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Sample records for chronic pain acceptance

  1. Mindfulness, acceptance and catastrophizing in chronic pain.

    Directory of Open Access Journals (Sweden)

    Maaike J de Boer

    Full Text Available OBJECTIVES: Catastrophizing is often the primary target of the cognitive-behavioral treatment of chronic pain. Recent literature on acceptance and commitment therapy (ACT suggests an important role in the pain experience for the concepts mindfulness and acceptance. The aim of this study is to examine the influence of mindfulness and general psychological acceptance on pain-related catastrophizing in patients with chronic pain. METHODS: A cross-sectional survey was conducted, including 87 chronic pain patients from an academic outpatient pain center. RESULTS: The results show that general psychological acceptance (measured with the AAQ-II is a strong predictor of pain-related catastrophizing, independent of gender, age and pain intensity. Mindfulness (measured with the MAAS did not predict levels of pain-related catastrophizing. DISCUSSION: Acceptance of psychological experiences outside of pain itself is related to catastrophizing. Thus, acceptance seems to play a role in the pain experience and should be part of the treatment of chronic pain. The focus of the ACT treatment of chronic pain does not necessarily have to be on acceptance of pain per se, but may be aimed at acceptance of unwanted experiences in general. Mindfulness in the sense of "acting with awareness" is however not related to catastrophizing. Based on our research findings in comparisons with those of other authors, we recommend a broader conceptualization of mindfulness and the use of a multifaceted questionnaire for mindfulness instead of the unidimensional MAAS.

  2. Mindfulness, Acceptance and Catastrophizing in Chronic Pain

    NARCIS (Netherlands)

    de Boer, Maaike J.; Steinhagen, Hannemike E.; Versteegen, Gerbrig J.; Struys, Michel M. R. F.; Sanderman, Robbert

    2014-01-01

    Objectives: Catastrophizing is often the primary target of the cognitive-behavioral treatment of chronic pain. Recent literature on acceptance and commitment therapy (ACT) suggests an important role in the pain experience for the concepts mindfulness and acceptance. The aim of this study is to exami

  3. Depressive symptoms and pain evaluations among persons with chronic pain: catastrophizing, but not pain acceptance, shows significant effects.

    Science.gov (United States)

    Richardson, Elizabeth J; Ness, Timothy J; Doleys, Daniel M; Baños, James H; Cianfrini, Leanne; Richards, J Scott

    2009-12-15

    Cognitive factors such as catastrophic thoughts regarding pain, and conversely, one's acceptance of that pain, may affect emotional functioning among persons with chronic pain conditions. The aims of the present study were to examine the effects of both catastrophizing and acceptance on affective ratings of experimentally induced ischemic pain and also self-reports of depressive symptoms. Sixty-seven individuals with chronic back pain completed self-report measures of catastrophizing, acceptance, and depressive symptoms. In addition, participants underwent an ischemic pain induction procedure and were asked to rate the induced pain. Catastrophizing showed significant effects on sensory and intensity but not affective ratings of the induced pain. Acceptance did not show any significant associations, when catastrophizing was also in the model, with any form of ratings of the induced pain. Catastrophizing, but not acceptance, was also significantly associated with self-reported depressive symptoms when these two variables were both included in a regression model. Overall, results indicate negative thought patterns such as catastrophizing appear to be more closely related to outcomes of perceived pain severity and affect in persons with chronic pain exposed to an experimental laboratory pain stimulus than does more positive patterns as reflected in measures of acceptance.

  4. Do Patients with Chronic Noncancer Pain Accept Treatment of Questionable Benefit More Readily that those Who Are Pain Free?

    Directory of Open Access Journals (Sweden)

    Mark K Simmonds

    2004-01-01

    Full Text Available BACKGROUND: The efficacy of some common, questionable chronic pain interventions has been debated and it is unclear why sufferers of chronic noncancer pain agree to receive them. This study attempts to determine if chronic pain sufferers characteristically more readily accept treatment with questionable benefit.

  5. Validation of the Danish-language chronic pain acceptance questionnaire

    DEFF Research Database (Denmark)

    la Cour, P; Højsted, J

    2015-01-01

    version of the CPAQ. METHODS: A total of 114 patients with chronic pain completed the questionnaire as well as other measures of pain, anxiety, depression, coping, and health-related quality of life. RESULTS: Internal consistency was satisfactory and the factorial analysis yielded a two-factor solution...

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

    Science.gov (United States)

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

    2007-01-01

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

  7. Neurophysiological mechanisms in acceptance and commitment therapy in opioid-addicted patients with chronic pain.

    Science.gov (United States)

    Smallwood, Rachel F; Potter, Jennifer S; Robin, Donald A

    2016-04-30

    Acceptance and Commitment Therapy (ACT) has been effectively utilized to treat both chronic pain and substance use disorder independently. Given these results and the vital need to treat the comorbidity of the two disorders, a pilot ACT treatment was implemented in individuals with comorbid chronic pain and opioid addiction. This pilot study supported using neurophysiology to characterize treatment effects and revealed that, following ACT, participants with this comorbidity exhibited reductions in brain activation due to painful stimulus and in connectivity at rest.

  8. Construct validity and reliability of the slovenian version of the Chronic Pain Acceptance Questionnaire (CPAQ

    Directory of Open Access Journals (Sweden)

    Barbara Horvat

    2014-11-01

    Full Text Available The psychological concept of acceptance has been increasingly considered in the process of chronic pain acceptance. The concept includes exposure to pain experienced without attempts of avoidance or control, and persistence in the physical activity in spite of chronic pain. At the University Rehabilitation Institute (URI in Ljubljana, we are using the Slovenian version of the Chronic Pain Acceptance Questionnaire (CPAQ; McCracken et al., 2004 for measuring the concept of acceptance. The aim of our study was to investigate its construct validity (fit of the two-factor model, i.e., the division of the 20 items into the Pain Willingness and Activity Engagement scales and its internal-consistency and retest reliability. The study included 241 participants who were examined at the outpatient clinic for patients with chronic non-malignant pain at the URI between March 2011 and June 2013. All of them completed the CPAQ. Confirmatory factor analysis and item analysis both pointed to inadequacy of the item No. 16, which should be either excluded or reworded. In general, reliability of the questionnaire (internal consistency of the two scales and of the total score, as well as retest reliability proved to be adequate for research application.

  9. Neurophysiological mechanisms in acceptance and commitment therapy in opioid-addicted patients with chronic pain.

    Science.gov (United States)

    Smallwood, Rachel F; Potter, Jennifer S; Robin, Donald A

    2016-04-30

    Acceptance and Commitment Therapy (ACT) has been effectively utilized to treat both chronic pain and substance use disorder independently. Given these results and the vital need to treat the comorbidity of the two disorders, a pilot ACT treatment was implemented in individuals with comorbid chronic pain and opioid addiction. This pilot study supported using neurophysiology to characterize treatment effects and revealed that, following ACT, participants with this comorbidity exhibited reductions in brain activation due to painful stimulus and in connectivity at rest. PMID:27107155

  10. Using Acceptance and Commitment Therapy in the Rehabilitation of an Adolescent Female with Chronic Pain: A Case Example

    Science.gov (United States)

    Wicksell, Rikard K.; Dahl, JoAnne; Magnusson, Bo; Olsson, Gunnar L.

    2005-01-01

    This case example illustrates how Acceptance and Commitment Therapy (ACT) within a behavior medicine approach was used in the rehabilitation of an adolescent with debilitating chronic pain. For chronic pain with unclear etiology (idiopathic pain), pharmacological therapy alone is often insufficient. Psychological treatment strategies have been…

  11. A comprehensive examination of the model underlying acceptance and commitment therapy for chronic pain.

    Science.gov (United States)

    Vowles, Kevin E; Sowden, Gail; Ashworth, Julie

    2014-05-01

    The therapeutic model underlying Acceptance and Commitment Therapy (ACT) is reasonably well-established as it applies to chronic pain. Several studies have examined measures of single ACT processes, or subsets of processes, and have almost uniformly indicated reliable relations with patient functioning. To date, however, no study has performed a comprehensive examination of the entire ACT model, including all of its component processes, as it relates to functioning. The present study performed this examination in 274 individuals with chronic pain presenting for an assessment appointment. Participants completed a battery of self-report questionnaires, assessing multiple aspects of the ACT model, as well as pain intensity, disability, and emotional distress. Initial exploratory factor analyses examined measures of the ACT model and measures of patient functioning separately with each analysis identifying three factors. Next, the fit of a model including ACT processes on the one hand and patient functioning on the other was examined using Structural Equation Modeling. Overall model fit was acceptable and indicated moderate correlations among the ACT processes themselves, as well as significant relations with pain intensity, emotional distress, and disability. These analyses build on the existing literature by providing, to our knowledge, the most comprehensive evaluation of the ACT theoretical model in chronic pain to date.

  12. Psychological flexibility and catastrophizing as associated change mechanisms during online Acceptance & Commitment Therapy for chronic pain.

    Science.gov (United States)

    Trompetter, Hester R; Bohlmeijer, Ernst T; Fox, Jean-Paul; Schreurs, Karlein M G

    2015-11-01

    The underlying mechanisms of the effectiveness of cognitive behavioural interventions for chronic pain need further clarification. The role of, and associations between, pain-related psychological flexibility (PF) and pain catastrophizing (PC) were examined during a randomized controlled trial on internet-based Acceptance & Commitment Therapy (ACT) for chronic pain. We assessed (1) the unique and combined indirect effects of PF and PC on outcomes, and (2) the causality of relations between PF, PC and the primary outcome pain interference in daily life (MPI) during ACT. A total of 238 pain sufferers were allocated to either ACT, a control condition on Expressive Writing, or a waiting list condition. Non-parametric cross-product of coefficients mediational analyses and cross-lagged panel designs were applied. Compared to control conditions, both baseline to post-intervention changes in PF and PC seemed to uniquely mediate baseline to three-month follow-up changes in pain interference and psychological distress. Only PF mediated changes in pain intensity. Indirect effects were twice as large for PF (κ2 = .09-.19) than for PC (κ² PCS = .05-.10). Further assessment of changes during ACT showed, however, that only PF, and not PC, predicted subsequent changes in MPI, while early and late changes in both PF and PC predicted later changes in each other. In conclusion, only PF functioned as a direct, causal working mechanism during ACT, with larger indirect effects that occurred earlier than changes in PC. Additionally, PC may function as an indirect mechanism of change during ACT for chronic pain via its direct influence on PF.

  13. Acceptability of an acupuncture intervention for geriatric chronic pain: an open pilot study

    Institute of Scientific and Technical Information of China (English)

    Marie-France Couilliot; Véronique Darees; Gérard Delahaye; Philippe Ercolano; Maud Carcaillé; Pavla Vytopilova; Bruno Tenenbaum

    2013-01-01

    OBJECTIVE:This study investigated the acceptability and effectiveness of acupuncture for persistent musculoskeletal pain in the elderly and assessed the conditions for a future controlled trial.METHODS:A total of 60 patients,hospitalized in a geriatric hospital were enrolled.The intervention consisted of eight acupuncture sessions.The main outcome was the patient's participation rate.Regarding pain,the evaluation was based on pre-and post-treatment variations.As a high proportion of the patients had cognitive impairment,the behavioral pain scale DOLOPLUS-2 was chosen although self evaluation was used wherever possible.RESULTS:The mean age of the patients was 83 years.The acceptance rate was very high (89.6%) and 90% of the patients completed the entire course of treatment.After five weeks,the mean DOLOPLUS score had decreased significantly (P<0.01).The patients reported improved sleep quality and a reduction in their anxiety symptoms.Furthermore,caregivers noticed a decrease in patient aggressiveness making care easier.CONCLUSION:Our results suggest that acupuncture is highly acceptable and could be very useful in the management of chronic pain when performed in very old frail people with chronic physical and mental disability.TRIAL REGISTRATION IDENTIFIER:NCT01043692 ClinicalTrials.gov.

  14. Several submaximal exercise tests are reliable, valid and acceptable in people with chronic pain, fibromyalgia or chronic fatigue: a systematic review

    Directory of Open Access Journals (Sweden)

    Julia Ratter

    2014-09-01

    [Ratter J, Radlinger L, Lucas C (2014 Several submaximal exercise tests are reliable, valid and acceptable in people with chronic pain, fibromyalgia or chronic fatigue: a systematic review. Journal of Physiotherapy 60: 144–150

  15. Acceptance- and mindfulness-based interventions for the treatment of chronic pain: a meta-analytic review.

    Science.gov (United States)

    Veehof, M M; Trompetter, H R; Bohlmeijer, E T; Schreurs, K M G

    2016-01-01

    The number of acceptance- and mindfulness-based interventions for chronic pain, such as acceptance and commitment therapy (ACT), mindfulness-based stress reduction (MBSR), and mindfulness-based cognitive therapy (MBCT), increased in recent years. Therefore an update is warranted of our former systematic review and meta-analysis of studies that reported effects on the mental and physical health of chronic pain patients. Pubmed, EMBASE, PsycInfo and Cochrane were searched for eligible studies. Current meta-analysis only included randomized controlled trials (RCTs). Studies were rated for quality. Mean quality did not improve in recent years. Pooled standardized mean differences using the random-effect model were calculated to represent the average intervention effect and, to perform subgroup analyses. Outcome measures were pain intensity, depression, anxiety, pain interference, disability and quality of life. Included were twenty-five RCTs totaling 1285 patients with chronic pain, in which we compared acceptance- and mindfulness-based interventions to the waitlist, (medical) treatment-as-usual, and education or support control groups. Effect sizes ranged from small (on all outcome measures except anxiety and pain interference) to moderate (on anxiety and pain interference) at post-treatment and from small (on pain intensity and disability) to large (on pain interference) at follow-up. ACT showed significantly higher effects on depression and anxiety than MBSR and MBCT. Studies' quality, attrition rate, type of pain and control group, did not moderate the effects of acceptance- and mindfulness-based interventions. Current acceptance- and mindfulness-based interventions, while not superior to traditional cognitive behavioral treatments, can be good alternatives. PMID:26818413

  16. Low back pain - chronic

    Science.gov (United States)

    Nonspecific back pain; Backache - chronic; Lumbar pain - chronic; Pain - back - chronic; Chronic back pain - low ... Low back pain is common. Almost everyone has back pain at some time in their life. Often, the exact cause ...

  17. Chronic pain - resources

    Science.gov (United States)

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

  18. Chronic Pelvic Pain

    Science.gov (United States)

    ... Events Advocacy For Patients About ACOG Chronic Pelvic Pain Home For Patients Search FAQs Chronic Pelvic Pain ... Pain FAQ099, August 2011 PDF Format Chronic Pelvic Pain Gynecologic Problems What is chronic pelvic pain? What ...

  19. Employees with Chronic Pain

    Science.gov (United States)

    ... Home | Accommodation and Compliance Series: Employees with Chronic Pain By Beth Loy, Ph.D. Preface Introduction Information ... at http://AskJAN.org/soar. Information about Chronic Pain How prevalent is chronic pain? Chronic pain has ...

  20. Positive Psychological Wellbeing Is Required for Online Self-Help Acceptance and Commitment Therapy for Chronic Pain to be Effective.

    Science.gov (United States)

    Trompetter, Hester R; Bohlmeijer, Ernst T; Lamers, Sanne M A; Schreurs, Karlein M G

    2016-01-01

    The web-based delivery of psychosocial interventions is a promising treatment modality for people suffering from chronic pain, and other forms of physical and mental illness. Despite the promising findings of first studies, patients may vary in the benefits they draw from self-managing a full-blown web-based psychosocial treatment. We lack knowledge on moderators and predictors of change during web-based interventions that explain for whom web-based interventions are especially (in)effective. In this study, we primarily explored for which chronic pain patients web-based Acceptance and Commitment Therapy (ACT) was (in)effective during a large three-armed randomized controlled trial. Besides standard demographic, physical and psychosocial factors we focused on positive mental health. Data from 238 heterogeneously diagnosed chronic pain sufferers from the general Dutch population following either web-based ACT (n = 82), or one of two control conditions [web-based Expressive Writing (EW; n = 79) and Waiting List (WL; n = 77)] were analysed. ACT and EW both consisted of nine modules and lasted nine to 12 weeks. Exploratory linear regression analyses were performed using the PROCESS macro in SPSS. Pain interference at 3-month follow-up was predicted from baseline moderator (characteristics that influence the outcome of specific treatments in comparison to other treatments) and predictor (characteristics that influence outcome regardless of treatment) variables. The results showed that none of the demographic or physical characteristics moderated ACT treatment changes compared to both control conditions. The only significant moderator of change compared to both EW and WL was baseline psychological wellbeing, and pain intensity was a moderator of change compared to EW. Furthermore, higher pain interference, depression and anxiety, and also lower levels of emotional well-being predicted higher pain interference in daily life 6 months later. These results suggest that web

  1. Positive Psychological Wellbeing Is Required for Online Self-Help Acceptance and Commitment Therapy for Chronic Pain to be Effective.

    Science.gov (United States)

    Trompetter, Hester R; Bohlmeijer, Ernst T; Lamers, Sanne M A; Schreurs, Karlein M G

    2016-01-01

    The web-based delivery of psychosocial interventions is a promising treatment modality for people suffering from chronic pain, and other forms of physical and mental illness. Despite the promising findings of first studies, patients may vary in the benefits they draw from self-managing a full-blown web-based psychosocial treatment. We lack knowledge on moderators and predictors of change during web-based interventions that explain for whom web-based interventions are especially (in)effective. In this study, we primarily explored for which chronic pain patients web-based Acceptance and Commitment Therapy (ACT) was (in)effective during a large three-armed randomized controlled trial. Besides standard demographic, physical and psychosocial factors we focused on positive mental health. Data from 238 heterogeneously diagnosed chronic pain sufferers from the general Dutch population following either web-based ACT (n = 82), or one of two control conditions [web-based Expressive Writing (EW; n = 79) and Waiting List (WL; n = 77)] were analysed. ACT and EW both consisted of nine modules and lasted nine to 12 weeks. Exploratory linear regression analyses were performed using the PROCESS macro in SPSS. Pain interference at 3-month follow-up was predicted from baseline moderator (characteristics that influence the outcome of specific treatments in comparison to other treatments) and predictor (characteristics that influence outcome regardless of treatment) variables. The results showed that none of the demographic or physical characteristics moderated ACT treatment changes compared to both control conditions. The only significant moderator of change compared to both EW and WL was baseline psychological wellbeing, and pain intensity was a moderator of change compared to EW. Furthermore, higher pain interference, depression and anxiety, and also lower levels of emotional well-being predicted higher pain interference in daily life 6 months later. These results suggest that web

  2. Positive psychological wellbeing is required for online self-help Acceptance & Commitment Therapy for chronic pain to be effective.

    Directory of Open Access Journals (Sweden)

    Hester R. Trompetter

    2016-03-01

    Full Text Available The web-based delivery of psychosocial interventions is a promising treatment modality for people suffering from chronic pain, and other forms of physical and mental illness. Despite the promising findings of first studies, patients may vary in the benefits they draw from self-managing a full-blown web-based psychosocial treatment. We lack knowledge on moderators and predictors of change during web-based interventions that explain for whom web-based interventions are especially (ineffective. In this study, we primarily explored for which chronic pain patients web-based Acceptance & Commitment Therapy (ACT was (ineffective during a large three-armed randomized controlled trial. Besides standard demographic, physical and psychosocial factors we focused on positive mental health. Data from 238 heterogeneously diagnosed chronic pain sufferers from the general Dutch population following either web-based ACT (n=82, or one of two control conditions (web-based Expressive Writing (EW; n=79 and waiting list (WL; n=77 were analysed. ACT and EW both consisted of nine modules and lasted nine to twelve weeks. Exploratory linear regression analyses were performed using the PROCESS macro in SPSS. Pain interference at three-month follow-up was predicted from baseline moderator (characteristics that influence the outcome of specific treatments in comparison to other treatments and predictor (characteristics that influence outcome regardless of treatment variables. The results showed that none of the demographic or physical characteristics moderated ACT treatment changes compared to both control conditions. The only significant moderator of change compared to both EW and WL was baseline psychological wellbeing, and pain intensity was a moderator of change compared to EW. Furthermore, higher pain interference, depression and anxiety, and also lower levels of emotional well-being predicted higher pain interference in daily life six months later. These results

  3. Model and Processes of Acceptance and Commitment Therapy (ACT) for Chronic Pain Including a Closer Look at the Self.

    Science.gov (United States)

    Yu, Lin; McCracken, Lance M

    2016-02-01

    Acceptance and commitment therapy (ACT) is one of the so called "third-wave" cognitive behavioral therapies. It has been increasingly applied to chronic pain, and there is accumulating evidence to support its effectiveness. ACT is based on a model of general human functioning called the psychological flexibility (PF) model. Most facets of the PF model have been examined in chronic pain. However, a potential key facet related to "self" appears underappreciated. Indeed, a positive or healthy sense of self seems essential to our well-being, and there have been numerous studies of the self in chronic pain. At the same time, these studies are not currently well organized or easy to summarize. This lack of clarity and integration creates barriers to progress in this area of research. PF with its explicit inclusion of self-related therapeutic processes within a broad, integrative, theoretical model may help. The current review summarizes the PF model in the context of chronic pain with a specific emphasis on the parts of the model that address self-related processes. PMID:26803836

  4. Model and Processes of Acceptance and Commitment Therapy (ACT) for Chronic Pain Including a Closer Look at the Self.

    Science.gov (United States)

    Yu, Lin; McCracken, Lance M

    2016-02-01

    Acceptance and commitment therapy (ACT) is one of the so called "third-wave" cognitive behavioral therapies. It has been increasingly applied to chronic pain, and there is accumulating evidence to support its effectiveness. ACT is based on a model of general human functioning called the psychological flexibility (PF) model. Most facets of the PF model have been examined in chronic pain. However, a potential key facet related to "self" appears underappreciated. Indeed, a positive or healthy sense of self seems essential to our well-being, and there have been numerous studies of the self in chronic pain. At the same time, these studies are not currently well organized or easy to summarize. This lack of clarity and integration creates barriers to progress in this area of research. PF with its explicit inclusion of self-related therapeutic processes within a broad, integrative, theoretical model may help. The current review summarizes the PF model in the context of chronic pain with a specific emphasis on the parts of the model that address self-related processes.

  5. Changes in Sleep Problems and Psychological Flexibility Following Interdisciplinary Acceptance and Commitment Therapy for Chronic Pain: An Observational Cohort Study

    Directory of Open Access Journals (Sweden)

    Aisling Daly

    2016-08-01

    Full Text Available Aims: Cognitive and behavioral treatments (CBT for sleep problems and chronic pain have shown good results, although these results could improve. More recent developments based on the psychological flexibility model, the model underlying Acceptance and Commitment Therapy (ACT may offer a useful addition to traditional CBT. The aim of this study was to examine whether an ACT-based treatment for chronic pain is associated with improved sleep. Secondly, we examined the associations between changes on measures of psychological flexibility and sleep-related outcomes.Methods: The study used an observational cohort methodology. Participants were 252 patients (73.8% female attending a four-week, interdisciplinary, pain management program in London, United Kingdom. Participants completed standard self-report measures of pain and functioning, sleep outcomes, and processes of psychological flexibility. Pre- to post-treatment, and pre-treatment to follow-up measures were examined for statistically significant differences using paired samples t-tests. Secondarily, hierarchical multiple regression analyses were conducted to examine change in process measures in relation to change in treatment outcome.Results: Participants showed statistically significant improvements (all p<.001 at post-treatment on measures of insomnia severity (d=.45, sleep interference (d=61, and sleep efficiency (d=.32. Significant improvements in insomnia severity and sleep interference were also observed at nine-month follow up. Small to medium effect sizes were observed across the sleep outcomes. Statistically significant changes were also observed on measures of psychological flexibility, and these improvements were significantly associated with improvements on sleep-related outcomes, independently contributing up to 19% of unique variance. Conclusion: This study supports the potential usefulness of ACT-based treatments for chronic pain for addressing co-occurring sleep difficulties

  6. Changes in Sleep Problems and Psychological Flexibility following Interdisciplinary Acceptance and Commitment Therapy for Chronic Pain: An Observational Cohort Study

    Science.gov (United States)

    Daly-Eichenhardt, Aisling; Scott, Whitney; Howard-Jones, Matthew; Nicolaou, Thaleia; McCracken, Lance M.

    2016-01-01

    Aims: Cognitive and behavioral treatments (CBT) for sleep problems and chronic pain have shown good results, although these results could improve. More recent developments based on the psychological flexibility model, the model underlying Acceptance and Commitment Therapy (ACT) may offer a useful addition to traditional CBT. The aim of this study was to examine whether an ACT-based treatment for chronic pain is associated with improved sleep. Secondly, we examined the associations between changes on measures of psychological flexibility and sleep-related outcomes. Methods: The study used an observational cohort methodology. Participants were 252 patients (73.8% female) attending a 4-week, interdisciplinary, pain management program in London, United Kingdom. Participants completed standard self-report measures of pain and functioning, sleep outcomes, and processes of psychological flexibility. Pre- to post-treatment, and pre-treatment to follow-up measures were examined for statistically significant differences using paired samples t-tests. Secondarily, hierarchical multiple regression analyses were conducted to examine change in process measures in relation to change in treatment outcome. Results: Participants showed statistically significant improvements (all p Statistically significant changes were also observed on measures of psychological flexibility, and these improvements were significantly associated with improvements on sleep-related outcomes, independently contributing up to 19% of unique variance. Conclusion: This study supports the potential usefulness of ACT-based treatments for chronic pain for addressing co-occurring sleep difficulties. Further research is needed to determine how to improve the impact of this treatment for co-morbid pain and sleep difficulties, possibly using a randomized-controlled trial design. PMID:27630601

  7. Waiting for Treatment for Chronic Pain – a Survey of Existing Benchmarks: Toward Establishing Evidence-Based Benchmarks for Medically Acceptable Waiting Times

    Directory of Open Access Journals (Sweden)

    Mary E Lynch

    2007-01-01

    Full Text Available As medical costs escalate, health care resources must be prioritized. In this context, there is an increasing need for benchmarks and best practices in wait time management. In December 2005, the Canadian Pain Society struck a Task Force to identify benchmarks for acceptable wait times for treatment of chronic pain. The task force mandate included a systematic review and survey to identify national or international wait time benchmarks for chronic pain, proposed or in use, along with a review of the evidence upon which they are based. An extensive systematic review of the literature and a survey of International Association for the Study of Pain Chapter Presidents and key informants has identified that there are no established benchmarks or guidelines for acceptable wait times for the treatment of chronic pain in use in the world. In countries with generic guidelines or wait time standards that apply to all outpatient clinics, there have been significant challenges faced by pain clinics in meeting the established targets. Important next steps are to ensure appropriate additional research and the establishment of international benchmarks or guidelines for acceptable wait times for the treatment of chronic pain. This will facilitate advocacy for improved access to appropriate care for people suffering from chronic pain around the world.

  8. What Is Chronic Pain?

    Medline Plus

    Full Text Available ... Programs Resource Guide to Chronic Pain Treatments Pain Awareness Toolkits Partners for Understanding Pain September is Pain Awareness Month Home Pain Management Tools Videos What Is ...

  9. Acceptance and Commitment Therapy in the Rehabilitation of a Girl with Chronic Idiopathic Pain: Are We Breaking New Ground?

    Science.gov (United States)

    Asmundson, Gordon J. G.; Hadjistavropolous, Heather D.

    2006-01-01

    Wicksell and colleagues (2005) addressed the important and currently understudied realm of chronic idiopathic musculoskeletal pain treatment in children. They presented a brief overview of empirically supported treatments for children with chronic pain, detailed their case and intervention strategy, and offered conclusions regarding the potential…

  10. Untying chronic pain

    OpenAIRE

    Häuser, Winfried; Wolfe, Frederik; Henningsen, Peter; Schmutzer, Gabriele; Brähler, Elmar; Hinz, Andreas

    2014-01-01

    Background: Chronic pain is a major public health problem. The impact of stages of chronic pain adjusted for disease load on societal burden has not been assessed in population surveys. Methods: A cross-sectional survey with 4360 people aged ≥ 14 years representative of the German population was conducted. Measures obtained included demographic variables, presence of chronic pain (based on the definition of the International Association for the Study of Pain), chronic pain stages (by chronic ...

  11. Chronic pain after hysterectomy

    DEFF Research Database (Denmark)

    Brandsborg, B.; Nikolajsen, L.; Kehlet, H.;

    2008-01-01

    BACKGROUND: Chronic pain is a well-known adverse effect of surgery, but the risk of chronic pain after gynaecological surgery is less established. METHOD: This review summarizes studies on chronic pain following hysterectomy. The underlying mechanisms and risk factors for the development of chronic...... post-hysterectomy pain are discussed. RESULTS AND CONCLUSION: Chronic pain is reported by 5-32% of women after hysterectomy. A guideline is proposed for future prospective studies Udgivelsesdato: 2008/3...

  12. Chronic pain after hysterectomy

    DEFF Research Database (Denmark)

    Brandsborg, B; Nikolajsen, L; Kehlet, Henrik;

    2008-01-01

    BACKGROUND: Chronic pain is a well-known adverse effect of surgery, but the risk of chronic pain after gynaecological surgery is less established. METHOD: This review summarizes studies on chronic pain following hysterectomy. The underlying mechanisms and risk factors for the development of chronic...... post-hysterectomy pain are discussed. RESULTS AND CONCLUSION: Chronic pain is reported by 5-32% of women after hysterectomy. A guideline is proposed for future prospective studies. Udgivelsesdato: 2008-Mar...

  13. What Is Chronic Pain?

    Medline Plus

    Full Text Available ... 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. What Is Chronic Pain?

    Medline Plus

    Full Text Available Already a member? Log In or Sign Up Home About Us Support the ACPA Contact Us Shop ... for Understanding Pain September is Pain Awareness Month Home Pain Management Tools Videos What Is Chronic Pain? ...

  15. Acceptance and commitment therapy in youth with neurofibromatosis type 1 (NF1) and chronic pain and their parents: A pilot study of feasibility and preliminary efficacy.

    Science.gov (United States)

    Martin, Staci; Wolters, Pamela L; Toledo-Tamula, Mary Anne; Schmitt, Shawn Nelson; Baldwin, Andrea; Starosta, Amy; Gillespie, Andrea; Widemann, Brigitte

    2016-06-01

    Neurofibromatosis type 1 (NF1) is an autosomal dominant genetic disorder affecting about 1 in 3,500 individuals. Chronic pain is commonly reported among individuals with NF1 and plexiform neurofibroma tumors (PNs). Acceptance and Commitment Therapy (ACT), an empirically supported method for addressing chronic pain, helps individuals re-focus on valued relationships and activities. This pilot study investigated the feasibility and preliminary efficacy of a brief ACT workshop in the NF1 population. Eligible participants included adolescents and young adults (AYA; 12-21 years) with NF1 and chronic pain that interfered with daily functioning and their parents. Patients and parents completed baseline measures of pain interference, pain intensity, functional disability, pain acceptance, depression, and anxiety. Then, AYA and parents participated separately in a 2-day small-group ACT workshop. A telephone booster session occurred 1 month post-intervention. Three-month post-treatment measures were completed by mail. Ten adolescents (4 males; M age = 16.9 years) and seven parents provided baseline and 3-month data. Mean satisfaction with the study was moderate to high (3.9 for patients and 4.6 for parents on a 1-5 scales). Patients and parents reported significant declines in patients' pain interference at 3 months post-treatment. Patient-reported pain intensity significantly declined from baseline to 3 months. Parents reported marginally greater acceptance of their child's pain. No changes emerged in functional ability or mood. Preliminary findings suggest that a brief ACT group intervention is feasible and may help AYA with NF1 and PNs cope with their chronic pain, although larger randomized studies are needed to confirm treatment efficacy. © 2016 Wiley Periodicals, Inc. PMID:27021207

  16. Acceptance and commitment therapy in youth with neurofibromatosis type 1 (NF1) and chronic pain and their parents: A pilot study of feasibility and preliminary efficacy.

    Science.gov (United States)

    Martin, Staci; Wolters, Pamela L; Toledo-Tamula, Mary Anne; Schmitt, Shawn Nelson; Baldwin, Andrea; Starosta, Amy; Gillespie, Andrea; Widemann, Brigitte

    2016-06-01

    Neurofibromatosis type 1 (NF1) is an autosomal dominant genetic disorder affecting about 1 in 3,500 individuals. Chronic pain is commonly reported among individuals with NF1 and plexiform neurofibroma tumors (PNs). Acceptance and Commitment Therapy (ACT), an empirically supported method for addressing chronic pain, helps individuals re-focus on valued relationships and activities. This pilot study investigated the feasibility and preliminary efficacy of a brief ACT workshop in the NF1 population. Eligible participants included adolescents and young adults (AYA; 12-21 years) with NF1 and chronic pain that interfered with daily functioning and their parents. Patients and parents completed baseline measures of pain interference, pain intensity, functional disability, pain acceptance, depression, and anxiety. Then, AYA and parents participated separately in a 2-day small-group ACT workshop. A telephone booster session occurred 1 month post-intervention. Three-month post-treatment measures were completed by mail. Ten adolescents (4 males; M age = 16.9 years) and seven parents provided baseline and 3-month data. Mean satisfaction with the study was moderate to high (3.9 for patients and 4.6 for parents on a 1-5 scales). Patients and parents reported significant declines in patients' pain interference at 3 months post-treatment. Patient-reported pain intensity significantly declined from baseline to 3 months. Parents reported marginally greater acceptance of their child's pain. No changes emerged in functional ability or mood. Preliminary findings suggest that a brief ACT group intervention is feasible and may help AYA with NF1 and PNs cope with their chronic pain, although larger randomized studies are needed to confirm treatment efficacy. © 2016 Wiley Periodicals, Inc.

  17. Internet-based guided self-help intervention for chronic pain based on Acceptance and Commitment Therapy: a randomized controlled trial.

    Science.gov (United States)

    Trompetter, Hester R; Bohlmeijer, Ernst T; Veehof, Martine M; Schreurs, Karlein M G

    2015-02-01

    Acceptance-based psychological interventions can potentially minimize the burden of chronic pain. This randomized controlled trial evaluated an internet-delivered, guided self-help intervention based on Acceptance and Commitment Therapy (ACT). A total of 238 chronic pain sufferers from the general population were randomly allocated to either ACT (n = 82), an internet-based control condition Expressive Writing (n = 79) or a waiting list condition (n = 77). Participants completed measures at baseline, posttreatment (3 months) and at a 3-month follow-up. At follow-up, ACT participants had improved in pain interference in daily life (primary outcome) compared to participants in Expressive Writing (Cohen's d = .47), but not compared to waiting list participants (p value = .11). Those who adhered to the ACT-intervention (48%) did improve significantly compared to waiting list participants (d = .49). ACT-participants also showed superior improvement on depression, pain intensity, psychological inflexibility and pain catastrophizing (d: .28-.60). Significant clinical improvement was present. Especially, 28% of ACT-participants showed general clinically relevant improvement in pain interference, as well as in pain intensity and depression (vs. Expressive Writing and waiting list 5%). Given these findings, internet-based ACT programs may be a promising treatment modality for chronic pain.

  18. The Effectiveness of Acceptance and Commitment Therapy for Children with Chronic Pain (CHACT on the Function of 7 to 12 Year-Old children

    Directory of Open Access Journals (Sweden)

    Soheila Ghomian

    2014-07-01

    Full Text Available Purpose: The purpose of this study is to evaluate the effect of Acceptance and Commitment Therapy for Children with Chronic Pain (CHACT on the function of 7 to 12 year-old children. Thus, the basic problem of the current study is whether CHACT can improve the function level of 7 to 12 year-old children with chronic pain? Method: According to the criteria of chronic pain, a number of children with chronic pain were selected by available sampling method from specialty and subspecialty pediatric hospitals of Tehran. Then, among the children, 20 children who according to their parents prepared to participate in this study and met the inclusion criteria, were selected. They were placed in the experimental group (n = 10 and control group (n = 10. The child and parent versions of Function Disability Inventory (FDI were answered by children and parents in both groups at the pre-test, post-test, first and second follow-up. Result: The result showed that the experimental group compared with the control group showed significant change in function in multiple stages. These changes continued after the treatment, first and secondary follow-up. Conclusion: Regarding the impact of CHACT on the function of children with chronic pain, it can be said that this protocol can be used in clinical fields, especially in the area of improving the function that appears that is one of the most vulnerable areas that children with chronic pain are faced with it.

  19. Acceptance and Values-Based Action in Chronic Pain: A Study of Treatment Effectiveness and Process

    Science.gov (United States)

    Vowles, Kevin E.; McCracken, Lance M.

    2008-01-01

    Developing approaches within cognitive behavioral therapy are increasingly process-oriented and based on a functional and contextual framework that differs from the focus of earlier work. The present study investigated the effectiveness of acceptance and commitment therapy (S. C. Hayes, K. Strosahl, & K. G. Wilson, 1999) in the treatment of…

  20. Managing your chronic pain

    Science.gov (United States)

    ... your chronic back pain To use the sharing features on this page, please enable JavaScript. Managing chronic pain means finding ways to make your back pain tolerable so you can live your life. You may not be able to ...

  1. What Is Chronic Pain?

    Medline Plus

    Full Text Available ... chronic pain there may be no apparent physical injury or illness to explain it. The physician and ... expected period of healing for an illness or injury. You can experience pain even if you are ...

  2. The Effectiveness of Acceptance and Commitment Therapy for Children with Chronic Pain on the Quality of Life on 7 to 12 Year-Old Children

    Directory of Open Access Journals (Sweden)

    Soheila Ghomian

    2014-08-01

    Full Text Available Backgrounds: The purpose of this study is to evaluate the effect of Acceptance and Commitment Therapy for Children with Chronic Pain (CHACT on quality of life of 7 to 12 year-old children. Thus, the basic problem of the current study is whether CHACT can increase the quality of life on 7 to 12 year-old children with chronic pain?   Materials and Methods: According to the criteria of chronic pain, a number of children suffering from chronic pain were selected by available sampling method from specialty and subspecialty pediatric hospitals of Tehran. Then, among the children, 20 children who according to their parents were prepared to participate in this study and met the inclusion criteria, were selected and were placed in the experimental group (n=10, and the control group (n=10. The KID Screen was administered in both groups at the pre-test, post-test, first and second follow-up.   Results: The results showed that the experimental group compared with the control group showed significant change in quality of life in multiple stages( P

  3. [Association between chronic pain and depression].

    Science.gov (United States)

    Alonso Fernández, Francisco

    2005-01-01

    The comorbidity integrated by chronic pain and depression is very common. The somatoform depressive symptoms appear often as diferent types of pain. Amon them premenstrual pain and fibromialgia are some of the most important clinical pictures. Chronic pain leads to depression as a consequence of these three kinds of factors: biomedical, psychosocial (passive attitude, disability) and pharmacological agents. Copping and acceptance of chronic pain is associated with lower pain intensity, less depression and less psychosocial disability. The appropriate use of analgesics in the management of chronic pain demands individualization. Several antidepressants have possitive effects on pain syndrom. Depression is underrecognized ad undertreated above all in patients with chronic pain. In order screening the depression seven ways are described here: personal and family history, type of the personality, clinic and evolutive aspects of somatoform symptom, search of other depressive symptoms and positive therapeutic effect determinated by an antidepressant.

  4. What Is Chronic Pain?

    Medline Plus

    Full Text Available ... after a period of time the spinal cord has changed, after a period of time there are ... absence of an apparent cause. But chronic pain has a physiological or neurological basis even when we ...

  5. Chronic Pain: Symptoms, Diagnosis, & Treatment

    Science.gov (United States)

    ... in the treatment. Treatment With chronic pain, the goal of treatment is to reduce pain and improve ... some treatments used for chronic pain. Less invasive psychotherapy, relaxation therapies, biofeedback, and behavior modification may also ...

  6. Chronic pain after open inguinal hernia repair.

    Science.gov (United States)

    Nikkolo, Ceith; Lepner, Urmas

    2016-01-01

    Following the widespread use of mesh repairs, recurrence rates after inguinal hernia surgery have become acceptable and focus has shifted from recurrence to chronic pain. Although pain can be controlled with analgesics, chronic postsurgical pain is a major clinical problem, which can significantly influence the patient's quality of life. The rate of chronic pain after inguinal hernia mesh repair can reach 51.6%. The reasons for posthernioplasty chronic pain are often unclear. It has been linked to nerve injury and nerve entrapment, but there is also association between the rate of chronic pain and the type of mesh used for hernia repair. As there are >160 meshes available in the market, it is difficult to choose a mesh whose usage would result in the best outcome. Different mesh characteristics have been studied, among them weight of mesh has probably gained the most attention. The choice of adequate therapy for chronic groin pain after inguinal hernia repair is controversial. The European Hernia Society recommends that a multidisciplinary approach at a pain clinic should be considered for the treatment of chronic postoperative pain. Although surgical treatment of chronic posthernioplasty pain is limited because of the lack of relevant research data, resection of entrapped nerves, mesh removal in the case of mesh related pain or removal of fixation sutures can be beneficial for the patient with severe pain after inguinal hernia surgery. One drawback of published studies is the lack of consensus over definition of chronic pain, which makes it complicated to compare the results of different studies and to conduct meta-analyses and systematic reviews. Therefore, a uniform definition of chronic pain and its best assessment methods should be developed in order to conduct top quality multicenter randomized trials. Further research to develop meshes with optimal parameters is of vital importance and should be encouraged. PMID:26567717

  7. The role of pain acceptance on function in individuals with disabilities: a longitudinal study.

    Science.gov (United States)

    Jensen, Mark P; Smith, Amanda E; Alschuler, Kevin N; Gillanders, David T; Amtmann, Dagmar; Molton, Ivan R

    2016-01-01

    Having higher levels of pain acceptance has been shown to be associated positively with quality of life in patients with chronic pain, but its role in adjustment to chronic pain among individuals with physical disabilities living in the community is not known. Moreover, issues related to item overlap between measures of pain acceptance and measures of patient function have limited the conclusions that can be drawn from previous research in this area. To better understand the role that pain acceptance plays in patient function, we administered measures of pain acceptance, pain intensity, depressive symptoms, and function to 392 individuals with physical disabilities, and the pain, symptom, and function measures were readministered 3.5 years later. Analyses evaluated the main and interaction effects of initial pain acceptance on subsequent changes in pain and function. Having higher levels of pain acceptance-in particular as reflected by a willingness to engage in activities despite pain-resulted in less increase in pain intensity and more improvements in pain interference, physical function, depressive symptoms, and sleep quality. The findings indicate that previous research supporting the importance of pain acceptance to function in patients from health care settings extends to individuals with chronic pain living in the community. Moreover, they indicate that pain acceptance may have long-lasting (up to 3.5 years) beneficial effects on subsequent pain and function and on the association between change in pain and depression. Research to examine the potential benefits of community-based treatments that increase pain acceptance is warranted.

  8. What Is Chronic Pain?

    Medline Plus

    Full Text Available ... manageable, but chronic pain is different. And because it is different, we need to think about it in very different ways. Ed Covington, M.D.: ... no apparent physical injury or illness to explain it. The physician and the patient are accustomed to ...

  9. Acetaminophen for Chronic Pain

    DEFF Research Database (Denmark)

    Ennis, Zandra Nymand; Dideriksen, Dorthe; Vaegter, Henrik Bjarke;

    2016-01-01

    conducted according to PRISMA guidelines. All studies were conducted in patients with hip- or knee osteoarthritis and six out of seven studies had observation periods of less than three months. All included studies showed no or little efficacy with dubious clinical relevance. In conclusion, there is little......Acetaminophen (paracetamol) is the most commonly used analgesic worldwide and recommended as first-line treatment in all pain conditions by WHO. We performed a systematic literature review to evaluate the efficacy of acetaminophen when used for chronic pain conditions. Applying three broad search...... evidence to support the efficacy of acetaminophen treatment in patients with chronic pain conditions. Assessment of continuous efficacy in the many patients using acetaminophen worldwide is recommended. This article is protected by copyright. All rights reserved....

  10. Measuring avoidance of pain : validation of the Acceptance and Action Questionnaire II-pain version

    NARCIS (Netherlands)

    Reneman, Michiel F.; Kleen, Marco; Trompetter, Hester R.; Schiphorst Preuper, Henrica R.; Koeke, Albere; van Baalen, Bianca; Schreurs, Karlein M. G.

    2014-01-01

    Psychometric research on widely used questionnaires aimed at measuring experiential avoidance of chronic pain has led to inconclusive results. To test the structural validity, internal consistency, and construct validity of a recently developed short questionnaire: the Acceptance and Action Question

  11. [Chronic pain in geriatrics].

    Science.gov (United States)

    Kennes, B

    2001-06-01

    Pain is frequent in communicative or no-communicative, ambulatory, institutionalized or hospitalized veterans. It is associated with severe comorbidity so much more than chronic pain could be neglected and expressed of atypical manner or masked by the absence of classical symptoms in particular in case of dementia or of sensory disorders. Pain detection by clinic examination or by pain assessment's methods and adequate approach by pharmacological and non pharmacological therapies are essential for correct pain management. On pharmacological plan, the strategy of the O.M.S. landings is applicable owing to a more particular attention to secondary effects and drugs interactions. AINS must be manipulated with prudence. There are no reasons to exclude opioides from the therapeutic arsenal but with a reduction of the starting doses, a regular adaptation and a very attentive survey. In drugs of landing 2, tramadol reveals itself as efficient and better tolerated as the codeine and dextropropoxyphene has to be to avoid. The obtaining of a satisfactory result depends on a regular assessment of the pain in a context of polydisciplinar approach (physicians, nurses, paramedicals, other care givers).

  12. Peripheral Pain Mechanisms in Chronic Widespread Pain

    OpenAIRE

    Staud, Roland

    2011-01-01

    Clinical symptoms of chronic widespread pain (CWP) conditions including fibromyalgia (FM), include pain, stiffness, subjective weakness, and muscle fatigue. Muscle pain in CWP is usually described as fluctuating and often associated with local or generalized tenderness (hyperalgesia and/or allodynia). This tenderness related to muscle pain depends on increased peripheral and/or central nervous system responsiveness to peripheral stimuli which can be either noxious (hyperalgesia) or non-noxiou...

  13. Chronic pain in Rehabilitation Medicine

    NARCIS (Netherlands)

    Geertzen, J.H.B.; van Wilgen, C.P.; Schrier, E.; Dijkstra, P.U.

    2006-01-01

    In this paper the chronicity of pain in non-specific pain syndromes is discussed. Experts in the study of pain with several professional backgrounds in rehabilitation are the authors of this paper. Clinical experience and literature form the basis of the paper. Non-specific low back pain and Complex

  14. Management of chronic musculoskeletal pain.

    Science.gov (United States)

    Uhl, Richard L; Roberts, Timothy T; Papaliodis, Dean N; Mulligan, Michael T; Dubin, Andrew H

    2014-02-01

    Chronic musculoskeletal pain results from a complex interplay of mechanical, biochemical, psychological, and social factors. Effective management is markedly different from that of acute musculoskeletal pain. Understanding the physiology of pain transmission, modulation, and perception is crucial for effective management. Pharmacologic and nonpharmacologic therapies such as psychotherapy and biofeedback exercises can be used to manage chronic pain. Evidence-based treatment recommendations have been made for chronic pain conditions frequently encountered by orthopaedic surgeons, including low back, osteoarthritic, posttraumatic, and neuropathic pain. Extended-release tramadol; select tricyclic antidepressants, serotonin reuptake inhibitors, and anticonvulsants; and topical medications such as lidocaine, diclofenac, and capsaicin are among the most effective treatments. However, drug efficacy varies significantly by indication. Orthopaedic surgeons should be familiar with the widely available safe and effective nonnarcotic options for chronic musculoskeletal pain. PMID:24486756

  15. Management of chronic visceral pain

    DEFF Research Database (Denmark)

    Olesen, Anne E; Farmer, Adam D; Olesen, Søren S;

    2016-01-01

    Despite marked differences in underlying pathophysiology, the current management of visceral pain largely follows the guidelines derived from the somatic pain literature. The effective management of patients with chronic visceral pain should be multifaceted, including both pharmacological......' symptoms, adopting an empathic approach and taking time to educate patients. To optimize treatment and outcomes in chronic visceral pain we need to move away from approaches exclusively based on dealing with peripheral nociceptive input toward more holistic strategies, taking into account alterations...... in central pain processing....

  16. Targeting Acceptance, Mindfulness, and Values-Based Action in Chronic Pain: Findings of Two Preliminary Trials of an Outpatient Group-Based Intervention

    Science.gov (United States)

    Vowles, Kevin E.; Wetherell, Julie Loebach; Sorrell, John T.

    2009-01-01

    Cognitive behavior therapy (CBT) for chronic pain is effective, although a number of issues in need of clarification remain, including the processes by which CBT works, the role of cognitive changes in the achievement of outcomes, and the formulation of a coherent theoretical model. Recent developments in psychology have attempted to address these…

  17. Widespread pain in chronic epicondylitis.

    Science.gov (United States)

    Pienimäki, Tuomo; Siira, Pertti; Vanharanta, Heikki

    2011-10-01

    We studied the associations of widespread pain with other pain and functional measures among patients with chronic epicondylitis. A total of 190 patients (66% females) participated in the study; with a mean age 43.7, mean duration of symptoms 48weeks, chronic lateral (n=160) and medial (n=30) epicondylitis. We analysed clinical status, grip strength and cubital pain thresholds and interviewed pain and disability, leisure time physical activity, strenuous hobby activities for arms, duration of symptoms, other systemic and upper extremity disorders, arm operations, and work ability. The location of pain was analysed using a whole-body pain drawing, categorized into three groups; the highest of which was classified as widespread pain. A total of 85 patients (45%) reported widespread pain. It was highly associated with female gender, high pain scores, decreased grip strength and pain thresholds (p<0.001 for all), with increased number of positive manual tests, low level of hobby strain for arms and physical activity, long duration of symptoms, and sick leave (p for all <0.05). It was also related to upper extremity disorders and arm surgery, but not with operated epicondylitis, other systemic diseases, workload or work ability. In addition, 39% of patients without other disease reported widespread pain. Widespread pain is common in chronic epicondylitis with and without other diseases, and is related to high pain scores, decreased function of the arm, long duration of symptoms, sick leave, and with a low level of physical activity. PMID:21565536

  18. Fighting Chronic Pain

    Science.gov (United States)

    ... leg pain from clogged arteries Stomach/Digestive: Gallstones, intestinal obstruction, diverticulitis, ulcers, severe indigestion, severe gas pain, inflammatory bowel disease, colitis Urinary/Reproductive: Kidney stones, pelvic pain, vulvodynia, ...

  19. What is an acceptable outcome of treatment before it begins? Methodological considerations and implications for patients with chronic low back pain

    DEFF Research Database (Denmark)

    Lauridsen, Henrik; Manniche, Claus; Korsholm, Lars;

    2009-01-01

    ), Bournemouth questionnaire (BQ) and numeric pain rating scale (NRS(pain)) were filled in at baseline. The modified questionnaires determined what the patient considered an acceptable post-treatment outcome which allowed us to calculate the MCID(pre). Concurrent comparisons between the MCID(pre), instrument......Understanding changes in patient-reported outcomes is indispensable for interpretation of results from clinical studies. As a consequence the term "minimal clinically important difference" (MCID) was coined in the late 1980s to ease classification of patients into improved, not changed...... measurement error and a retrospective approach of establishing the minimal clinically important difference (MCID(post)) were made. The results showed the prospective acceptable outcome method scores to have acceptable reproducibility outside measurement error. MCID(pre) was 4.5 larger for the ODI and 1...

  20. Psychosocial factors associated with chronic pain in adolescents.

    Science.gov (United States)

    Merlijn, Vivian P B M; Hunfeld, Joke A M; van der Wouden, Johannes C; Hazebroek-Kampschreur, Alice A J M; Koes, Bart W; Passchier, Jan

    2003-01-01

    A number of psychosocial factors have been associated with the onset, exacerbation and/or maintenance of chronic pain in adolescents. The present study was conducted to evaluate the relative importance of vulnerability, reinforcement, and modeling. We compared 222 adolescents with chronic pain and no documented physiological etiology (headache, back, limb and abdominal pain) with 148 controls and their (respectively 183 vs. 127) parents. Analyses showed that adolescents with chronic pain are more vulnerable in terms of neuroticism, negative fear of failure, and (less) experienced social acceptance. Contrary to our expectations, the chronic pain group experienced less reinforcement for their pain behavior by both parents and peers than the control group. While the number of pain models was higher in the chronic pain group, no differences were found between their parents and those of the adolescents without chronic pain in pain experience, pain parameters, and pain coping. Regression analyses on the contribution of psychosocial factors to chronic pain and its parameters sustained the positive relation between vulnerability, (less) pain reinforcement, pain models and coping with pain. Furthermore, we also found evidence that gender differences have to be taken into account. PMID:12507698

  1. Psychosocial factors associated with chronic pain in adolescents.

    Science.gov (United States)

    Merlijn, Vivian P B M; Hunfeld, Joke A M; van der Wouden, Johannes C; Hazebroek-Kampschreur, Alice A J M; Koes, Bart W; Passchier, Jan

    2003-01-01

    A number of psychosocial factors have been associated with the onset, exacerbation and/or maintenance of chronic pain in adolescents. The present study was conducted to evaluate the relative importance of vulnerability, reinforcement, and modeling. We compared 222 adolescents with chronic pain and no documented physiological etiology (headache, back, limb and abdominal pain) with 148 controls and their (respectively 183 vs. 127) parents. Analyses showed that adolescents with chronic pain are more vulnerable in terms of neuroticism, negative fear of failure, and (less) experienced social acceptance. Contrary to our expectations, the chronic pain group experienced less reinforcement for their pain behavior by both parents and peers than the control group. While the number of pain models was higher in the chronic pain group, no differences were found between their parents and those of the adolescents without chronic pain in pain experience, pain parameters, and pain coping. Regression analyses on the contribution of psychosocial factors to chronic pain and its parameters sustained the positive relation between vulnerability, (less) pain reinforcement, pain models and coping with pain. Furthermore, we also found evidence that gender differences have to be taken into account.

  2. How to investigate: Chronic pain.

    Science.gov (United States)

    Hague, Matthew; Shenker, Nicholas

    2014-12-01

    Chronic pain is defined as an unpleasant sensory and emotional experience persisting longer than the normal process of healing, usually longer than 3 months. About a fifth of the world's population is believed to suffer from chronic pain. In Europe, chronic pain accounts for nearly 500 m lost working days, and it costs the European economy >€34 billion (£28 billion) every year. Establishing a reliable diagnosis is the primary challenge in evaluating a patient with chronic pain. Common diagnoses not to miss include seronegative spondyloarthritides, endocrine abnormalities including severe vitamin D deficiency and polymyalgia rheumatica. Once important or treatable diagnoses have been ruled out, the history can be used as a tool to establish a therapeutic plan for shared decision-making using the biopsychosocial model. Onward referral to pain clinics can be helpful for more involved patient management, but often good outcomes are achieved with the support of primary care. PMID:26096090

  3. [Neurosurgical treatment of chronic pain].

    Science.gov (United States)

    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

  4. Neurovascular Unit in Chronic Pain

    Directory of Open Access Journals (Sweden)

    Beatrice Mihaela Radu

    2013-01-01

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

  5. Chronic pain management: nonpharmacological therapies for chronic pain.

    Science.gov (United States)

    Chang, Ku-Lang; Fillingim, Roger; Hurley, Robert W; Schmidt, Siegfried

    2015-05-01

    Nonpharmacologic therapies have become a vital part of managing chronic pain (CP). Although these can be used as stand-alone therapies, nonpharmacologic treatments often are used to augment and complement pharmacologic treatments (ie, multimodal therapy). Nonpharmacologic approaches can be classified as behavioral, cognitive, integrative, and physical therapies. Core principles in developing a treatment plan are explaining the nature of the CP condition, setting appropriate goals, and developing a comprehensive treatment approach and plan for adherence. Clinicians should become familiar with these interventions so that they can offer patients flexibility in the pain management approach. Effective noninvasive treatment modalities for CP include behavioral therapy for short-term pain relief; cognitive behavioral therapy for reducing long-term pain and disability; hypnosis as adjunctive therapy; guided imagery, diaphragmatic breathing, and muscle relaxation, especially for cancer-related pain; mindfulness-based stress reduction for patients with chronic low back pain; acupuncture for multiple pain conditions; combination manipulation, manual therapy, endurance exercise, stretching, and strengthening for chronic neck pain; animal-assisted therapy; and S-adenosyl-L-methionine for joint pain. Guidelines for use of these treatment modalities are based on expert panel recommendations in combination with data from randomized controlled trials. PMID:25970869

  6. What Is Chronic Pain?

    Medline Plus

    Full Text Available ... the ER Glossary Surveys What We Have Learned Communication Tools Videos Pain Management Programs Resource Guide to ... pain is real. Site Map Terms & Conditions Privacy Policy Advertising Policy Language Disclaimer Endorsement Policy Development of ...

  7. What Is Chronic Pain?

    Medline Plus

    Full Text Available ... Resources Going to the ER Glossary Surveys What We Have Learned Communication Tools Videos Pain Management Programs ... pain is different. And because it is different, we need to think about it in very different ...

  8. Managing chronic pain in family practice.

    OpenAIRE

    Librach, S. L.

    1993-01-01

    Pain is common in family practice. In dealing with chronic pain, both the family physician and the patient often have problems in defining and in understanding the origin of chronic pain and in providing effective pain relief. This article explores a practical, holistic approach to understanding and managing chronic pain.

  9. Chronic pain treatment : from psychological predictors to implementation

    NARCIS (Netherlands)

    Samwel, J.J.A.

    2008-01-01

    In this thesis, cognitive-behavioural factors were studied based on the Fear-avoidance model (catastrophizing, fear of pain and avoidance behaviour) and, based on recent literature, helplessness and acceptance. All were studied as predictors of chronic pain outcomes (pain intensity, functional disab

  10. Pregabalin for Pain Treatment in Chronic Pancreatitis

    DEFF Research Database (Denmark)

    Olesen, Søren Schou; Bowense, S; Wilder-Smith, Oliver;

    2011-01-01

    Intractable pain usually dominates the clinical presentation of chronic pancreatitis (CP). Slowing of electroencephalogram (EEG) rhythmicity has been associated with abnormal cortical pain processing in other chronic pain disorders. The aim of this study was to investigate the spectral distribution...

  11. From traditional cognitive-behavioural therapy to acceptance and commitment therapy for chronic pain: a mixed-methods study of staff experiences of change.

    Science.gov (United States)

    Barker, Estelle; McCracken, Lance M

    2014-08-01

    Health care organizations, both large and small, frequently undergo processes of change. In fact, if health care organizations are to improve over time, they must change; this includes pain services. The purpose of the present study was to examine a process of change in treatment model within a specialty interdisciplinary pain service in the UK. This change entailed a switch from traditional cognitive-behavioural therapy to a form of cognitive-behavioural therapy called acceptance and commitment therapy. An anonymous online survey, including qualitative and quantitative components, was carried out approximately 15 months after the initial introduction of the new treatment model and methods. Fourteen out of 16 current clinical staff responded to the survey. Three themes emerged in qualitative analyses: positive engagement in change; uncertainty and discomfort; and group cohesion versus discord. Quantitative results from closed questions showed a pattern of uncertainty about the superiority of one model over the other, combined with more positive views on progress reflected, and the experience of personal benefits, from adopting the new model. The psychological flexibility model, the model behind acceptance and commitment therapy, may clarify both processes in patient behaviour and processes of staff experience and skilful treatment delivery. This integration of processes on both sides of treatment delivery may be a strength of acceptance and commitment therapy.

  12. Pain management in chronic pancreatitis

    Institute of Scientific and Technical Information of China (English)

    Cathia Gachago; Peter V Draganov

    2008-01-01

    Abdominal pain is a major clinical problem in patients with chronic pancreatitis.The cause of pain is usually multifactorial with a complex interplay of factors contributing to a varying degree to the pain in an individual patient and,therefore,a rigid standardized approach for pain control tends to lead to suboptimal results.Pain management usually proceeds in a stepwise approach beginning with general lifestyle recommendations,low fat diet,alcohol and smoking cessation are encouraged.Analgesics alone are needed in almost all patients.Maneuvers aimed at suppression of pancreatic secretion are routinely tried.Patients with ongoing symptoms may be candidates for more invasive options such as endoscopic therapy,and resective or drainage surgery.The role of pain modifying agents (antidepressants,gabapentin,peregabalin),celiac plexus block,antioxidants,octreotide and total pancreatectomy with islet cell auto transplantation remains to be determined.

  13. Fibromyalgia and Chronic Pain Syndromes

    Science.gov (United States)

    Choy, Ernest; Clauw, Daniel J.; Goldenberg, Don L.; Harris, Richard E.; Helfenstein, Milton; Jensen, Troels Staehelin; Noguchi, Koichi; Silverman, Stuart L.; Ushida, Takahiro; Wang, Guochun

    2016-01-01

    This manuscript, developed by a group of chronic pain researchers and clinicians from around the world, aims to address the state of knowledge about fibromyalgia (FM) and identify ongoing challenges in the field of FM and other chronic pain syndromes that may be characterized by pain centralization/amplification/hypersensitivity. There have been many exciting developments in research studies of the pathophysiology and treatment of FM and related syndromes that have the potential to improve the recognition and management of patients with FM and other conditions with FM-like pain. However, much of the new information has not reached all clinicians, especially primary care clinicians, who have the greatest potential to use this new knowledge to positively impact their patients’ lives. Furthermore, there are persistent misconceptions about FM and a lack of consensus regarding the diagnosis and treatment of FM. This paper presents a framework for future global efforts to improve the understanding and treatment of FM and other associated chronic pain syndromes, disseminate research findings, identify ways to enhance advocacy for these patients, and improve global efforts to collaborate and reach consensus about key issues related to FM and chronic pain in general. PMID:27022674

  14. What Is Chronic Pain?

    Medline Plus

    Full Text Available ... but we may be looking in the wrong time. And what I mean by that is that ... pain problem which exists for some period of time can actually change the nervous system so that ...

  15. Melatonin in Chronic Pain Syndromes.

    Science.gov (United States)

    Danilov, Andrei; Kurganova, Julia

    2016-06-01

    Melatonin is a neurohormone secreted by epiphysis and extrapineal structures. It performs several functions including chronobiotic, antioxidant, oncostatic, immune modulating, normothermal, and anxiolytic functions. Melatonin affects the cardiovascular system and gastrointestinal tract, participates in reproduction and metabolism, and body mass regulation. Moreover, recent studies have demonstrated melatonin efficacy in relation to pain syndromes. The present paper reviews the studies on melatonin use in fibromyalgia, headaches, irritable bowel syndrome, chronic back pain, and rheumatoid arthritis. The paper discusses the possible mechanisms of melatonin analgesic properties. On one hand, circadian rhythms normalization results in sleep improvement, which is inevitably disordered in chronic pain syndromes, and activation of melatonin adaptive capabilities. On the other hand, there is evidence of melatonin-independent analgesic effect involving melatonin receptors and several neurotransmitter systems. PMID:26984272

  16. Managing painful chronic wounds: the Wound Pain Management Model

    DEFF Research Database (Denmark)

    Price, Patricia; Fogh, Karsten; Glynn, Chris;

    2007-01-01

    document persistent wound pain and not to develop a treatment and monitoring strategy to improve the lives of persons with chronic wounds. Unless wound pain is optimally managed, patient suffering and costs to health care systems will increase. Udgivelsesdato: 2007-Apr......Chronic wound pain is not well understood and the literature is limited. Six of 10 patients venous leg ulcer experience pain with their ulcer, and similar trends are observed for other chronic wounds. Chronic wound pain can lead to depression and the feeling of constant tiredness. Pain related...... to the wound should be handled as one of the main priorities in chronic wound management together with addressing the cause. Management of pain in chronic wounds depends on proper assessment, reporting and documenting patient experiences of pain. Assessment should be based on six critical dimensions...

  17. Comprehensive management of chronic pain in haemophilia.

    Science.gov (United States)

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

    2014-03-01

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

  18. Chronic pelvic pain: comorbidity between chronic musculoskeletal pain and vulvodynia

    Directory of Open Access Journals (Sweden)

    G. Biasi

    2014-06-01

    Full Text Available Chronic pelvic pain (CPP is a common condition that has a major impact on the quality of life of both men and women. Male CPP is usually attributable to well-defined urogenital conditions (most frequently infectious/non infectious prostatic diseases or musculoskeletal or bowel diseases, whereas the features of female CPP are much more complex and are of particular clinical and epidemiological importance. It is a multifactorial syndrome that can be due to diseases of the urogenital, gastrointestinal, or musculoskeletal systems, or to neurological or neuropsychiatric disorders. It is not always easy to identify its predominant pathogenesis, although it often occurs as a central sensitization syndrome triggered by an initial stimulus which is no longer detectable and only manifests itself clinically through pain. In this respect, there are some very interesting relationships between vulvodynia and fibromyalgic syndrome, as identified in a preliminary study of women with chronic musculoskeletal pain in which it was demonstrated that vulvar pain plays an important role, although it is often overlooked and undiagnosed.

  19. Hypnotherapy for the Management of Chronic Pain

    OpenAIRE

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

    2007-01-01

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

  20. Electronic momentary assessment in chronic pain 1: psychological pain responses as predictors of pain intensity

    OpenAIRE

    Sorbi, M.J.; Peters, M.L.; Kruise, D.A.; Maas, C.J.M.; Kerssens, J. J.; Verhaak, P.F.M.; BENSING, J

    2006-01-01

    Objectives and Methods: Electronic momentary assessment was employed to substantiate the relevance of psychological functioning in chronic pain. More than 7100 electronic diaries from 80 patients with varying IASP classified types of chronic pain served to investigate to what extent fear-avoidance, cognitive and spousal solicitous and punishing pain responses explained fluctuations in pain intensity and whether patients with pre-chronic, recently chronic and persistently chronic pain differed...

  1. Neurophysiology of pain and hypnosis for chronic pain

    OpenAIRE

    Dillworth, Tiara; Mendoza, M. Elena; Jensen, Mark P.

    2011-01-01

    In the past decade there has been a dramatic increase in (1) understanding the neurophysiological components of the pain experiences, (2) randomized clinical trials testing the efficacy of hypnotic treatments on chronic pain, and (3) laboratory research examining the effects of hypnosis on the neurophysiological processes implicated in pain. Work done in these areas has not only demonstrated the efficacy of hypnosis for treating chronic pain but is beginning to shed light on neurophysiologica...

  2. 'I just wanted someone to tell me it wasn't all in my mind and do something for me': Qualitative exploration of acceptability of a CBT based intervention to manage chronic orofacial pain.

    Science.gov (United States)

    Goldthorpe, J; Peters, S; Lovell, K; McGowan, L; Aggarwal, V

    2016-05-13

    Introduction Evidence suggests that psychosocial management may produce improved outcomes for patients suffering from chronic orofacial pain (COFP), when symptoms cannot be attributed to pathology. A complex intervention, based on cognitive behavioural therapy (CBT) was developed by a multi-disciplinary team, using evidence synthesis. An important element of developing and evaluating complex interventions is to establish acceptability to stakeholders; therefore qualitative interviews with patients were carried out.Objectives To explore levels of acceptability of a complex intervention to manage COFP.Method Semi-structured interviews were carried out with 17 participants who had been referred to the intervention. Thematic analysis was used to identify emerging issues and themes from the data.Results Themes relating to processes of engagement with the intervention emerged. Important processes were: identification with the intervention; feeling believed and understood; obtaining a plausible explanation for symptoms; degree of perceived effort required to engage; acceptance of having a long-term condition; and receiving demonstrative, positive feedback.Conclusion Patients presenting with unexplained COFP in a secondary care setting are able to accept a CBT based intervention to manage their condition. Findings may offer guidance for dentists who are not used to referring patients to psychosocial interventions and inform the way dentists communicate the nature of unexplained symptoms to patients. PMID:27173704

  3. Chronic widespread pain in spondyloarthritis

    Directory of Open Access Journals (Sweden)

    F. Atzeni

    2014-06-01

    Full Text Available The pain associated with spondyloarthritis (SpA can be intense, persistent and disabling. It frequently has a multifactorial, simultaneously central and peripheral origin, and may be due to currently active inflammation, or joint damage and tissue destruction arising from a previous inflammatory condition. Inflammatory pain symptoms can be reduced by non-steroidal anti-inflammatory drugs, but many patients continue to experience moderate pain due to alterations in the mechanisms that regulate central pain, as in the case of the chronic widespread pain (CWP that characterises fibromyalgia (FM. The importance of distinguishing SpA and FM is underlined by the fact that SpA is currently treated with costly drugs such as tumour necrosis factor (TNF inhibitors, and direct costs are higher in patients with concomitant CWP or FM than in those with FM or SpA alone. Optimal treatment needs to take into account symptoms such as fatigue, mood, sleep, and the overall quality of life, and is based on the use of tricyclic antidepressants or selective serotonin reuptake inhibitors such as fluoxetine, rather than adjustments in the dose of anti-TNF agents or disease-modifying drugs.

  4. Future perspectives: pathogenesis of chronic muscle pain.

    Science.gov (United States)

    Staud, Roland

    2007-06-01

    Chronic painful muscle conditions include non-inflammatory and inflammatory illnesses. This review is focused on chronic non-inflammatory pain conditions such as myofascial pain syndrome (MPS) and fibromyalgia syndrome (FM), and will not discuss metabolic, genetic or inflammatory muscle diseases such as McArdle's disease, muscular dystrophy, polymyositis, dermatomyositis, or inclusion body myositis.

  5. CHRONIC PAIN AFTER INGUINAL HERNIA REPAIR

    Directory of Open Access Journals (Sweden)

    Suresh

    2014-09-01

    Full Text Available : BACKGROUND: Chronic post herniorrhaphy groin pain is defined as pain lasting > 6 months after surgery, which is one of the most important complication occurring after inguinal hernia repair, occurs with greater frequency than previously thought. Chronic groin pain is one of the most significant complications following inguinal hernia repair, and majority of chronic pain has been attributed to ilioinguinal nerve entrapment. Various other factors are involved in development of chronic pain. MATERIAL AND METHODS: Patients undergoing elective inguinal hernioplasty in Victoria hospital from November2011 to May 2013 were included in the study. A total of 227 patients met the inclusion criteria and were available for follow up at end of six months. A detailed preoperative, intraoperative and post-operative details of cases were recorded according to proforma. The postoperative pain and pain at two, seven days and at end of six months were recorded on a VAS scale. RESULTS: Chronic pain at six month follow up was present in 89 patients constituting 39.4% of all patients undergoing hernia repair. It was seen that 26.9% without preoperative pain developed chronic pain whereas 76.7 % of patients with preoperative pain developed chronic pain. Patients with significant preoperative pain had higher chances of developing chronic pain (p<.0001. Preemptive analgesia failed to show statistical significance in development of chronic pain (p=0.079. Nerve injury were present in 22 of cases it was found that nerve injury significantly affected development of chronic pain (p=0.001.Post-operative infiltration of local anesthesia was practiced in 16.3 % of cases and it was found that local infiltration at incision site significantly reduced incidence of chronic pain (p=0.001.Postoperative complications in the form of hematoma, seroma or infection was present in 8.5 % of cases. It was found that post-operative complication not only increased early post-operative pain

  6. Chronic pain and invasive therapy

    Directory of Open Access Journals (Sweden)

    Alessandro Rocco

    2009-05-01

    Full Text Available The chronic pain “three-step” OMS ladder is likely to be revised, in order to introduce a “fourth step” including clinical indications for the invasive analgesic procedures. The number of patients who undergo such procedures is likely to increase, as well as modern oncology and palliative medicine development. Most of invasive approaches include central (spinal neuromodulation and peripheral (gangliar neurolysis, percutaneous vertebral reduction techniques, as well as pharmacological (opioids and adiuvants, chemical (alcohol and physical (electrical stimulation, thermic neurolysis means. Rarely effective as unique therapies, invasive procedures have to be accurately patient-selected and considered supplementary to conservative approaches, in order to minimize the adverse events deriving from a long term opioid therapy. In the near future, the development of both pain science and biomedical technology will probably be accompanied by the improvement of the knowledge regarding the recourse to invasive analgesic procedures.

  7. The burden of chronic pain

    DEFF Research Database (Denmark)

    Kurita, Geana Paula; Sjøgren, Per; Juel, Knud;

    2012-01-01

    in the adult Danish population and to analyze associated factors such as diseases, immigration, and opioid use. This cross-sectional survey combines individual-based information from the Danish Health Survey (2010) and official Danish health and socioeconomic, individual-based registers. The simple random...... sample consisted of 25,000 individuals (≥16 years old) living in Denmark. In all, 60.7% completed a mailed or online questionnaire. Associations were examined with multiple logistic regression analysis. The study population consisted of 14,925 individuals in whom a high prevalence of chronic pain (26...

  8. Ehlers-Danlos syndrome and chronic pain.

    Science.gov (United States)

    Hsu, Lanny

    2012-06-01

    Questions from patients about pain conditions and analgesic pharmacotherapy and responses from authors are presented to help educate patients and make them more effective self-advocates. The topics addressed in this issue are Ehlers-Danlos syndrome and associated chronic pain; the information is meant to help readers understand the mechanisms for pain in this connective tissue disorder as well as general treatment principles for chronic pain management. PMID:22616833

  9. Chronic Pain Syndromes and Borderline Personality

    OpenAIRE

    Sansone, Randy A.; Sansone, Lori A.

    2012-01-01

    The assessment and management of chronic pain is challenging and, according to the existing literature, oftentimes associated with various forms of psychopathology, including borderline personality disorder. Since 1994, eight studies have explored the relationship between chronic pain syndromes and borderline personality disorder. In averaging the prevalence rates in these studies, 30 percent of participants with chronic pain harbor this Axis II disorder. Related studies suggest that individu...

  10. Electronic momentary assessment in chronic pain (I): pain and psychological pain responses as predictors of pain intensity.

    OpenAIRE

    Sorbi, M.J.; Peters, M.L.; Kruise, D.A.; Maas, C.J.M.; Kerssens, J. J.; Verhaak, P.F.M.; Bensing, J M

    2006-01-01

    Objectives and Methods: Electronic momentary assessment was employed to substantiate the relevance of psychological functioning in chronic pain. More than 7100 electronic diaries from 80 patients with varying IASP classified types of chronic pain served to investigate to what extent fear-avoidance, cognitive and spousal solicitous and punishing pain responses explained fluctuations in pain intensity and whether patients with pre-chronic, recently chronic and persistently chronic pain differed...

  11. Psychological therapies for the management of chronic pain

    Directory of Open Access Journals (Sweden)

    Sturgeon JA

    2014-04-01

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

  12. Chronic pain after childhood groin hernia repair

    DEFF Research Database (Denmark)

    Aasvang, Eske Kvanner; Kehlet, Henrik

    2007-01-01

    BACKGROUND: In contrast to the well-described 10% risk of chronic pain affecting daily activities after adult groin hernia repair, chronic pain after childhood groin hernia repair has never been investigated. Studies of other childhood surgery before the age of 3 months suggest a risk of increased...... pain responsiveness later in life, but its potential relationship to chronic pain in adult life is unknown. METHODS: This was a nationwide detailed questionnaire study of chronic groin pain in adults having surgery for a groin hernia repair before the age of 5 years (n = 1075). RESULTS: The response...... the age of 3 months (n = 122) did not report groin pain more often or with higher intensity than other patients did. CONCLUSIONS: Groin pain in adult patients operated on for a groin hernia in childhood is uncommon and usually mild and occurs in relation to physical activity. Operation before the age...

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

    Science.gov (United States)

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

    2007-01-01

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

  14. Analyzing change processes resulting from a smartphone maintenance intervention based on acceptance and commitment therapy for women with chronic widespread pain.

    NARCIS (Netherlands)

    Nes, A.A.G.; Dulmen, S. van; Wicksell, R.; Fors, E.A.; Eide, H.

    2016-01-01

    Purpose: This study investigated change processes resulting from a randomized controlled trial smartphone-delivered maintenance intervention with daily electronic diaries and personalized written feedback based on acceptance and commitment therapy (ACT) following a rehabilitation program for patient

  15. Nonspecificity of Chronic Soft Tissue Pain Syndromes

    Directory of Open Access Journals (Sweden)

    Eldon Tunks

    1997-01-01

    Full Text Available Persistent (or chronic pain occurs with a prevalence of about 10% in the adult population, and chronic soft tissue pain is especially problematic. Criteria for diagnosis of these soft tissue pain disorders appear to suffer from specificity problems, even though they appear to be sensitive in distinguishing normal from soft tissue pain sufferers. A few decades ago the term 'neuraesthenia' was used as a diagnosis in individuals who now would probably be diagnosed as suffering from fibromyalgia, chronic fatigue and anxiety disorders with fatigue. Soft tissue pain provokes skepticism, especially among third-party payers, and controversy among clinicians. Recent epidemiological studies have demonstrated sex differences in the prevalence of widespread pain and multiple tender points, which are distributed variably throughout the adult population and tend to be correlated with subjective symptoms. Although there is a tendency for these syndromes to persist, follow-up studies show that they tend to vary in extent and sometimes show remissions over longer follow-up, casting doubt about the distinctions between chronic diffuse pains and localized chronic soft tissue pains. Because both accidents and soft tissue pains are relatively prevalent problems, the possibility of chance coincidence of accident and chronic soft tissue pain in an individual creates the need to be cautious in attributing these syndromes to specific accidents in medicolegal situations. At the same time, the available evidence does not support a generally dismissive attitude towards these patients.

  16. Assessment of patients with chronic pain.

    Science.gov (United States)

    Dansie, E J; Turk, D C

    2013-07-01

    Chronic pain is a public health concern affecting 20-30% of the population of Western countries. Although there have been many scientific advances in the understanding of the neurophysiology of pain, precisely assessing and diagnosing a patient's chronic pain problem is not straightforward or well-defined. How chronic pain is conceptualized influences how pain is evaluated and the factors considered when making a chronic pain diagnosis. There is no one-to-one relationship between the amount or type of organic pathology and pain intensity, but instead, the chronic pain experience is shaped by a myriad of biomedical, psychosocial (e.g. patients' beliefs, expectations, and mood), and behavioural factors (e.g. context, responses by significant others). Assessing each of these three domains through a comprehensive evaluation of the person with chronic pain is essential for treatment decisions and to facilitate optimal outcomes. This evaluation should include a thorough patient history and medical evaluation and a brief screening interview where the patient's behaviour can be observed. Further assessment to address questions identified during the initial evaluation will guide decisions as to what additional assessments, if any, may be appropriate. Standardized self-reported instruments to evaluate the patient's pain intensity, functional abilities, beliefs and expectations, and emotional distress are available, and can be administered by the physician, or a referral for in depth evaluation can be made to assist in treatment planning.

  17. Muscle strength in patients with chronic pain

    NARCIS (Netherlands)

    van Wilgen, C.P.; Akkerman, L.; Wieringa, J.; Dijkstra, P.U.

    2003-01-01

    Objective: To analyse the influence of chronic pain on muscle strength. Design: Muscle strength of patients with unilateral nonspecific chronic pain, in an upper or lower limb, were measured according to a standardized protocol using a hand-held dynamometer. Before and after muscle strength measurem

  18. Counseling Adult Clients Experiencing Chronic Pain

    Science.gov (United States)

    Burns, Stephanie T.

    2010-01-01

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

  19. The effects of music on chronic pain

    OpenAIRE

    Vaarala, Oula

    2014-01-01

    The purpose of this study was to find out what kind of music has been used to manage chronic pain, to identify in what kind of conditions music is listened to and to figure out the influence of music on different psychological or physiological variables among patients with chronic pain. The aim of the study was to gain information about the analgesic properties of music on chronic pain, in order to give nurses new ideas on how they can ease their patients’ pain. In this thesis a literatu...

  20. Chronic pain and the adaptive significance of positive emotions.

    Science.gov (United States)

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

    2015-04-01

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

  1. Review of occupational therapy for people with chronic pain.

    LENUS (Irish Health Repository)

    Robinson, Katie

    2011-04-01

    Chronic pain is a significant health-care problem. This review aims to critically analyse occupational therapy services for people with chronic pain and identify significant factors influencing the future development of occupational therapy services for people with chronic pain.

  2. Intrathecal drug administration in chronic pain syndromes.

    Science.gov (United States)

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

    2014-06-01

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

  3. 中文版简易慢性疼痛接受问卷信效度检验%Reliability and validity of Chinese-version of the chronic pain acceptance questionnaire-8

    Institute of Scientific and Technical Information of China (English)

    辛程; 王红艳; 柯红艳; 毕春霞; 程玲; 姜兆权; 张会君

    2014-01-01

    目的 检验简易慢性疼痛接受问卷(the Chronic Pain Acceptance Questionnaire-8,CPAQ-8)中文版的信效度.方法 将CPAQ-8译成中文,采用便利抽样方法调查223名老年慢性疼痛患者,用相关系数、Cronbach's系数、重测信度系数、探索性因子分析、验证性因子等对CPAQ-8进行检验.结果 中文版CPAQ-8总体平均得分(23.79±5.23)分,活动参与(activity engagement,AE)分量表(12.84±4.96)分,疼痛意愿(Pain willingness,PW)分量表(10.97±2.90)分.各分量表与总量表的相关系数是0.47~0.70(P<0.01).总量表的Cronbach's系数是0.853,Guttmann分半信度系数是0.843;探索性因子分析提取2个公因子,累计贡献率为58.217%;验证性因子分析显示修正模型显著性概率值P=0,322,模型适配指标结果为x2/df=1.124、GFI=0.979、AGFI=0.956、TLI=0.069、RMSEA=0.024、NFI=0.960、TLI=0.992、CFI=0.995.结论 该量表具有良好的信度和效度,可用于慢性疼痛患者的接受程度分析.%Objective To evaluate reliability and validity the Chinese-version of chronic pain acceptance questionnaire-8(CPAQ-8).Methods The reliability and validity of CPAQ-8 was tested in 223 old patients with chronic pain.Result The Chinese-version of CPAQ-8 was (23.79±-5.23),AE was (12.84±4.96),PW was(10.97 ±2.90).Cronbach' s of CPAQ-8 was 0.853,and Guttmann Split-Half Coefficient was 0.843.Two factors were extracted by factor analysis through exploratory factor analysis,whose cumulative contribution was 58.217%.While confirmatory factor analysis showed probability level of the modified model was P=0.322,with indexes as follows: x2/df =1.124,GFI =0.979,AGFI =0,956,TLI =0.069,RMSEA =0.024,NFI =0.960,TLI =0.992,CFI =0.995.Conclusion Reliability and validity of CPAQ-8 were both well.

  4. Osteomalacia as a Cause of Chronic Pain

    Directory of Open Access Journals (Sweden)

    Robert W Teasell

    1996-01-01

    Full Text Available Osteomalacia is a form of metabolic bone disease that can present as chronic pain. A 36-year-old woman presented with a three-year history of bilateral leg and back pain, and proximal leg weakness. Repeated consultations and investigations failed to discover a cause for her pain, and a diagnosis of chronic benign pain was made. She was admitted to hospital where the bone scan, laboratory investigation and bone biopsy established a diagnosis of renal phosphate-wasting adult-onset rickets (osteomalacia. Radiographs of the hip and magnetic resonance imaging revealed bilateral femoral neck fractures and segmental, avascular necrosis of the femoral heads. The patient was treated with high dose phosphate and vitamin D with marked relief of pain. Osteomalacia should be considered in unusual cases of intractable chronic pain.

  5. Hostility and Anger in Chronic Pain

    Directory of Open Access Journals (Sweden)

    Sara Oliveira

    2013-11-01

    Full Text Available Introduction: The affective component of pain incorporates various emotions, primarily negative in quality. A great emphasis has been traditionally given to the role of depression and anxiety in chronic pain. More recently, the focus has been directed towards hostility and anger, as fundamental components of the emotional experience of chronic pain. Objective: The aim of this article is to present a literature’s review about the association between chronic pain, anger and hostility. Discussion: Patients with several chronic disorders are characterized by high levels of trait anger and hostility. On the other hand, the manner in which angry feelings are typically handled (anger management style, especially the marked tendency to suppress or express angry feelings, is a particularly important determinant of the chronic pain severity. Conclusion: Hostility and anger are involved in the development, maintenance and treatment of chronic pain. Further research is needed to clarify its relationship with chronic pain and to evaluate the effects of anger management on treatment outcomes.

  6. Hostility and Anger in Chronic Pain

    Directory of Open Access Journals (Sweden)

    Lúcia Ribeiro

    2012-06-01

    Full Text Available Introduction: The affective component of pain incorporates various emotions, primarily negative in quality. A great emphasis has been traditionally given to the role of depression and anxiety in chronic pain. More recently, the focus has been directed towards hostility and anger, as fundamental components of the emotional experience of chronic pain. Objective: The aim of this article is to present a literature’s review about the association between chronic pain, anger and hostility. Discussion: Patients with several chronic disorders are characterized by high levels of trait anger and hostility. On the other hand, the manner in which angry feelings are typically handled (anger management style, especially the marked tendency to suppress or express angry feelings, is a particularly important determinant of the chronic pain severity. Conclusion: Hostility and anger are involved in the development, maintenance and treatment of chronic pain. Further research is needed to clarify its relationship with chronic pain and to evaluate the effects of anger management on treatment outcomes.

  7. Myofascial Pain Syndrome in Chronic Back Pain Patients

    Science.gov (United States)

    Nizar, Abd Jalil

    2011-01-01

    Background Myofascial pain syndrome (MPS) is a regional musculoskeletal pain disorder that is caused by myofascial trigger points. The objective of this study was to determine the prevalence of MPS among chronic back pain patients, as well as to identify risk factors and the outcome of this disorder. Methods This was a prospective observational study involving 126 patients who attended the Pain Management Unit for chronic back pain between 1st January 2009 and 31st December 2009. Data examined included demographic features of patients, duration of back pain, muscle(s) involved, primary diagnosis, treatment modality and response to treatment. Results The prevalence of MPS among chronic back pain patients was 63.5% (n = 80). Secondary MPS was more common than primary MPS, making up 81.3% of the total MPS. There was an association between female gender and risk of developing MPS (χ2 = 5.38, P = 0.02, O.R. = 2.4). Occupation, body mass index and duration of back pain were not significantly associated with MPS occurrence. Repeated measures analysis showed significant changes (P pain patients was significantly high, with female gender being a significant risk factor. With proper diagnosis and expert management, MPS has a favourable outcome. PMID:21716607

  8. Ethical issues in the management of chronic nonmalignant pain.

    Science.gov (United States)

    Pappagallo, M; Heinberg, L J

    1997-01-01

    Chronic pain represents a challenge to patients, families, employers, and the physicians who care for these individuals. Opioids remain the mainstay of the analgesic medications for the treatment of both acute and chronic pain. Controlled release preparations of morphine, oxycodone, fentanyl and long acting opioid agents such as methadone and levorphanol have been medically and ethically accepted in managing chronic cancer pain. However, the continued use of these medications for patients with chronic noncancer pain has been fiercely debated. This article attempts to reconcile the medical and ethical dilemma of using opioid medications for chronic noncancer pain. Growing clinical experience in the field of pain medicine has helped to clarify: (1) the misunderstanding of addiction, physical dependence and analgesic tolerance, (2) the misconception that chronic opioid therapy inevitably causes personality changes, depression, and impairment of cognitive and physical function, (3) the lack of information on the correct use of opioid analgesics with regard to titration and management of related side effects. The behavioral management of pain patients undergoing chronic opioid therapy is also discussed. A protocol for optimal patient management is proposed. Particular emphasis is given to the consent form, behavioral contracting, and the consequences of noncompliance. The importance of psychologic evaluation before a long-term opioid trial, to minimize future complications, is stressed. Although most patients on the opioid regimen do well, special attention must be given to patients with current addiction, a past history of addiction, or current misuse of opioid medications. Pharmacologic and conservative interventions are often warranted in those patients with significant behavioral problems. If such strategies fail, and chronic opioid therapy is deemed necessary, some treatment guidelines are offered. PMID:9311061

  9. Chronic pain in Australia: a prevalence study.

    Science.gov (United States)

    Blyth, F M; March, L M; Brnabic, A J; Jorm, L R; Williamson, M; Cousins, M J

    2001-01-01

    This study reports chronic pain prevalence in a randomly selected sample of the adult Australian population. Data were collected by Computer-Assisted Telephone Interview (CATI) using randomly generated telephone numbers and a two-stage stratified sample design. Chronic pain was defined as pain experienced every day for three months in the six months prior to interview. There were 17,543 completed interviews (response rate=70.8%). Chronic pain was reported by 17.1% of males and 20.0% of females. For males, prevalence peaked at 27.0% in the 65--69 year age group and for females, prevalence peaked at 31.0% in the oldest age group (80--84 years). Having chronic pain was significantly associated with older age, female gender, lower levels of completed education, and not having private health insurance; it was also strongly associated with receiving a disability benefit (adjusted OR=3.89, Punemployment benefit (adjusted OR=1.99, Punemployed for health reasons (adjusted OR=6.41, Pinsurance. There were strong associations between having interfering chronic pain and receiving disability benefits (adjusted OR=3.31, Punemployed due to health reasons (adjusted OR=7.94, P<0.001, respectively). The results show that chronic pain impacts upon a large proportion of the adult Australian population, including the working age population, and is strongly associated with markers of social disadvantage. PMID:11166468

  10. Neuroimmunological mechanisms of chronic pain syndrome

    Directory of Open Access Journals (Sweden)

    I. A. Vyshlova

    2016-01-01

    Full Text Available The article considers the mechanisms of chronic low back pain. Three pathophysiological mechanisms: nociceptive, neurogenic (neuropathic, and psychogenic are noted to be involved in the development of pain syndrome. The role of cellular and molecular changes in the posterior horn and in the somatosensory dysregulated mechanism of neuropathic pain is shown. Immunological processes, including neurohumoral (serotoninergic and hormonal (sex hormones and specific proteins ones, play an important role in the development of pain. The generalization and further study of these mechanisms are embodied in approaches to therapy for pain syndromes and hence these require analysis and further investigation. 

  11. Acute and Chronic Low Back Pain.

    Science.gov (United States)

    Patrick, Nathan; Emanski, Eric; Knaub, Mark A

    2016-01-01

    Low back pain is an extremely common presenting complaint that occurs in upward of 80% of persons. Treatment of an acute episode of back pain includes relative rest, activity modification, nonsteroidal anti-inflammatories, and physical therapy. Patient education is also imperative, as these patients are at risk for further future episodes of back pain. Chronic back pain (>6 months' duration) develops in a small percentage of patients. Clinicians' ability to diagnose the exact pathologic source of these symptoms is severely limited, making a cure unlikely. Treatment of these patients should be supportive, the goal being to improve pain and function. PMID:26614726

  12. [Treatment of chronic back pain: current standards].

    Science.gov (United States)

    Märker-Hermann, E; Kiltz, U; Braun, J

    2014-12-01

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

  13. Transdermal fentanyl in chronic nonmalignant pain

    Directory of Open Access Journals (Sweden)

    Vittorio Iorno

    2006-09-01

    Full Text Available Chronic non malignant pain is always a therapeutic challenge of great significance because a inappropriate and insufficient treatment is able to reduce the life’s quality of the patients. Many therapeutic strategies were used to solve these issues, no one exhaustive. In the treatment of cancer pain, opiates use is common, is not the same for the chronic non-malignant pain. The fear of possible side effects (addiction, tolerance, respiratory depression restrain the therapist to apply this remedy. The aim of our work is to demonstrate how a correct application of the opiates in patients with chronic benign pain is not only possible but also desirable to relieving the pain and improving the quality of life.

  14. Pain in chronic pancreatitis and pancreatic cancer.

    Science.gov (United States)

    Fasanella, Kenneth E; Davis, Brian; Lyons, John; Chen, Zongfu; Lee, Kenneth K; Slivka, Adam; Whitcomb, David C

    2007-06-01

    Chronic, debilitating abdominal pain is arguably the most important component of chronic pancreatitis, leading to significant morbidity and disability. Attempting to treat this pain, which is too often unsuccessful, is a frustrating experience for physician and patient. Multiple studies to improve understanding of the pathophysiology that causes pain in some patients but not in others have been performed since the most recent reviews on this topic. In addition, new treatment modalities have been developed and evaluated in this population. This review discusses new advances in neuroscience and the study of visceral pain mechanisms, as well as genetic factors that may play a role. Updates of established therapies, as well as new techniques used in addressing pain from chronic pancreatitis, are reviewed. Lastly, outcome measures, which have been highly variable in this field over the years, are addressed. PMID:17533083

  15. Prevention of chronic pain after whiplash

    OpenAIRE

    Ferrari, R.

    2002-01-01

    The acute whiplash injury is a significant health burden for patients and the healthcare system. Traditional approaches to treatment fail to resolve this ever growing medicolegal and social problem. A new biopsychosocial model of whiplash disorder encourages new ways of treating and preventing of the chronic disability. This biopsychosocial model takes into account the mechanism by which acute pain becomes chronic pain, and how this can be prevented. Specific education and treatments encourag...

  16. Chronic pain: Model of psychosomatic disorder (review

    Directory of Open Access Journals (Sweden)

    Chernus N.P.

    2011-12-01

    Full Text Available The article presents a detailed review on epidemiology, pathogenesis and interrelation of serotonin neuromedia-tor metabolism in the central nervous system in state of chronic pain and depression. It has been demonstrated that neurophysiological conditions serve as psychological defense of an individual. That mechanism has been proved to «transform» serious emotions onto the inner level (body and it assists in the development of psychosomatic disorders — chronic pain syndrome

  17. [Hypnosis for chronic pain of children].

    Science.gov (United States)

    Célestin-Lhopiteau, Isabelle

    2014-01-01

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

  18. Origin of chronic right upper quadrant pain.

    OpenAIRE

    Kingham, J G; Dawson, A. M.

    1985-01-01

    We have studied 22 consecutive patients referred for investigation of severe chronic right upper quadrant pain. The majority were women whose symptoms had been present for many years. All had undergone repeated investigations of the pancreatico-biliary, gastro-intestinal, urinary, and even gynaecological systems without a satisfactory diagnosis. Most had undergone at least one abdominal operation in an unsuccessful attempt to cure their pain. In 21 of 22 patients the customary pain was comple...

  19. Imaging studies in chronic low back pain

    International Nuclear Information System (INIS)

    Imaging brings to difficult problems in chronic low back pain incomplete data showing that it will need a lot of time to find therapeutic solutions. Some comparisons are made between tomodensitometry, nuclear magnetic imaging, the disco-scanner, these technologies allow to find small lesions but the problem is complete when it is not possible to find anything with persistent pains. 125 refs

  20. Neuroimaging revolutionizes therapeutic approaches to chronic pain

    Directory of Open Access Journals (Sweden)

    Borsook David

    2007-09-01

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

  1. Spiritual Coping with Chronic Pain

    OpenAIRE

    Henderson, Kevin

    2008-01-01

    Intro The object of this study was to investigate the relationship between an individual’s spiritual beliefs and how that affected their pain in those with arthritis. It focused mainly on the coping strategies they chose and how their personality influenced this. Method 113 people with various forms of arthritis completed a questionnaire which included scales measuring spiritual perspective (SPS), pain levels and pain interference (BPI), personality factors (Big 5 Domain), coping st...

  2. TMD and chronic pain: A current view

    Directory of Open Access Journals (Sweden)

    Bruno D'Aurea Furquim

    2015-02-01

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

  3. Pain acceptance-based coping in complex regional pain syndrome Type I: daily relations with pain intensity, activity, and mood.

    Science.gov (United States)

    Cho, Sungkun; McCracken, Lance M; Heiby, Elaine M; Moon, Dong-Eon; Lee, Jang-Han

    2013-10-01

    This study aimed to examine the temporal patterning of pain acceptance-based coping, activity, and mood in patients with complex regional pain syndrome Type I (CRPS-I), by using a daily diary method. A total of 30 patients with CRPS-I seeking treatment in a tertiary pain management center located in Seoul, Korea participated in the study. Multilevel random effects analyses indicated that (a) engagement in pain acceptance-based coping was significantly associated with lower same-day pain and negative mood and greater same-day activity and positive mood; (b) pain acceptance-based coping predicted increases in activity on the following day; (c) greater pain intensity was significantly associated with lower same-day pain acceptance-based coping and activity and greater same-day negative mood; and (d) pain intensity did not predict pain acceptance-based coping, activity, or mood on the following day. These findings suggest that patients with CRPS-I may benefit from responding to pain with acceptance. Further study and eventual application of this process in CRPS-I may improve upon the success of current approaches to this problem. PMID:22854886

  4. Neurophysiology of pain and hypnosis for chronic pain.

    Science.gov (United States)

    Dillworth, Tiara; Mendoza, M Elena; Jensen, Mark P

    2012-03-01

    In the past decade there has been a dramatic increase in (1) understanding the neurophysiological components of the pain experiences, (2) randomized clinical trials testing the efficacy of hypnotic treatments on chronic pain, and (3) laboratory research examining the effects of hypnosis on the neurophysiological processes implicated in pain. Work done in these areas has not only demonstrated the efficacy of hypnosis for treating chronic pain but is beginning to shed light on neurophysiological processes that may play a role in its effectiveness. This paper reviews a selection of published studies from these areas of research, focusing on recent findings that have the most potential to inform both clinical work and research in this area. The paper concludes with research and clinical recommendations for maximizing treatment efficacy based on the research findings that are available. PMID:24073099

  5. Anxiety and Related Factors in Chronic Pain

    Directory of Open Access Journals (Sweden)

    Gordon JG Asmundson

    2002-01-01

    Full Text Available Clinicians often encounter patients who present with both chronic pain and elevated levels of anxiety. In some cases, the source of the anxiety is vague and diffuse. For others, there is an identifiable precipitating object, event or situation. For example, some patients with chronic pain are able to attribute their anxiety to the possibility of not regaining lost functional abilities, financial difficulties, feelings of social inadequacy, or uncertainty about the meaning and consequences of pain. The association between chronic pain and anxiety may not be particularly surprising when one considers that, in the acute phase, both pain and target-oriented anxiety (or fear motivate actions that serve to minimize the threat and maximize the likelihood of successful escape. As well, their neurobiology, while distinct, interacts in the reticular system (1. Evaluations of the association between chronic pain and fear-relevant constructs were initiated in the 1960s and 1970s (2,3. It has only been of late, however, that theorists and researchers have begun to focus their attention on delineating the precise nature of the relationship and its specific implications for the assessment and management of pain.

  6. Hypnosis treatment for chronic low back pain.

    Science.gov (United States)

    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

  7. The "self" in pain: the role of psychological inflexibility in chronic pain adjustment.

    Science.gov (United States)

    Kwok, Silvia Sze Wai; Chan, Esther Chin Chi; Chen, Phoon Ping; Lo, Barbara Chuen Yee

    2016-10-01

    Self-discrepancy occurs when a person feels the failure to fulfill one's hopes or responsibilities. Although self-discrepancy has been widely examined to elucidate patients' chronic pain adjustment, the underlying mechanism is unclear. The present study proposes that the effect of self-discrepancy on pain outcomes is accounted for by psychological inflexibility, which involves the psychological processes that guide behaviors in the pursuit of goals and values. One-hundred patients with chronic pain were recruited from a public hospital. They were invited to participate in a semi-structured interview regarding their self-discrepancy and complete self-reported questionnaires regarding their psychological inflexibility and pain outcomes. The results confirmed that psychological inflexibility partly accounts for the variance observed between self-discrepancy and pain outcomes. The current study provides additional insight into the mechanism underpinning the impact of self-discrepancy on patients' pain adjustment and offers clinical implications regarding the use of acceptance commitment therapy for chronic pain management. PMID:27278752

  8. Biopsychosocial model of chronic recurrent pain

    Directory of Open Access Journals (Sweden)

    Zlatka Rakovec-Felser

    2009-07-01

    Full Text Available Pain is not merely a symptom of disease but a complex independent phenomenon where psychological factors are always present (Sternberg, 1973. Especially by chronic, recurrent pain it's more constructive to think of chronic pain as a syndrome that evolves over time, involving a complex interaction of physiological/organic, psychological, and behavioural processes. Study of chronic recurrent functional pain covers tension form of headache. 50 suffering persons were accidentally chosen among those who had been seeking medical help over more than year ago. We tested their pain intensity and duration, extent of subjective experience of accommodation efforts, temperament characteristics, coping strategies, personal traits, the role of pain in intra- and interpersonal communication. At the end we compared this group with control group (without any manifest physical disorders and with analyse of variance (MANOVA. The typical person who suffers and expects medical help is mostly a woman, married, has elementary or secondary education, is about 40. Pain, seems to appear in the phase of stress-induced psychophysical fatigue, by persons with lower constitutional resistance to different influences, greater irritability and number of physiologic correlates of emotional tensions. Because of their ineffective style of coping, it seems they quickly exhausted their adaptation potential too. Through their higher level of social–field dependence, reactions of other persons (doctor, spouse could be important factors of reinforcement and social learning processes. In managing of chronic pain, especially such as tension headache is, it's very important to involve bio-psychosocial model of pain and integrative model of treatment. Intra- and inter-subjective psychological functions of pain must be recognised as soon as possible.

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

    OpenAIRE

    Häuser, Winfried; Wolfe, Frederik; Henningsen, Peter; Schmutzer, Gabriele; Brähler, Elmar; Hinz, Andreas

    2014-01-01

    Background Chronic pain is a major public health problem. The impact of stages of chronic pain adjusted for disease load on societal burden has not been assessed in population surveys. Methods A cross-sectional survey with 4360 people aged ≥ 14 years representative of the German population was conducted. Measures obtained included demographic variables, presence of chronic pain (based on the definition of the International Association for the Study of Pain), chronic pain stages (by chronic pa...

  10. Clinical Holistic Medicine: Chronic Pain in the Locomotor System

    Directory of Open Access Journals (Sweden)

    Søren Ventegodt

    2005-01-01

    Full Text Available Most pains from the locomotor system arise due to involuntary, chronic tensions in the muscles or other tissues. When the patient is motivated, the pain is easily cured in most of the cases by using the tools of consciousness-based medicine, primarily therapeutic touch, conversation, and coaching the patient in a positive philosophy of life. The pains are often caused by “blockages” that may cause problems other than just pain. Often it turns out that the blocked areas develop actual physical damage over time: a slipped disk in the back, articular degeneration, or osteoarthritis when the cartilage is affected, can often be explained in this way. Apparently, the exact areas where the blockage is situated cause cellular problems, disrupting cellular order. The holistic process theory of healing and the related quality of life theories state that return to the natural state of being is possible, whenever the person gets the resources needed for existential healing. The resources needed are “holding” in the dimensions of awareness, respect, care, acknowledgment, and acceptance with support and processing in the dimensions of feeling, understanding, and letting go of negative attitudes and beliefs. The preconditions for holistic healing are trust and the intention for the healing to take place. Case stories of holistic treatment of patients with chronic back pain, low back pain, muscle problems, knee pain, and symptoms of rheumatoid arthritis are discussed with exercises relevant for patients with these conditions in the holistic clinic.

  11. Opioid Therapy for Chronic Nonmalignant Pain

    Directory of Open Access Journals (Sweden)

    Russell K Portenoy

    1996-01-01

    Full Text Available Long term administration of an opioid drug for chronic nonmalignant pain continues to be controversial, but is no longer uniformly rejected by pain specialists. This is true despite concerns that the regulatory agencies that oversee physician prescribing of opioid drugs continue to stigmatize the practice. The changing clinical perspective has been driven, in part, by widespread acknowledgement of the remarkably favourable outcomes achieved during opioid treatment of cancer pain. These outcomes contrast starkly with popular teaching about chronic opioid therapy and affirm the potential for prolonged efficacy, tolerable side effects, enhanced function associated with improved comfort and minimal risk of aberrant drug-related behaviours consistent with addiction. A large anecdotal experience in populations with nonmalignant pain suggests that these patients are more heterogeneous and that opioid therapy will greatly benefit some and will contribute to negative outcomes for others. The few controlled clinical trials that have been performed support the safety and efficacy of opioid therapy, but have been too limited to ensure generalization to the clinical setting. A critical review of the medical literature pertaining to chronic pain, opioid pharmacology and addiction medicine can clarify misconceptions about opioid therapy and provide a foundation for patient selection and drug administration. The available data support the view that opioids are no panacea for chronic pain, but should be considered in carefully selected patients using clinically derived guidelines that stress a structured approach and ongoing monitoring of efficacy, adverse effects, functional outcomes and the occurrence of aberrant drug-related behaviours.

  12. Mechanism for chronic pain generation

    Institute of Scientific and Technical Information of China (English)

    2000-01-01

    Neuropathic pain and the other abnormalities of sensation induced by axon injury or by peripheral nerve inflammation should result from functional compensations of the injured neurons during their regeneration. Ectopic distribution of proteins related to Na+, K+ and Ca2+ channels as well as of receptors on both membranes of injured axon and its cell body becomes a main pacemaker from which spontaneous ectopic afferent of primary sensatory neurons and crosstalk between neurons occur. Abnormal ectopic afferent activities lead to disorders of the sensation, such as hyperalgesia, allodynia, spontaneous pain and paraesthesia. Administration of some ion channel agents and/or α2-adrenergic blockers has shown efficiency in preventing neuropathic pain development and in relieving neuropathic pain.

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

    Science.gov (United States)

    Parkins, Jason M.; Gfroerer, Susan D.

    2009-01-01

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

  14. Electronic diary assessment of pain-related fear, attention to pain, and pain intensity in chronic low back pain patients.

    NARCIS (Netherlands)

    Roelofs, J.; Peters, M.L.; Patijn, J.; Schouten, E.G.; Vlaeyen, J.W.

    2004-01-01

    The present study investigated the relationships between pain-related fear, attention to pain, and pain intensity in daily life in patients with chronic low back pain. An experience sampling methodology was used in which electronic diary data were collected by means of palmtop computers from 40 chro

  15. Prevalence of chronic low back pain: systematic review

    OpenAIRE

    Rodrigo Dalke Meucci; Anaclaudia Gastal Fassa; Neice Muller Xavier Faria

    2015-01-01

    OBJECTIVE To estimate worldwide prevalence of chronic low back pain according to age and sex. METHODS We consulted Medline (PubMed), LILACS and EMBASE electronic databases. The search strategy used the following descriptors and combinations: back pain, prevalence, musculoskeletal diseases, chronic musculoskeletal pain, rheumatic, low back pain, musculoskeletal disorders and chronic low back pain. We selected cross-sectional population-based or cohort studies that assessed chronic low back pai...

  16. [Behavioral aspects of chronic pain syndromes].

    Science.gov (United States)

    Oliveira, J T

    2000-06-01

    The knowledge of biological pain mechanisms are not sufficient for the understanding of patients with chronic pain syndromes such as low back, cervicobrachial and muscle pain. Psychological and psychosocial aspects play important roles in the setting and perpetuation of symptoms. Mood and anxiety disorders, secondary gains such as early retirement and financial compensations, must all be acknowledged by the physician as possible contributors to the symptoms. Abnormal illness behavior may better characterize patients with chronic pain syndromes. Behavior observation, which is akin to medical practice, is therefore a powerful tool in the diagnosis and management of these syndromes. Physicians ought be very careful in not reinforcing the patients already strong organic convictions regarding their symptoms, avoiding making decisions based on patients complaints and alleged disabilities, and assigning poorly defined and disputable diagnosis labels. Society needs also to refrain from policies that encourage abnormal illness behaviors. PMID:10849642

  17. Effects of Mindfulness Meditation on Chronic Pain

    DEFF Research Database (Denmark)

    la Cour, Peter; Petersen, Marian

    2015-01-01

    OBJECTIVE: This randomized controlled clinical trial investigated the effects of mindfulness meditation on chronic pain. DESIGN: A total of 109 patients with nonspecific chronic pain were randomized to either a standardized mindfulness meditation program (mindfulness-based stress reduction [MBSR...... randomized patients completed the mindfulness program, while 47 remained in the control group. Data were compared at three time points: at baseline, after completion of the course/waiting period, and at the 6-month follow-up. RESULTS: Significant effect (Cohen's d = 0.39) was found on the primary outcome...... (nonsignificant) effect sizes were found for pain measures. There were no significant differences in the measures just after the intervention vs the 6-month follow-up. CONCLUSION: A standardized mindfulness program (MBSR) contributes positively to pain management and can exert clinically relevant effects...

  18. Surgical treatment of pain in chronic pancreatitis

    Directory of Open Access Journals (Sweden)

    Stefanović Dejan

    2006-01-01

    Full Text Available INTRODUCTION: The principal indication for surgical intervention in chronic pancreatitis is intractable pain. Depending upon the presence of dilated pancreatic ductal system, pancreatic duct drainage procedures and different kinds of pancreatic resections are applied. OBJECTIVE: The objective of the study was to show the most appropriate procedure to gain the most possible benefits in dependence of type of pathohistological process in chronic pancreatitis. METHOD: Our study included 58 patients with intractable pain caused by chronic pancreatitis of alcoholic genesis. The first group consisted of 30 patients with dilated pancreatic ductal system more than 10 mm. The second group involved 28 patients without dilated pancreatic ductal system. Pain relief, weight gain and glucose tolerance were monitored. RESULTS: All patients of Group I (30 underwent latero-lateral pancreaticojejunal - Puestow operation. 80% of patients had no pain after 6 month, 13.6% had rare pain and 2 patients, i.e. 6.4%, who continued to consume alcohol, had strong pain. Group II consisting of 28 patients was without dilated pancreatic ductal system. This group was subjected to various types of pancreatic resections. Whipple procedure (W was done in 6 patients, pylorus preserving Whipple (PPW in 7 cases, and duodenum preserving cephalic pancreatectomy (DPCP was performed in 15 patients. Generally, 89.2% of patients had no pain 6 month after the operation. An average weight gain was 1.9 kg in W group, 2.8 kg in PPW group and 4.1 kg in DPCP group. Insulin-dependent diabetes was recorded in 66.6% in W group, 57.1% in PPW group and 0% in DPCP group. CONCLUSION: According to our opinion, DPCP may be considered the procedure of choice for surgical treatment of pain in chronic pancreatitis in patients without dilatation of pancreas ductal system because of no serious postoperative metabolic consequences.

  19. Medication Treatment Efficacy and Chronic Orofacial Pain.

    Science.gov (United States)

    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

  20. Ecological System Influences in the Treatment of Pediatric Chronic Pain

    Directory of Open Access Journals (Sweden)

    Deirdre E Logan

    2012-01-01

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

  1. Ecological system influences in the treatment of pediatric chronic pain.

    Science.gov (United States)

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

    2012-01-01

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

  2. Clinical Holistic Medicine: Chronic Pain in Internal Organs

    Directory of Open Access Journals (Sweden)

    Søren Ventegodt

    2005-01-01

    Full Text Available Holistic medicine seems to be efficient in the treatment of chronic pain in internal organs, especially when the pain has no known cause. It is quite surprising that while chronic pain can be one of the toughest challenges in the biomedical clinic, it is often one of the simplest things to alleviate in the holistic clinic. These pains are regarded as being caused by repressed emotions and are explained as psychosomatic reactions. Using holistic medicine, the patients can often be cured of their suffering when they assume responsibility for the repressed feelings. The holistic process theory of healing states that the return to the natural (pain free state of being is possible whenever the person obtains the resources needed for existential healing. This shift is explained by the related quality of life and life mission theories. The resources needed are “holding” or genuine care in the dimensions of awareness, respect, care, acknowledgment, and acceptance with support and processing in the dimensions of feeling, understanding, and letting go of negative attitudes and beliefs. The preconditions for the holistic healing to take place are “love” and trust. Obtaining the full trust of the patient, therefore, seems to be the biggest challenge of holistic medicine, especially when dealing with a patient in pain.

  3. Psychological Assessment in Chronic Pain.

    Science.gov (United States)

    Duckro, Paul N.; And Others

    1985-01-01

    Compares several instruments of potential usefulness in assessment of anxiety and depression among pain patients (N=34). Results showed that the SCL-90-R appeared to offer the best combination of relevant data and efficient assessment. However, significant intercorrelations among SCL-90-R subscales suggest a unitary factor structure. (NRB)

  4. Beyond pain: modeling decision-making deficits in chronic pain

    Directory of Open Access Journals (Sweden)

    Leonardo Emanuel Hess

    2014-08-01

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

  5. Patient satisfaction with a pilot chronic pain management programme in Cape Town, South Africa

    Directory of Open Access Journals (Sweden)

    R. Parker

    2009-02-01

    Full Text Available Background: The goals of a chronic pain management clinic includeincreasing patient knowledge about pain, developing pain management skillsand increasing patients’ confidence in their pain management abilities.A  Chronic Pain Management Programme (CPMP based on evidence basedguidelines was developed at a chronic pain management clinic to facilitatepatient discharge to a primary healthcare level. Aim: The aim of this study was to explore patient satisfaction with, acceptability of and the perceived success which could be due to the CPMP developed at the Chronic Pain Management Clinic of Groote Schuur Hospital,Cape Town.Methods: Patients (n=14 were referred to the pilot study from the Chronic Pain Management Clinic. A s a pilot, four courses were run over a period ofone year. In order to reach the research aim, an eleven-question, structuredopen-ended interview was conducted with all participants. Results: Fourteen patients enrolled in the CPMP. Responses were favourable with participants emphasising the roleof increased knowledge about pain, the role of exercise and of stress management techniques. Participants also recog-nised a positive change in behaviours and attitudes following participation in the CPMP.Conclusions: Findings suggest that participants found the format of the course acceptable as regards course content,structure and delivery. Participant responses suggest that the course was acceptable and perceived as useful. However,future courses would benefit from refresher courses or structured support groups.

  6. Neuropsychological assessment of chronic non-malignant pain patients treated in a multidisciplinary pain centre

    DEFF Research Database (Denmark)

    Sjøgren, Per; Christrup, Lona Louring; Petersen, Morten Aa;

    2005-01-01

    The aim of the study was to investigate the influence of pain, sedation, pain medications and socio-demographics on cognitive functioning in chronic non-malignant pain patients. Chronic non-malignant pain patients (N=91) treated in a multidisciplinary pain centre were compared with age and sex ma...

  7. Craniosacral Therapy for the Treatment of Chronic Neck Pain

    Science.gov (United States)

    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

  8. The characteristics of chronic central pain after traumatic brain injury.

    Science.gov (United States)

    Ofek, Hadas; Defrin, Ruth

    2007-10-01

    Central pain following traumatic brain injury (TBI) has not been studied in depth. Our purpose was to conduct a systematic study of patients with TBI suffering from chronic central pain, and to describe the characteristics of the central pain. Groups were TBI patients with (TBIP) and without central pain (TBINP) and healthy controls. TBI patients with other pain mechanisms were excluded from the study. Participants underwent quantitative somatosensory testing in the painful and pain-free body regions. Thresholds for warmth, cold, heat-pain, touch and graphesthesia were measured and pathologically evoked pain (allodynia, hyperpathia and wind-up pain) evaluated. Chronic pain was mapped and characterized. Chronic pain developed at a relatively late onset (6.6+/-9 months) was almost exclusively unilateral and reported as pricking, throbbing and burning. Although both TBIP and TBINP exhibited a significant reduction in thermal and tactile sensations compared to controls, thermal sensations in the painful regions of TBIP were significantly more impaired than pain-free regions in the same patients (p<0.01) and in TBINP (p<0.01). Painful regions also exhibited very high rates of allodynia, hyperpathia and exaggerated wind-up. The characteristics of the chronic pain resembled those of other central pain patients although TBIP displayed several unique features. The sensory profile indicated that damage to the pain and temperature systems is a necessary but not sufficient condition for the development of chronic central pain following TBI. Neuronal hyperexcitability may be a contributing factor to the chronic pain.

  9. Ziconotide for treatment of severe chronic pain.

    Science.gov (United States)

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

    2010-05-01

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

  10. Spinal cord stimulation in chronic pain syndromes

    NARCIS (Netherlands)

    ten Vaarwerk, IAM; Staal, MJ

    1998-01-01

    Spinal cord stimulation (SCS) has been used for more than 30 years now, and although it has shown to be effective under certain well-described conditions of chronic pain, conclusive evidence on its effectiveness is still sparse. There is a need for more prospective and methodological good studies, i

  11. Antioxidants for pain in chronic pancreatitis

    NARCIS (Netherlands)

    Ahmed Ali, Usama; Jens, Sjoerd; Busch, Olivier R C; Keus, Frederik; van Goor, Harry; Gooszen, Hein G; Boermeester, Marja A

    2014-01-01

    BACKGROUND: Reduced intake and absorption of antioxidants due to pain and malabsorption are probable causes of the lower levels of antioxidants observed in patients with chronic pancreatitis (CP). Improving the status of antioxidants might be effective in slowing the disease process and reducing pai

  12. Unexplained severe chronic pain in general practice.

    NARCIS (Netherlands)

    Kerssens, J.J.; Verhaak, P.F.M.; Bartelds, A.I.M.; Sorbi, M.J.; Bensing, J.M.

    2002-01-01

    The aim of this study was to estimate the prevalence of unexplained severe chronic pain (USCP) in general practice and to report medical as well as psychological descriptions of patients suffering from this condition. A total of 45 GPs in 35 different practices included patients throughout the year

  13. Chronic pain, social withdrawal, and depression

    Directory of Open Access Journals (Sweden)

    Harris RA

    2014-09-01

    Full Text Available Rebecca Arden Harris Department of Family and Social Medicine, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY, USAWallace et al1 used an effective combination of qualitative methods, ie, photographs taken by patients with accompanying narratives, interviews, and focus group sessions, to elicit descriptions of the daily realities of living with chronic pain from the patient perspective. The details are intimate and poignant. Patients tell of how they must curtail everyday activities in order to cope with the discomfort, of their frustration in trying to relay their situation to others, and of their despair at the thick-skinned reception they sometimes get because pain presents differently from other ailments. Primary care physicians will learn a lot from these images, particularly with regard to depression as a comorbidity of chronic pain.View orginal paper by Wallace et al

  14. ["Coping... and the person with chronic pain"].

    Science.gov (United States)

    Ribeiro, Leonor Ana; Santos, Céila

    2008-01-01

    We intend to present some aspects related with the coping process in a person with chronic pain. The presence of pain has implications in daily life activities, such as eating, drinking, sleeping or selfcare. Pain can unchain responses in the person, namely depression, anxiety, isolation, fear of pain and pessimistic thoughts. Thus we verify that in his/her adaptation process to the condition of chronic pain the person needs to integrate some strategies to manage his/her day by day activities. In this article we try to systematize the process where nurses based on Lazarus and Folkman's Model: Stress processing and Coping, can systematize care. In fact, nurses try to help people in the identification of their personal resources as well as the socio-ecological resources. The sense the care process has as a goal is the improvement of the quality of life through pain control and the person's adaptation of his/her condition of health, through development of his/her knowledge and capacities to use the resources, be they personal as instrumental or social. PMID:19341045

  15. Alexithymia and anxiety in female chronic pain patients

    OpenAIRE

    Saatcioglu Omer; Celikel Feryal

    2006-01-01

    Abstract Objectives Alexithymia is highly prevalent among chronic pain patients. Pain is a remarkable cause for high levels of chronic anxiety. The purpose of this study was to investigate the prevalence of alexithymia and to determine anxiety levels among DSM-IV somatoform pain disorder (chronic pain) female patients and to examine the relationship between alexithymia and the self-reporting of pain. Methods Thirty adult females (mean age: 34,63 ± 10,62 years), who applied to the outpatient p...

  16. Chronic Pain in Canada: Have We Improved Our Management of Chronic Noncancer Pain?

    Directory of Open Access Journals (Sweden)

    Aline Boulanger

    2007-01-01

    Full Text Available BACKGROUND: Chronic noncancer pain (CNCP is a global issue, not only affecting individual suffering, but also impacting the delivery of health care and the strength of local economies.

  17. Acute and chronic pain syndromes in multiple sclerosis

    DEFF Research Database (Denmark)

    Stenager, E; Knudsen, L; Jensen, K

    1991-01-01

    A representative sample of 117 patients with definite multiple sclerosis (MS) was interviewed on pain syndromes. Chronic syndromes lasting more than one month included dysaestesthesia, low back pain, spasms, tonic seizures, tightening and painful sensations in the extremities. Acute syndromes...

  18. Fibromyalgia, chronic fatigue syndrome, and myofascial pain.

    Science.gov (United States)

    Bennett, R

    1998-03-01

    Epidemiologic studies continue to provide evidence that fibromyalgia is part of a spectrum of chronic widespread pain. The prevalence of chronic widespread pain is several times higher than fibromyalgia as defined by the 1990 American College of Rheumatology guidelines. There is now compelling evidence of a familial clustering of fibromyalgia cases in female sufferers; whether this clustering results from nature or nature remains to be elucidated. A wide spectrum of fibromyalgia-associated symptomatology and syndromes continues to be described. During the past year the association with interstitial cystitis has been explored, and neurally mediated hypotension has been documented in both fibromyalgia and chronic fatigue syndrome. Abnormalities of the growth hormone-insulin-like growth factor-1 axis have been also documented in both fibromyalgia and chronic fatigue syndrome. The commonly reported but anecdotal association of fibromyalgia with whiplash-type neck trauma was validated in a report from Israel. However, unlike North America, 100% of Israeli patients with posttraumatic fibromyalgia returned to work. Basic research in fibromyalgia continues to pinpoint abnormal sensory processing as being integral to understanding fibromyalgia pain. Drugs such as ketamine, which block N-methyl-D-aspartate receptors (which are often upregulated in central pain states) were shown to benefit fibromyalgia pain in an experimental setting. The combination of fluoxetine and amitriptyline was reported to be more beneficial than either drug alone in patients with fibromyalgia. A high prevalence of autoantibodies to cytoskeletal and nuclear envelope proteins was found in chronic fatigue syndrome, and an increased prevalence of antipolymer antibodies was found in symptomatic silicone breast implant recipients who often have fibromyalgia.

  19. Psychosocial assessment and self-management of chronic pain

    OpenAIRE

    Voerman, Jessica

    2015-01-01

    markdownabstractAbstract Chronic pain is prevalent in both children and adults and has major negative consequences for their daily life, e.g. reduced participation in activities and depressive and anxious feelings. Therefore, it is important to early signal and treat chronic pain. This thesis aimed to provide answers to two important questions: 1. How to improve early signaling and assessment of chronic pain in adolescents? and 2. How to improve self-management of chronic pain in both adolesc...

  20. Meeting the occupational needs of people with chronic pain

    OpenAIRE

    Robinson, Catherine T; Harmon, Dominic

    2012-01-01

    peer-reviewed This thesis comprises eight papers that aim to explore the relationship between occupation and chronic pain, augment the evidence available to occupational therapists working with people with chronic pain, and to develop occupational therapy services for people with chronic pain in Ireland. The practice of occupational therapists with people with chronic pain appears to reflect the profession wide theory-practice gap. A lack of evidence for occupationbased p...

  1. Pain experience of Iraq and Afghanistan Veterans with comorbid chronic pain and posttraumatic stress

    Directory of Open Access Journals (Sweden)

    Samantha D. Outcalt, PhD

    2014-07-01

    Full Text Available Chronic pain and posttraumatic stress disorder (PTSD co-occur at high rates, and Veterans from recent wars in Iraq and Afghanistan may be particularly vulnerable to both conditions. The objective of this study was to identify key aspects of chronic pain, cognitions, and psychological distress associated with comorbid PTSD among this sample of Veterans. Baseline data were analyzed from a randomized controlled trial testing a stepped-care intervention for chronic musculoskeletal pain. Operation Iraqi Freedom/Operation Enduring Freedom (OIF/OEF Veterans with chronic pain only (n = 173 were compared with those with chronic pain and clinically significant posttraumatic stress symptoms (n = 68. Group differences on pain characteristics, pain cognitions, and psychological distress were evaluated. Results demonstrated that OIF/OEF Veterans with comorbid chronic musculoskeletal pain and PTSD experienced higher pain severity, greater pain-related disability and increased pain interference, more maladaptive pain cognitions (e.g., catastrophizing, self-efficacy, pain centrality, and higher affective distress than those with chronic pain alone. Veterans of recent military conflicts in Iraq and Afghanistan may be particularly vulnerable to the compounded adverse effects of chronic pain and PTSD. These results highlight a more intense and disabling pain and psychological experience for those with chronic pain and PTSD than for those without PTSD.

  2. Placebo use in pain management: The role of medical context, treatment efficacy, and deception in determining placebo acceptability.

    Science.gov (United States)

    Kisaalita, Nkaku; Staud, Roland; Hurley, Robert; Robinson, Michael

    2014-12-01

    Placebo effects can act as powerful pain relievers. Although the ethics of therapeutic placebo use are highly controversial, recent evidence suggests that medical providers frequently utilize placebo treatments and patients may be open to these interventions in 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 in which they rated their knowledge of placebo and its efficacy for alleviating pain, evaluated the acceptability of placebo analgesic interventions across several unique medical contexts, and responded to 6 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 its 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, contrary to popular belief, patients may be rather pragmatic in their appraisals of placebo treatment acceptability, and may consider a variety of treatments/contexts as ethically 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.

  3. Electronic momentary assessment in chronic pain (II): pain and psychological pain responses as predictors of pain disability.

    NARCIS (Netherlands)

    Sorbi, M.J.; Peters, M.L.; Kruise, D.A.; Maas, C.J.M.; Kerssens, J.J.; Verhaak, P.F.M.; Bensing, J.M.

    2006-01-01

    Objectives and Methods: More than 7,100 electronic diaries from 80 patients with chronic pain (mean: 89.3, range 30-115) entered multilevel analyses to establish the statistical prediction of disability by pain intensity and by psychological functioning (fear avoidance, cognitive, and spousal pain r

  4. Immune mediators of chronic pelvic pain syndrome.

    Science.gov (United States)

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

    2014-05-01

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

  5. Pilot study evaluating a brief mindfulness intervention for those with chronic pain: study protocol for a randomized controlled trial.

    OpenAIRE

    Howarth, Ana; Perkins-Porras, Linda; Smith, Jared G; Subramaniam, Jeevakan; Copland, Claire; Hurley, Mike; Beith, Iain; Riaz, Muhammad; Ussher, Michael

    2016-01-01

    BACKGROUND: The burden of chronic pain is a major challenge, impacting the quality of life of patients. Intensive programmes of mindfulness-based therapy can help patients to cope with chronic pain but can be time consuming and require a trained specialist to implement. The self-management model of care is now integral to the care of patients with chronic pain; home-based interventions can be very acceptable, making a compelling argument for investigating brief, self-management intervent...

  6. Acupuncture For Severe Chronic Perineal Pain

    Institute of Scientific and Technical Information of China (English)

    W. Watere

    2004-01-01

    @@ A 42-year-old man (1.8 m, 80 kg), a postal employee, presented to our TCM-Centre, Elisabeth Hospital, Recklinghausen, Germany, with severe chronic perineal pain and hyperhidrosis, especially head, forehead, hand plains, and foot soles. Due to pain, the patient was unable to sit, unable to work for 3 months,and was depressed and fearful. He had bronchial asthma with no complaints under medication. The patient smoked 20 cigarettes daily; he reported no alcohol usage.During a 3-month period (summer 2002), he had consulted an urologist, internist, neurologist, psychiatrist, and radiologist.

  7. Smoking Cessation and Chronic Pain: Patient and Pain Medicine Physician Attitudes

    OpenAIRE

    Hooten, W. Michael; Vickers, Kristin S.; Shi, Yu; Ebnet, Kaye L.; Townsend, Cynthia O.; Patten, Christi A.; Warner, David O.

    2011-01-01

    Although previous studies suggest that the clinical setting of an interdisciplinary pain treatment program may provide an optimal environment to promote smoking cessation, currently available smoking cessation interventions may be less effective for adults with chronic pain due, in part, to unrecognized clinical factors related to chronic pain. The specific aim of this qualitative study was to solicit information from adult smokers with chronic pain participating in an interdisciplinary pain ...

  8. Behavioral Concepts in the Analysis of Chronic Pain Syndromes.

    Science.gov (United States)

    Keefe, Francis J.; Gil, Karen M.

    1986-01-01

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

  9. Altered central sensitization and pain modulation in the CNS in chronic joint pain

    DEFF Research Database (Denmark)

    Arendt-Nielsen, Lars; Skou, Søren Thorgaard; Nielsen, Thomas Arendt;

    2015-01-01

    Musculoskeletal pain disorders are the second largest contributor to global disability underlining the significance of effective treatments. However, treating chronic musculoskeletal pain, and chronic joint pain (osteoarthritis (OA)) in particular, is challenging as the underlying peripheral and ...... mechanisms, available tools are important for patent profiling and providing the basic knowledge for development of new drugs and for developing pain management regimes....... of human quantitative pain assessment tools (quantitative sensory testing (QST)) have been developed providing new opportunities for profiling patients and reaching a greater understanding of the mechanisms involved in chronic joint pain. As joint pain is a complex interaction between many different pain...

  10. Assessing and Managing Sleep Disturbance in Patients with Chronic Pain.

    Science.gov (United States)

    Cheatle, Martin D; Foster, Simmie; Pinkett, Aaron; Lesneski, Matthew; Qu, David; Dhingra, Lara

    2016-06-01

    Chronic pain is associated with symptoms that may impair a patient's quality of life, including emotional distress, fatigue, and sleep disturbance. There is a high prevalence of concomitant pain and sleep disturbance. Studies support the hypothesis that sleep and pain have a bidirectional and reciprocal relationship. Clinicians who manage patients with chronic pain often focus on interventions that relieve pain, and assessing and treating sleep disturbance are secondary or not addressed. This article reviews the literature on pain and co-occurring sleep disturbance, describes the assessment of sleep disturbance, and outlines nonpharmacologic and pharmacologic treatment strategies to improve sleep in patients with chronic pain. PMID:27208716

  11. Assessing and Managing Sleep Disturbance in Patients with Chronic Pain.

    Science.gov (United States)

    Cheatle, Martin D; Foster, Simmie; Pinkett, Aaron; Lesneski, Matthew; Qu, David; Dhingra, Lara

    2016-06-01

    Chronic pain is associated with symptoms that may impair a patient's quality of life, including emotional distress, fatigue, and sleep disturbance. There is a high prevalence of concomitant pain and sleep disturbance. Studies support the hypothesis that sleep and pain have a bidirectional and reciprocal relationship. Clinicians who manage patients with chronic pain often focus on interventions that relieve pain, and assessing and treating sleep disturbance are secondary or not addressed. This article reviews the literature on pain and co-occurring sleep disturbance, describes the assessment of sleep disturbance, and outlines nonpharmacologic and pharmacologic treatment strategies to improve sleep in patients with chronic pain.

  12. Epidemiology of chronic pain in Denmark: an update

    DEFF Research Database (Denmark)

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

    2008-01-01

    was associated with female gender and increasing age. Higher prevalence of chronic pain were associated with being divorced, separated or widowed, having less than 10 years of education and high BMI. Musculoskeletal diseases (66.8%) were the most common cause for chronic pain and most persons with chronic pain...... rated their health and quality of life as poor. Persons with earlier or present cancer diagnosis were more likely to report chronic pain. A substantial part of persons with chronic pain were not satisfied with the examinations and treatments offered. In conclusion, over a five-year period the prevalence...

  13. Chronic pain, perceived stress, and cellular aging: an exploratory study

    Directory of Open Access Journals (Sweden)

    Sibille Kimberly T

    2012-02-01

    Full Text Available Abstract Background Chronic pain conditions are characterized by significant individual variability complicating the identification of pathophysiological markers. Leukocyte telomere length (TL, a measure of cellular aging, is associated with age-related disease onset, psychosocial stress, and health-related functional decline. Psychosocial stress has been associated with the onset of chronic pain and chronic pain is experienced as a physical and psychosocial stressor. However, the utility of TL as a biological marker reflecting the burden of chronic pain and psychosocial stress has not yet been explored. Findings The relationship between chronic pain, stress, and TL was analyzed in 36 ethnically diverse, older adults, half of whom reported no chronic pain and the other half had chronic knee osteoarthritis (OA pain. Subjects completed a physical exam, radiographs, health history, and psychosocial questionnaires. Blood samples were collected and TL was measured by quantitative polymerase chain reaction (qPCR. Four groups were identified characterized by pain status and the Perceived Stress Scale scores: 1 no pain/low stress, 2 no pain/high stress, chronic pain/low stress, and 4 chronic pain/high stress. TL differed between the pain/stress groups (p = 0.01, controlling for relevant covariates. Specifically, the chronic pain/high stress group had significantly shorter TL compared to the no pain/low stress group. Age was negatively correlated with TL, particularly in the chronic pain/high stress group (p = 0.03. Conclusions Although preliminary in nature and based on a modest sample size, these findings indicate that cellular aging may be more pronounced in older adults experiencing high levels of perceived stress and chronic pain.

  14. Chronic low back pain in housewives

    Directory of Open Access Journals (Sweden)

    Mehmet Bulut

    2011-09-01

    Full Text Available Objectives: The aim of this study is to investigate low back pain of housewives and to deteremine relationships between psychological status, education and physical health in housewives.Materials and methods: Thirty premenopausal housewives aged 33-45 years with chronic low back pain were included and the control group consisted of 30 healthy premenopausal housewives. Physical examinations were performed. Age, height, weight, educational level, number of children, consumption of cigarettes and alcohol were recorded. The body mass index (BDI was measured. The severity of back pain was measured by the Oswestry Disability Index (ODI, psychological status was evaluated by the Beck Depression Inventory (BDI and muscle strength by manual technique.Results: There was no difference between demographic data of patients and controls. BDI scores of patients were significantly higher than the controls (p<0,01. Abdominal and dorsal muscle strength were higher in the control group but different was not significant. OBAS values in the patient group, were positively correlated with BDI and BMI (p= 0.011; p= 0.001, respectively, and negatively correlated with abdominal and dorsal muscle strength (p= 0.006 and p= 0.001. Significant correlations were found between abdominal and dorsal muscle strength and the BMI, ODI and BDI scores and high educational level positively affected the ODI and the BDI scores in patients.Conclusion: The housewives with chronic back pain and do not exercise regularly limit activities of daily living. Because of higher BDI scores of patients with chronic low back pain, these patients should also undergo psychiatric examination. J Clin Exp Invest 2011; 2 (3: 295-298.

  15. Psychoneuroimmunology: Potential Relevance to Chronic Orofacial Pain

    OpenAIRE

    Schleifer, Steven J.; Marbach, Joseph; Keller, Steven E.

    1990-01-01

    Studies undertaken over the past ten years have demonstrated that stress and depression can induce immune alterations, including decreased numbers of immunocompetent cells and impaired lymphocyte and natural killer cell activity. Factors such as age and severity of symptomatology influence these effects. The substantial stress and depression associated with chronic pain syndromes and the evidence for opioid involvement in immunomodulation suggest that immune system changes may occur in some p...

  16. Chronic pain, social withdrawal, and depression

    OpenAIRE

    Harris RA

    2014-01-01

    Rebecca Arden Harris Department of Family and Social Medicine, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY, USAWallace et al1 used an effective combination of qualitative methods, ie, photographs taken by patients with accompanying narratives, interviews, and focus group sessions, to elicit descriptions of the daily realities of living with chronic pain from the patient perspective. The details are intimate and poignant. Patients tell of how they must curtail ever...

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

    OpenAIRE

    S. Monti; 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. Effi cacy 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 undertr...

  18. Effects of daily pain intensity, positive affect, and individual differences in pain acceptance on work goal interference and progress.

    Science.gov (United States)

    Mun, Chung Jung; Karoly, Paul; Okun, Morris A

    2015-11-01

    Multilevel modeling was used to examine the effects of morning pain intensity and morning positive and negative affect on pain's interference with afternoon work goal pursuit and with evening work goal progress in a community sample of 132 adults who completed a 21-day diary. The moderating effects of pain acceptance and pain catastrophizing on the associations between morning pain intensity and afternoon work goal interference were also tested. Results revealed that the positive relationship between morning pain intensity and pain's interference with work goal pursuit was significantly moderated by pain acceptance, but not by pain catastrophizing. Both morning pain intensity and positive affect exerted significant indirect effects on evening work goal progress through the perception of pain's interference with work goal pursuit in the afternoon. Furthermore, the mediated effect of morning pain on evening work goal progress was significant when pain acceptance was at the grand mean and 1 SD below the grand mean, but not when pain acceptance was 1 SD above the grand mean. Thus, it appears that high pain acceptance significantly attenuates pain's capacity to disrupt work goal pursuit. Moreover, morning positive affect appears to operate as a protective factor. Additional interpretations and potential explanations for some inconsistent outcomes are discussed along with limitations, clinical implications, and suggestions for future studies.

  19. Development of Feeling Better: A web-based pain management programme for children with chronic pain and their parents.

    Directory of Open Access Journals (Sweden)

    Angeline M Traynor

    2015-10-01

    Conclusions: It is feasible to create an evidence-based and theory driven online self-management intervention to support children with chronic pain and their parents. Service users can be involved in the design and conduct of research in a meaningful way. An exploratory trial to test the feasibility of acceptability of Feeling Better is underway.

  20. Chronic pain disrupts the reward circuitry in multiple sclerosis.

    Science.gov (United States)

    Seixas, Daniela; Palace, Jacqueline; Tracey, Irene

    2016-08-01

    Pain commonly affects multiple sclerosis (MS) patients, and has the potential to become chronic and burden an already damaged central nervous system. Imaging studies are providing insights into brain restructuring associated with chronic pain and different chronic pain conditions seem to evoke distinct plasticity patterns. Our objective was to study the structural and functional brain changes of chronic neuropathic pain of MS. Employing structural and resting functional magnetic resonance imaging we compared MS patients with chronic central pain with MS patients without pain matched with respect to age, gender, subtype and duration of MS and disability. Mean duration of pain was 7.6 years. Comparing the pain and no-pain groups, brain functional default-mode network differences were found. There was decreased coactivation in the caudate nucleus and nucleus accumbens bilaterally. Also, for the relapsing-remitting subgroup of patients, grey matter thickness changes predominated in the pain group in the mesial region of the temporal lobes, caudate, putamen, thalami and the fronto-parietal cortex; in the group without pain, changes predominated in the frontopolar and orbitofrontal cortices and in the occipital areas. A dysfunction in the reward system in chronic pain of MS was found, particularly in the brain areas involved in its motivational aspects, as such probably reflecting the maladaptive physiology of chronic pain, and possibly the signature of pain in MS, in a disease where reward impairment seems to be already one of its features. PMID:27178661

  1. Heritability of chronic pain in 2195 extended families.

    Science.gov (United States)

    Hocking, L J; Morris, A D; Dominiczak, A F; Porteous, D J; Smith, B H

    2012-08-01

    Chronic pain is pathological, persisting beyond normal tissue healing time. Previous work has suggested ∼50% variation in chronic pain development is heritable. No data are currently available on the heritability of pain categorized using the Chronic Pain Grade (CPG). Furthermore, few existing studies have accounted for potential confounders that may themselves be under genetic control or indeed 'heritable' non-genetic traits. This study aimed to determine the relative contributions of genetic, measured and shared environmental and lifestyle factors to chronic pain. Chronic pain status was determined and CPG measured in participants from Generation Scotland: the Scottish Family Health Study, a large cohort of well-characterized, extended families from throughout Scotland, UK. Heritability estimates (h (2) ) for 'any chronic pain' and 'severe' chronic pain (CPG 3 or 4) were generated using SOLAR software, with and without adjustment for shared household effects and measured covariates age, body mass index, gender, household income, occupation and physical activity. Data were available for 7644 individuals in 2195 extended families. Without adjustment, h (2) for 'any chronic pain' was 29% [standard errors (SE) 6%; p study supports the use of chronic pain as a phenotype in genetic studies, with adequate correction for confounders to specifically identify genetic risk factors for chronic pain. PMID:22337623

  2. Association between chronic pain and the sperm motion characteristics

    DEFF Research Database (Denmark)

    Dardmeh, Fereshteh; Alipour, Hiva; Nielsen, Hans Ingolf;

    2015-01-01

    stimulation, it can be speculated that the observed difference in sperm kinematic parameters could be related to the alterations in serum sex hormone levels emanating from the chronic pain. Further studies are required to explain the possible mechanism of action of chronic pain on male fertility.......Sex hormones play an important role in pain in many chronic pain conditions. Relationship between chronic pain and sperm quality has not been investigated thoroughly and may provide an insight to better understanding, management and treatment of cases where chronic pain and male sub-fertility co......-exist. Neat (fresh semen) and processed sperm from 15 males with orthopedic chronic pain (CP) were assessed and compared with 15 healthy age matched controls. Sperm analysis was performed using the SCA computer-aided sperm analyzer. There was no significant difference in any parameters of the neat semen...

  3. Chronic pain following total hip arthroplasty: a nationwide questionnaire study

    DEFF Research Database (Denmark)

    Nikolajsen, Lone; Brandsborg, Birgitte; Lucht, Ulf;

    2006-01-01

    of chronic pain after THA in relation to pre-operative pain and early post-operative pain. METHODS: A questionnaire was sent to 1231 consecutive patients who had undergone THA 12-18 months previously, and whose operations had been reported to the Danish Hip Arthroplasty Registry. RESULTS: The response rate...... was 93.6%. Two hundred and ninety-four patients (28.1%) had chronic ipsilateral hip pain at the time of completion of the questionnaire, and pain limited daily activities to a moderate, severe or very severe degree in 12.1%. The chronic pain state was related to the recalled intensity of early post...

  4. Current understanding of the neuropathophysiology of pain in chronic pancreatitis

    Institute of Scientific and Technical Information of China (English)

    Amporn; Atsawarungruangkit; Supot; Pongprasobchai

    2015-01-01

    Chronic pancreatitis(CP) is a chronic inflammatory disease of the pancreas. The main symptom of patients with CP is chronic and severe abdominal pain. However, the pathophysiology of pain in CP remains obscure.Traditionally, researchers believed that the pain was caused by anatomical changes in pancreatic structure. However, treatment outcomes based on such beliefs are considered unsatisfactory. The emerging explanations of pain in CP are trending toward neurobiological theories. This article aims to review current evidence regarding the neuropathophysiology of pain in CP and its potential implications for the development of new treatments for pain in CP.

  5. Cortical plasticity as a new endpoint measurement for chronic pain

    Directory of Open Access Journals (Sweden)

    Zhuo Min

    2011-07-01

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

  6. Cognitive function in patients with chronic pain treated with opioids

    DEFF Research Database (Denmark)

    Kurita, G P; de Mattos Pimenta, C A; Braga, P E;

    2012-01-01

    The paucity of studies regarding cognitive function in patients with chronic pain, and growing evidence regarding the cognitive effects of pain and opioids on cognitive function prompted us to assess cognition via neuropsychological measurement in patients with chronic non-cancer pain treated...... with opioids....

  7. Chronic Pain: Where the Body Meets the Brain.

    Science.gov (United States)

    Crofford, Leslie J

    2015-01-01

    Chronic musculoskeletal pain is one of the most intractable clinical problems faced by clinicians and can be devastating for patients. Central pain amplification is perceived pain that cannot be fully explained on the basis of somatic or neuropathic processes and is due to physiologic alterations in pain transmission or descending pain modulatory pathways. In any individual, central pain amplification may complicate nociceptive or neuropathic pain. Furthermore, patients with somatic symptom disorders may have alterations in their psychological or behavioral responses to pain that contribute significantly to the clinical presentation. Genetic, physiologic, and psychological factors associated with central pain amplification are beginning to be understood. One important contributor to chronic pain is perceived stress and stress response systems. We and others have shown a complex relationship between the physiologic stress response and chronic pain symptoms. Unfortunately, treatments for chronic pain are woefully inadequate and often worsen clinical outcomes. Developing new treatment strategies for patients with chronic pain is of utmost urgency. This essay provides a framework for thinking about chronic pain and developing new treatment approaches. PMID:26330672

  8. Multiple faces of pain: effects of chronic pain on the brain regulation of facial expression.

    Science.gov (United States)

    Vachon-Presseau, Etienne; Roy, Mathieu; Woo, Choong-Wan; Kunz, Miriam; Martel, Marc-Olivier; Sullivan, Michael J; Jackson, Philip L; Wager, Tor D; Rainville, Pierre

    2016-08-01

    Pain behaviors are shaped by social demands and learning processes, and chronic pain has been previously suggested to affect their meaning. In this study, we combined functional magnetic resonance imaging with in-scanner video recording during thermal pain stimulations and use multilevel mediation analyses to study the brain mediators of pain facial expressions and the perception of pain intensity (self-reports) in healthy individuals and patients with chronic back pain (CBP). Behavioral data showed that the relation between pain expression and pain report was disrupted in CBP. In both patients with CBP and healthy controls, brain activity varying on a trial-by-trial basis with pain facial expressions was mainly located in the primary motor cortex and completely dissociated from the pattern of brain activity varying with pain intensity ratings. Stronger activity was observed in CBP specifically during pain facial expressions in several nonmotor brain regions such as the medial prefrontal cortex, the precuneus, and the medial temporal lobe. In sharp contrast, no moderating effect of chronic pain was observed on brain activity associated with pain intensity ratings. Our results demonstrate that pain facial expressions and pain intensity ratings reflect different aspects of pain processing and support psychosocial models of pain suggesting that distinctive mechanisms are involved in the regulation of pain behaviors in chronic pain. PMID:27411160

  9. Managing acute back pain patients to avoid the transition to chronic pain.

    Science.gov (United States)

    Chou, Roger; McCarberg, Bill

    2011-01-01

    Chronic back pain is a major source of disability, decreased quality of life and healthcare costs. Treating chronic back pain is difficult, with even effective therapies only being modestly effective. Helping patients avoid the transition from acute to chronic low back pain is a promising strategy for preventing suffering and reducing healthcare utilization. The biopsychosocial model provides a useful framework for understanding factors that contribute to chronicity in low back pain, and are important targets for interventions. This article reviews recent research on predictors of chronicity and treatment strategies in higher risk patients that may be helpful for preventing chronicity. PMID:24654586

  10. The Meaning and Process of Pain Acceptance. Perceptions of Women Living with Arthritis and Fibromyalgia

    Directory of Open Access Journals (Sweden)

    Diane L LaChapelle

    2008-01-01

    Full Text Available BACKGROUND: Within the past 10 years, cognitive-behavioural pain management models have moved beyond the traditional focus on coping strategies and perceived control over pain, to incorporate mindfulness-and acceptance-based approaches. Pain acceptance is the process of giving up the struggle with pain and learning to live life despite pain. Acceptance is associated with lower levels of pain, disability and psychological distress. Relatively little is known, however, about how patients arrive at a state of acceptance without the aid of therapy.

  11. Integrated, Team-Based Chronic Pain Management: Bridges from Theory and Research to High Quality Patient Care.

    Science.gov (United States)

    Driscoll, Mary A; Kerns, Robert D

    2016-01-01

    Chronic pain is a significant public health concern. For many, chronic pain is associated with declines in physical functioning and increases in emotional distress. Additionally, the socioeconomic burden associated with costs of care, lost wages and declines in productivity are significant. A large and growing body of research continues to support the biopsychosocial model as the predominant framework for conceptualizing the experience of chronic pain and its multiple negative impacts. The model also informs a widely accepted and empirically supported approach for the optimal management of chronic pain. This chapter briefly articulates the historical foundations of the biopsychosocial model of chronic pain followed by a relatively detailed discussion of an empirically informed, integrated, multimodal and interdisciplinary treatment approach. The role of mental health professionals, especially psychologists, in the management of chronic pain is particularly highlighted. PMID:26900068

  12. Prevalence of chronic low back pain: systematic review

    Directory of Open Access Journals (Sweden)

    Rodrigo Dalke Meucci

    2015-01-01

    Full Text Available OBJECTIVE To estimate worldwide prevalence of chronic low back pain according to age and sex.METHODS We consulted Medline (PubMed, LILACS and EMBASE electronic databases. The search strategy used the following descriptors and combinations: back pain, prevalence, musculoskeletal diseases, chronic musculoskeletal pain, rheumatic, low back pain, musculoskeletal disorders and chronic low back pain. We selected cross-sectional population-based or cohort studies that assessed chronic low back pain as an outcome. We also assessed the quality of the selected studies as well as the chronic low back pain prevalence according to age and sex.RESULTS The review included 28 studies. Based on our qualitative evaluation, around one third of the studies had low scores, mainly due to high non-response rates. Chronic low back pain prevalence was 4.2% in individuals aged between 24 and 39 years old and 19.6% in those aged between 20 and 59. Of nine studies with individuals aged 18 and above, six reported chronic low back pain between 3.9% and 10.2% and three, prevalence between 13.1% and 20.3%. In the Brazilian older population, chronic low back pain prevalence was 25.4%.CONCLUSIONS Chronic low back pain prevalence increases linearly from the third decade of life on, until the 60 years of age, being more prevalent in women. Methodological approaches aiming to reduce high heterogeneity in case definitions of chronic low back pain are essential to consistency and comparative analysis between studies. A standard chronic low back pain definition should include the precise description of the anatomical area, pain duration and limitation level.

  13. Correlates of Improvement in Multidisciplinary Treatment of Chronic Pain.

    Science.gov (United States)

    Jensen, Mark P.; And Others

    1994-01-01

    Chronic pain patients (n=94) completed measures of physical and psychological functioning, health care utilization, pain beliefs, and use of pain coping strategies at admission and three to six months after inpatient pain treatment. Improved functioning and decreased health care use were associated with changes in both beliefs and cognitive coping…

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

    Science.gov (United States)

    Strong, Jenny; And Others

    1994-01-01

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

  15. Managing Chronic Pain in Children and Adolescents: A Clinical Review.

    Science.gov (United States)

    Landry, Bradford W; Fischer, Philip R; Driscoll, Sherilyn W; Koch, Krista M; Harbeck-Weber, Cynthia; Mack, Kenneth J; Wilder, Robert T; Bauer, Brent A; Brandenburg, Joline E

    2015-11-01

    Chronic pain in children and adolescents can be difficult for a single provider to manage in a busy clinical setting. Part of this difficulty is that pediatric chronic pain not only impacts the child but also the families of these children. In this review article, we discuss etiology and pathophysiology of chronic pain, along with variables that impact the severity of chronic pain and functional loss. We review diagnosis and management of selected chronic pain conditions in pediatric patients, including headache, low back pain, hypermobility, chronic fatigue, postural orthostatic tachycardia syndrome, abdominal pain, fibromyalgia, and complex regional pain syndrome. For each condition, we create a road map that contains therapy prescriptions, exercise recommendations, and variables that may influence pain severity. Potential medications for these pain conditions and associated symptoms are reviewed. A multidisciplinary approach for managing children with these conditions, including pediatric pain rehabilitation programs, is emphasized. Lastly, we discuss psychological factors and interventions for pediatric chronic pain and potential complementary and alternative natural products and interventions. PMID:26568508

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

    Science.gov (United States)

    Becker, Karin L

    2013-02-01

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

  17. A 13-weeks Mindfulness Based Pain Management Program Improves Psychological Distress in Patients with Chronic Pain Compared with Waiting List Controls

    DEFF Research Database (Denmark)

    Andersen, Tonny Elmose; Vægter, Henrik Bjarke

    2016-01-01

    Background: Eradication of pain is seldom an option in chronic pain management. Hence, mindfulness meditation has become popular in pain management. Objective: This pilot study compared the effect of a 13-weeks cognitive behavioural therapy program with integrated mindfulness meditation (CBTm......) in patients with chronic non-malignant pain with a control condition. It was hypothesised that the CBTm program would reduce pain intensity and psychological distress compared to the control condition and that level of mindfulness and acceptance both would be associated with the reduction in pain intensity...... and psychological distress were performed in both groups at baseline and after 13 weeks. Results: The CBTm program reduced depression, anxiety and pain-catastrophizing compared with the control group. Increased level of mindfulness and acceptance were associated with change in psychological distress...

  18. Medical marijuana use for chronic pain: risks and benefits.

    Science.gov (United States)

    Greenwell, Garth T

    2012-01-01

    Questions from patients about medical marijuana use for chronic pain are becoming more common. The information in this report will help patients understand the potential risks and benefits of using this substance for painful conditions.

  19. Seniors and Chronic Pain | NIH MedlinePlus the Magazine

    Science.gov (United States)

    ... their own and 75-85 percent of the elderly in care facilities suffer from chronic pain. Yet, pain among older adults is largely undertreated, with serious health consequences, such as depression, anxiety, decreased mobility, social isolation, poor sleep, and ...

  20. Research design considerations for chronic pain prevention clinical trials

    DEFF Research Database (Denmark)

    Gewandter, Jennifer S; Dworkin, Robert H; Turk, Dennis C;

    2015-01-01

    for clinical trials investigating the prevention of chronic pain. We present general design considerations for prevention trials in populations that are at relatively high risk for developing chronic pain. Specific design considerations included subject identification, timing and duration of treatment...... the potential to reduce the prevalence of chronic pain in the population. Additionally, standardization of outcomes in prevention clinical trials will facilitate meta-analyses and systematic reviews and improve detection of preventive strategies emerging from clinical trials....

  1. Pain in patients with chronic fatigue syndrome: time for specific pain treatment?

    NARCIS (Netherlands)

    Nijs, J.; Crombez, G.; Meeus, M.; Knoop, H.; Damme, S.V.; Cauwenbergh, V.; Bleijenberg, G.

    2012-01-01

    BACKGROUND: Besides chronic fatigue, patients with chronic fatigue syndrome (CFS) have debilitating widespread pain. Yet pain from CFS is often ignored by clinicians and researchers. OBJECTIVES: To examine whether pain is a unique feature of CFS, or does it share the same underlying mechanisms as ot

  2. Epidemiology of chronic non-malignant pain in Denmark

    DEFF Research Database (Denmark)

    Eriksen, Jørgen; Jensen, Marianne K; Sjøgren, Per;

    2003-01-01

    or more'? An overall chronic pain prevalence of 19% was found -16% for men and 21% for women. Prevalence of chronic pain increased with increasing age. Persons >/=67 years had 3.9 higher odds of suffering from chronic pain than persons in the age group 16-24 years. Compared with married persons, divorced...... health were seven times higher among people belonging to the PG. A strong association between chronic pain and poor self-rated health was also demonstrated. The PG had twice as many contacts with various health professionals compared with the CG, and the health care system was, on average, utilised 25...

  3. Chronic pain management as a barrier to pediatric palliative care.

    Science.gov (United States)

    Thompson, Lindsay A; Meinert, Elizabeth; Baker, Kimberly; Knapp, Caprice

    2013-12-01

    Pain is common as a presenting complaint to outpatient and emergency departments for children, yet pain management represents one of the children's largest unmet needs. A child may present with acute pain for an intermittent issue or may have acute or chronic pain in the setting of chronic illness. The mainstay of treatment for pain uses a stepwise approach for pain management, such as set up by the World Health Organization. For children with life-limiting illnesses, the Institute of Medicine guidelines recommends referral upon diagnosis for palliative care, meaning that the child receives comprehensive services that include pain control in coordination with curative therapies; yet barriers remain. From the provider perspective, pain can be better addressed through a careful assessment of one's own knowledge, skills, and attitudes. The key components of pain management in children are multimodal, regardless of the cause of the pain. PMID:23329083

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

    Science.gov (United States)

    Anderson, Louis P.; Rehm, Lynn P.

    1984-01-01

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

  5. Women in pain : the course and diagnostics of chronic pelvic pain

    NARCIS (Netherlands)

    Weijenborg, Philomena Theodora Maria

    2009-01-01

    The main subject of this thesis is pelvic pain in women in secondary and/or tertiary medical care. Studies aim to examine: 1. The clinical course of acute abdominal pain and risks of pain persistence. 2. The clinical course of chronic pelvic pain (CPP) and predictors of recovery. 3. The moderat

  6. Basolateral amygdala lesion inhibits the development of pain chronicity in neuropathic pain rats.

    Directory of Open Access Journals (Sweden)

    Zheng Li

    Full Text Available BACKGROUND: Chronicity of pain is one of the most interesting questions in chronic pain study. Clinical and experimental data suggest that supraspinal areas responsible for negative emotions such as depression and anxiety contribute to the chronicity of pain. The amygdala is suspected to be a potential structure for the pain chronicity due to its critical role in processing negative emotions and pain information. OBJECTIVE: This study aimed to investigate whether amygdala or its subregions, the basolateral amygdala (BLA and the central medial amygdala (CeA, contributes to the pain chronicity in the spared nerve injury (SNI-induced neuropathic pain model of rats. METHODOLOGY/PRINCIPAL FINDINGS: (1 Before the establishment of the SNI-induced neuropathic pain model of rats, lesion of the amygdaloid complex with stereotaxic injection of ibotenic acid (IBO alleviated mechanical allodynia significantly at days 7 and 14, even no mechanical allodynia at day 28 after SNI; Lesion of the BLA, but not the CeA had similar effects; (2 however, 7 days after SNI when the neuropathic pain model was established, lesion of the amygdala complex or the BLA or the CeA, mechanical allodynia was not affected. CONCLUSION: These results suggest that BLA activities in the early stage after nerve injury might be crucial to the development of pain chronicity, and amygdala-related negative emotions and pain-related memories could promote pain chronicity.

  7. Addiction to opioids in chronic pain patients: a literature review

    DEFF Research Database (Denmark)

    Højsted, Jette; Sjøgren, Per

    2007-01-01

    Opioids have proven very useful for treatment of acute pain and cancer pain, and in the developed countries opioids are increasingly used for treatment of chronic non-malignant pain patients as well. This literature review aims at giving an overview of definitions, mechanisms, diagnostic criteria......, incidence and prevalence of addiction in opioid treated pain patients, screening tools for assessing opioid addiction in chronic pain patients and recommendations regarding addiction problems in national and international guidelines for opioid treatment in cancer patients and chronic non-malignant pain...... patients. The review indicates that the prevalence of addiction varied from 0% up to 50% in chronic non-malignant pain patients, and from 0% to 7.7% in cancer patients depending of the subpopulation studied and the criteria used. The risk of addiction has to be considered when initiating long-term opioid...

  8. Adaptation of Problem-Solving Skills Training (PSST) for Parent Caregivers of Youth with Chronic Pain.

    Science.gov (United States)

    Palermo, Tonya M; Law, Emily F; Essner, Bonnie; Jessen-Fiddick, Tricia; Eccleston, Christopher

    2014-09-01

    Research on the experience of parents caring for a child with chronic pain indicates that high levels of parental role stress, feelings of frustration over an inability to help, and psychological distress are common. Moreover, parental distress adversely influences child adjustment to chronic pain. Therefore, intervening with parents of youth with chronic pain may, in turn, result in positive outcomes for children in their ability to engage in positive coping strategies, reduce their own distress, and to function competently in their normal daily lives. Our aim was to adapt an intervention, Problem-Solving Skills Training, previously proven effective in reducing parental distress in other pediatric illness conditions to the population of caregivers of youth with chronic pain. In the first phase, the intervention was adapted based on expert review of the literature and review of parent responses on a measure of pain-related family impact. In the second phase, the intervention was tested in a small group of parents to evaluate feasibility, determined by response to treatment content, ratings of acceptability, and ability to enroll and deliver the treatment visits. This phase included piloting the PSST intervention and all outcome measures at pre-treatment and immediately post-treatment. In an exploratory manner we examined change in parent distress and child physical function and depression from pre- to post-treatment. Findings from this feasibility study suggest that PSST can be implemented with parents of youth with chronic pain, and they find the treatment acceptable.

  9. Biofeedback therapy for chronic pelvic pain syndrome

    Institute of Scientific and Technical Information of China (English)

    Zhang-QunYE; DanCAI; Ru-ZhuLAN; Guang-HuiDU; Xiao-YiYUAN; ZhongCHEN; Yang-ZhiMA; You-MingHU; Gui-YunZENG

    2003-01-01

    Aim: To evaluate the efficacy of biofeedback therapy in patients with chronic pelvic pain syndrome(CPPS). Methods: From November 2001 to April 2002, patients visiting the Urological Outpatient Clinic of this Hospital were evaluated by means of the National Institute of Health Chronic Prostatitis Symptom Index (NIH-CPSI)and classified by the NIH classification standard. Sixty-two patients of CPPS category Ⅲ were involved in this study. All patients had been treated by conventional approaches such as antibiotics and alpha-blockers for more than half a year without any improvement. The expressed prostatic secretion results were as follows: WBC 5 to 9/high power field, lipid +-+++ and bacterial culture negative. Their NIH-CPSI were 12-40. All the 62 cases complained of micturitional irritation (frequency, urgency, splitted stream and sense of residual urine), 32 cases, of pain or discomfort at the testicular, penile, scrotal, pelvic or rectal region and 13 cases, of white secretion-dripping. The patients were treated by the Urostym Biofeedback equipment (Laborie Co., Canada) 5 times a week for 2 weeks with a stimulus intensity of 15 mA-23 mA and duration of 20 minutes. Results: Sixty patients were significantly improved or cured, while no significant improvement in the remaining 2. No apparent side effect was observed. The NIH-CPSI dropped to 6 to 14 with an average reduction of 21 (P<0.01). In the 60 improved cases, pain was relieved after 2-3treatment courses and other symptoms disappeared after 4-5 courses. Conclusion: Biofeedback therapy is a safe and effective treatment for CPPS. Large randomized clinical trials are needed to confirm its efficacy and to explore the mechanism of action. ( Asian J Androl 2003 Jun; 5:155-158 )

  10. 'Women get this': gendered meanings of chronic pelvic pain.

    Science.gov (United States)

    Grace, Victoria M; MacBride-Stewart, Sara

    2007-01-01

    Chronic pelvic pain in women is a key site through which explorations of the meanings of female gender and pain might further insights into the broader question of the embodied experience of women in relation to pain. A biocultural approach is used to present an analysis of interviews with 40 New Zealand women in which they reflect on 'how come' they have chronic pelvic pain. Women consistently employ a mechanistic rendition of medical discourse and understandings in their constructions of 'how come' they have pain, accompanied by a reiteration of 'not knowing' and a normalizing of their pelvic pain. We explore how this normalizing works within the narratives to establish women's pelvic pain as intrinsically gendered. Etiological meanings that are constructed in medical terms and yet are unable to be interpreted within a dualist frame of normality and pathology, we argue, permeate and shape gendered experience of chronic pain conditions. PMID:17158831

  11. Validity of electrical stimulus magnitude matching in chronic pain

    DEFF Research Database (Denmark)

    Persson, Ann L; Westermark, Sofia; Merrick, Daniel;

    2009-01-01

    OBJECTIVE: To examine the validity of the PainMatcher in chronic pain. DESIGN: Comparison of parallel pain estimates from visual analogue scales with electrical stimulus magnitude matching. PATIENTS: Thirty-one patients with chronic musculoskeletal pain. METHODS: Twice a day ongoing pain was rated...... range of the instrument, the PainMatcher readings utilized only a small part of the instrument range and, importantly, had little or no relation to the visual analogue scale estimates. The validity of the PainMatcher procedure is doubtful....... on a standard 100-mm visual analogue scale, and thereafter magnitude matching was performed using a PainMatcher. The sensory threshold to electrical stimulation was tested twice on separate occasions. RESULTS: In 438 observations visual analogue scale ranged from 3 to 95 (median 41) mm, and Pain...

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

    Directory of Open Access Journals (Sweden)

    Anna M. eZamorano

    2015-01-01

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

  13. Effectiveness and cost-effectiveness of a guided and unguided internet-based Acceptance and Commitment Therapy for chronic pain: Study protocol for a three-armed randomised controlled trial.

    Directory of Open Access Journals (Sweden)

    Jiaxi Lin

    2015-03-01

    Discussion: This study will contribute to the evidence base of internet-based pain interventions and provide valuable information about the treatment success and cost-effectiveness regarding the intervention's level of guidance (self-help only vs. guided self-help. If ACTonPain is shown to be effective, investigations in different healthcare settings should follow, to examine possible ways of implementing ACTonPain into existing healthcare systems. The implementation of ACTonPain could help to shorten waiting times, expand access to pain treatment and, potentially, also reduce treatment costs.

  14. Mechanism of Chronic Pain in Rodent Brain Imaging

    Science.gov (United States)

    Chang, Pei-Ching

    Chronic pain is a significant health problem that greatly impacts the quality of life of individuals and imparts high costs to society. Despite intense research effort in understanding of the mechanism of pain, chronic pain remains a clinical problem that has few effective therapies. The advent of human brain imaging research in recent years has changed the way that chronic pain is viewed. To further extend the use of human brain imaging techniques for better therapies, the adoption of imaging technique onto the animal pain models is essential, in which underlying brain mechanisms can be systematically studied using various combination of imaging and invasive techniques. The general goal of this thesis is to addresses how brain develops and maintains chronic pain in an animal model using fMRI. We demonstrate that nucleus accumbens, the central component of mesolimbic circuitry, is essential in development of chronic pain. To advance our imaging technique, we develop an innovative methodology to carry out fMRI in awake, conscious rat. Using this cutting-edge technique, we show that allodynia is assoicated with shift brain response toward neural circuits associated nucleus accumbens and prefrontal cortex that regulate affective and cognitive component of pain. Taken together, this thesis provides a deeper understanding of how brain mediates pain. It builds on the existing body of knowledge through maximizing the depth of insight into brain imaging of chronic pain.

  15. Role of Alternative Therapies for Chronic Pain Syndromes.

    Science.gov (United States)

    Thomas, Donna-Ann; Maslin, Benjamin; Legler, Aron; Springer, Erin; Asgerally, Abbas; Vadivelu, Nalini

    2016-05-01

    There is increasing interest in the use of complimentary and alternative medicine (CAM) for the treatment of chronic pain. This review examines alternative and complimentary therapies, which can be incorporated as part of a biopsychosocial approach in the treatment of chronic pain syndromes. In the present investigation, literature from articles indexed on PubMed was evaluated including topics of alternative therapies, complimentary therapies, pain psychology, biofeedback therapy, physical exercise therapies, acupuncture, natural and herbal supplements, whole-body cryotherapy, and smartphone technologies in the treatment of chronic pain syndromes. This review highlights the key role of psychology in the treatment of chronic pain. Cognitive behavior therapy appears to be the most impactful while biofeedback therapy has also been shown to be effective for chronic pain. Exercise therapy has been shown to be effective in short-, intermediate-, and long-term pain states. When compared to that in sham controls, acupuncture has shown some benefit for neck pain immediately after the procedure and in the short term and improvement has also been demonstrated in the treatment of headaches. The role of smartphones and whole-body cryotherapy are new modalities and further studies are needed. Recent literature suggests that several alternate therapies could play a role in the treatment of chronic pain, supporting the biopsychosocial model in the treatment of pain states. PMID:27038968

  16. Chronic Pain Rehabilitation: A Challenge for Mental Health Counselors.

    Science.gov (United States)

    Finn, Paul E.

    1988-01-01

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

  17. Chronic pain in children and adolescents: observational studies

    NARCIS (Netherlands)

    C.W. Perquin (Christel)

    2002-01-01

    textabstractIn adults, chronic pain is by most people involved considered to be a serious disorder. Although chronic pain in adults is in general not life-threatening, a considerable amount of literature elucidates the large number of sufferers, the high cost to the person in question and to the soc

  18. Classification of chronic orofacial pain using an intravenous diagnostic test

    NARCIS (Netherlands)

    Tjakkes, G. -H. E.; De Bont, L. G. M.; van Wijhe, M.; Stegenga, B.

    2009-01-01

    The aim of this study was to evaluate the ability of a preliminary intravenous diagnostic test to classify chronic orofacial pain patients into different subgroups. Patients with chronic orofacial pain conditions that could not be unambiguously diagnosed. A retrospective evaluation of series of cond

  19. Psychosocial assessment and self-management of chronic pain

    NARCIS (Netherlands)

    J.S. Voerman (Jessica)

    2015-01-01

    markdownabstractAbstract Chronic pain is prevalent in both children and adults and has major negative consequences for their daily life, e.g. reduced participation in activities and depressive and anxious feelings. Therefore, it is important to early signal and treat chronic pain. This thesis aimed

  20. A standard for terminology in chronic pelvic pain syndromes

    DEFF Research Database (Denmark)

    Doggweiler, Regula; Whitmore, Kristene E; Meijlink, Jane M;

    2016-01-01

    AIMS: Terms used in the field of chronic pelvic pain (CPP) are poorly defined and often confusing. An International Continence Society (ICS) Standard for Terminology in chronic pelvic pain syndromes (CPPS) has been developed with the aim of improving diagnosis and treatment of patients affected b...

  1. Limitations associated with managing chronic low back pain.

    Science.gov (United States)

    Beland, Paul

    2016-04-20

    Non-specific chronic low back pain is an occupational hazard for nurses. It may result in persistent and disabling pain for some people. There are many techniques for investigating, assessing and treating chronic low back pain. However, research to support some of these interventions and the assumptions that underlie them is limited. Interventions that may be beneficial are not always available to those who need them. Changes to service provision are required to rectify this situation and provide effective treatment for patients with non-specific chronic low back pain. PMID:27097211

  2. Dysfunctional stress responses in chronic pain.

    Science.gov (United States)

    Woda, Alain; Picard, Pascale; Dutheil, Frédéric

    2016-09-01

    Many dysfunctional and chronic pain conditions overlap. This review describes the different modes of chronic deregulation of the adaptive response to stress which may be a common factor for these conditions. Several types of dysfunction can be identified within the hypothalamo-pituitary-adrenal axis: basal hypercortisolism, hyper-reactivity, basal hypocortisolism and hypo-reactivity. Neuroactive steroid synthesis is another component of the adaptive response to stress. Dehydroepiandrosterone (DHEA) and its sulfated form DHEA-S, and progesterone and its derivatives are synthetized in cutaneous, nervous, and adipose cells. They are neuroactive factors that act locally. They may have a role in the localization of the symptoms and their levels can vary both in the central nervous system and in the periphery. Persistent changes in neuroactive steroid levels or precursors can induce localized neurodegeneration. The autonomic nervous system is another component of the stress response. Its dysfunction in chronic stress responses can be expressed by decreased basal parasympathethic activity, increased basal sympathetic activity or sympathetic hyporeactivity to a stressful stimulus. The immune and genetic systems also participate. The helper-T cells Th1 secrete pro-inflammatory cytokines such as IL-1-β, IL-2, IL-6, IL-8, IL-12, IFN-γ, and TNF-α, whereas Th2 secrete anti-inflammatory cytokines: IL-4, IL-10, IGF-10, IL-13. Chronic deregulation of the Th1/Th2 balance can occur in favor of anti- or pro-inflammatory direction, locally or systemically. Individual vulnerability to stress can be due to environmental factors but can also be genetically influenced. Genetic polymorphisms and epigenetics are the main keys to understanding the influence of genetics on the response of individuals to constraints. PMID:27262345

  3. Chronic pain: the role of learning and brain plasticity.

    Science.gov (United States)

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

    2014-01-01

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

  4. Chronic Pain in Older African American Grandparent Caregivers.

    Science.gov (United States)

    Booker, Staja Q

    2016-06-01

    African American grandparent caregiving is increasing, and evidence shows that grandparent caregiving influences health and its management. As older adults age, their potential of experiencing chronic pain increases, and this is profound given that physiological research shows that African Americans, aside from aging, may have a predisposition for developing chronic pain. Research shows older African Americans experience significant chronic pain, but few have discussed the implications of managing chronic pain in older African Americans who have added parental responsibility. Many older African Americans receive home healthcare services and there is a unique role for home healthcare clinicians in caring for this vulnerable population. This article discusses the impact of pain on caregiving, challenges in pain management, and practice and policy implications to assist home healthcare clinicians maintain the safety and protection of both the older grandparent and grandchildren. PMID:27243429

  5. Assessment of Cognitive Factors in Chronic Pain: A Worthwhile Enterprise?

    Science.gov (United States)

    Turk, Dennis C.; Rudy, Thomas E.

    1986-01-01

    Provides a brief review of the history of pain theory and the recurrent role of cognition in various conceptualizations of pain. Discusses research evidence supporting the continued inclusion of cognitive factors in conceptualizations and treatment of chronic pain, relevant assessment instruments, the Diagnostic and Statistical Manual of Mental…

  6. Outpatient Group Treatment of Chronic Pain: Effects of Spouse Involvement.

    Science.gov (United States)

    Moore, James E.; Chaney, Edmund F.

    1985-01-01

    Assigned 43 chronic pain patients to couples group treatment, patient-only group treatment, or waiting-list control. The 16-hour cognitive-behavioral program produced reduction in pain, spouse-observed pain behavior, physical and psychosocial dysfunction, marital satisfaction, and use of health care resources. Spouse involvement did not facilitate…

  7. Control Beliefs, Coping Efforts, and Adjustment to Chronic Pain.

    Science.gov (United States)

    Jensen, Mark P.; Karoly, Paul

    1991-01-01

    Examined adaptation to chronic pain in 118 patients. Control appraisals, ignoring pain, using coping self-statements, and increasing activities were positively related to psychological functioning. Control appraisals, diverting attention, ignoring pain, and using coping self-statements were positively related to activity level for patients…

  8. [Approach to chronic pain by hypnosis: a general practitioner's experience].

    Science.gov (United States)

    Grünenwald, M

    2009-06-17

    Hypnosis is a modified state of consciousness linking the conscious and the unconscious of a person. In the context of chronic pain, hypnosis enables to help controlling the intensity of the pain, managing the pain and the emotions accompanying it and to help the patient finding his own resources allowing him getting involved in his treatment. PMID:19626764

  9. The Toronto General Hospital Transitional Pain Service: development and implementation of a multidisciplinary program to prevent chronic postsurgical pain.

    Science.gov (United States)

    Katz, Joel; Weinrib, Aliza; Fashler, Samantha R; Katznelzon, Rita; Shah, Bansi R; Ladak, Salima Sj; Jiang, Jiao; Li, Qing; McMillan, Kayla; Mina, Daniel Santa; Wentlandt, Kirsten; McRae, Karen; Tamir, Diana; Lyn, Sheldon; de Perrot, Marc; Rao, Vivek; Grant, David; Roche-Nagle, Graham; Cleary, Sean P; Hofer, Stefan Op; Gilbert, Ralph; Wijeysundera, Duminda; Ritvo, Paul; Janmohamed, Tahir; O'Leary, Gerald; Clarke, Hance

    2015-01-01

    Chronic postsurgical pain (CPSP), an often unanticipated result of necessary and even life-saving procedures, develops in 5-10% of patients one-year after major surgery. Substantial advances have been made in identifying patients at elevated risk of developing CPSP based on perioperative pain, opioid use, and negative affect, including depression, anxiety, pain catastrophizing, and posttraumatic stress disorder-like symptoms. The Transitional Pain Service (TPS) at Toronto General Hospital (TGH) is the first to comprehensively address the problem of CPSP at three stages: 1) preoperatively, 2) postoperatively in hospital, and 3) postoperatively in an outpatient setting for up to 6 months after surgery. Patients at high risk for CPSP are identified early and offered coordinated and comprehensive care by the multidisciplinary team consisting of pain physicians, advanced practice nurses, psychologists, and physiotherapists. Access to expert intervention through the Transitional Pain Service bypasses typically long wait times for surgical patients to be referred and seen in chronic pain clinics. This affords the opportunity to impact patients' pain trajectories, preventing the transition from acute to chronic pain, and reducing suffering, disability, and health care costs. In this report, we describe the workings of the Transitional Pain Service at Toronto General Hospital, including the clinical algorithm used to identify patients, and clinical services offered to patients as they transition through the stages of surgical recovery. We describe the role of the psychological treatment, which draws on innovations in Acceptance and Commitment Therapy that allow for brief and effective behavioral interventions to be applied transdiagnostically and preventatively. Finally, we describe our vision for future growth. PMID:26508886

  10. Psychological therapies for the management of chronic pain

    OpenAIRE

    Sturgeon JA

    2014-01-01

    John A Sturgeon Department of Anesthesiology, Stanford University, Palo Alto, CA, USA Abstract: Pain is a complex stressor that presents a significant challenge to most aspects of functioning and contributes to substantial physical, psychological, occupational, and financial cost, particularly in its chronic form. As medical intervention frequently cannot resolve pain completely, there is a need for management approaches to chronic pain, including psychological intervention. Psychotherapy fo...

  11. Chronic pain: The role of learning and brain plasticity

    OpenAIRE

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

    2014-01-01

    Based on theoretical considerations and recent observations, we argue that continued suffering of chronic pain is critically dependent on the state of motivational and emotional mesolimbic-prefrontal circuitry of the brain. The plastic changes that occur within this circuitry in relation to nociceptive inputs dictate the transition to chronic pain, rendering the pain less somatic and more affective in nature. This theoretical construct is a strong departure from the traditional scientific vie...

  12. Disability and borderline personality disorder in chronic pain patients

    OpenAIRE

    Sansone, Randy A.; J David Sinclair; Wiederman, Michael W.

    2010-01-01

    BACKGROUND AND OBJECTIVE: Few studies have examined the relationship between disability and borderline personality symptomatology, and, among those that have, findings have been inconsistent. In the present study, the relationship between medical disability and borderline personality symptomatology was examined in a sample of chronic pain patients.METHODS: In a consecutive insured sample of male and female chronic pain patients (n=117), who were being initially evaluated by an outpatient pain...

  13. Treatment Preferences for CAM in Children with Chronic Pain

    OpenAIRE

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

    2006-01-01

    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 examin...

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

    Directory of Open Access Journals (Sweden)

    Burns LC

    2015-01-01

    Full Text Available Lindsay C Burns,1–3 Sarah E Ritvo,1 Meaghan K Ferguson,1 Hance Clarke,3–5 Ze’ev Seltzer,3,5 Joel Katz1,3–5 1Department of Psychology, York University, Toronto, ON, Canada; 2Arthritis Research Centre of Canada, Vancouver, BC, Canada; 3Department of Anesthesia and Pain Management, Toronto General Hospital, Toronto, ON, Canada; 4Department of Anesthesia, University of Toronto, Toronto, ON, Canada; 5Centre for the Study of Pain, Faculties of Dentistry and Medicine, University of Toronto, Toronto, ON, Canada Background: Total knee arthroplasty (TKA is a common and costly surgical procedure. Despite high success rates, many TKA patients develop chronic pain in the months and years following surgery, constituting a public health burden. Pain catastrophizing is a construct that reflects anxious preoccupation with pain, inability to inhibit pain-related fears, amplification of the significance of pain vis-à-vis health implications, and a sense of helplessness regarding pain. Recent research suggests that it may be an important risk factor for untoward TKA outcomes. To clarify this impact, we systematically reviewed the literature to date on pain catastrophizing as a prospective predictor of chronic pain following TKA. Methods: We searched MEDLINE, EMBASE, and PsycINFO databases to identify articles related to pain catastrophizing, TKA, risk models, and chronic pain. We reviewed titles and abstracts to identify original research articles that met our specified inclusion criteria. Included articles were then rated for methodological quality. including methodological quality. Due to heterogeneity in follow-up, analyses, and outcomes reported across studies, a quantitative meta-analysis could not be performed. Results: We identified six prospective longitudinal studies with small-to-mid-sized samples that met the inclusion criteria. Despite considerable variability in reported pain outcomes, pain catastrophizing was identified as a significant

  15. Do illness perceptions of people with chronic low back pain differ from people without chronic low back pain?

    NARCIS (Netherlands)

    van Wilgen, C. Paul; van Ittersum, Miriam W.; Kaptein, Ad A.

    2013-01-01

    Objectives To determine why some people develop chronic low back pain, and whether illness perceptions are an important risk factor in the transition from acute to chronic low back pain. Design Cross-sectional study. Participants Four hundred and two members of the general Dutch population, with and

  16. Alexithymia and Early Maladaptive Schemas in chronic pain patients.

    Science.gov (United States)

    Saariaho, Anita S; Saariaho, Tom H; Mattila, Aino K; Karukivi, Max; Joukamaa, Matti I

    2015-08-01

    Psychological factors have an impact on subjective pain experience. The aim of this study was to explore the occurrence of alexithymia and Early Maladaptive Schemas in a sample of 271 first visit chronic pain patients of six pain clinics. The patients completed the study questionnaire consisting of the Toronto Alexithymia Scale-20, the Finnish version of the Young Schema Questionnaire short form-extended, the Beck Depression Inventory-II, and pain variables. Alexithymic patients scored higher on Early Maladaptive Schemas and had more pain intensity, pain disability and depression than nonalexithymic patients. Both alexithymia and depression correlated significantly with most Early Maladaptive Schemas. The co-occurrence of alexithymia, Early Maladaptive Schemas and depression seems to worsen the pain experience. Screening of alexithymia, depression and Early Maladaptive Schemas may help to plan psychological treatment interventions for chronic pain patients. PMID:26040835

  17. Management of chronic pain in osteoporosis: challenges and solutions

    Directory of Open Access Journals (Sweden)

    Paolucci T

    2016-04-01

    Full Text Available Teresa Paolucci,* Vincenzo Maria Saraceni, Giulia Piccinini* Physical Medicine and Rehabilitation Unit, Azienda Policlinico Umberto I, Rome, Italy *These authors contributed equally to this work Abstract: Osteoporosis (OP is a pathological condition that manifests clinically as pain, fractures, and physical disability, resulting in the loss of independence and the need for long-term care. Chronic pain is a multidimensional experience with sensory, affective, and cognitive aspects. Age can affect each of these dimensions and the pain that is experienced. In OP, chronic pain appears to have sensory characteristics and properties of nociceptive and neuropathic pain. Its evaluation and treatment thus require a holistic approach that focuses on the specific characteristics of this population. Pain management must therefore include pharmacological approaches, physiotherapy interventions, educational measures, and, in rare cases, surgical treatment. Most rehabilitative treatments in the management of patients with OP do not evaluate pain or physical function, and there is no consensus on the effects of rehabilitation therapy on back pain or quality of life in women with OP. Pharmacological treatment of pain in patients with OP is usually insufficient. The management of chronic pain in patients with OP is complicated with regard to its diagnosis, the search for reversible secondary causes, the efficacy and duration of oral bisphosphonates, and the function of calcium and vitamin D. The aim of this review is to discuss the most appropriate solutions in the management of chronic pain in OP. Keywords: physical therapy, exercise, pharmacological treatment, posture and balance

  18. Ziconotide in the treatment of pcoa chronic pain: cases report

    OpenAIRE

    Sabrina Giusto; Domenico Quattrone; Placido Calì

    2009-01-01

    Chronic pain related to PCOA is a clinical condition which affects more than 5 percent of the population. This article presents two clinical cases of severe pain related to the disease treated with opioids and epidural SCS with inadequate results. Treatment by intrathecal ziconotide showed, in both cases, a good reduction of pain. These clinical cases represent the first experience of ischemic pain treatment with ziconotide.

  19. Ziconotide in the treatment of pcoa chronic pain: cases report

    Directory of Open Access Journals (Sweden)

    Sabrina Giusto

    2009-05-01

    Full Text Available Chronic pain related to PCOA is a clinical condition which affects more than 5 percent of the population. This article presents two clinical cases of severe pain related to the disease treated with opioids and epidural SCS with inadequate results. Treatment by intrathecal ziconotide showed, in both cases, a good reduction of pain. These clinical cases represent the first experience of ischemic pain treatment with ziconotide.

  20. AMELOTEX IN THE TREATMENT OF CHRONIC BACK PAIN SYNDROMES

    Directory of Open Access Journals (Sweden)

    Irina Yuryevna Suvorova

    2010-01-01

    Full Text Available Recently there has been a considerable increase in the number of patients with lingering recurrent and chronic pain syndromes of various origin. Forty-one patients with dorsopathies were examined. Two types of pain were identified; these were vertebrogenic and nonvertebrogenic pains. The appropriateness of this identification was confirmed by instrumental studies. Treatment was performed using a selective nonsteroidal antiinflammatory drug (Amelotex. Pain syndrome relief was noted during the therapy

  1. Enhanced Brain Responses to Pain-Related Words in Chronic Back Pain Patients and Their Modulation by Current Pain

    Science.gov (United States)

    Ritter, Alexander; Franz, Marcel; Puta, Christian; Dietrich, Caroline; Miltner, Wolfgang H. R.; Weiss, Thomas

    2016-01-01

    Previous functional magnetic resonance imaging (fMRI) studies in healthy controls (HC) and pain-free migraine patients found activations to pain-related words in brain regions known to be activated while subjects experience pain. The aim of the present study was to identify neural activations induced by pain-related words in a sample of chronic back pain (CBP) patients experiencing current chronic pain compared to HC. In particular, we were interested in how current pain influences brain activations induced by pain-related adjectives. Subjects viewed pain-related, negative, positive, and neutral words; subjects were asked to generate mental images related to these words during fMRI scanning. Brain activation was compared between CBP patients and HC in response to the different word categories and examined in relation to current pain in CBP patients. Pain-related words vs. neutral words activated a network of brain regions including cingulate cortex and insula in subjects and patients. There was stronger activation in medial and dorsolateral prefrontal cortex (DLPFC) and anterior midcingulate cortex in CPB patients than in HC. The magnitude of activation for pain-related vs. negative words showed a negative linear relationship to CBP patients’ current pain. Our findings confirm earlier observations showing that pain-related words activate brain networks similar to noxious stimulation. Importantly, CBP patients show even stronger activation of these structures while merely processing pain-related words. Current pain directly influences on this activation. PMID:27517967

  2. A neural model for chronic pain and pain relief by extracorporeal shock wave treatment.

    Science.gov (United States)

    Wess, Othmar J

    2008-12-01

    The paper develops a new theory of chronic pain and pain relief by extracorporeal shock wave treatment. Chronic pain without underlying anatomical disorder is looked at as a pathological control function of memory. Conditioned reflexes are considered to be engraved memory traces linking sensory input of afferent signals with motor response of efferent signals. This feature can be described by associative memory functions of the nervous system. Some conditioned reflexes may cause inappropriate or pathological reactions. Consequently, a circulus vitiosus of pain sensation and muscle and/or vessel contraction is generated when pain becomes chronic (pain spiral). The key feature is a dedicated engram responsible for a pathological (painful) reaction. The pain memory may be explained by the concept of a holographic memory model published by several authors. According to this model it is shown how nervous systems may generate and recall memory contents. The paper shows how extracorporeal shock wave treatment may reorganize pathologic memory traces, thus giving cause to real and permanent pain relief. In a generalized manner, the idea of associative memory functions may help in the understanding of conditioning as a learning process and explain extracorporeal shock wave application as an efficient treatment concept for chronic pain. This concept may open the door for new treatment approaches to chronic pain and several other disorders of the nervous system.

  3. Could stress contribute to pain-related fear in chronic pain?

    Directory of Open Access Journals (Sweden)

    Sigrid eElsenbruch

    2015-12-01

    Full Text Available Learning to predict pain based on internal or external cues constitutes a fundamental and highly adaptive process aimed at self-protection. Pain-related fear is an essential component of this response, which is formed by associative and instrumental learning processes. In chronic pain, pain-related fear may become maladaptive, drive avoidance behaviors and contribute to symptom chronicity. Pavlovian fear conditioning has proven fruitful to elucidate associative learning and extinction involving aversive stimuli, including pain, but studies in chronic pain remain scarce. Stress demonstrably exerts differential effects on emotional learning and memory processes, but this has not been transferred to pain-related fear. Within this perspective, we propose that stress could contribute to impaired pain-related associative learning and extinction processes and call for interdisciplinary research. Specifically, we suggest to test the hypotheses that (1 extinction-related phenomena inducing a re-activation of maladaptive pain-related fear (e.g., reinstatement, renewal likely occur in everyday life of chronic pain patients and may alter pain processing, impair perceptual discrimination and favour overgeneralization; (2 acute stress prior to or during acquisition of pain-related fear may facilitate the formation and/or consolidation of pain-related fear memories, (3 stress during or after extinction may impair extinction efficacy resulting in greater reinstatement or context-dependent renewal of pain-related fear; and (4 these effects could be amplified by chronic stress due to early adversity and/or psychiatric comorbidity such as depression or anxiety in patients with chronic pain.

  4. Avoidance of affective pain stimuli predicts chronicity in patients with acute low back pain.

    Science.gov (United States)

    Sharpe, Louise; Haggman, Sonia; Nicholas, Michael; Dear, Blake F; Refshauge, Kathryn

    2014-01-01

    This prospective study of acute and sub-acute low back pain (LBP) patients was conducted to assess whether attentional biases predicted chronic pain status 3 and 6 months later. The attentional biases of 100 LBP patients were assessed within 3 months of developing pain and 6 months later. Participants also completed measures associated with outcome at 3 assessment points: baseline, 3 and 6 months later. Current pain status was assessed at follow-ups. Patients were classified as those that met standard criteria for chronic pain or those who did not (i.e., the comparison group). At baseline, participants demonstrated a bias toward sensory pain words. However, biases toward sensory pain words did not differentiate those who subsequently developed chronic pain and those who did not at either follow-up. The same bias was observed 6 months later, but again it failed to distinguish between the chronic pain and comparison groups. However, subjects who developed chronic pain at both 3 (n=22) and 6 (n=21) months demonstrated biases away from affective pain words at baseline but not 6 months later, in comparison to other participants. These results remained significant in multivariate analyses. These findings are consistent with patterns observed in the previous research, and suggest that avoidance of emotionally laden pain-related stimuli (i.e., affective pain words) is associated with negative outcomes for LBP patients in the acute and sub-acute phase. This research suggests that attentional biases in relation to pain-related stimuli are important for the development of chronic pain, but are more complex than initially thought. PMID:24028848

  5. Neurofeedback therapy in patients with acute and chronic pain syndromes--literature review and own experience.

    Science.gov (United States)

    Kubik, Alicja; Biedroń, Agnieszka

    2013-01-01

    Pain management is based mainly on pharmacotherapy which has many limitations. Non-pharmacological techniques, like neurofeedback (EEG-biofeedback) are alternative methods of pain treatment. Data from literature confirm high efficacy of neurofeedback in pain syndromes treatment, chronic and acute as well. Neurofeedback plays an important role in management of post stroke, post traumatic headaches and in primary headaches like tension type headaches or migraine. Literature review and own experience indicate importance of number and frequency of performed neurofeedback trainings on treatment effectiveness. Satisfactory results have already been observed after 30 trainings however usually 40-60 training have to be performed. Effectiveness of such therapy in pain syndromes is usually good or less often acceptable (50% reduction of headaches). Children with tension type headaches (differently than adults) need reminder therapy every 6-12 months, otherwise recurrence of headaches is observed. Based on our own experience neurofeedback therapy seems to play role in neuropathic pain and cancer pain management.

  6. Improvement and care seeking for temporomandibular-pain complaints: The complexity of chronic pain

    NARCIS (Netherlands)

    A. Rollman

    2013-01-01

    "Temporomandibular disorders" (TMD) is a collective term used to describe a group of musculoskeletal conditions occurring in the temporomandibular region. TMD shares features with other chronic musculoskeletal syndromes (such as low back pain and neck pain) including pain, limited range of motion an

  7. Multiple faces of pain : effects of chronic pain on the brain regulation of facial expression

    NARCIS (Netherlands)

    Vachon-Presseau, Etienne; Roy, Mathieu; Woo, Choong-Wan; Kunz, Miriam; Martel, Marc-Olivier; Sullivan, Michael J; Jackson, Philip L; Wager, Tor D; Rainville, Pierre

    2016-01-01

    Pain behaviors are shaped by social demands and learning processes, and chronic pain has been previously suggested to affect their meaning. In this study, we combined functional magnetic resonance imaging with in-scanner video recording during thermal pain stimulations and use multilevel mediation a

  8. Rethinking chronic pain in a primary care setting.

    Science.gov (United States)

    Stanos, Steven; Brodsky, Marina; Argoff, Charles; Clauw, Daniel J; D'Arcy, Yvonne; Donevan, Sean; Gebke, Kevin B; Jensen, Mark P; Lewis Clark, Evelyn; McCarberg, Bill; Park, Peter W; Turk, Dennis C; Watt, Stephen

    2016-06-01

    Chronic pain substantially impacts patient function and quality of life and is a burden to society at large in terms of increased health care utilization and loss of productivity. As a result, there is an increasing recognition of chronic pain as a public health crisis. However, there remains wide variability in clinical practices related to the prevention, assessment, and treatment of chronic pain. Certain fundamental aspects of chronic pain are often neglected including the contribution of the psychological, social, and contextual factors associated with chronic pain. Also commonly overlooked is the importance of understanding the likely neurobiological mechanism(s) of the presenting pain and how they can guide treatment selection. Finally, physicians may not recognize the value of using electronic medical records to systematically capture data on pain and its impact on mood, function, and sleep. Such data can be used to monitor onset and maintenance of treatments effects at the patient level and evaluate costs at the systems level. In this review we explain how these factors play a critical role in the development of a coordinated, evidence-based treatment approach tailored to meet specific needs of the patient. We also discuss some practical approaches and techniques that can be implemented by clinicians in order to enhance the assessment and management of individuals with chronic pain in primary care settings. PMID:27166559

  9. Resiliencia Psicológica y Dolor Crónico (Psychological resilience and chronic pain

    Directory of Open Access Journals (Sweden)

    Alicia Eva López Martínez

    2012-08-01

    Full Text Available The study of resilience continues to command wide-ranging interest, despite its long history. However, there is no universally accepted definition of resilience, despite its undoubted importance in the field of health. In this context, attention is being paid to the role played by resilience in the adaptation to physical diseases, including chronic pain. The few studies on this topic show resilience as a relevant variable in adjustment to chronic pain. Nevertheless, definitive conclusions cannot be formed due to differences in the conceptualization and measurement of this variable across different studies. Thus, further research in this area is needed.

  10. Utilisation of health care system by chronic pain patients who applied for disability pensions.

    Science.gov (United States)

    Højsted, J; Alban, A; Hagild, K; Eriksen, J

    1999-09-01

    The objective of this study was to investigate how economic compensation for disability (disability pensions) to chronic pain patients affected their utilisation of health care services. The study was carried out as a register investigation. Inclusion of 144 study patients was based on records from 1989 and 1990 of the Rehabilitation and Pension Board in the Municipality of Copenhagen. Only patients of Danish origin with chronic non-malignant pain were included. The study period was divided into three: Subperiod 1: The year preceding the submission of the application for a disability pension. Subperiod 2: The period from the submission of the application to the decision was made. Subperiod 3: The year following the final decision of the health authorities. The patients were divided into 4 Subgroups according to whether disability pensions was awarded or rejected, or whether the patients accepted or appealed the decision. Based on number and charges of visits to the GPs the total costs of care in the primary sector were calculated. By means of number of bed days, visits to outpatients clinics, operations, blood samples, and various investigations, the total costs of hospital care were calculated. We found that application for a disability pension in chronic pain patients significantly influenced the health care utilisation. Chronic pain patients had a significantly lower health care utilisation after receiving a disability pension than before the pension was awarded. Chronic pain patients who did not get a disability pension and those who were not satisfied with the level of the pension awarded, maintained their health care utilisation after the decision. The mean health care use by the patients who appealed the level of the pension was three times higher than the mean health care use by the patients who accepted the level of the pension awarded. The study may indicate that lack of or insufficient economic compensation from the social system in chronic pain patients

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

    Science.gov (United States)

    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

  12. CE: Appropriate Use of Opioids in Managing Chronic Pain.

    Science.gov (United States)

    Denenberg, Risa; Curtiss, Carol P

    2016-07-01

    : Over the past two decades, the use of opioids to manage chronic pain has increased substantially, primarily in response to the recognized functional, emotional, and financial burden associated with chronic pain. Within this same period, unintentional death related to prescription opioids has been identified as a public health crisis, owing in part to such factors as insufficient professional training and medication overprescription, misuse, and diversion. The authors discuss current best practices for prescribing opioids for chronic pain, emphasizing patient assessment and essential patient teaching points regarding safe medication use, storage, and disposal. PMID:27294667

  13. Testing a Model of Pain Appraisal and Coping in Children With Chronic Abdominal Pain

    OpenAIRE

    Walker, Lynn S.; Smith, Craig A; Garber, Judy; Claar, Robyn Lewis

    2005-01-01

    This prospective study of children with recurrent abdominal pain (N = 133; ages 8–15 years) used path analysis to examine relations among dispositional pain beliefs and coping styles, cognitions and behavior related to a specific pain episode, and short- and long-term outcomes. Children believing they could not reduce or accept pain appraised their episode-specific coping ability as low and reported passive coping behavior. Dispositional passive coping had direct effects on both episode-speci...

  14. The Comparison of Efficacy of Tricyclic Antidepressant with and without Non Steroidal Anti Inflammatory Drugs in Chronic Low Back Pain

    OpenAIRE

    A.R. Yavarikia

    2007-01-01

    Introduction & Objectives: Low back pain (LBP) is one of common medical problems with several accepted medical modalities such as drugs, physiotherapy, surgery, etc. We studied the efficacy of tricyclic antidepressant (TCA), and tricyclic antidepressant plus non steroidal anti inflammatory drugs (TCA + NSAID) in 200 patients with chronic LBP. Materials & Methods: In an experimental clinical trial study on patients with chronic low back pain without organic findings, patients were divided in t...

  15. Management of insomnia in patients with chronic pain conditions.

    Science.gov (United States)

    Stiefel, Frederic; Stagno, Daniele

    2004-01-01

    The management of insomnia in patients experiencing chronic pain requires careful evaluation, good diagnostic skills, familiarity with cognitive-behavioural interventions and a sound knowledge of pharmacological treatments. Sleep disorders are characterised by a circular interrelationship with chronic pain such that pain leads to sleep disorders and sleep disorders increase the perception of pain. Sleep disorders in individuals with chronic pain remain under-reported, under-diagnosed and under-treated, which may lead--together with the individual's emotional, cognitive and behavioural maladaptive responses--to the frequent development of chronic sleep disorders. The moderately positive relationship between pain severity and sleep complaints, and the specificity of pain-related arousal and mediating variables such as depression, illustrate that insomnia in relation to chronic pain is multifaceted and poorly understood. This may explain the limited success of the available treatments. This article discusses the evaluation of patients with chronic pain and insomnia and the available pharmacological and nonpharmacological interventions to manage the sleep disorder. Non-pharmacological interventions should not be considered as single interventions, but in association with one another. Some non-pharmacological interventions especially the cognitive and behavioural approaches, can be easily implemented in general practice (e.g. stimulus control, sleep restriction, imagery training and progressive muscle relaxation). Hypnotics are routinely prescribed in the medically ill, regardless of their adverse effects; however, their long-term efficacy is not supported by robust evidence. Antidepressants provide an interesting alternative to hypnotics, since they can improve pain perception as well as sleep disorders in selected patients. Sedative antipsychotics can be considered for sleep disturbances in those patients exhibiting psychotic features, or for those with

  16. Duloxetine in the management of chronic musculoskeletal pain

    Directory of Open Access Journals (Sweden)

    Smith EJ

    2012-06-01

    Full Text Available Howard S Smith,1 Eric J Smith,2 Benjamin R Smith21Department of Anesthesiology, Albany Medical College, Albany, NY; 2The Pharmaceutical Research Institute, Albany College of Pharmacy and Health Sciences, Rensselaer, NY, USAAbstract: Chronic musculoskeletal pain is among the most frequent painful complaints that healthcare providers address. The bulk of these complaints are chronic low back pain and chronic osteoarthritis. Osteoarthritis is the most common form of arthritis in the United States. It is a chronic degenerative disorder characterized by a loss of cartilage, and occurs most often in older persons. The management of osteoarthritis and chronic low back pain may involve both nonpharmacologic (eg, weight loss, resistive and aerobic exercise, patient education, cognitive behavioral therapy and pharmacologic approaches. Older adults with severe osteoarthritis pain are more likely to take analgesics than those with less severe pain. The pharmacologic approaches to painful osteoarthritis remain controversial, but may include topical as well as oral nonsteroidal antiinflammatory drugs, acetaminophen, duloxetine, and opioids. The role of duloxetine for musculoskeletal conditions is still evolving.Keywords: pain, musculoskeletal, duloxetine, osteoarthritis, low back, serotonin-norepinephrine reuptake inhibitor

  17. The Continuing and Growing Epidemic of Chronic Low Back Pain

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    Robert J. Gatchel

    2015-09-01

    Full Text Available Because of the great prevalence of chronic pain, it is not surprising that there have been a number of influential reports by the Institute of Medicine, National Institutes of Health, and the World Health Organization that have documented the medical, social and economic problems caused by it, and the need for better pain-management programs. The present article briefly reviews these reports, and then focuses on three important areas that need to be considered when addressing the continuing and growing epidemic of one of the most prevalent types of chronic pain [chronic low back pain (CLBP]: the biopsychosocial model of chronic pain; the paradigm shift in medicine from a disease model to an illness model of CLBP; and a review of the treatment- and cost-effectiveness of interdisciplinary chronic pain management programs. This overview will serve as an important prelude to other topics related to low back pain included in this Special Issue of Healthcare. Topics covered will range from assessment and treatment approaches, to important psychosocial mediators/moderators such as coping and pain beliefs.

  18. Complementary and alternative medicine therapies for chronic pain.

    Science.gov (United States)

    Bauer, Brent A; Tilburt, Jon C; Sood, Amit; Li, Guang-Xi; Wang, Shi-Han

    2016-06-01

    Pain afflflicts over 50 million people in the US, with 30.7% US adults suffering with chronic pain. Despite advances in therapies, many patients will continue to deal with ongoing symptoms that are not fully addressed by the best conventional medicine has to offer them. The patients frequently turn to therapies outside the usual purview of conventional medicine (herbs, acupuncture, meditation, etc.) called complementary and alternative medicine (CAM). Academic and governmental groups are also starting to incorporate CAM recommendations into chronic pain management strategies. Thus, for any physician who care for patients with chronic pain, having some familiarity with these therapies-including risks and benefits-will be key to helping guide patients in making evidence-based, well informed decisions about whether or not to use such therapies. On the other hand, if a CAM therapy has evidence of both safety and efficacy then not making it available to a patient who is suffering does not meet the need of the patient. We summarize the current evidence of a wide variety of CAM modalities that have potential for helping patients with chronic pain in this article. The triad of chronic pain symptoms, ready access to information on the internet, and growing patient empowerment suggest that CAM therapies will remain a consistent part of the healthcare of patients dealing with chronic pain. PMID:27339090

  19. Chronic pain and quality of life in schizophrenic patients

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    Jouce Gabriela de Almeida

    2013-03-01

    Full Text Available OBJECTIVE: To identify the prevalence and characteristics of chronic pain in schizophrenic patients and to compare the quality of life in patients with and without chronic pain. METHODS: Crossover design with a probablistic sample of 205 adult schizophrenic outpatients (80% paranoid schizophrenia. Socio-demographic, psychiatric disorder, pain and quality of life (WHOQOL- brief data were collected between June and September 2008. RESULTS: Mean age was 37 years, 65% were men, and the mean time spent in school was 9 years; 87% were single, 65% lived with parents and 25% had a job. Among patients with chronic pain, 70% did not receive treatment for pain. Regarding quality of life, patients with pain had more physical disabilities compared to those without pain (p < .001. There were no differences in other domains. Comparisons between patients with and without pain did not show any differences in how much they felt their mental health problems disabled them. Conclusion: Chronic pain was common in schizophrenic patients (similar to the general population of a similar age and decreased their quality of life. It is necessary to pay more attention to this co-morbidity.

  20. Alexithymia and anxiety in female chronic pain patients

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    Saatcioglu Omer

    2006-08-01

    Full Text Available Abstract Objectives Alexithymia is highly prevalent among chronic pain patients. Pain is a remarkable cause for high levels of chronic anxiety. The purpose of this study was to investigate the prevalence of alexithymia and to determine anxiety levels among DSM-IV somatoform pain disorder (chronic pain female patients and to examine the relationship between alexithymia and the self-reporting of pain. Methods Thirty adult females (mean age: 34,63 ± 10,62 years, who applied to the outpatient psychiatry clinic at a public hospital with the diagnosis of chronic pain disorder (DSM-IV, were included in the study. Thirty seven healthy females (mean age: 34,46 ± 7,43 years, who matched for sociodemographic features with the patient group, consisted the control group. A sociodemographic data form, 26-item Toronto Alexithymia Scale (TAS-26, Spielberger Trait Anxiety Inventory (STAI were administered to each subject and information was obtained on several aspects of the patients' pain, including intensity (measured by VAS, and duration. Results Chronic pain patients were found significantly more alexithymic than controls. There was a positive correlation between TAS-26 scores and the duration of pain. The alexithymic and nonalexithymic group did not differ in their perception of pain. Neither positive correlation nor significant difference was found between alexithymia and trait anxiety in pain patients. Discussion Alexithymia may be important in addressing the diversity of subjective factors involved in pain. The conceptualization of alexithymia as a personality trait as well as a secondary state reaction is underlined by our data.

  1. Comparison of acceptance and distraction strategies in coping with experimentally induced pain

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    Moore H

    2015-03-01

    Full Text Available Hazel Moore,1 Ian Stewart,1 Dermot Barnes-Holmes,2 Yvonne Barnes-Holmes,2 Brian E McGuire1,31School of Psychology, National University of Ireland, Galway, 2Department of Psychology, National University of Ireland, Maynooth, 3Centre for Pain Research, National University of Ireland, Galway, IrelandBackground: This study compared an acceptance-based strategy with a control-based strategy (distraction in terms of the ability of participants to tolerate a painful stimulus, across two experiments. In addition, participants were either actively encouraged, or not, to link pain tolerance with pursuit of valued goals to examine the impact of pursuing a personally meaningful goal or value on the extent to which pain will be tolerated.Methods: Participants in experiment 1 (n=41 and experiment 2 (n=52 were equally assigned to acceptance or distraction protocols. Further, half the participants in each group generated examples from their own lives in which they had pursued a valued objective, while the other half did not. In experiment 2, the values focus was enhanced to examine the impact on pain tolerance.Results: There were no significant differences overall between the acceptance and distraction groups on pain tolerance in either experiment. However, in experiment 2, individuals classified as accepting in terms of general coping style and who were assigned to the acceptance strategy showed significantly better pain tolerance than accepting individuals who were in the distraction condition. Across both experiments, those with strong goal-driven values in both protocols were more tolerant of pain. Participants appeared to have more difficulty adhering to acceptance than to distraction as a strategy.Conclusion: Acceptance may be associated with better tolerance of pain, but may also be more difficult to operationalize than distraction in experimental studies. Matching coping style and coping strategy may be most effective, and enhancement of goal

  2. Clinical study of acute and chronic pain after temporal craniotomy

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    WANG Cheng-wei

    2013-10-01

    Full Text Available Objective To investigate the correlation of chronic pain after surgery and acute pain within 48 h after temporal craniotomy. Methods One hundred and seventy-six patients who underwent surgery through temporal approach were divided into 3 groups and treated with morphine 30 mg (Group M, N = 57, tramadol 1000 mg (Group T, N = 60 and morphine 20 mg + flurbiprofen 200 mg (Group F, N = 59 by patient-controlled intravenous analgesia (PCIA. Postoperative acute pain (resting and movement was evaluated by Visual Analogue Scale (VAS at 4, 16, 24 and 48 h respectively. Chronic pain was measured by Short-Form McGill Pain Questionnaire (SF-MPQ 3 months after surgery. The characteristics of acute and chronic pain, the relationship between them and analgesic effect of 3 kinds of analgesic drugs were analyzed. Results The differences of observed indicators including gender, age, weight and operating time, which might affect the degree of postoperative pain between before and after surgery were not statistically significant (P > 0.05. VAS scores at different time points within 48 h after surgery in each group decreased gradually. The VAS scores in group T (2.91 ± 1.64 was significantly higher than group M (2.19 ± 1.68 and group F (1.71 ± 1.17, P 0.05. The overall incidence rate of chronic pain was 71.02% (125/176, with moderate and severe pain in 15.91% (28/176. Chronic pain and acute postoperative pain severity were positively correlated (resting: rs = 0.171, P = 0.012; movement: rs = 0.190, P = 0.006. The difference of the acute pain (VAS corresponding to SF-MPQ Ⅱ score > 0 and SF-MPQ Ⅱ score = 0 was statistically significant (P < 0.05. Conclusion The postoperative chronic pain following temporal craniotomy is related to acute pain within 48 h after operation. Effective treatment of early postoperative acute pain may reduce the incidence of chronic pain.

  3. Differences in the Association between Depression and Opioid Misuse in Chronic Low Back Pain versus Chronic Pain at Other Locations

    Directory of Open Access Journals (Sweden)

    Arpana Jaiswal

    2016-06-01

    Full Text Available Patients with chronic pain and depression are more likely to develop opioid abuse compared to patients without depression. It is not known if this association differs by pain location. We compared the strength of association between depression and opioid misuse in patients with chronic low back pain (CLBP vs. chronic pain of other location (CPOL. Chart abstracted data was obtained from 166 patients seeking care in a family medicine clinic. Depression was measured by the PHQ-9 and opioid misuse was measured using the Current Opioid Misuse Measure. Pain severity and interference questions came from the Brief Pain Inventory. Cross-tabulations were computed to measure the association between depression and opioid misuse stratified on pain location. Exploratory logistic regression modeled the association between depression and opioid misuse after adjusting for pain location and pain severity and interference. Depression was significantly associated with opioid misuse in CPOL but not in CLBP. Regression results indicate pain interference partly accounts for the depression–opioid misuse association. These preliminary results from a small patient sample suggest depression may co-occur with opioid misuse more often in CPOL than in CLBP. Further research is needed to compare this comorbidity in specific pain diagnoses such as arthritis, fibromyalgia and CLBP.

  4. Differences in the Association between Depression and Opioid Misuse in Chronic Low Back Pain versus Chronic Pain at Other Locations.

    Science.gov (United States)

    Jaiswal, Arpana; Scherrer, Jeffrey F; Salas, Joanne; van den Berk-Clark, Carissa; Fernando, Sheran; Herndon, Christopher M

    2016-01-01

    Patients with chronic pain and depression are more likely to develop opioid abuse compared to patients without depression. It is not known if this association differs by pain location. We compared the strength of association between depression and opioid misuse in patients with chronic low back pain (CLBP) vs. chronic pain of other location (CPOL). Chart abstracted data was obtained from 166 patients seeking care in a family medicine clinic. Depression was measured by the PHQ-9 and opioid misuse was measured using the Current Opioid Misuse Measure. Pain severity and interference questions came from the Brief Pain Inventory. Cross-tabulations were computed to measure the association between depression and opioid misuse stratified on pain location. Exploratory logistic regression modeled the association between depression and opioid misuse after adjusting for pain location and pain severity and interference. Depression was significantly associated with opioid misuse in CPOL but not in CLBP. Regression results indicate pain interference partly accounts for the depression-opioid misuse association. These preliminary results from a small patient sample suggest depression may co-occur with opioid misuse more often in CPOL than in CLBP. Further research is needed to compare this comorbidity in specific pain diagnoses such as arthritis, fibromyalgia and CLBP. PMID:27417622

  5. Managing chronic pain in older people.

    Science.gov (United States)

    Schofield, Patricia

    This article presents the results of a collaborative project between the British Pain Society and British Geriatric Society to produce guidelines on the management of pain in older adults. The guidelines are the first of their kind in the UK and aim to provide best practice for the management of pain to all health professionals working with older adults in any care setting.

  6. Meditation as an intervention for chronic pain: an integrative review.

    Science.gov (United States)

    Teixeira, M Elizabeth

    2008-01-01

    Chronic pain is a complex phenomenon that causes a significant disruption in the lives of those affected. Chronic pain is difficult to treat and challenges healthcare professionals' abilities to implement effective treatments. Therefore, chronic pain sufferers often seek complementary alternative medicine therapies such as meditation. Literature reviews have examined studies using mindfulness-based stress reduction program as an intervention for a variety of health problems. However, no reviews exist looking at a specific patient population's utilization of meditation-based programs. Therefore, the purpose of this integrative review is to examine studies that have investigated meditation as an intervention for chronic pain, identify gaps in the literature, and make recommendations for further research.

  7. Treating Chronic Pain with Opioids: Comparing Effectiveness and Cost

    Science.gov (United States)

    Treating Chronic Pain with Opioids: Comparing Effectiveness and Cost What are opioids? Opioids are very strong prescription ... using opioids. We compared the effectiveness, safety, and cost of different opioids. We chose these as Consumer ...

  8. Phenomenology, Hypnosis, and Chronic Pain: Steps for Clinical Understanding

    Directory of Open Access Journals (Sweden)

    Mauricio da Silva Neubern

    2014-04-01

    Full Text Available This paper proposes phenomenological notions of self-image and body schema as an explicative and clinical possibility for the relationship between hypnosis and chronic pain. It begins with a critique of the medical and nomothetic approach taken by contemporary research that does not usually address clinical issues, and then addresses a case study where a person suffering from chronic pain related both body schema and self-image is submitted to hypnotherapy. The study concludes that there is no linear relationship between such notions and that chronic pain is uniquely configured to each person. This requires a clinical and qualitative approach to access and understand chronic pain, both in terms of classic phenomenological notions of time, space, and material experiences, as well as socio-cultural dimensions that contribute to producing feelings related to the daily experiences of the subjects.

  9. Study Suggests Brain Is Hard-Wired for Chronic Pain

    Science.gov (United States)

    ... News Release Tuesday, September 17, 2013 NIH-funded study suggests brain is hard-wired for chronic pain ... Apkarian, Ph.D., a senior author of the study and professor of physiology at Northwestern University Feinberg ...

  10. Addiction to opioids in chronic pain patients: a literature review

    DEFF Research Database (Denmark)

    Højsted, Jette; Sjøgren, Per

    2007-01-01

    Opioids have proven very useful for treatment of acute pain and cancer pain, and in the developed countries opioids are increasingly used for treatment of chronic non-malignant pain patients as well. This literature review aims at giving an overview of definitions, mechanisms, diagnostic criteria...... patients. The review indicates that the prevalence of addiction varied from 0% up to 50% in chronic non-malignant pain patients, and from 0% to 7.7% in cancer patients depending of the subpopulation studied and the criteria used. The risk of addiction has to be considered when initiating long-term opioid...... are concerned with the fact that pain may be under treated because of fear of addiction, and the guidelines in management of non-malignant pain patients include warnings of addiction. According to the literature, it seems appropriate and necessary to be aware of the problems associated with addiction during...

  11. Accuracy of the unassisted pain drawings by patients with chronic pain.

    Science.gov (United States)

    Cummings, G S; Routan, J L

    1987-01-01

    This investigation was conducted to test the accuracy of unassisted pain maps drawn by patients with chronic pain. Three aspects of accuracy were investigated, the accuracy of the area of pain reported, whether all existing pains were reported, and whether related symptoms were reported. Thirty-six successive new admissions to a chronic pain rehabilitation center were used as subjects. Each patient filled out the pain map prior to meeting any professional staff. During their examination the investigators completed a new pain map without seeing the patient's map. Thirty-one pairs of pain maps were compared and scored, with most maps showing several pain areas. Area of pain was accurately represented 43% of the time. Of 139 distinct pains found during examination, only 58% were reported in the pain maps. Thirtyfour percent of related symptoms were reported. It appears that unassisted pain maps are sufficiently flawed to discourage their use as an indicator of the patients symptom location J Orthop Sports Phys Ther 1987;8(8):391-396.

  12. Phenomenology, Hypnosis, and Chronic Pain: Steps for Clinical Understanding

    OpenAIRE

    Mauricio da Silva Neubern

    2014-01-01

    This paper proposes phenomenological notions of self-image and body schema as an explicative and clinical possibility for the relationship between hypnosis and chronic pain. It begins with a critique of the medical and nomothetic approach taken by contemporary research that does not usually address clinical issues, and then addresses a case study where a person suffering from chronic pain related both body schema and self-image is submitted to hypnotherapy. The study concludes that there is n...

  13. Opioids Switching with Transdermal Systems in Chronic Cancer Pain

    OpenAIRE

    Barbarisi M; Sansone P; Pota V; Pace MC; Aurilio C; Grella E; Passavanti MB

    2009-01-01

    Abstract Background Due to tolerance development and adverse side effects, chronic pain patients frequently need to be switched to alternative opioid therapy Objective To assess the efficacy and tolerability of an alternative transdermally applied (TDS) opioid in patients with chronic cancer pain receiving insufficient analgesia using their present treatment. Methods A total of 32 patients received alternative opioid therapy, 16 were switched from buprenorphine to fentanyl and 16 were switche...

  14. Intervention treatments for chronic pain syndrome in cancer patients

    OpenAIRE

    V. V. Bryuzgin

    2010-01-01

    Noninvasive treatments for chronic pain syndrome benefit in 80-90% of cancer patients. Invasive, intervention procedures for analgesia should be used in other cases. These include neuroablative and neuromodulatory measures. Neuroablation is defined as the physical suspension of painful impulse transmission pathways by a surgical, chemical, or thermal method and comprises lytic and other blocks. Neuromodulation is the dynamic and functional suppression of pain impulse pathways by the intraspin...

  15. Chronic Pain May Trigger Many Cases of Painkiller Addiction

    Science.gov (United States)

    ... use of prescription or illegal drugs, or heavy alcohol consumption. The researchers found that 87 percent reported chronic pain. About ... to reduce their pain, the study said. The researchers said their findings ... and alcohol-abuse counseling strategies should consider if people turned ...

  16. Chronic neck pain disability due to an acute whiplash injury

    NARCIS (Netherlands)

    Nederhand, Marc J.; Hermens, Hermie J.; IJzerman, Maarten J.; Turk, Dennis C.; Zilvold, Gerrit

    2003-01-01

    Several theories about musculoskeletal pain syndromes such as whiplash-associated disorder (WAD) suggest that pain and muscle activity interact and may contribute to the chronicity of symptoms. Studies using surface electromyography (sEMG) have demonstrated abnormal muscle activation patterns of the

  17. Office management of chronic pain in the elderly.

    Science.gov (United States)

    Weiner, Debra K

    2007-04-01

    Chronic pain plagues older adults more than any other age group; thus, practitioners must be able to approach this problem with confidence and skill. This article reviews the assessment and treatment of the most common chronic nonmalignant pain conditions that affect older adults--myofascial pain, generalized osteoarthritis, chronic low back pain (CLBP), fibromyalgia syndrome, and peripheral neuropathy. Specific topics include essential components of the physical examination; how and when to use basic and advanced imaging in older adults with CLBP; a stepped care approach to treating older adults with generalized osteoarthritis and CLBP, including noninvasive and invasive management techniques; how to diagnose and treat myofascial pain; strategies to identify the older adult with fibromyalgia syndrome and avoid unnecessary "diagnostic" testing; pharmacological treatment for the older adult with peripheral neuropathy; identification and treatment of other factors such as dementia and depression that may significantly influence response to pain treatment; and when to refer the patient to a pain specialist. While common, chronic pain is not a normal part of aging, and it should be treated with an emphasis on improved physical function and quality of life.

  18. [Chronic knee pain and specific heat phobia. A case report].

    Science.gov (United States)

    Pepke, W; Neubauer, E; Schiltenwolf, M

    2013-02-01

    This case report presents the medical history of a patient suffering from chronic knee pain with specific heat phobia who had a long history of sick certificates. Using multimodal pain therapy and biofeedback therapy the acquired anxiety disorder could be solved. Long-term working ability could be achieved. PMID:23321701

  19. Genitofemoral neuralgia: adding to the burden of chronic vulvar pain

    Directory of Open Access Journals (Sweden)

    Verstraelen H

    2015-11-01

    Full Text Available Hans Verstraelen,1 Eline De Zutter,1 Martine De Muynck2 1Department of Obstetrics and Gynaecology, Vulvovaginal Disease Clinic, Ghent University Hospital, Ghent, Belgium; 2Department of Physical Medicine and Rehabilitation, Ghent University Hospital, Ghent, Belgium Abstract: The vulva is a particularly common locus of chronic pain with neuropathic characteristics that occurs in women of any age, though most women with neuropathic type chronic vulvar pain will remain undiagnosed even following multiple physician visits. Here, we report on an exemplary case of a middle-aged woman who was referred to the Vulvovaginal Disease Clinic with debilitating vulvar burning and itching over the right labium majus that had been persisting for 2 years and was considered intractable. Careful history taking and clinical examination, followed by electrophysiological assessment through somatosensory evoked potentials was consistent with genitofemoral neuralgia, for which no obvious cause could be identified. Adequate pain relief was obtained with a serotonin–noradrenaline reuptake inhibitor and topical gabapentin cream. We briefly discuss the epidemiology, diagnosis, and treatment of genitofemoral neuralgia and provide a series of clues to guide clinicians in obtaining a presumptive diagnosis of specific neuropathic pain syndromes that may underlie chronic vulvar pain. We further aim to draw attention to the tremendous burden of chronic, unrecognized vulvar pain. Keywords: vulvar pain, genitofemoral nerve, neuropathic pain, vulvodynia, vulvar disease

  20. Psychosocial perspectives in the treatment of pediatric chronic pain

    OpenAIRE

    Carter Bryan D; Threlkeld Brooke M

    2012-01-01

    Abstract 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 retu...

  1. Development of Viral Vectors for Gene Therapy for Chronic Pain

    Directory of Open Access Journals (Sweden)

    Yu Huang

    2011-01-01

    Full Text Available Chronic pain is a major health concern that affects millions of people. There are no adequate long-term therapies for chronic pain sufferers, leading to significant cost for both society and the individual. The most commonly used therapy for chronic pain is the application of opioid analgesics and nonsteroidal anti-inflammatory drugs, but these drugs can lead to addiction and may cause side effects. Further studies of the mechanisms of chronic pain have opened the way for development of new treatment strategies, one of which is gene therapy. The key to gene therapy is selecting safe and highly efficient gene delivery systems that can deliver therapeutic genes to overexpress or suppress relevant targets in specific cell types. Here we review several promising viral vectors that could be applied in gene transfer for the treatment of chronic pain and further discuss the possible mechanisms of genes of interest that could be delivered with viral vectors for the treatment of chronic pain.

  2. Behavioural alteration in chronic pain: are brain glia involved?

    Science.gov (United States)

    Panigada, T; Gosselin, R-D

    2011-10-01

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

  3. Auricular Point Acupressure for Chronic Low Back Pain: A Feasibility Study for 1-Week Treatment

    Directory of Open Access Journals (Sweden)

    Chao-Hsing Yeh

    2012-01-01

    Full Text Available Objectives. The objective of this one-group, repeated-measures design was to explore the acceptance of auricular point acupressure (APA to reduce chronic low back pain (CLBP and estimate minimum clinically important differences (MCIDs for pain intensity change. Methods. Subjects received 7-day APA treatment. After appropriate acupoints were identified, vaccaria seeds were carefully taped onto each selected auricular point for 7-day. The Brief Pain Inventory Short Form (BPI was used to collect outcome data. Results. A total of 74 subjects participated in the study. Ten subjects dropped out and the retention rate was 87%. Subjects reported a 46% reduction in BPI worst pain, and over 50% reduction in BPI average pain, overall pain severity and pain interference by the end of study, and 62.5% subjects also reported less pain medication use. The MCIDs for the subscale of BPI ranged from .70 to 1.86 points. The percentage improvement of MCIDs from baseline was between 14.5–24.9%. Discussion. APA appears to be highly acceptable to patients with CLBP. A sham group is needed in order to differentiate the true effects of APA from the possible psychological effects of more frequent visits by the auricular therapist and patients’ expectation of the APA treatment.

  4. Current Status of the New Antiepileptic Drugs in Chronic Pain

    Science.gov (United States)

    Sidhu, Harpreet S.; Sadhotra, Akshay

    2016-01-01

    Antiepileptic drugs (AEDs) are extensively used worldwide to treat a wide range of disorders other than epilepsy, such as neuropathic pain, migraine, and bipolar disorder. Due to this situation more than 20 new third-generation AEDs have been introduced in the market recently. The future design of new AEDs must also have potential to help in the non-epileptic disorders. The wide acceptance of second generation AEDs for the management of various non-epileptic disorders has caused the emergence of generics in the market. The wide use of approved AEDs outside epilepsy is based on both economic and scientific reasons. Bipolar disorders, migraine prophylaxis, fibromyalgia, and neuropathic pain represent the most attractive indication expansion opportunities for anticonvulsant developers, providing blockbuster revenues. Strong growth in non-epilepsy conditions will see Pfizer’s Lyrica become the market leading brand by 2018. In this review, we mainly focus on the current status of new AEDs in the treatment of chronic pain and migraine prophylaxis. AEDs have a strong analgesic potential and this is demonstrated by the wide use of carbamazepine in trigeminal neuralgia and sodium valproate in migraine prophylaxis. At present, data on the new AEDs for non-epileptic conditions are inconclusive. Not all AEDs are effective in the management of neuropathic pain and migraine. Only those AEDs whose mechanisms of action are match with pathophysiology of the disease, have potential to show efficacy in non-epileptic disorder. For this better understanding of the pathophysiology of the disease and mechanisms of action of new AEDs are essential requirement before initiating pre-clinical and clinical trials. Many new AEDs show good results in the animal model and open-label studies but fail to provide strong evidence at randomized, placebo-controlled trials. The final decision regarding the clinical efficacy of the particular AEDs in a specific non-epileptic disorder should be

  5. From acute musculoskeletal pain to chronic widespread pain and fibromyalgia: application of pain neurophysiology in manual therapy practice.

    Science.gov (United States)

    Nijs, Jo; Van Houdenhove, Boudewijn

    2009-02-01

    During the past decade, scientific research has provided new insight into the development from an acute, localised musculoskeletal disorder towards chronic widespread pain/fibromyalgia (FM). Chronic widespread pain/FM is characterised by sensitisation of central pain pathways. An in-depth review of basic and clinical research was performed to design a theoretical framework for manual therapy in these patients. It is explained that manual therapy might be able to influence the process of chronicity in three different ways. (I) In order to prevent chronicity in (sub)acute musculoskeletal disorders, it seems crucial to limit the time course of afferent stimulation of peripheral nociceptors. (II) In the case of chronic widespread pain and established sensitisation of central pain pathways, relatively minor injuries/trauma at any locations are likely to sustain the process of central sensitisation and should be treated appropriately with manual therapy accounting for the decreased sensory threshold. Inappropriate pain beliefs should be addressed and exercise interventions should account for the process of central sensitisation. (III) However, manual therapists ignoring the processes involved in the development and maintenance of chronic widespread pain/FM may cause more harm then benefit to the patient by triggering or sustaining central sensitisation.

  6. Prospective study of chronic pain after groin hernia repair

    DEFF Research Database (Denmark)

    Callesen, T; Bech, K; Kehlet, H

    1999-01-01

    BACKGROUND: The aim was to provide a detailed description of any residual pain 1 year after elective day-case open groin hernia repair under local anaesthesia. METHODS: This was a prospective consecutive case series study by questionnaire of 500 consecutive operations in 466 unselected adult...... severe pain 4 weeks after operation (24 versus 3 per cent; P < 0.001). CONCLUSION: Chronic pain is a significant problem after open groin hernia repair. It may be worse after surgery for a recurrent hernia and may be predicted by the intensity of early postoperative pain....... severe pain was higher after repair of recurrent than primary hernias (14 versus 3 per cent; P < 0.001). The risk of developing moderate or severe pain was increased in patients who had a high pain score 1 week after operation (9 versus 3 per cent; P < 0.05) and also in patients who had moderate or...

  7. Central hypersensitivity in chronic musculoskeletal pain

    DEFF Research Database (Denmark)

    Curatolo, Michele; Arendt-Nielsen, Lars

    2015-01-01

    Clinical research has consistently detected alteration in central pain processing leading to hypersensitivity. Most methods used in humans are reliable and have face validity to detect widespread central hypersensitivity. However, construct validity is difficult to investigate due to lack of gold...... standards. Reference values in the pain-free population have been generated, but need replication. Research on pain biomarkers that reflect specific central hypersensitivity processes is warranted. Few studies have analyzed the prognostic value of central hypersensitivity. Most medications acting at central...

  8. HSV gene transfer in the treatment of chronic pain

    Institute of Scientific and Technical Information of China (English)

    David J. Fink; Marina Mata

    2008-01-01

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

  9. Pacing: A Concept Analysis of a Chronic Pain Intervention

    Directory of Open Access Journals (Sweden)

    Kathryn Jamieson-Lega

    2013-01-01

    Full Text Available BACKGROUND: The intervention of pacing is regularly recommended for chronic pain patients. However, pacing is poorly defined and appears to be interpreted in varying, potentially contradictory manners within the field of chronic pain. This conceptual lack of clarity has implications for effective service delivery and for researchers’ ability to conduct rigorous study. An examination of the background literature demonstrates that while pacing is often one part of a multidisciplinary pain management program, outcome research is hindered by a lack of a clear and shared definition of this currently ill-defined construct.

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

    Science.gov (United States)

    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

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

    Directory of Open Access Journals (Sweden)

    S. Monti

    2015-10-01

    Full Text Available 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. Effi cacy 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 profi le, particularly concerning side effects, compared to traditional opioids. This novel analgesic represents a possible therapeutic option also in the rheumatologic fi eld, particularly in the treatment of osteoarthritis and low back pain.

  12. Treating Chronic Pain with SSRIs: What Do We Know?

    Directory of Open Access Journals (Sweden)

    Elias Patetsos

    2016-01-01

    Full Text Available Serotonin is a monoamine neurotransmitter that plays a major role in both nociception and mood regulation. Alterations in the 5-hydroxytryptophan (5HT system have been reported in chronic pain patients. In recent years, Selective Serotonin Reuptake Inhibitors (SSRIs have been suggested as an alternative treatment for chronic pain due to the fact that they are better tolerated presenting less secondary effects than other antidepressants such as tricyclic antidepressants. Although several clinical trials have been published, the effectiveness of SSRI as treatment for pain conditions is inconclusive. This review aims to summarise what is known, regarding the effectiveness of SSRI as a treatment for chronic pain conditions in adults. A total of 36 studies involving a total of 1898 participants were included in this review. Of the 36 trials included in the review, 2 used zimelidine as treatment, 3 used escitalopram, 4 used fluvoxamine, 4 used sertraline, 6 used citalopram, 8 used paroxetine, 9 used fluoxetine, and one used both citalopram and paroxetine. Because the trials included in this review are quite heterogeneous, only qualitative analyses were performed. SSRI seems to have an effect on most of chronic pain conditions; however, further clinical trials with good methodology leading to low risk of bias are needed in order to conclude once and for all the effect of this drug class as treatment for chronic pain conditions.

  13. Treating Chronic Pain with SSRIs: What Do We Know?

    Science.gov (United States)

    Patetsos, Elias

    2016-01-01

    Serotonin is a monoamine neurotransmitter that plays a major role in both nociception and mood regulation. Alterations in the 5-hydroxytryptophan (5HT) system have been reported in chronic pain patients. In recent years, Selective Serotonin Reuptake Inhibitors (SSRIs) have been suggested as an alternative treatment for chronic pain due to the fact that they are better tolerated presenting less secondary effects than other antidepressants such as tricyclic antidepressants. Although several clinical trials have been published, the effectiveness of SSRI as treatment for pain conditions is inconclusive. This review aims to summarise what is known, regarding the effectiveness of SSRI as a treatment for chronic pain conditions in adults. A total of 36 studies involving a total of 1898 participants were included in this review. Of the 36 trials included in the review, 2 used zimelidine as treatment, 3 used escitalopram, 4 used fluvoxamine, 4 used sertraline, 6 used citalopram, 8 used paroxetine, 9 used fluoxetine, and one used both citalopram and paroxetine. Because the trials included in this review are quite heterogeneous, only qualitative analyses were performed. SSRI seems to have an effect on most of chronic pain conditions; however, further clinical trials with good methodology leading to low risk of bias are needed in order to conclude once and for all the effect of this drug class as treatment for chronic pain conditions. PMID:27445601

  14. Chronic pain, opioid prescriptions, and mortality in Denmark

    DEFF Research Database (Denmark)

    Ekholm, Ola; Kurita, Geana Paula; Højsted, Jette;

    2014-01-01

    This study aimed to investigate the risk of death, development of cancer, and hospital inpatient admissions resulting from injuries and toxicity/poisoning among opioid users with chronic noncancer pain. A population-based cohort of 13,127 adults, who have participated in the Danish Health Interview...... Surveys in 2000 or 2005 and have been followed up prospectively by registers until the end of 2011, were classified according to the absence or presence of chronic pain (ie, pain lasting ⩾ 6 months) and long-term or short-term opioid use (individuals using at least 1 prescription per month for 6 months...... in the previous year and at least 1 prescription in the previous year, respectively). The risk of all-cause mortality was 1.72 (95% confidence interval [CI]=1.23-2.41) times higher among long-term opioid users than among individuals without chronic pain. The risk of death was lower, but still significantly higher...

  15. Critical issues on opioids in chronic non-cancer pain

    DEFF Research Database (Denmark)

    Eriksen, Jørgen; Sjøgren, Per; Bruera, Eduardo;

    2006-01-01

    The aim of the study was epidemiologically to evaluate the long-term effects of opioids on pain relief, quality of life and functional capacity in long-term/chronic non-cancer pain. The study was based on data from the 2000 Danish Health and Morbidity Survey. As part of a representative National...... in employment, higher use of the health care system, and a negative influence on quality of life as registered in all items in SF-36. Because of the cross-sectional nature causative relationships cannot be ascertained. However, it is remarkable that opioid treatment of long-term/chronic non-cancer pain does...... random sample of 16,684 individuals (>16 years of age), 10,066 took part in an interview and completed a self-administered questionnaire. Cancer patients were excluded. The interview and the self-administered questionnaire included questions on chronic/long-lasting pain (>6 months), health...

  16. Systematic review of chronic pain in persons with Marfan syndrome.

    Science.gov (United States)

    Velvin, G; Bathen, T; Rand-Hendriksen, S; Geirdal, A Ø

    2016-06-01

    The purpose of this study was to explore the literature on chronic pain in adults with Marfan syndrome (MFS), critically appraising and synthesizing relevant literature. A systematic review was conducted by searching the published literature databases using available medical, physical, psychological, social databases and other sources. All studies that addressed pain in MFS, published in peer-reviewed journals were assessed. Of 351 search results, 18 articles satisfied the eligibility criteria. All studies were cross-sectional and quantitative; no randomized controlled trials or intervention studies were found. Most studies had small sample sizes, low response rates and mainly dealt with other aspects of the diagnosis than pain. Only one article dealt mainly with pain. The research on chronic pain in MFS is limited in size and quality. Despite these limitations, studies describe that the prevalence of pain in patients with MFS is high, varying from 47 to 92% and affecting several anatomic sites. In addition, chronic pain limits daily function and few studies describe treatment options for pain in patients with MFS. Research is needed to obtain more evidence-based knowledge for developing more appropriate rehabilitation programs for people with MFS. PMID:26607862

  17. Spinal cord stimulation for chronic visceral pain secondary to chronic non-alcoholic pancreatitis.

    Science.gov (United States)

    Kapural, Leonardo; Rakic, Mladen

    2008-07-01

    Spinal cord stimulation (SCS) suppresses visceral response to colon distension in an animal model. In humans, it may be an effective therapy for chronic pain of pelvic origin, irritable bowel syndrome, and persistent unspecified abdominal pain. Described here is the case of SCS for 38-year-old woman with visceral pain secondary to chronic pancreatitis. Previous therapies included numerous endoscopic retrograde cholangiopancreatographies, multiple pancreatic duct stenting, chemical and surgical sympathectomies with short-lasting pain relief. After the initial evaluation, the patient underwent retrograde epidural differential block to determine possible source of pain. Delay in pain recurrence after block suggested that the origin of her pain was visceral. After the psychologic evaluation, the patient underwent SCS trial over 14 days. She had 2 trial leads placed epidurally via T9-T10 paramedian entry with the tips of both leads positioned at T6 vertebral body. During the trial, visual analog scale pain score decreased from 8 to 1 cm, Pain Disability Index from 62 to 14, and opioid use from 150 to 0 mg of morphine sulfate equivalent a day. After the completion of successful SCS trial, she was implanted with dual octrode leads and rechargeable pulse generator. Median pain scores decreased from 8 to 1 at 3 months after the implant. Pain Disability Index changed from 62 to 15. Opiate use decreased to none. It seems that SCS may have a significant therapeutic potential for the treatment of visceral pain secondary to chronic pancreatitis. PMID:18496389

  18. Recognizing myofascial pelvic pain in the female patient with chronic pelvic pain.

    Science.gov (United States)

    Pastore, Elizabeth A; Katzman, Wendy B

    2012-01-01

    Myofascial pelvic pain (MFPP) is a major component of chronic pelvic pain (CPP) and often is not properly identified by health care providers. The hallmark diagnostic indicator of MFPP is myofascial trigger points in the pelvic floor musculature that refer pain to adjacent sites. Effective treatments are available to reduce MFPP, including myofascial trigger point release, biofeedback, and electrical stimulation. An interdisciplinary team is essential for identifying and successfully treating MFPP.

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

    OpenAIRE

    Vidor, Liliane Pinto; Torres, Iraci LS; Medeiros, Liciane Fernandes; Dussán-Sarria, Jairo Alberto; Dall’Agnol, Letizzia; Deitos, Alicia; Brietzke, Aline; Laste, Gabriela; Joanna R Rozisky; Fregni, Felipe; Caumo, Wolnei

    2014-01-01

    Background: This study aimed to answer three questions related to chronic myofascial pain syndrome (MPS): 1) Is the motor cortex excitability, as assessed by transcranial magnetic stimulation parameters (TMS), related to state-trait anxiety? 2) Does anxiety modulate corticospinal excitability changes after evoked pain by Quantitative Sensory Testing (QST)? 3) Does the state-trait anxiety predict the response to pain evoked by QST if simultaneously receiving a heterotopic stimulus [Conditional...

  20. Emotional Status, Perceived Control of Pain, and Pain Coping Strategies in Episodic and Chronic Cluster Headache

    Directory of Open Access Journals (Sweden)

    Dominique Valade

    2012-08-01

    Full Text Available Cluster headache (CH is a chronic syndrome characterized by excruciatingly painful attacks occurring with circadian and circannual periodicity. The objectives of the present study were, in CH patients, to determine by principal component analysis the factor structure of two instruments commonly used in clinics to evaluate pain locus of control (Cancer Locus of Control Scale–CLCS and coping strategies (Coping Strategies Questionnaire–CSQ, to examine the relationship between internal pain controllability and emotional distress, and to compare psychosocial distress and coping strategies between two subsets of patients with episodic or chronic CH. Results indicate, for CLCS, a 3-factor structure (internal controllability, medical controllability, religious controllability noticeably different in CH patients from the structure reported in patients with other painful pathologies and, for CSQ, a 5-factor structure of CSQ which did not markedly diverge from the classical structure. Perceived internal controllability of pain was strongly correlated with study measures of depression (HAD depression/anhedonia subscale, Beck Depression Inventory. Comparison between subsets of patients with episodic or chronic CH of emotional status, pain locus of control, perceived social support and coping strategies did not reveal significant differences apart for the Reinterpreting pain sensations strategy which was more often used by episodic CH patients. Observed tendencies for increased anxiety and perceived social support in patients with episodic CH, and for increased depression and more frequent use of the Ignoring pain sensations strategy in patients with chronic CH, warrant confirmation in larger groups of patients.

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

    Directory of Open Access Journals (Sweden)

    Artner J

    2012-07-01

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

  2. Clinical biopsychosocial physiotherapy assessment of patients with chronic pain: The first step in pain neuroscience education.

    Science.gov (United States)

    Wijma, Amarins J; van Wilgen, C Paul; Meeus, Mira; Nijs, Jo

    2016-07-01

    Pain neuroscience education (PNE) is increasingly used as part of a physical therapy treatment in patients with chronic pain. A thorough clinical biopsychosocial assessment is recommended prior to PNE to allow proper explanation of the neurophysiology of pain and the biopsychosocial interactions in an interactive and patient-centered manner. However, without clear guidelines, clinicians are left wondering how a biopsychosocial assessment should be administered. Therefore, we provided a practical guide, based on scientific research and clinical experience, for the biopsychosocial assessment of patients with chronic pain in physiotherapy practice. The purpose of this article is to describe the use of the Pain - Somatic factors - Cognitive factors - Emotional factors - Behavioral factors - Social factors - Motivation - model (PSCEBSM-model) during the intake, as well as a pain analysis sheet. This model attempts to clearly establish what the dominant pain mechanism is (predominant nociceptive, neuropathic, or non-neuropathic central sensitization pain), as well as to assess the provoking and perpetuating biopsychosocial factors in patients with chronic pain. Using this approach allows the clinician to specifically classify patients and tailor the plan of care, including PNE, to individual patients. PMID:27351769

  3. Clinical biopsychosocial physiotherapy assessment of patients with chronic pain: The first step in pain neuroscience education.

    Science.gov (United States)

    Wijma, Amarins J; van Wilgen, C Paul; Meeus, Mira; Nijs, Jo

    2016-07-01

    Pain neuroscience education (PNE) is increasingly used as part of a physical therapy treatment in patients with chronic pain. A thorough clinical biopsychosocial assessment is recommended prior to PNE to allow proper explanation of the neurophysiology of pain and the biopsychosocial interactions in an interactive and patient-centered manner. However, without clear guidelines, clinicians are left wondering how a biopsychosocial assessment should be administered. Therefore, we provided a practical guide, based on scientific research and clinical experience, for the biopsychosocial assessment of patients with chronic pain in physiotherapy practice. The purpose of this article is to describe the use of the Pain - Somatic factors - Cognitive factors - Emotional factors - Behavioral factors - Social factors - Motivation - model (PSCEBSM-model) during the intake, as well as a pain analysis sheet. This model attempts to clearly establish what the dominant pain mechanism is (predominant nociceptive, neuropathic, or non-neuropathic central sensitization pain), as well as to assess the provoking and perpetuating biopsychosocial factors in patients with chronic pain. Using this approach allows the clinician to specifically classify patients and tailor the plan of care, including PNE, to individual patients.

  4. Neurodegenerative properties of chronic pain: cognitive decline in patients with chronic pancreatitis.

    Directory of Open Access Journals (Sweden)

    Marijtje L A Jongsma

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

  5. Multidimensional Pain Inventory derived classifications of chronic pain: evidence for maladaptive pain-related coping within the dysfunctional group.

    Science.gov (United States)

    Rusu, Adina C; Hasenbring, Monika

    2008-01-01

    This study examines maladaptive pain-related fear-avoidance and endurance coping in subgroups of patients with chronic back pain. Hypotheses were derived from the avoidance-endurance model of pain [Hasenbring M. Attentional control of pain and the process of chronification. In: Sandkühler J, Bromm B, Gebhart GF, editors. Progress in pain research, vol. 129. New York: Elsevier; 2000. p. 525-34.], which assumes that endurance coping (cognitive, behavioral tendency to endure severe pain to finish current activities irrespective of pain increases) leads to overuse of muscles, joints, and discs with an increase of pain as long-term consequence. Participants were 120 patients referred for treatment of chronic pain to General Practices. They were classified as 'dysfunctional-DYS' (15.8%), 'interpersonally distressed-ID' (10.8%), and 'adaptive copers-AC' (61.7%) based on the Multidimensional Pain Inventory [Kerns RD, Turk DC, Rudy TE. The West Haven-Yale Multidimensional Pain Inventory (WHYMPI). Pain 1985;23:345-56.] and compared on measures of pain-related fear-avoidance coping (anxiety/depression; help-/hopelessness; catastrophizing; avoidance of social/physical activity) and endurance coping (positive mood; thought suppression; endurance behavior) using the Kiel Pain Inventory [Hasenbring M. The Kiel Pain Inventory-Manual. Three questionnaire scales for assessment of pain-related cognitions, emotions and copying strategies. Bern:Huber; 1994.]. Multivariate analysis of variance indicated that groups differed significantly for pain-related fear-avoidance and endurance coping, even after control for pain intensity and depression. Univariate effects revealed that patients classified as DYS reported more anxiety/depression, help-/hopelessness, and catastrophizing than did those classified as AC. Furthermore, the DYS group showed more thought suppression compared to AC; however, subgroups did not differ significantly with regard to avoidance of social and physical activity

  6. Incorporating Family Function into Chronic Pain Disability: The Role of Catastrophizing

    Directory of Open Access Journals (Sweden)

    Fatemeh Akbari

    2016-01-01

    Full Text Available Background. Observers’ responses to pain are recently investigated to more comprehensively explain chronic pain (CP and disability. However, the role of family context, defined as interference in roles, communication, and problem-solving, and how (i.e., through which mechanisms these variables contribute to CP related disability have yet to be examined. Objectives. The aim of the present study is to examine family context in relationship to pain catastrophizing, fear of movement, and depression and its role in understanding CP disability. Three different models were examined. Methods. A total sample of 142 patients with musculoskeletal chronic pain was recruited to examine the role of fear of movement, pain intensity, pain catastrophizing, and depression in relationship to family functioning as predictors of disability. Results. Findings indicated that two models showed acceptable fit, but one of them revealed superior fit indices. Results of the model with superior fit indices indicated that family dysfunction may contribute to catastrophic thinking, which, in turn, contributes to patients’ disability through increasing fear of movement and depression. Discussion. The current study provides further support for the notion that the impact of emotional and cognitive variables upon CP-related disability can be better understood when we consider the social context of pain patients and family function in particular.

  7. Psycophisical predictor of outcome in pelvic chronic pain therapy

    Directory of Open Access Journals (Sweden)

    Paolo Poli

    2012-05-01

    Full Text Available 32 patients with chronic pelvic pain (CPP were compared with 24 patients with low back pain (LB for the entire course of treatment which lasted 1 year, with follow up at 1,6 and 12 months. At baseline, the group of subjects with CPP presented more hypochondriacal traits, major depression and affective inhibition if compared with LB group, but such psychological variables have not been able to predict the outcome to treatment. No significant difference has been found between LB and CPP subjects regarding the pain threshold of and/or the pain tolerance, when pain was induced by cold stimulation to the hand. High pain tolerance together with the high expectation of analgesia and the conviction of disease appear to be the most important predictors of treatment outcome.

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

    NARCIS (Netherlands)

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

    2013-01-01

    Accompanying leg pain is commonly observed in patients with chronic low back pain (CLBP) and is assumed to be an indicator for the disorder severity. However, it is still unknown whether it is possible to estimate a patient's functional status by the extent of leg pain present. In a post rehabilitat

  9. Chronic widespread pain in the spectrum of rheumatological diseases.

    Science.gov (United States)

    Bliddal, Henning; Danneskiold-Samsøe, Bente

    2007-06-01

    Chronic pain is very common in all European countries, with musculoskeletal problems predominating. About 1% of the adult population develops a syndrome of chronic muscle pain, fibromyalgia (FMS), characterized by multiple tender points, back or neck pain, and a number of associated problems from other organs, including a high frequency of fatigue. Evidence points to central sensitization as an important neurophysiological aberration in the development of FMS. Importantly, these neurological changes may result from inadequately treated chronic focal pain problems such as osteoarthritis or myofascial pain. It is important for health professionals to be aware of this syndrome and to diagnose the patients to avoid a steady increase in diagnostic tests. On the other hand, patients with chronic widespread pain have an increased risk of developing malignancies, and new or changed symptoms should be diagnosed even in FMS. In rheumatology practice it is especially important to be aware of the existence of FMS in association with immune inflammatory diseases, most commonly lupus and rheumatoid arthritis. Differential diagnoses are other causes of chronic pain, e.g. thyroid disease. The costs of this syndrome are substantial due to loss of working capability and direct expenses of medication and health-system usage. Fibromyalgia patients need recognition of their pain syndrome if they are to comply with treatment. Lack of empathy and understanding by healthcare professionals often leads to patient frustration and inappropriate illness behavior, often associated with some exaggeration of symptoms in an effort to gain some legitimacy for their problem. FMS is multifaceted, and treatment consists of both medical interventions, with emphasis on agents acting on the central nervous system, and physical exercises.

  10. Managing chronic pain in survivors of torture.

    Science.gov (United States)

    Amris, Kirstine; Williams, Amanda C de C

    2015-01-01

    All generalist and specialist clinicians are likely to encounter torture survivors among refugees and asylum seekers. A minority of people survive torture and a smaller minority reach a developed country; those who do tend to be the more resilient and resourceful. They have many health, social and welfare problems; persistent pain in the musculoskeletal system is one of the most common. There is little specific evidence on pain in survivors of torture; the guidelines on interdisciplinary specialist management are applicable. Most of the literature on refugee survivors of torture has an exclusive focus on psychological disorders, with particularly poor understanding of pain problems. This article summarizes the current status of assessment and treatment of pain problems in the torture survivor. PMID:25537694

  11. Managing a chronic pain patient in the perioperative period.

    Science.gov (United States)

    Kopf, Andreas

    2013-12-01

    The chronic pain patient with and without chronic opioid medication is at risk for under- and overtreatment perioperatively. Careful planning of the perioperative period by the anesthesiologist, the pain service and the surgeon is crucial. Epidural analgesia requires reduction of preoperative opioid doses to a maximum of 50% to avoid withdrawal as well as continuous postanesthesia care unit-monitoring for the first 24 hours. Brief cognitive behavioral interventions pre- and postoperatively contribute to successful pain management. The perioperative period may be used to re-evaluate the patient's opioid requirements. A follow-up by an experienced pain management service should be available after discharge of the chronic pain patient. Individualized assessment by a pain management team is necessary for this increasing group of patients. This report is adapted from paineurope 2013; Issue 2, ©Haymarket Medical Publications Ltd., and is presented with permission. paineurope is provided as a service to pain management by Mundipharma International, LTD. and is distributed free of charge to healthcare professionals in Europe. Archival issues can be accessed via the website: http://www.paineurope.com at which European health professionals can register online to receive copies of the quarterly publication. PMID:24303836

  12. Exercise therapy for chronic nonspecific low-back pain.

    Science.gov (United States)

    van Middelkoop, Marienke; Rubinstein, Sidney M; Verhagen, Arianne P; Ostelo, Raymond W; Koes, Bart W; van Tulder, Maurits W

    2010-04-01

    Exercise therapy is the most widely used type of conservative treatment for low back pain. Systematic reviews have shown that exercise therapy is effective for chronic but not for acute low back pain. During the past 5 years, many additional trials have been published on chronic low back pain. This articles aims to give an overview on the effectiveness of exercise therapy in patients with low back pain. For this overview, existing Cochrane reviews for the individual interventions were screened for studies fulfilling the inclusion criteria, and the search strategy outlined by the Cochrane Back Review Group (CBRG) was followed. Studies were included if they fulfilled the following criteria: (1) randomised controlled trials,(2) adult (> or =18 years) population with chronic (> or =12 weeks) nonspecific low back pain and (3) evaluation of at least one of the main clinically relevant outcome measures (pain, functional status, perceived recovery or return to work). Two reviewers independently selected studies and extracted data on study characteristics, risk of bias and outcomes at short-term, intermediate and long-term follow-up. The GRADE approach (GRADE, Grading of Recommendations Assessment, Development and Evaluation) was used to determine the quality of evidence. In total, 37 randomised controlled trials met the inclusion criteria and were included in this overview. Compared to usual care, exercise therapy improved post-treatment pain intensity and disability, and long-term function. The authors conclude that evidence from randomised controlled trials demonstrated that exercise therapy is effective at reducing pain and function in the treatment of chronic low back pain. There is no evidence that one particular type of exercise therapy is clearly more effective than others. However, effects are small and it remains unclear which subgroups of patients benefit most from a specific type of treatment. PMID:20227641

  13. Therapeutic exercise in chronic low back pain

    Directory of Open Access Journals (Sweden)

    OJOGA, Florina

    2013-12-01

    Full Text Available Rehabilitation of patients with low back pain is very important because the incidence of this symptom is very high among all ages, but especially after forty years. The rehabilitation team must perform a detailed clinical exam and an assessment of the functional limitations and functional goals to achieve at the end of the treatment for every patient. The goals of the therapy are normalization of impairments in flexibility, strength and endurance, and of course, reducing of pain.

  14. Chronic musculoskeletal pain in chronic fatigue syndrome: recent developments and therapeutic implications.

    Science.gov (United States)

    Nijs, Jo; Meeus, Mira; De Meirleir, Kenny

    2006-08-01

    Patients with chronic fatigue syndrome (CFS) experience chronic musculoskeletal pain which is even more debilitating than fatigue. Scientific research data gathered around the world enables clinicians to understand, at least in part, chronic musculoskeletal pain in CFS patients. Generalized joint hypermobility and benign joint hypermobility syndrome appear to be highly prevalent among CFS sufferers, but they do not seem to be of any clinical importance. On the other hand, pain catastrophizing accounts for a substantial portion of musculoskeletal pain and is a predictor of exercise performance in CFS patients. The evidence concerning pain catastrophizing is supportive of the indirect evidence of a dysfunctional pain processing system in CFS patients with musculoskeletal pain. CFS sufferers respond to incremental exercise with a lengthened and accentuated oxidative stress response, explaining muscle pain, postexertional malaise, and the decrease in pain threshold following graded exercise in CFS patients. Applying the scientific evidence to the manual physiotherapy profession, pacing self-management techniques and pain neurophysiology education are indicated for the treatment of musculoskeletal pain in CFS patients. Studies examining the effectiveness of these strategies for CFS patients are warranted.

  15. Effects of coping statements on experimental pain in chronic pain patients

    Directory of Open Access Journals (Sweden)

    Daniela Roditi

    2009-08-01

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

  16. Sexual Abuse and Sexual Functioning in a Chronic Pelvic Pain Sample

    Science.gov (United States)

    Randolph, Mary E.; Reddy, Diane M.

    2006-01-01

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

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

    Science.gov (United States)

    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

  18. Treatment Preferences for CAM in Children with Chronic Pain

    Directory of Open Access Journals (Sweden)

    Jennie C. I. Tsao

    2007-01-01

    Full Text Available 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.

  19. Chronic stress, cortisol dysfunction, and pain: a psychoneuroendocrine rationale for stress management in pain rehabilitation.

    Science.gov (United States)

    Hannibal, Kara E; Bishop, Mark D

    2014-12-01

    Pain is a primary symptom driving patients to seek physical therapy, and its attenuation commonly defines a successful outcome. A large body of evidence is dedicated to elucidating the relationship between chronic stress and pain; however, stress is rarely addressed in pain rehabilitation. A physiologic stress response may be evoked by fear or perceived threat to safety, status, or well-being and elicits the secretion of sympathetic catecholamines (epinephrine and norepinepherine) and neuroendocrine hormones (cortisol) to promote survival and motivate success. Cortisol is a potent anti-inflammatory that functions to mobilize glucose reserves for energy and modulate inflammation. Cortisol also may facilitate the consolidation of fear-based memories for future survival and avoidance of danger. Although short-term stress may be adaptive, maladaptive responses (eg, magnification, rumination, helplessness) to pain or non-pain-related stressors may intensify cortisol secretion and condition a sensitized physiologic stress response that is readily recruited. Ultimately, a prolonged or exaggerated stress response may perpetuate cortisol dysfunction, widespread inflammation, and pain. Stress may be unavoidable in life, and challenges are inherent to success; however, humans have the capability to modify what they perceive as stressful and how they respond to it. Exaggerated psychological responses (eg, catastrophizing) following maladaptive cognitive appraisals of potential stressors as threatening may exacerbate cortisol secretion and facilitate the consolidation of fear-based memories of pain or non-pain-related stressors; however, coping, cognitive reappraisal, or confrontation of stressors may minimize cortisol secretion and prevent chronic, recurrent pain. Given the parallel mechanisms underlying the physiologic effects of a maladaptive response to pain and non-pain-related stressors, physical therapists should consider screening for non-pain-related stress to

  20. The Toronto General Hospital Transitional Pain Service: development and implementation of a multidisciplinary program to prevent chronic postsurgical pain

    Directory of Open Access Journals (Sweden)

    Katz J

    2015-10-01

    Toronto General Hospital (TGH is the first to comprehensively address the problem of CPSP at three stages: 1 preoperatively, 2 postoperatively in hospital, and 3 postoperatively in an outpatient setting for up to 6 months after surgery. Patients at high risk for CPSP are identified early and offered coordinated and comprehensive care by the multidisciplinary team consisting of pain physicians, advanced practice nurses, psychologists, and physiotherapists. Access to expert intervention through the Transitional Pain Service bypasses typically long wait times for surgical patients to be referred and seen in chronic pain clinics. This affords the opportunity to impact patients' pain trajectories, preventing the transition from acute to chronic pain, and reducing suffering, disability, and health care costs. In this report, we describe the workings of the Transitional Pain Service at Toronto General Hospital, including the clinical algorithm used to identify patients, and clinical services offered to patients as they transition through the stages of surgical recovery. We describe the role of the psychological treatment, which draws on innovations in Acceptance and Commitment Therapy that allow for brief and effective behavioral interventions to be applied transdiagnostically and preventatively. Finally, we describe our vision for future growth. Keywords: Transitional Pain Service, chronic postsurgical pain, transition to chronic pain, opioid use, multidisciplinary treatment

  1. Sex differences between Veterans participating in interdisciplinary chronic pain rehabilitation

    Directory of Open Access Journals (Sweden)

    Jennifer L. Murphy, PhD

    2016-02-01

    Full Text Available The improved management of pain among the growing number of female Veterans receiving care through the Veterans Health Administration has been established as a priority, but studies suggest that females may respond differently to pain treatment. This study explored differences between female and male Veterans engaged in a Chronic Pain Rehabilitation Program and determined how female and male Veterans change following participation. Veterans (N = 324 in a 3 wk inpatient program completed self-report measures at admission, discharge, and 3 mo follow-up. Participants were 21% female (n = 67 and 79% male (n = 257. Compared with males, females were younger and less likely to be white or married/partnered. Females reported shorter pain duration and were more likely to have primary head or limb pain. At admission, fewer females were prescribed opioids than males and at lower doses. After opioid cessation in the program, however, there were no significant differences in use between the sexes at follow-up. Improvements in a range of domains were sustained at follow-up for both sexes, but females did not maintain gains in pain intensity or sleep while males reported more pain-related fear at discharge and follow-up. This study adds to the literature on sex-specific variations in chronic pain and implications for treatment.

  2. Central Hyperexcitability in Chronic Musculoskeletal Pain: A Conceptual Breakthrough with Multiple Clinical Implications

    Directory of Open Access Journals (Sweden)

    Jan Lidbeck

    2002-01-01

    Full Text Available Recent investigations of dysfunctional pain processing in the central nervous system have contributed much knowledge about the development of chronic musculoskeletal pain. Many common chronic musculoskeletal pain syndromes - including regional myofascial pain syndromes, whiplash pain syndromes, refractory work-related neck-shoulder pain, certain types of chronic low back pain, fibromyalgia and others - may essentially be explained by abnormalities in central pain modulation. The growing awareness of dysfunctional central pain modulation may be a conceptual breakthrough leading to a better understanding of common chronic pain disorders. A new paradigm will have multiple clinical implications, including re-evaluation of clinical practice routines and rehabilitation methods, and will focus on controversial issues of medicolegal concern. The concept of dysfunctional central pain processing will also necessitate a mechanism-based classification of pain for the selection of individual treatment and rehabilitation programs for subgroups of patients with chronic musculoskeletal pain due to different pathophysiological mechanisms.

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

    OpenAIRE

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

    2008-01-01

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

  4. A brain signature to differentiate acute and chronic pain in rats

    OpenAIRE

    Yifei eGuo; Yuzheng eWang; Yabin eSun; Jin-Yan eWang

    2016-01-01

    The transition from acute pain to chronic pain entails considerable changes of patients at multiple levels of the nervous system and in psychological states. An accurate differentiation between acute and chronic pain is essential in pain management as it may help optimize analgesic treatments according to the pain state of patients. Given that acute and chronic pain could modulate brain states in different ways and that brain states could greatly shape the neural processing of external inputs...

  5. New concepts in acute pain management: strategies to prevent chronic postsurgical pain, opioid-induced hyperalgesia, and outcome measures.

    Science.gov (United States)

    Grosu, Irina; de Kock, Marc

    2011-06-01

    Chronic postsurgical pain (CPSP) is a pain syndrome that has attracted attention for more than 10 years. CPSP is a pain syndrome that develops postoperatively and lasts for at least 2 months in the absence of other causes for pain (eg, recurrence of malignancy, chronic infection, and so forth). Pain continuing from a preexisting disease is not considered as CPSP. In this article, the authors discuss the etiopathogenesis of CPSP and interventions that can help prevent and treat this condition.

  6. Association between catastrophizing and self-rated pain and disability in patients with chronic low back pain

    OpenAIRE

    K. Meyer; Tschopp, A.; Sprott, H; Mannion, A. F.

    2009-01-01

    BACKGROUND: Catastrophizing plays an important role in models of pain chronicity, showing a consistent correlation with both pain intensity and disability. It is conceivable that these associations are mediated or confounded by other psychological attributes. OBJECTIVE: To examine the relative influence of catastrophizing and other psychological variables on pain and disability in patients with chronic low back pain. METHODS: Seventy-eight patients completed the Pain Catastrophizing Scale, Ro...

  7. Patients suffering benign chronic pain becoming acute: ER approach

    Directory of Open Access Journals (Sweden)

    Giovanni Nervetti

    2006-06-01

    Full Text Available Due to prescribing errors, to wrong therapeutic choice, to inadequate patient education, to errors in patients adherence to therapy, to social problems, to well known comorbidity between chronic pain and depression, a high number of patients, affected by chronic pain becoming acute, is in charge of the Emergency Department. But the Emergency Department is often the wrong place where to take care of such a complex condition. We present the results of a study conducted in our Emergency Department with the contribute of the Mental Health Department, concerning the evaluation of the diagnostic and therapeutic iter, the evolution of the symptoms, the customer satisfaction and the depression comorbidity, among the patients afferent to the Emergency Department because of a chronic non malignant pain becoming acute. The results of the study suggest the necessity of a more specific diagnostic and therapeutic approach to these patients, in both Emergency Hospital Department and outpatients settings.

  8. Addictive behaviors related to opioid use for chronic pain

    DEFF Research Database (Denmark)

    Højsted, Jette; Ekholm, Kim Ola Michael; Kurita, Geana Paula;

    2013-01-01

    The growing body of research showing increased opioid use in patients with chronic pain coupled with concerns regarding addiction encouraged the development of this population-based study. The goal of the study was to investigate the co-occurrence of indicators of addictive behaviors in patients...... with chronic non-cancer pain in long-term opioid treatment. The study combined data from the individual-based Danish Health Survey in 2010 and the official Danish health and socio-economic, individual-based registers. From a simple random sample of 25,000 adults (16 years or older) living in Denmark, 13......,281 individuals were analyzed through multiple logistic regression analyses to assess the association between chronic pain (lasting ⩾6 months), opioid use, health behavior, and body mass index. Six potential addictive behaviors were identified: daily smoking; high alcohol intake; illicit drug use in the past year...

  9. Craniosacral Therapy for the Treatment of Chronic Neck Pain

    OpenAIRE

    Haller, Heidemarie; 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)...

  10. Providing holistic care for women with chronic pelvic pain.

    Science.gov (United States)

    Abercrombie, Priscilla D; Learman, Lee A

    2012-01-01

    Chronic pelvic pain (CPP) is one of the most common pain conditions affecting women and can have a significant impact on quality of life. Assessment of women with CPP is best approached in a comprehensive, systematic manner that includes exploration of physiological and psychological causes. A range of treatment options that draw from conventional medicine and complementary and alternative modalities should be offered. The women's health nurse plays a pivotal role in all aspects of care.

  11. The Continuing and Growing Epidemic of Chronic Low Back Pain

    OpenAIRE

    Gatchel, Robert J.

    2015-01-01

    Because of the great prevalence of chronic pain, it is not surprising that there have been a number of influential reports by the Institute of Medicine, National Institutes of Health, and the World Health Organization that have documented the medical, social and economic problems caused by it, and the need for better pain-management programs. The present article briefly reviews these reports, and then focuses on three important areas that need to be considered when addressing the continuing a...

  12. Automatic Recognition of Protective Behaviour in Chronic Pain Rehabilitation

    OpenAIRE

    Aung, M. S. H.; Singh, A.; Lim, S L; CdC Williams, A.; Watson, P.; Bianchi-Berthouze, N.

    2013-01-01

    Exergames are increasingly being proposed for physical rehabilitation in chronic pain. They can be engaging, fun and can facilitate the setting of targets and evaluating performances through body movement tracking and multimodal feedback. While these attributes are important, it is also essential that psychological factors that lead to avoidance of physical activity are addressed in the game design. Anxiety about increased pain and/or of further damage often causes people to behave in a self-...

  13. An Exploratory Study into Objective and Reported Characteristics of Neuropathic Pain in Women with Chronic Pelvic Pain.

    Directory of Open Access Journals (Sweden)

    Lucy H R Whitaker

    Full Text Available Chronic pelvic pain (CPP affects 5.7-26.6% women worldwide. 55% have no obvious pathology and 40% have associated endometriosis. Neuropathic pain (NeP is pain arising as a consequence of a lesion/disease affecting the somatosensory system. The prevalence of NeP in women with CPP is not known. The diagnosis of NeP is challenging because there is no gold-standard assessment. Questionnaires have been used in the clinical setting to diagnose NeP in other chronic pain conditions and quantitative sensory testing (QST has been used in a research setting to identify abnormal sensory function. We aimed to determine if women with chronic pelvic pain (CPP have a neuropathic pain (NeP component to their painful symptoms and how this is best assessed. We performed an exploratory prospective cohort study of 72 pre-menopausal women with a diagnosis of CPP. They underwent a clinician completed questionnaire (DN4 and completed the S-LANSS and PainDETECT™ questionnaires. Additionally QST testing was performed by a clinician. They also completed a patient acceptability questionnaire. Clinical features of NeP were identified by both questionnaires and QST. Of the women who were NeP positive, 56%, 35% and 26% were identified by the S-LANSS, DN4 and PainDETECT™ respectively. When NeP was identified by questionnaire, the associated laparoscopy findings were similar irrespective of which questionnaire was used. No subject had entirely unchanged QST parameters. There were distinct loss and gain subgroups, as well as mixed alteration in function, but this was not necessarily clinically significant in all patients. 80% of patients were confident that questionnaires could diagnose NeP, and 90% found them easy to complete. Early identification of NeP in women with CPP with a simple questionnaire could facilitate targeted therapy with neuromodulators, which are cheap, readily available, and have good safety profiles. This approach could prevent unnecessary or fertility

  14. An Exploratory Study into Objective and Reported Characteristics of Neuropathic Pain in Women with Chronic Pelvic Pain

    Science.gov (United States)

    Whitaker, Lucy H. R.; Reid, Jen; Choa, Alex; McFee, Stuart; Seretny, Marta; Wilson, John; Elton, Rob A.; Vincent, Katy; Horne, Andrew W.

    2016-01-01

    Chronic pelvic pain (CPP) affects 5.7–26.6% women worldwide. 55% have no obvious pathology and 40% have associated endometriosis. Neuropathic pain (NeP) is pain arising as a consequence of a lesion/disease affecting the somatosensory system. The prevalence of NeP in women with CPP is not known. The diagnosis of NeP is challenging because there is no gold-standard assessment. Questionnaires have been used in the clinical setting to diagnose NeP in other chronic pain conditions and quantitative sensory testing (QST) has been used in a research setting to identify abnormal sensory function. We aimed to determine if women with chronic pelvic pain (CPP) have a neuropathic pain (NeP) component to their painful symptoms and how this is best assessed. We performed an exploratory prospective cohort study of 72 pre-menopausal women with a diagnosis of CPP. They underwent a clinician completed questionnaire (DN4) and completed the S-LANSS and PainDETECT™ questionnaires. Additionally QST testing was performed by a clinician. They also completed a patient acceptability questionnaire. Clinical features of NeP were identified by both questionnaires and QST. Of the women who were NeP positive, 56%, 35% and 26% were identified by the S-LANSS, DN4 and PainDETECT™ respectively. When NeP was identified by questionnaire, the associated laparoscopy findings were similar irrespective of which questionnaire was used. No subject had entirely unchanged QST parameters. There were distinct loss and gain subgroups, as well as mixed alteration in function, but this was not necessarily clinically significant in all patients. 80% of patients were confident that questionnaires could diagnose NeP, and 90% found them easy to complete. Early identification of NeP in women with CPP with a simple questionnaire could facilitate targeted therapy with neuromodulators, which are cheap, readily available, and have good safety profiles. This approach could prevent unnecessary or fertility

  15. Acupuncture for Chronic Pain in Japan: A Review

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    Kazunori Itoh

    2007-01-01

    Full Text Available Many Japanese reports of acupuncture and moxibustion for chronic pain are not listed in medical databases such as Medline. Therefore, they are not easily accessible to researchers outside of Japan. To complement existing reviews of acupuncture and moxibustion for chronic pain and to provide more detailed discussion and analysis, we did a literature search using ‘Igaku Chuo Zasshi Wed’ (Japana Centra Revuo Medicina and ‘Citation Information by National Institute of Information’ covering the period 1978–2006. Original articles and case reports of acupuncture and moxibustion treatment of chronic pain were included. Animal studies, surveys, and news articles were excluded. Two independent reviewers extracted data from located articles in a pre-defined structured way, and assessed the likelihood of causality in each case. We located 57 papers written in Japanese (20 full papers, 37 case reports. Conditions examined were headache (12 trials, chronic low back pain (9 trials, rheumatoid arthritis (8 trials, temporomandibular dysfunction (8 trials, katakori (8 trials and others (12 trials. While 23 were described as clinical control trials (CCTs, 11 employed a quasi-random method. Applying the 5-point Jadad quality assessment scoring system, the mean score was 1.5 ± 1.3 (SD. Eleven (52% of the CCTs were conducted to determine a more effective procedure for acupuncture; these compared a certain type of acupuncture with another type of acupuncture or specific additional points. In particular, the trigger point acupuncture was widely used to treat chronic low back pain in Japan. Many reports of chronic pain treatment by acupuncture and moxibustion are listed in Japanese databases. From the data, we conclude that there is limited evidence that acupuncture is more effective than no treatment, and inconclusive evidence that trigger point acupuncture is more effective than placebo, sham acupuncture or standard care.

  16. Psychiatric morbidity, pain perception, and functional status of chronic pain patients in palliative care

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    V Rajmohan

    2013-01-01

    Full Text Available Context: Psychological factors, such as that exist when we experience pain, can profoundly alter the strength of pain perception. Aim: The study aims to estimate the prevalence of psychiatric disorders, and its association with perception of pain and functional status in chronic patients in palliative care. Materials and Methods: The sample was selected via simple randomisation and post consent were assessed using (1 a semi- structured questionnaire to elicit socio-demographic information and medical data (2 Brief Pain Inventory (3 ICD-10 Symptom Checklist (4 ICD-10-Diagnostic Criteria for Research (DCR (5 Montgomery Asberg Depression Rating Scale (MADRS (6 Covi Anxiety Rating Scale (7 Karnofsky Performance Status Scale. Data was analysed using independent sample t test and chi square test. Results: The psychiatric morbidity was 67% with depression and adjustment disorders being the major diagnosis. There was a significant association between psychiatric morbidity pain variables (P = 0.000. Psychiatric morbidity significantly impaired activity, mood, working, walk, sleep, relationship, and enjoyment. There was no association between aetiology of pain, type of cancer, treatment for primary condition and treatment for pain and psychiatric morbidity. The functional status of cancer patients was also poorer in patients with psychiatric morbidity (P = 0.008. Conclusion: There is a high prevalence of psychiatric illness in chronic pain patients of any aetiology. Psychiatric morbidity is associated with increased pain perception, impairment in activity and poor functional status.

  17. Managing chronic pain in survivors of torture

    DEFF Research Database (Denmark)

    Amris, Kirstine; Williams, Amanda C de C

    2015-01-01

    All generalist and specialist clinicians are likely to encounter torture survivors among refugees and asylum seekers. A minority of people survive torture and a smaller minority reach a developed country; those who do tend to be the more resilient and resourceful. They have many health, social...... and welfare problems; persistent pain in the musculoskeletal system is one of the most common. There is little specific evidence on pain in survivors of torture; the guidelines on interdisciplinary specialist management are applicable. Most of the literature on refugee survivors of torture has an exclusive...

  18. Perspectives on physiotherapy guidelines for chronic low back pain

    Directory of Open Access Journals (Sweden)

    P. Berger

    2007-02-01

    Full Text Available The prevalence of chronic low back pain presents a world widedilemma to patients, physiotherapists and clinicians. There is scant evidence for prevention and treatment however it is now acknowledged that the use of  physiotherapy in a multidimensional context has proved the more appropriate model as a vital component of the collaborative approach required for effective pain management. The following article reviews the current literature, evaluates and combines the guidelines that have been proposed from various international studies to provide a practical approach to the management of chronic back pain. This approach recognizes a broad biopsychosocial model of health and the positive role of activity in health and healing with emphasis on function, rather than impairment. Therefore the development of a patient-centred rehabilitative approach has emerged that emphasizes the restoration of normal movement and function with the addition of physical modalities where appropriate. Recent advances in neurophysiology, the modulation of pain and its perception and the fact that biological systems are known to be greatly affected by electrical treatment provide a clearer rationale for the use of physical agents for rehabilitation of patients with pain and relateddisability. The modalities used in conjunction with active exercises include thermal, massage, electrical stimulation, traction, transcutaneous electrical nerve stimulation (Tens, myofascial release, dry needling, mobilization and acupuncture. An algorithm is provided with the intention of developing protocols for breaking the pain cycle in both nociceptive and neuropathic pain states and in reducing inflammation which is a component of both peripheral and central sensitization. Pain rehabilitation is a useful and cost-effective approach to chronic pain management and makes patients’ responsible partners in their own progress. It encourages planning, pacing of activities and activity related

  19. Traumatization and chronic pain: a further model of interaction

    Directory of Open Access Journals (Sweden)

    Egloff N

    2013-11-01

    Full Text Available Niklaus Egloff,1 Anna Hirschi,2 Roland von Känel1 1Department of General Internal Medicine, Division of Psychosomatic Medicine, Inselspital, University Hospital, Bern, Switzerland; 2Outpatient Clinic for Victims of Torture and War, Swiss Red Cross, Bern-Wabern, Switzerland Abstract: Up to 80% of patients with severe posttraumatic stress disorder are suffering from “unexplained” chronic pain. Theories about the links between traumatization and chronic pain have become the subject of increased interest over the last several years. We will give a short summary about the existing interaction models that emphasize particularly psychological and behavioral aspects of this interaction. After a synopsis of the most important psychoneurobiological mechanisms of pain in the context of traumatization, we introduce the hypermnesia–hyperarousal model, which focuses on two psychoneurobiological aspects of the physiology of learning. This hypothesis provides an answer to the hitherto open question about the origin of pain persistence and pain sensitization following a traumatic event and also provides a straightforward explanatory model for educational purposes. Keywords: posttraumatic stress disorder, chronic pain, hypermnesia, hypersensitivity, traumatization

  20. Psychosomatic group treatment helps women with chronic pelvic pain.

    Science.gov (United States)

    Albert, H

    1999-12-01

    This study evaluates group treatment for women suffering from chronic pelvic pain. The concept of group treatment was based on psychosomatic and physio-therapeutical principles and on cognitive and operant behavioral therapy. Each group was composed of up to six women suffering from chronic pelvic pain, and two physiotherapists. Each group treatment session lasted 2.5 h per week for a period of 10 weeks. The women completed questionnaires and pain drawings four times during the treatment period from the beginning of the period till 15 months later. During 13 group treatment periods 53 women accomplished the treatment. Before the treatment the women had experienced pain for an average period of 5 years and 9 months (ranging from 6 months to 22 years). The women's descriptions of the changes derived from group treatment were analyzed according to the Grounded Theory Method. A methodical triangulation of quantitative and qualitative data as well as analyzes of the drawings were applied. One year after the end of the treatment, 39% of the women were pain-free. The average level of pain measured according to the Visual Analog Scale was reduced from 2.8 to 0.9 (p Theory Analysis a model of the development process was elaborated. The process begins with the development of self-knowledge, followed by the woman assuming self responsibility for her own life and performing self-activeness. During the process the woman increases her feeling of self-control and personal mastery of her emotions. The women's pain drawings improved, resulting in more detailed drawings, the color intensity abating, the extent of pains declining, and the outlines blurring. In conclusion this kind of group treatment brings the women relief from their pain thus reducing the use of the National Health Service by women suffering from chronic pelvic pain. The women also experience a positive psychological development. This method of treatment, in which a synergetic combination of physical and

  1. Classification and identification of opioid addiction in chronic pain patients

    DEFF Research Database (Denmark)

    Højsted, Jette; Nielsen, Per Rotbøll; Guldstrand, Sally Kendall;

    2010-01-01

    Addiction is a feared consequence of long-term opioid treatment of chronic pain patients. The ICD-10 and DSM-IV diagnostic addiction criteria may not be appropriate in these patients. Therefore Portenoy's criteria (PC) were launched. The aim was to estimate the prevalence of addiction, to investi......Addiction is a feared consequence of long-term opioid treatment of chronic pain patients. The ICD-10 and DSM-IV diagnostic addiction criteria may not be appropriate in these patients. Therefore Portenoy's criteria (PC) were launched. The aim was to estimate the prevalence of addiction...

  2. Stereoselective pharmacokinetics of methadone in chronic pain patients

    DEFF Research Database (Denmark)

    Kristensen, K; Blemmer, T; Angelo, H R;

    1996-01-01

    Ten patients with chronic pain were randomized to an open, balanced, crossover study. Each patients received two different preparations of racemic methadone, i.e., tablets and intravenous infusion. The pharmacokinetic parameters of the R- and S-enantiomers of the racemate are reported. The analge......Ten patients with chronic pain were randomized to an open, balanced, crossover study. Each patients received two different preparations of racemic methadone, i.e., tablets and intravenous infusion. The pharmacokinetic parameters of the R- and S-enantiomers of the racemate are reported...

  3. Juvenile fibromyalgia in an adolescent patient with sickle cell disease presenting with chronic pain.

    Science.gov (United States)

    Ramprakash, Stalin; Fishman, Daniel

    2015-10-01

    Juvenile fibromyalgia in children with sickle cell disease has not been reported in the literature. We report an adolescent patient with sickle cell whose pain symptoms progressed from having recurrent acute sickle cell pain crisis episodes to a chronic pain syndrome over several years. He was eventually diagnosed with juvenile fibromyalgia based on the clinical history and myofascial tender points and his pain symptoms responded better to multidisciplinary strategies for chronic fibromyalgia pain. Chronic pain in sickle cell disease is an area of poor research, and in addition there is inconsistency in the definition of chronic pain in sickle cell disease. Central sensitisation to pain is shown to occur after recurrent painful stimuli in a genetically vulnerable individual. In a chronic pain condition such as fibromyalgia central sensitisation is thought to play a key role. Fibromyalgia should be considered as one of the main differential diagnosis in any sickle cell patient with chronic pain.

  4. Psychosocial perspectives in the treatment of pediatric chronic pain

    Directory of Open Access Journals (Sweden)

    Carter Bryan D

    2012-06-01

    Full Text Available Abstract 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.

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

    Science.gov (United States)

    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

  6. Emotional Disturbance and Chronic Low Back Pain.

    Science.gov (United States)

    McCreary, Charles P.; And Others

    1980-01-01

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

  7. Easing Chronic Pain: Better Treatments and Medications

    Science.gov (United States)

    ... and relieve stress. Psychological methods These include counseling, hypnosis, and cognitive-behavioral therapy—a treatment that involves a wide variety of coping skills and relaxation methods to help prepare for and cope with pain. Surgery Although not always an option, surgery may ...

  8. Breakthrough pain in opioid-treated chronic non-malignant pain patients referred to a multidisciplinary pain centre: a preliminary study

    DEFF Research Database (Denmark)

    Højsted, J; Nielsen, P R; Eriksen, Jacob Gram;

    2006-01-01

    Breakthrough pain (BTP) has not formerly been discussed as such in chronic non-malignant pain patients referred to pain centres and clinics. The purpose of the study was to investigate the prevalence, characteristics and mechanisms of BTP in opioid-treated chronic non-malignant pain patients refe...... referred to a pain centre and to assess the short-term effects of pain treatment.......Breakthrough pain (BTP) has not formerly been discussed as such in chronic non-malignant pain patients referred to pain centres and clinics. The purpose of the study was to investigate the prevalence, characteristics and mechanisms of BTP in opioid-treated chronic non-malignant pain patients...

  9. Early maladaptive schema factors, chronic pain and depressiveness: a study with 271 chronic pain patients and 331 control participants.

    Science.gov (United States)

    Saariaho, Tom; Saariaho, Anita; Karila, Irma; Joukamaa, Matti

    2012-01-01

    Chronic pain and depression are coexisting entities with high simultaneous prevalence. Both are linked with early adversities. Early maladaptive schemas (EMS) can be seen as a reflection of these adversities. EMSs extensively indicate underlying psychic patterns and provide a good opportunity to detect covert processes and psychic shapes (latent factors), which create the basis of how people rate their schemas. The purpose of this study was to explore these latent, higher order schema factors (SF) and to find out how they are associated with pain intensity or depression in chronic pain patients and a control sample. The study subjects consisted of 271 first-visit pain patients and 331 control participants. Sociodemographic and pain data were gathered by questionnaire; 18 EMSs were measured with the Young Schema Questionnaire (short form) and depressiveness was measured with the Beck Depression Inventory, Version II. Exploratory factor and regression analyses were used. The chronic pain patient group showed two SFs. The first SF showed a shameful, defective, socially isolated, failure, emotionally inhibited, deprived, submissive and resigned pattern. The second SF showed a demanding, approval seeking, self-sacrificing and punitive pattern. SF1 predicted more than half of the depressiveness in the pain patient sample. A three-factor structure was found in the control sample, and SFs 1 and 3 together predicted almost one-third of depressiveness. The pain patient and the control groups had a different, higher order factor structure. We assume that SF1 in the pain patients reflected a rather serious, undefined early psychic trauma and was also associated with their depressiveness. PMID:21210495

  10. Military Chronic Musculoskeletal Pain and Psychiatric Comorbidity: Is Better Pain Management the Answer?

    Science.gov (United States)

    McGeary, Cindy A; McGeary, Donald D; Moreno, Jose; Gatchel, Robert J

    2016-01-01

    Chronic musculoskeletal pain, such as low back pain, often appears in the presence of psychiatric comorbidities (e.g., depression, posttraumatic stress disorder (PTSD)), especially among U.S. military service members serving in the post-9/11 combat era. Although there has been much speculation about how to best address pain/trauma psychiatric symptom comorbidities, there are little available data to guide practice. The present study sought to examine how pre-treatment depression and PTSD influence outcomes in a functional restoration pain management program using secondary analysis of data from the Department of Defense-funded Functional and Orthopedic Rehabilitation Treatment (FORT) trial. Twenty-eight FORT completers were analyzed using a general linear model exploring how well depression and PTSD symptoms predict post-treatment pain (Visual Analog Scale (VAS) pain rating), disability (Oswestry Disability Index; Million Visual Analog Scale), and functional capacity (Floor-to-Waist and Waist-to-Eye Level progressive isoinertial lifting evaluation scores) in a sample of active duty military members with chronic musculoskeletal pain and comorbid depression or PTSD symptoms. Analysis revealed that pre-treatment depression and PTSD symptoms did not significantly predict rehabilitation outcomes from program completers. Implications of these findings for future research on trauma-related pain comorbidities are discussed. PMID:27417626

  11. Military Chronic Musculoskeletal Pain and Psychiatric Comorbidity: Is Better Pain Management the Answer?

    Directory of Open Access Journals (Sweden)

    Cindy A. McGeary

    2016-06-01

    Full Text Available Chronic musculoskeletal pain, such as low back pain, often appears in the presence of psychiatric comorbidities (e.g., depression, posttraumatic stress disorder (PTSD, especially among U.S. military service members serving in the post-9/11 combat era. Although there has been much speculation about how to best address pain/trauma psychiatric symptom comorbidities, there are little available data to guide practice. The present study sought to examine how pre-treatment depression and PTSD influence outcomes in a functional restoration pain management program using secondary analysis of data from the Department of Defense-funded Functional and Orthopedic Rehabilitation Treatment (FORT trial. Twenty-eight FORT completers were analyzed using a general linear model exploring how well depression and PTSD symptoms predict post-treatment pain (Visual Analog Scale (VAS pain rating, disability (Oswestry Disability Index; Million Visual Analog Scale, and functional capacity (Floor-to-Waist and Waist-to-Eye Level progressive isoinertial lifting evaluation scores in a sample of active duty military members with chronic musculoskeletal pain and comorbid depression or PTSD symptoms. Analysis revealed that pre-treatment depression and PTSD symptoms did not significantly predict rehabilitation outcomes from program completers. Implications of these findings for future research on trauma-related pain comorbidities are discussed.

  12. Does anterior trunk pain predict a different course of recovery in chronic low back pain?

    Science.gov (United States)

    Panagopoulos, John; Hancock, Mark J; Kongsted, Alice; Hush, Julia; Kent, Peter

    2014-05-01

    Patient characteristics associated with the course and severity of low back pain (LBP) and disability have been the focus of extensive research, however, known characteristics do not explain much of the variance in outcomes. The relationship between anterior trunk pain (ATP) and LBP has not been explored, though mechanisms for visceral referred pain have been described. Study objectives were: (1) determine prevalence of ATP in chronic LBP patients, (2) determine whether ATP is associated with increased pain and disability in these patients, and (3) evaluate whether ATP predicts the course of pain and disability in these patients. In this study, spinal outpatient department patients mapped the distribution of their pain and patients describing pain in their chest, abdomen or groin were classified with ATP. Generalized estimating equations were performed to investigate the relationship between ATP and LBP outcomes. A total of 2974 patients were included and 19.6% of patients reported ATP. At all time points, there were significant differences in absolute pain intensity and disability in those with ATP compared with those without. The presence of ATP did not affect the clinical course of LBP outcomes. The results of this study suggest that patients who present with LBP and ATP have higher pain and disability levels than patients with localised LBP. Visceral referred pain mechanisms may help to explain some of this difference.

  13. Does anterior trunk pain predict a different course of recovery in chronic low back pain?

    Science.gov (United States)

    Panagopoulos, John; Hancock, Mark J; Kongsted, Alice; Hush, Julia; Kent, Peter

    2014-05-01

    Patient characteristics associated with the course and severity of low back pain (LBP) and disability have been the focus of extensive research, however, known characteristics do not explain much of the variance in outcomes. The relationship between anterior trunk pain (ATP) and LBP has not been explored, though mechanisms for visceral referred pain have been described. Study objectives were: (1) determine prevalence of ATP in chronic LBP patients, (2) determine whether ATP is associated with increased pain and disability in these patients, and (3) evaluate whether ATP predicts the course of pain and disability in these patients. In this study, spinal outpatient department patients mapped the distribution of their pain and patients describing pain in their chest, abdomen or groin were classified with ATP. Generalized estimating equations were performed to investigate the relationship between ATP and LBP outcomes. A total of 2974 patients were included and 19.6% of patients reported ATP. At all time points, there were significant differences in absolute pain intensity and disability in those with ATP compared with those without. The presence of ATP did not affect the clinical course of LBP outcomes. The results of this study suggest that patients who present with LBP and ATP have higher pain and disability levels than patients with localised LBP. Visceral referred pain mechanisms may help to explain some of this difference. PMID:24502844

  14. Nordic walking and chronic low back pain

    DEFF Research Database (Denmark)

    Morsø, Lars; Hartvigsen, Jan; Puggaard, Lis;

    2006-01-01

    activity provide similar benefits. Nordic Walking is a popular and fast growing type of exercise in Northern Europe. Initial studies have demonstrated that persons performing Nordic Walking are able to exercise longer and harder compared to normal walking thereby increasing their cardiovascular metabolism......Low Back Pain is a major public health problem all over the western world. Active approaches including exercise in the treatment of low back pain results in better outcomes for patients, but it is not known exactly which types of back exercises are most beneficial or whether general physical...... when compared to unsupervised Nordic Walking and advice to stay active. In addition we investigate whether there is an increase in the cardiovascular metabolism in persons performing supervised Nordic Walking compared to persons who are advised to stay active. Finally, we investigate whether...

  15. Introducing Acceptance and Commitment Therapy to a physiotherapy-led pain rehabilitation programme: an Action Research study

    Science.gov (United States)

    Barker, Karen L; Heelas, Leila; Toye, Francine

    2015-01-01

    Background: Recent developments in pain rehabilitation emphasise the importance of promoting psychological flexibility. Acceptance and Commitment Therapy (ACT) is one approach that has been shown to be effective for the treatment of chronic musculoskeletal pain. However, studies have shown that introducing innovative approaches such as ACT into established health care can cause some anxiety for professional groups. We used Action Research to evaluate the implementation of ACT to a physiotherapy-led pain rehabilitation programme. Methods: All staff in the pain service were invited to participate. Participants took part in focus groups, engaged in reflective sessions/meetings and completed reflective diaries. The analysis was undertaken by an experienced qualitative researcher using constant comparison. Participants reviewed emerging themes and validated the findings. Results: Four key themes emerged from the study: (a) the need to see pain as an embodied, rather than dualistic, experience; (b) the need for a more therapeutic construction of ‘acceptance’; (c) value-based goals as profound motivation for positive change; and (d) it’s quite a long way from physiotherapy. Integral to a therapeutic definition of acceptance was the challenge of moving away from ‘fixing’ towards ‘sitting with’. Participants described this as uncomfortable because it did not fit their biomedical training. Conclusion: This article describes how Action Research methodology was used in the introduction of ACT to a physiotherapy-led pain rehabilitation programme. The innovation of this study is that it helps us to understand the potential barriers and facilitators to embedding an ACT philosophy within a physiotherapy setting. PMID:27551408

  16. Orofacial pain, jaw function, and temporomandibular disorders in adult women with a history of juvenile chronic arthritis or persistent juvenile chronic arthritis

    DEFF Research Database (Denmark)

    Bakke, M.; Zak, M.; Jensen, B.L.;

    2001-01-01

    Orofacial pain, jaw function, temporomandibular disorders, adult women persistent juvenil chronic arthritis......Orofacial pain, jaw function, temporomandibular disorders, adult women persistent juvenil chronic arthritis...

  17. Carbamazepine Withdrawal-induced Hyperalgesia in Chronic Neuropathic Pain.

    Science.gov (United States)

    Ren, Zhenyu; Yang, Bing; Yang, Bin; Shi, Le; Sun, Qing-Li; Sun, A-Ping; Lu, Lin; Liu, Xiaoguang; Zhao, Rongsheng; Zhai, Suodi

    2015-11-01

    Combined pharmacological treatments are the most used approach for neuropathic pain. Carbamazepine, an antiepileptic agent, is generally used as a third-line treatment for neuropathic pain and can be considered an option only when patients have not responded to the first- and second-line medications. In the case presented herein, a patient with neuropathic pain was treated using a combined pharmacological regimen. The patient's pain deteriorated, despite increasing the doses of opioids, when carbamazepine was discontinued, potentially because carbamazepine withdrawal disrupted the balance that was achieved by the multifaceted pharmacological regimen, thus inducing hyperalgesia. Interestingly, when carbamazepine was prescribed again, the patient's pain was successfully managed. Animal research has reported that carbamazepine can potentiate the analgesic effectiveness of morphine in rodent models of neuropathic pain and postoperative pain. This clinical case demonstrates that carbamazepine may have a synergistic effect on the analgesic effectiveness of morphine and may inhibit or postpone opioid-induced hyperalgesia. We postulate that a probable mechanism of action of carbamazepine may involve -aminobutyric acid-ergic potentiation and the interruption of glutamatergic function via N-methyl-D-aspartate receptors. Further research is warranted to clarify the analgesic action of carbamazepine and its potential use for the prevention of opioid-induced hyperalgesia in chronic neuropathic pain patients.

  18. Systematic Review of Multidisciplinary Chronic Pain Treatment Facilities.

    Science.gov (United States)

    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

  19. The Need for Knowledge Translation in Chronic Pain

    Directory of Open Access Journals (Sweden)

    James L Henry

    2008-01-01

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

  20. Fibromyalgia, chronic fatigue syndrome, and myofascial pain syndrome.

    Science.gov (United States)

    Buskila, D

    2001-03-01

    The prevalence of chronic widespread pain in the general population in Israel was comparable with reports from the USA, UK, and Canada. Comorbidity with fibromyalgia (FM) resulted in somatic hyperalgesia in patients with irritable bowel syndrome. One sixth of the subjects with chronic widespread pain in the general population were also found to have a mental disorder. Mechanisms involved in referred pain, temporal summation, muscle hyperalgesia, and muscle pain at rest were attenuated by the N-methyl-D-aspartate (NMDA) antagonist, ketamine, in FM patients. Delayed corticotropin release, after interleukin-6 administration, in FM was shown to be consistent with a defect in hypothalamic corticotropin-releasing hormone neural function. The basal autonomic state of FM patients was characterized by increased sympathetic and decreased parasympathetic systems tones. The severity of functional impairment as assessed by the Medical Outcome Survey Short Form (SF-36) discriminated between patients with widespread pain alone and FM patients. Chronic fatigue syndrome (CFS) occurred in about 0.42% of a random community-based sample of 28,673 adults in Chicago, Illinois. A significant clinical overlap between CFS and FM was reported. Cytokine dysregulation was not found to be a singular or dominant factor in the pathogenesis of CFS. A favorable outcome of CFS in children was reported; two thirds recovered and resumed normal activities. No major therapeutic trials in FM and CFS were reported over the past year.

  1. Classification and identification of opioid addiction in chronic pain patients

    DEFF Research Database (Denmark)

    Højsted, Jette; Nielsen, Per Rotbøll; Guldstrand, Sally Kendall;

    2010-01-01

    Addiction is a feared consequence of long-term opioid treatment of chronic pain patients. The ICD-10 and DSM-IV diagnostic addiction criteria may not be appropriate in these patients. Therefore Portenoy's criteria (PC) were launched. The aim was to estimate the prevalence of addiction, to investi......Addiction is a feared consequence of long-term opioid treatment of chronic pain patients. The ICD-10 and DSM-IV diagnostic addiction criteria may not be appropriate in these patients. Therefore Portenoy's criteria (PC) were launched. The aim was to estimate the prevalence of addiction......, to investigate whether PC were applicable and to compare these criteria with the ICD-10 criteria. The study was cross-sectional and included 253 patients with chronic pain at a tertiary pain centre. Patients were screened for addiction by a physician and a nurse. The addiction prevalence was 14.4% according...... treated pain patients and seems to be more sensitive and specific than ICD-10 criteria....

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

    Directory of Open Access Journals (Sweden)

    John Jarrell

    2011-01-01

    Full Text Available Objectives. This study was done to evaluate three bedside tests in discriminating visceral pain from somatic pain among women with chronic pelvic pain. Study Design. The study was an exploratory cross-sectional evaluation of 81 women with chronic pelvic pain of 6 or more months' duration. Tests included abdominal cutaneous allodynia (aCA, perineal cutaneous allodynia (pCA, abdominal and perineal myofascial trigger points (aMFTP and (pMFTP, and reduced pain thresholds (RPTs. Results. Eighty-one women were recruited, and all women provided informed consent. There were 62 women with apparent visceral pain and 19 with apparent somatic sources of pain. The positive predictive values for pelvic visceral disease were aCA-93%, pCA-91%, aMFTP-93%, pMFTP-81%, and RPT-79%. The likelihood ratio (+ and 95% C.I. for the detection of visceral sources of pain were aCA-4.19 (1.46, 12.0, pCA-2.91 (1.19, 7.11, aMTRP-4.19 (1.46, 12.0, pMFTP-1.35 (0.86, 2.13, and RPT-1.14 (0.85, 1.52, respectively. Conclusions. Tests of cutaneous allodynia, myofascial trigger points, and reduced pain thresholds are easily applied and well tolerated. The tests for cutaneous allodynia appear to have the greatest likelihood of identifying a visceral source of pain compared to somatic sources of pain.

  3. A comparison of coping strategies in patients with fibromyalgia, chronic neuropathic pain, and pain-free controls

    DEFF Research Database (Denmark)

    Baastrup, Sidsel; Schultz, Rikke; Moore, Rod;

    2016-01-01

    different groups of chronic pain patients and a group of healthy controls. Thirty neuropathic pain (NP) patients, 28 fibromyalgia (FM) patients, and 26 pain-free healthy controls completed the Coping Strategy Questionnaire (CSQ-48/27) and rated their daily pain. The results showed that FM and NP patients...

  4. Calcifying supracoracoid bursitis as a cause of chronic shoulder pain.

    OpenAIRE

    Mens, J; van der Korst, J K

    1984-01-01

    A case of chronic shoulder pain is reported with marked limitation of both active and passive elevations and a normal range of motion of the glenohumeral joint. X-ray examination demonstrated cloudy calcification in the coracoclavicular region, presumably indicating calcifying supracoracoid bursitis.

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

    Science.gov (United States)

    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…

  6. Role of diagnostic laparoscopy in chronic pelvic pain

    Directory of Open Access Journals (Sweden)

    Pushpa Bhatia

    2016-04-01

    Conclusions: Laparoscopy is a gold standard tool in evaluation of women with chronic pelvic pain, because diagnosis and often treatment can be accomplished in one sitting, without subjecting them to exploratory laparotomy. [Int J Reprod Contracept Obstet Gynecol 2016; 5(4.000: 1152-1157

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

    Science.gov (United States)

    Boiron, Clare

    2014-10-01

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

  8. Chronic widespread pain : clinical comorbidities and psychological correlates

    NARCIS (Netherlands)

    Burri, Andrea; Ogata, Soshiro; Vehof, Jelle; Williams, Frances

    2015-01-01

    Recent studies have provided consistent evidence for a genetic influence on chronic widespread pain (CWP). The aim of this study was to investigate (1) the etiological structure underlying CWP by examining the covariation between CWP and psychological comorbidities and psychoaffective correlates and

  9. Coping Constructs Related to College Students with Chronic Pain

    Science.gov (United States)

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

    2011-01-01

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

  10. Mexiletine for treatment of chronic painful diabetic neuropathy

    DEFF Research Database (Denmark)

    Dejgard, A; Kastrup, J; Petersen, P

    1988-01-01

    Sixteen of nineteen patients completed a randomised double-blind crossover trial to assess the effect of oral mexiletine (10 mg/kg bodyweight daily) on the symptoms and signs of chronic painful diabetic neuropathy. The median age of the sixteen patients was 50 years (range 30-64). Assessment...

  11. Chronic Pain and PTSD: A Guide for Patients

    Science.gov (United States)

    ... PTSD Basics Return from War Specific to Women Types of Trauma War Terrorism Violence and Abuse Disasters Is it PTSD? Treatment and Coping Treatment ... even worse. Survivors of physical, psychological, or sexual abuse tend to be ... developing certain types of chronic pain later in their lives. Date ...

  12. Is chronic groin pain a Bermuda triangle of sports medicine?

    Science.gov (United States)

    Šebečić, Božidar; Japjec, Mladen; Janković, Saša; Vencel Čuljak; Dojčinović, Bojan; Starešinić, Mario

    2014-12-01

    Chronic groin pain is one the most complex conditions encountered in the field of sports medicine. Conservative treatment is long lasting and the result of treatment is often uncer- tain and symptom recurrences are common, which can be very frustrating for both the patient and the physician. The complex etiology and uncertainties during treatment of chronic groin pain is the reason why some authors call it the Bermuda Triangle of sports medicine. In our prospective, 7-year study, 114 athletes with chronic groin pain resistant to conservative therapy were treated surgically. In 109 athletes with sports hernia, we performed nerve neurolysis along with resection of the genital branch of the genitofemoral nerve and we also reinforced the posterior wall of inguinal canal using a modified Shouldice technique. In 26 athletes that had concomitant adductor tendinosis and in 5 athletes with isolated tendinosis we performed tenotomy. Eighty-one of 83 patients with isolated sports hernia returned to sports within a mean of 4.4 (range, 3-16) weeks. Thirty-one athletes with adductor tenotomy returned to sports activity within a mean of 11.8 (range, 10-15) weeks. If carefully diagnosed using detailed history taking, physical examination and correct imaging techniques, chronic groin pain can be treated very successfully and quickly, so it need not be a Bermuda Triangle of sports medicine. PMID:25868316

  13. PRACTICAL CHRONIC PAIN ASSESSMENT TOOLS IN CLINICAL PRACTICE.

    Science.gov (United States)

    Loncarić-Katušin, Mirjana; Milošević, Milan; Žilić, Antonio; Mišković, Petar; Majerić-Kogler, Višnja; Žunić, Josip

    2016-03-01

    The aim of the study was to show the role of tools in the evaluation of chronic pain (CP) in general practitioner (GP) everyday clinical practice. The study was done by analyzing electronic database of the first visits of 1090 CP patients referred to the Pain Clinic of the Karlovac General Hospital, Karlovac, Croatia, by their GPs. All patient records were analyzed according to the cause of CP, strongest pain a week before the examination, quality of sleep, and the Patients' Global Impression of Change scale. All statistical analyses were done using the IBM SPSS Statistics version 19.0.0.1 (www.spss.com). CP predominantly occurs in older age group. Patients with musculoskeletal pain accounted for the highest percentage (n = 316; 29%), followed by those with neuropathic pain (n = 253; 23.20%) and those with low back pain (n = 225; 20.60%). The mean pain intensity rating scale score was 8.3 ± 1.8 a week before the examination and the mean quality of sleep score was 6.8 ± 1.9. Moderate and severe sleep quality disorder was significantly present in patients over 65 years of age (p = 0.007), patients with musculoskeletal and neuropathic pain, back pain, and those having rated Patients' Global Impression of Change scale as worsening (p = 0.001). The severity of pain and poor quality of sleep are the leading causes of deterioration of the Patients' Global Impression of Change scale in patients suffering from musculoskeletal and neuropathic pain. In order to treat CP comprehensively, it is important for GPs to evaluate the outcomes of clinical treatment using tools for CP assessment. PMID:27276768

  14. Associations between biopsychosocial factors and chronic upper limb pain among slaughterhouse workers

    DEFF Research Database (Denmark)

    Sundstrup, Emil; Jakobsen, Markus D; Brandt, Mikkel;

    2016-01-01

    BACKGROUND: Knowledge of factors associated with chronic pain is necessary for preventive strategies. The present study investigates biopsychosocial differences, with specific focus on rate of force development (RFD) and work ability, between workers with and without chronic upper limb pain...

  15. [Working women with chronic musculoskeletal pain: a case series].

    Science.gov (United States)

    Ordóñez-Hernández, Cecilia Andrea; Contreras-Estrada, Mónica Isabel; Soltero-Avelar, Ruben

    2015-10-01

    This study aimed to analyze the experience of working women suffering from chronic musculoskeletal pain, using a qualitative design with a phenomenological approach. The technique drew on in-depth interviews with five working women that presented to the orthopedics and neurosurgery departments of a hospital in Guadalajara, Mexico, with a complaint of musculoskeletal pain for more than six months. The study showed that the women felt rejection, segregation, discrimination, lack of support at the workplace, and feelings of frustration and powerlessness related to their health condition. The women also perceived as a barrier the lack of efficiency in disability proceedings and job reintegration or relocation. Financial and family responsibilities were their main reason for continuing to work despite their chronic musculoskeletal pain. PMID:26735388

  16. The Psychological Inflexibility in Pain Scale (PIPS) Exploration of Psychometric Properties in a Heterogeneous Chronic Pain Sample

    NARCIS (Netherlands)

    Trompetter, Hester R.; Bohlmeijer, Ernst T.; van Baalen, Bianca; Kleen, Marco; Koke, Albere; Reneman, Michiel; Schreurs, Karlein M. G.

    2014-01-01

    Psychological flexibility receives increasing attention as the overarching process in Acceptance and Commitment Therapy (ACT). This study investigates the psychometric properties of the Psychological Inflexibility in Pain Scale (PIPS), measuring "avoidance" and "cognitive fusion" with pain, in a het

  17. Reliability of the Multidimensional Pain Inventory and stability of the MPI classification system in chronic back pain

    NARCIS (Netherlands)

    Verra, M.L.; Angst, F.; Staal, J.B.; Brioschi, R.; Lehmann, S.; Aeschlimann, A.; Bie, R.A. de

    2012-01-01

    ABSTRACT: BACKGROUND: This cross validation study examined the reliability of the Multidimensional Pain Inventory (MPI) and the stability of the Multidimensional Pain Inventory Classification System of the empirically derived subgroup classification obtained by cluster analysis in chronic musculoske

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

    Institute of Scientific and Technical Information of China (English)

    Giuseppe Chiarioni; Corrado Asteria; William E Whitehead

    2011-01-01

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

  19. Insomnia Co-Occurring with Chronic Pain: Clinical Features, Interaction, Assessments and Possible Interventions

    OpenAIRE

    Tang, Nicole K. Y.

    2008-01-01

    Insomnia is a major source of distress to people with chronic pain; many of whom presenting for treatment want tangible help with sleep.Compared to chronic pain patients who do not have trouble sleeping, those who do, report more severe pain, longer pain duration, greater levels of anxiety, depression and health anxiety, and worse impairment in physical and psychosocial functioning.Sleep disturbance experienced by patients with chronic pain can be characterised by longer sleep onset, more fre...

  20. Unlocking pain: deep brain stimulation might be the key to easing depression and chronic pain.

    Science.gov (United States)

    Gosset, Nathalie; Dietz, Nicholas

    2015-01-01

    Depression and chronic pain know no geographical boundaries. About 350 million people around the world experience long-lasting sadness and an unshakeable sense of hopelessness, and one person out of ten tries to live each day to its fullest despite continuous physical pain. These two difficult conditions frequently coexist, becoming more common with age. Looking ahead, we can expect the incidence of depression and chronic illness to grow, since more people over age 65 will populate the world by 2020 than children younger than five. PMID:25782107

  1. Effective physical treatment for chronic low back pain.

    Science.gov (United States)

    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

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

    Science.gov (United States)

    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

  3. International guidelines for prevention and management of post-operative chronic pain following inguinal hernia surgery

    DEFF Research Database (Denmark)

    Alfieri, S; Amid, P K; Campanelli, G;

    2011-01-01

    To provide uniform terminology and definition of post-herniorrhaphy groin chronic pain. To give guidelines to the scientific community concerning the prevention and the treatment of chronic groin and testicular pain.......To provide uniform terminology and definition of post-herniorrhaphy groin chronic pain. To give guidelines to the scientific community concerning the prevention and the treatment of chronic groin and testicular pain....

  4. Regular physical activity prevents development of chronic pain and activation of central neurons

    OpenAIRE

    Sluka, Kathleen A; O'Donnell, James M.; DANIELSON, JESSICA; Rasmussen, Lynn A.

    2012-01-01

    Chronic musculoskeletal pain is a significant health problem and is associated with increases in pain during acute physical activity. Regular physical activity is protective against many chronic diseases; however, it is unknown if it plays a role in development of chronic pain. The current study induced physical activity by placing running wheels in home cages of mice for 5 days or 8 wk and compared these to sedentary mice without running wheels in their home cages. Chronic muscle pain was in...

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

    Science.gov (United States)

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

    2014-01-01

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

  6. The Prevalence of Fibromyalgia in Other Chronic Pain Conditions

    Directory of Open Access Journals (Sweden)

    Muhammad B. Yunus

    2012-01-01

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

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

    Science.gov (United States)

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

    2011-01-01

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

  8. Characteristics of highly impaired children with severe chronic pain: a 5-year retrospective study on 2249 pediatric pain patients

    Directory of Open Access Journals (Sweden)

    Zernikow Boris

    2012-05-01

    Full Text Available Abstract Background Prevalence of pain as a recurrent symptom in children is known to be high, but little is known about children with high impairment from chronic pain seeking specialized treatment. The purpose of this study was the precise description of children with high impairment from chronic pain referred to the German Paediatric Pain Centre over a 5-year period. Methods Demographic variables, pain characteristics and psychometric measures were assessed at the first evaluation. Subgroup analysis for sex, age and pain location was conducted and multivariate logistic regression applied to identify parameters associated with extremely high impairment. Results The retrospective study consisted of 2249 children assessed at the first evaluation. Tension type headache (48%, migraine (43% and functional abdominal pain (11% were the most common diagnoses with a high rate of co-occurrence; 18% had some form of musculoskeletal pain disease. Irrespective of pain location, chronic pain disorder with somatic and psychological factors was diagnosed frequently (43%. 55% of the children suffered from more than one distinct pain diagnosis. Clinically significant depression and general anxiety scores were expressed by 24% and 19% of the patients, respectively. Girls over the age of 13 were more likely to seek tertiary treatment compared to boys. Nearly half of children suffered from daily or constant pain with a mean pain value of 6/10. Extremely high pain-related impairment, operationalized as a comprehensive measure of pain duration, frequency, intensity, pain-related school absence and disability, was associated with older age, multiple locations of pain, increased depression and prior hospital stays. 43% of the children taking analgesics had no indication for pharmacological treatment. Conclusion Children with chronic pain are a diagnostic and therapeutic challenge as they often have two or more different pain diagnoses, are prone to misuse of

  9. Clinical pharmacy in a multidisciplinar team for chronic pain in adults.

    Science.gov (United States)

    Bauters, T G M; Devulder, J; Robays, H

    2008-01-01

    The aim of this study was to evaluate the role and the impact of a clinical pharmacist as a member of a multidisciplinary pain team. Although physicians have a good knowledge of pharmacotherapy in the field of pain medication, pharmacy interventions were necessary to enhance the quality of prescribing. On a population of 93 patients, a total of 120 interventions were recorded. The different types of interventions included: provision of information (10.0%), clinical intervention (89.2%) and the provision of a specific product (0.8%). Out of the 107 clinical interventions, a total of 95.3 % interventions were accepted by the physicians. The results highlight the clinical importance of the pharmacy in optimizing drug therapy for adult patients with chronic pain. PMID:19048702

  10. Psychosocial factors and their role in chronic pain: A brief review of development and current status

    Directory of Open Access Journals (Sweden)

    Innes Stanley I

    2005-04-01

    Full Text Available Abstract The belief that pain is a direct result of tissue damage has dominated medical thinking since the mid 20th Century. Several schools of psychological thought proffered linear causal models to explain non-physical pain observations such as phantom limb pain and the effects of placebo interventions. Psychological research has focused on identifying those people with acute pain who are at risk of transitioning into chronic and disabling pain, in the hope of producing better outcomes. Several multicausal Cognitive Behavioural models dominate the research landscape in this area. They are gaining wider acceptance and some aspects are being integrated and implemented into a number of health care systems. The most notable of these is the concept of Yellow Flags. The research to validate the veracity of such programs has not yet been established. In this paper I seek to briefly summarize the development of psychological thought, both past and present, then review current cognitive-behavioural models and the available supporting evidence. I conclude by discussing these factors and identifying those that have been shown to be reliable predictors of chronicity and those that may hold promise for the future.

  11. Behavioral and Cognitive-Behavioral Approaches to Chronic Pain: Recent Advances and Future Directions.

    Science.gov (United States)

    Keefe, Francis J.; And Others

    1992-01-01

    Reviews and highlights recent research advances and future research directions concerned with behavioral and cognitive-behavioral approaches to chronic pain. Reviews assessment research on studies of social context of pain, relationship of chronic pain to depression, cognitive variables affecting pain, and comprehensive assessment measures.…

  12. A Triage Approach to Managing a Two Year Wait-List in a Chronic Pain Program

    Directory of Open Access Journals (Sweden)

    Alexander J Clark

    2005-01-01

    Full Text Available OBJECTIVE: Individuals with chronic pain referred to specialist chronic pain management programs frequently wait months to years for assessment and care. In the authors' pain management program, approximately 600 patients are on the waiting list. An innovative recommendation program to encourage and educate referring physicians to continue active care of pain during this waiting period was developed.

  13. Health care costs, work productivity and activity impairment in non-malignant chronic pain patients

    DEFF Research Database (Denmark)

    Kronborg, Christian; Handberg, Gitte; Axelsen, Flemming

    2009-01-01

    This study explores the costs of non-malignant chronic pain in patients awaiting treatment in a multidisciplinary pain clinic in a hospital setting. Health care costs due to chronic pain are particular high during the first year after pain onset, and remain high compared with health care costs...

  14. Religious and Spiritual Beliefs and Practices of Persons with Chronic Pain

    Science.gov (United States)

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

    2007-01-01

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

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

    Science.gov (United States)

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

    2010-01-01

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

  16. Research design considerations for chronic pain prevention clinical trials: IMMPACT recommendations.

    Science.gov (United States)

    Gewandter, Jennifer S; Dworkin, Robert H; Turk, Dennis C; Farrar, John T; Fillingim, Roger B; Gilron, Ian; Markman, John D; Oaklander, Anne Louise; Polydefkis, Michael J; Raja, Srinivasa N; Robinson, James P; Woolf, Clifford J; Ziegler, Dan; Ashburn, Michael A; Burke, Laurie B; Cowan, Penney; George, Steven Z; Goli, Veeraindar; Graff, Ole X; Iyengar, Smriti; Jay, Gary W; Katz, Joel; Kehlet, Henrik; Kitt, Rachel A; Kopecky, Ernest A; Malamut, Richard; McDermott, Michael P; Palmer, Pamela; Rappaport, Bob A; Rauschkolb, Christine; Steigerwald, Ilona; Tobias, Jeffrey; Walco, Gary A

    2015-07-01

    Although certain risk factors can identify individuals who are most likely to develop chronic pain, few interventions to prevent chronic pain have been identified. To facilitate the identification of preventive interventions, an IMMPACT meeting was convened to discuss research design considerations for clinical trials investigating the prevention of chronic pain. We present general design considerations for prevention trials in populations that are at relatively high risk for developing chronic pain. Specific design considerations included subject identification, timing and duration of treatment, outcomes, timing of assessment, and adjusting for risk factors in the analyses. We provide a detailed examination of 4 models of chronic pain prevention (ie, chronic postsurgical pain, postherpetic neuralgia, chronic low back pain, and painful chemotherapy-induced peripheral neuropathy). The issues discussed can, in many instances, be extrapolated to other chronic pain conditions. These examples were selected because they are representative models of primary and secondary prevention, reflect persistent pain resulting from multiple insults (ie, surgery, viral infection, injury, and toxic or noxious element exposure), and are chronically painful conditions that are treated with a range of interventions. Improvements in the design of chronic pain prevention trials could improve assay sensitivity and thus accelerate the identification of efficacious interventions. Such interventions would have the potential to reduce the prevalence of chronic pain in the population. Additionally, standardization of outcomes in prevention clinical trials will facilitate meta-analyses and systematic reviews and improve detection of preventive strategies emerging from clinical trials.

  17. The Sensitization Model to Explain How Chronic Pain Exists Without Tissue Damage

    NARCIS (Netherlands)

    van Wilgen, C. Paul; Keizer, Doeke

    2012-01-01

    The interaction of nurses with chronic pain patients is often difficult. One of the reasons is that chronic pain is difficult to explain, because no obvious anatomic defect or tissue damage is present. There is now enough evidence available indicating that chronic pain syndromes such as low back pai

  18. Health care experiences and preferences of Dutch chronic pain patients: a call for coordination and continuity.

    NARCIS (Netherlands)

    Krol, M.; Boer, D. de; Plass, A.M.C.; Rademakers, J.

    2013-01-01

    Background: In Europe, about one in five adults suffer from chronic pain, a third of whom suffer from severe chronic pain. Although lower than the European average, in The Netherlands, chronic pain prevalence is still estimated at 15% of the population. Nevertheless, relatively little is known about

  19. Early signaling, referral, and treatment of adolescent chronic pain: A study protocol

    NARCIS (Netherlands)

    J.S. Voerman (Jane); S.C. Remerie (Sylvia); L.E. de Graaf (Esther); P.M. van de Looij-Jansen (Petra); T. Westendorp (Tessa); I. van Elderen (Ina); F. de Waart (Frouwkje); J. Passchier (Jan); A. Dommisse-Van Berkel (Anke); C. de Klerk (Cora)

    2012-01-01

    textabstractBackground: Chronic pain is prevalent among young people and negatively influences their quality of life. Furthermore, chronic pain in adolescence may persist into adulthood. Therefore, it is important early on to promote the self-management skills of adolescents with chronic pain by imp

  20. Can a back pain screening tool help classify patients with acute pain into risk levels for chronic pain?

    Science.gov (United States)

    Mehling, W.E.; Avins, A.L.; Acree, M.C.; Carey, T.S.; Hecht, F.M.

    2016-01-01

    Background The 9-item STarT-Back screening tool was developed in primary care patients with low back pain (LBP) to identify those at greatest risk for chronic pain and requiring targeted treatment. We conducted a secondary data analysis study to examine the performance of comparable questionnaire items in a sample of primary care patients with well-defined acute LBP. Methods In a prospective cohort study, 605 primary care patients with LBP of less than 30 days answered a questionnaire with 6 items identical and 3 items analogous to the 9-item STarT-Back. Participants were followed up at 6 months and 2 years. STarT-Back rules were applied to classify participant's risk of chronic LBP, and the performance of the screening items in predicting outcomes was assessed using likelihood ratios. Results The proportion of patients with chronic pain at follow-up was considerably lower (6 months: 22%; 2 years: 25%) than in the STarT-Back validation cohort (40%) of patients with pain of any duration. The probability of developing chronic pain given a high-risk designation by items similar to the STarT-Back increased the pre-test probability to 31% and 35%. Likelihood ratios were close to 1. Conclusions A risk classification schema using the recommended cut-off scores with items similar to the STarT-Back in a primary care population with strictly defined acute LBP had limited ability to identify persons who progressed to chronic pain. The results suggest caution when applying the STarT-Back in patients with acute LBP and a need to consider a modification of its cut-offs. PMID:25381748

  1. Opioids Switching with Transdermal Systems in Chronic Cancer Pain

    Directory of Open Access Journals (Sweden)

    Barbarisi M

    2009-05-01

    Full Text Available Abstract Background Due to tolerance development and adverse side effects, chronic pain patients frequently need to be switched to alternative opioid therapy Objective To assess the efficacy and tolerability of an alternative transdermally applied (TDS opioid in patients with chronic cancer pain receiving insufficient analgesia using their present treatment. Methods A total of 32 patients received alternative opioid therapy, 16 were switched from buprenorphine to fentanyl and 16 were switched from fentanyl to buprenorphine. The dosage used was 50% of that indicated in equipotency conversion tables. Pain relief was assessed at weekly intervals for the next 3 weeks Results Pain relief as assessed by VAS, PPI, and PRI significantly improved (p Conclusion Opioid switching at 50% of the calculated equianalgesic dose produced a significant reduction in pain levels and rescue medication. The incidence of side effects decreased and no new side effects were noted. Further studies are required to provide individualized treatment for patients according to their different types of cancer.

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

    NARCIS (Netherlands)

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

    2009-01-01

    Introduction: Workers with chronic low back pain (LBP) mean a heavy human and social-economic burden. Their medical histories often include different treatments without attention to work-relatedness or communication with occupational health providers, leaving them passive and medicalized in (outpati

  3. Staying at work with chronic musculoskeletal pain: A new reference for pain rehabilitation

    NARCIS (Netherlands)

    de Vries, Haitze; Brouwer, Sandra; Groothoff, J.W.; Geertzen, J.H.B.; Reneman, M.F.

    2011-01-01

    Background and Aims: Chronic nonspecific musculoskeletal pain (CMP) results often in work disability and sick-leave, confronting employers, insurance companies, and society with considerable costs. However, a substantial amount of workers stay at work despite CMP. It is currently unknown on which fa

  4. Unusual Giant Adrenal Myelolipoma with Chronic Mild Postprandial Pain

    Directory of Open Access Journals (Sweden)

    Haluk Soylemez

    2014-03-01

    Full Text Available Adrenal myelolipomas are rare, small, benign, non-functioning tumors, which must be histopathologically differentiated from other tumors such as lipomas or liposarcomas. They are usually identified incidentally during autopsy, imaging or laparotomy. Occasionally, they may present acutely due to complications such as abdominal pain from retroperitoneal bleeding or systemic symptoms of infection. In differantial diagnosis, Magnetic Resonance Imaging may be useful to show characterize of tissue and relationship with other organs. We report a 66-year-old man with a giant adrenal myelolipoma clinically presenting with chronic mild postprandial pain with a brief review of the literature.

  5. Complementary and alternative medications for chronic pelvic pain.

    Science.gov (United States)

    Leong, Fah Che

    2014-09-01

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

  6. [Spinal cord stimulation for the management of chronic pain].

    Science.gov (United States)

    Perruchoud, Christophe; Mariotti, Nicolas

    2016-06-22

    Neuromodulation techniques modify the activity of the central or peripheral nervous system. Spinal cord stimulation is a reversible and minimally invasive treatment whose efficacy and cost effectiveness are recognized for the treatment of chronic neuropathic pain or ischemic pain. Spinal cord stimulation is not the option of last resort and should be considered among other options before prescribing long-term opioids or considering reoperation. The selection and regular follow-up of patients are crucial to the success of the therapy. PMID:27506068

  7. Chronic pain management in the active-duty military

    Science.gov (United States)

    Jamison, David; Cohen, Steven P.

    2012-06-01

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

  8. Managing Chronic Pain in Special Populations with Emphasis on Pediatric, Geriatric, and Drug Abuser Populations.

    Science.gov (United States)

    Baumbauer, Kyle M; Young, Erin E; Starkweather, Angela R; Guite, Jessica W; Russell, Beth S; Manworren, Renee C B

    2016-01-01

    In the adult population chronic pain can lead to loss of productivity and earning potential, and decreased quality of life. There are distinct groups with increased vulnerability for the emergence of chronic pain. These groups may be defined by developmental status and/or life circumstances. Within the pediatric, geriatric, and drug abuser populations, chronic pain represents a significant health issue. This article focuses on known anatomic, physiologic, and genetic mechanisms underlying chronic pain in these populations, and highlights the need for a multimodal approach from multiple health care professionals for management of chronic pain in those with the most risk.

  9. Managing Chronic Pain in Special Populations with Emphasis on Pediatric, Geriatric, and Drug Abuser Populations.

    Science.gov (United States)

    Baumbauer, Kyle M; Young, Erin E; Starkweather, Angela R; Guite, Jessica W; Russell, Beth S; Manworren, Renee C B

    2016-01-01

    In the adult population chronic pain can lead to loss of productivity and earning potential, and decreased quality of life. There are distinct groups with increased vulnerability for the emergence of chronic pain. These groups may be defined by developmental status and/or life circumstances. Within the pediatric, geriatric, and drug abuser populations, chronic pain represents a significant health issue. This article focuses on known anatomic, physiologic, and genetic mechanisms underlying chronic pain in these populations, and highlights the need for a multimodal approach from multiple health care professionals for management of chronic pain in those with the most risk. PMID:26614727

  10. Metabotropic Glutamate Receptor Dependent Cortical Plasticity in Chronic Pain.

    Science.gov (United States)

    Koga, Kohei; Li, Shermaine; Zhuo, Min

    2016-01-01

    Many cortical areas play crucial roles in higher order brain functions such as pain and emotion-processing, decision-making, and cognition. Among them, anterior cingulate cortex (ACC) and insular cortex (IC) are two key areas. Glutamate mediates major excitatory transmission during long-term plasticity in both physiological and pathological conditions. Specifically related to nociceptive or pain behaviors, metabotropic glutamate subtype receptors (mGluRs) have been involved in different types of synaptic modulation and plasticity from periphery to the spinal cord. However, less is known about their functional roles in plasticity related to pain and its related behaviors within cortical regions. In this review, we first summarized previous studies of synaptic plasticity in both the ACC and IC, and discussed how mGluRs may be involved in both cortical long-term potentiation (LTP) and long-term depression (LTD)-especially in LTD. The activation of mGluRs contributes to the induction of LTD in both ACC and IC areas. The loss of LTD caused by peripheral amputation or nerve injury can be rescued by priming ACC or IC with activations of mGluR1 receptors. We also discussed the potential functional roles of mGluRs for pain-related behaviors. We propose that targeting mGluRs in the cortical areas including the ACC and IC may provide a new therapeutic strategy for the treatment of chronic pain, phantom pain or anxiety. PMID:27296638

  11. Investigating the Burden of Chronic Pain: An Inflammatory and Metabolic Composite

    Directory of Open Access Journals (Sweden)

    Kimberly T. Sibille

    2016-01-01

    Full Text Available Background. Chronic pain is associated with increased morbidity and mortality, predominated by cardiovascular disease and cancer. Investigating related risk factor measures may elucidate the biological burden of chronic pain. Objectives. We hypothesized that chronic pain severity would be positively associated with the risk factor composite. Methods. Data from 12,982 participants in the 6th Tromsø study were analyzed. Questionnaires included demographics, health behaviors, medical comorbidities, and chronic pain symptoms. The risk factor composite was comprised of body mass index, fibrinogen, C-reactive protein, and triglycerides. Chronic pain severity was characterized by frequency, intensity, time/duration, and total number of pain sites. Results. Individuals with chronic pain had a greater risk factor composite than individuals without chronic pain controlling for covariates and after excluding inflammation-related health conditions (p<0.001. A significant “dose-response” relationship was demonstrated with pain severity (p<0.001. In individuals with chronic pain, the risk factor composite varied by health behavior, exercise, lower levels and smoking, and higher levels. Discussion. The risk factor composite was higher in individuals with chronic pain, greater with increasing pain severity, and influenced by health behaviors. Conclusions. Identification of a biological composite sensitive to pain severity and adaptive/maladaptive behaviors would have significant clinical and research utility.

  12. Investigating the Burden of Chronic Pain: An Inflammatory and Metabolic Composite

    Science.gov (United States)

    Sibille, Kimberly T.; Steingrímsdóttir, Ólöf A.; Fillingim, Roger B.; Stubhaug, Audun; Schirmer, Henrik; Chen, Huaihou; McEwen, Bruce S.; Nielsen, Christopher S.

    2016-01-01

    Background. Chronic pain is associated with increased morbidity and mortality, predominated by cardiovascular disease and cancer. Investigating related risk factor measures may elucidate the biological burden of chronic pain. Objectives. We hypothesized that chronic pain severity would be positively associated with the risk factor composite. Methods. Data from 12,982 participants in the 6th Tromsø study were analyzed. Questionnaires included demographics, health behaviors, medical comorbidities, and chronic pain symptoms. The risk factor composite was comprised of body mass index, fibrinogen, C-reactive protein, and triglycerides. Chronic pain severity was characterized by frequency, intensity, time/duration, and total number of pain sites. Results. Individuals with chronic pain had a greater risk factor composite than individuals without chronic pain controlling for covariates and after excluding inflammation-related health conditions (p < 0.001). A significant “dose-response” relationship was demonstrated with pain severity (p < 0.001). In individuals with chronic pain, the risk factor composite varied by health behavior, exercise, lower levels and smoking, and higher levels. Discussion. The risk factor composite was higher in individuals with chronic pain, greater with increasing pain severity, and influenced by health behaviors. Conclusions. Identification of a biological composite sensitive to pain severity and adaptive/maladaptive behaviors would have significant clinical and research utility. PMID:27445627

  13. Investigating the Burden of Chronic Pain: An Inflammatory and Metabolic Composite.

    Science.gov (United States)

    Sibille, Kimberly T; Steingrímsdóttir, Ólöf A; Fillingim, Roger B; Stubhaug, Audun; Schirmer, Henrik; Chen, Huaihou; McEwen, Bruce S; Nielsen, Christopher S

    2016-01-01

    Background. Chronic pain is associated with increased morbidity and mortality, predominated by cardiovascular disease and cancer. Investigating related risk factor measures may elucidate the biological burden of chronic pain. Objectives. We hypothesized that chronic pain severity would be positively associated with the risk factor composite. Methods. Data from 12,982 participants in the 6th Tromsø study were analyzed. Questionnaires included demographics, health behaviors, medical comorbidities, and chronic pain symptoms. The risk factor composite was comprised of body mass index, fibrinogen, C-reactive protein, and triglycerides. Chronic pain severity was characterized by frequency, intensity, time/duration, and total number of pain sites. Results. Individuals with chronic pain had a greater risk factor composite than individuals without chronic pain controlling for covariates and after excluding inflammation-related health conditions (p < 0.001). A significant "dose-response" relationship was demonstrated with pain severity (p < 0.001). In individuals with chronic pain, the risk factor composite varied by health behavior, exercise, lower levels and smoking, and higher levels. Discussion. The risk factor composite was higher in individuals with chronic pain, greater with increasing pain severity, and influenced by health behaviors. Conclusions. Identification of a biological composite sensitive to pain severity and adaptive/maladaptive behaviors would have significant clinical and research utility. PMID:27445627

  14. Evidence-based pharmacological management of chronic neuropathic pain

    Directory of Open Access Journals (Sweden)

    Zarrin Ansari

    2013-06-01

    Full Text Available Neuropathic pain (NP is a chronic, debilitating symptomatology of lesions/injuries of the central and peripheral nervous system. As per pooled estimates, the prevalence is 7-8% in the general population; however, the prevalence varies with different neuropathic conditions. The aetiology can range from peripheral neuropathic conditions viz. peripheral diabetic neuropathic pain (PDNP, post-herpetic neuralgia (PHN, trigeminal neuralgia, HIV- associated polyneuropathy, cervical radiculopathy to central neuropathic conditions, viz. central post-stroke pain, spinal cord injury and the neuropathic pain associated with multiple sclerosis. Apart from the symptomatic perception of pain, neuropathic pain affects the cognitive and emotional aspects of the affected individual. The pain, being debilitating and resistant to over-the-counter analgesics, diminishes the quality of life, disrupts sleep and leads to psychiatric complications such as comorbid anxiety and depression. The management is palliative and involves drugs, psychological intervention, stimulations and nerve-blocking techniques. This review concentrates on the pharmacological therapeutic options available and focuses on the selection of the agent/s in accordance with the evidence. The first-line treatment includes the tricyclic antidepressants ([TCAs]; amitriptyline, nortriptyline, selective serotonin norepinephrine inhibitors ([SNRIs]; duloxetine, venlafaxine, calcium channel alpha 2 - delta ligands (pregabalin, gabapentin, carbamazepine and oxcarbazepine. Lidocaine plasters are first-line options for specific focal conditions such as post-herpetic neuralgia. The second-line therapy includes the opioid analgesics and tramadol. The choice of drug selection should complement the patient’s age, type of neuropathic condition, tolerability to an agent, comorbid condition and cost-effectiveness. Management must be individualized with a realistic and composite goal of making the pain tolerable and

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

    Directory of Open Access Journals (Sweden)

    Smith TP

    2014-08-01

    Full Text Available Terika P Smith,1 Tami Haymond,1 Sherika N Smith,1 Sarah M Sweitzer1,2 1Department of Pharmacology, Physiology and Neuroscience, University of South Carolina, Columbia, SC, USA; 2Department of Pharmaceutical and Administrative Sciences, Presbyterian College School of Pharmacy, Clinton, SC, USA Abstract: 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. Keywords: endothelin-1, acute pain, chronic pain, endothelin receptor antagonists

  16. [Therapeutic exercise for patients with chronic low-back pain].

    Science.gov (United States)

    Grazio, Simeon; Grgurević, Lovorka; Vlak, Tonko; Perić, Porin; Nemčić, Tomislav; Vrbanić, Tea Schurrer Luke; Kadojić, Mira; Gnjidić, Zoja; Grubišić, Frane; Balen, Diana; Vuga, Katarina Lohman; Ćurković, Boždiar

    2014-01-01

    Low Back Pain (LBP) is a major medical and socio-economical problem in the industrialized countries. Exercise therapy is the keystone of conservative treatment for chronic low back pain (CLBP). Numerous randomized trials and clinical practice guidelines have supported that exercise diminishes disability and pain severity while improving fitness and occupational status in patients with CLBP, as well as decrease its recurrence rate. However, there is no significant evidence that one particular type of exercise is clearly more effective than others. Here we present a descriptive review of different types of exercise for therapeutic or prevention purposes in patients with CLBP. Studies suggest that individually tailored, supervised exercise programs are associated with the best outcomes. High quality clinical trials are needed to determine the effectiveness of specific interventions (type, time, intensity and other characteristics) aimed at individuals and/or specific target groups.

  17. Computer mouse use predicts acute pain but not prolonged or chronic pain in the neck and shoulder

    DEFF Research Database (Denmark)

    Gerster, Mette; Grimstrup, S; Lassen, C F;

    2008-01-01

    BACKGROUND: Computer use may have an adverse effect on musculoskeletal outcomes. This study assessed the risk of neck and shoulder pain associated with objectively recorded professional computer use. METHODS: A computer programme was used to collect data on mouse and keyboard usage and weekly...... reports of neck and shoulder pain among 2146 technical assistants. Questionnaires were also completed at baseline and at 12 months. The three outcome measures were: (1) acute pain (measured as weekly pain); (2) prolonged pain (no or minor pain in the neck and shoulder region over four consecutive weeks...... followed by three consecutive weeks with a high pain score); and (3) chronic pain (reported pain or discomfort lasting more than 30 days and "quite a lot of trouble" during the past 12 months). RESULTS: Risk for acute neck pain and shoulder pain increased linearly by 4% and 10%, respectively, for each...

  18. Perspectives on Yoga Inputs in the Management of Chronic Pain

    OpenAIRE

    Nandini Vallath

    2010-01-01

    Chronic pain is multi-dimensional. At the physical level itself, beyond the nociceptive pathway, there is hyper arousal state of the components of the nervous system, which negatively influences tension component of the muscles, patterns of breathing, energy levels and mindset, all of which exacerbate the distress and affect the quality of life of the individual and family. Beginning with the physical body, Yoga eventually influences all aspects of the person: vital, mental, emotional, intell...

  19. The sports hernia: a cause of chronic groin pain.

    OpenAIRE

    Hackney, R. G.

    1993-01-01

    The management of chronic pain in sportsmen and women requires consideration of a wide differential diagnosis. A syndrome caused by a distension of the posterior inguinal wall is described, effectively an early direct inguinal hernia. The diagnosis can be made from certain aspects of the history and examination, which are described. The results of surgical repair to the posterior inguinal wall are excellent. The procedure was carried out on 14 sportsmen and one woman. There is an 87% return t...

  20. CHRONIC GROIN PAIN FOLLOWING LICHTENSTEIN MESH HERNIOPLASTY FOR INGUINAL HERNIA

    OpenAIRE

    Ajay; Prabir Kr

    2015-01-01

    AIMS AND OBJECTIVES To assess the incidence of Chronic Groin pain following Lichtenstein Mesh Hernioplasty for Inguinal Hernia. MATERIALS AND METHODS The study includes 210 patients from December 2010-November 2014 who underwent Lichtenstein Mesh Hernioplasty for Inguinal Hernia, but only 154 patients reported at three months and 147 reported at six months. Because 63 patients did not report at six months, they were finally excluded from the study. So ultimately 147 p...

  1. Core strength training for patients with chronic low back pain

    OpenAIRE

    Chang, Wen-Dien; Lin, Hung-Yu; Lai, Ping-Tung

    2015-01-01

    [Purpose] Through core strength training, patients with chronic low back pain can strengthen their deep trunk muscles. However, independent training remains challenging, despite the existence of numerous core strength training strategies. Currently, no standardized system has been established analyzing and comparing the results of core strength training and typical resistance training. Therefore, we conducted a systematic review of the results of previous studies to explore the effectiveness ...

  2. Chronic Low Back Pain due to Retroperitoneal Cystic Lymphangioma

    Directory of Open Access Journals (Sweden)

    Asieh Sadat Fattahi

    2014-03-01

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

  3. Chronic Low Back Pain due to Retroperitoneal Cystic Lymphangioma

    Directory of Open Access Journals (Sweden)

    Asieh Sadat Fattahi

    2014-03-01

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

  4. Associations between chronic pelvic pain and psychiatric disorders and symptoms

    OpenAIRE

    ANA CAROLINA FRANCO CARVALHO; OMERO BENEDITO POLI NETO; JOSÉ ALEXANDRE DE SOUZA CRIPPA; JAIME EDUARDO CECÍLIO HALLAK; FLÁVIA DE LIMA OSÓRIO

    2015-01-01

    Background Chronic pelvic pain (CPP) is a complex condition wich is associated with emotional factors, specially depression and anxiety. Objectives To make a systematic review to provide a detailed summary of relevant literature on the association between CPP and different psychiatric disorders/symptoms. Methods A systematic review of articles in the international literature published between 2003 and 2014 was performed in the electronic databases PubMed, PsycINFO, LILACS, and SciELO using th...

  5. A Systematic Review of Dextrose Prolotherapy for Chronic Musculoskeletal Pain

    OpenAIRE

    Hauser, Ross A.; Lackner, Johanna B.; Steilen-Matias, Danielle; Harris, David K.

    2016-01-01

    OBJECTIVE The aim of this study was to systematically review dextrose (d-glucose) prolotherapy efficacy in the treatment of chronic musculoskeletal pain. DATA SOURCES Electronic databases PubMed, Healthline, OmniMedicalSearch, Medscape, and EMBASE were searched from 1990 to January 2016. STUDY SELECTION Prospectively designed studies that used dextrose as the sole active prolotherapy constituent were selected. DATA EXTRACTION Two independent reviewers rated studies for quality of evidence usi...

  6. Predictive validity of behavioural animal models for chronic pain

    OpenAIRE

    Berge, Odd-Geir

    2011-01-01

    Rodent models of chronic pain may elucidate pathophysiological mechanisms and identify potential drug targets, but whether they predict clinical efficacy of novel compounds is controversial. Several potential analgesics have failed in clinical trials, in spite of strong animal modelling support for efficacy, but there are also examples of successful modelling. Significant differences in how methods are implemented and results are reported means that a literature-based comparison between precl...

  7. Chronic Low Back Pain due to Retroperitoneal Cystic Lymphangioma.

    Science.gov (United States)

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

    2014-03-01

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

  8. Intimate Partner Aggression Perpetration in Primary Care Chronic Pain Patients

    OpenAIRE

    Taft, Casey; Schwartz, Sonia; Liebschutz, Jane M.

    2010-01-01

    This study examined the prevalence and correlates of partner aggression perpetration in 597 primary care chronic pain patients. Approximately 30% of participants reported perpetrating low-level aggression, 12% reported injuring their partner, and 5% reported engaging in sexual coercion. Women reported more low-level aggression perpetration than men, and men reported more engagement in sexual coercion than women. Substance use disorders (SUD) were associated with all outcomes, and both aggress...

  9. Factors associated with increased risk for pain catastrophizing in patients with chronic neck pain: A retrospective cross-sectional study.

    Science.gov (United States)

    Park, Sang Jun; Lee, Rippy; Yoon, Duck Mi; Yoon, Kyung Bong; Kim, Kiwook; Kim, Shin Hyung

    2016-09-01

    Pain catastrophizing is becoming increasingly recognized as a clinically important psychological factor in chronic musculoskeletal pain. In this retrospective cross-sectional study, we have identified factors associated with an increased risk for pain catastrophizing in chronic neck pain (CNP) patients. We obtained data from our medical database on 331 patients who were treated for neck pain as their chief complaint at our clinic. The Pain Catastrophizing Scale (PCS) was used to define a high pain catastrophizing state (PCS score ≥21) in this study. Patient demographics, pain-related factors, and psychological factors were evaluated with logistic regression analysis to identify risk factors of high pain catastrophizing among patients with CNP. A total of 256 patients with CNP satisfied the study inclusion criteria and were included in the analyses. The median PCS score was 16 (range, 0-45), and 86 of 256 patients (33.5%) reported a PCS score ≥21. In multivariate analysis, high pain intensity, clinical insomnia, and a high level of depression/anxiety were strongly associated with high pain catastrophizing in patients with CNP. Depression was the strongest predictor of high pain catastrophizing, with an odds ratio of 7.35 (95% confidence interval 2.23-24.22). High pain catastrophizing was not significantly related to age, gender, comorbidities, or neck pain-related physical symptoms. In conclusion, poor psychological states should be addressed as an important part of pain management in CNP patients who are susceptible to high pain catastrophizing. PMID:27631217

  10. An improved behavioural assay demonstrates that ultrasound vocalizations constitute a reliable indicator of chronic cancer pain and neuropathic pain

    Directory of Open Access Journals (Sweden)

    Selvaraj Deepitha

    2010-03-01

    Full Text Available Abstract Background On-going pain is one of the most debilitating symptoms associated with a variety of chronic pain disorders. An understanding of mechanisms underlying on-going pain, i.e. stimulus-independent pain has been hampered so far by a lack of behavioural parameters which enable studying it in experimental animals. Ultrasound vocalizations (USVs have been proposed to correlate with pain evoked by an acute activation of nociceptors. However, literature on the utility of USVs as an indicator of chronic pain is very controversial. A majority of these inconsistencies arise from parameters confounding behavioural experiments, which include novelty, fear and stress due to restrain, amongst others. Results We have developed an improved assay which overcomes these confounding factors and enables studying USVs in freely moving mice repetitively over several weeks. Using this improved assay, we report here that USVs increase significantly in mice with bone metastases-induced cancer pain or neuropathic pain for several weeks, in comparison to sham-treated mice. Importantly, analgesic drugs which are known to alleviate tumour pain or neuropathic pain in human patients significantly reduce USVs as well as mechanical allodynia in corresponding mouse models. Conclusions We show that studying USVs and mechanical allodynia in the same cohort of mice enables comparing the temporal progression of on-going pain (i.e. stimulus-independent pain and stimulus-evoked pain in these clinically highly-relevant forms of chronic pain.

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

    OpenAIRE

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

    2008-01-01

    Abstract Background Changes of health and quality-of-life in chronic conditions are mostly small and require specific and sensitive instruments. The aim of this study was to determine and compare responsiveness, i.e. the sensitivity to change of five outcome instruments for effect measurement in chronic pain. Methods In a prospective cohort study, 273 chronic pain patients were assessed on the Numeric Rating Scale (NRS) for pain, the Short Form 36 (SF-36), the Multidimensional Pain Inventory ...

  12. Sodium hydrosulfide relieves neuropathic pain in chronic constriction injured rats.

    Science.gov (United States)

    Lin, Jian-Qing; Luo, Hui-Qin; Lin, Cai-Zhu; Chen, Jin-Zhuan; Lin, Xian-Zhong

    2014-01-01

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

  13. Sodium Hydrosulfide Relieves Neuropathic Pain in Chronic Constriction Injured Rats

    Directory of Open Access Journals (Sweden)

    Jian-qing Lin

    2014-01-01

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

  14. Associations between chronic pelvic pain and psychiatric disorders and symptoms

    Directory of Open Access Journals (Sweden)

    ANA CAROLINA FRANCO CARVALHO

    2015-02-01

    Full Text Available Background Chronic pelvic pain (CPP is a complex condition wich is associated with emotional factors, specially depression and anxiety. Objectives To make a systematic review to provide a detailed summary of relevant literature on the association between CPP and different psychiatric disorders/symptoms. Methods A systematic review of articles in the international literature published between 2003 and 2014 was performed in the electronic databases PubMed, PsycINFO, LILACS, and SciELO using the terms (chronic pelvic pain AND (psychiatry OR psychiatric OR depression OR anxiety OR posttraumatic stress OR somatoform. The searches returned a total of 529 matches that were filtered according to predefined inclusion and exclusion criteria. A total of 18 articles were selected. Results The investigations focused mainly on the assessment of depression and anxiety disorders/symptoms, with rather high rates (17-38.6%. Depression and anxiety symptoms were more prevalent among women with CPP compared to healthy groups. Comparisons between groups with CPP and with specific pathologies that also have pain as a symptom showed that depression indicators are more frequent in CPP. Depressive symptoms tend to be more common in CPP and have no particular association with pain itself, the core feature of CPP. Discussion Other aspects of CPP seem to play a specific role in this association. Anxiety and other psychiatric disorders require further investigation so that their impact on CPP can be better understood.

  15. Occupational Therapy Interventions in Chronic Pain--A Systematic Review.

    Science.gov (United States)

    Hesselstrand, Malin; Samuelsson, Kersti; Liedberg, Gunilla

    2015-12-01

    The use of interventions based on the best available evidence in occupational therapy is essential, and evaluation of research is part of an evidence-based practice. The aim of this study was to assess the quality of studies describing and evaluating the effects of occupational therapy interventions on chronic pain. A systematic review of studies with diverse designs was carried out. A quality assessment was conducted, and the level of evidence was defined using the Research Pyramid Model. Of 19 included studies, three received the highest evidence level, and three were considered to be of high quality. The clinical recommendations that can be derived from this study are the following: occupational therapy interventions should start from the identified needs of the person with chronic pain; no support exists for the effectiveness of electromyographic biofeedback training as a supplement, more studies are needed to confirm this result; the efficacy of instructions on body mechanics was significant during work-hardening treatment; and occupational therapists need to perform and present more clinical studies of high quality and high-evidence level to build up a trustworthy arsenal of evidence-based interventions, for example, in persons with chronic pain.

  16. Validation and usefulness of the Danish version of the Pain Medication Questionnaire in opioid-treated chronic pain patients

    DEFF Research Database (Denmark)

    Højsted, J; Nielsen, P R; Kendall, S;

    2011-01-01

    Addiction is a feared complication of long-term opioid therapy for chronic pain patients. A screening tool to assess the potential risk of addiction may be helpful.......Addiction is a feared complication of long-term opioid therapy for chronic pain patients. A screening tool to assess the potential risk of addiction may be helpful....

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

    Science.gov (United States)

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

    2009-01-01

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

  18. Antidepressant Drugs for Chronic Urological Pelvic Pain: An Evidence-Based Review

    Directory of Open Access Journals (Sweden)

    Christos Papandreou

    2009-01-01

    Full Text Available The use of antidepressant drugs for the management of chronic pelvic pain has been supported in the past. This study aimed to evaluate the available evidence for the efficacy and acceptability of antidepressant drugs in the management of urological chronic pelvic pain. Studies were selected through a comprehensive literature search. We included all types of study designs due to the limited evidence. Studies were classified into levels of evidence according to their design. Ten studies were included with a total of 360 patients. Amitriptyline, sertraline, duloxetine, nortriptyline, and citalopram are the antidepressants that have been reported in the literature. Only four randomized controlled trials (RCTs were identified (two for amitriptyline and two for sertraline with mixed results. We conclude that the use of antidepressants for the management of chronic urological pelvic pain is not adequately supported by methodologically sound RCTs. From the existing studies amitriptyline may be effective in interstitial cystitis but publication bias should be considered as an alternative explanation. All drugs were generally well tolerated with no serious events reported.

  19. Patient utilities in chronic musculoskeletal pain: how useful is the standard gamble method?

    Science.gov (United States)

    Goossens, M E; Vlaeyen, J W; Rutten-van Mölken, M P; van der Linden, S M

    1999-03-01

    The main goal of current pain management approaches is to increase the patients' quality of life by improving pain coping skills and by reducing the levels of disability in daily life, often despite persistent pain. Direct measurement of quality of life is of crucial importance in economic evaluation research, in which not only is the estimation of financial costs and benefits included, but so is the evaluation of costs and benefits in terms of changes in health states. The purpose of this study is to compare the psychometric qualities of two instruments for assessing patients' utilities, the rating scale (RS) and the standard gamble (SG). Such instruments are designed for their application in economic evaluation research, but have seldomly been used in chronic pain trials. Both methods provide a single measure between 0 and 1. The relationship between these utility measures and descriptive and domain-specific quality of life measures was examined in 133 fibromyalgia patients and 148 patients with chronic non-specific low back pain. Mean utility score at baseline was 0.43 with the RS and 0.78 for the SG. The correlation between both methods was found to be poor (r = 0.21). Both measures appeared to be fairly stable in a 2-week test-retest period (intra class correlation coefficient (ICC) = 0.74 and 0.77). Scores on the description of patient's own health on six domains, global assessment of change and domain specific measures correlated moderately with the RS scores and low with the SG. Multiple regression analyses demonstrated that 32% of the variance in RS values and only 13% of the variance in SG utilities could be explained by domain-specific measures. These results suggest an acceptable construct validity for the RS but insufficient construct validity for the SG. Valuations of ones own health appear only partially to be related to the assessment of the pain-specific measures and measures of distress. It can be concluded that the RS and domain-specific measures

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

    OpenAIRE

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

    2011-01-01

    Objective To ascertain whether a small sample of patients with chronic pelvic pain experienced any pain-related cognitions in the form of mental images. Patients Ten women with chronic pelvic pain consecutively referred from a tertiary referral center by the physicians in charge of their treatment. Outcome measures An interview was used to determine the presence, emotional valence, content, and impact of cognitions about pain in the form of mental images and verbal thoughts. The Brief Pain In...

  1. Is the pain in chronic pancreatitis of neuropathic origin? Support from EEG studies during experimental pain

    Institute of Scientific and Technical Information of China (English)

    Asbjφrn M Drewes; Maciej Gratkowski; Saber AK Sami; Georg Dimcevski; Peter Funch-Jensen; Lars Arendt-Nielsen

    2008-01-01

    AIM: To prove the hypothesis that patients with chronic pancreatitis would show increased theta activity during painful visceral stimulation.METHODS: Eight patients and 12 healthy controls underwent an experiment where the esophagus was electrically stimulated at the pain threshold using a nasal endoscope. The electroencephalogram (EEG) was recorded from 64 surface electrodes and "topographic matching pursuit" was used to extract the EEG information in the early brain activation after stimulation.RESULTS: A major difference between controls and patients were seen in delta and theta bands, whereas there were only minor differences in other frequency bands. In the theta band, the patients showed higher activity than controls persisting throughout the 450 ms of analysis with synchronous brain activation between the channels. The main theta components oscillated with 4.4Hz in the patients and 5.5Hz in the controls. The energy in the delta (0.5-3.5Hz) band was higher in the controls, whereas the patients only showed scattered activity in this band.CONCLUSION: The differences in the theta band indicate that neuropathic pain mechanisms are involved in chronic pancreatitis. This has important implications for the understanding and treatment of pain in these patients, which should be directed against drugs with effects on neuropathic pain disorders.

  2. Clinical significance of pain in patients with chronic heart failure

    Institute of Scientific and Technical Information of China (English)

    GAN Qian; ZHANG Feng-ru; ZHOU Qing-fen; DAI Li-ying; LIU Ye-hong; CHAI Xi-chen; WU Fang; SHEN Wei-feng

    2012-01-01

    Background There is a paucity of studies investigating the clinical and biochemical characteristics of pain in chronic heart failure (CHF) patients.This study aimed to determine the clinical and biochemical characteristics and outcomes in Chinese patients with CHF and symptoms of pain.Methods Sociodemographics,serum levels of creatinine,NT-proBNP,high-sensitivity C-reactive protein (hs-CRP),tumor necrosis factor (TNF)-α,interleukin (IL)-6 and IL-10,and two-dimensional echocardiographic left ventricular ejection fraction (LVEF) were determined in 305 patients with CHF.A questionnaire packet including the Brief Pain Inventory (BPI) and the Minnesota Living with Heart Failure Questionnaire (MLHFQ) was used to assess the degree of pain rated on a 0-10 scale and the quality of life (QOL).A six-minute walking test was performed during routine clinic visits.Major adverse cardiac events (MACE) were recorded; including all-cause or cardiac mortality and rehospitalization because of myocardial infarction,worsening heart failure or stroke at follow-up.Results Pain occurred in 25.6% of CHF patients,and was more common when the New York Heart Association (NYHA) functional class was worse.More patients with pain were female in gender,and had more co-morbidities,lower LVEF,and shorter distance during the 6-minute walking test.Despite similar serum levels of creatinine,N-terminal prohormone of brain natriuretic peptide (NT-proBNP),IL-6 and IL-10,the TNF-α levels were higher and MLHFQ scores were greater in CHF patients with pain.At follow-up,CHF patients with moderate to severe pain (≥4 scale) had higher rates of all-cause and cardiac mortality and rehospitalization because of myocardial infarction,worsening heart failure or stroke.Multivariate regression analysis revealed that the presence of pain was an independent risk factor for MACE and reduced QOL in CHF patients.Conclusions Pain occurs in all stages of the CHF trajectory,and its incidence increases as clinical

  3. A comparison of still point induction to massage therapy in reducing pain and increasing comfort in chronic pain.

    Science.gov (United States)

    Townsend, Carolyn S; Bonham, Elizabeth; Chase, Linda; Dunscomb, Jennifer; McAlister, Susan

    2014-01-01

    A quantitative study was completed to determine whether complementary techniques provide pain relief and comfort in patients with chronic pain. Subjects participated in sessions including aromatherapy and music therapy. Massage or cranial still point induction was randomly assigned. Statistically significant improvement in pain and comfort was noted in both groups. PMID:24503744

  4. Calibration and validation of the Dutch-Flemish PROMIS Pain Behavior item bank in patients with chronic pain

    NARCIS (Netherlands)

    M.H.P. Crins; L.D. Roorda; N. Smits; H.C.W. de Vet; R. Westhovens; D. Cella; K.F. Cook; D. Revicki; J. van Leeuwen; M. Boers; J. Dekker; C.B. Terwee

    2015-01-01

    Background The aims of the current study were to calibrate the item parameters of the Dutch-Flemish PROMIS Pain Behavior item bank using a sample of Dutch patients with chronic pain and to evaluate cross-cultural validity between the Dutch-Flemish and the US PROMIS Pain Behavior item banks. Furtherm

  5. Chronic pain disorders in HIV primary care: clinical characteristics and association with healthcare utilization.

    Science.gov (United States)

    Jiao, Jocelyn M; So, Eric; Jebakumar, Jebakaran; George, Mary Catherine; Simpson, David M; Robinson-Papp, Jessica

    2016-04-01

    Chronic pain is common in HIV, but incompletely characterized, including its underlying etiologies, its effect on healthcare utilization, and the characteristics of affected patients in the HIV primary care setting. These data are needed to design and justify appropriate clinic-based pain management services. Using a clinical data warehouse, we analyzed one year of data from 638 patients receiving standard-of-care antiretroviral therapy in a large primary care HIV clinic, located in the Harlem neighborhood of New York City. We found that 40% of patients carried one or more chronic pain diagnoses. The most common diagnoses were degenerative musculoskeletal disorders (eg, degenerative spinal disease and osteoarthritis), followed by neuropathic pain and headache disorders. Many patients (16%) had multiple chronic pain diagnoses. Women, older patients, and patients with greater burdens of medical illness, and psychiatric and substance use comorbidities were disproportionately represented among those with chronic pain diagnoses. Controlling for overall health status, HIV patients with chronic pain had greater healthcare utilization including emergency department visits and radiology procedures. In summary, our study demonstrates the high prevalence of chronic pain disorders in the primary care HIV clinic. Colocated interventions for chronic pain in this setting should not only focus on musculoskeletal pain but also account for complex multifaceted pain syndromes, and address the unique biopsychosocial features of this population. Furthermore, because chronic pain is prevalent in HIV and associated with increased healthcare utilization, developing clinic-based pain management programs could be cost-effective.

  6. "It's very hard to change yourself": an exploration of overactivity in people with chronic pain using interpretative phenomenological analysis.

    Science.gov (United States)

    Andrews, Nicole Emma; Strong, Jenny; Meredith, Pamela Joy; Gordon, Kellie; Bagraith, Karl Singh

    2015-07-01

    Overactivity (activity engagement that significantly exacerbates pain) is a common term in the chronic pain literature. Overactivity is accepted clinically as a behaviour that adversely affects an individual's daily functioning and is the target of one of the most widely endorsed pain management strategies among health professionals (ie, activity pacing). Little research, however, has investigated links between overactivity behaviour and indicators of patient functioning, and activity pacing has not been evaluated as a stand-alone treatment specifically for individuals with chronic pain who are habitually overactive. Two studies, using qualitative research designs and interpretative phenomenological analyses, were conducted to provide insight into (1) why certain individuals develop habitual overactivity patterns in response to pain, (2) the impact of overactivity on daily functioning, and (3) the value of activity pacing as a treatment strategy for this population. Findings suggest that overactivity behaviour is complex, influenced by multiple factors, and negatively impacts on multiple quality-of-life domains. Some participants who were followed up 3 to 6 months after a pain management program were able to learn pacing strategies and enact behaviour change with health professional support; however, the majority reported difficulties changing their behaviour after treatment. It is suggested that provision of pacing education, alone, to chronic pain patients who engage in overactivity behaviour may not be effective in eliciting behavioural change. Key factors that participants believed to contribute to the development and maintenance of their overactive behaviour in this study should be considered in future clinical approaches and empirical investigations.

  7. The role of cognitive behavioral therapy for chronic pain in adolescents.

    Science.gov (United States)

    Zagustin, Tamara K

    2013-08-01

    Chronic pain is frequently experienced in adolescents; it affects functionality and requires interventions to decrease the impairments caused by pain. Cognitive behavioral therapy (CBT) has been analyzed in numerous studies that evaluated its effects on reducing the different types of chronic pain in children and adolescents. Interestingly, the outcome of CBT was initially focused on pain intensity, but, because there is no correspondence between children's pain intensity and level of disability, the ability to participate in school and social and recreational activities have been the primary focus of recent studies. There are innovative methods of CBT (such as the third generation of CBT) with and without the use of technology that facilitates the availability of this psychological treatment to adolescents with chronic pain, optimizing its accessibility and comprehensiveness, and maintaining its effectiveness. In the future, specific types of CBT could be specific to the diagnosis of chronic pain in the adolescent, sociodemographics, and other unique features. Parents of children with chronic pain are usually included in these programs, either as coaches in the intervention or as recipients of psychological therapies (including CBT) to optimize benefits. CBT has no adverse effect on chronic pain in adolescents, and there is no literature that makes reference to the effectiveness of CBT in preventing chronic pain in adolescents. A review of the role of CBT in chronic pain in adolescents via a PubMed database search was performed to identify the role of CBT in the management of chronic pain in adolescents.

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

    Science.gov (United States)

    Wulle, C

    2010-02-01

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

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

    OpenAIRE

    Roberts MH; Mapel DW; Thomson HN

    2015-01-01

    Melissa H Roberts,1 Douglas W Mapel,1 Heather N Thomson2 1Lovelace Clinic Foundation, Albuquerque, NM, USA; 2Endo Pharmaceuticals, Malvern, PA, USA Objective: To examine how pain affects health care utilization and direct medical costs in individuals with chronic obstructive pulmonary disease (COPD) compared to patients with other chronic diseases. Study design: A retrospective cohort analysis using administrative data of a managed health care system in the Southwestern US for years 2006&...

  10. Pain, Depression and Quality of Life in Patients with Chronic Cervical Miyofascial Pain Syndrome

    Directory of Open Access Journals (Sweden)

    Ümit Dundar

    2014-03-01

    Aim: The aim of this study was to investigate the levels of depression, pain and disability in patients with chronic cervical miyofascial pain syndrome (MPS and to determine their association with quality of life. Material and Method: Forty patients with Cervical MPS and 40 age and sex-matched healthy controls enrolled in this study. The social and demographic characteristics of the patients and controls were examined. All patients and controls were evaluated with respect to pain (at night, rest and movement and assessed by visual analog scale (VAS. Neck disability index (NDI was used to calculate functional disability. Quality of life was evaluated with the the Short Form 36 Health Survey (SF-36. Also all of the patients and controls underwent Beck depression inventory (BDI. Results: There was no statistical difference between the patients and control cases according to demographical data. The SF-36 scores of the study patients were lower than controls. NDI, BDI and VAS scores were higher in the patients with chronic cervical MPS compared to controls. BDI scores of the patients with chronic cervical MPS  were negatively and closely associated with subparameters of the SF-36 (physical function (r:-0,599, p<0.001, role limitations due to physical functioning (r:-0,558, p<0.001, bodily pain (r:-0.540, p<0.001, general health (r:- 0,708 p<0.001, vitality (r:-0,692, p<0.001, social functioning (r:-0,559, p<0.001, role limitations due to emotional problems (r:-0,537, p<0.001 and mental health (r: -0,787, p<0.001. Discussion: BDI scores are higher in patients with chronic cervical MPS than healthy controls and negatively affect their quality of life. Psychiatric evaluation of the patients with chronic cervical MPS may improve their quality of life and treatments outcome.

  11. Postconcussion Symptoms in Patients with Injury-Related Chronic Pain

    Directory of Open Access Journals (Sweden)

    Britt Marie Stålnacke

    2012-01-01

    Full Text Available Background. Postconcussion symptoms (PCSs—such as fatigue, headache, irritability, dizziness, and impaired memory—are commonly reported in patients who have mild traumatic brain injuries (MTBIs. Evaluation of PCS after MTBI is proposed to have a diagnostic value although it is unclear whether PCS are specific to MTBI. After whiplash injuries, patients most often complain of headaches and neck pain; the other PCS are not as closely evaluated. In patients with chronic pain because of other injuries, the presence of PCS is unclear. This study aimed to describe the frequency of PCS in patients with injury-related pain and to examine the relationships between PCS, pain, and psychological factors. Methods. This study collected data using questionnaires addressing PCS (Rivermead Postconcussion Questionnaire, RPQ, pain intensity (Visual Analogue Scale, depression, anxiety (Hospital, Anxiety, and Depression Scale, and posttraumatic stress (Impact of Event Scale. Results. Fatigue (90.7%, sleep disturbance (84.9%, headache (73.5%, poor concentration (88.2%, and poor memory (67.1% were some of the most commonly reported PCS. Significant relationships were found between PCS and posttraumatic stress, depression, and anxiety. Conclusion. To optimize treatment, it is important to assess each patient’s PCS, the mechanism of injury, and factors such as posttraumatic stress and depression.

  12. Hormonal and reproductive factors are associated with chronic low back pain and chronic upper extremity pain in women--the MORGEN study.

    NARCIS (Netherlands)

    Wijnhoven, Hanneke A H; Vet, Henrica C W de; Smit, Henriëtte A; Picavet, H Susan J

    2006-01-01

    STUDY DESIGN: Cross-sectional study of 11,428 women aged 20-59 years who were included in a postal questionnaire survey in the Dutch general population. OBJECTIVE: To examine how hormonal and reproductive factors are associated with chronic low back pain (LBP) and chronic upper extremity pain (UEP)

  13. Pain Intensity and Patients’ Acceptance of Surgical Complication Risks With Lumbar Fusion

    Science.gov (United States)

    Bono, Christopher M.; Harris, Mitchel B.; Warholic, Natalie; Katz, Jeffrey N.; Carreras, Edward; White, Andrew; Schmitz, Miguel; Wood, Kirkham B.; Losina, Elena

    2014-01-01

    Study Design Cross-sectional study with prospective recruitment Objective To determine the relationship of pain intensity (back and leg) on patients’ acceptance of surgical complication risks when deciding whether or not to undergo lumbar spinal fusion. Background To formulate informed decisions regarding lumbar fusion surgery, preoperative discussions should include a review of the risk of complications balanced with the likelihood of symptom relief. Pain intensity has the potential to influence a patient’s decision to consent to lumbar fusion. We hypothesized that pain intensity is associated with a patient’s acceptance of surgical complication risks. Methods Patients being seen for the first time by a spine surgeon for treatment of a non-traumatic or non-neoplastic spinal disorder completed a structured questionnaire. It posed 24 scenarios, each presenting a combination of risks of 3 complications (nerve damage, wound infection, nonunion) and probabilities of symptom relief. For each scenario, the patient indicated whether he/she would/would not consent to a fusion for low back pain (LBP). The sum of the scenarios in which the patient responded that he or she would elect surgery was calculated to represent acceptance of surgical complication risks. A variety of other data were also recorded, including age, gender, education level, race, history of non-spinal surgery, duration of pain, and history of spinal injections. Data were analyzed using bivariate analyses and multivariate regression analyses. Results The mean number of scenarios accepted by 118 enrolled subjects was 10.2 (median 8, standard deviation 8.5, range 0 to 24, or 42.5% of scenarios). In general, subjects were more likely to accept scenarios with lower risks and higher efficacy. Spearman’s rank correlation estimates demonstrated a moderate association between the LBP intensity and acceptance of surgical complication risks (r=0.37, p=0.0001) while leg pain intensity had a weak but positive

  14. A qualitative study exploring the effects of attending a community pain service choir on wellbeing in people who experience chronic pain.

    Science.gov (United States)

    Hopper, Mirella J; Curtis, Suzi; Hodge, Suzanne; Simm, Rebecca

    2016-08-01

    In line with growing evidence of the health benefits of singing, this study aimed to explore participants' perceptions of the impact of a service-user-led community pain choir on their psychological wellbeing, self-efficacy and relationships with their chronic pain. The choir has links to a multidisciplinary pain management service, which is informed by the ethos of solution-focused (SF) principles, specifically in identifying and drawing upon patients' resources. Seven choir members participated in semi-structured interviews, grounded in lines of enquiry commonly used in SF practice. Thematic analysis of the data uncovered seven themes: Physical Improvements, Emotional Impact, Personal Growth, Interpersonal Processes, Relationship with the 'Self', Living Well with Pain and Sharing the Music and Spreading the Word. Participants' narratives provided support for participation in the choir in enhancing positive affect, self-worth, interpersonal relationships and overall wellbeing. The choir enabled continued progress towards accomplishing key pain management programme aims: self-management, coping and living well with pain. Findings expanded upon existing evidence relating to singing and wellbeing by highlighting the choir's role in promoting resilience and acceptance of pain. Clinical implications are explored in relation to psychosocial dimensions of pain. PMID:27583139

  15. A qualitative study exploring the effects of attending a community pain service choir on wellbeing in people who experience chronic pain

    Science.gov (United States)

    Hopper, Mirella J; Curtis, Suzi; Hodge, Suzanne; Simm, Rebecca

    2016-01-01

    In line with growing evidence of the health benefits of singing, this study aimed to explore participants’ perceptions of the impact of a service-user-led community pain choir on their psychological wellbeing, self-efficacy and relationships with their chronic pain. The choir has links to a multidisciplinary pain management service, which is informed by the ethos of solution-focused (SF) principles, specifically in identifying and drawing upon patients’ resources. Seven choir members participated in semi-structured interviews, grounded in lines of enquiry commonly used in SF practice. Thematic analysis of the data uncovered seven themes: Physical Improvements, Emotional Impact, Personal Growth, Interpersonal Processes, Relationship with the ‘Self’, Living Well with Pain and Sharing the Music and Spreading the Word. Participants’ narratives provided support for participation in the choir in enhancing positive affect, self-worth, interpersonal relationships and overall wellbeing. The choir enabled continued progress towards accomplishing key pain management programme aims: self-management, coping and living well with pain. Findings expanded upon existing evidence relating to singing and wellbeing by highlighting the choir’s role in promoting resilience and acceptance of pain. Clinical implications are explored in relation to psychosocial dimensions of pain.

  16. The Role of Traditional Chinese Medicine in the Management of Chronic Pain: A Biopsychosocial Approach

    Directory of Open Access Journals (Sweden)

    John Burns

    2015-11-01

    Full Text Available The National Institute of Medicine revealed that chronic pain affects more than 100 million adults in the United States, citing chronic pain as the leading reason patients seek medical care. Pain is also an extremely costly problem, with $635 billion per year spent nationally, more than cancer, heart disease and diabetes combined. The biomedical model of chronic pain management has largely revolved around the use of narcotic analgesics for pain control. Unfortunately, this corresponds to a growth in the rate of abuse, misuse and overdose of these drugs. Additionally, there is an inherent failure rate to the myriad procedures used to control pain, such as spinal epidural injections and insertion of indwelling narcotic delivery systems, largely because these procedures fail to comprehensively address the multiple facets of pain generation. With its roots in the biopsychosocial model of pain management, traditional Chinese medicine may be a useful systematic or adjunct approach in the management of chronic pain.

  17. Depression among Chronic Pain Patients: Cognitive-Behavioral Analysis and Effect on Rehabilitation Outcome.

    Science.gov (United States)

    Kerns, Robert D.; Haythornthwaite, Jennifer A.

    1988-01-01

    Examined relevance of depression to chronic pain. Found significant differences among 131 depressed, mildly depressed, and nondepressed chronic pain sufferers on instrumental activities and coping skills, with more depressed subjects reporting lower levels of functioning and less support. Depressed pain patients showed greater tendency to drop out…

  18. PSYCHOLOGICAL-ASPECTS OF FIBROMYALGIA COMPARED WITH CHRONIC AND NONCHRONIC PAIN

    NARCIS (Netherlands)

    BIRNIE, DJ; KNIPPING, AA; VANRIJSWIJK, MH; DEBLECOURT, AC; DEVOOGD, N

    1991-01-01

    The description of psychological aspects of fibromyalgia are similar to those of other patients with chronic pain. Three groups, a chronic pain group (n = 99), a nonchronic pain group (n = 34) and a fibromyalgia group (n = 36) were compared, using a standardized interview and psychological questionn

  19. Executive and Attentional Functions in Chronic Pain: Does Performance Decrease with Increasing Task Load?

    Directory of Open Access Journals (Sweden)

    Joukje M Oosterman

    2012-01-01

    Full Text Available BACKGROUND: Diminished executive function and attentional control has been reported in chronic pain patients. However, the precise pattern of impairment in these aspects of cognition in chronic pain remains unclear. Moreover, a decline in psychomotor speed could potentially influence executive and attentional control performance in pain patients.

  20. A stepwise approach for effective management of chronic pain in autosomal-dominant polycystic kidney disease

    NARCIS (Netherlands)

    Casteleijn, Niek F.; Visser, Folkert W.; Drenth, Joost P. H.; Gevers, Tom J. G.; Groen, Gerbrand J.; Hogan, Marie C.; Gansevoort, Ron T.

    2014-01-01

    Chronic pain, defined as pain existing for >4-6 weeks, affects >60% of patients with autosomal-dominant polycystic disease (ADPKD). It can have various causes, indirectly or directly related to the increase in kidney and liver volume in these patients. Chronic pain in ADPKD patients is often severe,

  1. Chronic pain after open mesh and sutured repair of indirect inguinal hernia in young males

    DEFF Research Database (Denmark)

    Bay-Nielsen, M; Nilsson, E; Nordin, P;

    2004-01-01

    BACKGROUND: Chronic pain is common after herniorrhaphy, but the effect of surgical technique (mesh versus non-mesh repair) and the social consequences of the pain have not been established. The aim of this study was to analyse chronic postherniorrhaphy pain and its social consequences in young...

  2. Discriminative ability of reflex receptive fields to distinguish patients with acute and chronic low back pain

    DEFF Research Database (Denmark)

    Monika, Müller; Biurrun Manresa, José; Fabienne, Treichel;

    2016-01-01

    Low back pain has a life time prevalence of 70-85%. 10-20% of all patients experience recurrent episodes or develop chronic low back pain. Socio-demographic, clinical and psychological characteristics explain the transition from acute to chronic low back pain only to a limited extent. Altered cen...

  3. Chronic pain and its impact on quality of life in adolescents and their families

    NARCIS (Netherlands)

    J.A.M. Hunfeld (Joke); C.W. Perquin (Christel); H.J. Duivenvoorden (Hugo); A.A.J.M. Hazebroek-Kampschreur (Alice); J. Passchier (Jan); L.W.A. van Suijlekom-Smit (Lisette); J.C. van der Wouden (Hans)

    2001-01-01

    textabstractOBJECTIVE: To study chronic pain not caused by somatic disease in adolescents and the effect of pain on the quality of life of the adolescents and their families. METHODS: One hundred twenty-eight youngsters (12-18 years) who had reported chronic pain kept a

  4. Reliability of the Multidimensional Pain Inventory and stability of the MPI classification system in chronic back pain

    OpenAIRE

    Verra Martin L; Angst Felix; Staal J; Brioschi Roberto; Lehmann Susanne; Aeschlimann André; de Bie Rob A

    2012-01-01

    Abstract Background This cross validation study examined the reliability of the Multidimensional Pain Inventory (MPI) and the stability of the Multidimensional Pain Inventory Classification System of the empirically derived subgroup classification obtained by cluster analysis in chronic musculoskeletal pain. Reliability of the German Multidimensional Pain Inventory was only examined once in the past in a small sample. Previous international studies mainly involving fibromyalgia patients showe...

  5. Smartphone applications for chronic pain management: a critical appraisal

    Directory of Open Access Journals (Sweden)

    Alexander JC

    2016-09-01

    Full Text Available John C Alexander, Girish P JoshiDepartment of Anesthesiology & Pain Management, University of Texas Southwestern Medical Center, Dallas, TX, USAChronic pain is a common condition with significant detrimental physical, psychological, social, and economic impact. The Institute of Medicine estimates that >100 million Americans suffer from chronic pain,1 representing approximately one-third of the entire population of the US.2 Conservative estimates suggest that well over US $500 billion per year is spent in the treatment of these pain conditions, not to mention the lost productivity of these individuals or the burden that their suffering engenders for patients and their families. Despite tremendous efforts, chronic pain continues to be a major societal problem.1Smartphones have become one of the most rapidly adopted technologies in the modern history of mankind allowing for previously unimaginable opportunities for communication and access to information.3 Powering this societal revolution is not so much the onboard or attachable hardware for smartphones, but the dizzying array of software programs that use the hardware to add novel functions; we call the unifying software programs “applications” or, more commonly, “apps”. While each phone comes with onboard technologies, such as Wi-Fi, Bluetooth, lights, microphones, cameras, accelerometers, and even barometers, it is the development of the app that combines these functionalities to create new and innovative uses for the same hardware for everything from Skype4 to Pokémon GO.5The use of such applications within the health care industry continues to grow, and it is estimated that the market for mobile health apps will grow to US$26 billion in 2017.6 The immense size of this market is due to the functional flexibility that apps can provide. These emerging technologies also provide new opportunities to engage with patients and improve health care outcomes. Studies have shown that mobile

  6. Changes of brain microstructure in patients with painful chronic pancreatitis assessed by diffusion tensor imaging

    DEFF Research Database (Denmark)

    Frøkjær, Jens Brøndum; Olesen, Søren Schou; Gram, Mikkel;

    Objective In patients with painful chronic pancreatitis (CP) there is increasing evidence of abnormal pain processing in the central nervous system. Using magnetic resonance (MR) diffusion tensor imaging, brain microstructure in areas involved in processing of visceral pain was characterised...... to patients' clinical pain scores. Conclusion The findings suggest that microstructural changes of the brain accompany pain in CP. The changes are likely to be a consequence of ongoing pain and structural reorganisation of the neuromatrix as also seen in other diseases characterised by chronic pain....

  7. Perspectives on yoga inputs in the management of chronic pain.

    Science.gov (United States)

    Vallath, Nandini

    2010-01-01

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

  8. Perspectives on Yoga inputs in the management of chronic pain

    Directory of Open Access Journals (Sweden)

    Nandini Vallath

    2010-01-01

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

  9. Perspectives on yoga inputs in the management of chronic pain.

    Science.gov (United States)

    Vallath, Nandini

    2010-01-01

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

  10. Childeren growing up with chronic pain: Psychiatric comorbidity, quality of life & familial illness

    NARCIS (Netherlands)

    Knook, L.M.E.

    2012-01-01

    Background: Chronic pain is common in childhood and often co-occurs with psychiatric disorders. It frequently influences daily activities, undermines the child’s confidence in one's health, and affects general well-being. Parents of children with chronic pain often suffer from chronic illness themse

  11. Chronic pain among homeless persons: characteristics, treatment, and barriers to management

    Directory of Open Access Journals (Sweden)

    Berends Jon

    2011-07-01

    Full Text Available Abstract Background Little information is available on the problem of chronic pain among homeless individuals. This study aimed to describe the characteristics of and treatments for chronic pain, barriers to pain management, concurrent medical conditions, and substance use among a representative sample of homeless single adult shelter users who experience chronic pain in Toronto, Canada. Methods Participants were randomly selected at shelters for single homeless adults between September 2007 and February 2008 and screened for chronic pain, defined as having pain in the body for ≥ 3 months or receiving treatment for pain that started ≥ 3 months ago. Cross-sectional surveys obtained information on demographic characteristics, characteristics of and treatments for chronic pain, barriers to pain management, concurrent medical conditions, and substance use. Whenever possible, participants' physicians were also interviewed. Results Among 152 homeless participants who experienced chronic pain, 11 (8% were classified as Chronic Pain Grade I (low disability-low intensity, 47 (32% as Grade II (low disability-high intensity, 34 (23% as Grade III (high disability-moderately limiting, and 54 (37% as Grade IV (high disability-severely limiting. The most common self-reported barriers to pain management were stress of shelter life, inability to afford prescription medications, and poor sleeping conditions. Participants reported using over-the-counter medications (48%, street drugs (46%, prescribed medications (43%, and alcohol (29% to treat their pain. Of the 61 interviewed physicians, only 51% reported treating the patient's pain. The most common physician-reported difficulties with pain management were reluctance to prescribe narcotics due to the patient's history of substance abuse, psychiatric comorbidities, frequently missed appointments, and difficulty getting the patient to take medications correctly. Conclusions Clinicians who provide healthcare for

  12. Characterization of chronic pain and somatosensory function in spinal cord injury subjects.

    Science.gov (United States)

    Defrin, R; Ohry, A; Blumen, N; Urca, G

    2001-01-01

    The pathophysiology of the chronic pain following spinal cord injury (SCI) is unclear. In order to study it's underlying mechanism we characterized the neurological profile of SCI subjects with (SCIP) and without (SCINP) chronic pain. Characterization comprised of thermal threshold testing for warmth, cold and heat pain and tactile sensibility testing of touch, graphesthesia and identification of speed of movement of touch stimuli on the skin. In addition, spontaneously painful areas were mapped in SCIP and evoked pathological pain--allodynia, hyperpathia and wind-up pain evaluated for both groups. Both SCIP and SCINP showed similar reductions in both thermal and tactile sensations. In both groups thermal sensations were significantly more impaired than tactile sensations. Chronic pain was present only in skin areas below the lesion with impaired or absent temperature and heat-pain sensibilities. Conversely, all the thermally impaired skin areas in SCIP were painful while painfree areas in the same subjects were normal. In contrast, chronic pain could be found in skin areas without any impairment in tactile sensibilities. Allodynia could only be elicited in SCIP and a significantly higher incidence of pathologically evoked pain (i.e. hyperpathia and wind-up pain) was seen in the chronic pain areas compared to SCINP. We conclude that damage to the spinothalamic tract (STT) is a necessary condition for the occurrence of chronic pain following SCI. However, STT lesion is not a sufficient condition since it could also be found in SCINP. The abnormal evoked pain seen in SCIP is probably due to neuronal hyperexcitability in these subjects. The fact that apparently identical sensory impairments manifest as chronic pain and hyperexcitability in one subject but not in another implies that either genetic predisposition or subtle differences in the nature of spinal injury determine the emergence of chronic pain following SCI.

  13. Occurrence, Characteristics, and Predictors of Pain in Patients with Chronic Obstructive Pulmonary Disease.

    Science.gov (United States)

    Christensen, Vivi Lycke; Holm, Are Martin; Kongerud, Johny; Bentsen, Signe Berit; Paul, Steven M; Miaskowski, Christine; Rustøen, Tone

    2016-04-01

    Few studies have provided a detailed characterization of pain in patients with chronic obstructive pulmonary disease (COPD). The aims of this cross-sectional study were to describe the occurrence, intensity, locations, and level of interference associated with pain, as well as pain relief; to identify differences in demographic, clinical, and symptom characteristics between COPD patients with and without pain; and to determine which demographic, clinical, and symptom characteristics were associated with average pain, worst pain, and pain interference. A total of 258 patients with COPD provided information on demographic characteristics; comorbidities; respiratory parameters including dyspnea; body mass index; and symptom characteristics (i.e., anxiety, depression, sleep disturbance, and fatigue). Pain was measured using the Brief Pain Inventory. Of these 258 COPD patients, 157 (61%) reported pain. Multiple linear regression analyses were performed to determine which demographic, clinical, and symptom characteristics were associated with average pain severity, worst pain severity, and mean pain interference. Lower stages of COPD were associated with higher worst pain and higher pain interference scores. Higher depression scores were associated with higher average pain and higher pain interference scores. In addition, higher number of pain locations was associated with higher average and higher worst pain severity scores. Findings from this study confirm that pain is a significant problem and highlights the need for specific pain management interventions for patients with COPD. More research is needed about specific pain characteristics and symptoms to gain an increased knowledge about the causes of pain in these patients. PMID:27095390

  14. Prognosis of chronic low back pain: design of an inception cohort study

    Directory of Open Access Journals (Sweden)

    McAuley James H

    2007-02-01

    Full Text Available Abstract Background Although clinical guidelines generally portray chronic low back pain as a condition with a poor prognosis this portrayal is based on studies of potentially unrepresentative survival cohorts. The aim of this study is to describe the prognosis of an inception cohort of people with chronic low back pain presenting for primary care. Methods/Design The study will be an inception cohort study with one year follow-up. Participants are drawn from a cohort of consecutive patients presenting with acute low back pain (less than 2 weeks duration to primary care clinics in Sydney, Australia. Those patients who continue to experience pain at three months, and are therefore classified as having chronic back pain, are invited to participate in the current study. The cohort will be followed up by telephone at baseline, 9 months and 12 months after being diagnosed with chronic low back pain. Recovery from low back pain will be measured by sampling three different outcomes: pain intensity, interference with function due to pain, and work status. Life tables will be generated to determine the one year prognosis of chronic low back pain. Prognostic factors will be assessed using Cox regression. Discussion This study will determine the prognosis of chronic non-specific low back pain in a representative cohort of patients sourced from primary care. The results of this study will improve understanding of chronic low back pain, allowing clinicians to provide more accurate prognostic information to their patients.

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

    Science.gov (United States)

    Cho, Hwi-Young; Kim, Eun-Hye; Kim, Junesun

    2014-08-01

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

  16. mHealth in Chronic Pain Assessment: Present and Future.

    Science.gov (United States)

    Pliakos, Ioannis; Kefaliakos, Antonios; Diomidous, Marianna

    2016-01-01

    Chronic Pain (CP) is a condition which is difficult to assess. Existing methods are based on self-management treatments and leaving the big part of the assessment on the patient. According on this method, mHealth applications offer tools to CP patients to self-manage their condition and improve it. All the applications are limited by the type of data they collect and the data based on self-reporting. In the future the applications for CP management will not be based only on this type of data. Multiple types of data will be gathered and analyzed, as well as the specialists will be able to have a better prospective for the patients' pain levels. PMID:27350520

  17. mHealth in Chronic Pain Assessment: Present and Future.

    Science.gov (United States)

    Pliakos, Ioannis; Kefaliakos, Antonios; Diomidous, Marianna

    2016-01-01

    Chronic Pain (CP) is a condition which is difficult to assess. Existing methods are based on self-management treatments and leaving the big part of the assessment on the patient. According on this method, mHealth applications offer tools to CP patients to self-manage their condition and improve it. All the applications are limited by the type of data they collect and the data based on self-reporting. In the future the applications for CP management will not be based only on this type of data. Multiple types of data will be gathered and analyzed, as well as the specialists will be able to have a better prospective for the patients' pain levels.

  18. Pathogenesis and mechanisms of pain in chronic pancreatitis

    Institute of Scientific and Technical Information of China (English)

    Dale E. Bockman

    2003-01-01

    The pathology of chronic pancreatitis is well known but the early events leading to the condition are less certain. Common characteristics of chronic pancreatitis, including fibrosis, chronic inflammation, and disappearance of parenchyma, usually are well established by the time tissue can be studied. Characteristics of acute pancreatitis may co-exist. Some experts assert that chronic pancreatitis begins with acute pancreatitis. Others consider that chronic pancreatitis develops first, and acute attacks occur on this background. The pain associated with chronic pancreatitis can be initiated through a variety of mechanisms. Increased pressure may distort nerves, affect blood flow, change pH, and cause retention of noxious substances, initiating action potentials. Tissue destruction and inflammation release biologically active materials capable of activating afferent nerves. Furthermore, inflammation damages nerves directly, triggering neuropathic pain. Understanding the neural pathways in the periphery and central nervous system that transmit impulses interpreted as pain should suggest the best methods for alleviating pancreatic pain. Pain may be transmitted through splanchnic, vagus, spinal, and phrenic peripheral nerves. It may be relayed through the dorsal columns of the spinal cord in addition to the spinothalamic tract. New methods of treating pancreatic pain therefore are possible.%虽然慢性胰腺炎的病理已经十分清楚,但其早期的致病机制尚不明确.慢性胰腺炎的一般特点为纤维化,慢性炎症和胰腺实质的消失,这些特征会随着疾病的发展而逐渐出现,同时还伴有急性胰腺炎的症状.一些专家认为慢性胰腺炎继发于急性胰腺炎.另一些则认为慢性胰腺炎首先发生,急性胰腺炎则在此基础上发生.慢性胰腺炎所引起的疼痛可通过许多机制发生.增高的胰腺压力可干扰神经,影响血流,改变pH值,并引起有毒物质的潴留,激活动作电位.组织的

  19. Predictors of multidisciplinary treatment outcome in patients with chronic musculoskeletal pain

    NARCIS (Netherlands)

    Boonstra, Anne M.; Reneman, Michiel F.; Waaksma, Berend R.; Schiphorst Preuper, Henrica; Stewart, Roy E.

    2015-01-01

    Purpose: The present study aimed to identify predictors of rehabilitation outcome for patients with chronic musculoskeletal pain (CMP) and psychological problems. Methods: A retrospective cohort study including 230 adult patients with CMP admitted for multidisciplinary pain rehabilitation. Potential

  20. Radiofrequency Ablation for Chronic Low Back Pain: A Systematic Review of Randomized Controlled Trials

    Directory of Open Access Journals (Sweden)

    Laura E Leggett

    2014-01-01

    Full Text Available BACKGROUND: Radiofrequency ablation (RFA, a procedure using heat to interrupt pain signals in spinal nerves, is an emerging treatment option for chronic low back pain. Its clinical efficacy has not yet been established.

  1. Self-reported somatosensory symptoms of neuropathic pain in fibromyalgia and chronic widespread pain correlate with tender point count and pressure-pain thresholds

    DEFF Research Database (Denmark)

    Amris, Kirstine; Jespersen, Anders; Bliddal, Henning

    2010-01-01

    Widespread pain and pain hypersensitivity are the hallmark of fibromyalgia, a complex pain condition linked to central sensitization. In this study the painDETECT questionnaire (PDQ), validated to identify neuropathic pain and based on pain quality items, was applied in a cross-sectional sample...... of patients with chronic widespread pain (CWP). The aims of the study were to assess the patient-reported sensory neuropathic symptoms by PDQ and to correlate these with tender point (TP) count and pressure-pain thresholds. Eighty-one patients (75 F, 6 M) with CWP (ACR-criteria) filled in the PDQ. Manual TP...... examination was conducted according to ACR guidelines. Computerized cuff pressure algometry was used for the assessment of pressure-pain detection thresholds (PDT, unit: kPa) and pressure-pain tolerance thresholds (PTT, unit: kPa). Mean TP count was 14.32 (range: 2-18), mean PDQ score 22.75 (range: 5...

  2. Chronic Paraspinal Pain due to Multiple Aortic Aneurysms.

    Science.gov (United States)

    Basu, Arindam; Biswas, Nirendra Mohan; Roy, Pinaki; Maity, Pranab Kumar; Mukhopadhyay, Mainak

    2015-05-01

    Aneurysms of the aorta are not uncommon, both of the thoracic aorta or the abdominal aorta and may be associated with congenital aortic valve diseases, cystic medial necrosis, Marfan's Syndrome or Ehlers-Danlos syndrome, or atherosclerosis. We report a case of a 46 year old smoker who had developed multiple aneurysms of the aorta in both the thoracic and abdominal parts and was incidentally diagnosed on work-up of a chronic back pain associated with venous prominence on left side of chest and left arm. PMID:26591150

  3. Spreading of chronic pain between body regions: Prospective cohort study among health care workers

    OpenAIRE

    Andersen, LL; Clausen, T; Carneiro, IG; Holtermann, A.

    2012-01-01

    Objective To estimate the prognostic value of pain in one body region on the risk for developing chronic pain in other body regions. Methods Prospective cohort study among 5052 Danish female health care workers responding to a baseline and follow-up questionnaire in 2005 and 2006, respectively. Using adjusted logistic regression analysis, the risk for developing chronic pain (>30 days last year) at follow-up in the low back (among those without low back pain during the last year at baseline) ...

  4. Short-term prospective memory deficits in chronic back pain patients

    OpenAIRE

    Ling, Jonathan; Heffernan, Tom; Campbell, Carol; Greenough, Charles G.

    2007-01-01

    Objective: Chronic pain, particularly low back pain, is widespread. Although a great deal is known about the impact that this has on quality of life and physical activity, relatively little has been established regarding the more cognitive effects of pain. This study aims to find out whether individuals with chronic pain experience memory deficits in prospective memory (PM), the process of remembering to do things at some future point in time. Examples of PM include remembering to keep an app...

  5. Radiofrequency ablation for chronic low back pain: A systematic review of randomized controlled trials

    OpenAIRE

    Laura E Leggett; Lesley JJ Soril; Diane L Lorenzetti; Tom Noseworthy; Rodney Steadman; Simrandeep Tiwana; Fiona Clement

    2014-01-01

    BACKGROUND: Radiofrequency ablation (RFA), a procedure using heat to interrupt pain signals in spinal nerves, is an emerging treatment option for chronic low back pain. Its clinical efficacy has not yet been established. OBJECTIVE: To determine the efficacy of RFA for chronic low back pain associated with lumbar facet joints, sacroiliac joints, discogenic low back pain and the coccyx. METHODS: A systematic review was conducted. Medline, EMBASE, PubMed, SPORTDiscus, CINAHL and the Cochrane Lib...

  6. A cognitive-behavioural program for adolescents with chronic pain - A pilot study

    OpenAIRE

    Merlijn, Vivian; Hunfeld, Joke; Wouden, Hans; Hazebroek-Kampschreur, Alice; van Suijlekom-Smit, Lisette; Koes, Bart; Passchier, Jan

    2005-01-01

    textabstractThe purpose of this pilot study is to evaluate the feasibility of a cognitive-behavioural training program for adolescents with chronic pain irrespective of pain localisation. A secondary aim was to give an impression of the effect of the program on pain and quality of life. Eight adolescents (14-18 years) with chronic non-organic pain recruited from the general population (and their parents) participated in this pilot study. The intervention included five group meetings alternate...

  7. Management of chronic pain in the elderly: focus on transdermal buprenorphine

    OpenAIRE

    Vadivelu, Nalini

    2008-01-01

    Nalini Vadivelu, Roberta L HinesDepartment of Anesthesiology, Yale University School of Medicine, New Haven, USAAbstract: Chronic pain in the elderly is a significant problem. Pharmacokinetic and metabolic changes associated with increased age makes the elderly vulnerable to side effects and overdosing associated with analgesic agents. Therefore the management of chronic cancer pain and chronic nonmalignant pain in this growing population is an ongoing challenge. New routes of administration ...

  8. Centering as a model for group visits among women with chronic pelvic pain.

    Science.gov (United States)

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

    2012-01-01

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

  9. Effectiveness of mindfulness meditation (Vipassana) in the management of chronic low back pain

    OpenAIRE

    Patil, Sangram G

    2009-01-01

    Summary Chronic low back pain (CLBP) is challenging to treat with its significant psychological and cognitive behavioural element involved. Mindfulness meditation helps alter the behavioural response in chronic pain situations. Significant body of research in the filed of mindfulness meditation comes from the work of Dr Kabat-Zinn. The current evidence in the field, though not grade one, shows that there is a place for mindfulness meditation in managing chronic pain conditions including CLBP....

  10. Neuro Emotional Technique for the treatment of trigger point sensitivity in chronic neck pain sufferers: A controlled clinical trial

    Directory of Open Access Journals (Sweden)

    Pollard Henry

    2008-05-01

    improved when compared to a control group which received a sham protocol of NET. Chronic neck pain sufferers may benefit from NET treatment in the relief of trigger point sensitivity. Further research including long-term randomised controlled trials for the effect of NET on chronic neck pain, and other chronic pain syndromes are recommended. Trial Registration This trial has been registered and allocated the Australian Clinical Trials Registry (ACTR number ACTRN012607000358448. The ACTR has met the requirements of the ICMJE's trials registration policy and is an ICMJE acceptable registry.

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

    Directory of Open Access Journals (Sweden)

    Gerdle B

    2014-06-01

    Full Text Available Björn Gerdle,1,2 Bijar Ghafouri,1,3 Malin Ernberg,4 Britt Larsson1,21Rehabilitation Medicine, Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden; 2Pain and Rehabilitation Centre, County Council of Östergötland, Linköping, Sweden; 3Rehabilitation Medicine, Department of Medicine and Health Sciences, Linköping University, Linköping, Sweden; 4Department of Dental Medicine, Section of Orofacial Pain and Jaw Function, Karolinska Institutet, Huddinge, SwedenAbstract: Chronic musculoskeletal pain conditions are multifaceted, and approximately 20% of the adult population lives with severe chronic pain, with a higher prevalence in women and in lower income groups. Chronic pain is influenced by and interacts with physical, emotional, psychological, and social factors, and a biopsychosocial framework is increasingly applied in clinical practice. However, there is still a lack of assessment procedures based on the activated neurobiological pain mechanisms (ie, the biological part of the biopsychosocial model of pain, which may be a necessary step for further optimizing outcomes after treatments for patients with chronic pain. It has been suggested that chronic pain conditions are mainly driven by alterations in the central nervous system with little or no peripheral stimuli or nociception. In contrast, other authors argue that such central alterations are driven by peripheral alterations and nociceptive input. Microdialysis is an in vivo method for studying local tissue alterations and allows for sampling of substances in the interstitium of the muscle, where nociceptor free nerve endings are found close to the muscle fibers. The extracellular matrix plays a key role in physiologic functions of cells, including the primary afferent nociceptor. The present review mainly concerns the results of microdialysis studies and how they can contribute to the understanding of activated peripheral nociceptive and pain

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

    Science.gov (United States)

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

    2011-04-01

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

  13. Living with Difference: Exploring the Social Self of Adolescents with Chronic Pain

    Directory of Open Access Journals (Sweden)

    Paula A Forgeron

    2013-01-01

    Full Text Available BACKGROUND: Chronic pain negatively affects an adolescent’s life; however, little is known about the social impact of chronic pain for adolescents. More is known about the general peer relationships of adolescents with chronic pain than their close friendships. Close friendships begin to take on more importance during adolescence as these relationships facilitate the development of an adolescent’s sense of personal identity and increasing independence from family influences. Thus, chronic pain may create friendship challenges for adolescents beyond those typically experienced during this developmental trajectory, which may negatively impact their abilities to secure social support.

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

    Science.gov (United States)

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

    2013-01-01

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

  15. Interprofessional Education for the Dentist in Managing Acute and Chronic Pain.

    Science.gov (United States)

    Shaefer, Jeffry; Barreveld, Antje M; Arnstein, Paul; Kulich, Ronald J

    2016-10-01

    Dental education is at the intersection of affordable health care, opioid-abuse crisis, and collaborative practice benefits. Students must engage in interprofessional education (IPE) for pain management. Graduates must recognize appropriate management of acute dental pain and understand the dentist's role in interprofessional treatment of chronic disease, including management of temporomandibular disorders and orofacial neuropathic pain, chronic pain in general, and the consideration of opioids. This article reviews accreditation standards, compares these standards with recommendations from the International Association for the Study of Pain and regulatory boards, and presents examples of enhanced pain education. PMID:27671956

  16. Changes of brain microstructure in patients with painful chronic pancreatitis assessed by diffusion tensor imaging

    DEFF Research Database (Denmark)

    Frøkjær, Jens Brøndum; Olesen, Søren Schou; Gram, Mikkel;

    Objective In patients with painful chronic pancreatitis (CP) there is increasing evidence of abnormal pain processing in the central nervous system. Using magnetic resonance (MR) diffusion tensor imaging, brain microstructure in areas involved in processing of visceral pain was characterised and...... correlated to patients' clinical pain scores. Conclusion The findings suggest that microstructural changes of the brain accompany pain in CP. The changes are likely to be a consequence of ongoing pain and structural reorganisation of the neuromatrix as also seen in other diseases characterised by chronic...

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

    Science.gov (United States)

    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.

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

    Science.gov (United States)

    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

  19. Chronic pain patients with possible co-morbid post-traumatic stress disorder admitted to multidisciplinary pain rehabilitation

    DEFF Research Database (Denmark)

    Andersen, Tonny Elmose; Andersen, Lou-Ann Christensen; Andersen, Per Grünwald

    2014-01-01

    of a possible PTSD diagnosis with symptoms of pain, physical and mental functioning, as well as the use of opioids, and (2) to compare the outcome of multidisciplinary chronic pain rehabilitation for patients with a possible PTSD diagnosis at admission with patients without PTSD at admission. METHOD......BACKGROUND: Although post-traumatic stress disorder (PTSD) is a common co-morbidity in chronic pain, little is known about the association between PTSD and pain in the context of chronic pain rehabilitation. OBJECTIVE: The aim of the present study was two-fold: (1) to investigate the association...... were admitted to further multidisciplinary treatment and included in the outcome study. RESULTS: A high prevalence of possible PTSD was found (26.3%). Patients with possible co-morbid PTSD experienced significantly poorer general and mental health, poorer sleep quality, and more cognitive problems...

  20. The oxidative response in the chronic constriction injury model of neuropathic pain.

    NARCIS (Netherlands)

    Tan, E.C.T.H.; Bahrami, S.; Kozlov, A.V.; Kurvers, H.A.J.M.; Laak, H.J. ter; Nohl, H.; Redl, H.; Goris, R.J.A.

    2009-01-01

    BACKGROUND: In the chronic constriction injury model of rat neuropathic pain, oxidative stress as well as antioxidants superoxide dismutase and reduced glutathione (GSH) are important determinants of neuropathological and behavioral consequences. Studies of the chronic constriction injury model obse