huggins, Kimberly Hanson; Sherman, Jeffrey J.; Lentz, Gretchen; LeResche, Linda

    2011-01-01

    Mounting evidence supports the importance of hormonal fluctuations in temporomandibular disorder (TMD) pain among women. Stabilizing influential hormones or having a plan and skills for coping with hormonally-related increases in TMD pain therefore may be beneficial for women with TMD pain. This randomized clinical trial evaluated the short- and long-term efficacy of three interventions for women with TMD pain: (1) dental hygienist-delivered pain self-management training (SMT; n = 59); (2) the same dental hygienist-delivered pain self-management training, but with a focus on menstrual cycle-related changes in pain and other symptoms (targeted SMT, or TSMT; n = 55); and (3) continuous oral contraceptive therapy (6 month trial), aimed at stabilizing hormones believed to be influential in TMD pain (COCT; n = 57). Study participants completed outcome (pain, activity interference, depression) and process (pain beliefs, catastrophizing, coping effectiveness) measures before randomization, and 6 and 12 months later. Intent-to-treat analyses supported the benefits of the SMT and TSMT interventions relative to COCT. Targeting the self-management treatment to menstrual cycle-related symptoms did not increase the treatment’s efficacy. The benefits of the self-management interventions relative to COCT for pain and activity interference were statistically significant at 12 months, but not at 6 months, whereas the benefits for the process measures generally were apparent at both timepoints. COCT was associated with multiple adverse events (none serious). The study provides further support for long-term benefits of a safe, low intensity (two in-person sessions and six brief telephone contacts), dental hygienist-delivered self-management treatment for TMD pain. PMID:21680092

  14. Evaluating Persistent Postoperative Pain in One Tertiary Hospital: Incidence, Quality of Life, Associated Factors, and Treatment

    PubMed Central

    Guimaraes-Pereira, Luis; Valdoleiros, Ines; Reis, Pedro; Abelha, Fernando

    2016-01-01

    Background Persistent postoperative pain (PPP) is defined as persistent pain after surgery of greater than three months’ duration. Objectives Identify the incidence of PPP in our hospital and its associated factors; evaluate quality of life (QoL) and treatment of patients. Patients and Methods We conducted an observational prospective study in adults proposed to various types of surgery using the brief pain inventory short form preoperatively (T0), one day after surgery, and three months later (T3). If the patient had pain at T3 and other causes of pain were excluded, they were considered to have PPP, and the McGill Pain Questionnaire Short Form was applied. QoL was measured with the EuroQol 5-dimension questionnaire (EQ-5D). Results One hundred seventy-five patients completed the study. The incidence of PPP was 28%, and the affected patients presented lower QoL. The majority referred to a moderate to severe level of interference in their general activity. Cholecystectomies were less associated with PPP, and total knee/hip replacements were more associated with it. Preoperative pain, preoperative benzodiazepines or antidepressants, and more severe acute postoperative pain were associated with the development of PPP. Half of the patients with PPP were under treatment, and they refer a mean symptomatic relief of 69%. Conclusions This study, apart from attempting to better characterize the problem of PPP, emphasizes the lack of its treatment. PMID:27252908

  15. Complex regional pain syndrome: observations on diagnosis, treatment and definition of a new subgroup.

    PubMed

    Żyluk, A; Puchalski, P

    2013-07-01

    Several definitions and sets of diagnostic criteria of complex regional pain syndrome have been proposed, but to date none has been accepted completely. This article presents a specific subtype of the disease, called 'chronic, refractory complex regional pain syndrome' which is extremely severe, disabling and resistant to treatment. It also emphasizes difficulties with diagnosing complex regional pain syndrome because of its variable clinical presentation and diagnostic criteria being insufficiently precise. The necessity to distinguish between criteria for clinical use and for scientific purposes is suggested with a proposal of practical guideline for diagnosing acute complex regional pain syndrome. A review of treatments for complex regional pain syndrome is presented, with opinion on their effectiveness: good in an early stage, less well in chronic and generally poor in the chronic, refractory subtype. PMID:23221182

  16. Randomized controlled trial of nettle sting for treatment of base-of-thumb pain.

    PubMed Central

    Randall, C; Randall, H; Dobbs, F; Hutton, C; Sanders, H

    2000-01-01

    There are numerous published references to use of nettle sting for arthritis pain but no randomized controlled trials have been reported. We conducted a randomized controlled double-blind crossover study in 27 patients with osteoarthritic pain at the base of the thumb or index finger. Patients applied stinging nettle leaf (Urtica dioica) daily for one week to the painful area. The effect of this treatment was compared with that of placebo, white deadnettle leaf (Lamium album), for one week after a five-week washout period. Observations of pain and disability were recorded for the twelve weeks of the study. After one week's treatment with nettle sting, score reductions on both visual analogue scale (pain) and health assessment questionnaire (disability) were significantly greater than with placebo (P = 0.026 and P = 0.0027). PMID:10911825

  17. [The physicians' recognition and treatment of hypochondriac pain before the Ming Dynasty].

    PubMed

    Zhang, Jin-Zhong; Wang, Zhen-Rui

    2013-03-01

    There were two phases for the recognition and treatment of hypochondriac pain before the Ming Dynasty, and the Song Dynasty being their demarcation line. Before the Song Dynasty, hypochondriac pain was regarded generally as a concomitant symptom, generally attributed to pathogen of coldness, and the materia medica with the warm nature were always used for the treatment. This recognition was related with the traditional idea paying attention predominantly to the yang of the yin-yang theory. Since the Song Dynasty, especially the Jin-Yuan Period, the hypochondriac pain was regarded gradually as an independent symptom. Physicians got more and more recognition about its causes and pathogenesis. The treatment was changed from dispelling cold to activating qi, and the idea of treatment based on syndrome differentiation on hypochondriac pain was finally established, reflecting the influence of spirit of medical innovation during the Jin-Yuan Period on the recognition of disease. PMID:24135472

  18. Exercise and spinal manipulation in the treatment of low back pain.

    PubMed

    Twomey, L; Taylor, J

    1995-03-01

    Current research clearly indicates the importance of exercise and mobility in the treatment of low back pain and also that bed rest and inactivity should play a relatively small part in treatment. The use of intensive, physical exercise and "work hardening" routines have been shown to be necessary for treating chronic low back pain and returning individuals to work. Evidence derived from valid clinical studies of the use of manipulation in the treatment of low back pain shows a role for it in the acute treatment of "mechanical" low back disorders. These studies have demonstrated that manipulative procedures result in more rapid pain and functional relief compared with other conservative therapies. Over a longer time frame, this advantage disappears. PMID:7604333

  19. New modalities of pain treatment after outpatient orthopaedic surgery.

    PubMed

    Beaussier, M; Sciard, D; Sautet, A

    2016-02-01

    Postoperative pain relief is one of the cornerstones of success of orthopaedic surgery. Development of new minimally-invasive surgical procedures, as well as improvements in pharmacological and local and regional techniques should result in optimal postoperative pain control for all patients. The analgesic strategy has to be efficient, with minimal side effects, and be easy to manage at home. Multimodal analgesia allows for a reduction of opiate use and thereby its side effects. Local and regional analgesia is a major component of this multimodal strategy, associated with optimal pain relief, even upon mobilization, and it has beneficial effects on postoperative recovery. Ultrasound guidance improves the success rate of distal nerve blocks and makes distal selective blockade possible, helping to preserve the limb's motility. Besides peripheral nerve blocks, local infiltration (incisional and/or intra-articular) is also important to consider. Duration of the nerve blockade is limited after a single injection. This must be taken into consideration to avoid the recurrence of pain when the patient returns home. Continuous perineural blocks using catheters are an option that can be easily managed at home with monitoring by home-care nurses. Extended-release liposomal bupivacaine and adjuvants such as dexamethasone could significantly enhance the duration of the sensory block, thereby reducing the indications for pain pumps. Non-pharmacological approaches, such as cryotherapy, hypnosis and acupuncture should not be ignored. PMID:26803223

  20. Motor cortex stimulation for the treatment of refractory peripheral neuropathic pain.

    PubMed

    Lefaucheur, Jean-Pascal; Drouot, Xavier; Cunin, Patrick; Bruckert, Rémy; Lepetit, Hélène; Créange, Alain; Wolkenstein, Pierre; Maison, Patrick; Keravel, Yves; Nguyen, Jean-Paul

    2009-06-01

    Epidural motor cortex stimulation (MCS) has been proposed as a treatment for chronic, drug-resistant neuropathic pain of various origins. Regarding pain syndromes due to peripheral nerve lesion, only case series have previously been reported. We present the results of the first randomized controlled trial using chronic MCS in this indication. Sixteen patients were included with pain origin as follows: trigeminal neuralgia (n = 4), brachial plexus lesion (n = 4), neurofibromatosis type-1 (n = 3), upper limb amputation (n = 2), herpes zoster ophthalmicus (n = 1), atypical orofacial pain secondary to dental extraction (n = 1) and traumatic nerve trunk transection in a lower limb (n = 1). A quadripolar lead was implanted, under radiological and electrophysiological guidance, for epidural cortical stimulation. A randomized crossover trial was performed between 1 and 3 months postoperative, during which the stimulator was alternatively switched 'on' and 'off' for 1 month, followed by an open phase during which the stimulator was switched 'on' in all patients. Clinical assessment was performed up to 1 year after implantation and was based on the following evaluations: visual analogue scale (VAS), brief pain inventory, McGill Pain questionnaire, sickness impact profile and medication quantification scale. The crossover trial included 13 patients and showed a reduction of the McGill Pain questionnaire-pain rating index (P = 0.0166, Wilcoxon test) and McGill Pain questionnaire sensory subscore (P = 0.01) when the stimulator was switched 'on' compared to the 'off-stimulation' condition. However, these differences did not persist after adjustment for multiple comparisons. In the 12 patients who completed the open study, the VAS and sickness impact profile scores varied significantly in the follow-up and were reduced at 9-12 months postoperative, compared to the preoperative baseline. At final examination, the mean rate of pain relief on VAS scores was 48% (individual results

  1. Treatment of patients with hypertension and arthritis pain: new concepts.

    PubMed

    Weber, Michael A

    2009-05-01

    Arthritis pain often occurs concurrently with hypertension and other cardiovascular risk factors. Treating patients with hypertension who have arthritis and other painful conditions can be a challenge because of potential risks associated with the agents commonly used to treat pain and inflammation. Hypertension is associated with endothelial dysfunction and decreased bioavailability of nitric oxide (NO). Naproxcinod, an investigational drug, is the first in a new class of agents called cyclooxygenase-inhibiting NO donators. They differ from traditional nonsteroidal anti-inflammatory drugs in their ability to donate NO, a signaling molecule known to have potentially beneficial effects on the vasculature and the gastrointestinal tract. Naproxcinod, by donating NO, offers a therapeutic option that might mitigate the negative blood pressure effects and adverse gastrointestinal effects associated with traditional arthritis therapies. This article reviews some preliminary preclinical and clinical studies of key safety data of an investigational new NO-donating anti-inflammatory agent. PMID:19393822

  2. Computer assisted treatment prediction of low back pain pathologies.

    PubMed

    Gal, Norbert; Stoicu-Tivadar, Vasile; Andrei, Diana; Nemeş, Dan Ion; Nădăşan, Emanuela

    2014-01-01

    The paper presents a fuzzy inference system based prediction with the role to determine the appropriate action for patients that presents lower back pain. If not treated correctly lower back pain can degenerate in various diseases. The system infers three possible actions: (1) spinal cord surgery, (2) medication combined with exercises and (3) no action needed. The system takes in consideration the age and sex of the patient, a pain intensity parameter, the metabolic rate of the patient and mobility parameters from the Zebris Mobility device. In total 243 rules have been formulated but only 21% of the rules suggests surgery. The initial results are promising; there is a correlation of 0.83% between the control results and the results from the system. PMID:24743076

  3. Preoperative pain treatment in acute abdomen in Osogbo, Nigeria: a randomized double-blind placebo-controlled study

    PubMed Central

    2013-01-01

    Background Withholding analgesics in acute abdomen for fear of masking clinical features and impairing diagnosis and decision-making is still being practiced despite recent evidence to the contrary. This study assesses the effect of preoperative analgesia on clinical findings, clinical diagnosis, and decision-making in patients with non-trauma acute abdomen. Method This is a randomized, double-blind, placebo-controlled study using Tramal, a brand of tramadol, at the ED of LAUTECH Teaching Hospital Osogbo, Nigeria. Ninety-five patients between 18–60 years received Tramal (n = 46) or placebo (n = 49). The pain score, clinical findings, provisional diagnosis, and treatment plan were noted before and 15–20 min after administration of the analgesic or placebo. The final diagnosis arrived at after adequate investigation or operation was considered the gold standard. The pain scores, diagnosis, treatment plan, and decision between the two groups were compared. Statistical analysis was by SPSS 16. Results were considered statistically significant at p < 0.05. Results Demography and case distribution were similar in both groups. The improvement in pain was greater in the Tramal group (p = 0.001). The abdominal palpation findings were also better in the Tramal group (p = 0.02). There were more changes in the diagnosis after use of Tramal (p = 0.01). There were more changes in the decision in the Tramal group (p = 0.03). Most of the changes in diagnosis and decision in the Tramal group were for the better. Conclusion The preoperative use of Tramal in acute abdomen improved the experience of pain and did not adversely affect the accuracy of the diagnosis or decision-making. PMID:23343476

  4. The use of CAM and conventional treatments among primary care consulters with chronic musculoskeletal pain

    PubMed Central

    Artus, Majid; Croft, Peter; Lewis, Martyn

    2007-01-01

    Background Chronic musculoskeletal pain is the single most cited reason for use of complementary and alternative medicine (CAM). Primary care is the most frequent conventional medical service used by patients with pain in the UK. We are unaware, however, of a direct evidence of the extent of CAM use by primary care patients, and how successful they perceive it to be. Methods Aims and objectives To determine CAM use among patients with chronic musculoskeletal pain who have consulted about their pain in primary care. Study design Face-to-face interview-based survey. Setting Three general practices in North Staffordshire. Participants Respondents to a population pain survey who had reported having musculoskeletal pain in the survey and who had consulted about their pain in primary care in the previous 12 months as well as consenting to further research and agreeing to an interview. Information was gathered about their pain and the use of all treatments for pain, including CAM, in the previous year. Results 138 interviews were completed. 116 participants (84%) had used at least one CAM treatment for pain in the previous year. 65% were current users of CAM. The ratio of over-the-counter CAM use to care from a CAM provider was 3:2. 111 participants (80%) had used conventional treatment. 95 (69%) were using a combination of CAM and conventional treatment. Glucosamine and fish oil were the most commonly used CAM treatments (38%, 35% respectively). Most CAM treatments were scored on average as being helpful, and users indicated that they intended to use again 87% of the CAM treatments they had already used. Conclusion We provide direct evidence that most primary care consulters with chronic musculoskeletal pain have used CAM in the previous year, usually in combination with conventional treatments. The high prevalence and wide range of users experiences of benefit and harm from CAM strengthen the argument for more research into this type of medicine to quantify benefit and

  5. Spinal Cord Stimulation Therapy for the Treatment of Concomitant Phantom Limb Pain and Critical Limb Ischemia.

    PubMed

    De Caridi, Giovanni; Massara, Mafalda; Serra, Raffaele; Risitano, Claudia; Giardina, Massimiliano; Acri, Ignazio Eduardo; Volpe, Pietro; David, Antonio

    2016-04-01

    Phantom limb pain (PLP) is a chronic condition experienced by about 80% of patients who have undergone amputation. In most patients, both the frequency and the intensity of pain attacks diminish with time, but severe pain persists in about 5-10%. Probably, factors in both the peripheral and central nervous system play a role in the occurrence and persistence of pain in the amputated lower limb. The classical treatment of PLP can be divided into pharmacologic, surgical, anesthetic, and psychological modalities. Spinal cord stimulation (SCS) does not represent a new method of treatment for this condition. However, the concomitant treatment of PLP and critical lower limb ischemia by using SCS therapy has not yet been described in the current literature. The aim of the present article is to highlight the possibility of apply SCS for the simultaneous treatment of PLP and critical lower limb ischemia on the contralateral lower limb after failure of medical therapy in a group of 3 patients, obtaining pain relief in both lower limbs, delaying an endovascular or surgical revascularization. After SCS implantation and test stimulation, the pain was reduced by 50% on both the right and the left side in all our patients. The main indications for permanent SCS therapy after 1 week of test stimulation were represented by transcutaneous oxygen (TcPO2) increase >75%, decrease of opioids analgesics use of at least 50% and a pain maintained to within 20-30/100 mm on visual analog scale. PMID:26802307

  6. Cancer pain

    SciTech Connect

    Swerdlow, M.; Ventafridda, V.

    1987-01-01

    This book contains 13 chapters. Some of the chapter titles are: Importance of the Problem; Neurophysiology and Biochemistry of Pain; Assessment of Pain in Patients with Cancer; Drug Therapy; Chemotherapy and Radiotherapy for Cancer Pain; Sympton Control as it Relates to Pain Control; and Palliative Surgery in Cancer Pain Treatment.

  7. Patient Centered Outcome Criteria for Successful Treatment of Facial Pain and Fibromyalgia

    PubMed Central

    Robinson, Michael E.; McCulloch, Robert C.; Banou, Evangelia; Gremillion, Henry A.; Waxenberg, Lori B.; Staud, Roland

    2013-01-01

    BACKGROUND AND PURPOSE Patient-centered models of healthcare and patient derived criteria for success are becoming increasingly important. Research studies of such success criteria have not targeted facial pain (FP) or fibromyalgia (FM) individuals and little is known about the consistency across pain groups. This study examined patient-centered success criteria of individuals with FP and FM. METHODS Participants included 53 FP (46 women, 7 men) and 52 FM (49 women, 3 men) individuals who completed the Patient Centered Outcomes (PCO) Questionnaire. The PCO assesses four relevant domains of chronic pain: pain, fatigue, distress, and interference in daily activities. Participants rated their usual levels, expected levels, levels considered as successful improvements, and how important improvements were in each of the four domains following treatment. RESULTS Both groups of participants defined treatment success as a substantial decrease in their pain, fatigue, distress, and interference ratings (all approx. 60%). FM participants reported high levels of pain (M = 7.08, SD = 2.04), fatigue (M = 7.82, SD = 1.71), distress (M = 6.35, SD = 2.46), and interference (M = 7.35, SD = 2.21). FP participants’ ratings of these domains were significantly lower for pain (M = 5.62, SD = 2.38), fatigue (M = 5.28, SD = 2.64), distress (M = 4.34, SD = 2.78) and interference (M = 4.10, SD = 3.06). INTERPRETATIONS These results demonstrate the high expectations of individuals with chronic pain regarding treatments of their symptoms. Healthcare providers should incorporate these expectations into their treatment plans and discuss realistic treatment goals with their pain populations. PMID:19264035

  8. Neuropathic Pain Post Spinal Cord Injury Part 1: Systematic Review of Physical and Behavioral Treatment

    PubMed Central

    2013-01-01

    Background: Neuropathic pain has various physiologic and psychosocial aspects. Hence, there is a growing use of adjunct nonpharmacological therapy with traditional pharmacotherapy to reduce neuropathic pain post spinal cord injury (SCI). Objective: The purpose of this study was to conduct a systematic review of published research on nonpharmacological treatment of neuropathic pain after SCI. Methods: MEDLINE, CINAHL, EMBASE, and PsycINFO databases were searched for articles addressing nonpharmacological treatment of pain post SCI. Articles were restricted to the English language. Article selection was conducted by 2 independent reviewers with the following inclusion criteria: the subjects participated in a treatment or intervention for neuropathic pain; at least 50% of the subjects had an SCI; at least 3 subjects had an SCI; and a definable intervention was being studied. Data extracted included study design, study type, subject demographics, inclusion and exclusion criteria, sample size, outcome measures, and study results. Randomized controlled trials (RCTs) were assessed for quality using the Physiotherapy Evidence Database (PEDro) assessment scale. Levels of evidence were assigned to each intervention using a modified Sackett scale. Results: The 16 articles selected for this review fell into 1 of 2 categories of nonpharmacological management of pain after SCI: physical and behavioral treatments. The pooled sample size of all studies included 433 participants. Of the 16 studies included, 7 were level 1, 3 were level 2, and 6 were level 4 studies. Conclusions: Physical interventions demonstrated the strongest evidence based on quality of studies and numbers of RCTs in the nonpharmacological treatment of post-SCI pain. Of these interventions, transcranial electrical stimulation had the strongest evidence of reducing pain. Despite a growing body of literature, there is still a significant lack of research on the use of nonpharmacological therapies for SCI pain

  9. Self-Reported Pain and Disease Symptoms Persist in Juvenile Idiopathic Arthritis Despite Treatment Advances

    PubMed Central

    Bromberg, Maggie H.; Connelly, Mark; Anthony, Kelly K.; Gil, Karen M.; Schanberg, Laura E.

    2014-01-01

    Objective To use electronic diaries (e-diaries) to determine whether pain, stiffness, and fatigue continue to be common, disabling symptoms in children with juvenile idiopathic arthritis (JIA) despite the use of aggressive treatments in contemporary medical management. Methods Fifty-nine children with JIA (ages 8–18 years) provided ratings of pain, stiffness, and fatigue intensity and functional limitations using a smartphone e-diary 3 times each day for 1 month. Medication information was collected via parent report and checked for accuracy by chart review. Descriptive analyses were conducted to determine typical symptom intensity, frequency, and variability. Multilevel modeling was used to analyze associations between symptoms and functional outcomes and between medication use and symptom intensity. Results Children reported moments of pain in 66% of e-diary entries. No children were entirely pain-free across the reporting period. In 31% of all e-diary entries the visual analog scale score for pain was >40 (high pain intensity), with 86% of children reporting a high level of pain at least once during the study period. The mean ratings of pain, stiffness, and fatigue intensity were in the mild-to-moderate range. Medication class was not a reliable predictor of differences in symptom intensity, even though 79% of children were prescribed a disease-modifying antirheumatic drug and 47% were prescribed a biologic agent. Moments of higher pain intensity and higher stiffness intensity were each uniquely predictive of higher concurrent functional limitations. Conclusion Self-reported pain, stiffness, and fatigue continue to be common in children with JIA, despite contemporary advances in treatment strategies, including use of biologic agents. These findings are surprisingly consistent with previous results from research using daily paper diaries in the pre-biologics era. There remains a pressing and ongoing need to optimize pain and symptom management in JIA. PMID

  10. Cannabinoids for treatment of chronic non-cancer pain; a systematic review of randomized trials.

    PubMed

    Lynch, Mary E; Campbell, Fiona

    2011-11-01

    Effective therapeutic options for patients living with chronic pain are limited. The pain relieving effect of cannabinoids remains unclear. A systematic review of randomized controlled trials (RCTs) examining cannabinoids in the treatment of chronic non-cancer pain was conducted according to the PRISMA statement update on the QUORUM guidelines for reporting systematic reviews that evaluate health care interventions. Cannabinoids studied included smoked cannabis, oromucosal extracts of cannabis based medicine, nabilone, dronabinol and a novel THC analogue. Chronic non-cancer pain conditions included neuropathic pain, fibromyalgia, rheumatoid arthritis, and mixed chronic pain. Overall the quality of trials was excellent. Fifteen of the eighteen trials that met the inclusion criteria demonstrated a significant analgesic effect of cannabinoid as compared with placebo and several reported significant improvements in sleep. There were no serious adverse effects. Adverse effects most commonly reported were generally well tolerated, mild to moderate in severity and led to withdrawal from the studies in only a few cases. Overall there is evidence that cannabinoids are safe and modestly effective in neuropathic pain with preliminary evidence of efficacy in fibromyalgia and rheumatoid arthritis. The context of the need for additional treatments for chronic pain is reviewed. Further large studies of longer duration examining specific cannabinoids in homogeneous populations are required. PMID:21426373

  11. Intradiscal methylene blue injection for the treatment of chronic discogenic low back pain.

    PubMed

    Peng, Baogan; Zhang, Yingmin; Hou, Shuxun; Wu, Wenwen; Fu, Xiaobing

    2007-01-01

    This article was a preliminary report of prospective clinical trial of a group of patients with chronic discogenic low back pain who met the criteria for lumbar interbody fusion surgery but were treated instead with an intradiscal injection of methylene blue (MB) for the pain relief. Twenty-four patients with chronic discogenic low back pain underwent diagnostic discography with intradiscal injection of MB. The principal criteria to judge the effectiveness included alleviation of pain, assessed by visual analog scale (VAS), and improvement in disability, as assessed with the Oswestry Disability Index (ODI) for functional recovery. The mean follow-up period was 18.2 months (range 12-23 months). Of the 24 patients, 21 (87%) reported a disappearance or marked alleviation of low back pain, and experienced a definite improvement in physical function. A statistically significant and clinically meaningful improvement in the changes in the ODI and the VAS scores were obtained in the patients with chronic discogenic low back pain (P=0.0001) after the treatment. The study suggests that the injection of MB into the painful disc may be a very effective alternative for the surgical treatment of chronic discogenic low back pain. PMID:16496191

  12. Cannabinoids for treatment of chronic non-cancer pain; a systematic review of randomized trials

    PubMed Central

    Lynch, Mary E; Campbell, Fiona

    2011-01-01

    Effective therapeutic options for patients living with chronic pain are limited. The pain relieving effect of cannabinoids remains unclear. A systematic review of randomized controlled trials (RCTs) examining cannabinoids in the treatment of chronic non-cancer pain was conducted according to the PRISMA statement update on the QUORUM guidelines for reporting systematic reviews that evaluate health care interventions. Cannabinoids studied included smoked cannabis, oromucosal extracts of cannabis based medicine, nabilone, dronabinol and a novel THC analogue. Chronic non-cancer pain conditions included neuropathic pain, fibromyalgia, rheumatoid arthritis, and mixed chronic pain. Overall the quality of trials was excellent. Fifteen of the eighteen trials that met the inclusion criteria demonstrated a significant analgesic effect of cannabinoid as compared with placebo and several reported significant improvements in sleep. There were no serious adverse effects. Adverse effects most commonly reported were generally well tolerated, mild to moderate in severity and led to withdrawal from the studies in only a few cases. Overall there is evidence that cannabinoids are safe and modestly effective in neuropathic pain with preliminary evidence of efficacy in fibromyalgia and rheumatoid arthritis. The context of the need for additional treatments for chronic pain is reviewed. Further large studies of longer duration examining specific cannabinoids in homogeneous populations are required. Linked Article This article is linked to a themed issue in the British Journal of Pharmacology on Respiratory Pharmacology. To view this issue visit http://dx.doi.org/10.1111/bph.2011.163.issue-1 PMID:21426373

  13. The feasibility and acceptability of groups for pain management in methadone maintenance treatment

    PubMed Central

    Barry, Declan T.; Savant, Jonathan D.; Beitel, Mark; Cutter, Christopher J.; Schottenfeld, Richard S.; Kerns, Robert D.; Moore, Brent A.; Oberleitner, Lindsay; Joy, Michelle T.; Keneally, Nina; Liong, Christopher; Carroll, Kathleen M.

    2014-01-01

    Objectives Effective and safe pain management interventions in methadone maintenance treatment are needed. Methods We examined the feasibility (i.e., single session attendance) and acceptability (i.e., patient satisfaction, booster session attendance) of cognitive-behavioral therapy-informed groups for pain management: Coping with Pain, Relaxation Training, Group Singing, and Mindful Walking. Pre- and post-session measures were collected. Results 349 (out of a census of approximately 800) methadone-maintained patients attended at least one of the groups. Group satisfaction was high. Booster session attendance was numerically lower in Mindful Walking (15%) as compared to the other groups (at least 40%). Repeat attendance at Coping with Pain was associated with reduced characteristic pain intensity and depression, while repeat attendance at Relaxation Training was associated with decreased anxiety. Conclusions Coping with Pain, Relaxation Training, and Group Singing are transportable, affordable, adaptable, and tolerated well by patients with pain and show promise as components of a multimodal pain management approach in methadone maintenance treatment. PMID:25100310

  14. Effect of a perspective-taking intervention on the consideration of pain assessment and treatment decisions

    PubMed Central

    Wandner, Laura D; Torres, Calia A; Bartley, Emily J; George, Steven Z; Robinson, Michael E

    2015-01-01

    Objectives Pain is often poorly managed, highlighting the need to better understand and treat patients’ pain. Research suggests that pain is assessed and treated differently depending on patient sex, race, and/or age. Perspective-taking, whereby one envisions the perspective of another, has been found to reduce racial disparities in pain management. This study used virtual human (VH) technology to examine whether a perspective-taking intervention impacts pain management decisions. Methods Ninety-six participants were randomized to an online treatment or control group and viewed 16 video clips of VHs with standardized levels of pain. Participants provided ratings on the VHs’ pain intensity and their willingness to administer opioids to them. The intervention group received a brief perspective-taking intervention that consisted of having participants imagine how the patient’s suffering could affect his/her life, whereas the control group was asked to wait for the next VH videos to load. A LENS model analysis was used to investigate both group level (nomothetic) and individual level (idiographic) decision policies. A LENS model of analysis is typically used as an analog method for capturing how groups of people and individuals use information in their environment to form judgments. Results Nomothetic results found that participants rated pain higher and were more likely to prescribe opioids to VHs postintervention, irrespective of group. Idiographic results, however, found that the use of cues to make pain management decisions was mitigated by the perspective-taking group. The participants in the perspective-taking group were more likely to think about pain and the patients’ perspective during the intervention, while control participants were more likely to reflect on the VHs’ sex, race, or age. Conclusion A brief intervention may alter participants’ pain management decisions. These results indicate that a brief intervention might be an initial step toward

  15. Combined photon-electron beams in the treatment of the supraclavicular lymph nodes in breast cancer: A novel technique that achieves adequate coverage while reducing lung dose

    SciTech Connect

    Salem, Ahmed; Mohamad, Issa; Dayyat, Abdulmajeed; Kanaa’n, Haitham; Sarhan, Nasim; Roujob, Ibrahim; Salem, Abdel-Fattah; Afifi, Shatha; Jaradat, Imad; Mubiden, Rasmi; Almousa, Abdelateif

    2015-10-01

    -only plans (mean = 16.2 ± 3%, p < 0.001). As expected, photon-only plans demonstrated the highest target coverage and total lung V{sub 20} {sub Gy}. The superiority of electron-only beams, in terms of decreasing lung dose, is set back by the dosimetric hotspots associated with such plans. Combined photon-electron treatment is a feasible technique for supraclavicular nodal irradiation and results in adequate target coverage, acceptable dosimetric hotspot volume, and slightly reduced lung dose.

  16. [Self-hypnosis, a resource for children undergoing painful treatment].

    PubMed

    Restif, Anne-Sophie

    2010-01-01

    Learning self-hypnosis enables children to partially or totally manage the sensory and emotional components of pain, especially that linked to the use of a central line in paediatric onco-haematology. Specially trained paediatric nurses can teach this special technique. PMID:20518243

  17. Perceptions of Pharmacy Students Concerning Cancer Pain and Its Treatment.

    ERIC Educational Resources Information Center

    Holdsworth, Mark T.; Raisch, Dennis W.

    1993-01-01

    A survey of 62 third- and 105 fourth-year pharmacy students found a number of misperceptions concerning cancer pain and its management that may translate into inadequate provision of care to future patients. Research on educational strategies to address these misperceptions is recommended. (Author/MSE)

  18. Clinical evaluation of nonarthritic shoulder pain: Diagnosis and treatment.

    PubMed

    Holmes, Robert E; Barfield, William R; Woolf, Shane K

    2015-07-01

    Shoulder pain and dysfunction is a complex problem frequently encountered by primary care physicians. Common nonarthritic conditions seen in the primary care setting include rotator cuff syndrome, impingement, posttraumatic stiffness, adhesive capsulitis, and instability. A thorough history and physical examination can aid in the diagnosis of many common shoulder complaints. Pain and instability are the most common shoulder complaints. Pain that is sharp or burning is commonly radicular in origin, whereas pain caused by tendinitis is often dull, diffuse, and aching. Instability is frequently found in patients with a history of dislocation, but also may occur with no prior history. Imaging modalities such as magnetic resonance imaging can be helpful for more advanced pathology. However, many common shoulder conditions can be diagnosed without imaging, and may be initially treated with a short course of rest, ice, topical analgesics, nonsteroidal anti-inflammatory drugs, directed and supervised physical therapy, and occasionally subacromial corticosteroid injections. As always, a detailed history and a thorough physical exam by a primary care physician are vital for diagnosis. When conservative measures fail, referral to an orthopaedic surgeon may be necessary for further patient management. PMID:25622930

  19. Comparison of Operant Behavioral and Cognitive-Behavioral Group Treatment for Chronic Low Back Pain.

    ERIC Educational Resources Information Center

    Turner, Judith A.; Clancy, Steve

    1988-01-01

    Assigned chronic low back pain patients to operant behavioral (OB) treatment, cognitive-behavioral (CB) treatment, or waiting-list (WL) condition. Both treatments resulted in decreased physical and psychosocial disability. OB patients' greater improvement leveled off at followup; CB patients continued to improve over the 12 months following…

  20. Muscle relaxation for individuals having tattoos removed through laser treatment: possible effects regarding anxiety and pain.

    PubMed

    Huang, Faye; Chou, Wen-Jiun; Chen, Tien-Hsing; Chen, Ching; Hsieh, Yu-Lian; Chong, Mian-Yoon; Hung, Chi-Fa; Lin, Shu-Ching; Tsai, Hsiu-Huang; Wang, Liang-Jen

    2016-08-01

    Effectively managing pain is vital for the well-being and satisfaction of patients undergoing dermatologic treatments involving lasers. This study investigates the potential outcome of using muscle relaxation techniques to reduce pain among people having their tattoos removed with laser treatment. This study consists of 56 participants (mean age 18.1 ± 2.1 years) that had tattoos removed using the principle of selective photothermolysis. These participants underwent muscle relaxation before receiving the laser treatment. Their peripheral skin temperatures (PST) were measured both at the beginning and the end of the muscle relaxation period. Then, the Beck Anxiety Inventory was applied to evaluate anxiety levels. Once the laser treatment was completed, pain levels were measured using a visual analogue scale. A total of 125 person-sessions of laser treatment and psychometric assessments were performed in this study. The muscle relaxation method significantly increased the PST of the participants while reducing the levels of anxiety and pain throughout the course of the laser treatment procedure. The PST, anxiety scores, and pain scores all showed significant correlations with one another. According to the results obtained, this study proposes that muscle relaxation techniques be considered possibly auxiliary treatment options for individuals having tattoos removed through laser treatment. Additional studies with a comparison group and a larger sample size are required in the future to confirm the effectiveness of such intervention. PMID:27184151

  1. Battlefield analgesia: a brief review of current trends and concepts in the treatment of pain in US military casualties from the conflicts in Iraq and Afghanistan.

    PubMed

    Plunkett, Anthony; Turabi, Ali; Wilkinson, Indy

    2012-05-01

    SUMMARY Battlefield analgesia and post-injury pain management is a high priority within the military medical community. The combined military services of the USA have developed a Pain Task Force and clinical practice guidelines to ensure that adequate analgesia is provided to our wounded soldiers as far forward as the point of injury on the battlefield. As a result of this emphasis, novel analgesic techniques and equipment have led to improved pain management. Continuous peripheral nerve blocks, intranasal ketamine, battlefield acupuncture and other adjuncts have all been utilized safely and successfully. The ability to provide rapid analgesia as early in the course of injury as possible not only helps with the immediate pain of the soldier, but potentially minimizes the risk of developing chronic postinjury pain. During the long medical evacuation system the risks of both undertreatment and overtreatment of pain are very real. Future studies and observation will help to delineate best treatment regimens and pave the way for the next generation of medical providers to positively impact a soldier's recovery. This article is written from the perspective of the USA with a focus on the conflicts in Afghanistan (Operation Enduring Freedom) and Iraq (Operation Iraqi Freedom). PMID:24654665

  2. Efficacy of Pregabalin in the Treatment of Radicular Pain: Results of a Controlled Trial

    PubMed Central

    Malik, Khalid M.; M. Nelson, Ariana; J. Avram, Michael; Lee Robak, Sabrina; T. Benzon, Honorio

    2015-01-01

    Background: Pregabalin is commonly used to treat patients with various neuropathic pain syndromes. Objectives: The purpose of the present study was to evaluate the efficacy of pregabalin in patients with lumbar or cervical radicular pain. Patients and Methods: A prospective, randomized, double-blind trial was conducted in 39 patients with lumbar and cervical radicular pain, who received 3 weeks of either pregabalin (n = 10) or placebo (n = 9) treatment. Baseline pain and disability were evaluated before the treatment and were re-evaluated, along with overall patient satisfaction, after the 3 weeks of treatment. Results: Data on 19 of the 39 patients recruited were available for analysis. No statistically significant differences in the pain, disability, and patient satisfaction scores were found between the groups. When the individual patient scores were assessed, the placebo treatment was found to be efficacious in 4 of the 9 patients and pregabalin was effective in 2 of the 10 patients, but the difference was not statistically significant (P = 0.350). Conclusions: The present data do not suggest that pregabalin is more efficacious than placebo in the treatment of lumbar and cervical radicular pain. However, the small sample size of this study may have affected the ability to detect such a difference. PMID:26478867

  3. Older People’s Experiences of Patient-Centered Treatment for Chronic Pain: A Qualitative Study

    PubMed Central

    Teh, Carrie F.; Karp, Jordan F.; Kleinman, Arthur; Reynolds, Charles F.; Weiner, Debra K.; Cleary, Paul D.

    2010-01-01

    Introduction Older adults with chronic pain who seek treatment often are in a health care environment that emphasizes patient-directed care, a change from the patriarchal model of care to which many older adults are accustomed. Objective To explore the experiences of older adults seeking treatment for chronic pain, with respect to patient-directed care and the patient–provider relationship. Design In-depth interviews with 15 Caucasian older adults with chronic pain who had been evaluated at a university-based pain clinic. All interviews were audiotaped and the transcripts were analyzed using a grounded theory based approach. Results Older adults with chronic pain vary in their willingness to be involved in their treatment decisions. Many frequently participate in decisions about their pain treatment by asking for or refusing specific treatments, demanding quality care, or operating outside of the patient–provider relationship to manage pain on their own. However, others prefer to let their provider make the decisions. In either case, having a mutually respectful patient–provider relationship is important to this population. Specifically, participants described the importance of “being heard” and “being understood” by providers. Conclusions As some providers switch from a patriarchal model of care toward a model of care that emphasizes patient activation and patient-centeredness, the development and cultivation of valued patient–provider relationships may change. While it is important to encourage patient involvement in treatment decisions, high-quality, patient-centered care for older adults with chronic pain should include efforts to strengthen the patient–provider relationship by attending to differences in patients’ willingness to engage in patient-directed care and emphasizing shared decision-making. PMID:19207235

  4. A Systematic Review of Pharmacological Treatments of Pain Following Spinal Cord Injury

    PubMed Central

    Teasell, Robert W.; Mehta, Swati; Aubut, Jo-Anne L.; Foulon, Brianne; Wolfe, Dalton L.; Hsieh, Jane T.C.; Townson, Andrea F.; Short, Christine

    2011-01-01

    Objective To conduct a systematic review of published research on the pharmacological treatment of pain after spinal cord injury (SCI). Data Sources Medline, CINAHL, EMBASE and PsycINFO databases were searched for articles published 1980 to June 2009 addressing the treatment of pain post SCI. Randomized controlled trials (RCTs) were assessed for methodological quality using the PEDro assessment scale, while non-RCTs were assessed using the Downs and Black evaluation tool. A level of evidence was assigned to each intervention using a modified Sackett scale. Study Selection The review included randomized controlled trials and non-randomized controlled trials which included prospective controlled trials, cohort, case series, case-control, pre-post and post studies. Case studies were included only when there were no other studies found. Data Extraction Data extracted included the PEDro or Downs and Black score, the type of study, a brief summary of intervention outcomes, type of pain, type of pain scale and the study findings.. Data Synthesis Articles selected for this particular review evaluated different interventions in the pharmacological management of pain post SCI. 28 studies met inclusion criteria: there were 21 randomized controlled trials of these 19 had Level 1 evidence. Treatments were divided into five categories: anticonvulsants, antidepressants, analgesics, cannabinoids and antispasticity medications. Conclusions Most studies did not specify participants’ types of pain; hence making it difficult to identify the type of pain being targeted by the treatment. Anticonvulsant and analgesic drugs had the highest levels of evidence and were the drugs most often studied. Gabapentin and pregabalin had strong evidence (five Level 1 RCTs) for effectiveness in treating post-SCI neuropathic pain, as did intravenous analgesics (lidocaine, ketamine and morphine) but the latter only had short term benefits. Tricyclic antidepressants only showed benefit for neuropathic

  5. Treatment of an elderly patient with acute abdominal pain with traditional Korean medicine.

    PubMed

    Son, Chang-Gue

    2014-10-01

    Abdominal pain in elderly patients leads to challenge due to diagnostic difficulty and high incidence of complications. This case report presents an elderly patient with acute and severe abdominal pain, who did not respond to Western treatments. The patient was diagnosed to have abdominal pain by Yang deficiency of spleen (脾陽虛). Acupuncture (mainly at LI4 and LR3), indirect moxibustion (CV4 and CV8), and a herbal drug [DaehwangBuja-Tang (大黃附子湯)] were given to the patient; the abdominal pain and related symptoms disappeared completely within 3 days. This study proved the potential use of traditional Korean medicine for treating abdominal pain in elderly patients. PMID:25441951

  6. Physical exercise as non-pharmacological treatment of chronic pain: Why and when

    PubMed Central

    Ambrose, Kirsten R.; Golightly, Yvonne M.

    2015-01-01

    Chronic pain broadly encompasses both objectively defined conditions and idiopathic conditions that lack physical findings. Despite variance in origin or pathogenesis, these conditions are similarly characterized by chronic pain, poor physical function, mobility limitations, depression, anxiety and sleep disturbance and are treated alone or in combination by pharmacologic and nonpharmacologic approaches, such as physical activity (aerobic conditioning, muscle strengthening, flexibility training and movement therapies). Physical activity improves general health, disease risk and progression of chronic illnesses such as cardiovascular disease, type-2 diabetes and obesity. When applied to chronic pain conditions within appropriate parameters (frequency, duration, intensity), physical activity significantly improves pain and related symptoms. For chronic pain, strict guidelines for physical activity are lacking, but frequent movement is preferable to sedentary behavior. This gives considerable freedom in prescribing physical activity treatments, which are most successful when tailored individually, progressed slowly and account for physical limitations, psychosocial needs and available resources. PMID:26267006

  7. Factors related to compliance with oral analgesic treatment of inpatients with chronic pain.

    PubMed

    Zhu, Hong; Zheng, Yuzhu; Gao, Hui; Liu, Li; Yang, Lie

    2015-09-01

    This study aimed to determine the relationship between the different factors of analgesic therapy and the compliance of chronic pain inpatients. We prospectively investigated 100 consecutive inpatients with noncancer chronic pain who were hospitalized to receive oral analgesic treatment in the Pain Department of West China Hospital from May 2013 to October 2013. Patients who completed the treatment plan were recorded as good compliance, whereas patients who partly completed or even refused the treatment were recorded as moderate or non-compliance, respectively. A total of 73 (73.7%), 17 (17.1%), and 9 (9.2%) patients showed good, moderate, and non-compliance, respectively. Univariate analyses showed significantly better compliance among farmers, patients educated in college or above, with family income of < 3000 CNY, and with severe or moderate pain than those employed and unemployed (P = 0.02), patients educated below college (P = 0.013), with family income of ≥ 3000 CNY (P = 0.025), and with mild pain (P < 0.001), respectively. Logistic regression analysis showed that the family income of ≥ 3000 CNY (OR: 2.50, 95%CI: 1.65-4.51, P = 0.021) and mild pain (OR: 1.27, 95%CI: 1.03-3.31, P = 0.016) were associated with moderate or non-compliance with oral analgesic treatment. In conclusion, the low compliance with oral treatment of analgesics was found in Chinese inpatients with chronic pain and compliance was negatively associated with family income and degree of pain of patients. PMID:26290285

  8. Evidence of effectiveness of herbal antiinflammatory drugs in the treatment of painful osteoarthritis and chronic low back pain.

    PubMed

    Chrubasik, J E; Roufogalis, B D; Chrubasik, S

    2007-07-01

    Treatment with herbal medicines is very popular in Europe. In order to get information on the evidence of effectiveness of oral herbal medicines in the treatment of pain in the joints or lower back, OVID(MEDLINE), PUBMED and COCHRANE COLLABORATION LIBRARY were searched back to 1985 for systematic reviews. The level of evidence of effectiveness was defined as strong - at least two confirmatory studies demonstrating a clinical relevant effect, moderate - one confirmatory study with a clinical relevant effect and/or multiple exploratory studies of good quality; otherwise the evidence was insufficient or conflicting in the case of inconsistent findings. Fifteen systematic reviews were identified. The evidence of effectiveness was strong for a proprietary unsaponifiable avocado soybean fraction and Harpagophytum preparations containing > 50 mg harpagoside in the daily dosage, moderate for ginger and a proprietary rose hip and seed powder, insufficient for Boswellia serrata gum resin and other herbal preparations and inconsistent for a proprietary willow bark extract. Further rigorous studies are required to confirm the usefulness of herbal medicines in the treatment of osteoarthritic complaints and chronic low back pain in order to enable acceptance of the herbal medicines into the treatment guidelines. PMID:17444576

  9. Nucleoplasty in the Treatment of Lumbar Diskogenic Back Pain: One Year Follow-Up

    SciTech Connect

    Masala, Salvatore Massari, Francesco; Fabiano, Sebastiano; Ursone, Antonio; Fiori, Roberto; Pastore, Francesco; Simonetti, Giovanni

    2007-06-15

    Purpose. The spine is an important source of pain and disability, affecting two thirds of adults at some time in their lives. Treatment in these patients is mainly conservative medical management, based on medication, physical therapy, behavioral management, and psychotherapy, surgery being limited to elective cases with neurologic deficits. This study was carried out to evaluate the efficacy of percutaneous nucleoplasty in patients affected by painful diskal protrusions and contained herniations. Methods. From February 2004 to October 2005, 72 patients (48 men, 24 women; mean age 48 years) affected by lumbar disk herniation were treated with nucleoplasty coblation. All patients were evaluated clinically and with radiography and MRI in order to confirm the presence of lumbalgic and/or sciatalgic pain, in the absence of major neurologic deficit and with lack of response after 6 weeks of conservative management. Results. Average preprocedural pain level for all patients was 8.2 (on a visual analog scale of 1 to 10), while the average pain level at 12 months follow-up was 4.1. At the 1 year evaluation, 79% of patients demonstrated a statistically significant improvement in numeric pain scores (p < 0.01): 17% (12 patients) were completely satisfied with complete resolution of symptoms, and 62% (43 patients) obtained a good result. Conclusion. Our data indicate that nucleoplasty coblation is a promising treatment option for patients with symptomatic disk protrusion and herniation who present with lumbalgic and/or sciatalgic pain, have failed conservative therapies, and are not considered candidates for open surgery.

  10. DoD–NCCAM/NIH Workshop on Acupuncture for Treatment of Acute Pain

    PubMed Central

    Belard, Jean Louis; Glowa, John; Khalsa, Partap; Weber, Wendy; Huntley, Kristen

    2013-01-01

    Abstract The Department of Defense (DoD) and the National Center for Complementary and Alternative Medicine (NCCAM) at the National Institutes of Health (NIH) cosponsored a workshop that explored the possible benefits of acupuncture treatment for acute pain. One goal of the workshop was to establish a roadmap to building an evidence base on that would indicate whether acupuncture is helpful for treating active-duty military personnel experiencing acute pain. The workshop highlighted brief presentations on the most current research on acupuncture and acute pain mechanisms. The impact of various modifiers (stress, genetics, population, phenotypes, etc.) on acute pain pathways and response to acupuncture treatment was discussed. Additional presentations focused on common neural mechanisms, an overview of real-world experience with using acupuncture to treat traumatic acute pain, and best tools and methods specific for acupuncture studies. Three breakout groups addressed the gaps, opportunities, and barriers to acupuncture use for acute pain in military and trauma settings. Different models of effectiveness research and optimal research designs for conducting trials in acute traumatic pain were also discussed. PMID:23020611

  11. Racial/ethnic disparities in the assessment and treatment of pain: psychosocial perspectives.

    PubMed

    Tait, Raymond C; Chibnall, John T

    2014-01-01

    Racial/ethnic disparities not only are prevalent throughout the U.S. health care system but also have proved refractory to change. Such disparities are evident and similarly persistent in the treatment of patients with chronic pain conditions, exacting high personal and societal costs. While psychosocial factors contribute significantly to this intractable problem, an integrated examination of the literature is lacking. This article provides an overview of psychosocial factors that contribute to disparities in the treatment of chronic pain patients and in their adjustment to pain. It focuses initially on aspects of pain assessment that can occasion disparate care. Because pain is a subjective phenomenon that often defies objective medical assessment, it is particularly susceptible to social psychological influences, such as stereotypes. We pay particular attention to negative racial/ethnic stereotypes as well as to the circumstances that are likely to trigger stereotype-driven judgments. Subsequent sections review psychosocial factors that can influence a patient's experience of pain, those that can influence the patient-provider interaction, and those that operate in the public health environment. After each section, we suggest actions that could address identified issues related to clinical care, research, and policy. Policy recommendations generally are linked to provisions of the Affordable Care Act. We conclude with a discussion of the role that psychology should play in future efforts to address the persistent problem of racial/ethnic disparities in pain care. PMID:24547799

  12. Botulinum toxin in the treatment of muscle specific Oro-facial pain: a literature review.

    PubMed

    Sunil Dutt, C; Ramnani, Pooja; Thakur, Deepak; Pandit, Manish

    2015-06-01

    Facial pain associated with temporomandibular joint (TMJ) and surrounding structures has been a challenge to clinicians as far as diagnosis and management is concerned. Complexity of anatomical structures within a small area, function of teeth and surrounding periodontal ligament, action of muscles, pathologies, lack of diagnostic investigations, all these complicate specific diagnosis of TMJ disorders. Various classifications have been designed and studied to help diagnose and treat TMJ related disorders, of which the simplest one is pain from TMJ proper and surrounding muscles. Many treatment modalities to treat pain arising from muscles around TMJ like splints, mouth restriction exercises, injection of sclerosing agents etc. have been used with various degrees of success. Botulinum toxin has been shown to be effective in the treatment of oro-facial pain due to muscular disorders and the same is discussed in detail in this review literature. PMID:26028831

  13. The endocannabinoid system and neuropathic pain.

    PubMed

    Maldonado, Rafael; Baños, Josep Eladi; Cabañero, David

    2016-02-01

    The research of new therapeutic strategies for neuropathic pain represents a major current priority. Important drawbacks to advance in the development of these therapies are the limited translational value of the animal models now available and the elucidation of the complex neuronal and immune pathophysiological mechanisms underlying neuropathic pain. One of the neurotransmitter systems participating in neuropathic pain control that has recently raised a particular interest is the endocannabinoid system. This system is highly expressed in neurons and immune cells, and it plays a crucial role in the development of neuropathic pain. Preclinical studies have provided important findings, revealing the potential interest of the endocannabinoid system for the treatment of neuropathic pain. These studies have reported the analgesic effects of cannabinoid agonists in multiple neuropathic pain models, and they have identified specific targets within this system to develop more effective and safe analgesic compounds. However, further studies using more relevant neuropathic pain animal models are required to confirm these interesting results. Several clinical studies suggest that cannabinoids significantly reduced neuropathic pain, although most of these trials fail the required standards of quality. The different pain patient populations included in the systematic reviews also make it difficult to get adequate conclusions. Therefore, additional clinical trials that consider an adequate number of patients, the use active treatments as controls, and longer duration of administration are required to have an adequate profile of the effectiveness and safety of cannabinoids in neuropathic pain. PMID:26785153

  14. Prevention and Treatment of Pain in Children: Toward a Paradigm Shift.

    PubMed

    Friedrichsdorf, Stefan J; Sidman, James; Krane, Elliot J

    2016-05-01

    Rosenfeld et al in their recent article "Office Insertion of Tympanostomy Tubes without Anesthesia in Young Children" describe using a "papoose board for restraint" while performing a procedure resulting in severe pain for a significant number of children: a myringotomy and tube insertion. In 2016, it is inappropriate to perform elective painful procedures in children without treatment to avoid or minimize pain. We strongly disagree with the authors' conclusion "that office insertion of tubes in young children is a feasible alternative to general anesthesia for caregivers and clinicians who are comfortable with this choice." PMID:27130944

  15. [The role of open neurosurgery in the treatment of cancer pain].

    PubMed

    Gottlieb, A

    1984-06-01

    After a brief foreword on the indication of open surgery in the treatment of neoplastic pain those procedures are detailed which are more effective and widely used: Posterior Rhizotomy, Cordotomy, Mediolongitudinal Mielotomy and Bulbar trigeminal tractotomy. Of each procedure main technical features, indications and complications are detailed. It is concluded that these techniques are still very useful in management of severe cancer pain. PMID:6588308

  16. Role of calcium and vitamin D in the treatment of muscle pain

    PubMed Central

    Liang, Raymond CR

    1985-01-01

    Calcium and vitamin D deficiencies are associated with abnormal muscular functions including non-specific pain and weakness. A diet survey of a patient complaining of back pain showed a low calcium intake. Clinically patients may have low utilization of dietary calcium. In addition to the normal chiropractic treatments, the patient was given calcium and vitamin D supplements. These supplements greatly improved the recovery of the patient. The nutritional status of calcium and vitamin D in the general Canadian population is discussed.

  17. Wilderness Medical Society practice guidelines for the treatment of acute pain in remote environments: 2014 update.

    PubMed

    Russell, Katie W; Scaife, Courtney L; Weber, David C; Windsor, Jeremy S; Wheeler, Albert R; Smith, William R; Wedmore, Ian; McIntosh, Scott E; Lieberman, James R

    2014-12-01

    The Wilderness Medical Society convened an expert panel to develop evidence-based guidelines for the management of pain in austere environments. Recommendations are graded on the basis of the quality of supporting evidence as defined by criteria put forth by the American College of Chest Physicians. This is an updated version of the original WMS Practice Guidelines for the Treatment of Acute Pain in Remote Environments published in Wilderness & Environmental Medicine 2014;25(1):41-49. PMID:25498266

  18. Successful treatment of pain in melorheostosis with zoledronate, with improvement on bone scintigraphy.

    PubMed

    Slimani, Samy; Nezzar, Adlen; Makhloufi, Hachemi

    2013-01-01

    Melorheostosis is a very rare sclerosing bone disorder that involves frequently one limb. It may be asymptomatic, but pain and limb deformity may occur and can be very debilitating. Different reports have indicated efficacy of bisphosphonates (pamidronate and etidronate) on symptoms. We report an adult patient with a very painful melorheostosis, who  improved after treatment with zoledronate, either on symptoms or on bone scans. PMID:23813581

  19. Intradermal Therapy (Mesotherapy) for the Treatment of Acute Pain in Carpal Tunnel Syndrome: A Preliminary Study

    PubMed Central

    Conforti, Giorgio; Capone, Loredana

    2014-01-01

    Background The carpal tunnel syndrome (CTS) is the most common cause of severe hand pain. In this study we treated acute pain in CTS patients by means of local intradermal injections of anti-inflammatory drugs (mesotherapy). Methods In twenty-five patients (forty-five hands), CTS diagnosis was confirmed by clinical and neurophysiological examination prior to mesotherapy. A mixture containing lidocaine 10 mg, ketoprophen lysine-acetylsalycilate 80 mg, xantinol nicotinate 100 mg, cyanocobalamine 1,000 mcg plus injectable water was used. Sites of injection were three parallel lines above the transverse carpal ligament and two v-shaped lines, one at the base of the thenar eminence, and the other at the base of the hypothenar eminence. Results The day after the treatment, all but four patients reported a significant reduction in pain and paresthesias. After 12 months, 17 patients had a complete pain relief, eight patients reported recurrence of pain and sensory symptoms and four out of them underwent surgical treatment. Conclusions With the obvious limits of a small-size open-label study, our results suggest that mesotherapy can temporary relieve pain and paresthesias in most CTS patients and in some cases its effect seems to be long-lasting. Further controlled studies are needed to confirm our preliminary findings and to compare mesotherapy to conventional approaches for the treatment of CTS. PMID:24478901

  20. Treatment of mild to moderate pain of acute soft tissue injury: diflunisal vs acetaminophen with codeine.

    PubMed

    Muncie, H L; King, D E; DeForge, B

    1986-08-01

    Acute soft tissue injuries create pain and limitation of function. Treatment requires analgesia and time for full recovery. Acetaminophen with codeine (650 mg plus 60 mg, respectively, every 4 to 6 hours) is used frequently as the analgesic of choice. Diflunisal (1,000 mg initially then 500 mg twice a day) vs acetaminophen with codeine was prospectively studied in the treatment of acute mild to moderate pain from soft tissue injuries. Thirty-five patients with acute strains, sprains, or low back pain were randomized to treatment (17 acetaminophen with codeine vs 18 diflunisal). Both groups were similar in the amount of pain and type of injury at initiation of therapy. Patient pain rating went from 3.3 +/- 0.6 to 1.6 +/- 1.5 for acetaminophen with codeine and from 3.3 +/- 0.6 to 1.3 +/- 1.1 for diflunisal. However, 65 percent of acetaminophen with codeine patients experienced side effects, with 35 percent of these patients stopping the medication because of intolerable side effects. In the diflunisal group, 28 percent of the patients experienced side effects and 5 percent had to stop the medication early. Diflunisal was found to be an effective analgesic in mild to moderate pain of acute soft tissue injuries, and caused fewer and more tolerable side effects than did acetaminophen with codeine. PMID:2942630

  1. [Use of alpha-lipoic acid and omega-3 in postpartum pain treatment].

    PubMed

    Costantino, D; Guaraldi, C; Costantino, M; Bounous, V E

    2015-10-01

    Postpartum pain is a frequent condition that negatively affects women's quality of life, interferring with everyday life. Analgesic drugs and surgery are often contraindicated in pregnancy and during breast feeding. This review of the literature aims to evaluate the rational of the association of lipoic acid and omega-3 employ in the management of postpartum pain. Lipoic acid is a cofactor essential in mitochondrial metabolism with antioxidant and anti-inflammatory activity. Lipoic acid has been shown to be effective in neuropatic pain treatment in patients with sciatica, carpal tunnel syndrome and diabetic neuropathy. Omega-3 are known for their anti-inflammatory and neurotrophic activity. The peripheral and central activity of both substances allows to act on neuroinflammation mechanisms thus reducing cronicization of pain and also determining a potential improvement of women's emotional status. The preliminary data here presented confirm the positive effect of this association on the treatment of postpartum perineal pain. The supplementation of lipoic acid in association with omega-3 seems effective and safe for the treatment of chronic postpartum pain, allowing a pathogenetic approach to neuroinflammation, thus reducing the consumption of analgesic drugs, often contraindicated during breast-feeding. PMID:26491825

  2. Prevalence and type of pain during conventional and self-ligating orthodontic treatment.

    PubMed

    Tecco, Simona; D'Attilio, Michele; Tetè, Stefano; Festa, Felice

    2009-08-01

    This study investigated the prevalence and type of pain experienced during orthodontic treatment in 30 subjects (12 males, 18 females, aged 12-18 years) with crowding. Fifteen patients were treated with conventional brackets (Victory Series) and 15 with self-ligating brackets (Damon SL II). The first archwire for all patients was a 0.014 inch nickel-titanium (NiTi) archwire with a force of approximately 100 g. Conventional brackets were ligated with elastomeric modules. A visual analogue scale (VAS) was used daily to assess the intensity of pain; the use of pain medication was also reported in a specially designed daybook for a total period of 3 months. Pearson's chi-square was used to investigate the difference between groups in the frequency of pain experience, its nature, and the use of analgesia. Non-parametric statistics (Mann-Whitney U-test) were computed to compare pain intensity between the groups. To investigate reported pain assessments, Friedman's two-way analysis of variance was used and the differences were estimated using Wilcoxon's signed-rank test. The results showed that pain was reported for a period of 9 days after archwire insertion. Patients treated with self-ligating brackets reported the highest pain intensity on the day following placement of the first archwire (VAS mean = 42.6), while those treated with conventional brackets experienced the greatest pain intensity at placement of the first archwire (VAS mean = 52) and after the second orthodontic appointment (VAS mean = 59.6). Analgesics were used by 16.5 per cent of patients treated with self-ligating brackets and by 10 per cent of those treated with conventional brackets, most often during the first 2 days after archwire placement. Patients treated with conventional brackets reported significantly more 'constant' pain than those treated with self-ligating brackets who complained of 'chewing/biting' pain. Pain appears to be common during orthodontic treatment but perhaps less intense when

  3. Familiarizing Students with the Empirically Supported Treatment Approaches for Psychophysiological Disorders and Chronic Pain.

    ERIC Educational Resources Information Center

    Wilkins, Victoria; Chambliss, Catherine

    In training counseling students, it is increasingly important to acquaint them with the clinical research literature exploring the efficacy of particular treatments. This review of empirically supported treatments (EST's) concerning psychophysiological disorders and chronic pain is intended to facilitate the educational process. EST's, or…

  4. Treatment of Oppositional Behavior in Children of Parents with Brain Injury and Chronic Pain.

    ERIC Educational Resources Information Center

    Ducharme, Joseph M.; Davidson, Amy; Rushford, Nancy

    2002-01-01

    This case study evaluated effects of errorless compliance training on cooperation of sons of two fathers with brain injury and chronic pain. Following treatment, children displayed high levels of compliance to parent requests as well as generalization and maintenance of treatment gains. Errorless compliance training is recommended to foster…

  5. Intrathecal opioid treatment for chronic non-malignant pain: a 3-year prospective study.

    PubMed

    Thimineur, Mark A; Kravitz, Edward; Vodapally, Mohan S

    2004-06-01

    Intrathecal (IT) opioid therapy is a treatment alternative for patients with severe chronic non-malignant pain. Several uncontrolled retrospective and prospective outcome studies have suggested a benefit in chronic non-malignant pain patients, but uncertainties about patient selection in these studies weaken the results. This study evaluated long-term outcome of IT opioid therapy in chronic non-malignant pain prospectively, and included two comparative groups to improve understanding of selection criteria and relative severity of intrathecal pump recipients (PRs). The study subjects included 38 PRs while the comparative groups included 31 intrathecal candidates who either had an unsuccessful trial, or declined the IT therapy, and another group of 41 newly referred patients. The following data were analyzed at study entry, and at 6 monthly intervals for a 3-year period: Symptom Check List 90 (SLC-90), SF-36 Health survey, Beck Depression Inventory, McGill Pain Questionnaire (short form), Oswestry Disability Index, Pain Drawings and Pain rating on visual analogue scale. Data analysis suggests the study group of PRs had improvements in pain, mood, and function from baseline to 36 months. These same parameters improved among new referrals (less severe patients receiving conservative pain management) while non-recipients significantly worsened. Although PRs improved, they were still worse off at 36 months than new referrals were at baseline. The study showed that when patients with extremely severe pain problems are selected as pump candidates, they will likely improve with the therapy, but their overall severity of pain and symptoms still remains high. PMID:15157684

  6. Effective pain management and improvements in patients' outcomes and satisfaction.

    PubMed

    Glowacki, Diane

    2015-06-01

    Adequate pain management is a compelling and universal requirement in health care. Despite considerable advancements, the adverse physiological and psychological implications of unmanaged pain remain substantially unresolved. Ineffective pain management can lead to a marked decrease in desirable clinical and psychological outcomes and patients' overall quality of life. Effective management of acute pain results in improved patient outcomes and increased patient satisfaction. Although research and advanced treatments in improved practice protocols have documented progressive improvements in management of acute and postoperative pain, little awareness of the effectiveness of best practices persists. Improved interventions can enhance patients' attitudes to and perceptions of pain. What a patient believes and understands about pain is critical in influencing the patient's reaction to the pain therapy provided. Use of interdisciplinary pain teams can lead to improvements in patients' pain management, pain education, outcomes, and satisfaction. PMID:26033099

  7. Primary treatment of painful varicocoele through percutaneous retrograde embolization with fibred coils.

    PubMed

    Puche-Sanz, I; Flores-Martín, J F; Vázquez-Alonso, F; Pardo-Moreno, P L; Cózar-Olmo, J M

    2014-09-01

    The literature on the treatment of painful varicocoele is limited, likely because of the short period since it was recognized as a clinical entity and the limitations posed by the subjectivity of pain. Our aim was to systematically analyse the results of percutaneous embolization as the chosen treatment for this condition. We conducted a retrospective study of patients undergoing percutaneous embolization as primary treatment for painful varicocoele from January 2007 to November 2013. Radiologic and ultrasonographic successes were evaluated according to the existence or absence of venous reflux on venography after embolization and on Echo Doppler control at 3-6 months. Clinical success was assessed by Visual Analog Scale pain questionnaires before surgery and at 3-6 months; in addition, at the time of the study, telephone interviews were conducted to update the clinical situation and development. A total of 154 patients received operations. The median pain before surgery, at 3-6 months and at the time of interview was 7, 1 and 0 points respectively (p < 0.001). The ultrasonographic success rate at 3-6 months was 68.6%. With a median follow-up of 39 months, the success and relapse/clinical persistence rates were 86.9 and 13.1% respectively. By studying the degree of agreement between clinical success and ultrasonographic success, a kappa index = 0.443 was obtained. Patients with success recounted greater pre-operative pain scores than those who relapsed or persisted (7.5 vs. 5.0; p = 0.004). In patients with painful varicocoele, the ultrasonographic recurrence of venous reflux does not imply the recurrence of pain; hence, the proper assessment of success in these patients should include a systematic assessment of their pain and grade of reflux. Percutaneous retrograde embolization as a primary treatment for painful varicocoele is a clinically effective option with a high success rate that can be maintained in the long term, especially in patients with high pre

  8. Long-term opioid treatment of chronic nonmalignant pain: unproven efficacy and neglected safety?

    PubMed Central

    Kissin, Igor

    2013-01-01

    Background For the past 30 years, opioids have been used to treat chronic nonmalignant pain. This study tests the following hypotheses: (1) there is no strong evidence-based foundation for the conclusion that long-term opioid treatment of chronic nonmalignant pain is effective; and (2) the main problem associated with the safety of such treatment – assessment of the risk of addiction – has been neglected. Methods Scientometric analysis of the articles representing clinical research in this area was performed to assess (1) the quality of presented evidence (type of study); and (2) the duration of the treatment phase. The sufficiency of representation of addiction was assessed by counting the number of articles that represent (1) editorials; (2) articles in the top specialty journals; and (3) articles with titles clearly indicating that the addiction-related safety is involved (topic-in-title articles). Results Not a single randomized controlled trial with opioid treatment lasting >3 months was found. All studies with a duration of opioid treatment ≥6 months (n = 16) were conducted without a proper control group. Such studies cannot provide the consistent good-quality evidence necessary for a strong clinical recommendation. There were profound differences in the number of addiction articles related specifically to chronic nonmalignant pain patients and to opioid addiction in general. An inadequate number of chronic pain-related publications were observed with all three types of counted articles: editorials, articles in the top specialty journals, and topic-in-title articles. Conclusion There is no strong evidence-based foundation for the conclusion that long-term opioid treatment of chronic nonmalignant pain is effective. The above identified signs indicating neglect of addiction associated with the opioid treatment of chronic nonmalignant pain were present. PMID:23874119

  9. Effects of Virtual Walking Treatment on Spinal Cord Injury-Related Neuropathic Pain: Pilot Results and Trends Related to Location of Pain and at-level Neuronal Hypersensitivity.

    PubMed

    Jordan, Melissa; Richardson, Elizabeth J

    2016-05-01

    Previous studies have shown that virtual walking to treat spinal cord injury-related neuropathic pain (SCI-NP) can be beneficial, although the type of SCI-NP that may benefit the most is unclear. This study's aims were to (1) determine the effect of location of SCI-NP on pain outcomes after virtual walking treatment and (2) examine the potential relationship between neuronal hyperexcitability, as measured by quantitative sensory testing, and pain reduction after virtual walking treatment. Participants were recruited from a larger ongoing trial examining the benefits of virtual walking in SCI-NP. Neuropathic pain was classified according to location of pain (at- or below-level). In addition, quantitative sensory testing was performed on a subset of individuals at a nonpainful area corresponding to the level of their injury before virtual walking treatment and was used to characterize treatment response. These pilot results suggest that when considered as a group, SCI-NP was responsive to treatment irrespective of the location of pain (F1, 44 = 4.82, P = 0.03), with a trend for the greatest reduction occurring in at-level SCI-NP (F1, 44 = 3.18, P = 0.08). These pilot results also potentially implicate cold, innocuous cool, and pressure hypersensitivity at the level of injury in attenuating the benefits of virtual walking to below-level pain, suggesting certain SCI-NP sensory profiles may be less responsive to virtual walking. PMID:26544859

  10. A Traditional Chinese Medicine Xiao-Ai-Tong Suppresses Pain through Modulation of Cytokines and Prevents Adverse Reactions of Morphine Treatment in Bone Cancer Pain Patients

    PubMed Central

    Cong, Yan; Sun, Kefu; He, Xueming; Li, Jinxuan; Dong, Yanbin; Zheng, Bin; Tan, Xiao; Song, Xue-Jun

    2015-01-01

    Treating cancer pain continues to possess a major challenge. Here, we report that a traditional Chinese medicine Xiao-Ai-Tong (XAT) can effectively suppress pain and adverse reactions following morphine treatment in patients with bone cancer pain. Visual Analogue Scale (VAS) and Quality of Life Questionnaire (EORTC QLQ-C30) were used for patient's self-evaluation of pain intensity and evaluating changes of adverse reactions including constipation, nausea, fatigue, and anorexia, respectively, before and after treatment prescriptions. The clinical trials showed that repetitive oral administration of XAT (200 mL, bid, for 7 consecutive days) alone greatly reduced cancer pain. Repetitive treatment with a combination of XAT and morphine (20 mg and 30 mg, resp.) produced significant synergistic analgesic effects. Meanwhile, XAT greatly reduced the adverse reactions associated with cancer and/or morphine treatment. In addition, XAT treatment significantly reduced the proinflammatory cytokines interleukin-1β and tumor necrosis factor-α and increased the endogenous anti-inflammatory cytokine interleukin-10 in blood. These findings demonstrate that XAT can effectively reduce bone cancer pain probably mediated by the cytokine mechanisms, facilitate analgesic effect of morphine, and prevent or reduce the associated adverse reactions, supporting a use of XAT, alone or with morphine, in treating bone cancer pain in clinic. PMID:26617438

  11. Intrinsic brain networks normalize with treatment in pediatric complex regional pain syndrome

    PubMed Central

    Becerra, Lino; Sava, Simona; Simons, Laura E.; Drosos, Athena M.; Sethna, Navil; Berde, Charles; Lebel, Alyssa A.; Borsook, David

    2014-01-01

    Pediatric complex regional pain syndrome (P-CRPS) offers a unique model of chronic neuropathic pain as it either resolves spontaneously or through therapeutic interventions in most patients. Here we evaluated brain changes in well-characterized children and adolescents with P-CRPS by measuring resting state networks before and following a brief (median = 3 weeks) but intensive physical and psychological treatment program, and compared them to matched healthy controls. Differences in intrinsic brain networks were observed in P-CRPS compared to controls before treatment (disease state) with the most prominent differences in the fronto-parietal, salience, default mode, central executive, and sensorimotor networks. Following treatment, behavioral measures demonstrated a reduction of symptoms and improvement of physical state (pain levels and motor functioning). Correlation of network connectivities with spontaneous pain measures pre- and post-treatment indicated concomitant reductions in connectivity in salience, central executive, default mode and sensorimotor networks (treatment effects). These results suggest a rapid alteration in global brain networks with treatment and provide a venue to assess brain changes in CRPS pre- and post-treatment, and to evaluate therapeutic effects. PMID:25379449

  12. Determinants of Pain Treatment Response and Non-Response: Identification of TMD Patient Subgroups

    PubMed Central

    Litt, Mark D.; Porto, Felipe B.

    2013-01-01

    The purpose of the present study was to determine if we could identify a specific subtype of temporomandibular disorder (TMD) pain patients that does not respond to treatment. Patients were 101 men and women with chronic TMD pain recruited from the community and randomly assigned to one of two treatment conditions: a standard conservative care (STD) condition or a standard care plus cognitive-behavioral treatment condition (STD+CBT) in which patients received all elements of STD, but also received cognitive-behavioral coping skills training. Growth mixture modeling, incorporating a series of treatment-related predictors, was used to distinguish several distinct classes of responders or non-responders to treatment based on reported pain over a one-year follow-up period. Results indicated that treatment non-responders accounted for 16% of the sample, and did not differ from treatment responders on demographics or temporomandibular joint pathology, but that they reported more psychiatric symptoms, poorer coping, and higher levels of catastrophizing. Treatment-related predictors of membership in treatment responder groups versus the non-responder group included the addition of CBT to standard treatment, treatment attendance, and decreasing catastrophization. It was concluded that CBT may be made more efficacious for TMD patients by placing further emphasis on decreasing catastrophization and on individualizing care. PMID:24094979

  13. The Potential of Traditional Chinese Medicine in the Treatment and Modulation of Pain.

    PubMed

    Du, Guan-Hua; Yuan, Tian-Yi; Du, Li-da; Zhang, Yong-Xiang

    2016-01-01

    Pain is an unpleasant sensory and emotional experience associated with various diseases. Extensive research has been conducted to find appropriate methods of relieving pain and improving the quality of life. However, the most commonly used pain-relieving agents such as opioid therapeutics are often associated with harmful side effects; moreover, users are prone to become addicted to these agents and may develop tolerance. Often, nonopioid therapeutics is only marginally effective, thus leading to a significant unmet medical need. Scientists have studied herbal medicines, finding more than 800 kinds of traditional Chinese medicine (TCM) to be effective in relieving pain while also creating several monomeric compounds to develop novel analgesic drugs. In this review, we summarize the representative TCM currently available for the treatment and modulation of pain. Ten different natural products, mainly herbs, used in Chinese medicine to relieve pain are discussed in light of the theories of TCM and modern pharmacology. We hope that this review will provide valuable information for future studies on the potential of TCM in alleviating pain. PMID:26920018

  14. Ability of the Pain Recognition and Treatment (PRT) Protocol to Reduce Expressions of Pain among Institutionalized Residents with Dementia: A Cluster Randomized Controlled Trial.

    PubMed

    Chen, Yi-Heng; Lin, Li-Chan

    2016-02-01

    Many strategies have been used to improve pain management in institutionalized care settings, but there is no consensus on the effects of these methods. The study purpose was to compare the effect of a Pain Recognition and Treatment (PRT) protocol coupled with basic pain education (experimental group) versus basic pain education alone (control group) in (1) improving the pain management performance of registered nurses (RNs) and (2) reducing pain-related expressions of residents with dementia postintervention and at 3-month follow up. A double-blind cluster randomized controlled trial with a 3-month follow-up period was conducted with 195 residents of six dementia special-care units. The weekly pain management performance of RNs (e.g., use of pharmacologic and nonpharmacologic strategies, use of referral) was recorded and weekly average scores of the pain-related expressions of residents were assessed using the following: the Verbal Descriptor Scale (VDS), Pain Assessment in Advanced Dementia Scale (PAINAD), and the Cohen-Mansfield Agitation Inventory (CMAI). The generalized linear mixed model analysis showed that, after intervention, the experimental group had significantly more weekly nonpharmacologic pain relief strategies and weekly referrals for pain management than the control group. Residents in the experimental group had significantly fewer verbal and behavioral expressions of pain compared to those in the control group. However, the groups did not differ significantly in the use of pharmacological strategies or the agitated behaviors expressed by residents. The PRT protocol is effective and is recommended for routine use in residents with dementia to improve the quality of pain care. PMID:26584896

  15. Incidence of post obturation pain following single and multi visit root canal treatment in a teaching hospital of Bangladesh.

    PubMed

    Jabeen, S; Khurshiduzzaman, M

    2014-04-01

    Post obturation pain is the pain of any degree after endodontic treatment. There are different opinions regarding incidence of post obturation pain related to single and multi visit root canal treatment. This prospective study was conducted to evaluate the incidence of post obturation pain in single visit and multi visit root canal treatment and to compare the incidence of pain between the two treatment groups. A total of 120 cases of endodontically involved asymptomatic non vital single rooted teeth were selected for this study. The patients were assigned and divided in to two treatment groups, sixty patients each. In single visit group, all teeth were prepared and filled using the standardized preparation and lateral condensation filling technique. In the multi visit treatment group, at the first appointment, the teeth were prepared, and dressed with calcium hydroxide paste for 7 days. At the second appointment, the teeth were prepared and obturated by using lateral condensation technique. The frequency of post obturation pain was recorded as no pain, slight, moderate and severe pain and evaluated at the day 1 and at the day 7 after obturation. The data were analyzed statistically by using SPSS version-12. P value <0.05 was taken as significant. The study showed that the post obturation pain in the single visit treatment group was more than multi visit treatment group, which is significant (p value <0.044). Out of the 120 patients, 86(71.7%) patients had no pain, 19(15.8%) had slight pain and 15(12.5%) patients had moderate pain at the day 1 after obturation. At the day 7 after obturation, 108(90%) patients had no pain, 9(7.5%) had slight pain and 3(2.5%) patients had moderate pain. No patient noticed severe pain during the follow up period. Older patient had significantly more post obturation pain than the younger patient. There was higher incidence of post obturation pain following the single visit root canal treatment. In multi visit root canal treatment with

  16. Treatment of absolute painful glaucoma with dynamic arcs using novalis shaped beam radiosurgery

    SciTech Connect

    Gonzalez-Olhovich, Irene . E-mail: irenegonol@hotmail.com; Celis, Miguel Angel; Larraga-Gutierrez, Jose; Lopez-Ayala, Temuchino; Suarez-Campos, Jose; Garcia-Garduno, Amanda; Herrera-Gomez, Leopoldo; Hernandez-Bojorquez, Mariana B.Sc.

    2006-11-15

    Purpose: We assessed the effect of shaped beam conformal stereotactic radiosurgery (SRS) in 1 patient with chronic painful glaucoma in one eye refractory to medical treatment. Methods and Materials: Left eye ciliary body was targeted at 18 Gy (90% isodose curve) with a dedicated linear accelerator (Novalis, BrainLAB, Germany) SRS. Interval follow-up was performed weekly for the first month, and every 2 months until 1 year was completed with clinical examinations and intraocular pressure (IOP) measurements. Results: Ocular pain resolved at 6 weeks after SRS treatment. IOP decreased and normalized at 1 year. Conclusions: We present a case in which SRS appears to be an effective treatment of chronic refractory painful glaucoma. Further Phase I studies are needed to know the best parameters for radiation dose, tolerance of organs at risk, and pathophysiologic effects.

  17. Opioid treatment of experimental pain activates nuclear factor-κB

    PubMed Central

    Compton, Peggy; Griffis, Charles; Breen, Elizabeth Crabb; Torrington, Matthew; Sadakane, Ryan; Tefera, Eshetu; Irwin, Michael R.

    2015-01-01

    Objective To determine the independent and combined effects of pain and opioids on the activation of an early marker of inflammation, nuclear factor-κB (NF-κB). Design NF-κB activation was compared within-subjects following four randomly ordered experimental sessions of opioid-only (intravenous fentanyl 1 μg/kg), pain-only (cold-pressor), opioid + pain, and a resting condition. Setting University General Clinical Research Center. Participants Twenty-one (11 female) healthy controls. Interventions Following exposure to treatment (fentanyl administration and/or cold-pressor pain), blood samples for NF-kB analysis were obtained. Main outcome measures Intracellular levels of activated NF-κB, in unstimulated and stimulated peripheral blood mononuclear cells at 15 and 30 minutes. Results Neither pain nor opioid administration alone effected NF-κB levels in cell populations; however, the combination of treatments induced significant increases of NF-κB in stimulated peripheral blood mononuclear cell, lymphocytes, and monocytes. Conclusions The combination of acute pain with opioids, as occurs in clinical situations, activates a key transcription factor involved in proinflammatory responses. PMID:25901477

  18. Doxepin for Radiation Therapy-Induced Mucositis Pain in the Treatment of Oral Cancers

    PubMed Central

    Jayakrishnan, Ritujith; Chang, Kenneth; Ugurluer, Gamze; Miller, Robert C.

    2015-01-01

    Radiotherapy (RT), an integral part of the oncologic treatment for patients with head and neck cancer, can cause adverse side effects such as oral mucositis (OM). Pain from OM can impact a patient’s quality of life and interrupt RT treatment schedules, which decreases the probability for achieving cancer cure. Conventionally, RT-induced OM pain is treated with analgesics and/or mouthwash rinses. Doxepin, a traditional tricyclic antidepressant with analgesic and anesthetic properties when applied topically to the mucosa, has been shown to lower OM pain in multiple single-arm trials (Epstein et al.) and more recently, in a placebo-controlled crossover study (Leenstra and Miller et al.). Currently, a placebo-controlled study (Sio and Miller et al.) using doxepin for esophagitis pain caused by RT to the thorax is underway. Doxepin will also be further compared with magic mouthwash and a placebo solution in a three-arm trial (Miller and Sio et al.) with head and neck cancer patients with OM pain caused by RT. Doxepin may represent a new standard for treating RT-induced OM pain in the future. PMID:26779314

  19. Dimethyl sulfoxide and sodium bicarbonate in the treatment of refractory cancer pain.

    PubMed

    Hoang, Ba X; Tran, Dao M; Tran, Hung Q; Nguyen, Phuong T M; Pham, Tuan D; Dang, Hong V T; Ha, Trung V; Tran, Hau D; Hoang, Cuong; Luong, Khue N; Shaw, D Graeme

    2011-01-01

    Pain is a major concern of cancer patients and a significant problem for therapy. Pain can become a predominant symptom in advanced cancers. In this open-label clinical study, the authors have treated 26 cancer patients who have been declared as terminal without the option of conventional treatment. These patients suffered from high levels of pain that was poorly managed by all available interventional approaches recommended by World Health Organization (WHO) guideline. The results indicate that intravenous infusion of dimethyl sulfoxide (DMSO) and sodium bicarbonate (SB) solution can be a viable, effective, and safe treatment for refractory pain in cancer patients. These patients had pain due to the disease progression and complication of chemotherapy and radiation. Moreover, the preliminary clinical outcome of 96-day follow-up suggests that the application of DMSO and SB solution intravenously could lead to better quality of life for patients with nontreatable terminal cancers. The data of this clinical observation indicates that further research and application of the DMSO and SB combination may help the development of an effective, safe, and inexpensive therapy to manage cancer pain. PMID:21426213

  20. Adult stem cell as new advanced therapy for experimental neuropathic pain treatment.

    PubMed

    Franchi, Silvia; Castelli, Mara; Amodeo, Giada; Niada, Stefania; Ferrari, Daniela; Vescovi, Angelo; Brini, Anna Teresa; Panerai, Alberto Emilio; Sacerdote, Paola

    2014-01-01

    Neuropathic pain (NP) is a highly invalidating disease resulting as consequence of a lesion or disease affecting the somatosensory system. All the pharmacological treatments today in use give a long lasting pain relief only in a limited percentage of patients before pain reappears making NP an incurable disease. New approaches are therefore needed and research is testing stem cell usage. Several papers have been written on experimental neuropathic pain treatment using stem cells of different origin and species to treat experimental NP. The original idea was based on the capacity of stem cell to offer a totipotent cellular source for replacing injured neural cells and for delivering trophic factors to lesion site; soon the researchers agreed that the capacity of stem cells to contrast NP was not dependent upon their regenerative effect but was mostly linked to a bidirectional interaction between the stem cell and damaged microenvironment resident cells. In this paper we review the preclinical studies produced in the last years assessing the effects induced by several stem cells in different models of neuropathic pain. The overall positive results obtained on pain remission by using stem cells that are safe, of easy isolation, and which may allow an autologous transplant in patients may be encouraging for moving from bench to bedside, although there are several issues that still need to be solved. PMID:25197647

  1. Chronic Pain Medicines

    MedlinePlus

    ... Treatment of chronic pain usually involves medicines and therapy. Medicines used for chronic pain include pain relievers, antidepressants and anticonvulsants. Different types of medicines help ...

  2. The Efficacy of Pulsed Radiofrequency Treatment of Cervical Radicular Pain Patients

    PubMed Central

    Yoon, Young Moon; Lee, Seung Jun; Choi, Chan Young; Sohn, Moon Jun; Lee, Chae Heuck

    2014-01-01

    Objective Cervical radicular pain is defined as pain arising in the arm caused by irritation of a cervical spinal nerve or its roots. Although many treatment modalities are described in the literature, the available evidence for efficacy is not sufficient to allow definitive conclusions. The goal of this study was to establish the benefits and prognostic factors of pulsed radiofrequency (PRF) on the adjacent cervical dorsal root ganglia (DRG) of cervical radicular pain patients. Methods A retrospective study of PRF treatment of patients with cervical radicular pain was carried out. Two times diagnostic block of cervical DRG were performed before PRF. PRF was applied for 2 minutes at a setting of 2 Hz and 45 V by two times on the same targets, with the end point being an electrode tip temperature 42℃. Numerical rating scale (NRS) score was evaluated post-treatment 2 week, 1 month, 3 months and 6 months, which were compared with pretreatment value. A successful outcome was defined that NRS change was improved more than 50% at 6 months. Results The mean age was 54 years. The success rate was 68%(15/22) after six months of follow-up. PRF induced complications were not observed. Between success and failure group, we do not find any positive outcome prognostic factor. Interestingly, PRF treatment on foraminal stenosis is better outcome than herniated cervical disc. Conclusion PRF on adjacent cervical DRG is effective and safe treatment option for cervical radicular pain patients. However, more long-term follow up and larger patients are needed to establish effectiveness PRF treatment on cervical radicular pain patients. PMID:25346754

  3. Transcranial magnetic stimulation of the brain: guidelines for pain treatment research.

    PubMed

    Klein, Max M; Treister, Roi; Raij, Tommi; Pascual-Leone, Alvaro; Park, Lawrence; Nurmikko, Turo; Lenz, Fred; Lefaucheur, Jean-Pascal; Lang, Magdalena; Hallett, Mark; Fox, Michael; Cudkowicz, Merit; Costello, Ann; Carr, Daniel B; Ayache, Samar S; Oaklander, Anne Louise

    2015-09-01

    Recognizing that electrically stimulating the motor cortex could relieve chronic pain sparked development of noninvasive technologies. In transcranial magnetic stimulation (TMS), electromagnetic coils held against the scalp influence underlying cortical firing. Multiday repetitive transcranial magnetic stimulation (rTMS) can induce long-lasting, potentially therapeutic brain plasticity. Nearby ferromagnetic or electronic implants are contraindications. Adverse effects are minimal, primarily headaches. Single provoked seizures are very rare. Transcranial magnetic stimulation devices are marketed for depression and migraine in the United States and for various indications elsewhere. Although multiple studies report that high-frequency rTMS of the motor cortex reduces neuropathic pain, their quality has been insufficient to support Food and Drug Administration application. Harvard's Radcliffe Institute therefore sponsored a workshop to solicit advice from experts in TMS, pain research, and clinical trials. They recommended that researchers standardize and document all TMS parameters and improve strategies for sham and double blinding. Subjects should have common well-characterized pain conditions amenable to motor cortex rTMS and studies should be adequately powered. They recommended standardized assessment tools (eg, NIH's PROMIS) plus validated condition-specific instruments and consensus-recommended metrics (eg, IMMPACT). Outcomes should include pain intensity and qualities, patient and clinician impression of change, and proportions achieving 30% and 50% pain relief. Secondary outcomes could include function, mood, sleep, and/or quality of life. Minimum required elements include sample sources, sizes, and demographics, recruitment methods, inclusion and exclusion criteria, baseline and posttreatment means and SD, adverse effects, safety concerns, discontinuations, and medication-usage records. Outcomes should be monitored for at least 3 months after initiation

  4. Transcranial magnetic stimulation of the brain: guidelines for pain treatment research

    PubMed Central

    Klein, Max M.; Treister, Roi; Raij, Tommi; Pascual-Leone, Alvaro; Park, Lawrence; Nurmikko, Turo; Lenz, Fred; Lefaucheur, Jean-Pascal; Lang, Magdalena; Hallett, Mark; Fox, Michael; Cudkowicz, Merit; Costello, Ann; Carr, Daniel B.; Ayache, Samar S.; Oaklander, Anne Louise

    2015-01-01

    Abstract Recognizing that electrically stimulating the motor cortex could relieve chronic pain sparked development of noninvasive technologies. In transcranial magnetic stimulation (TMS), electromagnetic coils held against the scalp influence underlying cortical firing. Multiday repetitive transcranial magnetic stimulation (rTMS) can induce long-lasting, potentially therapeutic brain plasticity. Nearby ferromagnetic or electronic implants are contraindications. Adverse effects are minimal, primarily headaches. Single provoked seizures are very rare. Transcranial magnetic stimulation devices are marketed for depression and migraine in the United States and for various indications elsewhere. Although multiple studies report that high-frequency rTMS of the motor cortex reduces neuropathic pain, their quality has been insufficient to support Food and Drug Administration application. Harvard's Radcliffe Institute therefore sponsored a workshop to solicit advice from experts in TMS, pain research, and clinical trials. They recommended that researchers standardize and document all TMS parameters and improve strategies for sham and double blinding. Subjects should have common well-characterized pain conditions amenable to motor cortex rTMS and studies should be adequately powered. They recommended standardized assessment tools (eg, NIH's PROMIS) plus validated condition-specific instruments and consensus-recommended metrics (eg, IMMPACT). Outcomes should include pain intensity and qualities, patient and clinician impression of change, and proportions achieving 30% and 50% pain relief. Secondary outcomes could include function, mood, sleep, and/or quality of life. Minimum required elements include sample sources, sizes, and demographics, recruitment methods, inclusion and exclusion criteria, baseline and posttreatment means and SD, adverse effects, safety concerns, discontinuations, and medication-usage records. Outcomes should be monitored for at least 3 months after

  5. Treatment efficacy of 153Sm-EDTMP for painful bone metastasis

    PubMed Central

    Ayati, Narjess; Aryana, Kamran; Jalilian, Amir; Hoseinnejad, Toktam; Samani, Ali Bahrami; Ayati, Zahra; Shariati, Farzane; Zakavi, S. Rasoul

    2013-01-01

    Introduction: Involvement of the skeleton can cause an excruciating pain in two-thirds of terminal patients with a history of malignancy. Due to several limitations of other therapies, such as analgesics, bisphosphonates, chemotherapy, hormonal therapy and external beam radiotherapy; bone-seeking radiopharmaceuticals have an important role in palliation of pain from bone metastases. Although these kinds of therapies have many advantages including the ability to treat multiple sites of tumoral involvement simultaneously, no significant confliction with other treatments, ease of administration and the potential to be used repetitively; in Iran using of this modality is not widely practiced. In this study we evaluated the clinical usefulness of Sm-153 lexidronamfor pain management of bone metastases. Methods: 28 patients (14 males and 14 females) aged 38-77 years with a history of painful bone metastases caused by different cancers, not responding to conventional treatments were included in the study. All patients had a recent whole body bone scan indicating multiple bone metastases. 1 mCi/Kg Sm-153 lexidronam was injected intravenously to the patients. Whole body scintigraphy was done 3 or 18 hours post injection. Pain relief and quality of life have been evaluated by analog pain scale and Karnofsky index every week, respectively. Also, all patients were evaluated for hematological toxicity every two weeks. Active follow ups were performed. Results: 43% of patients showed the presence of the flare phenomenon during the first three days after Sm injection with a mean duration of 2.2 days. The pain relief began between 2 and 16 days post injection and the duration of pain palliation was in the range of 4 to 32 weeks (mean±SD=15.22±7.8). 64.3% of patients showed complete relief of pain and 21.4% achieved partial response to therapy. (Over all response to therapy was 85.7%). The lowest amount of peripheral blood cells was detected in the fourth week for RBCs and in the

  6. Predicting pain outcomes after traumatic musculoskeletal injury.

    PubMed

    Rosenbloom, Brittany N; Katz, Joel; Chin, Kelly Y W; Haslam, Lynn; Canzian, Sonya; Kreder, Hans J; McCartney, Colin J L

    2016-08-01

    Traumatic musculoskeletal injury results in a high incidence of chronic pain; however, there is little evidence about the nature, quality, and severity of the pain. This study uses a prospective, observational, longitudinal design to (1) examine neuropathic pain symptoms, pain severity, pain interference, and pain management at hospital admission and 4 months after traumatic musculoskeletal injury (n = 205), and (2) to identify predictors of group membership for patients with differing moderate-to-severe putative neuropathic pain trajectories. Data were collected on mechanism of injury, injury severity, pain (intensity, interference, neuropathic quality), anxiety (anxiety sensitivity, general anxiety, pain catastrophizing, pain anxiety), depression, and posttraumatic stress while patients were in-hospital and 4 months after injury. A third of patients had chronic moderate-to-severe neuropathic pain 4 months after injury. Specifically, 11% of patients developed moderate-to-severe pain by 4 months and 21% had symptoms immediately after injury that persisted over time. Significant predictors of the development and maintenance of moderate-to-severe neuropathic pain included high levels of general anxiety while in-hospital immediately after injury (P < 0.001) and symptoms of posttraumatic stress 4 months after injury (P < 0.001). Few patients had adequate pharmacological, physical, or psychological pain management in-hospital and at 4 months. Future research is needed among trauma patients to better understand the development of chronic pain and to determine the best treatment approaches. PMID:27058677

  7. [Can orthodontic treatment generate temporomandibular disorders and pain? A review].

    PubMed

    Gebeile-Chauty, Sarah; Robin, Olivier; Messaoudi, Yassine; Aknin, Jean-Jacques

    2010-03-01

    While considered for years to play the primary role in the etiology of temporo-mandibular joint disturbances (TMD), occlusal discrepancies are now considered to be just one causative factor among many. Recent studies, literature reviews or meta-analyses, and longitudinal studies with follow-up of children treated for many years all conclude that there is no risk of orthodontic treatment giving rise to episodes of temporo-mandibular disorders. The signs of TMD appearing during the course of orthodontic treatment should be considered in the context of the epidemiology of the disorder, which is characterized by a strong increase in its occurrence during adolescence. In conclusion, it should be stated that if orthodontic treatment can no longer be considered as one of the etiopathogenic factors in the TMD complex, there are no scientific arguments to justify the converse, that there are indications for orthodontic treatment whose sole goal would be the treatment of TMD. PMID:20359451

  8. Botulinum Toxin Type A for the Treatment of Neuropathic Pain in Neuro-Rehabilitation

    PubMed Central

    Intiso, Domenico; Basciani, Mario; Santamato, Andrea; Intiso, Marta; Di Rienzo, Filomena

    2015-01-01

    Pain is a natural protective mechanism and has a warning function signaling imminent or actual tissue damage. Neuropathic pain (NP) results from a dysfunction and derangement in the transmission and signal processing along the nervous system and it is a recognized disease in itself. The prevalence of NP is estimated to be between 6.9% and 10% in the general population. This condition can complicate the recovery from stroke, multiple sclerosis, spinal cord lesions, and several neuropathies promoting persistent disability and poor quality of life. Subjects suffering from NP describe it as burning, itching, lancing, and numbness, but hyperalgesia and allodynia represent the most bothersome symptoms. The management of NP is a clinical challenge and several non-pharmacological and pharmacological interventions have been proposed with variable benefits. Botulinum toxin (BTX) as an adjunct to other interventions can be a useful therapeutic tool for the treatment of disabled people. Although BTX-A is predominantly used to reduce spasticity in a neuro-rehabilitation setting, it has been used in several painful conditions including disorders characterized by NP. The underlying pharmacological mechanisms that operate in reducing pain are still unclear and include blocking nociceptor transduction, the reduction of neurogenic inflammation by inhibiting neural substances and neurotransmitters, and the prevention of peripheral and central sensitization. Some neurological disorders requiring rehabilitative intervention can show neuropathic pain resistant to common analgesic treatment. This paper addresses the effect of BTX-A in treating NP that complicates frequent disorders of the central and peripheral nervous system such as spinal cord injury, post-stroke shoulder pain, and painful diabetic neuropathy, which are commonly managed in a rehabilitation setting. Furthermore, BTX-A has an effect in relief pain that may characterize less common neurological disorders including post

  9. Botulinum Toxin Type A for the Treatment of Neuropathic Pain in Neuro-Rehabilitation.

    PubMed

    Intiso, Domenico; Basciani, Mario; Santamato, Andrea; Intiso, Marta; Di Rienzo, Filomena

    2015-07-01

    Pain is a natural protective mechanism and has a warning function signaling imminent or actual tissue damage. Neuropathic pain (NP) results from a dysfunction and derangement in the transmission and signal processing along the nervous system and it is a recognized disease in itself. The prevalence of NP is estimated to be between 6.9% and 10% in the general population. This condition can complicate the recovery from stroke, multiple sclerosis, spinal cord lesions, and several neuropathies promoting persistent disability and poor quality of life. Subjects suffering from NP describe it as burning, itching, lancing, and numbness, but hyperalgesia and allodynia represent the most bothersome symptoms. The management of NP is a clinical challenge and several non-pharmacological and pharmacological interventions have been proposed with variable benefits. Botulinum toxin (BTX) as an adjunct to other interventions can be a useful therapeutic tool for the treatment of disabled people. Although BTX-A is predominantly used to reduce spasticity in a neuro-rehabilitation setting, it has been used in several painful conditions including disorders characterized by NP. The underlying pharmacological mechanisms that operate in reducing pain are still unclear and include blocking nociceptor transduction, the reduction of neurogenic inflammation by inhibiting neural substances and neurotransmitters, and the prevention of peripheral and central sensitization. Some neurological disorders requiring rehabilitative intervention can show neuropathic pain resistant to common analgesic treatment. This paper addresses the effect of BTX-A in treating NP that complicates frequent disorders of the central and peripheral nervous system such as spinal cord injury, post-stroke shoulder pain, and painful diabetic neuropathy, which are commonly managed in a rehabilitation setting. Furthermore, BTX-A has an effect in relief pain that may characterize less common neurological disorders including post

  10. A long-term, open-label safety study of single-entity hydrocodone bitartrate extended release for the treatment of moderate to severe chronic pain

    PubMed Central

    Nalamachu, Srinivas; Rauck, Richard L; Hale, Martin E; Florete, Orlando G; Robinson, Cynthia Y; Farr, Stephen J

    2014-01-01

    Objective To evaluate the long-term safety, tolerability, and effectiveness of single-entity extended-release hydrocodone in opioid-experienced subjects with moderate to severe chronic pain not receiving adequate pain relief or experiencing intolerable side effects from their current opioid. Methods This multicenter, open-label study started with a conversion/titration phase (≤6 weeks) where subjects (n=638) were converted to individualized doses (range 20–300 mg) of extended-release hydrocodone dosed every 12 hours, followed by a 48-week maintenance phase (n=424). The primary objective (safety and tolerability) and the secondary objective (long-term efficacy as measured by change in average pain score; 0= no pain, 10= worst imaginable pain) were monitored throughout the study. Results Subjects were treated for a range of chronic pain etiologies, including osteoarthritis, low back pain, and neuropathic and musculoskeletal conditions. The mean hydrocodone equivalent dose at screening was 68.9±62.2 mg/day and increased to 139.5±81.7 mg/day at the start of the maintenance phase. Unlimited dose adjustments were permitted at the investigator’s discretion during the maintenance phase, reflecting typical clinical practice. No unexpected safety issues were reported. Common adverse events during the conversion/titration and maintenance phases, respectively, were constipation (11.3% and 12.5%), nausea (10.7% and 9.9%), vomiting (4.1% and 9.7%), and somnolence (7.7% and 4.2%). Four deaths occurred during the study; all were considered unrelated to treatment. One subject died 13 months after the study ended. From the start to end of the conversion/titration phase, 84% of subjects had a clinically meaningful improvement in average pain score (≥30% improvement), and the mean average pain scores remained stable through the maintenance phase. Conclusion This single-entity, extended-release formulation of hydrocodone was generally safe, well tolerated, and effective in

  11. Can Acupuncture Treatment Be Double-Blinded? An Evaluation of Double-Blind Acupuncture Treatment of Postoperative Pain

    PubMed Central

    Vase, Lene; Baram, Sara; Takakura, Nobuari; Takayama, Miho; Yajima, Hiroyoshi; Kawase, Akiko; Schuster, Lars; Kaptchuk, Ted J.; Schou, Søren; Jensen, Troels Staehelin; Zachariae, Robert; Svensson, Peter

    2015-01-01

    Blinding protects against bias but the success of blinding is seldom assessed and reported in clinical trials including studies of acupuncture where blinding represents a major challenge. Recently, needles with the potential for double-blinding were developed, so we tested if acupuncture can be double-blinded in a randomized study of sixty-seven patients with acute pain ≥ 3 (0-10 scale following third molar removal) who received active acupuncture with a penetrating needle or placebo acupuncture with a non-penetrating needle. To test if acupuncture was administered double-blind, patients and acupuncturists were asked about perceived treatment allocation at the end of the study. To test if there were clues which led to identification of the treatment, deep dull pain associated with needle application and rotation (termed “de qi” in East Asian medicine), and patients’ pain levels were assessed. Perceived treatment allocation depended on actual group allocation (p < 0.015) for both patients and acupuncturists, indicating that the needles were not successful in double-blinding. Up to 68% of patients and 83% of acupuncturists correctly identified the treatment, but for patients the distribution was not far from 50/50. Also, there was a significant interaction between actual or perceived treatment and the experience of de qi (p = 0.027), suggesting that the experience of de qi and possible non-verbal clues contributed to correct identification of the treatment. Yet, of the patients who perceived the treatment as active or placebo, 50% and 23%, respectively, reported de qi. Patients’ acute pain levels did not influence the perceived treatment. In conclusion, acupuncture treatment was not fully double-blinded which is similar to observations in pharmacological studies. Still, the non-penetrating needle is the only needle that allows some degree of practitioner blinding. The study raises questions about alternatives to double-blind randomized clinical trials in

  12. Oral health: treatment of dental trauma and pain.

    PubMed

    Martonffy, Andrea Ildiko

    2015-01-01

    Dental trauma is common among adults and children. As children become mobile, they frequently experience trauma to their primary teeth because of falls. Injuries to permanent teeth are common results of falls, motor vehicle accidents, sports injuries, and violence. Trauma can affect the tooth enamel, dentin, pulp, root, periodontal ligament, gum, or alveolar bone. Avulsions are characterized by complete displacement of the tooth from the socket. Avulsed primary teeth should not be replanted because replantation is associated with a risk of damage to the developing permanent tooth. Avulsed permanent teeth are considered a dental emergency and should be replanted by the first individual capable of doing so. If immediate replantation is not possible, the tooth should be stored in cold animal or human milk; it also can be stored in the mouth, adjacent to the buccal mucosa, if the patient is capable of doing so. Water should be avoided as a storage medium because it impedes healing of the periodontal ligament, but storage in water is superior to dry storage. Intruded teeth (ie, pushed into the jaw) may need immediate extraction, depending on their orientation. All patients with dental trauma should follow up promptly with a dentist. Patients presenting with chronic dental pain without an obvious treatable etiology will benefit from ongoing support from their family physicians. PMID:25594450

  13. Acute dental pain, Part II: Diagnosis and emergency treatment.

    PubMed

    Antonelli, J R

    1990-09-01

    Part II of this two-part series differentiates and explores endodontic-related emergencies with reversible and irreversible pulpitis. Indications and contra-indications for vital pulp therapy are explained, and treatment is outlined. The inflammatory process involved in irreversible pulpal disease is summarized, and the clinical signs, symptoms, and treatment of irreversible pulpitis (with and without acute periradicular involvement, with pulp necrosis, and acute periradicular abscess with and without cellulitis) are discussed. PMID:2097056

  14. The Effectiveness of Endoscopic Radiofrequency Denervation of Medial Branch for Treatment of Chronic Low Back Pain

    PubMed Central

    Jeong, Sun Yoon; Choi, Won Suh; Hur, Jung Woo; Ryu, Kyoung Sik

    2014-01-01

    Objective The aim of this study is to evaluate the clinical results of endoscopic radiofrequency ablation of medial branch in patients with chronic low back pain originating from facet joints. Methods Between October 2010 and December 2013, 52 consecutive patients had suffering from chronic low back pain had undergone endoscopic radiofrequency denervation of medial branch of dorsal ramus. The clinical outcomes of these 52 patients were reviewed retrospectively. Preoperative and postoperative Visual Analogue Scale (VAS) and Korean version of Oswestry Disability Index (K-ODI), and patients' satisfaction with the procedure were assessed. Results The pain scores on the VAS for back pain had improved significantly from a preoperative mean of 7.1 to a postoperative mean of 2 at the last follow-up (p<0.001). The clinical outcomes based on the K-ODI had also improved significantly from a preoperative mean of 26.5% to postoperative mean of 7.7% at the last follow-up (p<0.001). 80% of patients were satisfied with the procedure. There were no complications associated with the procedure. Conclusion Our preliminary results demonstrate that endoscopic radiofrequency denervation of medial branch could be an effective alternative treatment modality for chronic back pain originating from facet joints that provides long-term pain relief. PMID:25371785

  15. Low back pain of mechanical origin: randomised comparison of chiropractic and hospital outpatient treatment.

    PubMed Central

    Meade, T W; Dyer, S; Browne, W; Townsend, J; Frank, A O

    1990-01-01

    OBJECTIVE--To compare chiropractic and hospital outpatient treatment for managing low back pain of mechanical origin. DESIGN--Randomised controlled trial. Allocation to chiropractic or hospital management by minimisation to establish groups for analysis of results according to initial referral clinic, length of current episode, history, and severity of back pain. Patients were followed up for up two years. SETTING--Chiropractic and hospital outpatient clinics in 11 centres. PATIENTS--741 Patients aged 18-65 who had no contraindications to manipulation and who had not been treated within the past month. INTERVENTIONS--Treatment at the discretion of the chiropractors, who used chiropractic manipulation in most patients, or of the hospital staff, who most commonly used Maitland mobilisation or manipulation, or both. MAIN OUTCOME MEASURES--Changes in the score on the Oswestry pain disability questionnaire and in the results of tests of straight leg raising and lumbar flexion. RESULTS--Chiropractic treatment was more effective than hospital outpatient management, mainly for patients with chronic or severe back pain. A benefit of about 7% points on the Oswestry scale was seen at two years. The benefit of chiropractic treatment became more evident throughout the follow up period. Secondary outcome measures also showed that chiropractic was more beneficial. CONCLUSIONS--For patients with low back pain in whom manipulation is not contraindicated chiropractic almost certainly confers worthwhile, long term benefit in comparison with hospital outpatient management. The benefit is seen mainly in those with chronic or severe pain. Introducing chiropractic into NHS practice should be considered. PMID:2143092

  16. Intradiscal Electrothermal Treatment for Chronic Lower Back Pain Patients with Internal Disc Disruption

    PubMed Central

    Park, Si-Young; Moon, Seong-Hwan; Park, Moon Soo; Kim, Hak-Sun; Choi, Youn-Jin

    2005-01-01

    Chronic lower back pain is one of the most common musculoskeletal problems; it is also the most expensive industrial injury. Not surprisingly, many treatments have been developed to combat this expensive and debilitating condition. One of these, intradiscal electrothermal treatment (IDET), was developed for patients with chronic discogenic lower back pain who failed to improve with any of the wide variety of non-surgical treatments. The present study sought to evaluate the efficacy of IDET for patients with chronic lower back pain. Twenty-five patients were enrolled in this prospective study; the patients received IDET between June 2001 and June 2003. MRI was used to confirm the diagnosis of internal disc disruption in all patients. The patients then underwent a pre-operative provocative test and discography. The follow-up duration was at least 1 year in all cases, and the visual analogue scale, recovery rate, and satisfaction of each patient were evaluated. The average age of the patients was 32 years (age range 18 to 49 years), and the patient group was 33% male and 67% female. Of the 25 patients, 5 underwent lumbar fusion surgery within 1 year of IDET. After IDET, 8 patients (32%) reported more pain than before, 14 patients (56%) reported less pain, and 3 patients (12%) experienced no change. Twelve patients (48%) were satisfied with IDET, 11 (44%) were dissatisfied, and 2 (8%) were undecided about the treatment. At least 1 year after IDET, nearly half the study patients were dissatisfied with their medical outcome. Consequently, 5 patients (20%) underwent fusion surgery at 1 year after IDET. Although other studies have shown good results with IDET for at least 2 years, this investigation suggests the IDET may be somewhat less effective. In order to firmly establish the efficacy of IDET for treating chronic discogenic lower back pain, additional studies with larger numbers of patients evaluated over longer time periods are recommended. PMID:16127780

  17. Acupuncture is a feasible treatment for post-thoracotomy pain: results of a prospective pilot trial

    PubMed Central

    Vickers, Andrew J; Rusch, Valerie W; Malhotra, Vivek T; Downey, Robert J; Cassileth, Barrie R

    2006-01-01

    Background Thoracotomy is associated with severe pain that may persist for years. Acupuncture is a complementary therapy with a proven role in pain control. A randomized trial showed that acupuncture was effective in controlling pain after abdominal surgery, but the efficacy of this technique for the treatment of thoracotomy pain has not been established. We developed a novel technique for convenient application of acupuncture to patients undergoing thoracotomy, and in a Phase II trial evaluated the safety of this intervention and the feasibility of doing a randomized trial. Methods Adult patients scheduled for unilateral thoracotomy with preoperative epidural catheter placement received acupuncture immediately prior to surgery. Eighteen semi-permanent intradermal needles were inserted on either side of the spine, and four were inserted in the legs and auricles. Needles were removed after four weeks. Using a numerical rating scale, pain was measured on the first five postoperative days. After discharge, pain was assessed using the Brief Pain Inventory at 7, 30, 60 and 90 days. Results Thirty-six patients were treated with acupuncture. Of these, 25, 23, and 22 patients provided data at 30, 60, and 90 days, respectively. The intervention was well tolerated by patients with only one minor and transient adverse event of skin ulceration. Conclusion The rate of data completion met our predefined criterion for determining a randomized trial to be feasible (at least 75% of patients tolerated the intervention and provided evaluable data). This novel intervention is acceptable to patients undergoing thoracotomy and does not interfere with standard preoperative care. There was no evidence of important adverse events. We are now testing the hypothesis that acupuncture significantly adds to standard perioperative pain management in a randomized trial. PMID:16672065

  18. Vitamin D for the treatment of chronic painful conditions in adults

    PubMed Central

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

    2014-01-01

    Background Vitamin D is produced in the skin after sun-light exposure and can also be obtained through food. Vitamin D deficiency has recently been linked with a range of diseases including chronic pain. Observational and circumstantial evidence suggests that there may be a role for vitamin D deficiency in the aetiology of chronic pain conditions. Objectives To assess the efficacy and adverse events of vitamin D supplementation in chronic painful conditions. Search methods We searched Cochrane CENTRAL, MEDLINE, EMBASE and the Oxford Pain Relief Database for studies to September 2009. This was supplemented by searching the reference lists of retrieved articles, textbooks and reviews. Selection criteria Studies were included if they were randomised double blind trials of vitamin D supplementation compared with placebo or with active comparators for the treatment of chronic pain conditions in adults. Data collection and analysis Two review authors independently selected the studies for inclusion, assessed methodological quality, and extracted data. Pooled analysis was not undertaken due to paucity and heterogeneity of data. Main results Four studies, with a total of 294 participants, were included. The studies were heterogeneous with regard to study quality, the chronic painful conditions that were investigated, and the outcome measures reported. Only one study reported a beneficial effect, the others found no benefit of vitamin D over placebo in treating chronic pain. Authors’ conclusions The evidence base for the use of vitamin D for chronic pain in adults is poor at present. This is due to low quality and insufficient randomised controlled trials in this area of research. PMID:20091647

  19. Comparing complementary alternative treatment for chronic shoulder pain of myofascial origin

    PubMed Central

    Pan, Ru-Yu; Hsu, Yung-Chi; Wong, Chih-Shung; Lin, Shinn-Long; Li, Tsung-Ying; Cherng, Chen-Hwan; Ko, Shan-Chi; Yeh, Chun-Chang

    2016-01-01

    Abstract The aim of this study was to compare the short-term outcomes between 2 different treatments for unilateral chronic shoulder pain of myofascial origin, that is, local tender area related meridians (LTARMs) treatment and collateral meridian therapy (CMT), which were performed 6 times over a period of 4 weeks. Seventy patients with unilateral shoulder pain of chronic myofascial origin were enrolled. The patients were randomly assigned to 2 different treatment groups: 1 group received CMT (n = 35) and the other received LTARM (n = 35). Before and after the 2 treatment processes, all patients rated their overall pain intensity on a visual analogue scale (VAS) and a validated 13-question shoulder pain and disability index (SPADI) questionnaire was used to measure shoulder pain and functional impairment after therapy for 4 weeks. After CMT, the pain intensity was reduced after CMT. VAS score is reduced from 5.90 ± 2.07 (a mean of 5.90 and standard deviation of 2.07) to 3.39 ± 1.2. This was verified by the SPADI pain subscale scores (from 0.58 ± 0.193 to 0.33 ± 0.14). The pain-relief effect of CMT was significantly better than that of LTARM (VAS score from 5.78 ± 1.64 to 4.58 ± 1.40; P < 0.005; SPADI pain subscale score from 0.58 ± 0.16 to 0.45 ± 0.14, P < 0.001). In addition, the VAS scores of patients changed considerably in the CMT group after 4 weeks of treatment, where 63% of patients felt no or mild pain, whereas the VAS scores for moderate pain were even higher in the LTARM group in 75% of patients (P < 0.001). Moreover, the SPADI disability subscale scores improved significantly in the CMT group because of their greater mobility associated with shoulder impairment (disability score: from 0.58 ± 0.20 to 0.35 ± 0.14) than those in the LTARM group (disability score: from 0.55 ± 0.17 to 0.44 ± 0.14, P < 0.001). CMT may be more effective in reducing chronic shoulder pain of

  20. [Clinical evaluation of the efficacy of external therapies of traditional Chinese medicine in treatment of cancer pain].

    PubMed

    Zhu, Shi-jie; Jia, Li-qun; Li, Pei-wen

    2011-01-01

    There lack scientific methods for evaluating the treatment of cancer pain with external therapies of traditional Chinese medicine (TCM). The level of clinical study in this field needs to be improved. The authors assert that when external therapies of TCM are applied to treat cancer pain, different types of cancer pain should be distinguished and treatment should be applied according to such a differentiation. Under this framework scientific evaluation can be conducted. The authors also assert that the findings of randomized, blinded and controlled trials should be given particular attention, and it is necessary to include titration of morphine into clinical trails of external therapies for the treatment of cancer pain, not only complying with the three-ladder principle for treating cancer pain suggested by the World Health Organization, but also not influencing the effect evaluation of external therapies of TCM on cancer pain. Patient diaries recording pain were revised as observation indexes. The primary indicator of efficacy was the pain intensity score and the secondary indicators were the equivalent of morphine and the remission rate of pain. The time to onset, remission duration and comparison of assessment of pain influence can mirror the characteristics of external therapies of TCM on cancer pain. PMID:21227027

  1. What Does It Take? Comparing Intensive Rehabilitation to Outpatient Treatment for Children With Significant Pain-Related Disability

    PubMed Central

    Sieberg, Christine B.; Pielech, Melissa; Conroy, Caitlin; Logan, Deirdre E.

    2013-01-01

    Objectives This study compared outcomes between day hospital pain rehabilitation patients and patients engaged in outpatient multidisciplinary pain treatment. Methods This study included 100 children who presented for an initial tertiary care pain clinic evaluation. 50 patients enrolled in intensive day hospital pain rehabilitation and 50 patients pursued outpatient multidisciplinary treatment. Across 2 time points, children completed measures of functional disability, pain-related fear, and readiness to change and parents completed measures of pain-related fear and readiness to change. Results Across both treatment modalities, patients and parents reported improvements. Patients enrolled in intensive pain rehabilitation had significantly larger improvements in functional disability, pain-related fear, and readiness to change. Parents of day hospital patients reported larger declines in child pain-related fear and increased readiness to change compared with their outpatient counterparts. Discussion For patients with high levels of pain-related disability and distress, intensive pain rehabilitation provides rapid, dramatic improvements in functioning. PMID:23104827

  2. Treatment of localized neuropathic pain of different etiologies with the 5% lidocaine medicated plaster – a case series

    PubMed Central

    Likar, Rudolf; Demschar, Susanne; Kager, Ingo; Neuwersch, Stefan; Pipam, Wolfgang; Sittl, Reinhard

    2015-01-01

    Objective To assess the efficacy and safety of the topical 5% lidocaine medicated plaster in the treatment of localized neuropathic pain. Study design This was a case series at an Austrian pain clinic, using retrospective analysis. Patients and methods Data of 27 patients treated for localized neuropathic pain with the 5% lidocaine medicated plaster were retrospectively analyzed. Assessment included changes in overall pain intensity, in intensity of different pain qualities, and of hyperalgesia and allodynia, and changes in sleep quality. Results Patients (17 female, ten male; mean age 53.4±11.4 years) presented mainly with dorsalgia (16 patients) or postoperative/posttraumatic pain (seven patients); one patient suffered from both. The mean overall pain intensity prior to treatment with lidocaine medicated plaster was 8.4±1.2 on the 11-point Likert scale. In the majority of cases, the lidocaine plaster was applied concomitantly with preexisting pain medication (81.5% of the patients). During the 6-month observation period, overall mean pain intensity was reduced by almost 5 points (4.98) to 3.5±2.6. Substantial reductions were also observed for neuralgiform pain (5 points from 7.9±2.6 at baseline) and burning pain (3 points from 5.2±4.1). Sleep quality improved from 4.6±2.6 at baseline to 5.5±1.8. Stratification by pain diagnosis showed marked improvements in overall pain intensity for patients with dorsalgia or postoperative/posttraumatic pain. The lidocaine plaster was well tolerated. Conclusion Overall, topical treatment with the 5% lidocaine medicated plaster was associated with effective pain relief and was well tolerated. PMID:25565882

  3. Treatment Algorithm for Patients with Non-arthritic Hip Pain, Suspect for an Intraarticular Pathology

    PubMed Central

    Jørgensen, R. Wejnold; Dippmann, C.; Dahl, L.; Stürup, J.

    2016-01-01

    Background: The amount of patients referred with longstanding, non-arthritic hip pain is increasing, as are the treatment options. Left untreated hip dysplasia, acetabular retroversion and femoroacetabular impingement (FAI) may lead to osteoarthritis (OA). Finding the right treatment option for the right patient can be challenging in patients with non-arthritic hip pain. Purpose: The purpose of this study was to categorize the radiographic findings seen in patients with longstanding hip pain, suspect for an intraarticular pathology, and provide a treatment algorithm allocating a specific treatment option for each clinical condition. Material and Methods: A review of the literature was performed using Public Medline searches of MeSH terms combined with synonyms for femoroacetabular impingement, acetabular retroversion, periacetabular osteotomy and hip arthroscopy. Results: Radiographic findings associated with acetabular retroversion described in the literature were the crossover sign, the posterior wall sign and the ischial spine sign, while Wiberg’s lateral center-edge angle (CE-angle) together with Leqeusne’s acetabular index indicate hip dysplasia. A Tönnis index >2 indicates osteoarthritis, however unsatisfying results are documented following joint preserving surgery with a Tönnis index >1. Furthermore, ischial spine sign in combination with the posterior wall sign indicates total acetabular retroversion prone to periacetabular osteotomy in contrast to focal retroversion prone to hip arthroscopy. These findings were used creating a treatment algorithm for intraarticular pathologies in patients with longstanding hip pain. Conclusion: Based on the radiographic findings, the algorithm presented in this study can be a helpful tool in the decision-making for the treatment of patients with non-arthritic hip pain, suspect for intraarticular pathologies. PMID:27583059

  4. Outcomes of a Simple Treatment for Complex Regional Pain Syndrome Type I in Children

    PubMed Central

    Dietz, Frederick R.; Compton, Stephen P.

    2015-01-01

    Background Chronic Regional Pain Syndrome type I (CRPSI) in children is a disorder of unknown etiology. No standard diagnostic criteria or treatment exists. Published treatment protocols are often time and resource intensive. Nonetheless, CRPSI is not rare and can be disabling. This reports the results of a simple and inexpensive treatment protocol involving no medicines, nerve blockades, physical therapy resources or referrals to pain specialists. The patient is instructed in a self-administered massage and mobilization program. The diagnosis required allodynia (pain on light touch of the skin) and signs or the history of signs of autonomic dysfunction. Methods A chart review of patient coded for “reflex sympathetic dystrophy” or ‘autonomic dysfunction” was performed yielding a cohort of eighty-three patients treated by a common protocol. Most patients were identified in the last 15 years. Most patients with this CRPSI were doubtless coded simply as “foot pain” or “knee pain”, etc and were not identified in this search. Charts were reviewed for patient demographics and outcomes. A subset of patients filled out the Pediatric Outcomes Data Collection Instrument (PODCI) giving a validated pre-treatment disability measure. Results The cohort characteristics were similar to prior reports with respect to age, gender, location, and history of trauma. Of the 26 patients who completed the PODCI before treatment the Pain/Comfort Core Scale score mean was 20.81(0–63). The Global Functioning Scale score mean was 52.11(27–83.5). Eighty-nine percent of 51 patients who attended clinic until their outcome was definite had no or minimal residual pain. Treatment averaged 2.2 visits per patient, typically over a six-week period. Conclusions A simple, inexpensive protocol can be effective in treating CRPSI in children. The protocol is risk free, inexpensive to families and conservative of physician and physical therapy resources. Level of Evidence Therapeutic

  5. Duloxetine in the treatment of chronic pain due to fibromyalgia and diabetic neuropathy

    PubMed Central

    Wright, Alan; Luedtke, Kyle E; VanDenBerg, Chad

    2011-01-01

    Duloxetine is a serotonin-norepinephrine reuptake inhibitor approved by the US Food and Drug Administration for the treatment of fibromyalgia and painful diabetic neuropathy at doses of 60 mg daily. Duloxetine has been shown to significantly improve the symptoms of chronic pain associated with these disorders, as measured by the Fibromyalgia Impact Questionnaire, Brief Pain Inventory scores, the Clinical Global Impressions Scale, and other various outcome measures in several placebo-controlled, randomized, double-blind, multicenter studies. Symptom improvement generally began within the first few weeks, and continued for the duration of the study. In addition, the efficacy of duloxetine was found to be due to direct effects on pain symptoms rather than secondary to improvements in depression or anxiety. Adverse events including nausea, constipation, dry mouth, and insomnia, were mild and transient and occurred at relatively low rates. In conclusion, duloxetine, a selective inhibitor for the serotonin and norepinephrine transporters, is efficacious in the treatment of chronic pain associated with fibromyalgia or diabetic neuropathy, and has a predictable tolerability profile, with adverse events generally being mild to moderate. PMID:21386950

  6. Use of Theraflex-TMJ topical cream for the treatment of temporomandibular joint and muscle pain.

    PubMed

    Lobo, Silvia Lobo; Mehta, Noshir; Forgione, Albert G; Melis, Marcello; Al-Badawi, Emad; Ceneviz, Caroline; Zawawi, Khalid H

    2004-04-01

    This randomized, double-blind study was designed to evaluate the effectiveness of the topical cream Theraflex-TMJ (NaBob/Rx, San Mateo, CA) in patients with masseter muscle pain and temporomandibular joint (TMJ) pain. Fifty-two subjects (5 males and 47 females) were instructed to apply a cream over the afflicted masseter muscle(s) or over the jaw joint(s) twice daily for two weeks. Theraflex-TMJ cream was used by the experimental group, while a placebo cream was used by the control group. The means of pain ratings were calculated prior to the application of the cream (baseline), after ten days of tx (period 1), and 15 days of tx (period 2) days of treatment and five days after stopping the treatment (follow-up). There was a significant decrease in reported pain levels from baseline in the experimental group for period 1 (p < 0.01), period 2 (p < 0.001), and follow-up (p < 0.01). For the control group, no significant differences were found between the different time periods (p > 0.05). There was evidence of minor side effects such as skin irritation and/or burning on the site of the application in two subjects in the experimental as well as two subjects in the control groups. The data strongly suggest that Theraflex-TMJ topical cream is safe and effective for reducing pain in the masseter muscle and the temporomandibular joint. PMID:15134414

  7. Hydrotherapy for the Treatment of Pain in People with Multiple Sclerosis: A Randomized Controlled Trial

    PubMed Central

    Castro-Sánchez, Adelaida María; Matarán-Peñarrocha, Guillermo A.; Lara-Palomo, Inmaculada; Saavedra-Hernández, Manuel; Arroyo-Morales, Manuel; Moreno-Lorenzo, Carmen

    2012-01-01

    Background. Multiple sclerosis (MS) is a chronic demyelinating neurological disease. Several studies have reported that complementary and alternative therapies can have positive effects against pain in these patients. Objective. The objective was to investigate the effectiveness of an Ai-Chi aquatic exercise program against pain and other symptoms in MS patients. Methods. In this randomized controlled trial, 73 MS patients were randomly assigned to an experimental or control group for a 20-week treatment program. The experimental group underwent 40 sessions of Ai-Chi exercise in swimming pool and the control group 40 sessions of abdominal breathing and contraction-relaxation exercises in therapy room. Outcome variables were pain, disability, spasm, depression, fatigue, and autonomy, which were assessed before the intervention and immediately and at 4 and 10 weeks after the last treatment session. Results. The experimental group showed a significant (P < 0.028) and clinically relevant decrease in pain intensity versus baseline, with an immediate posttreatment reduction in median visual analogue scale scores of 50% that was maintained for up to 10 weeks. Significant improvements were also observed in spasm, fatigue, disability, and autonomy. Conclusion. According to these findings, an Ai-Chi aquatic exercise program improves pain, spasms, disability, fatigue, depression, and autonomy in MS patients. PMID:21785645

  8. Systemic metabolic radiopharmaceutical therapy in the treatment of metastatic bone pain.

    PubMed

    Paes, Fabio M; Serafini, Aldo N

    2010-03-01

    Bone pain due to skeletal metastases constitutes the most common type of chronic pain among patients with cancer. It significantly decreases the patient's quality of life and is associated with comorbidities, such as hypercalcemia, pathologic fractures and spinal cord compression. Approximately 65% of patients with prostate or breast cancer and 35% of those with advanced lung, thyroid, and kidney cancers will have symptomatic skeletal metastases. The management of bone pain is extremely difficult and involves a multidisciplinary approach, which usually includes analgesics, hormone therapies, bisphosphonates, external beam radiation, and systemic radiopharmaceuticals. In patients with extensive osseous metastases, systemic radiopharmaceuticals should be the preferred adjunctive therapy for pain palliation. In this article, we review the current approved radiopharmaceutical armamentarium for bone pain palliation, focusing on indications, patient selection, efficacy, and different biochemical characteristics and toxicity of strontium-89 chloride, samarium-153 lexidronam, and rhenium-186 etidronate. A brief discussion on the available data on rhenium-188 is presented focusing on its major advantages and disadvantages. We also perform a concise appraisal of the other available treatment options, including pharmacologic and hormonal treatment modalities, external beam radiation, and bisphosphonates. Finally, the available data on combination therapy of radiopharmaceuticals with bisphosphonates or chemotherapy are discussed. PMID:20113678

  9. Gagging and Associations with Dental Care-Related Fear, Fear of Pain, and Beliefs about Treatment

    PubMed Central

    Randall, Cameron L.; Shulman, Grant P.; Crout, Richard J.; McNeil, Daniel W.

    2014-01-01

    Background Gagging is a behavioral response that interferes with oral health care and has been suggested to relate to dental care-related fear. Little is known, however, about the epidemiology of gagging during dental treatment. Methods To explore this phenomenon, 478 participants were recruited from the waiting area of an oral diagnosis clinic. Participants completed the Dental Fear Survey, the Short Form-Fear of Pain Questionnaire, Dental Beliefs Scale, and a demographics questionnaire that included items about problems with gagging. Results Over half of the participants reported gagging on at least one occasion during dental visits, with 7.5% almost always, or always gagging. With higher frequency of problems with gagging, patients were more likely to have greater levels of dental care-related fear, fear of pain, and more negative beliefs of dental professionals and dental treatment. Further, participants who gagged more readily had greater dental care-related fear than other gaggers. Conclusion Gagging in the dental clinic is a prevalent problem, and dental care-related fear and fear of pain are associated with more frequent gagging. Clinical Implications Given the prevalence of patients reporting problem gagging, it may be helpful for providers to assess for this barrier to treatment. By targeting dental care-related fear, fear of pain, and negative beliefs about dental care in patients who often gag in the clinic, gagging may be reduced in frequency or intensity, potentially making treatment more comfortable for patients and easier for dental care providers. PMID:24789238

  10. Sativex: clinical efficacy and tolerability in the treatment of symptoms of multiple sclerosis and neuropathic pain.

    PubMed

    Barnes, Michael Philip

    2006-04-01

    Sativex is one of the first cannabis-based medicines to undergo conventional clinical development and to be approved as a prescription medicine. It is an oromucosal spray that allows flexible, individualised dosing. Patients self titrate their overall dose and pattern of dosing according to their response to and tolerance of the medicine. This usually results in the administration of approximately 8-12 sprays/day. Each spray delivers tetrahydrocannabinol 2.7 mg and cannabidiol 2.5 mg, giving an approximate average dose of tetrahydrocannabinol 22-32 mg/day and cannabidiol 20-30 mg/day. Development has concentrated on the treatment of symptoms of multiple sclerosis, notably spasticity and neuropathic pain, as well as the treatment of neuropathic pain of other aetiologies. Positive results in placebo-controlled trials of the use of Sativex as an add-on therapy in these indications demonstrate that Sativex is efficacious and well tolerated in the treatment of these symptoms. Sativex has been approved for use in neuropathic pain due to multiple sclerosis in Canada. If ongoing studies replicate the results already observed, further approvals for the treatment of spasticity in multiple sclerosis and for neuropathic pain are likely. PMID:16553576

  11. Pain and nurses' emotion work in a paediatric clinic: treatment procedures and nurse-child alignments.

    PubMed

    Rindstedt, Camilla

    2013-01-01

    In the treatment of cancer in children, treatment procedures have been reported to be one of the most feared elements, as more painful than the illness as such. This study draws on a video ethnography of routine needle procedure events, as part of fieldwork at a paediatric oncology clinic documenting everyday treatment negotiations between nurses and young children. On the basis of detailed transcriptions of verbal and nonverbal staff-child interaction, the analyses focus on ways in which pain and anxiety can be seen as phenomena that are partly contingent on nurses' emotion work. The school-age children did not display fear. In the preschool group, though, pain and fear seemed to be phenomena that were greatly reduced through nurses' emotion work. This study focuses on three preschoolers facing potentially painful treatment, showing how the nurses engaged in massive emotion work with the children, through online commentaries, interactive formats (delegation of tasks, consent sequences, collaborative 'we'-formats), as well as solidarity-oriented moves (such as praise and endearment terms). Even a young toddler would handle the distress of needle procedures, when interacting with an inventive nurse who mobilized child participation through skilful emotion work. PMID:24851517

  12. Mediation and Moderation of Psychological Pain Treatments: Response Expectancies and Hypnotic Suggestibility

    ERIC Educational Resources Information Center

    Milling, Leonard S.; Reardon, John M.; Carosella, Gina M.

    2006-01-01

    The mediator role of response expectancies and the moderator role of hypnotic suggestibility were evaluated in the analogue treatment of pain. Approximately 1,000 participants were assessed for hypnotic suggestibility. Later, as part of a seemingly unrelated experiment, 188 of these individuals were randomly assigned to distraction,…

  13. Early results of percutaneous laser disc decompression (PLDD) as a treatment of discopathic lumbar pain.

    PubMed

    Sobieraj, Andrzej; Maksymowicz, Wojciech; Barczewska, Monika; Konopielko, Marcin; Mazur, Dariusz

    2004-06-30

    Background. The purpose of this paper is to present the technique of percutaneous laser disc decompression (PLDD), give some indications for its use, and provide a preliminary evaluation of the clinical effectiveness of this procedure in the treatment of low back pain, based on the authors' own experience. Material and methods. We performed a prospective analysis of treatment outcome in 212 patients who received PLDD in our clinic between March 2003 and January 2004, and who reported for the planned follow-up examination. Results. In 79.2% of these cases we achieved resolution or significant reduction of pain, and this effect persisted throughout the observation period of 6 weeks post surgery. In 3.8% of our patients, transient improvement was followed by intensification of low back pain, associated with the appearance of the most common complication after PLDD: inflammation of the disk and adjacent fragments of the elastic lamina of the vertebral bodies. Conclusions. In most cases PLDD is not a genuine alternative to open surgery on lumbar discopathy. It is most often administered to patients who have chronic pain from a slight extrusion of the disc, typically not qualified for surgery as the treatment method of choice. All other patients, even with larger herniations, can be administered PLDD as a last attempt at minimally invasive treatment prior to surgery, provided there are no obvious features of disruption of the posterior longitudinal ligament. PMID:17675983

  14. Yoga as a treatment for chronic low back pain: A systematic review of the literature

    PubMed Central

    Chang, Douglas G.; Holt, Jacquelyn A.; Sklar, Marisa; Groessl, Erik J.

    2016-01-01

    Objectives Chronic low back pain (CLBP) affects millions of people worldwide, and appears to be increasing in prevalence. It is associated not only with pain, but also with increased disability, psychological symptoms, and reduced quality of life. There are various treatment options for CLBP, but no single therapy stands out as being the most effective. In the past 10 years, yoga interventions have been studied as a CLBP treatment approach. The objective of this paper is to review the current literature supporting the efficacy of yoga for CLBP. Methods A literature search through the beginning of 2015 was conducted in Pub Med for randomized control trials addressing treatment of CLBP with yoga. Results In this review we evaluate the use of yoga as a treatment for CLBP. Specifically we evaluate how yoga impacts physical functioning and disability, pain, and associated psychological symptoms. We also evaluate possible mediators of the effect of yoga and the safety of yoga. Discussion With few exceptions, previous studies and the recent randomized control trials (RCTs) indicate that yoga can reduce pain and disability, can be practiced safely, and is well received by participants. Some studies also indicate that yoga may improve psychological symptoms, but these effects are currently not as well established. PMID:27231715

  15. Assessment and Treatment of Recurrent Abdominal Pain: Guidelines for the School Psychologist.

    ERIC Educational Resources Information Center

    McMahon, Colleen; And Others

    1990-01-01

    Notes that somatic complaints without clear organic origin are also primary indicators for both anxiety and depression in childhood and adolescence. Review of literature provides school psychologists with basic information regarding prevalence, assessment, and treatment of one of most common types of somatic complaints: recurrent abdominal pain.…

  16. Demographic and Psycho-Social Implications for Assessment and Treatment of Chronic Pain Patients.

    ERIC Educational Resources Information Center

    Auvenshine, Dwight

    Several demographic and psychosocial variables affect assessment and treatment of chronic pain patients. The variables include demographic characteristics, life styles, family constellations, job conditions, financial status, support networks, and leisure activities. In recent years clinics and programs have emerged in a variety of configurations.…

  17. Interventional treatment for low back pain: general risks.

    PubMed

    Hartog, Arthur

    2010-11-01

    The commonly performed spinal procedures, such as epidural injections, spinal nerve blocks, zygapophysial joint (z-joint) interventions, and discography, are reported to be safe. However, diagnostic and therapeutic spinal interventions can lead to serious complications, although their incidence seems to be low. Knowledge of potential complications is still required to minimize risks. This article describes the risks associated with the most commonly performed procedures, precautions that can be taken to minimize these risks, and treatment options available once complications have occurred. This article describes the risks associated with the most commonly performed procedures, precautions that can be taken to minimize these risks, and treatment options available once complications have occurred. PMID:20977964

  18. Thyroidectomy for Painful Thyroiditis Resistant to Steroid Treatment: Three New Cases with Review of the Literature

    PubMed Central

    Mazza, Enrico; Quaglino, Francesco; Suriani, Adolfo; Palestini, Nicola; Gottero, Cristina; Leli, Renzo; Taraglio, Stefano

    2015-01-01

    Thyroidal pain is usually due to subacute thyroiditis (SAT). In more severe forms prednisone doses up to 40 mg daily for 2-3 weeks are recommended. Recurrences occur rarely and restoration of steroid treatment cures the disease. Rarely, patients with Hashimoto's thyroiditis (HT) have thyroidal pain (painful HT, PHT). Differently from SAT, occasional PHT patients showed no benefit from medical treatment so that thyroidectomy was necessary. We report three patients who did not show clinical response to prolonged high dose prednisone treatment: a 50-year-old man, a 35-year-old woman, and a 33-year-old woman. Thyroidectomy was necessary, respectively, after nine-month treatment with 50 mg daily, two-month treatment with 75 mg daily, and one-month treatment with 50 mg daily. The two women were typical cases of PHT. Conversely, in the first patient, thyroid histology showed features of granulomatous thyroiditis, typical of SAT, without fibrosis or lymphocytic infiltration, typical of HT/PHT, coupled to undetectable serum anti-thyroid antibodies. Our data (1) suggest that not only PHT but also SAT may show resistance to steroid treatment and (2) confirm a previous observation in a single PHT patient that increasing prednisone doses above conventional maximal dosages may not be useful in these patients. PMID:26137327

  19. Do parents of children with attention-deficit/hyperactivity disorder (ADHD) receive adequate information about the disorder and its treatments? A qualitative investigation

    PubMed Central

    Ahmed, Rana; Borst, Jacqueline M; Yong, Cheng Wei; Aslani, Parisa

    2014-01-01

    Background Attention-deficit/hyperactivity disorder (ADHD) is the most prevalent pediatric neurodevelopmental condition, commonly treated using pharmacological agents such as stimulant medicines. The use of these agents remains contentious, placing parents in a difficult position when deciding to initiate and/or continue their child’s treatment. Parents refer to a range of information sources to assist with their treatment decision-making. This qualitative study aimed to investigate 1) parents’ ADHD-related knowledge pre- and post-diagnosis, 2) the information sources accessed by parents, 3) whether parents’ information needs were met post-diagnosis, and 4) parents’ views about strategies to meet their information needs. Methods Three focus groups (n=16 parents), each lasting 1.0–1.5 hours were conducted. Focus groups were audio-recorded and transcribed verbatim. Transcripts were analyzed using the framework method, coded, and categorized into themes. Results Generally, parents had limited ADHD-related knowledge prior to their child’s diagnosis and perceived prescription medicines indicated for ADHD in a negative context. Parents reported improved knowledge after their child’s diagnosis; however, they expressed dissatisfaction with information that they accessed, which was often technical and not tailored to their child’s needs. Verbal information sought from health care professionals was viewed to be reliable but generally medicine-focused and not necessarily comprehensive. Parents identified a need for concise, tailored information about ADHD, the medicines used for its treatment, and changes to their child’s medication needs with age. They also expressed a desire for increased availability of support groups and tools to assist them in sourcing information from health care professionals during consultations, such as question prompt lists. Conclusion There are gaps in parents’ knowledge about ADHD and its treatment, and an expressed need for

  20. A Day-Hospital Approach to Treatment of Pediatric Complex Regional Pain Syndrome: Initial Functional Outcomes

    PubMed Central

    Logan, Deirdre E.; Carpino, Elizabeth A.; Chiang, Gloria; Condon, Marianne; Firn, Emily; Gaughan, Veronica J.; Hogan, Melinda, P.T.; Leslie, David S.; Olson, Katie, P.T.; Sager, Susan; Sethna, Navil; Simons, Laura E.; Zurakowski, David; Berde, Charles B.

    2013-01-01

    Objectives To examine clinical outcomes of an interdisciplinary day hospital treatment program (comprised of physical, occupational, and cognitive-behavioral therapies with medical and nursing services) for pediatric complex regional pain syndrome (CRPS). Methods The study is a longitudinal case series of consecutive patients treated in a day hospital pediatric pain rehabilitation program. Participants were 56 children and adolescents ages 8–18 years (median = 14 years) with CRPS spectrum conditions who failed to progress sufficiently with a previous outpatient and/or inpatient treatments. Patients participated in daily physical therapy, occupational therapy and psychological treatment and received nursing and medical care as necessary. The model places equal emphasis on physical and cognitive-behavioral approaches to pain management. Median duration of stay was 3 weeks. Outcome measures included assessments of physical, occupational, and psychological functioning at program admission, discharge, and at post-treatment follow-up at a median of 10 months post-discharge. Scores at discharge and follow-up were compared with measures on admission by Wilcoxon tests, paired t tests, or ANOVA as appropriate, with corrections for multiple comparisons. Results Outcomes demonstrate clinically and statistically significant improvements from admission to discharge in pain intensity (p<0.001), functional disability (p<0.001), subjective report of limb function (p<0.001), timed running (p<0.001) occupational performance (p<0.001), medication use (p<0.01), use of assistive devices (p<0.001), and emotional functioning (anxiety, p<0.001; depression, p<0.01). Functional gains were maintained or further improved at follow-up. Discussion A day-hospital interdisciplinary rehabilitation approach appears effective in reducing disability and improving physical and emotional functioning and occupational performance among children and adolescents with complex regional pain syndromes that

  1. Surgical versus injection treatment for injection-confirmed chronic sacroiliac joint pain

    PubMed Central

    Spiker, William Ryan; Lawrence, Brandon D.; Raich, Annie L.; Skelly, Andrea C.; Brodke, Darrel S.

    2012-01-01

    Study design: Systematic review. Study rationale: Chronic sacroiliac joint pain (CSJP) is a common clinical entity with highly controversial treatment options. A recent systematic review compared surgery with denervation, but the current systematic review compares outcomes of surgical intervention with therapeutic injection for the treatment of CSJP and serves as the next step for evaluating current evidence on the comparative effectiveness of treatments for non-traumatic sacroiliac joint pain. Objective or clinical question: In adult patients with injection-confirmed CSJP, does surgical treatment lead to better outcomes and fewer complications than injection therapy? Methods: A systematic review of the English-language literature was undertaken for articles published between 1970 and June 2012. Electronic databases and reference lists of key articles were searched to identify studies evaluating surgery or injection treatment for injection-confirmed CSJP. Studies involving traumatic onset or non-injection–confirmed CSJP were excluded. Two independent reviewers assessed the level of evidence quality using the grading of recommendations assessment, development and evaluation (GRADE) system, and disagreements were resolved by consensus. Results: We identified twelve articles (seven surgical and five injection treatment) meeting our inclusion criteria. Regardless of the type of treatment, most studies reported over 40% improvement in pain as measured by Visual Analog Scale or Numeric rating Scale score. Regardless of the type of treatment, most studies reported over 20% improvement in functionality. Most complications were reported in the surgical studies. Conclusion: Surgical fusion and therapeutic injections can likely provide pain relief, improve quality of life, and improve work status. The comparative effectiveness of these interventions cannot be evaluated with the current literature. PMID:23526911

  2. The Painful Long Head of the Biceps Brachii: Nonoperative Treatment Approaches.

    PubMed

    Wilk, Kevin E; Hooks, Todd R

    2016-01-01

    The long head of the biceps has garnered increased attention and interest due to the high prevalence of pain that can be a primary condition or occur secondary to shoulder dysfunction. The successful treatment of biceps tendinopathy is dependent on an accurate diagnosis and recognizing all causative factors. The treatment program will be individualized with a rehabilitation program designed to restore strength and flexibility and restore normal tendon mechanics. PMID:26614470

  3. The Learning About My Pain study protocol: Reducing disparities with literacy-adapted psychosocial treatments for chronic pain, a comparative behavioral trial.

    PubMed

    Eyer, Joshua C; Thorn, Beverly E

    2016-09-01

    Chronic pain is a critical public health problem that affects over 100 million Americans. Medical pain treatments carry undesirable side effects, whereas low-risk psychosocial treatments offer notable benefits, in combination or in isolation. This report presents the protocol for the Learning About My Pain study, one of the first comparative-effectiveness trials funded by the Patient-Centered Outcomes Research Institute. Adhering to published standards for clinical trials (e.g. Standard Protocol Items: Recommendations for Intervention Trials), it provides an overview of the trial (n = 294), comparing cognitive-behavioral and education pain interventions to usual care, and a detailed description of how its methodology reduces the risks from bias. PMID:25712491

  4. Clinical Impact of MALDI-TOF MS Identification and Rapid Susceptibility Testing on Adequate Antimicrobial Treatment in Sepsis with Positive Blood Cultures

    PubMed Central

    Verroken, Alexia; Defourny, Lydwine; le Polain de Waroux, Olivier; Belkhir, Leïla; Laterre, Pierre-François; Delmée, Michel; Glupczynski, Youri

    2016-01-01

    Shortening the turn-around time (TAT) of positive blood culture (BC) identification (ID) and susceptibility results is essential to optimize antimicrobial treatment in patients with sepsis. We aimed to evaluate the impact on antimicrobial prescription of a modified workflow of positive BCs providing ID and partial susceptibility results for Enterobacteriaceae (EB), Pseudomonas aeruginosa and Staphylococcus aureus on the day of BC positivity detection. This study was divided into a pre-intervention period (P0) with a standard BC workflow followed by 2 intervention periods (P1, P2) with an identical modified workflow. ID was performed with MALDI-TOF MS from blood, on early or on overnight subcultures. According to ID results, rapid phenotypic assays were realized to detect third generation cephalosporin resistant EB/P. aeruginosa or methicillin resistant S. aureus. Results were transmitted to the antimicrobial stewardship team for patient’s treatment revision. Times to ID, to susceptibility results and to optimal antimicrobial treatment (OAT) were compared across the three study periods. Overall, 134, 112 and 154 positive BC episodes in P0, P1 and P2 respectively were included in the analysis. Mean time to ID (28.3 hours in P0) was reduced by 65.3% in P1 (10.2 hours) and 61.8% in P2 (10.8 hours). Mean time to complete susceptibility results was reduced by 27.5% in P1 and 27% in P2, with results obtained after 32.4 and 32.6 hours compared to 44.7 hours in P0. Rapid tests allowed partial susceptibility results to be obtained after a mean time of 11.8 hours in P1 and 11.7 hours in P2. Mean time to OAT was decreased to 21.6 hours in P1 and to 17.9 hours in P2 compared to 36.1 hours in P0. Reducing TAT of positive BC with MALDI-TOF MS ID and rapid susceptibility testing accelerated prescription of targeted antimicrobial treatment thereby potentially improving the patients’ clinical outcome. PMID:27228001

  5. Treatment of Complex Regional Pain Syndrome (CRPS) using low dose naltrexone (LDN).

    PubMed

    Chopra, Pradeep; Cooper, Mark S

    2013-06-01

    Complex Regional Pain Syndrome (CRPS) is a neuropathic pain syndrome, which involves glial activation and central sensitization in the central nervous system. Here, we describe positive outcomes of two CRPS patients, after they were treated with low-dose naltrexone (a glial attenuator), in combination with other CRPS therapies. Prominent CRPS symptoms remitted in these two patients, including dystonic spasms and fixed dystonia (respectively), following treatment with low-dose naltrexone (LDN). LDN, which is known to antagonize the Toll-like Receptor 4 pathway and attenuate activated microglia, was utilized in these patients after conventional CRPS pharmacotherapy failed to suppress their recalcitrant CRPS symptoms. PMID:23546884

  6. Arthroscopic treatment of painful Sinding-Larsen-Johansson syndrome in a professional handball player.

    PubMed

    Kajetanek, C; Thaunat, M; Guimaraes, T; Carnesecchi, O; Daggett, M; Sonnery-Cottet, B

    2016-09-01

    Sinding-Larsen-Johansson (SLJ) syndrome is a type of osteochondrosis of the distal pole of the patella most often caused by repeated microtrauma. Here, we describe the case of a professional athlete with painful SLJ syndrome treated arthroscopically. A 29-year-old male professional handball player presented with anterior knee pain that persisted after 4 months of an eccentric rehabilitation protocol and platelet-rich plasma injections. Despite this conservative treatment, the patient could not participate in his sport. The SLJ lesion was excised arthroscopically, which led to complete disappearance of symptoms and return to competitive sports after 5 months. PMID:27450859

  7. Application of osteopathic manipulative technique in the treatment of back pain during pregnancy.

    PubMed

    Majchrzycki, Marian; Wolski, Hubert; Seremak-Mrozikiewicz, Agnieszka; Lipiec, Joanna; Marszałek, Sławomir; Mrozikiewicz, Przemysław M; Klejewski, Andrzej; Lisiński, Przemyslaw

    2015-03-01

    Changes in body posture, musculoskeletal disorders and somatic dysfunctions are frequently observed during pregnancy especially ligament, joint and myofascial impairment. The aim of the paper is to present the use of osteopathic manipulative treatment (OMT) for back and pelvic pain in pregnancy on the basis of a review of the available literature. MEDLINE and Cochrane Library were searched in January 2014 for relevant reports, randomized controlled trials, clinical and case studies of OMT use in pregnant women. Each eligible source was verified and analyzed by two independent reviewers. OMT procedures appear to be effective and safe for pelvic and spinal pain management in the lumbosacral area in pregnant women. PMID:25920314

  8. Randomized Multicenter Feasibility Trial of Myofascial Physical Therapy for Treatment of Urologic Chronic Pelvic Pain Syndrome

    PubMed Central

    FitzGerald, Mary P; Anderson, Rodney U; Potts, Jeannette; Payne, Christopher K; Peters, Kenneth M; Clemens, J Quentin; Kotarinos, Rhonda; Fraser, Laura; Cosby, Annamarie; Fortman, Carole; Neville, Cynthia; Badillo, Suzanne; Odabachian, Lisa; Sanfield, Anna; O’Dougherty, Betsy; Halle-Podell, Rick; Cen, Liyi; Chuai, Shannon; Landis, J Richard; Kusek, John W; Nyberg, Leroy M

    2010-01-01

    Objectives To determine the feasibility of conducting a randomized clinical trial designed to compare two methods of manual therapy (myofascial physical therapy (MPT) and global therapeutic massage (GTM)) among patients with urologic chronic pelvic pain syndromes. Materials and Methods Our goal was to recruit 48 subjects with chronic prostatitis/chronic pelvic pain syndrome or interstitial cystitis/painful bladder syndrome at six clinical centers. Eligible patients were randomized to either MPT or GTM and were scheduled to receive up to 10 weekly treatments, each 1 hour in duration. Criteria to assess feasibility included adherence of therapists to prescribed therapeutic protocol as determined by records of treatment, adverse events which occurred during study treatment, and rate of response to therapy as assessed by the Patient Global Response Assessment (GRA). Primary outcome analysis compared response rates between treatment arms using Mantel-Haenszel methods. Results Twenty-three (49%) men and 24 (51%) women were randomized over a six month period. Twenty-four (51%) patients were randomized to GTM, 23 (49%) to MPT; 44 (94%) patients completed the study. Therapist adherence to the treatment protocols was excellent. The GRA response rate of 57% in the MPT group was significantly higher than the rate of 21% in the GTM treatment group (p=0.03). Conclusions The goals to judge feasibility of conducting a full-scale trial of physical therapy methods were met. The preliminary findings of a beneficial effect of MPT warrants further study. PMID:19535099

  9. Cranial Treatment and Spinal Manipulation for a Patient With Low Back Pain: A Case Study

    PubMed Central

    Powell, Wayne; Knaap, Simone F.C.

    2015-01-01

    Objective The purpose of this case study is to present chiropractic management of a patient with chronic low back pain by focusing on the craniomandibular system. Clinical Features A 37-year-old man consulted a chiropractor for pain in the lumbosacral area with radiation down the anterolateral side of the upper left leg. The symptoms started after a fall the previous year. Examination showed a post-traumatic chronic L4-L5 facet dysfunction and left sacro-iliac joint dysfunction. Chiropractic spinal manipulation to the lumbar spine and pelvis gave only temporary relief from the pain. Intervention and Outcome A year later a bone scintigraphy was conducted, in which a lesion was found over the right sphenoid area. Cranial treatment of this area was added to the chiropractic treatment plan. After this treatment, the patient reported that he was pain free and could return to normal activities of daily living. Conclusion The clinical progress of this case suggests that for some patients, adding craniosacral therapy may be helpful in patients with low back symptoms. PMID:26644786

  10. Buprenorphine – an attractive opioid with underutilized potential in treatment of chronic pain

    PubMed Central

    Khanna, Ish K; Pillarisetti, Sivaram

    2015-01-01

    Despite proven clinical utility, buprenorphine has not been used widely for the treatment of chronic pain. Questions about “ceiling effect” or bell-shaped curve observed for analgesia in preclinical studies and potential withdrawal issues on combining with marketed μ-agonists continue to hinder progress in expanding full potential of buprenorphine in the treatment of cancer and noncancer pain. Mounting evidence from clinical studies and conclusions drawn by a panel of experts strongly support superior safety and efficacy profile of buprenorphine vs marketed opioids. No ceiling on analgesic effect has been reported in clinical studies. The receptor pharmacology and pharmacokinetics profile of buprenorphine is complex but unique and contributes to its distinct safety and efficacy. The buprenorphine pharmacology also allows it to be combined with other μ-receptor opioids for additivity in efficacy. Transdermal delivery products of buprenorphine have been preferred choices for the management of pain but new delivery options are under investigation for the treatment of both opioid dependence and chronic pain. PMID:26672499

  11. Specific rehabilitation exercise for the treatment of patients with chronic low back pain

    PubMed Central

    Tomanova, Michaela; Lippert-Grüner, Marcela; Lhotska, Lenka

    2015-01-01

    [Purpose] To evaluate the efficacy of our special rehabilitation method for patients with low back pain (LBP). [Subjects and Methods] All participants (n=33) received at least five individual 30-minute therapy sessions per week using the INFINITY method® and six group therapy sessions per week in a gymnasium and swimming pool, each lasting 30 minutes and including the INFINITY method®. The treatment lasted between four to seven weeks. Plantar function using a graphic method (computer plantography), graphical quantification of postural control during static standing (posturography), and pain were measured and evaluated before and after rehabilitation therapy. The INFINITY method® is a special rehabilitation method for patients with musculoskeletal problems. The method focuses on stabilization and strengthening of the trunk, dorsal and abdominal muscles, including the deep stabilization system which is closely linked with diaphragmatic breathing. It teaches the central nervous system to control muscles more precisely. [Results] Plantar functions, postural control in the upright stance and pain of LBP patients were significantly improved by 4−7 weeks of rehabilitation treatment with the INFINITY method®. There were significant differences in all measured dependent variables of the patients between before and after treatment. [Conclusion] Rehabilitation therapy with the INFINITY method® positively influences body stabilization and pain in patients with problems of the lumbar spine. This method presents a new improved approach (with enhanced effect) to rehabilitation therapy for LBP patients. PMID:26356065

  12. Pain Management

    MedlinePlus

    ... the brain played a role in producing the perception of pain. In the 19th century, physician-scientists ... they are experiencing. Discoveries of differences in pain perceptions and responses to treatment by gender has have ...

  13. Magnetic resonance-guided focused ultrasound surgery for treatment of painful osseous metastases

    NASA Astrophysics Data System (ADS)

    Hurwitz, Mark; Machtinger, Ronit; Fennessy, Fiona

    2011-03-01

    Magnetic resonance guided focused ultrasound surgery (MRgFUS) is an emerging technology that can non-invasively heat and ablate targeted tissue utilizing ultrasound energy. Use of MR imaging for treatment guidance provides several key advantages over more widely used ultrasound guidance for focused ultrasound ablation. MR allows for precise targeting, detailed beam path visualization, real time non-invasive temperature measurement, and treatment feedback to ensure therapeutic goals are achieved. In the realm of oncology, management of painful bone metastases is a common and daunting clinical problem. The Insightec ExAblate System has been shown in phase I/II trials for treatment of bone metastases to have an excellent safety profile and high rates of pain response. An international multi-center phase III trial for patients with painful bone metastases or multiple myeloma who are not candidates for radiation therapy is currently open. Patients are randomized 3:1 to MRgFUS or sham treatment with crossover to study treatment allowed for sham failures. The primary study endpoint is assessment of pain control over 3 months following treatment. In addition safety, quality of life, cost effectiveness analysis, and patient perceived clinical benefit are also being assessed. Details of the MRgFUS system, technical and clinical therapeutic parameters, use of real time non-invasive MR thermometry, and examples of patient treatments with use of MRgFUS to treat bone metastases will be discussed. New directions in use of MRgFUS including an update on development of a new mobile applicator and integration of MRgFUS in multimodality oncologic care will also be presented.

  14. Dynamic stabilization devices in the treatment of low back pain.

    PubMed

    Sengupta, D K

    2005-12-01

    Soft stabilization has an important role in the treatment of the degenerative lumbar spine. Fusion of one or two motion segments may not make a big difference in the total range of motion of the lumbar spine, but preserving flexibility of a motion segment may prevent adjacent segment disease and may permit disc replacement, even when facet joints need to be excised. A favourable environment is created in the motion segment by unloading the disc and permitting near normal motion, the disc may be able to repair itself or may supplement reparative potential of gene therapy. PMID:16565539

  15. Novel Treatment of Radicular Pain With a Multi-Mechanistic Combination Topical Agent: A Case Series and Literature Review

    PubMed Central

    Safaeian, Pegah; Mattie, Ryan; Hahn, Matthew; Plastaras, Christopher T.; McCormick, Zachary L.

    2016-01-01

    Introduction Pharmacologic treatment of radicular pain with oral medications is limited by adverse effects and concern for dependence. While topical formulations have been explored in pain research, there is no published literature evaluating the efficacy in radicular pain. We present the first three cases of radicular pain successfully treated with a topical formulation of diclofenac, ibuprofen, baclofen, cyclobenzaprine, bupivacaine, gabapentin, and pentoxifylline (T7). Case Presentation Case series evaluating T7 for treatment of radicular pain in a single, outpatient pain center. Pain was rated on the numeric rating scale (NRS) on initial evaluation and follow up after a trial of T7. One to two grams of T7 was applied to the affected area 3 - 4 times daily in addition to the patient’s baseline pharmacologic management. Three patients with median age of 50 (range, 39 to 65) and diagnosis of cervical and/or lumbosacral radicular pain participated. Two of the three had chronic radicular pain despite use of analgesic agents, spinal injections and failed spinal surgery syndrome. Each reported subjective improvement in radicular pain, function and sleep. There was an average decrease in NRS score consistent with 30% - 40% global improvement in symptoms, clinically significant based on the minimal clinically important difference for radicular pain. T7 was well tolerated without adverse reactions. Surgery was prevented or delayed in all cases. Conclusions This is the first report of the successful treatment of radicular pain with a topical agent. This highlights the need for randomized, prospective study of both single and compounded topical agents for treatment of radicular pain. PMID:27252902

  16. Treatment of Extraspinal Painful Bone Metastases with Percutaneous Cementoplasty: A Prospective Study of 50 Patients

    SciTech Connect

    Anselmetti, Giovanni Carlo Manca, Antonio; Ortega, Cinzia; Grignani, Giovanni; DeBernardi, Felicino; Regge, Daniele

    2008-11-15

    The aim of this study was to assess the efficacy of percutaneous cementoplasty (PC) with polymethylmethacrylate (PMMA) in painful extravertebral lytic bone metastases not responding to conventional therapy. Fifty patients (25 females), mean age 64.7 {+-} 11.2 years, underwent PC after giving informed consent. Procedures were performed under fluoroscopy (1/50) or combined fluoroscopy-CT (49/50) guidance in local anesthesia or under deep sedation in 7 patients with large metastases who underwent radiofrequency thermoablation (RFA) in the same session. Seventy lesions were treated (1-6 per patient; average, 1.4 {+-} 0.9), arranging in size from 1 to 10 cm (average, 3.6 {+-} 2.1 cm). Mean volume of PMMA per lesion was 5.9 {+-} 3.2 ml (range, 1.5-15.0 ml). Pain was prospectively evaluated on an 11-point visual analog scale (VAS) before and after the procedure (follow-up, 15 to 36 months). Mean VAS score dropped from 9.1 {+-} 1.2 (range: 6-10) to 2.1 {+-} 2.5 (range: 0-9). Mean VAS difference was 7.0 {+-} 2.3 (range, 1-10; p < 0.0001, Wilcoxon signed rank test). Forty-seven of the 50 patients (94%) suspended narcotic drugs, in 22 (44%) pain was controlled with a nonsteroidal anti-inflammatory drug, in 25 (50%) analgesic therapy was suspended, and 13 of 50 (26%) had complete pain regression. In 3 of the 50 patients (6%) pain was not improved. No statistical difference between osteoplasty and osteoplasty plus RFA was found (p = 0.8338, Mann-Whitney test). No complications arose during the procedure. Two patients with metastases in the femoral diaphysis reported a fracture 1 month after treatment. PC is effective to obtain pain regression in painful bone metastases not responding to conventional analgesic therapy; bone consolidation cannot be obtained in the diaphysis of long weight-bearing bones.

  17. The application of sonography in shoulder pain evaluation and injection treatment after stroke: a systematic review

    PubMed Central

    Tao, Wu; Fu, Yu; Hai-xin, Song; Yan, Dong; Jian-hua, Li

    2015-01-01

    [Purpose] This review article is designed to expose the application of sonography in shoulder pain after stroke. [Methods] A range of databases was searched to identify articles that address sonography examination, with or without ultrasound guided corticosteroid injection for hemiplegic shoulder pain (HSP). The electronic databases of PubMed, CENTRAL, CINAHL, Cochrane Library, Medline were searched. [Results] According to the articles identified in our databases research, sonographic technique has potential to provide objective measurements in patients with HSP. The main sonography finding of HSP included subacromial subdeltoid (SASD) bursal effusion, tendinosis of the supraspinatus and subscapularis tendon, long head of biceps tendon sheath effusion, and shoulder subluxation. Our analysis also revealed significantly decreased pain score (VAS) and increased passive external rotation degree in the steroid injection group than control group. [Conclusion] The sonography examination is useful for HSP assessment and ultrasound guided technique is recommended for HSP injection treatment. PMID:26504346

  18. Autologous Fat Grafting in the Treatment of Painful Postsurgical Scar of the Oral Mucosa

    PubMed Central

    Lisa, Andrea; Summo, Valeria; Bandi, Valeria; Maione, Luca; Murolo, Matteo; Klinger, Francesco; Klinger, Marco

    2015-01-01

    Background. Persistent pain as a consequence of surgical treatment has been reported for several common surgical procedures and represents a clinical problem of great magnitude. Material and Methods. We describe the case of a 47-year-old female who presented a retractile scar that adhered to deep planes at the upper right of the vestibule due to surgical removal of maxillary exostosis, which determined important pain symptoms extending till the right shoulder during both chewing and rest. We subsequently treated her with autologous fat grafting according to Coleman's technique. Results. Clinical assessments were performed at 5 and 14 days, 1, 3, and 6 months, and 1 year after surgical procedure. We observed a progressive release of scar retraction together with an important improvement of pain symptoms. Conclusion. The case described widens the possible application of autologous fat grafting on a new anatomical site as buccal vestibule and in one specific clinical setting confirming its promising biological effects. PMID:26064132

  19. Features of color reflection in psychogenic pain in patients with somatoform disorders during psychotherapeutic treatment.

    PubMed

    Ishinova, Vera A; Svyatogor, Irina A; Reznikova, Tatiana N

    2009-11-01

    The present work examines the change in color reflection in psychogenic pain in patients with somatoform disorders (SFD) during psychotherapeutic treatment, for which empatho-techniques were used. At the start and end of the course the psychophysiological condition was determined according to psychological parameters and assessment of bioelectrical brain activity. All initial indicators for the patients significantly differed from those for the healthy subjects. At the same time, color reflection in the psychogenic pain was characterised by colors in the longwave part of the spectrum, in contradistinction to healthy subjects for whom achromatic and shortwave colors predominated. After the completed course patients with SFD had a significant improvement of all psychophysiological indicators and a lack of color reflectons in the longwave part of the spectrum. The data obtained permits the proposition that there exists a link between the psychogenic pain, its color reflection and anxiety, and also changes in the functional condition of the CNS. PMID:19899672

  20. Biopsychosocial perspective on a mechanisms-based approach to assessment and treatment of pain following spinal cord injury.

    PubMed

    Widerström-Noga, Eva G; Finnerup, Nanna B; Siddall, Philip J

    2009-01-01

    This article applies a biopsychosocial perspective to a mechanisms-based approach to the assessment and treatment of the heterogeneous and persistent pain conditions associated with spinal cord injury (SCI). This article presents an overview of the types of pains experienced after SCI and some of the research on the mechanisms, diagnostic issues, and psychosocial factors relevant for the development of treatments targeting specific underlying mechanisms of pain. This review also discusses several diagnostic challenges of determining the underlying causes of pain in each individual patient. PMID:19533516

  1. Psychological Treatments and Psychotherapies in the Neurorehabilitation of Pain: Evidences and Recommendations from the Italian Consensus Conference on Pain in Neurorehabilitation

    PubMed Central

    Castelnuovo, Gianluca; Giusti, Emanuele M.; Manzoni, Gian Mauro; Saviola, Donatella; Gatti, Arianna; Gabrielli, Samantha; Lacerenza, Marco; Pietrabissa, Giada; Cattivelli, Roberto; Spatola, Chiara A. M.; Corti, Stefania; Novelli, Margherita; Villa, Valentina; Cottini, Andrea; Lai, Carlo; Pagnini, Francesco; Castelli, Lorys; Tavola, Mario; Torta, Riccardo; Arreghini, Marco; Zanini, Loredana; Brunani, Amelia; Capodaglio, Paolo; D'Aniello, Guido E.; Scarpina, Federica; Brioschi, Andrea; Priano, Lorenzo; Mauro, Alessandro; Riva, Giuseppe; Repetto, Claudia; Regalia, Camillo; Molinari, Enrico; Notaro, Paolo; Paolucci, Stefano; Sandrini, Giorgio; Simpson, Susan G.; Wiederhold, Brenda; Tamburin, Stefano

    2016-01-01

    Background: It is increasingly recognized that treating pain is crucial for effective care within neurological rehabilitation in the setting of the neurological rehabilitation. The Italian Consensus Conference on Pain in Neurorehabilitation was constituted with the purpose identifying best practices for us in this context. Along with drug therapies and physical interventions, psychological treatments have been proven to be some of the most valuable tools that can be used within a multidisciplinary approach for fostering a reduction in pain intensity. However, there is a need to elucidate what forms of psychotherapy could be effectively matched with the specific pathologies that are typically addressed by neurorehabilitation teams. Objectives: To extensively assess the available evidence which supports the use of psychological therapies for pain reduction in neurological diseases. Methods: A systematic review of the studies evaluating the effect of psychotherapies on pain intensity in neurological disorders was performed through an electronic search using PUBMED, EMBASE, and the Cochrane Database of Systematic Reviews. Based on the level of evidence of the included studies, recommendations were outlined separately for the different conditions. Results: The literature search yielded 2352 results and the final database included 400 articles. The overall strength of the recommendations was medium/low. The different forms of psychological interventions, including Cognitive—Behavioral Therapy, cognitive or behavioral techniques, Mindfulness, hypnosis, Acceptance and Commitment Therapy (ACT), Brief Interpersonal Therapy, virtual reality interventions, various forms of biofeedback and mirror therapy were found to be effective for pain reduction in pathologies such as musculoskeletal pain, fibromyalgia, Complex Regional Pain Syndrome, Central Post—Stroke pain, Phantom Limb Pain, pain secondary to Spinal Cord Injury, multiple sclerosis and other debilitating syndromes

  2. Association between Substance Use Disorder Status and Pain-Related Function Following 12 Months of Treatment in Primary Care Patients with Musculoskeletal Pain

    PubMed Central

    Morasco, Benjamin J.; Corson, Kathryn; Turk, Dennis C.; Dobscha, Steven K.

    2010-01-01

    The goal of this study was to examine relationships between substance use disorder (SUD) history and 12-month outcomes among primary care patients with chronic noncancer pain (CNCP). Patients were enrolled in a randomized trial of collaborative care intervention (CCI) versus treatment-as-usual (TAU) to improve pain-related physical and emotional function. At baseline, 72 of 362 patients (20.0%) had a history of SUD. Compared to CNCP patients without SUD, those with comorbid SUD had poorer pain-related function and were more likely to meet criteria for current major depression and posttraumatic stress disorder (all p-values<0.05). Logistic regression analyses were conducted to examine whether SUD status was associated with clinically significant change over 12 months in pain-related function (30% reduction in Roland Morris Disability Questionnaire Score). The overall model was not significant in the CCI group. However, within the TAU group, participants with a SUD history were significantly less likely to show improvements in pain-related function (OR=0.30, 95% CI=0.11–0.82). CNCP patients with comorbid SUD reported greater functional impairment at baseline. Patients with SUD who received usual care were 70% less likely to have clinically significant improvements in pain-related function 12 months post-baseline, and SUD status did not impede improvement for the CCI group. Perspective Chronic non-cancer pain patients with a history of a substance use disorder (SUD) report poorer pain-related functioning and are less likely to experience clinically significant improvements from usual pain treatment. Providers should assess for SUD status and provide more intensive interventions for these patients. PMID:20851057

  3. Ultrasound-Guided Trigger Point Injection for Serratus Anterior Muscle Pain Syndrome: Description of Technique and Case Series.

    PubMed

    Vargas-Schaffer, Grisell; Nowakowsky, Michal; Eghtesadi, Marzieh; Cogan, Jennifer

    2015-09-15

    Chronic chest pain is a challenge, and serratus anterior muscle pain syndrome (SAMPS) is often overlooked. We have developed an ultrasound-guided technique for infiltrating local anesthetics and steroids in patients with SAMPS. In 8 patients, the duration of chronic pain was approximately 19 months. Three months after treatment, all patients had experienced a significant reduction in pain. Infiltration for SAMPS confirms the diagnosis and provides adequate pain relief. PMID:26361386

  4. Re-engineering clostridial neurotoxins for the treatment of chronic pain: current status and future prospects.

    PubMed

    Pickett, Andy

    2010-06-01

    Clostridial neurotoxins from the botulinum neurotoxin (BoNT) family are protein complexes, derived from the bacterium Clostridium botulinum, which potently inhibit acetylcholine release and result in a reversible blockade of the neuromuscular junction. This feature led to the clinical development of BoNT-A for a number of neuromuscular disorders. BoNT-A toxins are commercially available as three different preparations: Dysport/Azzalure, Botox/Vistabel, and Xeomin/Bocouture. Although BoNT-A preparations have not yet been approved for the treatment of pain, a substantial body of preclinical and clinical evidence shows that BoNT-A is effective in treating a number of different types of pain. It is thought to exert an analgesic effect both via muscle-relaxant properties and also directly, via inhibition of nociceptive neuropeptides. This review explores the mechanistic basis of this analgesic effect, summarizing current knowledge of the structure-function relationship of BoNT and discussing effects on both motor and pain neurons. For a complete picture of the analgesic properties of BoNT-A, clinical evidence of efficacy in myofascial pain and neuropathic pain is considered in tandem with a mechanistic rationale for activity. Patients experiencing chronic pain are clear candidates for treatment with a modified clostridial endopeptidase that would provide enduring inhibition of neurotransmitter release. A strong preclinical evidence base underpins the concept that re-engineering of BoNT could be used to enhance the analgesic potential of this neurotoxin, and it is hoped that the first clinical studies examining re-engineered BoNT-A will confirm this potential. PMID:20462283

  5. Antiepileptic drugs for the treatment of neuropathic pain: A systematic review

    PubMed Central

    Vargas-Espinosa, Maríam L.; Sanmartí-García, Gemma; Vázquez-Delgado, Eduardo

    2012-01-01

    Many therapies have been proposed for the management of neuropathic pain, and they include the use of different antiepileptic drugs. However, the lack of high quality studies indicates that results on the different neuropathic disorders under study do not recommend a particular drug treatment. This study makes a systematic review of the published literature on the use of several antiepileptic drugs to treat neuropathic pain, and has the objective of considering both its clinical characteristics and pharmacological use, which will depend on their level of scientific evidence and will follow the principles of evidence-based dentistry. The articles were stratified according to their scientific evidence using the SORT criteria (Strength of Recommendation Taxonomy), and it included those articles that only have level 1 or 2. Randomized clinical trials were stratified according to their level of quality using the JADAD scale, an instrument described by Jadad et al. (7). to assess the quality of clinical trials, while studies with a level below 3 were discarded. Recently, type A or B recommendations are given in favor or against the use of antiepileptic drugs to treat neuropathic pain on the basis of their scientific quality. Key words:Neuropathic pain, antiepileptic drugs (AEDs), trigeminal neuralgia, glossopharyngeal neuralgia, post- herpetic neuralgia, burning mouth syndrome, persistent idiopathic facial pain. PMID:22549682

  6. Efficacy of Analgesic Treatments to Manage Children's Postoperative Pain After Laparoscopic Appendectomy: Retrospective Medical Record Review.

    PubMed

    Manworren, Renee C B; McElligott, Connor D; Deraska, Peter V; Santanelli, James; Blair, Sherry; Ruscher, Kimberly A; Weiss, Richard; Rader, Christine; Finck, Christine; Bourque, Michael; Campbell, Brendan

    2016-03-01

    Knowledge of the effectiveness of multimodal analgesic treatments to manage children's postoperative pain during hospital stays is limited. Our retrospective chart review of a convenience sample of 200 pediatric surgical patients' pain experiences during the first 24 hours after laparoscopic appendectomy demonstrates the benefits of a multimodal analgesic approach. We found that pediatric patients who received perioperative IV ketorolac in addition to opioids reported statistically significantly lower mean pain intensity (n = 134, mean [M] = 2.9, standard deviation [SD] = 1.7) during the first 24 hours after surgery when compared with the pain intensity of patients who did not receive perioperative IV ketorolac (n = 66, M = 3.7, SD = 1.7, t = 3.14, P = .002). Patients who received perioperative IV ketorolac (M = 0.94, SD = 0.71) also received significantly fewer morphine equivalents of postoperative opioids during the first 24 hours after surgery than those who did not (M = 1.21, SD = 0.78, t = 2.41, P = .02). We will use data from these patients to introduce the potential for a personalized medicine approach to postoperative pain. PMID:26924376

  7. Alpha9 alpha10 nicotinic acetylcholine receptors as target for the treatment of chronic pain.

    PubMed

    Del Bufalo, Alessandra; Cesario, Alfredo; Salinaro, Gianluca; Fini, Massimo; Russo, Patrizia

    2014-01-01

    Chronic pain is a widespread healthcare problem affecting not only the patient but in many ways all the society. Chronic pain is a disease itself that endures for a long period of time and it is resistant to the majority of medical treatments that provide modest improvements in pain and minimum improvements in physical and emotional functioning. More co-existing chronic pain conditions may be present in the same individual (patient). The α9α10 nicotinic acetylcholine receptor (nAChR) may be a potential target in the pathophysiology of chronic pain, as well in the development of breast and lung cancers. α-conotoxins (α-CNT) are small peptides used offensively by carnivorous marine snails known as Conus that target nAChR. Among α-CNT there are potent and selective antagonists of α9α10 nAChR such as RgIA and Vc1.1 that produces both acute and long lasting analgesia. Moreover, these peptides accelerate the recovery of nerve function after injury, likely through immune/inflammatory-mediated mechanisms. We review the background, findings, implications and problems in using compounds that act on α9α10 nAChR. PMID:24641230

  8. Placebo and nocebo: how to enhance therapies and avoid unintended sabotage to pain treatment.

    PubMed

    Marchand, Serge; Gaumond, Isabelle

    2013-07-01

    SUMMARY There is good evidence showing that placebo and nocebo responses do not only reflect a psychological reappraisal of an unchanged nociceptive activity. There are several scientific evidences indicating that placebo or nocebo responses trigger changes in the brain that activate descending modulatory mechanisms, affecting the nociceptive signal early in the CNS. Among the psychological factors that trigger a placebo or nocebo response, conditioning and expectation have been demonstrated to greatly affect the outcomes of pain perception, but also the response to treatment. Placebo or nocebo responses can be triggered without the administration of an inert substance in several therapeutic contexts and will affect the treatment outcome. In this article, we will describe different experimental situations where psychological factors produce physiological changes of the nociceptive signal in the brain, and how these changes are reflected in the spinal cord. Finally, we will discuss the importance of better understanding placebo and nocebo mechanisms in clinical contexts for pain treatment. PMID:24654814

  9. Development of a taxonomy to describe massage treatments for musculoskeletal pain

    PubMed Central

    Sherman, Karen J; Dixon, Marian W; Thompson, Diana; Cherkin, Daniel C

    2006-01-01

    Background One of the challenges in conducting research in the field of massage and bodywork is the lack of consistent terminology for describing the treatments given by massage therapists. The objective of this study was to develop a taxonomy to describe what massage therapists actually do when giving a massage to patients with musculoskeletal pain. Methods After conducting a review of the massage treatment literature for musculoskeletal pain, a list of candidate techniques was generated for possible inclusion in the taxonomy. This list was modified after discussions with a senior massage therapist educator and seven experienced massage therapists participating in a study of massage for neck pain. Results The taxonomy was conceptualized as a three level classification system, principal goals of treatment, styles, and techniques. Four categories described the principal goal of treatment (i.e., relaxation massage, clinical massage, movement re-education and energy work). Each principal goal of treatment could be met using a number of different styles, with each style consisting of a number of specific techniques. A total of 36 distinct techniques were identified and described, many of which could be included in multiple styles. Conclusion A new classification system is presented whereby practitioners using different styles of massage can describe the techniques they employ using consistent terminology. This system could help facilitate standardized reporting of massage interventions. PMID:16796753

  10. [Mirror therapy for the treatment of phantom limb pain after bilateral thigh amputation. A case report].

    PubMed

    Wosnitzka, M; Papenhoff, M; Reinersmann, A; Maier, C

    2014-12-01

    This case study is the first to report successful treatment of bilateral phantom limb pain (PLP) in a patient with bilateral thigh amputation and inefficacious medical treatment using a protocol of graded interventions including mirror therapy (MT). MT is a common treatment for PLP but requires the induction of a visual illusion of an intact limb in the mirror, usually achieved by mirroring the healthy extremity. Here, we illustrate how application of a unilateral prosthesis sufficed to induce the necessary illusion. After sequential imagery, then lateralization training, which alleviated pain attacks, the patient received a further 3-week treatment of mirror treatment. Pain intensity was reduced by more than 85 %; the number of attacks were decreased by more than 90% per day. The analgesic efficacy lasted until the unexpected death of the patient several months later. This case illustrates the mechanisms of MT through overcoming the sensory incongruences underlying the distorted body schema and its efficacy in patients with bilateral amputation. PMID:25392090

  11. Buprenorphine-naloxone therapy in pain management.

    PubMed

    Chen, Kelly Yan; Chen, Lucy; Mao, Jianren

    2014-05-01

    Buprenorphine-naloxone (bup/nal in 4:1 ratio; Suboxone; Reckitt Benckiser Pharmaceuticals Incorporation, Richmond, VA) is approved by the Food and Drug Administration for outpatient office-based addiction treatment. In the past few years, bup/nal has been increasingly prescribed off-label for chronic pain management. The current data suggest that bup/nal may provide pain relief in patients with chronic pain with opioid dependence or addiction. However, the unique pharmacological profile of bup/nal confers it to be a weak analgesic that is unlikely to provide adequate pain relief for patients without opioid dependence or addiction. Possible mechanisms of pain relief by bup/nal therapy in opioid-dependent patients with chronic pain may include reversal of opioid-induced hyperalgesia and improvement in opioid tolerance and addiction. Additional studies are needed to assess the implication of bup/nal therapy in clinical anesthesia and perioperative pain management. PMID:24509068

  12. BUPRENORPHINE-NALXONE THERAPY IN PAIN MANAGEMENT

    PubMed Central

    Chen, Kelly Yan; Chen, Lucy; Mao, Jianren

    2014-01-01

    Buprenorphine-naloxone (bup/nal in 4:1 ratio; Suboxone®, Reckitt Benckiser Pharmaceuticals Incorporation, Richmond, VA) is approved by the Food and Drug Administration for outpatient office-based addiction treatment. In the past few years, bup/nal has been increasingly prescribed off-label for chronic pain management. The current data suggests that bup/nal may provide pain relief in chronic pain patients with opioid dependence or addiction. However, the unique pharmacological profile of bup/nal confers it to be a weak analgesic that is unlikely to provide adequate pain relief for patients without opioid dependence or addiction. Possible mechanisms of pain relief by bup/nal therapy in opioid-dependent chronic pain patients may include reversal of opioid-induced hyperalgesia as well as improvement in opioid tolerance and addiction. Additional studies are needed to assess the implication of bup/nal therapy in clinical anesthesia and perioperative pain management. PMID:24509068

  13. What Is Chronic Pain?

    MedlinePlus Videos and Cool Tools

    ... Contact Us Shop FAQs The Art of Pain Management Resources Going to the ER Glossary Surveys What We Have Learned Communication Tools Videos Pain Management Programs Resource Guide to Chronic Pain Treatments Pain ...

  14. American Chronic Pain Association

    MedlinePlus

    ... ACPA Contact Us Shop FAQs The Art of Pain Management Resources Going to the ER Glossary Surveys What We Have Learned Communication Tools Videos Pain Management Programs Resource Guide to Chronic Pain Treatments Pain ...

  15. When pain is not only pain: inserting needles into the body evokes distinct reward-related brain responses in the context of a treatment.

    PubMed

    Lee, In-Seon; Wallraven, Christian; Kong, Jian; Chang, Dong-Seon; Lee, Hyejung; Park, Hi-Joon; Chae, Younbyoung

    2015-03-01

    The aim of this study was to compare behavioral and functional brain responses to the act of inserting needles into the body in two different contexts, treatment and stimulation, and to determine whether the behavioral and functional brain responses to a subsequent pain stimulus were also context dependent. Twenty-four participants were randomly divided into two groups: an acupuncture treatment (AT) group and an acupuncture stimulation (AS) group. Each participant received three different types of stimuli, consisting of tactile, acupuncture, and pain stimuli, and was given behavioral assessments during fMRI scanning. Although the applied stimuli were physically identical in both groups, the verbal instructions differed: participants in the AS group were primed to consider the acupuncture as a painful stimulus, whereas the participants in the AT group were told that the acupuncture was part of therapeutic treatment. Acupuncture yielded greater brain activation in reward-related brain areas (ventral striatum) of the brain in the AT group when compared to the AS group. Brain activation in response to pain stimuli was significantly attenuated in the bilateral secondary somatosensory cortex and the right dorsolateral prefrontal cortex after prior acupuncture needle stimulation in the AT group but not in the AS group. Inserting needles into the body in the context of treatment activated reward circuitries in the brain and modulated pain responses in the pain matrix. Our findings suggest that pain induced by therapeutic tools in the context of a treatment is modulated differently in the brain, demonstrating the power of context in medical practice. PMID:25528104

  16. Treatment strategies for osteoarthritis patients with pain and hypertension.

    PubMed

    Verdecchia, Paolo; Angeli, Fabio; Mazzotta, Giovanni; Martire, Paola; Garofoli, Marta; Gentile, Giorgio; Reboldi, Gianpaolo

    2010-08-01

    Out of 100 patients with osteoarthritis (OA), almost 40 have a concomitant diagnosis of hypertension. Nonsteroidal anti-inflammatory drugs (NSAIDs) and cyclooxygenase-2 (COX-2) inhibitors may trigger a rise in blood pressure (BP), which is more marked in patients with established hypertension. NSAIDs and COX-2 inhibitors attenuate the antihypertensive effect of several antihypertensive agents. Frequent BP controls are needed in treated hypertensive patients who are concomitantly receiving NSAIDs or COX-2 inhibitors because even a small increase in BP may be associated with an important rise in the risk of major cardiovascular complications. In meta-analyses, an increase in systolic BP of 5mmHg was associated with a 25% higher risk of cardiovascular events. These data have been confirmed in randomized studies with rofecoxib and celecoxib, where a modest increase in BP was associated with a significantly higher risk of cardiovascular disease. There is emerging evidence that the COX-inhibiting nitric oxide donator (CINOD) class is promising in the treatment of patients with OA. Naproxcinod, the first CINOD investigated in clinical trials, is composed of the traditional NSAID naproxen covalently bound to the nitric oxide (NO)-donating moiety butanediol mono-nitrate (BDMN). The molecule has the potential to provide a sustained release of NO. In clinical studies, naproxcinod prevented the BP rise in normotensive and hypertensive patients observed with naproxen. The BP benefit of naproxcinod over naproxen was greater in patients concomitantly receiving angiotensin-converting enzyme inhibitors or angiotensin II receptor blockers. These investigational data suggest that naproxcinod is a valuable alternative to NSAIDs and COX-2 inhibitors for treatment of OA patients. PMID:22870450

  17. Treatment Strategies for Osteoarthritis Patients with Pain and Hypertension

    PubMed Central

    Verdecchia, Paolo; Angeli, Fabio; Mazzotta, Giovanni; Martire, Paola; Garofoli, Marta; Gentile, Giorgio; Reboldi, Gianpaolo

    2010-01-01

    Out of 100 patients with osteoarthritis (OA), almost 40 have a concomitant diagnosis of hypertension. Nonsteroidal anti-inflammatory drugs (NSAIDs) and cyclooxygenase-2 (COX-2) inhibitors may trigger a rise in blood pressure (BP), which is more marked in patients with established hypertension. NSAIDs and COX-2 inhibitors attenuate the antihypertensive effect of several antihypertensive agents. Frequent BP controls are needed in treated hypertensive patients who are concomitantly receiving NSAIDs or COX-2 inhibitors because even a small increase in BP may be associated with an important rise in the risk of major cardiovascular complications. In meta-analyses, an increase in systolic BP of 5mmHg was associated with a 25% higher risk of cardiovascular events. These data have been confirmed in randomized studies with rofecoxib and celecoxib, where a modest increase in BP was associated with a significantly higher risk of cardiovascular disease. There is emerging evidence that the COX-inhibiting nitric oxide donator (CINOD) class is promising in the treatment of patients with OA. Naproxcinod, the first CINOD investigated in clinical trials, is composed of the traditional NSAID naproxen covalently bound to the nitric oxide (NO)-donating moiety butanediol mono-nitrate (BDMN). The molecule has the potential to provide a sustained release of NO. In clinical studies, naproxcinod prevented the BP rise in normotensive and hypertensive patients observed with naproxen. The BP benefit of naproxcinod over naproxen was greater in patients concomitantly receiving angiotensin-converting enzyme inhibitors or angiotensin II receptor blockers. These investigational data suggest that naproxcinod is a valuable alternative to NSAIDs and COX-2 inhibitors for treatment of OA patients. PMID:22870450

  18. Hypnosis as a treatment of chronic widespread pain in general practice: A randomized controlled pilot trial

    PubMed Central

    Grøndahl, Jan Robert; Rosvold, Elin Olaug

    2008-01-01

    Background Hypnosis treatment in general practice is a rather new concept. This pilot study was performed to evaluate the effect of a standardized hypnosis treatment used in general practice for patients with chronic widespread pain (CWP). Methods The study was designed as a randomized control group-controlled study. Sixteen patients were randomized into a treatment group or a control group, each constituting eight patients. Seven patients in the treatment group completed the schedule. After the control period, five of the patients in the control group also received treatment, making a total of 12 patients having completed the treatment sessions. The intervention group went through a standardized hypnosis treatment with ten consecutive therapeutic sessions once a week, each lasting for about 30 minutes, focusing on ego-strengthening, relaxation, releasing muscular tension and increasing self-efficacy. A questionnaire was developed in order to calibrate the symptoms before and after the 10 weeks period, and the results were interpolated into a scale from 0 to 100, increasing numbers representing increasing suffering. Data were analyzed by means of T-tests. Results The treatment group improved from their symptoms, (change from 62.5 to 55.4), while the control group deteriorated, (change from 37.2 to 45.1), (p = 0,045). The 12 patients who completed the treatment showed a mean improvement from 51.5 to 41.6. (p = 0,046). One year later the corresponding result was 41.3, indicating a persisting improvement. Conclusion The study indicates that hypnosis treatment may have a positive effect on pain and quality of life for patients with chronic muscular pain. Considering the limited number of patients, more studies should be conducted to confirm the results. Trial Registration The study was registered in ClinicalTrials.gov and released 27.08.07 Reg nr NCT00521807 Approval Number: 05032001. PMID:18801190

  19. Treatment of Lower Back Pain-The Gap between Guideline-Based Treatment and Medical Care Reality.

    PubMed

    Werber, Andreas; Schiltenwolf, Marcus

    2016-01-01

    Despite the fact that unspecific low back pain is of important impact in general health care, this pain condition is often treated insufficiently. Poor efficiency has led to the necessity of guidelines addressing evidence-based strategies for treatment of lower back pain (LBP). We present some statements of the German medical care reality. Self-responsible action of the patient should be supported while invasive methods in particular should be avoided due to lacking evidence in outcome efficiency. However, it has to be stated that no effective implementation strategy has been established yet. Especially, studies on the economic impact of different implementation strategies are lacking. A lack of awareness of common available guidelines and an uneven distribution of existing knowledge throughout the population can be stated: persons with higher risk suffering from LBP by higher professional demands and lower educational level are not skilled in advised management of LBP. Both diagnostic imaging and invasive treatment methods increased dramatically leading to increased costs and doctor workload without being associated with improved patient functioning, severity of pain or overall health status due to the absence of a functioning primary care gate keeping system for patient selection. Opioids are prescribed on a grand scale and over a long period. Moreover, opioid prescription is not indicated properly, when predominantly persons with psychological distress like somatoform disorders are treated with opioids. PMID:27417632

  20. Chronic pelvic pain after laser prostatectomy: treatment by resection of the perineal branches of the pudendal nerve.

    PubMed

    Dellon, A Lee; Wright, E James; Manson, Paul N

    2014-10-01

    Development of chronic pelvic pain after laser resection for benign prostatic hypertrophy has not been described previously (Clavien IIIb complication). The etiology of this chronic pain, which persisted despite medical chronic pain and urologic management for 5 years, was proven to be of pudendal nerve origin by local anesthetic blockade of the pudendal nerves bilaterally at the ischial spines. Surgical treatment was based upon the anatomic proximity of the perineal and dorsal branches of the pudendal nerve to the site of laser therapy on the pelvic side of the urogenital diaphragm. Treatment required resection of the perineal branches of the pudendal nerve bilaterally and neurolysis of the dorsal nerve to the penis bilaterally through incisions overlying the inferior pubic ramus. Relief of perineal pain and pain with micturition occurred in the immediate postoperative period. Pain relief and resumption of all normal activity occurred by 3 months postoperatively and continues 13 months following the surgery. PMID:24535673

  1. EAU guidelines on pain management.

    PubMed

    Francesca, Francesco; Bader, Pia; Echtle, Dieter; Giunta, Francesco; Williams, John

    2003-10-01

    Pain is the most common symptom of any illness; the physician's therapeutic task is twofold: to discover and treat the cause of pain and the pain itself, whether or not the underlying cause is treatable, to provide relief and reduce the suffering caused by pain. Although we use the term of pain to define all sensations that hurt or are unpleasant, actually two quite different kinds of pain exist. The first (nociceptive) is associated with tissue damage or inflammation, the second (neuropathic) results from a lesion to the peripheral or central nervous systems. Pain can also be divided in acute and chronic. Caregivers are to face pain in two main settings: after surgery and in cancer patients. These tasks require a multidisciplinary team, able to properly assess and treat pain. Postoperative pain is to be treated early and aggressively. Several drug options are available, to be tailored on the surgical procedure and the patient. Pain in cancer patients consists of different aspects: it can be caused by the cancer itself or may be secondary to muscular spasm or cancer treatments. The management involves mainly pharmacotherapy, but also primary treatments as surgery, radiochemotherapy or even antibiotics can provide an adequate relief. Analgesics are to be employed according to an ascending scale, but other options can be combined to improve the outcome when a satisfactory balance between relief and side effects is not achieved; they include invasive techniques, physical and psychological therapy. The mainstay of pain management entails a interdisciplinary cooperation; it requires a full knowledge of the methods of evaluation and treatment of this condition. PMID:14499670

  2. Use of an orthotic device in the treatment of posterior heel pain.

    PubMed

    Wooten, B; Uhl, T L; Chandler, J

    1990-01-01

    Research Funded by the Lexington Clinic Foundation for Research and Education. Posterior heel pain (PHP) presents a difficult clinical challenge. The causes of PHP include Haglund syndrome (pump bump deformity), Achilles tendinitis, and Sever's disease (retrocalcaneal bursitis, traction apophysitis). The purposes of this study were to 1) describe a new orthotic device used in the treatment of PHP and 2) evaluate the effectiveness of this device. The orthotic device consisted of a neoprene sleeve holding 1/4 inch PPT foam rubber horseshoe (Sports Supports, Inc., Dallas, TX). The horseshoe was placed directly over the injury to protect and relieve pressure or was inverted and used as a counterforce brace to reduce the tensile stress to the Achilles tendon. Eight patients (6 children, 2 adults) were evaluated at the time of application and after 1 month of use. Three criteria were considered: 1) subjective pain scale, 2) active goniometric measurements, and 3) toe raise test. The statistical analysis indicated a significant improvement in pain during activity from initial to follow-up and in pain after activity from initial to follow-up. All patients demonstrated improved strength and flexibility. It was concluded that this device may be an effective adjunct to the treatment of PHP. J Orthop Sports Phys Ther 1990;11(9):410-413. PMID:18787273

  3. Treatment of phantom limb pain by cryoneurolysis of the amputated nerve.

    PubMed

    Moesker, Albert A; Karl, Helen W; Trescot, Andrea M

    2014-01-01

    The pathophysiology of phantom limb pain (PLP) is multifactorial. It probably starts in the periphery and is amplified and modified in the central nervous system. A small group of patients with PLP were questioned as to the portion of the phantom limb affected by pain (e.g., "great toe," "thumb"). In the stump, the corresponding amputated nerve was located with a nerve stimulator. With correct placement and stimulation, the PLP could then be reproduced or exacerbated. A small dose of local anesthesia was then injected, resulting in the disappearance of the PLP. If a peripheral nerve injection gave temporary relief, our final treatment was cryoanalgesia at this location. Evaluation of 5 patients, followed for at least 2.5 years, yielded the following results: 3 patients had excellent results (100%, 95%, and 90% decrease in complaints, respectively), 1 patient had an acceptable result (40% decrease), and 1 patient had only a 20% decrease in pain. Although both central and peripheral components are likely involved in PLP, treatment of a peripheral pain locus with cryoanalgesia should be considered. We propose the identification of a peripheral etiology may help match patients to an appropriate therapy, and cryoanalgesia may result in long-term relief of PLP. PMID:23279331

  4. Long-term safety and effectiveness of tanezumab as treatment for chronic low back pain.

    PubMed

    Gimbel, Joseph S; Kivitz, Alan J; Bramson, Candace; Nemeth, Mary Anne; Keller, David S; Brown, Mark T; West, Christine R; Verburg, Kenneth M

    2014-09-01

    A noncontrolled, randomized, multicenter study (NCT00924664) evaluated long-term safety and effectiveness of tanezumab in patients with chronic low back pain following a randomized placebo- and active-controlled parent study that evaluated analgesic efficacy. Patients were randomized to tanezumab 10mg (n=321) or 20mg (n=527) administered at 8-week intervals via 3 intravenous injections followed by 4 subcutaneous injections. Effectiveness analyses included change from parent study baseline in Brief Pain Inventory Short Form, Roland Morris Disability Questionnaire, and Patient's Global Assessment of low back pain. Safety assessments included adverse event documentation, physical/neurological examinations, and laboratory tests. Mean treatment duration during the extension study was 194 and 202 days with tanezumab 10 and 20mg, respectively. Both tanezumab doses provided similar and sustained improvements in all effectiveness outcomes. The most frequently reported adverse events were arthralgia, paresthesia, and hypoesthesia. Adverse events initially described as osteonecrosis were reported in 6 patients (tanezumab 10mg, n=2; tanezumab 20mg, n=4); 9 additional patients (tanezumab 10mg, n=7; tanezumab 20mg, n=2) underwent total joint replacement (TJR). A blinded, independent adjudication committee reviewed all 6 patients with reported osteonecrosis and 4 of the 9 patients undergoing TJR. Adjudication outcomes were osteonecrosis (n=0), worsening osteoarthritis (n=5; 1 rapidly progressive), and another diagnosis or indeterminate (n=5). Tanezumab 10mg had better tolerability than tanezumab 20mg, and may represent an effective long-term treatment for chronic low back pain. PMID:24937440

  5. [Multidisciplinary outpatient clinics for back pain patients--a new treatment program].

    PubMed

    Skouen, Jan Sture; Laerum, Even; Jensen, Thor Øivind

    2003-10-23

    Chronic low back pain (LBP) represents a major health problem, especially in Western Europe and North America. The aim of this study is to give an account of why a multidisciplinary treatment program in an outpatient spine clinic is the best treatment for many sub-acute and chronic LBP patients on long-term sick leave. We present an overview of documented treatment effects from multidisciplinary treatment programmes, an outline of the treatment in an outpatient spine clinic, and an account of why multidisciplinary programs are beneficial. The treatment of this patient group is also shown to be cost-effective when one differentiates between light and extensive multidisciplinary programmes. A future challenge rests in the fact that even after optimal treatment, approximately 20 % of patients still do not return to work. PMID:14600719

  6. Phenytoin (Dilantin) and acupuncture therapy in the treatment of intractable oral and facial pain.

    PubMed

    Lu, Dominic P; Lu, Winston I; Lu, Gabriel P

    2011-01-01

    Phenytoin is an anti-convulsant and anti-arrhythmic medication. Manufactured by various pharmaceutical companies with various brand names, phenytoin (PHT) is also known as Dilantain, Hydantoin or Phenytek in the United States; Dilantain or Remytoine in Canada; Epamin, Hidantoina in Mexico; and Fenidatoin or Fenitron or other names elsewhere in the world. Phenytoin (PHT) is especially useful for patients suffering from intractable oral and facial pain especially those who exhibit anger, stress, depression and irrational emotions commonly seen in the patients with oral and facial pain. When used properly, Phenytoin is also an effective anxiolysis drug in addition to its theraputic effects on pain and can be used alone or, even better, if combined with other compatible sedatives. Phenytoin is particularly valuable when combined with acupuncture for patients with trigeminal neuralgia, glossopharyneal neuralgia, Bell's palsy, and some other facial paralysis and pain. It also has an advantage of keeping the patient relatively lucid after treatment. Either PHT or acupuncture alone can benefit patients but the success of treatment outcome may be limited. We found by combining both acupuncture and PHT with Selective Drug Uptake Enhancement by stimulating middle finger at the first segment of ventral (palmar) and lateral surfaces, as well as prescribing PHT with the dosage predetermined for each patient by Bi-Digital O-Ring Test (BDORT), the treatment outcome was much better resulted with less recurrence and intensity of pain during episodes of attack. Patients with Bell's palsy were most benefited by acupuncture therapy that could completely get rid of the illness. PMID:21830351

  7. [Traditional Chinese medicine for cancer pain].

    PubMed

    Wang, Ju-yong; Xu, Ling; Zhang, Rui-xin; Lao, Lixing

    2011-02-01

    Pain is one of the common symptoms of cancer which seriously affects the quality of life of the patients. Cancer pain is mainly treated with the three-step method, biological therapy or nerve block therapy based on antitumor therapy. However, up to 50 percent of patients with cancer-related pain do not receive adequate pain relief, affecting their physical and psychological well-being, and leading to a lower quality of life for the patient after conventional treatment. Clinical observation suggests that traditional Chinese medicine may alleviate cancer-related pain either by oral administration, topical administration, acupuncture or other means with continuing non-addictive and non-drug-resistant qualities. However, scientific evaluation of the efficacy of herbs in the treatment of pain is insufficient; the underlying mechanisms are unclear and, safety and toxicity remain a concern. PMID:21288445

  8. [Controlled release oxycodone--a new option in the treatment of severe and very severe pain. Review of studies on neuropathic, physical activity-related and postoperative pain].

    PubMed

    Stiehl, M

    2004-08-01

    Opioids are used not only in the treatment of cancer pain, but also pain of non-malignant genesis. In recent years, the efficacy of controlled release (CR) oxycodone in the treatment of the above-mentioned types of pain has been investigated in a number of clinical studies. The present article reviews the clinical studies that have been already published. Thanks to its outstanding pharmacological and pharmacodynamic properties, CR oxycodone is fast acting and brings about long lasting pain relief, coupled with benefits for physical and mental activities. This results in a significant quality-of-life improvement. Oral therapy with CR oxycodone is safe and can be precisely controlled. Since there are no clinical relevant metabolites, there is no danger of accumulation in patients with renal infarction due to these metabolites. Side effects are those typical for opioids, and are readily manageable. CR oxycodone is a good alternative in the treatment of non-cancer pain and can be recommended as first-line treatment for the above-mentioned indications. PMID:16739361

  9. Effectiveness of pregabalin for the treatment of chronic low back pain with accompanying lower limb pain (neuropathic component): a non-interventional study in Japan

    PubMed Central

    Taguchi, Toshihiko; Igarashi, Ataru; Watt, Stephen; Parsons, Bruce; Sadosky, Alesia; Nozawa, Kazutaka; Hayakawa, Kazuhiro; Yoshiyama, Tamotsu; Ebata, Nozomi; Fujii, Koichi

    2015-01-01

    Objective To evaluate the impact of pregabalin on sleep, pain, function, and health status in patients with chronic low back pain with accompanying neuropathic pain (CLBP-NeP) under routine clinical practice. Methods This prospective, non-interventional, observational study enrolled Japanese adults (≥18 years) with CLBP-NeP of duration ≥3 months and severity ≥5 on a numerical rating scale (0= no pain, 10= worst possible pain). Treatment was 8 weeks with pregabalin (n=157) or usual care alone (n=174); choice of treatment was determined by the physician. The primary efficacy outcome was change from baseline to 8 weeks in pain-related interference with sleep, assessed using the Pain-Related Sleep Interference Scale (PRSIS; 0= did not interfere with sleep, 10= completely interferes with sleep). Secondary endpoints were changes in PRSIS at week 4, and changes at weeks 4 and 8 in pain (numerical rating scale), function (Roland-Morris Disability Questionnaire), and quality of life (EuroQol 5D-5L); global assessments of change were evaluated from the clinician and patient perspectives at the final visit. Results Demographic characteristics were similar between cohorts, but clinical characteristics suggested greater disease severity in the pregabalin group including a higher mean (standard deviation) pain score, 6.3 (1.2) versus 5.8 (1.1) (P<0.001). For the primary endpoint, pregabalin resulted in significantly greater improvements in PRSIS at week 8, least-squares mean changes of −1.3 versus −0.4 for usual care (P<0.001); pregabalin also resulted in greater PRSIS improvement at week 4 (P=0.012). Relative to usual care at week 8, pregabalin improved pain and function (both P<0.001), and showed global improvements since beginning study medication (P<0.001). Pregabalin was well tolerated. Conclusion In clinical practice in patients with CLBP-NeP, pregabalin showed significantly greater improvements in pain-related interference with sleep relative to usual care. In

  10. A Focus Group on Dental Pain Complaints with General Medical Practitioners: Developing a Treatment Algorithm

    PubMed Central

    Carter, Geoff; Abbey, Robyn

    2016-01-01

    Objective. The differential diagnosis of pain in the mouth can be challenging for general medical practitioners (GMPs) as many different dental problems can present with similar signs and symptoms. This study aimed to create a treatment algorithm for GMPs to effectively and appropriately refer the patients and prescribe antibiotics. Design. The study design is comprised of qualitative focus group discussions. Setting and Subjects. Groups of GMPs within the Gold Coast and Brisbane urban and city regions. Outcome Measures. Content thematically analysed and treatment algorithm developed. Results. There were 5 focus groups with 8-9 participants per group. Addressing whether antibiotics should be given to patients with dental pain was considered very important to GMPs to prevent overtreatment and creating antibiotic resistance. Many practitioners were unsure of what the different forms of dental pains represent. 90% of the practitioners involved agreed that the treatment algorithm was useful to daily practice. Conclusion. Common dental complaints and infections are seldom surgical emergencies but can result in prolonged appointments for those GMPs who do not regularly deal with these issues. The treatment algorithm for referral processes and prescriptions was deemed easily downloadable and simple to interpret and detailed but succinct enough for clinical use by GMPs. PMID:27462469

  11. A Focus Group on Dental Pain Complaints with General Medical Practitioners: Developing a Treatment Algorithm.

    PubMed

    Carter, Ava Elizabeth; Carter, Geoff; Abbey, Robyn

    2016-01-01

    Objective. The differential diagnosis of pain in the mouth can be challenging for general medical practitioners (GMPs) as many different dental problems can present with similar signs and symptoms. This study aimed to create a treatment algorithm for GMPs to effectively and appropriately refer the patients and prescribe antibiotics. Design. The study design is comprised of qualitative focus group discussions. Setting and Subjects. Groups of GMPs within the Gold Coast and Brisbane urban and city regions. Outcome Measures. Content thematically analysed and treatment algorithm developed. Results. There were 5 focus groups with 8-9 participants per group. Addressing whether antibiotics should be given to patients with dental pain was considered very important to GMPs to prevent overtreatment and creating antibiotic resistance. Many practitioners were unsure of what the different forms of dental pains represent. 90% of the practitioners involved agreed that the treatment algorithm was useful to daily practice. Conclusion. Common dental complaints and infections are seldom surgical emergencies but can result in prolonged appointments for those GMPs who do not regularly deal with these issues. The treatment algorithm for referral processes and prescriptions was deemed easily downloadable and simple to interpret and detailed but succinct enough for clinical use by GMPs. PMID:27462469

  12. Management of chronic ankle pain using joint mobilization and ASTYM® treatment: a case report

    PubMed Central

    Slaven, Emily J; Mathers, Jessie

    2011-01-01

    Treatment of ankle sprains predominately focuses on the acute management of this condition; less emphasis is placed on the treatment of ankle sprains in the chronic phase of recovery. Manual therapy, in the form of joint mobilization and manipulation, has been shown to be effective in the management of this condition, but the combination of joint mobilization and manipulation in tandem with ASTYM® treatment has not been explored. The purpose of this case report is to chronicle the management of a patient with chronic ankle pain who was treated with manual therapy including manipulation and ASTYM treatment. As a result of a fall down stairs 6 months previously, the patient sustained a severe ankle sprain. The soft tissue damage was accompanied by bony disruptions which warranted the patient spending 3 weeks in a walking boot. At the initial evaluation, the patient reported difficulty with descending stairs reciprocally and not being able to run more than 4 minutes on the treadmill before the pain escalated to the level that she had to stop running. After five sessions of therapy consisting of joint mobilization, manipulation and ASTYM, the patient was able to descend stairs and run 40 minutes without pain. PMID:22547921

  13. Chiropractic clinical practice guideline: evidence-based treatment of adult neck pain not due to whiplash

    PubMed Central

    Anderson-Peacock, Elizabeth; Blouin, Jean-Sébastien; Bryans, Roland; Danis, Normand; Furlan, Andrea; Marcoux, Henri; Potter, Brock; Ruegg, Rick; Gross Stein, Janice; White, Eleanor

    2005-01-01

    OBJECTIVE To provide an evidence-based clinical practice guideline for the chiropractic cervical treatment of adults with acute or chronic neck pain not due to whiplash. This is a considerable health concern considered to be a priority by stakeholders, and about which the scientific information was poorly organized. OPTIONS Cervical treatments: manipulation, mobilization, ischemic pressure, clinic- and home-based exercise, traction, education, low-power laser, massage, transcutaneous electrical nerve stimulation, pillows, pulsed electromagnetic therapy, and ultrasound. OUTCOMES The primary outcomes considered were improved (reduced and less intrusive) pain and improved (increased and easier) ranges of motion (ROM) of the adult cervical spine. EVIDENCE An “extraction” team recorded evidence from articles found by literature search teams using 4 separate literature searches, and rated it using a Table adapted from the Oxford Centre for Evidence-based Medicine. The searches were 1) Treatment; August, 2003, using MEDLINE, CINAHL, AMED, MANTIS, ICL, The Cochrane Library (includes CENTRAL), and EBSCO, identified 182 articles. 2) Risk management (adverse events); October, 2004, identified 230 articles and 2 texts. 3) Risk management (dissection); September, 2003, identified 79 articles. 4) Treatment update; a repeat of the treatment search for articles published between September, 2003 and November, 2004 inclusive identified 121 articles. VALUES To enable the search of the literature, the authors (Guidelines Development Committee [GDC]) regarded chiropractic treatment as including elements of “conservative” care in the search strategies, but not in the consideration of the range of chiropractic practice. Also, knowledge based only on clinical experience was considered less valid and reliable than good-caliber evidence, but where the caliber of the relevant evidence was low or it was non-existent, unpublished clinical experience was considered to be equivalent to

  14. Chronic pain, substance abuse and addiction.

    PubMed

    Compton, Peggy; Athanasos, Peter

    2003-09-01

    Health care professionals face numerous challenges in assessing and treating chronic pain patients with a substance abuse history. Societal perspectives on morality and criminality, imprecise addiction terminology, litigation fears, and genuine concern for a patient's relapse into or escalation of substance abuse result in unrelieved and under-relieved pain in precisely the population that--as increasing evidence indicates--is generally intolerant of pain. Before adequate pain relief can occur in chronic pain patients with current or past substance abuse issues, it is imperative that the clinician recognize addiction as a disease with known symptoms and treatments. Further, the clinician must realize the difference between true addiction and similar conditions, so the patient's condition can be monitored and regulated properly. Although clinicians are often reluctant to medicate with opioids, it is always best to err on the side of adequate pain relief. Withholding opioids from chronic pain patients in order to avoid the onset or relapse of addiction is contrary to the growing body of evidence and results only in unnecessary pain for the patient. Chronic pain in patients with a history of addictive disease can be treated successfully with opiate analgesia; it just requires caution and careful monitoring of medication use. If addiction is treated as a known risk when providing opioid analgesia to a recovering addict, its development can be minimized while pain relief is provided. PMID:14567207

  15. Characteristics of highly impaired children with severe chronic pain: a 5-year retrospective study on 2249 pediatric pain patients

    PubMed Central

    2012-01-01

    impaired. They are at increased risk for developmental stagnation. Adequate treatment and referral are essential to interrupt progression of the chronic pain process into adulthood. PMID:22591492

  16. Placebo use in pain management: the role of medical context, treatment efficacy, and deception in determining placebo acceptability

    PubMed Central

    Kisaalita, Nkaku; Staud, Roland; Hurley, Robert; Robinson, Michael

    2014-01-01

    Placebo effects can act as powerful pain relievers. While the ethics of therapeutic placebo use is highly controversial, recent evidence suggests that medical providers frequently utilize placebo treatments, and patients may be open to these interventions under certain contexts. This investigation used a patient-centered approach to answer essential questions about placebo treatment acceptability. People with chronic musculoskeletal pain completed a placebo survey where they: 1) rated their knowledge of placebo and its efficacy for alleviating pain; 2) evaluated the acceptability of a placebo analgesic interventions across several unique medical contexts; and 3) responded to six different patient-physician treatment scenarios to assess the role of deception and placebo effectiveness on mood and provider trust. Results showed that participants had limited knowledge of placebo and it’s efficacy for alleviating pain. Placebo acceptability was highly dependent on the context of the intervention, as placebo treatments were considered acceptable when used as complementary/adjunct treatments and when no other established treatments were available. Also, an analgesic placebo response mitigated the negative consequences of deception by improving provider trust and decreasing negative mood. These findings suggest that patients may be rather pragmatic in their appraisals of placebo treatment acceptability and may consider a variety of treatments/contexts as permissible for managing their pain. This is the first study of its kind to quantify perceptions of placebo analgesia knowledge and efficacy among individuals with chronic pain, and to assess the role of different medical contexts in treatment acceptability. PMID:25267208

  17. Accelerated Resolution Therapy for treatment of pain secondary to symptoms of combat-related posttraumatic stress disorder

    PubMed Central

    Kip, Kevin E.; Rosenzweig, Laney; Hernandez, Diego F.; Shuman, Amy; Diamond, David M.; Girling, Sue Ann; Sullivan, Kelly L.; Wittenberg, Trudy; Witt, Ann M.; Lengacher, Cecile A.; Anderson, Brian; McMillan, Susan C.

    2014-01-01

    Background As many as 70% of veterans with chronic pain treated within the US Veterans Administration (VA) system may have posttraumatic stress disorder (PTSD), and conversely, up to 80% of those with PTSD may have pain. We describe pain experienced by US service members and veterans with symptoms of PTSD, and report on the effect of Accelerated Resolution Therapy (ART), a new, brief exposure-based therapy, on acute pain reduction secondary to treatment of symptoms of PTSD. Methods A randomized controlled trial of ART versus an attention control (AC) regimen was conducted among 45 US service members/veterans with symptoms of combat-related PTSD. Participants received a mean of 3.7 sessions of ART. Results Mean age was 41.0 + 12.4 years and 20% were female. Most veterans (93%) reported pain. The majority (78%) used descriptive terms indicative of neuropathic pain, with 29% reporting symptoms of a concussion or feeling dazed. Mean pre-/post-change on the Pain Outcomes Questionnaire (POQ) was −16.9±16.6 in the ART group versus −0.7±14.2 in the AC group (p=0.0006). Among POQ subscales, treatment effects with ART were reported for pain intensity (effect size = 1.81, p=0.006), pain-related impairment in mobility (effect size = 0.69, p=0.01), and negative affect (effect size = 1.01, p=0.001). Conclusions Veterans with symptoms of combat-related PTSD have a high prevalence of significant pain, including neuropathic pain. Brief treatment of symptoms of combat-related PTSD among veterans by use of ART appears to acutely reduce concomitant pain. PMID:24959325

  18. The role of information search in seeking alternative treatment for back pain: a qualitative analysis

    PubMed Central

    2014-01-01

    Background Health consumers have moved away from a reliance on medical practitioner advice to more independent decision processes and so their information search processes have subsequently widened. This study examined how persons with back pain searched for alternative treatment types and service providers. That is, what information do they seek and how; what sources do they use and why; and by what means do they search for it? Methods 12 persons with back pain were interviewed. The method used was convergent interviewing. This involved a series of semi-structured questions to obtain open-ended answers. The interviewer analysed the responses and refined the questions after each interview, to converge on the dominant factors influencing decisions about treatment patterns. Results Persons with back pain mainly search their memories and use word of mouth (their doctor and friends) for information about potential treatments and service providers. Their search is generally limited due to personal, provider-related and information-supply reasons. However, they did want in-depth information about the alternative treatments and providers in an attempt to establish apriori their efficacy in treating their specific back problems. They searched different sources depending on the type of information they required. Conclusions The findings differ from previous studies about the types of information health consumers require when searching for information about alternative or mainstream healthcare services. The results have identified for the first time that limited information availability was only one of three categories of reasons identified about why persons with back pain do not search for more information particularly from external non-personal sources. PMID:24725300

  19. Impact of Osteopathic Treatment on Pain in Adult Patients with Cystic Fibrosis – A Pilot Randomized Controlled Study

    PubMed Central

    Hubert, Dominique; Soubeiran, Lucile; Gourmelon, Fabrice; Grenet, Dominique; Serreau, Raphaël; Perrodeau, Elodie; Zegarra-Parodi, Rafael; Boutron, Isabelle

    2014-01-01

    Background Pain is a common complication in patients with cystic fibrosis (CF) and is associated with shorter survival. We evaluated the impact of osteopathic manipulative treatment (OMT) on pain in adults with CF. Methods A pilot multicenter randomized controlled trial was conducted with three parallel arms: OMT (group A, 16 patients), sham OMT (sham treatment, group B, 8 patients) and no treatment (group C, 8 patients). Medical investigators and patients were double-blind to treatment for groups A and B, who received OMT or sham OMT monthly for 6 months. Pain was rated as a composite of its intensity and duration over the previous month. The evolution of chest/back pain after 6 months was compared between group A and groups B+C combined (control group). The evolution of cervical pain, headache and quality of life (QOL) were similarly evaluated. Results There was no statistically significant difference between the treatment and control groups in the decrease of chest/back pain (difference = −2.20 IC95% [−4.81; 0.42], p = 0.098); also, group A did not differ from group B. However, chest/back pain decreased more in groups A (p = 0.002) and B (p = 0.006) than in group C. Cervical pain, headache and QOL scores did not differ between the treatment and control groups. Conclusion This pilot study demonstrated the feasibility of evaluating the efficacy of OMT to treat the pain of patients with CF. The lack of difference between the group treated with OMT and the control group may be due to the small number of patients included in this trial, which also precludes any definitive conclusion about the greater decrease of pain in patients receiving OMT or sham OMT than in those with no intervention. Trial Registration ClinicalTrials.gov NCT01293019 PMID:25029347

  20. Early Systemic Granulocyte-Colony Stimulating Factor Treatment Attenuates Neuropathic Pain after Peripheral Nerve Injury

    PubMed Central

    Lee, Yun-Lin; Chen, Jin-Chung; Wang, Hung-Li; Yang, Yi-Ling; Cheng, Mei-Yun; Liao, Ming-Feng; Ro, Long-Sun

    2012-01-01

    Recent studies have shown that opioid treatment can reduce pro-inflammatory cytokine production and counteract various neuropathic pain syndromes. Granulocyte colony-stimulating factor (G-CSF) can promote immune cell differentiation by increasing leukocytes (mainly opioid-containing polymorphonuclear (PMN) cells), suggesting a potential beneficial role in treating chronic pain. This study shows the effectiveness of exogenous G-CSF treatment (200 µg/kg) for alleviating thermal hyperalgesia and mechanical allodynia in rats with chronic constriction injury (CCI), during post-operative days 1–25, compared to that of vehicle treatment. G-CSF also increases the recruitment of opioid-containing PMN cells into the injured nerve. After CCI, single administration of G-CSF on days 0, 1, and 2, but not on day 3, relieved thermal hyperalgesia, which indicated that its effect on neuropathic pain had a therapeutic window of 0–48 h after nerve injury. CCI led to an increase in the levels of interleukin-6 (IL-6) mRNA and tumor necrosis factor-α (TNF-α) protein in the dorsal root ganglia (DRG). These high levels of IL-6 mRNA and TNF-α were suppressed by a single administration of G-CSF 48–144 h and 72–144 h after CCI, respectively. Furthermore, G-CSF administered 72–144 h after CCI suppressed the CCI-induced upregulation of microglial activation in the ipsilateral spinal dorsal horn, which is essential for sensing neuropathic pain. Moreover, the opioid receptor antagonist naloxone methiodide (NLXM) reversed G-CSF-induced antinociception 3 days after CCI, suggesting that G-CSF alleviates hyperalgesia via opioid/opioid receptor interactions. These results suggest that an early single systemic injection of G-CSF alleviates neuropathic pain via activation of PMN cell-derived endogenous opioid secretion to activate opioid receptors in the injured nerve, downregulate IL-6 and TNF-α inflammatory cytokines, and attenuate microglial activation in the spinal dorsal horn. This

  1. Hyoscine butylbromide: a review of its use in the treatment of abdominal cramping and pain.

    PubMed

    Tytgat, Guido N

    2007-01-01

    Abdominal cramping and pain is a frequent problem in the adult population of Western countries, with an estimated prevalence of < or =30%. Hyoscine butylbromide (scopolamine butylbromide) [Buscopan/Buscapina] is an antispasmodic drug indicated for the treatment of abdominal pain associated with cramps induced by gastrointestinal (GI) spasms. It was first registered in Germany in 1951 and marketed in 1952, and has since become available worldwide both as a prescription drug and as an over-the-counter medicine in many countries. This article reviews the pharmacology and pharmacokinetic profile of hyoscine butylbromide, and summarises efficacy and safety data from clinical trials of this drug for abdominal cramping and pain. Pharmacological studies have revealed that hyoscine butylbromide is an anticholinergic drug with high affinity for muscarinic receptors located on the smooth-muscle cells of the GI tract. Its anticholinergic action exerts a smooth-muscle relaxing/spasmolytic effect. Blockade of the muscarinic receptors in the GI tract is the basis for its use in the treatment of abdominal pain secondary to cramping. Hyoscine butylbromide also binds to nicotinic receptors, which induces a ganglion-blocking effect. Several pharmacokinetic studies in humans have consistently demonstrated the low systemic availability of hyoscine butylbromide after oral administration, with plasma concentrations of the drug generally being below the limit of quantitation. The bioavailability of hyoscine butylbromide, estimated from renal excretion, was generally <1%. However, because of its high tissue affinity for muscarinic receptors, hyoscine butylbromide remains available at the site of action in the intestine and exerts a local spasmolytic effect.Ten placebo-controlled studies have evaluated the efficacy and safety of oral or rectal hyoscine butylbromide. Hyoscine butylbromide was considered beneficial in all of these trials, which supports its use in the treatment of abdominal

  2. CLINICIAN PROFICIENCY IN DELIVERING MANUAL TREATMENT FOR NECK PAIN WITHIN SPECIFIED FORCE RANGES

    PubMed Central

    Gudavalli, Maruti Ram; Vining, Robert D.; Salsbury, Stacie A.; Corber, Lance; Long, Cynthia R.; Patwardhan, Avinash G.; Goertz, Christine M.

    2015-01-01

    Background Context Neck pain is a common musculoskeletal complaint responsive to manual therapies. Doctors of chiropractic commonly use manual cervical distraction, a mobilization procedure, to treat neck pain patients. However, it is unknown if clinicians can consistently apply standardized cervical traction forces, a critical step toward identifying an optimal therapeutic dose. Purpose The purpose of this study was to assess clinicians’ proficiency in delivering manually applied traction forces within specified ranges to neck pain patients. Study Design/Setting Observational study nested within a randomized clinical trial. Sample Two research clinicians provided study interventions to 48 participants with neck pain. Outcome Measures Clinician proficiency in delivering cervical traction forces within three specified ranges (low force <20 newtons (N); medium force 21–50N; and high force 51–100N). Methods This study was funded by a grant from the National Center for Complementary and Alternative Medicine, National Institutes of Health (Grant # 1 U19AT004663-01), and conducted in a facility funded by National Center for Research Resources, National Institutes of Health (Grant # C06 RR15433-01), and approved by an Institutional Review Board for the protection of human subjects. Senior author receives approximately $400–600 travel reimbursements per year for giving research presentations at certification seminars. The table manufacturer (Haven Innovations) sold the treatment table at a discounted price ($5000 discount) for research purposes. Participants were randomly allocated to three force-based treatment groups. Participants received five manual cervical distraction treatments over two weeks while lying prone on a treatment table instrumented with force sensors. Two clinicians delivered manual traction forces by treatment group. Clinicians treated participants first without real-time visual feedback displaying traction force and then with visual feedback

  3. Postoperative Pain after Endodontic Treatment of Asymptomatic Teeth Using Rotary Instruments: A Randomized Clinical Trial

    PubMed Central

    Shahi, Shahriar; Asghari, Vahideh; Rahimi, Saeed; Lotfi, Mehrdad; Samiei, Mohammad; Yavari, Hamidreza; Shakouie, Sahar; Nezafati, Saeed

    2016-01-01

    Introduction: The aim of the present study was to compare the effect of two different rotary instruments on postoperative pain in teeth with asymptomatic irreversible pulpitis. Methods and Materials: A total of 78 mandibular first and second molars were divided into two groups (n=39) and their root canal preparation was carried out with either RaCe or ProTaper rotary instruments. All the subjects underwent one-visit root canal treatment and the severity of postoperative pain was evaluated using visual analog scale (VAS) at 4-, 12-, 24-, 48- and 72-h and 1-week intervals. In addition, the need for taking analgesics was recorded. Data were analyzed with the repeated-measures ANOVA and the Mann-Whitney U test was used for two-by-two comparison. Statistical significance was set at 0.05. Results: Comparison of mean pain severity between the two groups at various postoperative intervals did not reveal any significant differences (P=0.10). The difference in amount of analgesics taken by each groups was not statistically significant (P=0.25). Conclusion: There were no significant differences in the postoperative pain reported between the two groups; which indicates the clinical acceptability of both systems. PMID:26843876

  4. Optimizing deep hyperthermia treatments: are locations of patient pain complaints correlated with modelled SAR peak locations?

    NASA Astrophysics Data System (ADS)

    Canters, R. A. M.; Franckena, M.; van der Zee, J.; van Rhoon, G. C.

    2011-01-01

    During deep hyperthermia treatment, patient pain complaints due to heating are common when maximizing power. Hence, there exists a good rationale to investigate whether the locations of predicted SAR peaks by hyperthermia treatment planning (HTP) are correlated with the locations of patient pain during treatment. A retrospective analysis was performed, using the treatment reports of 35 patients treated with deep hyperthermia controlled by extensive treatment planning. For various SAR indicators, the average distance from a SAR peak to a patient discomfort location was calculated, for each complaint. The investigated V0.1 closest (i.e. the part of the 0.1th SAR percentile closest to the patient complaint) performed the best, and leads to an average distance between the SAR peak and the complaint location of 3.9 cm. Other SAR indicators produced average distances that were all above 10 cm. Further, the predicted SAR peak location with V0.1 provides a 77% match with the region of complaint. The current study demonstrates that HTP is able to provide a global indication of the regions where hotspots during treatment will most likely occur. Further development of this technology is necessary in order to use HTP as a valuable toll for objective and advanced SAR steering. The latter is especially valid for applications that enable 3D SAR steering.

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

    PubMed

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

    2011-01-01

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

  6. A primary care-based interdisciplinary team approach to the treatment of chronic pain utilizing a pragmatic clinical trials framework.

    PubMed

    Debar, Lynn L; Kindler, Lindsay; Keefe, Francis J; Green, Carla A; Smith, David H; Deyo, Richard A; Ames, Katharine; Feldstein, Adrianne

    2012-12-01

    Chronic pain affects at least 116 million adults in the USA and exacts a tremendous cost in suffering and lost productivity. While health systems offer specialized pain services, the primary care setting is where most patients seek and receive care for pain. Primary care-based treatment of chronic pain by interdisciplinary teams (including behavioral specialists, nurse case managers, physical therapists, and pharmacists) is one of the most effective approaches for improving outcomes and managing costs. To ensure robust integration of such services into sustainable health-care programs, evaluations must be conducted by researchers well versed in the methodologies of clinical trials, mixed methods and implementation research, bioinformatics, health services, and cost-effectiveness. Recent national health policy changes, in addition to the increasing recognition of the high prevalence and cost of chronic pain conditions, present a unique opportunity to shift the care paradigm for patients with chronic pain. PMID:23440672

  7. Treatment seeking behaviour in southern Chinese elders with chronic orofacial pain: a qualitative study

    PubMed Central

    2014-01-01

    Background Chronic orofacial pain (OFP) is common in general adult populations worldwide. High levels of psychological distress and impaired coping abilities are common among Western people with chronic OFP but limited information was found in southern Chinese people. This study aimed to explore the perceptions and experiences of community dwelling elderly people with chronic OFP symptoms and their treatment seeking behaviour in Hong Kong. Methods An exploratory qualitative interview study was conducted. Elderly people experiencing chronic OFP symptoms were invited to take part in an individual semi-structured interview. A total of 25 semi-structured interviews were performed for 25 participants. Results Pertinent issues relating to the treatment seeking behaviour emerged from the interviews, many of which were inter-related and overlapping. They were organized into three major themes: (i) Impact of chronic OFP on daily life; (ii) Personal knowledge and feeling of chronic OFP; (iii) Management of chronic OFP. The participants were found to have the intention to seek professional treatment, but there were barriers which discouraged them continuing to seek professional treatment. They also received complementary treatment for chronic OFP, such as acupuncture, massage and “chi kung”. Moreover, a wide range self-management techniques were also mentioned. On the other hand, those who did not seek professional treatment for the chronic OFP claimed that they had accepted or adapted to the pain as part of their lives. Conclusions This qualitative study observed that elderly people affected by chronic OFP symptoms in Hong Kong sought many different ways to manage their pain including traditional and complementary approaches. The role of the dentist in dealing with chronic OFP is unclear. Multiple barriers exist to accessing care for chronic OFP. The findings may be used to inform future chronic OFP management strategies in Hong Kong. PMID:24460663

  8. Building a diagnostic algorithm on localized neuropathic pain (LNP) and targeted topical treatment: focus on 5% lidocaine-medicated plaster

    PubMed Central

    Casale, Roberto; Mattia, Consalvo

    2014-01-01

    Within the broad definition of neuropathic pain, the refinement of clinical diagnostic procedures has led to the introduction of the concept of localized neuropathic pain (LNP). It is characterized by consistent and circumscribed area(s) of maximum pain, which are associated with negative or positive sensory signs and/or spontaneous symptoms typical of neuropathic pain. This description outlines the clinical features (currently lacking in guidelines and treatment recommendations) in patients for whom topical targeted treatment with 5% lidocaine-medicated plaster is suggested as first-line therapy. Few epidemiologic data are present in the literature but it is generally estimated that about 60% of neuropathic pain conditions are localized, and therefore identifiable as LNP. A mandatory clinical criterion for the diagnosis of LNP is that signs and symptoms must be present in a clearly identified and defined area(s). Cartographic recordings can help to define each area and to assess variations. The diagnosis of LNP relies on careful neurological examination more than on pain questionnaires, but it is recognized that they can be extremely useful for recording the symptom profiles and establishing a more targeted treatment. The most widely studied frequent/relevant clinical presentations of LNP are postherpetic neuralgia, diabetic neuropathy, and neuropathic postoperative pain. They successfully respond to treatment with 5% lidocaine-medicated plaster with equal if not better pain control but with fewer side effects versus conventional systemic treatments. Generally, the more localized the pain (ie, the area of an A4 sheet of paper) the better the results of topical treatment. This paper proposes an easy-to-understand algorithm to identify patients with LNP and to guide targeted topical treatments with 5% lidocaine medicated plaster. PMID:24790451

  9. Topical treatment with Tong-Luo-San-Jie Gel alleviates bone cancer pain in rats

    PubMed Central

    Wang, Juyong; Zhang, Ruixin; Dong, Changsheng; Jiao, Liying; Xu, Ling; Liu, Jiyong; Wang, Zhengtao; Ying, Qi Liang Mao; Fong, Harry; Lao, Lixing

    2012-01-01

    Ethnopharmacological relevance The herbal analgesic gel Tong-Luo-San-Jie (TLSJ) and its modifications are used in traditional Chinese medicine to manage cancer pain. However, its mechanisms are still unknown. Aim of the study To investigate the effects and mechanisms of TLSJ gel on bone cancer pain in a rat model. Materials and Methods A bone cancer pain rat model was established by inoculating Walker 256 rat carcinoma cells directly into the right tibial medullary cavity of Sprague-Dawley rats (150–170 g); Phosphate buffered saline (PBS) tibial inoculation was used as control. Cancer-bearing rats were treated twice a day with external TLSJ gel (0.5 g/cm2/day) or inert gel control for 21 days (n=10/group). Behavioral tests such as mechanical threshold and paw withdrawal latency (PWL) were carried out. Osteoclastic activities were determined and carboxyterminal pyridinoline cross-linked type I collagen telopeptides (ICTP) and bone-specific alkaline phosphatase (BAP) concentrations were detected with ELISA after treatment. Adverse effects were monitored, and biochemical and histological tests were performed in naïve rats treated with local TLSJ gel for six weeks. Results TLSJ treatment significantly restored bone cancer-induced decrease of PWL and mechanical threshold compared to inert gel. It also decreased the level of blood serum ICTP and BAP and inhibited osteoclast activities. No adverse effects or abnormal biochemical and histological changes were detected after TLSJ treatment. Conclusion The present study shows that TLSJ significantly inhibits bone cancer-induced thermal and mechanical sensitization. It suggests that the gel may be useful in managing cancer pain and that it may act by inhibiting osteoclastic activity. PMID:22960543

  10. Mesotherapy versus Systemic Therapy in the Treatment of Acute Low Back Pain: A Randomized Trial.

    PubMed

    Costantino, Cosimo; Marangio, Emilio; Coruzzi, Gabriella

    2011-01-01

    Pharmacological therapy of back pain with analgesics and anti-inflammatory drugs is frequently associated with adverse effects, particularly in the elderly. Aim of this study was to compare mesotherapic versus conventional systemic administration of nonsteroidal anti-inflammatory drugs (NSAIDs) and corticosteroids in patients with acute low back pain. Eighty-four patients were randomized to receive anti-inflammatory therapy according to the following protocols: (a) mesotherapy group received the 1st and 4th day 2% lidocaine (1 mL) + ketoprofen 160 mg (1 mL) + methylprednisolone 40 mg (1 mL), then on 7th, 10th, and 13th day, 2% lidocaine (1 mL) + ketoprofen 160 mg (1 mL) + methylprednisolone 20 mg (1 mL) (b) conventional therapy group received ketoprofen 80 mg × 2/die and esomeprazole 20 mg/die orally for 12 days, methylprednisolone 40 mg/die intramuscularly for 4 days, followed by methylprednisolone 20 mg/die for 3 days, and thereafter, methylprednisolone 20 mg/die at alternate days. Pain intensity and functional disability were assessed at baseline (T0), at the end of treatment (T1), and 6 months thereafter (T2) by using visual analogic scale (VAS) and Roland-Morris disability questionnaire (RMDQ). In both groups, VAS and RMDQ values were significantly reduced at the end of drug treatment and after 6 months, in comparison with baseline. No significant differences were found between the two groups. This suggests that mesotherapy may be a valid alternative to conventional therapy in the treatment of acute low back pain with corticosteroids and NSAIDs. PMID:20953425

  11. Patellofemoral Pain.

    PubMed

    Dutton, Rebecca A; Khadavi, Michael J; Fredericson, Michael

    2016-02-01

    Patellofemoral pain is characterized by insidious onset anterior knee pain that is exaggerated under conditions of increased patellofemoral joint stress. A variety of risk factors may contribute to the development of patellofemoral pain. It is critical that the history and physical examination elucidate those risk factors specific to an individual in order to prescribe an appropriate and customized treatment plan. This article aims to review the epidemiology, risk factors, diagnosis, and management of patellofemoral pain. PMID:26616176

  12. Predicting response to physiotherapy treatment for musculoskeletal shoulder pain: protocol for a longitudinal cohort study

    PubMed Central

    2013-01-01

    Background Shoulder pain affects all ages, with a lifetime prevalence of one in three. The most effective treatment is not known. Physiotherapy is often recommended as the first choice of treatment. At present, it is not possible to identify, from the initial physiotherapy assessment, which factors predict the outcome of physiotherapy for patients with shoulder pain. The primary objective of this study is to identify which patient characteristics and baseline measures, typically assessed at the first physiotherapy appointment, are related to the functional outcome of shoulder pain 6 weeks and 6 months after starting physiotherapy treatment. Methods/Design Participants with musculoskeletal shoulder pain of any duration will be recruited from participating physiotherapy departments. For this longitudinal cohort study, the participants care pathway, including physiotherapy treatment will be therapist determined. Potential prognostic variables will be collected from participants during their first physiotherapy appointment and will include demographic details, lifestyle, psychosocial factors, shoulder symptoms, general health, clinical examination, activity limitations and participation restrictions. Outcome measures (Shoulder Pain and Disability Index, Quick Disability of the Arm, Shoulder and Hand, and Global Impression of Change) will be collected by postal self-report questionnaires 6 weeks and 6 months after commencing physiotherapy. Details of attendance and treatment will be collected by the treating physiotherapist. Participants will be asked to complete an exercise dairy. An initial exploratory analysis will assess the relationship between potential prognostic factors at baseline and outcome using univariate statistical tests. Those factors significant at the 5% level will be further considered as prognostic factors using a general linear model. It is estimated that 780 subjects will provide more than 90% power to detect an effect size of less than 0

  13. The treatment of myofascial pain-dysfunction syndrome using the biofeedback principle.