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Sample records for chronic pain patients

  1. 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.

  2. 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

  3. 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

  4. 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 ...

  5. 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...

  6. 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

  7. 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.

  8. 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....

  9. 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...

  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......, 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...

  11. 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

  12. 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

  13. 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...

  14. 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

  15. 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...

  16. Chronic pain and quality of life in schizophrenic patients

    Directory of Open Access Journals (Sweden)

    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.

  17. 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

  18. Alexithymia and anxiety in female chronic pain patients

    Directory of Open Access Journals (Sweden)

    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.

  19. 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

  20. 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...

  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. 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.

  4. 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

  5. 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

  6. 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.

  7. 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

  8. 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....

  9. 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.

  10. [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

  11. 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

  12. 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.

  13. 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.

  14. 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...

  15. 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

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

    Directory of Open Access Journals (Sweden)

    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. [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.

  18. 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 ...

  19. 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...

  20. 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.

  1. 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 ...

  2. 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.

  3. 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...

  4. 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

  5. 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

  6. 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...

  7. 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 ...

  8. 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.

  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. 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

  11. Profile of sexuality in Moroccan chronic low back pain patients

    Directory of Open Access Journals (Sweden)

    Bahouq Hanane

    2013-02-01

    Full Text Available Abstract Background Sexual life had an important role in preserving the good quality of life for patients and for their partner. Chronic Low Back Pain (CLBP as other musculoskeletal diseases may affect all aspects of life including sexual functioning. The purpose of this study is to describe the impact of CLBP on the sexual life of patients and to identify the factors that affect their Sexual Quality of Life (SQOL. Methods One hundred CLBP sexually active patients were included. Patients and disease Characteristics were collected. Impact on sexual life (sexual intercourse and SQOL was also assessed. Univariate and multivariate analysis were performed to analyze significant determinants associated with the SQOL disturbance. Results Eighty one percent of our patients complained about sexual difficulties related to CLBP. Libido decrease and painful intercourse position were reported respectively in 14.8 and 97.5% of cases. The most pain generating position was supine. Mean of sexual intercourse frequency decrease was at −10.4 ± 4.8 per month. SQOL score mean was at 44.6 ± 17.4%. Men suffered more than women from sexual problems (respectively 90% vs. 72%; p = 0.02. Men had worse SQOL than women (respectively 38.9 ± 17.2 vs. 50.3 ± 15.7%; p = 0.001. Univariate and multivariate analysis showed that advanced age (p = 0.009, poor functional status (p = 0.03, male gender (p = 0.03 and sexual intercourse frequency decrease (p = 0.005 were the independent variables associated with the SQOL disturbance. Conclusion Our study suggests that sexuality is profoundly disturbed in CLBP patients; both their sexual intercourse and SQOL were affected. This disturbance seems to be associated with patient and disease characteristics. Sexuality should be taken into account in managing CLBP patients.

  12. 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 ...

  13. 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...

  14. INTESTINAL PARASITES IN PATIENTS WITH CHRONIC ABDOMINAL PAIN.

    Science.gov (United States)

    Omran, Eman Kh; Mohammad, Asmaa N

    2015-08-01

    Information about intestinal parasites in Sohag (Upper Egypt) in patients with chronic abdominal pain is scarce. This study determined the intestinal parasites symptoms in 130 patients with chronic abdominal pain and cross-matched 20 healthy persons. Parasitic infection was confirmed by stool analysis.The most commonest clinical data with stool analysis was as following: 1-Entamoeba histolytica associated with nausea 20 (3 7.74%) followed by anorexia 19 (35.85%), 2-Entamoeba coli associated with diarrhea 3 (100%) followed by nausea 2 (66.67%) and vomiting 2 (66.67%), 3-Enetrobius vermicularis associated with nausea 2 (66.67%), diarrhea 2 (66.67%) followed by flatulence 1(33.33%), 4-Giardia lamblia associated with anorexia 3 (42.86%), vomiting 3 (42.86%) followed by diarrhea 2 (28.57%)., 6-Hymenolepis nana associated with anorexia 10 (40.00%) followed by flatulence 9 (36.00%), 7-Taenia saginata associated with dyspepsia 3 (60.00%) followed by flatulence 2 (40.00%), and 8-Ancylostoma duodenal associated with anorexia 2 (66.67%) and diarrhea 2 (66.67%). PMID:26485858

  15. 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

  16. 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

  17. 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....

  18. 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 ...

  19. 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

  20. 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…

  1. 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...

  2. Interdisciplinary rehabilitation of patients with chronic widespread pain:

    DEFF Research Database (Denmark)

    Amris, Kirstine; Wæhrens, Eva E; Christensen, Robin;

    2014-01-01

    This study examined the functional and psychological outcomes of a 2-week, group-based multicomponent treatment course that targeted patients with chronic widespread pain. Patients (192 included in the intention-to-treat population), all fulfilling the 1990 American College of Rheumatology...... classification criteria for fibromyalgia, were consecutively recruited from a tertiary care setting and randomized (1:1) to either the treatment course or a waiting list control group. Co-primary outcomes were the Assessment of Motor and Process Skills (AMPS) and SF-36 Mental Composite Score (MCS) evaluated at 6......-month follow-up. Primary endpoints were partly achieved with a statistically significant improvement in AMPS activities of daily living motor (group mean difference: 0.20 [95% confidence interval (CI): 0.09 to 0.31] logits; P=.0003) and AMPS activities of daily living process (0.20 [95% CI: 0.12 to 0...

  3. 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....

  4. Cognitive-Somatic Anxiety Response Patterning in Chronic Pain Patients and Nonpatients.

    Science.gov (United States)

    DeGood, Douglas E.; And Others

    1985-01-01

    Examined group differences in self-reporting anxiety for one hundred chronic pain patients, an equal number of college students, and two smaller comparison samples. Pain patients, relative to nonpatients, acknowledged dramatically fewer total signs of anxiety. Also, pain patients endorsed significantly more somatic than cognitive indicators of…

  5. 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

  6. Undiagnosed mood disorders and sleep disturbances in primary care patients with chronic musculoskeletal pain.

    OpenAIRE

    2013-01-01

    Objective. The study aims to determine the prevalence of undiagnosed comorbid mood disorders in patients suffering chronic musculoskeletal pain in a primary care setting and to identify sleep disturbances and other associated factors in these patients, and to compare the use of health services by chronic musculoskeletal pain patients with and without comorbid mood disorders. Design. Cross-sectional study. Subjects. A total of 1,006 patients with chronic musculoskele...

  7. 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

  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. Toward an Empirically Derived Taxonomy of Chronic Pain Patients: Integration of Psychological Assessment Data.

    Science.gov (United States)

    Turk, Dennis C.; Rudy, Thomas E.

    1988-01-01

    Developed and cross-validated an empirically derived classification system of chronic pain patients. Identified three unique subgroups of chronic pain patients, labeled dysfunctional, interpersonally distressed, and minimizers/adaptive copers. Cross-validated and confirmed the uniqueness and accuracy of the taxonomy in a second study. Offers…

  10. 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...

  11. Outcomes of Follow-Up Visits to Chronic Nonmalignant Pain Patients

    DEFF Research Database (Denmark)

    Sørensen, Jan

    2010-01-01

    to chronic nonmalignant pain patients regarding health-related quality of life (HRQoL), pain, opioid treatment, quality of sleep, and depression. A total of 102 patients were enrolled in a prospective randomized controlled trial during a 2-year period after discharge from multidisciplinary pain treatment...

  12. Reduced cortical thickness of brain areas involved in pain processing in patients with chronic pancreatitis.

    NARCIS (Netherlands)

    Frokjaer, J.B.; Bouwense, S.A.W.; Olesen, S.S.; Lundager, F.H.; Eskildsen, S.F.; Goor, H. van; Wilder-Smith, O.H.G.; Drewes, A.M.

    2012-01-01

    BACKGROUND & AIMS: Patients with painful chronic pancreatitis (CP) might have abnormal brain function. We assessed cortical thickness in brain areas involved in visceral pain processing. METHODS: We analyzed brain morphologies of 19 patients with painful CP and compared them with 15 healthy individu

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

    Science.gov (United States)

    Lackner, Jeffrey M.; And Others

    1996-01-01

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

  14. 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 ...

  15. Pregabalin and placebo responders show different effects on central pain processing in chronic pancreatitis patients

    NARCIS (Netherlands)

    Bouwense, S.A.; Olesen, S.S.; Drewes, A.M.; Goor, H. van; Wilder-Smith, O.H.G.

    2015-01-01

    BACKGROUND: Pain control in chronic pancreatitis is a major challenge; the mechanisms behind analgesic treatment are poorly understood. This study aims to investigate the differences in pain sensitivity and modulation in chronic pancreatitis patients, based on their clinical response (responders vs

  16. 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.

  17. Treatment of myofascial trigger points in patients with chronic shoulder pain : a randomized, controlled trial

    NARCIS (Netherlands)

    Bron, Carel; de Gast, Arthur; Dommerholt, Jan; Stegenga, Boudewijn; Wensing, Michel; Oostendorp, Rob A. B.

    2011-01-01

    Background: Shoulder pain is a common musculoskeletal problem that is often chronic or recurrent. Myofascial trigger points (MTrPs) cause shoulder pain and are prevalent in patients with shoulder pain. However, few studies have focused on MTrP therapy. The aim of this study was to assess the effecti

  18. SURGICAL TREATMENT OF PAIN IN CHRONIC PANCREATITIS:STUDIES OF 111 PATIENTS

    Institute of Scientific and Technical Information of China (English)

    D. Guinier; P. Mathieu; B. Heyd; G. Mantion

    2004-01-01

    Objective Evaluation of the efficacy of pancreatic resections for the treatment of chronic pains during chronic pancreatitis. Methods Retrospective study of inpatients for chronic pancreatitis between 1982 to 2000. Purpose of admission, morphological changes, treatments and results were evaluated. Results 142 patients were admitted for chronic pancreatitis. 111 patients suffered from chronic pains, due to morphological changes such as pseudocysts, inflammatory masses in the head, dilated pancreatic ducts, biliary or duodenal compressions. Denervations were never efficient, pancreatic resections achieved relief of pain in up to 75% of cases and drainages were efficient in 52% of cases. Conclusions Pancreatic resections during chronic pancreatitis seem to be the most efficient treatment of chronic pains. New techniques such as duodenum-preserving head resection or total pancreatectomy with islet autotransplantation should improve these results.

  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. FEATURES OF THE CHRONIC PAIN SYNDROME IN PATIENTS WITH RHEUMATOID ARTHRITIS AND MEDICAL DIAGNOSTIC TACTICS

    Directory of Open Access Journals (Sweden)

    M. A. Gromova

    2016-01-01

    Full Text Available Objective: to establish features of a chronic pain syndrome disorders in patients with rheumatoid arthritis, to reveal correlation with psychoemotional disorders and to develop the differential approach to maintaining patients. Materials and methods. 101 patients at the age of 60.6 ± 11.8 years, 92 % of women, with reliable rheumatoid arthritis (American College of Rheumatology – ACR, 1987, were examined. The visual analog scale was used for an assessment of pain strength at the moment; the Van Korff’s questionnaire – for determination of pain strength at the moment and retrospectively for the last half a year with an assessment of disadaptation level and disability, ranging of a chronic pain syndrome on classes; the McGill Pain Questionnaire – for the characteristic of touchsensitive and emotional components of pain. Neuropathic pain was revealed by DN4 questionnaire. Anxiety and depression were determined by the Hospital Anxiety and Depression Scale (HADS. Fibromyalgia diagnosed by criteria of ACR, (1990. Results. Pain estimated by various scales and questionnaires varied from moderated to intensive. According to Van Korff’s questionnaire it was characterized by average level of disadaptation and easy disability that corresponded to the second class of chronic pain. The Rank pain index of the McGill Pain Questionnaire touch scale testified that pain was described by a smaller number of definitions on a touch scale than on emotional. This indicates a moderate impact of pain syndrome on a state of mind. Neuropathic pain is diagnosed for 37.3 % of patients with tunnel syndrome, mononeuritis and touch polyneuropathy. The secondary fibromyalgia is revealed for 2 % of patients with early rheumatoid arthritis of high activity. According to HADS anxiety and depression was revealed for 58 and 59 % of patients correspondingly. This demanded psychotherapeutic consultation and additional correction. We proposed the algorithm of diagnostic and

  1. 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 ...

  2. Minimally invasive spine surgery in chronic low back pain patients

    NARCIS (Netherlands)

    Spoor, A. B.; Oner, F. C.

    2013-01-01

    Low back pain (LBP) is a common disorder with a lifetime prevalence of 85%. The pathophysiology of LBP can be various depending on the underlying problem. Only in about 10% of the patients specific underlying disease processes can be identified. Patients with scoliosis, spondylolisthesis, herniated

  3. Effects of Parasternal Block on Acute and Chronic Pain in Patients Undergoing Coronary Artery Surgery.

    Science.gov (United States)

    Doğan Bakı, Elif; Kavrut Ozturk, Nilgün; Ayoğlu, Rauf Umut; Emmiler, Mustafa; Karslı, Bilge; Uzel, Hanife

    2016-09-01

    Background Sternotomy causes considerable postoperative pain and postoperative pain management encompasses different analgesic regimens. In this study, we aimed to investigate the effect of peroperative parasternal block with levobupivacaine on acute and chronic pain after coronary artery bypass graft surgery. Materials and Methods A total of 81 patients undergoing coronary artery bypass graft surgery were included in this study. Patients were randomly allocated by opening an envelope to receive either parasternal block with pharmacologic analgesia (group P; before sternal wire placement: sternotomy and mediastinal tube sites were infiltrated with local anesthetics) or pharmacologic analgesia alone (group C) for postoperative pain relief. All patients received intravenous tramadol with patient-controlled analgesia at the end of the surgery. Demographic characteristics, vital signs, tramadol consumption, analgesic intake, and intensity of pain with a visual analogue scale were recorded for each patient. Six months after surgery, the patients' type of chronic pain was evaluated using the Leeds Assessment Neuropathic Symptoms and Signs pain scale questionnaire. Results Patients who received parasternal block experienced less pain and needed less opioid analgesic (125.75 ± 28.9 mg in group P vs 213.17 ± 61.25 mg in group C) for 24 hours postoperatively (P block had a benefical effect on the management of postoperative acute pain and decreased opioid consumption after surgery but had no significant effect in chronic post surgical pain. PMID:25900900

  4. Quality of sleep in patients with chronic low back pain: a case-control study.

    Science.gov (United States)

    Marty, M; Rozenberg, S; Duplan, B; Thomas, P; Duquesnoy, B; Allaert, F

    2008-06-01

    Animal experiments and studies in humans clearly show that the relation between pain (acute and chronic) and sleep quality is two-way: sleep disorders can increase pain, which in turn may cause sleep disorders. Sleep disorders and chronic low back pain are frequent health problems and it is unsurprising that the two can co-exist. This study was conducted to evaluate if sleep disorders and chronic pain associated are more frequently than one would expect. The objective of the study was to compare sleep quality in a population of patients with chronic low back pain and a control population. Sleep quality was assessed in 101 patients with chronic low back pain (CLBP) and in 97 sex- and age-matched healthy control subjects using the Pittsburgh Sleep Quality Index [PSQI; score from 0 (no disorder) to 21]. The French version of the Dallas Pain Questionnaire (DPQ) was used to assess the impact of low back pain on patients' quality of life. This impact was taken as nil in the healthy controls. The patients with CLBP and the controls were comparable in age, sex, and height, but mean bodyweight was higher in the CLBP group (70.3 +/- 14.5 vs. 61.8 +/- 11.4 kg; P low back pain on daily life. Our findings do not indicate whether sleep disorders are a cause or a consequence of CLBP. PMID:18389288

  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. [Pain syndromes following amputation. Analysis of 100 affected patients with chronic stump and phantom pain].

    Science.gov (United States)

    Wörz, R; Wörz, E

    1990-02-10

    One hundred amputees (m = 95, f = 5) with a pain syndrome were analysed. In 80 patients post-amputation pain of the lower, in 20 of the upper, extremities presented. Thirty-two patients suffered bouts of pain, 68 constant pain of various types. The most commonly cited type of pain in the patients with intermittent pain was lancinating, in the case of constant pain a burning sensation. In some patients pain occurred immediately after the loss of the limb, in others not until several years, or even decades, later. Forty per cent of our patients indicated that the incidence and intensity of the pain increased with time. Neurological, orthopedic and internistic causes of stump or phantom pain have been described. In 72% of the patients with constant pain and in 34% of those suffering from bouts of pain, an algogenic psychosyndrome had developed. Complications and late sequelae of amputations are of considerable significance for the development and intensity of stump and phantom pain.

  7. 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.

  8. Predictors of outcome in neck pain patients undergoing chiropractic care: comparison of acute and chronic patients

    Directory of Open Access Journals (Sweden)

    Peterson Cynthia

    2012-08-01

    Full Text Available Abstract Background Neck pain is a common complaint in patients presenting for chiropractic treatment. The few studies on predictors for improvement in patients while undergoing treatment identify duration of symptoms, neck stiffness and number of previous episodes as the strong predictor variables. The purpose of this study is to continue the research for predictors of a positive outcome in neck pain patients undergoing chiropractic treatment. Methods Acute ( 3 months (n = 255 neck pain patients with no chiropractic or manual therapy in the prior 3 months were included. Patients completed the numerical pain rating scale (NRS and Bournemouth questionnaire (BQ at baseline prior to treatment. At 1 week, 1 month and 3 months after start of treatment the NRS and BQ were completed along with the Patient Global Impression of Change (PGIC scale. Demographic information was provided by the clinician. Improvement at each of the follow up points was categorized using the PGIC. Multivariate regression analyses were done to determine significant independent predictors of improvement. Results Baseline mean neck pain and total disability scores were significantly (p  Conclusions The most consistent predictor of clinically relevant improvement at both 1 and 3 months after the start of chiropractic treatment for both acute and chronic patients is if they report improvement early in the course of treatment. The co-existence of either radiculopathy or dizziness however do not imply poorer prognosis in these patients.

  9. Attentional Bias For Prescription Opioid Cues Among Opioid Dependent Chronic Pain Patients

    OpenAIRE

    GARLAND, ERIC L.; Froeliger, Brett; Passik, Steven D.; Howard, Matthew O

    2012-01-01

    Recurrent use of prescription opioid analgesics by chronic pain patients may result in opioid dependence, which involves implicit neurocognitive operations that organize and impel craving states and compulsive drug taking behavior. Prior studies have identified an attentional bias (AB) towards heroin among heroin dependent individuals. The aim of this study was to determine whether opioid-dependent chronic pain patients exhibit an AB towards prescription opioidrelated cues. Opioid-dependent c...

  10. Comparison of Contraction Rates of Abdominal Muscles of Chronic Low Back Pain Patients in Different Postures

    OpenAIRE

    Cho, Sung-Hak; Kim, Kang Hoon; Baek, Il-Hun; Goo, Bong-Oh

    2013-01-01

    [Purpose] This study examined the contraction rates of abdominal muscles in relation to the posture of chronic lumbar pain patients and normal subjects. [Subjects] The subjects were 17 chronic low back pain (CLBP) patients and 17 normal people between the ages of 20 and 59. [Methods] Experimental postures included a supine position, a sitting position, and a standing position. Measurements were taken at rest and during abdominal contraction. The measurement at rest was taken during expiration...

  11. Opioid-induced hyperalgesia in chronic pain patients and the mitigating effects of gabapentin.

    Science.gov (United States)

    Stoicea, Nicoleta; Russell, Daric; Weidner, Greg; Durda, Michael; Joseph, Nicholas C; Yu, Jeffrey; Bergese, Sergio D

    2015-01-01

    Chronic pain patients receiving opioid drugs are at risk for opioid-induced hyperalgesia (OIH), wherein opioid pain medication leads to a paradoxical pain state. OIH involves central sensitization of primary and secondary afferent neurons in the dorsal horn and dorsal root ganglion, similar to neuropathic pain. Gabapentin, a gamma-aminobutyric acid (GABA) analog anticonvulsant used to treat neuropathic pain, has been shown in animal models to reduce fentanyl hyperalgesia without compromising analgesic effect. Chronic pain patients have also exhibited lower opioid consumption and improved pain response when given gabapentin. However, few human studies investigating gabapentin use in OIH have been performed in recent years. In this review, we discuss the potential mechanisms that underlie OIH and provide a critical overview of interventional therapeutic strategies, especially the clinically-successful drug gabapentin, which may reduce OIH.

  12. Opioid-Induced Hyperalgesia in Chronic Pain Patients and the Mitigating Effects of Gabapentin

    Directory of Open Access Journals (Sweden)

    Nicoleta eStoicea

    2015-05-01

    Full Text Available Chronic pain patients receiving opioid drugs are at risk for opioid-induced hyperalgesia (OIH, wherein opioid pain medication leads to a paradoxical pain state. OIH involves central sensitization of primary and secondary afferent neurons in the dorsal horn and dorsal root ganglion, similar to neuropathic pain. Gabapentin, a gamma-aminobutyric acid (GABA analogue anticonvulsant used to treat neuropathic pain, has been shown in animal models to reduce fentanyl hyperalgesia without compromising analgesic effect. Chronic pain patients have also exhibited lower opioid consumption and improved pain response when given gabapentin. However, few human studies investigating gabapentin use in OIH have been performed in recent years. In this review, we discuss the potential mechanisms that underlie OIH and provide a critical overview of interventional therapeutic strategies, especially the clinically-successful drug gabapentin, which may reduce OIH.

  13. Dressing-related pain in patients with chronic wounds: an international patient perspective.

    Science.gov (United States)

    Price, Patricia E; Fagervik-Morton, Hilde; Mudge, Elizabeth J; Beele, Hilde; Ruiz, Jose Contreras; Nystrøm, Theis Huldt; Lindholm, Christina; Maume, Sylvie; Melby-Østergaard, Britta; Peter, Yolanda; Romanelli, Marco; Seppänen, Salla; Serena, Thomas E; Sibbald, Gary; Soriano, Jose Verdú; White, Wendy; Wollina, Uwe; Woo, Kevin Y; Wyndham-White, Carolyn; Harding, Keith G

    2008-06-01

    This cross-sectional international survey assessed patients' perceptions of their wound pain. A total of 2018 patients (57% female) from 15 different countries with a mean age of 68.6 years (SD = 15.4) participated. The wounds were categorised into ten different types with a mean wound duration of 19.6 months (SD = 51.8). For 2018 patients, 3361 dressings/compression systems were being used, with antimicrobials being reported most frequently (n= 605). Frequency of wound-related pain was reported as 32.2%, 'never' or 'rarely', 31.1%, 'quite often' and 36.6%, 'most' or 'all of the time', with venous and arterial ulcers associated with more frequent pain (P= 0.002). All patients reported that 'the wound itself' was the most painful location (n= 1840). When asked if they experienced dressing-related pain, 286 (14.7%) replied 'most of the time' and 334 (17.2%) reported pain 'all of the time'; venous, mixed and arterial ulcers were associated with more frequent pain at dressing change (P dressing change, for 449 (22.2%) it took 1-2 hours, for 192 (9.5%) it took 3-5 hours and for 154 (7.6%) patients it took more than 5 hours. Pain intensity was measured using a visual analogue scale (VAS) (0-100) giving a mean score of 44.5 (SD = 30.5, n= 1981). Of the 1141 who reported that they generally took pain relief, 21% indicated that they did not feel it was effective. Patients were asked to rate six symptoms associated with living with a chronic wound; 'pain' was given the highest mean score of 3.1 (n= 1898). In terms of different types of daily activities, 'overdoing things' was associated with the highest mean score (mean = 2.6, n= 1916). During the stages of the dressing change procedure; 'touching/handling the wound' was given the highest mean score of 2.9, followed by cleansing and dressing removal (n= 1944). One thousand four hundred and eighty-five (80.15%) patients responded that they liked to be actively involved in their dressing changes, 1141 (58.15%) responded that

  14. Synergistic effect of a rehabilitation program and treadmill exercise on pain and dysfunction in patients with chronic low back pain.

    Science.gov (United States)

    Cho, Young-Ki; Kim, Dae-Young; Jung, Sun-Young; Seong, Jun-Hyuk

    2015-04-01

    [Purpose] The present study examined the influence of treadmill exercise added to a low back pain rehabilitation program on low back extensor strength, pain, and dysfunction in chronic low back pain patients. [Subjects and Methods] Twenty men aged 22-36 years with chronic low back pain were randomly divided into experimental and control groups of 10 patients each. Both groups underwent a low back pain rehabilitation program lasting 30 min each, thrice/week for 8 weeks. The experimental group was prescribed an additional 30 min of treadmill exercise without a slope at a speed of 3.0-3.5 km/h, at which patients could walk comfortably. Low back extensor strength was tested using the Medx lumbar extension machine, pain level was tested, using the visual analog scale, and dysfunction was tested, using the Oswestry Low Back Pain Disability Questionnaire. [Results] Changes in low back extensor strength by angle showed significant interaction effects between measurement time and group at 12°, 24°, and 36°. The results of the visual analog scale and Oswestry Questionnaire showed a decreasing trend after the experiment in both groups. However, there was no interaction effect of the additional treadmill exercise in the experimental group. [Conclusion] The combination of a low back pain rehabilitation program and treadmill exercise has a synergistic effect, to some extent, on the improvement of low back extensor strength and should be considered for treatment and rehabilitation of low back pain patients.

  15. Generalized deep-tissue hyperalgesia in patients with chronic low-back pain

    DEFF Research Database (Denmark)

    O'Neill, Søren; Manniche, Claus; Graven-Nielsen, Thomas;

    2007-01-01

    demonstrated in a group of patients with chronic low-back pain with intervertebral disc herniation. Twelve patients with MRI confirmed lumbar intervertebral disc herniation and 12 age and sex matched controls were included. Subjects were exposed to quantitative nociceptive stimuli to the infraspinatus and...... in the anterior tibialis muscle compared to controls. In conclusion, generalized deep-tissue hyperalgesia was demonstrated in chronic low-back pain patients with radiating pain and MRI confirmed intervertebral disc herniation, suggesting that this central sensitization should also be addressed in the...

  16. The Efficacy of a Perceptive Rehabilitation on Postural Control in Patients with Chronic Nonspecific Low Back Pain

    Science.gov (United States)

    Paolucci, Teresa; Fusco, Augusto; Iosa, Marco; Grasso, Maria R.; Spadini, Ennio; Paolucci, Stefano; Saraceni, Vincenzo M.; Morone, Giovanni

    2012-01-01

    Patients with chronic low back pain have a worse posture, probably related to poor control of the back muscles and altered perception of the trunk midline. The aim of this study was to evaluate the efficacy of a perceptive rehabilitation in terms of stability and pain relief in patients with chronic nonspecific low back pain. Thirty patients were…

  17. 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 ...

  18. 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...

  19. 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...

  20. Chronic Foot Pain due to Pachyonychia Congenita in a Pediatric Patient: A Successful Management Strategy.

    Science.gov (United States)

    Tariq, Sarah; Schmitz, Michael L; Kanjia, Megha Karkera

    2016-05-15

    We report the case of an 11-year-old girl who presented to our multidisciplinary pain center with the chief complaint of chronic bilateral foot pain because of a rare congenital keratin disorder. This patient had been diagnosed with pachyonychia congenita, an extremely rare genetic disorder primarily affecting the skin and nails. The child had bilateral foot pain for years because of the characteristic blisters and calluses on the soles of her feet. Chronic pain was negatively impacting her quality of life; she was severely limited in her activities of daily living secondary to pain. Furthermore, she reported absenteeism from school, lack of social activities, and frequent nighttime awakenings. We discuss the successful management of her chronic foot pain using a multimodal, multidisciplinary approach. PMID:27182712

  1. Limbic associated pelvic pain: a hypothesis to explain the diagnostic relationships and features of patients with chronic pelvic pain.

    Science.gov (United States)

    Fenton, Bradford W

    2007-01-01

    Limbic associated pelvic pain is a proposed pathophysiology designed to explain features commonly encountered in patients with chronic pelvic pain, including the presence of multiple pain diagnoses, the frequency of previous abuse, the minimal or discordant pathologic changes of the involved organs, the paradoxical effectiveness of many treatments, and the recurrent nature of the condition. These conditions include endometriosis, interstitial cystitis, irritable bowel syndrome, levator ani syndrome, pelvic floor tension myalgia, vulvar vestibulitis, and vulvodynia. The hypothesis is based on recent improvements in the understanding of pain processing pathways in the central nervous system, and in particular the role of limbic structures, especially the anterior cingulate cortex, hippocampus and amygdala, in chronic and affective pain perception. Limbic associated pelvic pain is hypothesized to occur in patients with chronic pelvic pain out of proportion to any demonstrable pathology (hyperalgesia), and with more than one demonstrable pain generator (allodynia), and who are susceptible to development of the syndrome. This most likely occurs as a result of childhood sexual abuse but may include other painful pelvic events or stressors, which lead to limbic dysfunction. This limbic dysfunction is manifest both as an increased sensitivity to pain afferents from pelvic organs, and as an abnormal efferent innervation of pelvic musculature, both visceral and somatic. The pelvic musculature undergoes tonic contraction as a result of limbic efferent stimulation, which produces the minimal changes found on pathological examination, and generates a further sensation of pain. The pain afferents from these pelvic organs then follow the medial pain pathway back to the sensitized, hypervigilant limbic system. Chronic stimulation of the limbic system by pelvic pain afferents again produces an efferent contraction of the pelvic muscles, thus perpetuating the cycle. This cycle is

  2. 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 ...

  3. 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? ...

  4. Pathological C-fibres in patients with a chronic painful condition.

    Science.gov (United States)

    Ørstavik, Kristin; Weidner, Christian; Schmidt, Roland; Schmelz, Martin; Hilliges, Marita; Jørum, Ellen; Handwerker, Herman; Torebjörk, Erik

    2003-03-01

    Little is known about the contribution of C-afferent fibres to chronic painful conditions in humans. We sought to investigate the role of C-fibres in the pathophysiology of pain and hyperalgesia in erythromelalgia as a model disease for chronic pain. Erythromelalgia is a condition characterized by painful, red and hot extremities, and patients often report tenderness on walking. We made microneurographic recordings from single C-fibres in cutaneous fascicles of the peroneal nerve in patients suffering from this disease. All patients had had a pain attack recently and psychophysical signs of allodynia and punctate hyperalgesia were found. We obtained recordings from a total of 103 C-fibres and found significantly lower conduction velocities and increased activity-dependent slowing of the conduction velocity of afferent C-fibres in the patients compared with healthy controls. Furthermore, several units with biophysical properties of mechano-insensitive fibres were pathological, being spontaneously active or sensitized to mechanical stimuli. Since these fibres also mediate the axon reflex flare, their hyperexcitability might account not only for ongoing pain and tenderness but also for redness and warming in this pain syndrome. The changes in conductive properties found in the C-fibres of these patients could be the first signs of a small-fibre neuropathy. This is the first systematic study of single C-fibres in patients and it shows an active contribution of mechano-insensitive fibres to chronic pain. PMID:12566278

  5. 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

  6. Chronic orofacial pain in dental patients: retrospective investigation over 12 years.

    Science.gov (United States)

    Tomoyasu, Yumiko; Higuchi, Hitoshi; Mori, Megumi; Takaya, Kumiko; Honda, Yuka; Yamane, Ayaka; Yabuki, Akiko; Hayashi, Tomoko; Ishii-Maruyama, Minako; Jinzenji, Ayako; Maeda, Shigeru; Kohjitani, Atsushi; Shimada, Masahiko; Miyawaki, Takuya

    2014-01-01

    Orofacial pain is often difficult to diagnose and treat. However, there have been few reports on the clinical observation of dental patients with orofacial pain. We retrospectively investigated the characteristics of 221 dental patients who had suffered from persistent orofacial pain. Data were collected from the outpatient medical records in our clinic over the past 12 years. More than half of the patients (53.8%) had suffered with pain for more than 6 months from pain onset until the first visit to our clinic. The main diagnoses were neuropathic pain (30.3%), myofascial pain (23.5%), psychogenic pain (20.4%), odontogenic toothache (17.2%), and others (7.7%) such as temporomandibular disorders and glossitis. The treatments included pharmacotherapy, splint therapy, and others such as nerve block, dental treatment, physiotherapy, and/or psychotherapy. Excluding the patients (52 of 221 initially enrolled patients) with unknown responses to treatment, 65.7% showed remission or a significant improvement in pain in response to treatment. Although only a small group of patients had odontogenic toothache, the rate of improvement was highest for this disorder. In conclusion, early consultation with a dentist is useful to prevent chronicity of odontogenic pain and to make a differential diagnosis in patients with orofacial pain. PMID:25338483

  7. Intrathecal clonidine and adenosine: effects on pain and sensory processing in patients with chronic regional pain syndrome.

    Science.gov (United States)

    Rauck, Richard L; North, James; Eisenach, James C

    2015-01-01

    Chronic pain may be accompanied by hyperalgesia and allodynia, and analgesic interventions may reduce these hypersensitivity phenomena. Preclinical data suggest that intrathecal clonidine and adenosine reduce hypersensitivity, but only clonidine reduces pain; therefore, we tested the effects of these interventions in patients with chronic pain. Twenty-two subjects with pain and hyperalgesia in a lower extremity from complex regional pain syndrome were recruited in a double-blind crossover study to receive intrathecal clonidine, 100 μg, or adenosine, 2 mg. Primary outcome measure was proportion with ≥30% reduction in pain 2 hours after injection, and secondary measures were pain report, areas of hypersensitivity, and temporal summation to heat stimuli. Treatments did not differ in the primary outcome measure (10 met success criterion after clonidine administration and 5 after adenosine administration), although they did differ in pain scores over time, with clonidine having a 3-fold greater effect (P = 0.014). Both drugs similarly reduced areas of hyperalgesia and allodynia by approximately 30% and also inhibited temporal summation. The percentage change in pain report did not correlate with the percentage change in areas of hyperalgesia (P = 0.09, r = 0.08) or allodynia (P = 0.24, r = 0.24) after drug treatment. Both intrathecal clonidine and adenosine acutely inhibit experimentally induced and clinical hypersensitivity in patients with chronic regional pain syndrome. Although these drugs do not differ in analgesia by the primary outcome measure, their difference in effect on pain scores over time and lack of correlation between effect on pain and hypersensitivity suggest that analgesia does not parallel antihyperalgesia with these treatments.

  8. Practical considerations and patient selection for intrathecal drug delivery in the management of chronic pain

    OpenAIRE

    Saulino M; Kim PS; Shaw E

    2014-01-01

    Michael Saulino,1,2 Philip S Kim,3,4 Erik Shaw5 1MossRehab, Elkins Park, PA, USA; 2Department of Rehabilitation Medicine, Jefferson Medical College, Philadelphia, PA, USA; 3Helen F Graham Cancer Center, Christiana Care Health System, Newark, DE, USA; 4Center for Interventional Pain Spine, LLC., Bryn Mawr, PA, USA; 5Shepherd Pain Institute, Shepherd Center, Atlanta, GA, USA Abstract: Chronic pain continues to pose substantial and growing challenges for patients, caregivers, health care profes...

  9. Clinical practice guidelines for chronic non-malignant pain syndrome patients.

    Science.gov (United States)

    Sanders, S H; Rucker, K S; Anderson, K O; Harden, R N; Jackson, K W; Vicente, P J; Gallagher, R M

    1995-01-01

    The current paper provides specific guidelines for treating chronic non-malignant pain syndrome patients. The guidelines were developed from an extensive review of existing literature on practice guidelines, the research literature, and common clinical practice across major pain treatment facilities in the USA. They are intended for application to all chronic pain syndrome patients (other than cancer pain) regardless of specific site or etiology of pain. They advocate goal directed treatment to reduce medication misuse and invasive medical procedures, maximize and maintain physical activity, return to productive activity, increase the patient's ability to manage pain, reduce subjective pain intensity, reduce or eliminate the use of healthcare services for primary pain complaint, provide useful information for case settlement, and minimize treatment cost without sacrificing quality. The guidelines recommend interdisciplinary integrated evaluation and treatment on a time limit basis with a focus on conservative medical, psychological behavioral, physical, and vocational interventions based upon the patient's needs. There is emphasis on increasing the patient's level of function and ability to manage pain and related problems. Outpatient care is strongly recommended, with specific upper limits regarding treatment intensity and the use of trigger point injections and nerve blocks delineated. The guidelines also recommend that the long term use of opioid or sedative-hypnotic medications, surgery, implantable spinal devices, or brain stimulation techniques be avoided with chronic pain syndrome patients. These guidelines are intended to serve as a starting point to effectively extend and complement those released by the Agency for Health Care Policy and Research for other types of pain problems such as cancer and acute low back pain. PMID:24572192

  10. Psychological characteristics of Japanese patients with chronic pain assessed by the Rorschach test

    Directory of Open Access Journals (Sweden)

    Abe Tetsuya

    2010-11-01

    Full Text Available Abstract Background The increasing number of patients with chronic pain in Japan has become a major issue in terms of the patient's quality of life, medical costs, and related social problems. Pain is a multi-dimensional experience with physiological, affective, cognitive, behavioral and social components, and recommended to be managed via a combination of bio-psycho-social aspects. However, a biomedical approach is still the dominant method of pain treatment in Japan. The current study aimed to evaluate comprehensive psychological functions and processes in Japanese chronic pain patients. Methods The Rorschach Comprehensive System was administered to 49 in-patients with non-malignant chronic pain. Major variables and frequencies from the test were then compared to normative data from non-patient Japanese adults by way of the t-test and chi-square test. Results Patients exhibited high levels of emotional distress with a sense of helplessness with regard to situational stress, confusion, and ambivalent feelings. These emotions were managed by the patients in an inappropriate manner. Cognitive functions resulted in moderate dysfunction in all stages. Information processing tended to focus upon minute features in an inflexible manner. Mediational dysfunction was likely to occur with unstable affective conditions. Ideation was marked by pessimistic and less effective thinking. Since patients exhibited negative self-perception, their interpersonal relationship skills tended to be ineffective. Originally, our patients displayed average psychological resources for control, stress tolerance, and social skills for interpersonal relationships. However, patient coping styles were either situation- or emotion-dependent, and patients were more likely to exhibit emotional instability influenced by external stimuli, resulting in increased vulnerability to pain. Conclusions Data gathered from the Rorschach test suggested psychological approaches to support

  11. Practical considerations and patient selection for intrathecal drug delivery in the management of chronic pain.

    Science.gov (United States)

    Saulino, Michael; Kim, Philip S; Shaw, Erik

    2014-01-01

    Chronic pain continues to pose substantial and growing challenges for patients, caregivers, health care professionals, and health care systems. By the time a patient with severe refractory pain sees a pain specialist for evaluation and management, that patient has likely tried and failed several nonpharmacologic and pharmacologic approaches to pain treatment. Although relegated to one of the interventions of "last resort", intrathecal drug delivery can be useful for improving pain control, optimizing patient functionality, and minimizing the use of systemic pain medications in appropriately selected patients. Due to its clinical and logistical requirements, however, intrathecal drug delivery may fit poorly into the classic pain clinic/interventional model and may be perceived as a "critical mass" intervention that is feasible only for large practices that have specialized staff and appropriate office resources. Potentially, intrathecal drug delivery may be more readily adopted into larger practices that can commit the necessary staff and resources to support patients' needs through the trialing, initiation, monitoring, maintenance, and troubleshooting phases of this therapy. Currently, two agents - morphine and ziconotide - are approved by the United States Food and Drug Administration for long-term intrathecal delivery. The efficacy and safety profiles of morphine have been assessed in long-term, open-label, and retrospective studies of >400 patients with chronic cancer and noncancer pain types. The efficacy and safety profiles of ziconotide have been assessed in three double-blind, placebo-controlled trials of 457 patients, and safety has been assessed in 1,254 patients overall, with severe chronic cancer, noncancer, and acquired immunodeficiency syndrome pain types. Both agents are highlighted as first-line intrathecal therapy for the management of neuropathic or nociceptive pain. The purpose of this review is to discuss practical considerations for intrathecal

  12. Long term clinical outcome of peripheral nerve stimulation in patients with chronic peripheral neuropathic pain

    DEFF Research Database (Denmark)

    Calenbergh, F. Van; Gybels, J.; Laere, K. Van;

    2009-01-01

    BACKGROUND: Chronic neuropathic pain after injury to a peripheral nerve is known to be resistant to treatment. Peripheral nerve stimulation is one of the possible treatment options, which is, however, not performed frequently. In recent years we have witnessed a renewed interest for PNS. The aim...... of the present study was to evaluate the long-term clinical efficacy of PNS in a group of patients with peripheral neuropathic pain treated with PNS since the 1980s. METHODS: Of an original series of 11 patients, 5 patients could be invited for clinical examination, detailed assessment of clinical pain and QST...... functioning) also showed positive effects. Quantitative Sensory Testing results did not show significant differences in cold pain and heat pain thresholds between the "ON" and "OFF" conditions. CONCLUSION: In selected patients with peripheral neuropathic pain PNS remains effective even after more than 20...

  13. 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....

  14. Practical considerations and patient selection for intrathecal drug delivery in the management of chronic pain

    Science.gov (United States)

    Saulino, Michael; Kim, Philip S; Shaw, Erik

    2014-01-01

    Chronic pain continues to pose substantial and growing challenges for patients, caregivers, health care professionals, and health care systems. By the time a patient with severe refractory pain sees a pain specialist for evaluation and management, that patient has likely tried and failed several nonpharmacologic and pharmacologic approaches to pain treatment. Although relegated to one of the interventions of “last resort”, intrathecal drug delivery can be useful for improving pain control, optimizing patient functionality, and minimizing the use of systemic pain medications in appropriately selected patients. Due to its clinical and logistical requirements, however, intrathecal drug delivery may fit poorly into the classic pain clinic/interventional model and may be perceived as a “critical mass” intervention that is feasible only for large practices that have specialized staff and appropriate office resources. Potentially, intrathecal drug delivery may be more readily adopted into larger practices that can commit the necessary staff and resources to support patients’ needs through the trialing, initiation, monitoring, maintenance, and troubleshooting phases of this therapy. Currently, two agents – morphine and ziconotide – are approved by the United States Food and Drug Administration for long-term intrathecal delivery. The efficacy and safety profiles of morphine have been assessed in long-term, open-label, and retrospective studies of >400 patients with chronic cancer and noncancer pain types. The efficacy and safety profiles of ziconotide have been assessed in three double-blind, placebo-controlled trials of 457 patients, and safety has been assessed in 1,254 patients overall, with severe chronic cancer, noncancer, and acquired immunodeficiency syndrome pain types. Both agents are highlighted as first-line intrathecal therapy for the management of neuropathic or nociceptive pain. The purpose of this review is to discuss practical considerations

  15. Hormone replacement therapy in morphine-induced hypogonadic male chronic pain patients

    Directory of Open Access Journals (Sweden)

    Ravaioli Laura

    2011-02-01

    Full Text Available Abstract Background In male patients suffering from chronic pain, opioid administration induces severe hypogonadism, leading to impaired physical and psychological conditions such as fatigue, anaemia and depression. Hormone replacement therapy is rarely considered for these hypogonadic patients, notwithstanding the various pharmacological solutions available. Methods To treat hypogonadism and to evaluate the consequent endocrine, physical and psychological changes in male chronic pain patients treated with morphine (epidural route, we tested the administration of testosterone via a gel formulation for one year. Hormonal (total testosterone, estradiol, free testosterone, DHT, cortisol, pain (VAS and other pain questionnaires, andrological (Ageing Males' Symptoms Scale - AMS and psychological (POMS, CES-D and SF-36 parameters were evaluated at baseline (T0 and after 3, 6 and 12 months (T3, T6, T12 respectively. Results The daily administration of testosterone increased total and free testosterone and DHT at T3, and the levels remained high until T12. Pain rating indexes (QUID progressively improved from T3 to T12 while the other pain parameters (VAS, Area% remained unchanged. The AMS sexual dimension and SF-36 Mental Index displayed a significant improvement over time. Conclusions In conclusion, our results suggest that a constant, long-term supply of testosterone can induce a general improvement of the male chronic pain patient's quality of life, an important clinical aspect of pain management.

  16. 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 ...

  17. An evidence-based guideline on yoga in reducing pain among adult patients with chronic low back pain

    OpenAIRE

    林德; Lam, Tak

    2013-01-01

    Low back pain (LBP) is a common complaint and health problem in Hong Kong, particularly among middle-aged individuals. LBP is the main cause of chronic disability which significantly affects the daily life activities of patients. Pain might result in repeated hospital admissions and subsequently increase the burden on health care providers in Hong Kong. LBP has an enormous effect on quality of life and therefore deserves research attention. Growing evidence shows that yoga may help reduce...

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

    Directory of Open Access Journals (Sweden)

    Perhac J Stephen

    2006-04-01

    Full Text Available Abstract Background Opioid misuse can complicate chronic pain management, and the non-medical use of opioids is a growing public health problem. The incidence and risk factors for opioid misuse in patients with chronic pain, however, have not been well characterized. We conducted a prospective cohort study to determine the one-year incidence and predictors of opioid misuse among patients enrolled in a chronic pain disease management program within an academic internal medicine practice. Methods One-hundred and ninety-six opioid-treated patients with chronic, non-cancer pain of at least three months duration were monitored for opioid misuse at pre-defined intervals. Opioid misuse was defined as: 1. Negative urine toxicological screen (UTS for prescribed opioids; 2. UTS positive for opioids or controlled substances not prescribed by our practice; 3. Evidence of procurement of opioids from multiple providers; 4. Diversion of opioids; 5. Prescription forgery; or 6. Stimulants (cocaine or amphetamines on UTS. Results The mean patient age was 52 years, 55% were male, and 75% were white. Sixty-two of 196 (32% patients committed opioid misuse. Detection of cocaine or amphetamines on UTS was the most common form of misuse (40.3% of misusers. In bivariate analysis, misusers were more likely than non-misusers to be younger (48 years vs 54 years, p Conclusion Opioid misuse occurred frequently in chronic pain patients in a pain management program within an academic primary care practice. Patients with a history of alcohol or cocaine abuse and alcohol or drug related convictions should be carefully evaluated and followed for signs of misuse if opioids are prescribed. Structured monitoring for opioid misuse can potentially ensure the appropriate use of opioids in chronic pain management and mitigate adverse public health effects of diversion.

  19. Biospectral analysis of the bladder channel point in chronic low back pain patients

    Science.gov (United States)

    Vidal, Alberto Espinosa; Nava, Juan José Godina; Segura, Miguel Ángel Rodriguez; Bastida, Albino Villegas

    2012-10-01

    Chronic pain is the main cause of disability in the productive age people and is a public health problem that affects both the patient and society. On the other hand, there isn't any instrument to measure it; this is only estimated using subjective variables. The healthy cells generate a known membrane potential which is part of a network of biologically closed electric circuits still unstudied. It is proposed a biospectral analysis of a bladder channel point as a diagnosis method for chronic low back pain patients. Materials and methods: We employed a study group with chronic low back pain patients and a control group without low back pain patients. The visual analog scale (VAS) to determine the level of pain was applied. Bioelectric variables were measured for 10 seconds and the respective biostatistical analyses were made. Results: Biospectral analysis on frequency domain shows a depression in the 60-300 Hz frequency range proportional to the chronicity of low back pain compared against healthy patients.

  20. Abnormal brain processing of cutaneous pain in patients with chronic migraine.

    Science.gov (United States)

    de Tommaso, Marina; Valeriani, Massimiliano; Guido, Marco; Libro, Giuseppe; Specchio, Luigi Maria; Tonali, Pietro; Puca, Francomichele

    2003-01-01

    Syndromes with chronic daily headache include chronic migraine (CM). The reason for the transformation of migraine into chronic daily headache is still unknown. In this study, we aimed to evaluate heat pain thresholds and event-related potentials following CO(2)-laser thermal stimulation (LEPS) in hand and facial regions in patients with CM, to show changes in nociceptive brain responses related to dysfunction of pain elaboration at the cortical level. The results were compared with findings from normal control subjects and from subjects who suffer from migraine without aura. The effects of stimulus intensity, subjective pain perception and attention were monitored and compared with features of the LEPS. Twenty-five CM patients, 15 subjects suffering from migraine without aura and 15 normal control subjects were enrolled in the study. LEPS amplitude variation was reduced in CM patients with respect to the perceived stimulus intensity, in comparison with migraine without aura patients and control subjects. In both headache groups, the distraction from the painful laser stimulus induced by an arithmetic task failed to suppress the LEPS amplitude, in comparison with control subjects. These results suggest an abnormal cortical processing of nociceptive input in CM patients, which could lead to the chronic state of pain. In both headache groups, an inability to reduce pain elaboration during an alternative cognitive task emerged as an abnormal behaviour probably predisposing to migraine.

  1. Do implantable devices improve mood? Comparisons of chronic pain patients with or without an implantable device.

    Science.gov (United States)

    Jamison, Robert N; Washington, Tabitha A; Fanciullo, Gilbert J; Ross, Edgar L; McHugo, Gregory J; Baird, John C

    2008-10-01

    Objective.  This descriptive study compares outcome measures of a computerized assessment of pain, emotional distress, and quality of life between chronic noncancer pain patients who have received an implantable device (spinal cord stimulator or intrathecal pump; N = 143) and those who have not received a device (N = 130). Methods.  Each patient marked the location of their pain on a body diagram and rated pain intensity, emotional distress, and impact of their pain on mood, sleep, and quality of life using a computerized pain assessment program. An electronic version of the Hospital Anxiety and Depression Scale (HADS) also was administered. Results.  No significant differences were found on the pain variables between the two groups. Patients with an implantable device gave lower ratings (less impact) on emotional distress (p quality of life as better compared with control patients (p devices also scored lower on the HADS Depression Subscale. Conclusion.  The results suggest that although patients with an implantable device seem to have more pathology and greater disability, they report less emotional distress and improved quality of life compared with patients with chronic pain without an implantable device. Future controlled trials are needed to establish the role that an implantable device plays in improving mood and quality of life. PMID:22151138

  2. 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.

  3. Effect of Tramadol/Acetaminophen on Motivation in Patients with Chronic Low Back Pain.

    Science.gov (United States)

    Tetsunaga, Tomoko; Tetsunaga, Tomonori; Tanaka, Masato; Nishida, Keiichiro; Takei, Yoshitaka; Ozaki, Toshifumi

    2016-01-01

    Background. The contribution of apathy, frequently recognized in individuals with neurodegenerative diseases, to chronic low back pain (LBP) remains unclear. Objectives. To investigate levels of apathy and clinical outcomes in patients with chronic LBP treated with tramadol-acetaminophen. Methods. A retrospective case-control study involving 73 patients with chronic LBP (23 male, 50 female; mean age 71 years) treated with tramadol-acetaminophen (n = 36) and celecoxib (n = 37) was performed. All patients were assessed using the self-reported questionnaires. A mediation model was constructed using a bootstrapping method to evaluate the mediating effects of pain relief after treatment. Results. A total of 35 (55.6%) patients met the criteria for apathy. A four-week treatment regimen in the tramadol group conferred significant improvements in the Apathy scale and numerical rating scale but not in the Rolland-Morris Disability Questionnaire, Pain Disability Assessment Scale, or Pain Catastrophizing Scale. The depression component of the Hospital Anxiety and Depression Scale was lower in the tramadol group than in the celecoxib group. The mediation analysis found that the impact of tramadol-acetaminophen on the change in apathy was not mediated by the pain relief. Conclusions. Tramadol-acetaminophen was effective at reducing chronic LBP and conferred a prophylactic motivational effect in patients with chronic LBP. PMID:27445626

  4. Effect of Tramadol/Acetaminophen on Motivation in Patients with Chronic Low Back Pain.

    Science.gov (United States)

    Tetsunaga, Tomoko; Tetsunaga, Tomonori; Tanaka, Masato; Nishida, Keiichiro; Takei, Yoshitaka; Ozaki, Toshifumi

    2016-01-01

    Background. The contribution of apathy, frequently recognized in individuals with neurodegenerative diseases, to chronic low back pain (LBP) remains unclear. Objectives. To investigate levels of apathy and clinical outcomes in patients with chronic LBP treated with tramadol-acetaminophen. Methods. A retrospective case-control study involving 73 patients with chronic LBP (23 male, 50 female; mean age 71 years) treated with tramadol-acetaminophen (n = 36) and celecoxib (n = 37) was performed. All patients were assessed using the self-reported questionnaires. A mediation model was constructed using a bootstrapping method to evaluate the mediating effects of pain relief after treatment. Results. A total of 35 (55.6%) patients met the criteria for apathy. A four-week treatment regimen in the tramadol group conferred significant improvements in the Apathy scale and numerical rating scale but not in the Rolland-Morris Disability Questionnaire, Pain Disability Assessment Scale, or Pain Catastrophizing Scale. The depression component of the Hospital Anxiety and Depression Scale was lower in the tramadol group than in the celecoxib group. The mediation analysis found that the impact of tramadol-acetaminophen on the change in apathy was not mediated by the pain relief. Conclusions. Tramadol-acetaminophen was effective at reducing chronic LBP and conferred a prophylactic motivational effect in patients with chronic LBP.

  5. Practical considerations and patient selection for intrathecal drug delivery in the management of chronic pain

    Directory of Open Access Journals (Sweden)

    Saulino M

    2014-11-01

    Full Text Available Michael Saulino,1,2 Philip S Kim,3,4 Erik Shaw5 1MossRehab, Elkins Park, PA, USA; 2Department of Rehabilitation Medicine, Jefferson Medical College, Philadelphia, PA, USA; 3Helen F Graham Cancer Center, Christiana Care Health System, Newark, DE, USA; 4Center for Interventional Pain Spine, LLC., Bryn Mawr, PA, USA; 5Shepherd Pain Institute, Shepherd Center, Atlanta, GA, USA Abstract: Chronic pain continues to pose substantial and growing challenges for patients, caregivers, health care professionals, and health care systems. By the time a patient with severe refractory pain sees a pain specialist for evaluation and management, that patient has likely tried and failed several nonpharmacologic and pharmacologic approaches to pain treatment. Although relegated to one of the interventions of “last resort”, intrathecal drug delivery can be useful for improving pain control, optimizing patient functionality, and minimizing the use of systemic pain medications in appropriately selected patients. Due to its clinical and logistical requirements, however, intrathecal drug delivery may fit poorly into the classic pain clinic/interventional model and may be perceived as a "critical mass" intervention that is feasible only for large practices that have specialized staff and appropriate office resources. Potentially, intrathecal drug delivery may be more readily adopted into larger practices that can commit the necessary staff and resources to support patients' needs through the trialing, initiation, monitoring, maintenance, and troubleshooting phases of this therapy. Currently, two agents – morphine and ziconotide – are approved by the United States Food and Drug Administration for long-term intrathecal delivery. The efficacy and safety profiles of morphine have been assessed in long-term, open-label, and retrospective studies of >400 patients with chronic cancer and noncancer pain types. The efficacy and safety profiles of ziconotide have been

  6. Effect of NCPB and VSPL on pain and quality of life in chronic pancreatitis patients

    Institute of Scientific and Technical Information of China (English)

    Andrzej Basinski; Tomasz Stefaniak; Ad Vingerhoets; Wojciech Makarewicz; Lukasz Kaska; Aleksander Stanek; Andrzej J. Lachinski; Zbigniew Sledzinski

    2005-01-01

    AIM: To compare the effects of neurolytic celiac plexus block (NCPB) and videothoracoscopic splanchnicectomy (VSPL) on pain and quality of life of chronic pancreatitis (CP) patients.METHODS: Forty-eight small duct CP patients were treated invasively with NCPB (n = 30) or VSPL (n = 18) in two non-randomized, prospective, case-controlled protocols due to chronic pain syndrome, and compared to a control group who were treated conservatively (n = 32). Visual analog scales were used to assess pain and opioid consumption rate was evaluated. In addition, the quality of life was measured using QLQ C-30 for NCPB and FACIT for VSPL.Although both questionnaires covered similar problems,they could not be compared directly one with another.Therefore, the studies were compared by meta-analysis methodology.RESULTS: Both procedures resulted in a significant positive effect on pain of CP patients. Opioids were withdrawn totally in 47.0% of NCPB and 36.4% of VSPL patients,and reduced in 53.0% and 45.4% of the respective patient groups. No reduction in opioid usage was observed in the control group. In addition, fatigue and emotional well-being showed improvements. Finally, NCPB demonstrated stronger positive effects on social support, which might possibly be attributed to earlier presentation of patients treated with NCPB.CONCLUSION: Both invasive pain treatment methods are effective in CP patients with chronic pain.

  7. The Effectiveness of Mindfulness-based Cognitive Therapy (MBCT and Cognitive Behavior Therapy (CBT on Decreasing Pain, Depression and Anxiety of Patients with Chronic Low Back Pain

    Directory of Open Access Journals (Sweden)

    M Abdolghadery

    2014-02-01

    Conclusion: The results support the effectiveness of MBCT and CBT in decreasing pain, depression and anxiety. Therefore, taking account of these two therapeutic methods is very important for patients with chronic low back pain.

  8. The high prevalence of obsessive-compulsive disorder in patients with chronic pain.

    Directory of Open Access Journals (Sweden)

    Ali Mehraban

    2014-12-01

    Full Text Available Chronic pain is a common disorder with a high prevalence of psychiatric disorder that imposes a worse prognosis on both conditions. Obsessive compulsive disorder (OCD is estimated to be the fourth most prevalent life time psychiatric disorder, but yet has gained less attention in chronic pain comorbidity researches.Ninety three heterogeneous chronic pain patients who attended a pain clinic in Tehran (Iran in an outpatient setting during three months were included in this study. Diagnosis was made by Structured Clinical Interview for DSM-IV (SCID.The mean age of the patients was 46.37 (SD 15.005 years; of the patients, 66.7% were female and 33.3% were male. The mean duration of pain was 34.43 (SD 51.422 months. The mean pain severity on numerical pain scale was 5.82 (SD 1.950 from 10. The mean pain site number was 3.68 (SD 3.401 from the maximum of 27 places. Furthermore, 61.3% of the participants were diagnosed with lifetime OCD, 25.8% with subclinical OCD and 61.5 % with major depressive disorder (MDD. OCD diagnosis was not correlated with MDD or pain intensity. Female gender was associated with OCD (OD; 4.182, 95% CL (1.655-10.568. Pain intensity was correlated with MDD (P < 0.05.The high prevalence of OCD was comorbidity, independent of MDD and most pain characteristics. The high prevalence of OCD may be explained by the high rate of undiagnosed cause of pain as well as cultural and local factors. Using screening tests is suggested for tackling under diagnosis and under treatment of OCD and MDD.

  9. Impulsivity and risk for prescription opioid misuse in a chronic pain patient sample.

    Science.gov (United States)

    Vest, Noel; Reynolds, Caleb J; Tragesser, Sarah L

    2016-09-01

    Misuse of, and addiction to, prescription opioid pain relievers is a growing concern, in both non-clinical samples and chronic pain patients receiving opioid analgesic therapy. Research is needed to identify which patients may be more prone to misuse or dependence on opioids in a chronic pain treatment setting. Based on literature showing the role of impulsivity in substance use disorders generally, we predicted that impulsivity may also be important to understanding which individuals may be at risk for opioid misuse when opioids are prescribed for pain. The present study examined associations between impulsivity facets and measures of prescription opioid misuse and symptoms. Four facets of impulsivity were examined: urgency, sensation seeking, lack of premeditation, and lack of perseverance. 143 patients receiving treatment for chronic pain at a regional pain clinic completed a series of questionnaires including the UPPS and measures of opioid risk and misuse. Consistent with predictions, urgency was associated with risk for future misuse (β=0.246, p<0.05), current misuse (β=0.253, p<0.01), and symptoms of current opioid use disorder (OUD; β=0.206, p<0.05). Sensation seeking was also associated with current misuse (β=0.279, p<0.01). These results suggest that identifying facets of impulsivity is important to understanding and assessing for risk of prescription opioid misuse in the context of chronic pain treatment. These data indicate that patients who react impulsively to negative mood states and cravings may be especially prone to developing aberrant use patterns when taking prescription opioids. This is the first known study to identify the role of urgency in predicting risk for OUDs in chronic pain patients. PMID:27156219

  10. Life satisfaction in patients with chronic musculoskeletal pain and its predictors

    NARCIS (Netherlands)

    Boonstra, Anne M.; Reneman, Michiel F.; Stewart, Roy E.; Post, Marcel W.; Preuper, Henrica R. Schiphorst

    2013-01-01

    Purpose To determine the life satisfaction of patients with chronic non-malignant musculoskeletal pain (CMP) compared to the general population (GP) and to identify predictors of life satisfaction. Methods Subjects were patients with CMP (n = 1,082) admitted to multidisciplinary rehabilitation and a

  11. Pregabalin and placebo responders show different effects on central pain processing in chronic pancreatitis patients

    Directory of Open Access Journals (Sweden)

    Bouwense SA

    2015-07-01

    Full Text Available Stefan AW Bouwense,1 Søren S Olesen,2 Asbjørn M Drewes,2 Harry van Goor,1 Oliver HG Wilder-Smith31Pain and Nociception Neuroscience Research Group, Department of Surgery, Radboud university medical center, Nijmegen, The Netherlands; 2Mech-Sense, Department of Gastroenterology and Hepatology, Aalborg University Hospital, Aalborg, Denmark; 3Pain and Nociception Neuroscience Research Group, Department of Anaesthesiology, Pain and Palliative Medicine, Radboud university medical center, Nijmegen, The NetherlandsBackground: Pain control in chronic pancreatitis is a major challenge; the mechanisms behind analgesic treatment are poorly understood. This study aims to investigate the differences in pain sensitivity and modulation in chronic pancreatitis patients, based on their clinical response (responders vs nonresponders to placebo or pregabalin treatment. Methods: This study was part of a randomized, double-blind, placebo-controlled trial evaluating the analgesic effects of pregabalin and placebo in chronic pancreatitis. Post hoc, patients were assigned to one of four groups, ie, responders and nonresponders to pregabalin (n=16; n=15 or placebo (n=12; n=17 treatment. Responders were defined as patients with >30% pain reduction after 3 weeks of treatment. We measured change in pain sensitivity before and after the treatment using electric pain detection thresholds (ePDT in dermatomes C5 (generalized effects and Ventral T10 (segmental effects. Descending endogenous pain modulation was quantified via conditioned pain modulation (CPM paradigm. Results: Sixty patients were analyzed in a per-protocol analysis. ePDT change in C5 was significant vs baseline and greater in pregabalin (1.3 mA vs placebo responders (−0.1 mA; P=0.015. This was not so for ePDT in Ventral T10. CPM increased more in pregabalin (9% vs placebo responders (−17%; P<0.001. CPM changed significantly vs baseline only for pregabalin responders (P=0.006. Conclusion: This hypothesis

  12. Post-traumatic stress, depression, and anxiety in patients with injury-related chronic pain: A pilot study

    OpenAIRE

    Sofia Åhman; Britt-Marie Stålnacke

    2008-01-01

    Sofia Åhman, Britt-Marie StålnackeDepartment of Community Medicine and Rehabilitation, Umeå University, SwedenAim: To investigate, in patients with injury-related chronic pain, pain intensity, levels of post-traumatic stress, anxiety and depressions.Methods: One hundred and sixty patients aged 17–62 years, admitted for assessment to the Pain Rehabilitation Clinic at the Umeå University Hospital, Umeå Sweden, for chronic pain caused b...

  13. Reports of perceptual distortion of the face are common in patients with different types of chronic oro-facial pain.

    Science.gov (United States)

    Dagsdóttir, L K; Skyt, I; Vase, L; Baad-Hansen, L; Castrillon, E; Svensson, P

    2016-06-01

    Anecdotally, chronic oro-facial pain patients may perceive the painful face area as 'swollen'. Because there are no clinical signs, these self-reported 'illusions' may represent perceptual distortions and can be speculated to contribute to the maintenance of oro-facial pain. This descriptive study investigated whether chronic oro-facial pain patients experience perceptual distortions - a kind of body image disruption. Sixty patients were consecutively recruited to fill in questionnaires regarding i) pain experience, ii) self-reports of perceptual distortion and iii) psychological condition. Perceptual distortions were examined in the total group and in three diagnostic subgroups: i) painful post-traumatic trigeminal neuropathy (PPTN), ii) painful temporomandibular disorder (TMD) or iii) persistent idiopathic facial pain (PIFP). A large proportion of oro-facial pain patients reported perceptual distortions of the face (55·0%). In the diagnostic subgroups, perceptual distortions were most pronounced in PPTN patients (81·5%) but with no significant group differences. In the total group of chronic oro-facial pain patients, the present pain intensity explained 16·9% of the variance in magnitude of the perceptual distortions (R(2) = 16·9, F(31) = 6·3, P = 0·017). This study demonstrates that many chronic oro-facial pain patients may experience perceptual distortions. Future studies may clarify the mechanisms underlying perceptual distortions, which may point towards new complementary strategies for the management of chronic oro-facial pain. PMID:26826628

  14. Strategies for Coping with Chronic Lower Back Pain in Patients with Long Physiotherapy Wait Time.

    Science.gov (United States)

    Cabak, Anna; Dąbrowska-Zimakowska, Anna; Truszczyńska, Aleksandra; Rogala, Patryk; Laprus, Katarzyna; Tomaszewski, Wiesław

    2015-01-01

    BACKGROUND Treatment efficacy for the increasing prevalence of back pain is a great challenge for both health care providers and individuals coping with this problem. This study aimed to evaluate pain coping strategies used by primary care patients with chronic lower back pain (CLBP) as a supplementation of medical diagnosis before a physiotherapy programme. MATERIAL AND METHODS A total of 88 people were divided into 3 age groups: young adults (21-40 years old), middle-aged adults (41-60 years old), and the elderly (over 60 years old). Data was gathered from rehabilitation centers and primary medical care facilities. A cross-sectional design was used. The Coping Strategies Questionnaire (CSQ) was completed before the physiotherapy course. RESULTS Patients complained of CLBP for 11.32±6.81 years on average. The most common strategies to cope with back pain included declaring that the pain is manageable, praying and hoping, as well as increased behavioral activity. Statistically significant differences in coping strategies were found between age groups. The elderly patients were more likely to "declare coping with pain" in comparison to the younger age groups (pphysiotherapy. The basic assessment of pain coping strategies should be consistently taken into account and included in rehabilitation protocols in chronic pain treatment.

  15. A novel use for testosterone to treat central sensitization of chronic pain in fibromyalgia patients.

    Science.gov (United States)

    White, Hillary D; Robinson, Thomas D

    2015-08-01

    Fibromyalgia is a diffuse chronic pain condition that occurs predominantly in women and may be under-reported in men. Symptoms include a loss of feeling of well-being and generalized widespread flu-like muscle aches and pain that fail to resolve due to central sensitization of nociceptive neurons. It has commonalities with a myriad of other chronic pain conditions which include PTSD, "Gulf War Syndrome", and various stress-induced conditions caused, for example, by viral infection, emotional or physical stress, trauma, combat, accident or surgery. It is not understood why some individuals are susceptible to this condition and others are not. White et al., elsewhere in this issue, present a clinical feasibility study designed to test the hypothesis that 1) low or deficient testosterone serum levels are linked to a high risk for an inflamed nociceptive nervous system and resultant chronic pain states, and 2) a testosterone transdermal gel applied once a day by fibromyalgia patients can be an effective therapeutic against chronic pain. Here, a short profile of fibromyalgia is provided along with a brief summary of best practices currently recommended by clinical specialists. The link between testosterone and pain is then discussed, with an overview of scientific studies that lay the foundation for testosterone as a possible important additional therapeutic that has the potential to be safely administered and effective but also avoid the adverse effects of other therapeutics. Finally, novel mechanisms by which testosterone therapy is likely to down-modulate pain signaling are proposed.

  16. 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....

  17. Adaptations to pain rehabilitation programmes for non-native patients with chronic pain

    NARCIS (Netherlands)

    Sloots, Maurits; Dekker, Jos H. M.; Bartels, Edien A. C.; Geertzen, Jan Henricus; Dekker, Joost

    2011-01-01

    Purpose. (i) To determine whether adaptations for non-native patients have been implemented in pain rehabilitation programmes; (ii) to determine whether characteristics of the rehabilitation institute are related to having adaptations for non-native patients in place. Subjects. Rehabilitation instit

  18. Investigating patient expectations and treatment outcome in a chronic low back pain population

    Directory of Open Access Journals (Sweden)

    Sanderson KB

    2012-01-01

    Full Text Available Kristen B Sanderson1, Daniela Roditi1, Steven Z George2, James W Atchison3, Evangelia Banou4, Michael E Robinson11Department of Clinical Health Psychology, 2Department of Physical Therapy, 3Department of Orthopedics and Rehabilitation, University of Florida, Gainesville, FL, USA; 4Chronic Pain Rehabilitation Program, James A Haley VA Hospital, Tampa, FL, USAObjective: This study aimed to measure the outcomes that patients consider clinically meaningful across four treatment domains – (1 pain, (2 fatigue, (3 emotional distress, and (4 level of interference – and determine if patients met their own success criteria. Additionally, the role of expectations in treatment outcome was examined. This study also aimed to determine how change in levels of pain, fatigue, disability, and level of interference varied according to the type of treatment delivered to participants.Patients: Forty-seven chronic low back pain patients were recruited from university-affiliated pain clinics.Design: The study design was longitudinal, consisting of two randomly assigned treatment conditions. The first treatment condition used opioid medication only and the second used both opioid medication and brief cognitive behavioral therapy. Pre- and post-treatment assessments were conducted, which occurred approximately 3 months after the initiation of treatment.Outcome measures: A patient-centered outcomes questionnaire was completed by participants at both pre- and post-treatment assessment.Results: Results suggest that patients did not meet their own success criteria in treatment across any of the four domains. There was a significant main effect of time for level of pain indicating that both treatment groups had a decrease in their level of pain at post-treatment, F(1, 45 = 11.98, P < 0.001. There was a significant main effect of time for level of interference domain indicating that both groups experienced a reduction in the level of pain-related interference with daily

  19. 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.

  20. Smoking history, nicotine dependence and opioid use in patients with chronic non-malignant pain

    DEFF Research Database (Denmark)

    Plesner, K; Jensen, H I; Højsted, J

    2016-01-01

    BACKGROUND: Previous studies have demonstrated a positive association between smoking and addiction to opioids in patients with chronic non-malignant pain. This could be explained by a susceptibility in some patients to develop addiction. Another explanation could be that nicotine influences both...... pain and the opioid system. The objective of the study was to investigate whether smoking, former smoking ± nicotine use and nicotine dependence in patients with chronic non-malignant pain were associated with opioid use and addiction to opioids. METHODS: The study was a cross-sectional study carried...... as in the general population. The prevalence of patients using opioids was 54% and the prevalence of addiction to opioids was 6%. No significant differences in addiction were found between the different smoking groups, but smokers and former smokers using nicotine tended to use opioids more frequently and at higher...

  1. Sex differences in trauma symptoms, body image and intensity of pain in a Polish sample of patients suffering from chronic pain.

    Science.gov (United States)

    Rzeszutek, Marcin; Oniszczenko, Włodzimierz; Schier, Katarzyna; Biernat-Kałuża, Edyta; Gasik, Robert

    2016-10-01

    The main goal of the current study was to investigate sex differences in the relationship between the level of trauma symptoms appearing in posttraumatic stress disorder (PTSD) and intensity of pain in a sample of 300 Polish patients suffering from chronic pain, specifically rheumatoid arthritis and lower back pain. We also focused on participants' body image with body esteem as a mediator. To assess the intensity of pain among participants, we used the Numerical Rating Scale. The level of trauma symptoms was assessed with the PTSD Factorial Version Inventory. To measure body image among participants, we used the Body Esteem Scale. The results of our study suggest that trauma symptoms and body image dimensions were significant predictors of pain intensity among men suffering from chronic pain. Moreover, trauma symptoms and age were significant predictors of pain intensity among women suffering from chronic pain. Finally, we demonstrated that sex differentiates the reaction to chronic pain. PMID:26609737

  2. Effectiveness of mindfulness meditation on pain and quality of life of patients with chronic low back pain

    Directory of Open Access Journals (Sweden)

    Sudha Banth

    2015-01-01

    Effectiveness of mindfulness meditation on pain and quality of life of patients with chronic low back pain Eighty-eight patients diagnosed as NSCLBP by physician and randomly assigned to experimental (MBSR+ usual medical care and the control group (usual medical care only. The subjects assessed in 3 times frames; before, after and 4 weeks after intervention by Mac Gil pain and standard brief quality of life scales. Data obtained from the final sample analyzed by ANCOVA using SPSS software. Results: The findings showed MBSR was effective in reduction of pain severity and the patients who practiced 8 sessions meditation reported significantly lower pain than patients who only received usual medical care. There was a significant effect of the between subject factor group (F [1, 45] = 16.45, P < 0.001 and (F [1, 45] = 21.51, P < 0.001 for physical quality of life and (F [1, 45] = 13.80, P < 0.001 and (F [1, 45] = 25.07, P < 0.001 mental quality of life respectively. Conclusion: MBSR as a mind-body therapy including body scan, sitting and walking meditation was effective intervention on reduction of pain severity and improvement of physical and mental quality of life of female patients with NSCLBP.

  3. 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

  4. Self-reports of medication side effects and pain-related activity interference in patients with chronic pain: a longitudinal cohort study.

    Science.gov (United States)

    Martel, Marc O; Finan, Patrick H; Dolman, Andrew J; Subramanian, Subu; Edwards, Robert R; Wasan, Ajay D; Jamison, Robert N

    2015-06-01

    The primary purpose of this study was to examine the association between self-reports of medication side effects and pain-related activity interference in patients with chronic pain. The potential moderators of the association between reports of side effects and pain-related activity interference were also examined. A total of 111 patients with chronic musculoskeletal pain were asked to provide, once a month for a period of 6 months, self-reports of medication use and the presence of any perceived side effects (eg, nausea, dizziness, headaches) associated with their medications. At each of these time points, patients were also asked to provide self-reports of pain intensity, negative affect, and pain-related activity interference. Multilevel modeling analyses revealed that month-to-month increases in perceived medication side effects were associated with heightened pain-related activity interference (P effects were associated with heightened pain-related activity interference even after controlling for the influence of patient demographics, pain intensity, and negative affect. This study provides preliminary evidence that reports of medication side effects are associated with heightened pain-related activity interference in patients with chronic pain beyond the influence of other pain-relevant variables. The implications of our findings for clinical practice and the management of patients with chronic pain conditions are discussed.

  5. Psychological Distress in Out-Patients Assessed for Chronic Pain Compared to Those with Rheumatoid Arthritis.

    Science.gov (United States)

    Rice, D; Mehta, S; Shapiro, A; Pope, J; Harth, M; Morley-Forster, P; Sequeira, K; Teasell, R

    2016-01-01

    Background. Patients diagnosed with chronic pain (CP) and rheumatoid arthritis (RA) represent two samples with overlapping symptoms, such as experiencing significant pain. Objectives. To compare the level of psychological distress among patients diagnosed CP attending a specialist pain clinic with those attending a specialist RA clinic. Measures. A cross-sectional study was conducted at an academic specialist chronic pain and rheumatology clinic. Participants. 330 participants included a CP group (n = 167) and a RA group (n = 163) completed a booklet of questionnaires regarding demographic characteristics, duration, and severity of their pain. Psychological and personality variables were compared between the CP and RA participants using a Multivariate Analysis of Covariance (MANCOVA). Results. Level of psychological distress based on the subscales of the DASS (depression, anxiety, and stress), PASS (escape avoidance, cognitive anxiety, fear of pain, and physiological anxiety), and PCS (rumination, magnification, and helplessness) was significantly higher in the CP group compared to the RA group. Categorization of individuals based on DASS severity resulted in significant differences in rates of depression and anxiety symptoms between groups, with a greater number of CP participants displaying more severe depressive and anxiety symptoms. Discussion and Conclusions. This study found greater levels of psychological distress among CP individuals referred to an academic pain clinic when compared to RA patients referred to an academic rheumatology clinic. PMID:27445623

  6. Opioid therapy in non-cancer chronic pain patients: Trends and efficacy in different types of pain, patients age and gender

    Directory of Open Access Journals (Sweden)

    Yasin S AlMakadma

    2013-01-01

    Full Text Available Background: In both developing and developed countries, chronic pain remains a real issue and a true disease that affects up to 42% of the population in some areas. Opioids are widely used for the management of chronic pain with variations in prescribing practices, indications and observed efficacy. Aim: to analyze trends in opioids prescribing and patient response in chronic non-cancer pain conditions. Methods: Retrospective study of 1500 casenotes of patients suffering variable non-cancer chronic pain conditions. Detailed review of those cases who were managed using opioids. Statistical analysis using "SOFA" software set. Results: The prevalence of opioids prescribing in patients suffering this condition was thus around 35% (n=526. Women older than 50 years were more likely than men to have a chronic pain condition and to be given opioid therapy for 1 year or more. Opioid efficacy on neuropathic and mixed types of pain was found to be significant with relatively low rate of drop-out and limited side-effects that are not life threatening. Overall, patients stopped or changed their opioid medication due to inefficacy in only 12.7% of cases. Conclusions: The simple fact of having pain is itself a source of self-reported disability regardless of the actual physiological or pathological mechanism. Policy makers should be aware of the huge impact of chronic pain disease and of its serious effects on social and economical well-being. In developing countries, chronic pain could represent a real challenge for all parties. Multimodal management, including opioids, appears crucial for the approach of this disease.

  7. Outcome of instrumented spinal fusion for chronic low back pain: review of 100 patients

    International Nuclear Information System (INIS)

    Objective of this study was to evaluate the outcome of instrumented spinal fusion in selected patients with Chronic Low Back Pain (CLBP) in our setup. Consecutive first one hundred patients were selected from spine unit database that underwent instrumented spinal fusion for chronic low back pain lasting more than one year, due to degenerative disease of spine. Average age was 42 years. There were 62 males and 38 females. Diagnosis included; spinal stenosis (26%), failed disc surgery (22%), spondylolisthesis (19%), degenerative disc disease (17%), and instability (16%). Operations performed; Pedicle Screw Fixation (PSF) with Postero-lateral Fusion (PLF) in 3% patients. Trans Laminar Facet Screw (TLFS) with PLF in 24% patients. Anterior Lumbar Inter-body Fusion (ALIF) in 9% patients. Posterior Lumbar Inter-body Fusion (PLIF) in 40% patients and Trans-foraminal Lumbar Inter-body Fusion (TLIF) in 24% patients. Average follow up was for 30 months. 86% patients had full spinal fusion. 71% patients were fully satisfied with treatment, 28% were partially satisfied. Post-operatively, on average, visual analogue scale (VAS) showed 48 points significant improvement and Oswestry Disability Index (ODI) showed 53 points significant improvement. Instrumented Spinal Fusion is effective in our set up for relieving symptoms and improving functional outcome in selected patients with debilitating Chronic Low Back Pain due to degenerative disease of spine. Single fusion technique is not ideal for all types of patients and surgeon has to be versatile and trained in using different fusion techniques as the situation demands. (author)

  8. Fear of movement/(re)injury and muscular reactivity in chronic low back pain patients : an experimental investigation

    NARCIS (Netherlands)

    Vlaeyen, Johan W.S.; Seelen, HAM; Peters, Madelon L.; de Jong, Peter; Aretz, E; Beisiegel, E; Weber, WEJ

    1999-01-01

    This experiment was set up to test the hypothesis that confrontation with feared movements would lead to symptom-specific muscular reactivity in chronic low back pain patients who report high fear of movement/(re)injury. Thirty-one chronic low back pain patients were asked to watch a neutral nature

  9. 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 ...

  10. Neural Correlates of Fear of Movement in Patients with Chronic Low Back Pain vs. Pain-Free Individuals.

    Science.gov (United States)

    Meier, Michael L; Stämpfli, Philipp; Vrana, Andrea; Humphreys, Barry K; Seifritz, Erich; Hotz-Boendermaker, Sabina

    2016-01-01

    Fear of movement (FOM) can be acquired by a direct aversive experience such as pain or by social learning through observation and instruction. Excessive FOM results in heightened disability and is an obstacle for recovery from acute, subacute, and chronic low back pain (cLBP). FOM has further been identified as a significant explanatory factor in the Fear Avoidance (FA) model of cLBP that describes how individuals experiencing acute back pain may become trapped into a vicious circle of chronic disability and suffering. Despite a wealth of evidence emphasizing the importance of FOM in cLBP, to date, no related neural correlates in patients were found and this therefore has initiated a debate about the precise contribution of fear in the FA model. In the current fMRI study, we applied a novel approach encompassing: (1) video clips of potentially harmful activities for the back as FOM inducing stimuli; and (2) the assessment of FOM in both, cLBP patients (N = 20) and age- and gender-matched pain-free subjects (N = 20). Derived from the FA model, we hypothesized that FOM differentially affects brain regions involved in fear processing in patients with cLBP compared to pain-free individuals due to the recurrent pain and subsequent avoidance behavior. The results of the whole brain voxel-wise regression analysis revealed that: (1) FOM positively correlated with brain activity in fear-related brain regions such as the amygdala and the insula; and (2) differential effects of FOM between patients with cLBP and pain-free subjects were found in the extended amygdala and in its connectivity to the anterior insula. Current findings support the FOM component of the FA model in cLBP. PMID:27507941

  11. Theory of Mind and Emotional Awareness in Chronic Somatoform Pain Patients.

    Directory of Open Access Journals (Sweden)

    Matthias Zunhammer

    Full Text Available The present study aimed at investigating whether chronic pain patients are impaired in Theory of Mind (ToM, or Emotional Awareness.Thirty inpatients suffering from chronic somatoform pain, as well as thirty healthy controls matched for age, sex, and education were recruited. ToM abilities were measured using the Frith-Happé animation task, in which participants interpret video-clips depicting moving geometric forms that mimic social interactions. The responses given were scored for appropriateness and the degree of inferred intentionality according to established protocols. Emotional awareness was measured using the Levels of Emotional Awareness Scale (LEAS, for which participants provide written descriptions of feelings in imaginary emotional situations. Standardized scoring was performed to capture the number and quality of emotional terms used.Responses lengths were similar in both groups and for both tasks. Patients attained significantly lower intentionality but not appropriateness scores when interpreting ToM interactions. No significant group differences were found when interpreting goal directed interactions. Emotional awareness scores were significantly lower in patients compared to healthy controls.Our results suggest that chronic pain patients are impaired in mentalizing and emotional awareness. Future studies are needed to determine whether these ToM and emotional awareness deficits contribute to the etiology of somatoform pain and whether addressing these deficits in therapeutic interventions can improve polymodal pain therapy.

  12. Daily physical activities of patients with chronic pain or fatigue versus asymptomatic controls : a systematic review

    NARCIS (Netherlands)

    Weering, van Marit; Vollenbroek-Hutten, M.M.R.; Kotte, E.M.; Hermens, H.J.

    2007-01-01

    Objective: To gain an insight into the daily physical activity levels of patients with chronic pain or fatigue compared with asymptomatic controls. Data sources: MEDLINE, EMBASE, PsycINFO, Picarta, Cochrane Database of Systematic Reviews, reference tracking and a manual search of relevant journals.

  13. Reliability and validity of the visual analogue scale for disability in patients with chronic musculoskeletal pain

    NARCIS (Netherlands)

    Boonstra, Anne M.; Schiphorst Preuper, Henrica R.; Reneman, Michiel F.; Posthumus, Jitze B.; Stewart, Roy E.

    2008-01-01

    To determine the reliability and concurrent validity of a visual analogue scale (VAS) for disability as a single-item instrument measuring disability in chronic pain patients was the objective of the study. For the reliability study a test-retest design and for the validity study a cross-sectional d

  14. Nonspecific Chronic Low Back Pain Patients Are Deconditioned and Have An Increased Body Fat Percentage

    Science.gov (United States)

    Hodselmans, Audy P.

    2010-01-01

    The aim of this cross-sectional study was to compare data on the level of aerobic capacity and body composition of nonspecific chronic low back pain (CLBP) patients with normative data matched for sex, age and level of sporting activity. The study population consisted of 101 outpatients with nonspecific CLBP who had entered a rehabilitation…

  15. Motor control impairment of the contralateral wrist in patients with unilateral chronic wrist pain

    NARCIS (Netherlands)

    Smeulders, MJC; Kreulen, M; Hage, JJ; Ritt, MJPF; Mulder, T

    2002-01-01

    Objective: Assessment of the quality of fine motor control in patients with unilateral chronic wrist pain seldom focuses on the possibility that control of movements is effector independent at the cerebral level. This mechanism may be involved in an impairment of motor function in the unaffected wri

  16. Nonspecific chronic low back pain patients are deconditioned and have an increased body fat percentage

    NARCIS (Netherlands)

    Hodselmans, Audy P.; Dijkstra, Pieter U.; Geertzen, Jan H. B.; van der Schans, Cees P.

    2010-01-01

    The aim of this cross-sectional study was to compare data on the level of aerobic capacity and body composition of nonspecific chronic low back pain (CLBP) patients with normative data matched for sex, age and level of sporting activity. The study population consisted of 101 outpatients with nonspec

  17. Distinct cerebral metabolic patterns related to high pain sensitivity in episodic or chronic migraine patients and healthy volunteers

    OpenAIRE

    D'Ostilio, Kevin; Lisicki Martinez, Marco; Schoenen, Jean; Magis, Delphine

    2016-01-01

    Introduction Allodynia, i.e. pain evoked by a non-painful stimulus, is prevalent in chronic pain and in migraine where it augments with disease severity and chronicity [1]. Central sensitization is thought to be the culprit [2]. It is not known, however, which central areas are involved. The aim of the present study was to evaluate whether brain metabolism in subjects that are more sensitive to pain is different between migraine patients and healthy controls. Subjects and methods Qu...

  18. Longitudinal evaluation of patient-reported outcomes measurement information systems measures in pediatric chronic pain.

    Science.gov (United States)

    Kashikar-Zuck, Susmita; Carle, Adam; Barnett, Kimberly; Goldschneider, Kenneth R; Sherry, David D; Mara, Constance A; Cunningham, Natoshia; Farrell, Jennifer; Tress, Jenna; DeWitt, Esi Morgan

    2016-02-01

    The Patient-Reported Outcomes Measurement Information System (PROMIS) initiative is a comprehensive strategy by the National Institutes of Health to support the development and validation of precise instruments to assess self-reported health domains across healthy and disease-specific populations. Much progress has been made in instrument development, but there remains a gap in the validation of PROMIS measures for pediatric chronic pain. The purpose of this study was to investigate the construct validity and responsiveness to change of 7 PROMIS domains for the assessment of children (ages: 8-18) with chronic pain--Pain Interference, Fatigue, Anxiety, Depression, Mobility, Upper Extremity Function, and Peer Relationships. The PROMIS measures were administered at the initial visit and 2 follow-up visits at an outpatient chronic pain clinic (CPC; N = 82) and at an intensive amplified musculoskeletal pain day-treatment program (N = 63). Aim 1 examined construct validity of PROMIS measures by comparing them with corresponding "legacy" measures administered as part of usual care in the CPC sample. Aim 2 examined sensitivity to change in both CPC and amplified musculoskeletal pain samples. Longitudinal growth models showed that PROMIS' Pain Interference, Anxiety, Depression, Mobility, Upper Extremity, and Peer Relationship measures and legacy instruments generally performed similarly with slightly steeper slopes of improvement in legacy measures. All 7 PROMIS domains showed responsiveness to change. Results offered initial support for the validity of PROMIS measures in pediatric chronic pain. Further validation with larger and more diverse pediatric pain samples and additional legacy measures would broaden the scope of use of PROMIS in clinical research.

  19. Clinical features in patients with chronic muscle pain--with special reference to fibromyalgia

    DEFF Research Database (Denmark)

    Jacobsen, Søren; Petersen, I S; Danneskiold-Samsøe, B

    1993-01-01

    Clinical characteristics were studied in patients with chronic muscle pain, divided into three groups according to the characteristics of their pain; "fibromyalgia" (n = 23), "widespread muscle pain" (n = 21), and "regional muscle pain" (n = 28). Typical fibromyalgia features were also seen...... in the other groups of patients, but not to the same extent. In particular, sleep disturbance, subjective swelling, cold and exercise intolerance and low self-reported physical performance were significantly related to fibromyalgia. The major components of fibromyalgia were not wholly different compared...... with other European and North American studies, except for sleep disturbance and subjective swelling, which was somewhat more pronounced in this study. The most used medications in fibromyalgia patients at referral were analgesics, anxiolytic drugs and female sex hormones. Medication in fibromyalgia...

  20. Single cell morphology of muscle in patients with chronic muscle pain

    DEFF Research Database (Denmark)

    Jacobsen, Søren; Bartels, E M; Danneskiold-Samsøe, B

    1991-01-01

    In 119 patients referred with suspected fibromyalgia, biopsies from the quadriceps muscle were analyzed for "rubber band" morphology, and isokinetic quadriceps strength was measured. Eighty-four fulfilled the criteria for fibromyalgia, 26 had chronic myofascial pain (CMP) and 9 had other diseases...... to the biopsy score. "Rubber band" morphology is seen more often in fibromyalgia patients than in CMP patients. The exact genesis of this phenomenon is still unknown but theories connected with the possible pathogenesis of the syndrome are presented....

  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. 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. Patient phenotyping in clinical trials of chronic pain treatments

    DEFF Research Database (Denmark)

    Edwards, Robert R.; Dworkin, Robert H.; Turk, Dennis C.;

    2016-01-01

    There is tremendous interpatient variability in the response to analgesic therapy (even for efficacious treatments), which can be the source of great frustration in clinical practice. This has led to calls for "precision medicine" or personalized pain therapeutics (ie, empirically based algorithm...

  4. Affect School for chronic benign pain patients showed improved alexithymia assessments with TAS-20

    Directory of Open Access Journals (Sweden)

    Thulesius Hans O

    2010-06-01

    Full Text Available Abstract Background Alexithymia is a disturbance associated with psychosomatic disorders, pain syndromes, and a variety of psychiatric disorders. The Affect School (AS based on Tomkins Affect Theory is a therapy focusing on innate affects and their physiological expressions, feelings, emotions and scripts. In this pilot study we tried the AS-intervention method in patients with chronic benign pain. Methods The AS-intervention, with 8 weekly group sessions and 10 individual sessions, was offered to 59 patients with chronic non-malignant pain at a pain rehabilitation clinic in Sweden 2004-2005. Pre and post intervention assessments were done with the Hospital Anxiety and Depression scale (HAD, the Toronto Alexithymia Scale-20 (TAS-20, the Visual Analogue Scale for pain assessment (VAS-pain, the European Quality of Life health barometer (EQoL and the Stress and Crisis Inventory-93 (SCI-93. After the group sessions we used Bergdahl's Questionnaire for assessing changes in interpersonal relations, general well-being and evaluation of AS. Results The AS intervention was completed by 54 out of 59 (92% patients. Significant reductions in total TAS-20 post-test scores (p = 0.0006 as well as TAS-20 DIF and DDF factors (Difficulties Identifying Feelings, and Difficulties Describing Feelings were seen (p = 0.0001, and p = 0.0008 while the EOT factor (Externally Oriented Thinking did not change. Improvements of HAD-depression scores (p = 0.04, EQoL (p = 0.02 and self-assessed changes in relations to others (p Conclusions This pilot study involving 59 patients with chronic benign pain indicates that the alexithymia DIF and DDF, as well as depression, social relations and quality of life may be improved by the Affect School therapeutic intervention.

  5. Reproducibility of tender point examination in chronic low back pain patients as measured by intrarater and inter-rater reliability and agreement

    DEFF Research Database (Denmark)

    Jensen, Ole Kudsk; Callesen, Jacob; Nielsen, Merete Graakjaer;

    2013-01-01

    To evaluate the reliability and agreement of digital tender point (TP) examination in chronic low back pain (LBP) patients.......To evaluate the reliability and agreement of digital tender point (TP) examination in chronic low back pain (LBP) patients....

  6. 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...

  7. 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

  8. Analgesic effects of dextromethorphan and morphine in patients with chronic pain.

    Science.gov (United States)

    Heiskanen, Tarja; Härtel, Brita; Dahl, Marja-Liisa; Seppälä, Timo; Kalso, Eija

    2002-04-01

    N-methyl-aspartate (NMDA) receptor antagonists have been shown to improve opioid analgesia in the animal model. The cough suppressant dextromethorphan is a clinically available NMDA-receptor antagonist. In this randomised, double-blind, placebo-controlled study 20 patients with chronic pain of several years duration were given 100 mg of oral dextromethorphan or matching placebo 4 h prior to an intravenous infusion of morphine 15 mg. Pain intensity and adverse effects were assessed at 0, 4, 5 and 7 h. Dextromethorphan had no effect on morphine analgesia: the mean (+/-SEM) visual analogue scores for pain relief (VAS, 0-100 mm) at the end of the morphine infusion were 38 (+/-6) for dextromethorphan+morphine and 38 (+/-7) for placebo+morphine. VAS scores for pain intensity were comparable both at rest and at movement at all time points. The most common adverse effects reported were dizziness, nausea and sedation. There were no significant differences in either the incidence or severity of adverse effects. In conclusion, oral dextromethorphan 100 mg had no effect on pain relief by intravenous morphine 15 mg in patients with chronic pain. PMID:11972998

  9. The Durability of Cognitive Behavioral Therapy for Insomnia in Patients with Chronic Pain

    Directory of Open Access Journals (Sweden)

    Carla R. Jungquist

    2012-01-01

    Full Text Available The purpose of this study was to assess the long-term (six months effects of cognitive behavioral therapy for insomnia (CBT-I in patients with chronic pain. The results of the pre-post treatment effects have been reported previously. The therapy was delivered by an advanced practice nurse in a research setting using a parallel-group, randomized, single blind trial of CBT-I with a contact/measurement control condition. Outcomes included sleep diary, the Insomnia Severity Index, the Multidimensional Pain Inventory, the Beck Depression Inventory, the Profile of Mood States-short form, and the Pain Disability Index. Measurement time points were end-of-treatment, three-month and six-month posttherapy. Subjects receiving CBT-I (n=19, as compared to control subjects (n=9, did not exhibit any significant group by visit effects on measures of sleep, pain, mood, or function after end of treatment. However, subjects in the treatment group exhibited statistically (P=0.03 and clinically significant improvement in total sleep time (23 minutes over the six months following treatment. In this paper, cognitive behavioral therapy directed to improve insomnia was successfully delivered to patients with moderate-to-severe chronic pain and the positive effects of CBT-I continued to improve despite the presence of continued moderate-to-severe pain.

  10. Measuring disability in patients with chronic low back pain: the usefulness of different instruments

    OpenAIRE

    Kuijer, Wietske

    2006-01-01

    Measuring disability is an important topic in rehabilitation research in patients with chronic low back pain (CLBP). Due to the major impact of CLBP on functioning in both daily living and work, measuring disability in patients with CLBP is best described in terms of limitations in activities and restrictions in participation in daily living and work. A frequently used measurement instrument in rehabilitation medicine to measure self-reported limitations in activities of daily living (ADL) in...

  11. Classification and targeted treatment of patients with Non Specific Chronic Low Back Pain

    OpenAIRE

    Fersum, Kjartan Vibe

    2011-01-01

    Non-specific chronic low back pain (NSCLBP) disorders have proven highly resistant to change in spite of enormous resources directed at them. There is lack of evidence for single treatment interventions for patients with NSCLBP despite the substantial amount of Randomised Controlled Trials (RCT) evaluating treatment outcome for this disorder. It has been hypothesised that this vacuum of evidence is caused by the lack of sub-classifying the heterogeneous population of patient...

  12. Treatment satisfaction and dissatisfaction in patients with chronic low back pain

    OpenAIRE

    Rofail, Diana

    2010-01-01

    This thesis was submitted for the degree of Doctor of Philosophy and awarded by Brunel University. This thesis explores treatment satisfaction and dissatisfaction in patients with chronic low back pain (CLBP). Chapters 1 and 2 provide background on CLBP, and treatment satisfaction and dissatisfaction. Chapter 3 presents study 1, the systematic review which identified research concerning treatment satisfaction and dissatisfaction in patients with CLBP. Findings indicated a need to def...

  13. Predictors of communication preferences in patients with chronic low back pain

    Directory of Open Access Journals (Sweden)

    Farin E

    2013-10-01

    Full Text Available Erik Farin, Lukas Gramm, Erika SchmidtUniversity Freiburg, Medical Center, Department of Quality Management and Social Medicine, Freiburg, GermanyBackground: The objective of this exploratory study was to identify patient-related predictors of communication preferences in patients with chronic low back pain for various dimensions of patient-physician communication (patient participation and orientation, effective and open communication, emotionally supportive communication, communication about personal circumstances.Methods: Eleven rehabilitation centers from various parts of Germany participated in collection of data between 2009 and 2011. A total of 701 patients with chronic low back pain were surveyed at the start of rehabilitation. The patient questionnaire captured communication preferences, pain impact, pain intensity, and psychologic variables (fear avoidance beliefs, illness coherence, control beliefs, communication self-efficacy, and personality characteristics. The rehabilitation physicians filled out a documentation sheet containing information on diagnosis, inability to work, duration of the illness, and comorbidity at the beginning and end of rehabilitation. Hierarchical regression analyses were performed.Results: On average, effective, open, and patient-centered communication was very important for patients with back pain, emotionally supportive communication was important, and communication about personal circumstances was somewhat important. The variance in communication preferences explained by the predictors studied here was 8%–19%. Older patients showed a lower preference for patient-centered and open communication, but a higher preference for communication about personal circumstances. Patients with psychologic risk factors (eg, fear avoidance beliefs, extroverted patients, and patients with high self-efficacy in patient-physician interaction generally had higher expectations of the physician's communicative behavior

  14. 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

  15. Assessing the Construct Validity and Internal Reliability of the Screening Tool Test Your Memory in Patients with Chronic Pain.

    Science.gov (United States)

    Ojeda, B; Salazar, A; Dueñas, M; Torres, L M; Mico, J A; Failde, I

    2016-01-01

    Patients with chronic pain often complain about cognitive difficulties, and since these symptoms represent an additional source of suffering and distress, evaluating the cognitive status of these patients with valid and reliable tests should be an important part of their overall assessment. Although cognitive impairment is a critical characteristic of pain, there is no specific measure designed to detect these effects in this population. The objective was to analyze the psychometric properties of the "Test Your Memory" (TYM) test in patients with chronic pain of three different origins. A cross-sectional study was carried out on 72 subjects free of pain and 254 patients suffering from different types of chronic pain: neuropathic pain (104), musculoskeletal pain (99) and fibromyalgia (51). The construct validity of the TYM was assessed using the Mini-Mental State Examination (MMSE), Hospital Anxiety and Depression Scale (HADs), Index-9 from MOS-sleep, SF-12, and through the intensity (Visual Analogical Scale) and duration of pain. An exploratory factor analysis was also performed and internal reliability was assessed using Cronbach's alpha. After adjusting for potential confounders the TYM could distinguish between pain and pain-free patients, and it was correlated with the: MMSE (0.89, pvalid and reliable screening instrument to assess cognitive function in chronic pain patients that will be of particular value in clinical situations.

  16. [Chronic noncancer pain and patient education: a place for e-learning?].

    Science.gov (United States)

    Braillard, Olivia; Cedraschi, Christine; Jesaimani, Ameena; Piguet, Valérie

    2015-06-24

    Chronic non cancerous pain considerably limits the patients' quality of life. Yet, chronic non cancerous pain has a prevalence as high as 25% to 35%, Therapeutic education allows to work on the knowledge and know-how about the disease, the treatment, the management of health resources and health behaviors. E-learning uses new technologies of communication to improve the quality of learning by facilitating access to the resources and favoring the interactivity. It is attractive by its wide accessibility and its limited logistic needs. The level of proof of its efficacy is weak, mainly because of methodological limitations. Some good quality studies are promising, with a positive effect of e-learning programs on pain intensity, disability, autonomy and medication misuse.

  17. Treatment of myofascial trigger points in patients with chronic shoulder pain: a randomized, controlled trial

    Directory of Open Access Journals (Sweden)

    Stegenga Boudewijn

    2011-01-01

    Full Text Available Abstract Background Shoulder pain is a common musculoskeletal problem that is often chronic or recurrent. Myofascial trigger points (MTrPs cause shoulder pain and are prevalent in patients with shoulder pain. However, few studies have focused on MTrP therapy. The aim of this study was to assess the effectiveness of multimodal treatment of MTrPs in patients with chronic shoulder pain. Methods A single-assessor, blinded, randomized, controlled trial was conducted. The intervention group received comprehensive treatment once weekly consisting of manual compression of the MTrPs, manual stretching of the muscles and intermittent cold application with stretching. Patients were instructed to perform muscle-stretching and relaxation exercises at home and received ergonomic recommendations and advice to assume and maintain good posture. The control group remained on the waiting list for 3 months. The Disabilities of Arm, Shoulder and Hand (DASH questionnaire score (primary outcome, Visual Analogue Scale for Pain (VAS-P, Global Perceived Effect (GPE scale and the number of muscles with MTrPs were assessed at 6 and 12 weeks in the intervention group and compared with those of a control group. Results Compared with the control group, the intervention group showed significant improvement (P Conclusions The results of this study show that 12-week comprehensive treatment of MTrPs in shoulder muscles reduces the number of muscles with active MTrPs and is effective in reducing symptoms and improving shoulder function in patients with chronic shoulder pain. Trial registration number ISRCTN: ISRCTN75722066

  18. [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

  19. Migraine, daily chronic headache and fibromyalgia in the same patient: an evolutive "continuum" of non organic chronic pain? About 100 clinical cases.

    Science.gov (United States)

    Centonze, V; Bassi, A; Cassiano, M A; Munno, I; Dalfino, L; Causarano, V

    2004-10-01

    Aim of this study is to evaluate if migraine, daily chronic headache and fibromyalgia in the same patient can be considered as an evolutive continuum of non organic chronic pain. Therefore, migraine, daily chronic headache and fibromyalgia should be considered the expression of chronic antinociceptive system alteration. PMID:15549565

  20. Association between chronic low back pain, anxiety and depression in patients at a tertiary care centre

    International Nuclear Information System (INIS)

    Objective: To observe the prevalence of anxiety and depression in chronic low back pain population at a tertiary care centre. Methods: The prospective cross-sectional study was conducted using convenience sampling at the Department of Neurosurgery, at Liaquat National Hospital, Karachi, Pakistan, from January to June 2010. The prevalence of anxiety and depression in chronic low back pain patients was studied according to specified age and gender groups using Hospital Anxiety and Depression Scale. Results: Of the 140 patients in the study, 66 (47.14%) were females and 74 (52.85%) were males. The average age of the patients was 43.02+-13.34 years. The average duration of symptoms was 4.29+-3.3 years. Abnormal level of anxiety and depression were found in 77 (55%) and 68 (48.57%) patients respectively. Out of them 54 (38.5%) and 51 (36.4%) were borderline abnormal for anxiety and depression respectively, while 23 (16.4%) and 17 (12.1%) were abnormal for anxiety and depression respectively. Among the males, there were 20 (14.28%) and 23 (16.42%) patients with abnormal levels of the corresponding numbers among the females were 57 (40.71%) and 45 (32.14%). There was a significant association in anxiety (p0.05). Conclusion: Individuals with chronic low back pain were at high risk to experience anxiety and depression. This risk was higher for females. (author)

  1. 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...

  2. Critical appraisal of extended-release hydrocodone for chronic pain: patient considerations

    Directory of Open Access Journals (Sweden)

    Gould HJ III

    2015-10-01

    Full Text Available Harry J Gould III,1,3–7 Dennis Paul1–8 1Department of Neurology, 2Department of Pharmacology and Experimental Therapeutics, 3Department of Internal Medicine, Section of Physical Medicine and Rehabilitation, 4Department of Anesthesiology, 5Neuroscience Center of Excellence, 6Center of Excellence for Oral and Craniofacial Biology, 7Pain Mastery Center of Louisiana, 8Alcohol and Drug Abuse Center of Excellence, Louisiana State University Health Sciences Center, New Orleans, LA, USA Abstract: Opioid analgesics are currently the most effective pharmacologic option for the management of both acute and chronic forms of moderate-to-severe pain. Although the “as-needed” use of immediate-release formulations is considered optimum for treating acute, painful episodes of limited duration, the scheduled dosing of extended-release formulations with immediate-release supplementation for breakthrough pain is regarded to be most effective for managing chronic conditions requiring around-the-clock treatment. The recent introduction of extended-release formulations of the opioid analgesic hydrocodone potentially broadened the possibility of providing pain relief for individuals for whom current formulations are either ineffective or not tolerated. However, reaction to the approval of the new formulations has fueled controversy over the general safety and need for opioid medications, in light of their potential for misuse, abuse, diversion, and addiction. Here, we discuss how the approval of extended-release formulations of hydrocodone and the emotionally charged controversy over their release may affect physician prescribing and the care available to patients in need of chronic opioid therapy for the management of pain. Keywords: opioid analgesics, patient risks, patient benefits, misuse, addiction

  3. Meaning in life in chronic pain patients over time: associations with pain experience and psychological well-being.

    Science.gov (United States)

    Dezutter, Jessie; Luyckx, Koen; Wachholtz, Amy

    2015-04-01

    We explored the relationship between meaning in life and adjustment to chronic pain in a three-wave, 2 year, longitudinal study of 273 Belgian chronic pain patients. We examined the directionality of the relationships among the meaning in life dimensions (Presence of Meaning and Search for Meaning) and indicators of adjustment (depressive symptoms, life satisfaction, pain intensity, and pain medication use). We found that Presence of Meaning was an important predictor of well-being. Secondly, we used a typological methodology to distinguish meaning in life profiles, and the relationship of individual meaning in life profiles with indicators of adjustment. Five meaning in life profiles emerged: High Presence High Search, High Presence Low Search, Moderate Presence Moderate Search, Low Presence Low Search, and Low Presence High Search. Each meaning in life profile was associated with a unique adjustment outcome. Profiles that scored high on Presence of Meaning showed more optimal adjustment. The profiles showed little change over time and did not moderate the development of adjustment indicators, except for life satisfaction. Practical implications and suggestions for future research are discussed.

  4. Greater trochanteric pain syndrome due to tumoral calcinosis in a patient with chronic kidney disease.

    Science.gov (United States)

    Baek, Dongjin; Lee, Sang Eun; Kim, Woo-Jin; Jeon, Sanghoon; Lee, Kihwa; Jung, Jaewook; Joo, Hyunchul; Park, Jaehong; Kim, Yonghan; Choi, Young-gyun

    2014-01-01

    Tumoral calcinosis is a rare syndrome characterized by massive subcutaneous soft tissue deposits of calcium phosphate near the large joints. It is more prevalent in patients with chronic kidney disease undergoing dialysis. A 57-year-old woman was referred to our pain clinic with the complaint of severe pain in the left buttock and lateral hip. The patient had been suffering from chronic kidney disease for 10 years and had been undergoing peritoneal dialysis over the past 5 years. The patient's symptom was initially suspected to be of lumbar origin at the L5 level and a left L5 transforaminal epidural block was performed, but without success. Re-evaluation of the physical examination revealed severe tenderness over the left greater trochanter and piriformis muscle. On ultrasonographic evaluation, multiple mass-like lesions in the left buttock were observed. About 30 mL of fluid was aspirated from the cystic lesions, followed by 30 mL mixture of 0.08% levobupivacaine and triamcinolone 40 mg injected into the bursa under ultrasound guidance, which brought pain relief. Trochanteric bursitis was thought of as the cause of the symptoms. The patient was diagnosed with tumoral calcinosis based on the past medical history, simple plain radiographs, and hip magnetic resonance imaging (MRI). We diagnosed a case of greater trochanteric pain syndrome due to tumoral calcinosis related to chronic kidney disease in a patient whose symptoms had initially been considered to be radiating leg pain caused by lumbar spinal disease. We report our experience of symptomatic improvement following the repeated ultrasound-guided aspiration of calcific fluid and the injection of a mixture of local anesthetic and steroid. PMID:25415793

  5. Acupuncture in the treatment of patients with chronic facial pain and mandibular dysfunction.

    Science.gov (United States)

    List, T; Helkimo, M

    1987-01-01

    Ten patients with chronic facial pain and long lasting mandibular dysfunction symptoms were treated with acupuncture. All patients, two men and eight women aged between 39 and 71 years (mean = 51.0 years), exhibited a complex pain symptomatology with, basically, daily constant pain with an average duration of 13 years. The patients had resisted all previous conventional stomatognathic treatment. The symptoms and signs were evaluated before and immediately after treatment and at follow-ups three and seven months later. Four methods were used for evaluating the effect of the treatment. Subjective evaluation according to a 6-graded verbal scale. Clinical dysfunction index according to Helkimo (1974). Intensity of pain according to a visual analogue scale (VAS-scale, Pilowsky & Kaufman, 1965). Medicine consumption. Six to eight acupuncture treatments were given at one week intervals. The acupuncture points were stimulated both manually and electrically for 30 minutes with a frequency of approximately 2-3 Hz and 20-30 mA. All patients reported some degree of subjectively experienced improvement. Four felt much better and six somewhat better. At the follow-ups the same reports were given with the exception for one patient who reported unchanged discomfort. The objective criteria used for assessment of a favourable response to treatment were fulfilled by three patients immediately after treatment and at 3, 7 and 14 months after treatment. No significant negative effects of the treatment were recorded. It is concluded that acupuncture may be a realistic alternative to other, conventional stomatognathic treatment for some patients with long lasting chronic facial pain.

  6. Differences in brain structure in patients with distinct sites of chronic pain A voxel-based morphometric analysis

    Institute of Scientific and Technical Information of China (English)

    Cuiping Mao; Longxiao Wei; Qiuli Zhang; Xia Liao; Xiaoli Yang; Ming Zhang

    2013-01-01

    A reduction in gray matter volume is common in patients with chronic back pain, and different types of pain are associated with gray matter abnormalities in distinct brain regions. To examine ences in brain morphology in patients with low back pain or neck and upper back pain, we gated changes in gray matter volume in chronic back pain patients having different sites of pain using voxel-based morphometry. A reduction in cortical gray matter volume was found primarily in the left postcentral gyrus and in the left precuneus and bilateral cuneal cortex of patients with low back pain. In these patients, there was an increase in subcortical gray matter volume in the bilateral putamen and accumbens, right pal idum, right caudate nucleus, and left amygdala. In upper back pain patients, reduced cortical gray matter volume was found in the left precentral and left tral cortices. Our findings suggest that regional gray matter volume abnormalities in low back pain patients are more extensive than in upper back pain patients. Subcortical gray matter volume in-creases are found only in patients with low back pain.

  7. Prediction of sickness absence in patients with chronic low back pain: A systematic review

    OpenAIRE

    Kuijer, Wietske; Groothoff, Johan W.; Brouwer, Sandra; Geertzen, Jan H. B.; Dijkstra, Pieter U.

    2006-01-01

    Objectives: To provide evidence of predictors for sickness absence in patients with non-specific chronic low back pain (CLBP), distinguishing predictors aimed at the decision to report sick (absence threshold) and decision to return to work (return to work threshold). Methods: Medical and psychological databases were searched, as well as citations from relevant reviews. In- and exclusion criteria were applied. Two reviewers assessed the methodological quality of the papers independently. Resu...

  8. 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

  9. 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...

  10. Characteristics of Evoked Potential Multiple EEG Recordings in Patients with Chronic Pain by Means of Parallel Factor Analysis

    Directory of Open Access Journals (Sweden)

    Juan Wang

    2012-01-01

    Full Text Available This paper presents an alternative method, called as parallel factor analysis (PARAFAC with a continuous wavelet transform, to analyze of brain activity in patients with chronic pain in the time-frequency-channel domain and quantifies differences between chronic pain patients and controls in these domains. The event related multiple EEG recordings of the chronic pain patients and non-pain controls with somatosensory stimuli (pain, random pain, touch, random touch are analyzed. Multiple linear regression (MLR is applied to describe the effects of aging on the frequency response differences between patients and controls. The results show that the somatosensory cortical responses occurred around 250 ms in both groups. In the frequency domain, the neural response frequency in the pain group (around 4 Hz was less than that in the control group (around 5.5 Hz under the somatosensory stimuli. In the channel domain, cortical activation was predominant in the frontal region for the chronic pain group and in the central region for controls. The indices of active ratios were statistical significant between the two groups in the frontal and central regions. These findings demonstrate that the PARAFAC is an interesting method to understanding the pathophysiological characteristics of chronic pain.

  11. 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.

  12. efficacy and safety of a willow bark extract (salicin) and St John`s wort extract (hypericum): Two observational studies in patients with chronic back pain and depression

    OpenAIRE

    Zielisch, Heide

    2010-01-01

    Phytotherapy (Herbal medicine) for chronic back pain: Efficacy and Safety of a willow bark extract (salicin) and St. John`s wort extract (hypericum): Two observational studies in patients with chronic back pain and mild to moderate depression

  13. Laparoscopic Uterine Nerve Ethanol Neurolysis (LUNEN in Patients with Chronic Pelvic Pain

    Directory of Open Access Journals (Sweden)

    Seyhan Sönmez

    2016-03-01

    Full Text Available Objective: To investigate the efficacy of laparoscopic uterine nerve ethanol neurolysis (LUNEN for pain man­agement in patients with chronic pelvic pain (CPP. Methods: LUNEN, as a chemical neurolysis procedure, was performed on 22 subjects, and these were com­pared with 20 controls that had a diagnostic laparoscopy alone. Pre-treatment and postoperative 6th month Visual Analogue Scale (VAS scores were estimated and a sub­jective pain evaluation questioning patients’ satisfaction about pain relief in the 6th month after surgery was also performed. Results: A total of 31 (73.8% out of 42 CPP patients had a laparoscopic pelvic pathology. Preoperative VAS scores were similar in the groups; however, the mean postop­erative VAS score was significantly lower in the LUNEN group than in the control group (3.18 ± 2.88 vs. 5.35 ± 3.09; p=0.02. In the LUNEN group, the number of pa­tients who stated that their pain was relieved partially or completely was also significantly higher than in the con­trol group (82% vs. 40%, p=0.019. Conclusion: LUNEN is a feasible, safe and effective sur­gical alternative to traditional surgical methods in patients suffering from CPP. J Clin Exp Invest 2016; 7 (1: 7-13

  14. Sphincter of Oddi dysfunction: Managing the patient with chronic biliary pain

    Institute of Scientific and Technical Information of China (English)

    Lana Bistritz; Vincent G Bain

    2006-01-01

    Sphincter of Oddi dysfunction (SOD) is a syndrome of chronic biliary pain or recurrent pancreatitis due to functional obstruction of pancreaticobiliary flow at the level of the sphincter of Oddi. The Milwaukee classification stratifies patients according to their clinical picture based on elevated liver enzymes, dilated common bile duct and presence of abdominal pain. Type I patients have pain as well as abnormal liver enzymes and a dilated common bile duct. Type Ⅱ SOD consists of pain and only one objective finding, and Type Ⅲ consists of biliary pain only. This classification is useful to guide diagnosis and management of sphincter of Oddi dysfunction. The current gold standard for diagnosis is manometry to detect elevated sphincter pressure, which correlates with outcome to sphincterotomy. However,manometry is not widely available and is an invasive procedure with a risk of pancreatitis. Non-invasive testing methods, including fatty meal ultrasonography and scintigraphy, have shown limited correlation with manometric findings but may be useful in predicting outcome to sphincterotomy. Endoscopic injection of botulinum toxin appears to predict subsequent outcome to sphincterotomy, and could be useful in selection of patients for therapy, especially in the setting where manometry is unavailable.

  15. The validity of self-rating depression scales in patients with chronic widespread pain

    DEFF Research Database (Denmark)

    Amris, Kirstine; Omerovic, Emina; Danneskiold-Samsøe, Bente;

    2016-01-01

    BACKGROUND: Assessment of depression in chronic pain patients by self-rating questionnaires developed and validated for use in normal and/or psychiatric populations is common. The aim of this study was to evaluate the psychometric properties of the Major Depression Inventory (MDI) in a sample...... of females with chronic widespread pain (CWP). METHOD: A total of 263 females diagnosed with CWP and referred for rehabilitation completed the MDI as part of the baseline evaluation. Rasch analysis was applied to this dataset. Rasch measurement models allow detailed analyses of an instrument's rating scale...... and further aspects of validity, including fit of individual scale items to a unidimensional model indicating assessment of a single construct (depression), as a prerequisite for measurement. RESULTS: The Rasch analysis revealed substantial problems with the rating scale properties of the MDI and lack...

  16. 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...

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

    Science.gov (United States)

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

    2016-01-01

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

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

    Science.gov (United States)

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

    2016-01-01

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

  19. COGNITIVE MECHANISMS OF CHANGE IN MULTIDISCIPLINARY TREATMENT OF PATIENTS WITH CHRONIC WIDESPREAD PAIN : A PROSPECTIVE COHORT STUDY

    NARCIS (Netherlands)

    de Rooij, Aleid; de Boer, Michiel R.; van der Leeden, Marike; Roorda, Leo D.; Steultjens, Martijn P. M.; Dekker, Joost

    2014-01-01

    Objective: To evaluate the contribution of improvement in negative emotional cognitions, active cognitive coping, and control and chronicity beliefs to the outcome of multidisciplinary treatment in patients with chronic widespread pain. Design: Prospective cohort study. Patients: A total of 120 subj

  20. 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 ...

  1. Longitudinal associations of depressive symptoms and pain with quality of life in patients receiving chronic hemodialysis.

    Science.gov (United States)

    Belayev, Linda Y; Mor, Maria K; Sevick, Mary Ann; Shields, Anne Marie; Rollman, Bruce L; Palevsky, Paul M; Arnold, Robert M; Fine, Michael J; Weisbord, Steven D

    2015-04-01

    Depressive symptoms and pain are common in patients on chronic hemodialysis (HD), yet their associations with quality of life (QOL) are not fully understood. We sought to characterize the longitudinal associations of these symptoms with QOL. As part of a trial comparing two symptom management strategies in patients receiving chronic HD, we assessed depressive symptoms using the Patient Health Questionnaire-9 (PHQ-9), and pain using the Short Form McGill Pain Questionnaire (SF-MPQ) monthly over 24 months. We assessed health-related QOL (HR-QOL) quarterly using the Short Form 12 (SF-12) and global QOL (G-QOL) using a single-item survey. We used random effects linear regression to analyze the independent associations of depressive symptoms and pain, scaled based on 5-point increments in symptom scores, with HR-QOL and G-QOL. Overall, 286 patients completed 1417 PHQ-9 and SF-MPQ symptom assessments, 1361 SF-12 assessments, and 1416 G-QOL assessments. Depressive symptoms were independently and inversely associated with SF-12 physical HR-QOL scores (β = -1.09; 95% confidence interval [CI]: -1.69, -0.50, P < 0.001); SF-12 mental HR-QOL scores (β = -4.52; 95% CI: -5.15, -3.89, P < 0.001); and G-QOL scores (β = -0.64; 95%CI: -0.79, -0.49, P < 0.001). Pain was independently and inversely associated with SF-12 physical HR-QOL scores (β = -0.99; 95% CI: -1.30, -0.68, P < 0.001) and G-QOL scores (β = -0.12; 95%CI: -0.20, -0.05, P = 0.002); but not with SF-12 mental HR-QOL scores (β = -0.16; 95%CI: -0.050, 0.17, P = 0.34). In patients receiving chronic HD, depressive symptoms and to a lesser extent pain, are independently associated with reduced HR-QOL and G-QOL. Interventions to alleviate these symptoms could potentially improve patients' HR-QOL and G-QOL.

  2. Temporal associations between spouse criticism/hostility and pain among patients with chronic pain: a within-couple daily diary study.

    Science.gov (United States)

    Burns, John W; Peterson, Kristina M; Smith, David A; Keefe, Francis J; Porter, Laura S; Schuster, Erik; Kinner, Ellen

    2013-12-01

    Chronic musculoskeletal pain can strain marriages, perhaps even to the point of engendering spouse criticism and hostility directed toward patients. Such negative spouse responses may have detrimental effects on patient well-being. While results of cross-sectional studies support this notion, we extended these efforts by introducing expressed emotion (EE) and interpersonal theoretical perspectives, and by using electronic diary methods to capture both patient and spouse reports in a prospective design. Patients with chronic low back pain (CLBP) and their spouses (N = 105 couples) reported on perceived spouse behavior and patient pain 5 times/day for 14 days using Personal Data Assistants (PDAs). Concurrent and lagged within-couple associations between patient's perceptions of spouse criticism/hostility and patient self-reported pain and spouses' observations of patient pain behaviors revealed that (1) patient perceived spouse criticism and hostility were correlated significantly with pain intensity, and spouse observed patient pain behavior was related significantly with patient perceived hostility at the same time point; (2) patient perceived spouse hostility significantly predicted patient pain intensity 3 hours later, and spouse observed pain behaviors significantly predicted patient perceived spouse hostility 3 hours later. Results support both EE and interpersonal models, and imply that a comprehensive model would combine these conceptualizations to fully illustrate how spouse criticism/hostility and patient pain interact to produce a negative spiral. Given that marital interactions are amenable to clinical intervention, improved insight into how spouse behavior and patient pain are tightly linked will encourage productive translational efforts to target this neglected area.

  3. Differences in performance on the functional movement screen between chronic low back pain patients and healthy control subjects.

    Science.gov (United States)

    Ko, Min-Joo; Noh, Kyung-Hee; Kang, Min-Hyeok; Oh, Jae-Seop

    2016-07-01

    [Purpose] Differences in scores on the Functional Movement Screen between patients with chronic lower back pain and healthy control subjects were investigated. [Subjects and Methods] In all, 20 chronic lower back pain patients and 20 healthy control subjects were recruited. Chronic lower back pain patients and healthy controls performed the Functional Movement Screen (deep squat, hurdle step, inline lunge, shoulder mobility, active straight leg raise, trunk stability pushup, and rotary stability). The Mann-Whitney test was used to analyze differences in Functional Movement Screen scores between the two groups. [Results] Chronic lower back pain patients scored lower on the Functional Movement Screen total composite compared with healthy control subjects. Chronic lower back pain patients scored lower on Functional Movement Screen subtests including the deep squat, hurdle step, active straight leg raise, and rotary stability tests. [Conclusion] The deep squat, hurdle step, active straight leg raise, and rotary stability tasks of the Functional Movement Screen can be recommended as a functional assessment tools to identify functional deficits in chronic lower back pain patients. PMID:27512272

  4. Prevalence and severity of pain in adult end-stage renal disease patients on chronic intermittent hemodialysis: a systematic review

    Directory of Open Access Journals (Sweden)

    Brkovic T

    2016-06-01

    Full Text Available Tonci Brkovic,1 Eliana Burilovic,2 Livia Puljak3 1Department of Internal Medicine, Division of Nephrology, 2Department of Psychiatry, University Hospital Split, 3Department of Anatomy, Histology and Embryology, Laboratory for Pain Research, University of Split School of Medicine, Split, Croatia Objectives: Understanding the epidemiology of pain in patients on hemodialysis (HD is crucial for further improvement in managing pain. The aim of this study was to systematically review available evidence on the prevalence and severity of pain in adult end-stage renal disease patients on chronic intermittent HD. Materials and methods: We carried out a systematic review of the literature and developed a comprehensive search strategy based on search terms on pain and HD. We searched the databases MEDLINE, Scopus, PsycINFO, and CINAHL from the earliest date of each database to July 24, 2014. Manuscripts in all languages were taken into consideration. Two authors performed each step independently, and all disagreements were resolved after discussion with the third author. The quality of studies was estimated using the STROBE checklist and Cochrane risk-of-bias tool.Results: We included 52 studies with 6,917 participants. The prevalence of acute and chronic pain in HD patients was up to 82% and 92%, respectively. A considerable number of patients suffered from severe pain. Various locations and causes of pain were described, with most of the studies reporting pain in general, pain related to arteriovenous access, headache, and musculoskeletal pain.Conclusion: The findings of this systematic review indicate high prevalence of pain in HD patients and considerable gaps and limitations in the available evidence. Pain in this population should be recognized as a considerable health concern, and the nephrology community should promote pain management in HD patients as a clinical and research priority to improve patients’ quality of life and pain

  5. Associations between demographics and health-related quality of life for chronic non-malignant pain patients treated at a multidisciplinary pain centre

    DEFF Research Database (Denmark)

    Jensen, Hanne Irene; Plesner, Karin; Kvorning, Nina;

    2016-01-01

    OBJECTIVE: To describe the associations between demographics and health-related quality of life for chronic non-malignant pain patients. DESIGN: A cohort study. SETTING: A multidisciplinary Danish pain centre. STUDY PARTICIPANTS: All patients treated at the centre between 2007 and 2013. MAIN.......7 ± 14.4 (range 18-89), and 21% were able to work full or part time. On a Numeric Rating Scale from 0 to 10, median pain-intensity was 8 (interquartile range 7-8) and pain-discomfort 8 (interquartile range 7-9) at time of referral. More than half of the patients had symptoms of anxiety and depression...

  6. 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...

  7. 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 ...

  8. Treatment Expectations for CAM Interventions in Pediatric Chronic Pain Patients and their Parents

    Directory of Open Access Journals (Sweden)

    Jennie C. I. Tsao

    2005-01-01

    Full Text Available Patient expectations regarding complementary and alternative medicine (CAM interventions have important implications for treatment adherence, attrition and clinical outcome. Little is known, however, about parent and child treatment expectations regarding CAM approaches for pediatric chronic pain problems. The present study examined ratings of the expected benefits of CAM (i.e. hypnosis, massage, acupuncture, yoga and relaxation and conventional medicine (i.e. medications, surgery interventions in 45 children (32 girls; mean age = 13.8 years ± 2.5 and parents (39 mothers presenting for treatment at a specialty clinic for chronic pediatric pain. Among children, medications and relaxation were expected to be significantly more helpful than the remaining approaches (P < 0.01. However, children expected the three lowest rated interventions, acupuncture, surgery and hypnosis, to be of equal benefit. Results among parents were similar to those found in children but there were fewer significant differences between ratings of the various interventions. Only surgery was expected by parents to be significantly less helpful than the other approaches (P < 0.01. When parent and child perceptions were compared, parents expected hypnosis, acupuncture and yoga, to be more beneficial than did children, whereas children expected surgery to be more helpful than did parents (P < 0.01. Overall, children expected the benefits of CAM to be fairly low with parents' expectations only somewhat more positive. The current findings suggest that educational efforts directed at enhancing treatment expectations regarding CAM, particularly among children with chronic pain, are warranted.

  9. Opioid use and walking among patients with chronic low back pain

    Directory of Open Access Journals (Sweden)

    Sarah L. Krein, PhD, RN

    2016-02-01

    Full Text Available This study examined the effect of a walking intervention on step counts among patients with chronic back pain who report opioid use. Data were collected as part of a randomized trial to reduce back-pain-related disability. Participants (n = 118 usual care, 111 intervention were Veterans receiving care within one healthcare system. Step counts were collected at baseline, 6 mo, and 12 mo via an uploading pedometer. Self-reported opioid use was collected by survey. More than 40% (n = 99 of participants reported opioid use at baseline. After adjustment, the predicted mean step count for baseline opioid users assigned to the intervention increased by more than 1,200 steps compared with a reduction of nearly 400 steps for those assigned to usual care (between-group difference = 1,625 steps, p = 0.004. Among nonopioid users, there was no change for those in the intervention (–16 steps and an increase of about 660 steps for those assigned to usual care (between-group difference = 683 steps, p = 0.17. These data show that patients taking opioids may engage in walking to help manage their back pain. This finding emphasizes the importance of encouraging the use of alternative pain management strategies for these patients.

  10. Efficacy of the Pilates method for pain and disability in patients with chronic nonspecific low back pain: a systematic review with meta-analysis

    OpenAIRE

    Gisela C. Miyamoto; Leonardo O. P. Costa; Cabral, Cristina M.N.

    2013-01-01

    OBJECTIVE: To systematically review the available evidence on the efficacy of the Pilates method in patients with chronic nonspecific low back pain. METHOD: Searches were performed in MEDLINE, EMBASE, PEDro, SciELO, LILACS, CINAHL and CENTRAL in March 2013. Randomized controlled trials that tested the effectiveness of the Pilates method (against a nontreatment group, minimal intervention or other types of interventions) in adults with chronic low back pain were included regardless the la...

  11. Buprenorphine/naloxone as a promising therapeutic option for opioid abusing patients with chronic pain: reduction of pain, opioid withdrawal symptoms, and abuse liability of oral oxycodone.

    OpenAIRE

    Roux, Perrine; Sullivan, Maria,; Cohen, Julien; Fugon, Lionel; Jones, Jermaine,; Vosburg, Suzanne,; Cooper, Ziva; Manubay, Jeanne,; Mogali, Shanthi; Comer, Sandra

    2013-01-01

    International audience Few studies have examined abuse of prescription opioids among individuals with chronic pain under buprenorphine/naloxone (Bup/Nx) maintenance. The current 7-week inpatient study assessed oral oxycodone self-administration by patients with chronic pain who had a history of opioid abuse. Participants (n=25) were transitioned from their preadmission prescribed opioid to Bup/Nx. All of the participants were tested under each of the sublingual Bup/Nx maintenance doses (2/...

  12. Predictors of long-term opioid use among chronic nonmalignant pain patients

    DEFF Research Database (Denmark)

    Hansen, Carrinna; Abrahamsen, Bo

    Aims: 1) To determine the distribution and determinants of opioid use among chronic nonmalignant pain(CNP) patients. 2) To identify the patient, treatment and socioeconomic characteristics as determinants for potential risk groups. We hypothesized that CNP patient who use opioids for more than 1...... year would differ in demographics and comorbidity from other patients who use opioids for less than 6 months. Methods: National registers were used to include patients beginning opioid therapy in the period 01/01/2000 to 31/12/2014(incl.). The cohort consists of adults aged 16 years or older who...... redeemed at least one prescription for an opioid product and residing in Denmark, analysing only patients who survived for at least two years. Follow-up minimum one year after the last redeemed opioid prescription or to 31/12/2015. Participants are included at first redeemed prescription for an opioid...

  13. Patients with Rheumatoid Arthritis and Chronic Pain Display Enhanced Alpha Power Density at Rest

    Science.gov (United States)

    Meneses, Francisco M.; Queirós, Fernanda C.; Montoya, Pedro; Miranda, José G. V.; Dubois-Mendes, Selena M.; Sá, Katia N.; Luz-Santos, Cleber; Baptista, Abrahão F.

    2016-01-01

    Patients with chronic pain due to neuropathy or musculoskeletal injury frequently exhibit reduced alpha and increased theta power densities. However, little is known about electrical brain activity and chronic pain in patients with rheumatoid arthritis (RA). For this purpose, we evaluated power densities of spontaneous electroencephalogram (EEG) band frequencies (delta, theta, alpha, and beta) in females with persistent pain due to RA. This was a cross-sectional study of 21 participants with RA and 21 healthy controls (mean age = 47.20; SD = 10.40). EEG was recorded at rest over 5 min with participant's eyes closed. Twenty electrodes were placed over five brain regions (frontal, central, parietal, temporal, and occipital). Significant differences were observed in depression and anxiety with higher scores in RA participants than healthy controls (p = 0.002). Participants with RA exhibited increased average absolute alpha power density in all brain regions when compared to controls [F(1.39) = 6.39, p = 0.016], as well as increased average relative alpha power density [F(1.39) = 5.82, p = 0.021] in all regions, except the frontal region, controlling for depression/anxiety. Absolute theta power density also increased in the frontal, central, and parietal regions for participants with RA when compared to controls [F(1, 39) = 4.51, p = 0.040], controlling for depression/anxiety. Differences were not exhibited on beta and delta absolute and relative power densities. The diffuse increased alpha may suggest a possible neurogenic mechanism for chronic pain in individuals with RA. PMID:27540360

  14. Patients with Rheumatoid Arthritis and Chronic Pain Display Enhanced Alpha Power Density at Rest.

    Science.gov (United States)

    Meneses, Francisco M; Queirós, Fernanda C; Montoya, Pedro; Miranda, José G V; Dubois-Mendes, Selena M; Sá, Katia N; Luz-Santos, Cleber; Baptista, Abrahão F

    2016-01-01

    Patients with chronic pain due to neuropathy or musculoskeletal injury frequently exhibit reduced alpha and increased theta power densities. However, little is known about electrical brain activity and chronic pain in patients with rheumatoid arthritis (RA). For this purpose, we evaluated power densities of spontaneous electroencephalogram (EEG) band frequencies (delta, theta, alpha, and beta) in females with persistent pain due to RA. This was a cross-sectional study of 21 participants with RA and 21 healthy controls (mean age = 47.20; SD = 10.40). EEG was recorded at rest over 5 min with participant's eyes closed. Twenty electrodes were placed over five brain regions (frontal, central, parietal, temporal, and occipital). Significant differences were observed in depression and anxiety with higher scores in RA participants than healthy controls (p = 0.002). Participants with RA exhibited increased average absolute alpha power density in all brain regions when compared to controls [F (1.39) = 6.39, p = 0.016], as well as increased average relative alpha power density [F (1.39) = 5.82, p = 0.021] in all regions, except the frontal region, controlling for depression/anxiety. Absolute theta power density also increased in the frontal, central, and parietal regions for participants with RA when compared to controls [F (1, 39) = 4.51, p = 0.040], controlling for depression/anxiety. Differences were not exhibited on beta and delta absolute and relative power densities. The diffuse increased alpha may suggest a possible neurogenic mechanism for chronic pain in individuals with RA.

  15. Evidence for associations among somatoform dissociation, psychological dissociation, and reported trauma in patients with chronic pelvic pain

    NARCIS (Netherlands)

    Nijenhuis, ERS; van Dyck, R; ter Kuile, MM; Mourits, MJE; Spinhoven, P; van der Hart, O

    2003-01-01

    This study investigates somatoform as well as psychological dissociation, somatization and reported trauma among patients with chronic pelvic pain (CPP). Women with CPP (n = 52) who were newly referred to a gynecology department, or whose pain had resisted treatment, completed standardized self-repo

  16. The non-invasive investigation of lumbar disc degeneration in patients with chronic low back pain

    International Nuclear Information System (INIS)

    The painful degenerate disc is a recognised cause of low back pain. Magnetic Resonance Imaging (MRI) has now replaced discography in the non-invasive assessment of disk degeneration. However, the prohibitive capital expense of MRI and the small number of MR units in Australia produce limitations in clinical access. In contrast, Computed Tomography (CT) is readily available and is performed in most patients prior to MRI referral. This prospective study was undertaken to determine whether preliminary CT could offer any information about disc degeneration and so reduce the demand on a MRI scanner. 30 consecutive patients were studied all of whom had both CT and MRI examinations. Of a total 107 discs examined by both techniques, MRI was able to identify 37 degenerate discs. Conclusive evidence of degeneration (i.e. the presence of intervertebral gas) was only seen in 3 discs at CT (1 patient). Of the 29 posterior disc bulges found on CT, all were both bulging and degenerate on MRI. Indications for MRI based on the CT findings are recommended. Using these criteria, 13% (4 patients) of this study group could have avoided an expensive and unnecessary MR investigation. A useful algorithm for the investigation and assessment of patients with chronic low back pain is discussed. 8 refs., 5 figs., 1 tab

  17. [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.

  18. Assessing the Construct Validity and Internal Reliability of the Screening Tool Test Your Memory in Patients with Chronic Pain.

    Directory of Open Access Journals (Sweden)

    B Ojeda

    Full Text Available Patients with chronic pain often complain about cognitive difficulties, and since these symptoms represent an additional source of suffering and distress, evaluating the cognitive status of these patients with valid and reliable tests should be an important part of their overall assessment. Although cognitive impairment is a critical characteristic of pain, there is no specific measure designed to detect these effects in this population. The objective was to analyze the psychometric properties of the "Test Your Memory" (TYM test in patients with chronic pain of three different origins. A cross-sectional study was carried out on 72 subjects free of pain and 254 patients suffering from different types of chronic pain: neuropathic pain (104, musculoskeletal pain (99 and fibromyalgia (51. The construct validity of the TYM was assessed using the Mini-Mental State Examination (MMSE, Hospital Anxiety and Depression Scale (HADs, Index-9 from MOS-sleep, SF-12, and through the intensity (Visual Analogical Scale and duration of pain. An exploratory factor analysis was also performed and internal reliability was assessed using Cronbach's alpha. After adjusting for potential confounders the TYM could distinguish between pain and pain-free patients, and it was correlated with the: MMSE (0.89, p<0.001; HAD-anxiety (-0.50, p<0.001 and HAD-depression scales (-0.52, p<0.001; MOS-sleep Index-9 (-0.49, p<0.001; and the physical (0.49, p < .001 and mental components (0.55, p < .001 of SF-12. The exploratory structure of the TYM showed an 8-factor solution that explained 53% of the variance, and Cronbach's alpha was 0.66. The TYM is a valid and reliable screening instrument to assess cognitive function in chronic pain patients that will be of particular value in clinical situations.

  19. 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

  20. 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

  1. Alcohol and smoking behavior in chronic pain patients: the role of opioids

    DEFF Research Database (Denmark)

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

    2008-01-01

    The primary aim of this epidemiological study was to investigate associations between chronic non-cancer pain with or without opioid treatment and the alcohol and smoking behavior. The secondary aims were to investigate self-reported quality of life, sleeping problems, oral health and the use...... chronic/long-lasting pain lasting 6 months or more?' The question concerning alcohol intake assessed the frequency of alcohol intake and binge drinking. Smoking behavior assessed the daily number of cigarettes. Individuals reporting chronic pain were stratified into two groups (opioid users and non...... individuals. We found, that individuals suffering from chronic pain were less likely to drink alcohol. In opioid users alcohol consumption was further reduced. Cigarette smoking was significantly increased in individuals suffering from chronic pain and in opioid users smoking was further increased. Poor oral...

  2. The Effect of the Modified Lateral Suprascapular Block on Shoulder Function in Patients With Chronic Shoulder Pain

    OpenAIRE

    Dorn, Christian; Rumpold-Seitlinger, Gudrun; Farzi, Sylvia; Auer, Johann; Bornemann-Cimenti, Helmar

    2015-01-01

    Background: Suprascapular nerve block (SSNB) is commonly used in pain therapy for patients with chronic shoulder pain. The effect of SSNB on shoulder function has, however, not been investigated so far. If in shoulder function, i.e. the range of motion is increased after application of the nerve block, it can be expected that subsequent physiotherapy, besides being less painful, is also more effective in terms of restoring shoulder mobility. Objectives: Our aim was to evaluate the effect of S...

  3. 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.

  4. The Durability of Cognitive Behavioral Therapy for Insomnia in Patients with Chronic Pain

    OpenAIRE

    Jungquist, Carla R.; Yolande Tra; Smith, Michael T; Pigeon, Wilfred R.; Sara Matteson-Rusby; Yinglin Xia; Perlis, Michael L.

    2012-01-01

    The purpose of this study was to assess the long-term (six months) effects of cognitive behavioral therapy for insomnia (CBT-I) in patients with chronic pain. The results of the pre-post treatment effects have been reported previously. The therapy was delivered by an advanced practice nurse in a research setting using a parallel-group, randomized, single blind trial of CBT-I with a contact/measurement control condition. Outcomes included sleep diary, the Insomnia Severity Index, the Multidime...

  5. The effects of trunk stability exercise and a combined exercise program on pain, flexibility, and static balance in chronic low back pain patients.

    Science.gov (United States)

    Hwangbo, Gak; Lee, Chae-Woo; Kim, Seong-Gil; Kim, Hyeon-Su

    2015-04-01

    [Purpose] The aim of this study was to examine the effect of trunk stability exercise and combined exercise program on pain, flexibility, and static balance in chronic low back pain patients. [Subjects and Methods] Thirty persons diagnosed with chronic low back pain were divided into a trunk stability exercise group and a combined exercise group and then conducted exercise for six weeks. [Results] VAS and sway lengths decreased significantly in both groups. A comparison of sway lengths after the intervention between the two groups revealed that the trunk stability exercise group had a bigger decrease than the combined exercise group. [Conclusion] The results of this study indicated that trunk stability exercise would have bigger effect than combined exercise on the daily activities of chronic low back pain patients as it strengthens deep abdominal muscles and improves flexibility and balancing ability.

  6. Does a combination of physical training, specific exercises and pain education improve health-related quality of life in patients with chronic neck pain?

    DEFF Research Database (Denmark)

    Ris Hansen, Inge; Søgaard, Karen; Gram, Bibi;

    2016-01-01

    controlled trial of 200 neck pain patients receiving pain education. The exercise group received additional exercises for neck/shoulder, balance and oculomotor function, plus graded physical activity training. Patient-reported outcome measures (Short Form-36 Physical and Mental component summary scores, Euro...... anterior and cervical spine, Cranio-cervical Flexion, Cervical Extension muscle function, and oculomotion) were recorded at baseline and after 4 months. RESULTS: The exercise group showed statistically significant improvement in physical HR-QoL, mental HR-QoL, depression, cervical pressure pain threshold......AIM: To investigate the effect of combining pain education, specific exercises and graded physical activity training (exercise) compared with pain education alone (control) on physical health-related quality of life (HR-QoL) in chronic neck pain patients. METHODS: A multicentre randomised...

  7. 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

    did not cope differently with pain. The only difference between the groups was that FM patients felt more in control of their pain than NP patients. Both patient groups used more maladaptive/passive coping strategies, but surprisingly also more adaptive/active coping strategies than healthy controls...

  8. 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

  9. Post-traumatic stress, depression, and anxiety in patients with injury-related chronic pain: A pilot study

    Directory of Open Access Journals (Sweden)

    Sofia Åhman

    2008-10-01

    Full Text Available Sofia Åhman, Britt-Marie StålnackeDepartment of Community Medicine and Rehabilitation, Umeå University, SwedenAim: To investigate, in patients with injury-related chronic pain, pain intensity, levels of post-traumatic stress, anxiety and depressions.Methods: One hundred and sixty patients aged 17–62 years, admitted for assessment to the Pain Rehabilitation Clinic at the Umeå University Hospital, Umeå Sweden, for chronic pain caused by an injury, answered a set of questionnaires to assess post-traumatic stress (Impact of Event Scale [IES], pain intensity (VAS, depression, and anxiety (Hospital Anxiety and Depression Scale [HAD].Results: Moderate to severe post-traumatic stress was reported by 48.1% of the patients. Possible–probable anxiety on the HAD was scored by 44.5% and possible–probable depression by 45.2%. Pain intensity (VAS was significantly correlated to post-traumatic stress (r = 0.183, p = 0.022, the HAD-scores anxiety (r = 0.186, p = 0.0021, and depression (r = 0.252, p = 0.002. No statistically significant differences were found between genders for post-traumatic stress, pain intensity, anxiety, or depression. Participants with moderate to severe stress reaction reported statistically significant higher anxiety scores on the HAD (p = 0.030 in comparison with patients with mild stress.Conclusion: The findings of relationships between pain intensity, post-traumatic stress, depression, and anxiety may have implications for clinicians and underline the importance of considering all these factors when managing patients with injury-related chronic pain.Keywords: post-traumatic stress disorder, anxiety, chronic pain

  10. Spiritual Needs among Patients with Chronic Pain Diseases and Cancer Living in a Secular Society

    DEFF Research Database (Denmark)

    Büssing, Arndt; Janko, Annina; Baumann, Klaus;

    2013-01-01

    Satisfaction Scale, Interpretation of Illness Questionnaire, and Escape from Illness (Escape). Results We enrolled 392 patients (67% women, mean age 56.3 ± 13.6 years; 61% Christian denomination) with chronic pain diseases (86%) and cancer (14%). Religious Needs (mean score 0.5 ± 0.8 on the scale....... Methods In an anonymous cross-sectional study, standardized questionnaires were provided to German patients with chronic pain diseases (and cancer), i.e., Spiritual Needs Questionnaire (SpNQ), Spirituality/Religiosity and Coping (SpREUK-15), Spiritual Well-being (FACIT-Sp), Brief Multidimensional Life......) and Existential Needs (0.8 ± 0.8 on the scale) were low, while needs for Inner Peace (1.5 ± 0.9 on the scale) and Giving/Generativity were scored high (1.3 ± 1.0 on the scale). Regression analyses indicated that Religious Needs can be predicted best by (religious) “Trust,” the illness interpretation “call...

  11. Short Term Effects of Mobilization Techniques on Neck Pain and Deep Neck Flexor Muscle Endurance in Patients with Mechanical Chronic Neck Pain

    Science.gov (United States)

    Kılınç, Hasan Erkan; Harput, Gülcan; Baltacı, Gül; İnce, Deniz İnal

    2014-01-01

    Objectives: The aim of the study was to investigate short term effects of cervical and scapular mobilization techniques on neck pain and deep cervical muscles endurance in chronical mechanical neck pain patients. Methods: 22 chronical mechanic neck pain patients four male 18 female (mean age: mean±sd 35.59± 15.85) were included. Before treatment, neck pain level (visual analog scale) and deep neck flexor muscles endurance (in supine position with digital chronometer) of all patients were evaluated. Cyriax cervical mobilization for 10 minutes and scapular mobilization for 10 repetition 10 sets were performed to patients as treatment protocol. After treatment, 24 hours after and a week after evaluations of neck pain and deep cervical muscles endurance were repeated. Results: Before treatment Neck pain Visual Analog Scale scores was 5.78±1.43 point, 2.80±1.99 point after treatment, 24 hours later 3.36±2.12 point, one week later 3.91±2.24 point. This alteration was found significant statistically (p<0.01). Before treatment deep cervical flexor muscle endurance score was 27.25±17.74 sec, after treatment 39.46±25.20 sec, 24 hours later 38.67±28.43 and one week later 40.11±27.82 sec. This alteration was also found significant statistically (p=0.01). Conclusion: Initially neck pain scores in our subjects decreased quickly, after 24 hours these scores increased but last scores were below first neck pain level in a week follow-up. Deep neck cervical flexor muscles test scores also increased quickly, after 24 hours later this scores were stable along a week. Mobilization techniques are effective methods on neck pain and endurance in chronical mechanic neck pain patients.

  12. Patient Participation in Chronic Pain Management Through Social Media: A Clinical Study.

    Science.gov (United States)

    Merolli, Mark; Gray, Kathleen; Martin-Sanchez, Fernando

    2016-01-01

    Chronic pain places a significant burden on individuals as well as health services. Long wait lists to access public clinical pain management services can result, and health outcomes deteriorate. Innovative technologies, such as social media provide opportunities to support self-management within the participatory health framework. This paper aims to investigate patients' perceptions towards using social media while waiting for clinic access, with a particular focus on therapeutic affordances. Seventeen wait-listed patients underwent intervention using various social media resources as part of self-management. Thematic content analysis of semi-structured interviews examined patients' perceptions about social media use and participation. Three therapeutic affordances were most evident in the qualitative data: exploration, connection and narration. Barriers to participation were also identified, such as 'specificity of the resources'. Findings suggest social media are perceived positively. However, there is also the need to balance a desire to deliver evidence-based practice with patient-preferences in shared-decision making about social media use. PMID:27332267

  13. Effect of electroacupuncture on opioid consumption in patients with chronic musculoskeletal pain: protocol of a randomised controlled trial

    Directory of Open Access Journals (Sweden)

    Xue Charlie CL

    2012-09-01

    Full Text Available Abstract Background Chronic musculoskeletal pain is common and has been increasingly managed by opioid medications, of which the long-term efficacy is unknown. Furthermore, there is evidence that long-term use of opioids is associated with reduced pain control, declining physical function and quality of life, and could hinder the goals of integrated pain management. Electroacupuncture (EA has been shown to be effective in reducing postoperative opioid consumption. Limited evidence suggests that acupuncture could assist patients with chronic pain to reduce their requirements for opioids. The proposed research aims to assess if EA is an effective adjunct therapy to standard pain and medication management in reducing opioids use by patients with chronic musculoskeletal pain. Methods In this multicentre, randomised, sham-acupuncture controlled, three-arm clinical trial, 316 patients regularly taking opioids for pain control and meeting the defined selection criteria will be recruited from pain management centres and clinics of primary care providers in Victoria, Australia. After a four-week run-in period, the participants are randomly assigned to one of three treatment groups to receive EA, sham EA or no-EA with a ratio of 2:1:1. All participants receive routine pain medication management delivered and supervised by the trial medical doctors. Twelve sessions of semi-structured EA or sham EA treatment are delivered over 10 weeks. Upon completion of the acupuncture treatment period, there is a 12-week follow-up. In total, participants are involved in the trial for 26 weeks. Outcome measures of opioid and non-opioid medication consumption, pain scores and opioid-related adverse events are documented throughout the study. Quality of life, depression, function, and attitude to pain medications are also assessed. Discussion This randomised controlled trial will determine whether EA is of significant clinical value in assisting the management of

  14. Unspecific chronic low back pain – a simple functional classification tested in a case series of patients with spinal deformities

    Directory of Open Access Journals (Sweden)

    Werkmann Mario

    2009-02-01

    Full Text Available Abstract Background Up to now, chronic low back pain without radicular symptoms is not classified and attributed in international literature as being "unspecific". For specific bracing of this patient group we use simple physical tests to predict the brace type the patient is most likely to benefit from. Based on these physical tests we have developed a simple functional classification of "unspecific" low back pain in patients with spinal deformities. Methods Between January 2006 and July 2007 we have tested 130 patients (116 females and 14 males with spinal deformities (average age 45 years, ranging from 14 years to 69 and chronic unspecific low back pain (pain for > 24 months along with the indication for brace treatment for chronic unspecific low back pain. Some of the patients had symptoms of spinal claudication (n = 16. The "sagittal realignment test" (SRT was applied, a lumbar hyperextension test, and the "sagittal delordosation test" (SDT. Additionally 3 female patients with spondylolisthesis were tested, including one female with symptoms of spinal claudication and 2 of these patients were 14 years of age and the other 43yrs old at the time of testing. Results 117 Patients reported significant pain release in the SRT and 13 in the SDT (>/= 2 steps in the Roland & Morris VRS. 3 Patients had no significant pain release in both of the tests ( Pain intensity was high (3,29 before performing the physical tests (VRS-scale 0–5 and low (1,37 while performing the physical test for the whole sample of patients. The differences where highly significant in the Wilcoxon test (z = -3,79; p In the 16 patients who did not respond to the SRT in the manual investigation we found hypermobility at L5/S1 or a spondylolisthesis at level L5/S1. In the other patients who responded well to the SRT loss of lumbar lordosis was the main issue, a finding which, according to scientific literature, correlates well with low back pain. The 3 patients who did not

  15. 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.

  16. Thought suppression as a mediator of the association between depressed mood and prescription opioid craving among chronic pain patients.

    Science.gov (United States)

    Garland, Eric L; Brown, Samantha M; Howard, Matthew O

    2016-02-01

    Emerging research suggests that prescription opioid craving is associated with negative mood and depression, but less is known about cognitive factors linking depressive symptoms to opioid craving among adults with chronic pain. The present cross-sectional study examined thought suppression as a mediator of the relation between depression and prescription opioid craving in a sample of chronic pain patients receiving long-term opioid pharmacotherapy. Data were obtained from 115 chronic pain patients recruited from primary care, pain, and neurology clinics who had taken prescription opioids daily or nearly every day for ≥90 days prior to assessment. In this sample, 60 % of participants met DSM-IV criteria for current major depressive disorder. Depressed mood (r = .36, p suppression (r = .33, p suppression on the association between depressed mood and opioid craving (indirect effect = .09, 95 % CI .01, .20). Sensitivity analyses showed a similar indirect effect of suppression linking major depressive disorder diagnosis and opioid craving. Attempts to suppress distressing and intrusive thoughts may result in increased craving to use opioids among chronic pain patients with depressive symptoms. Results highlight the need for interventions that mitigate thought suppression among adults with pain and mood disorders. PMID:26345263

  17. Thought suppression as a mediator of the association between depressed mood and prescription opioid craving among chronic pain patients.

    Science.gov (United States)

    Garland, Eric L; Brown, Samantha M; Howard, Matthew O

    2016-02-01

    Emerging research suggests that prescription opioid craving is associated with negative mood and depression, but less is known about cognitive factors linking depressive symptoms to opioid craving among adults with chronic pain. The present cross-sectional study examined thought suppression as a mediator of the relation between depression and prescription opioid craving in a sample of chronic pain patients receiving long-term opioid pharmacotherapy. Data were obtained from 115 chronic pain patients recruited from primary care, pain, and neurology clinics who had taken prescription opioids daily or nearly every day for ≥90 days prior to assessment. In this sample, 60 % of participants met DSM-IV criteria for current major depressive disorder. Depressed mood (r = .36, p craving. Multivariate path analyses with bootstrapping indicated the presence of a significant indirect effect of thought suppression on the association between depressed mood and opioid craving (indirect effect = .09, 95 % CI .01, .20). Sensitivity analyses showed a similar indirect effect of suppression linking major depressive disorder diagnosis and opioid craving. Attempts to suppress distressing and intrusive thoughts may result in increased craving to use opioids among chronic pain patients with depressive symptoms. Results highlight the need for interventions that mitigate thought suppression among adults with pain and mood disorders.

  18. Quality of Life as Medicine: A Pilot Studyof Patients with Chronic Illness and Pain

    Directory of Open Access Journals (Sweden)

    Soren Ventegodt

    2003-01-01

    Full Text Available An intensive 5-day quality-of-life (QoL session was constructed based on a psychosomatic model. The session was comprised of teaching on philosophy of life, psychotherapy, and body therapy. The three elements were put together in such a way that they mutually supported each other. The synergy attained was considerable. The pilot study demonstrated that in the course of only 1 week, patients had time to revise essential life-denying views and to integrate important, unfinished life events involving negative feelings. Consequently, the patients became more present in the body’s blocked-off areas and subjectively healthier. Nineteen persons with chronic illness and pain (fibromyalgia, chronic tiredness, whiplash, mild depression, and problems involving pain in arms and legs including osteoarthritis, and unemployed for 5–7 years attended the course. In the week before and after the 5-day course, the participants completed the validated SEQOL (Self-Evaluation of Quality of Life Questionnaire including questions on self-evaluated health and the unvalidated “Self-Evaluation of Working-Life Quality Questionnaire” (SEQWL. This pilot study was without a control group or clinical control. As far as diagnoses were concerned, the group was inhomogeneous. Common for the group was a low QoL, poor quality of working life QWL, and numerous health problems. The study showed an 11.2% improvement in QoL (p < 0.05, a 6.3% improvement in QWL (p < 0.05, and a 12.0% improvement in self-perceived physical health (p = 0.08. There was a 17.3% improvement in self-perceived psychological health (p < 0.05 and satisfaction with health in general improved by 21.4% (p < 0.05. Symptoms like pain were almost halved and several of the participants were free of pain for the first time in years. In conclusion it seemed that the combination of training in philosophy of life, psychotherapy, and body therapy can give patients a large, fast, and efficient improvement in QoL, QWL

  19. Effects of gyrokinesis exercise on the gait pattern of female patients with chronic low back pain.

    Science.gov (United States)

    Seo, Kook-Eun; Park, Tae-Jin

    2016-01-01

    [Purpose] The purpose of the present study was to use kinematic variables to identify the effects of 8/weeks' performance of a gyrokinesis exercise on the gait pattern of females with chronic low back pain. [Subjects] The subjects of the present study were females in their late 20s to mid 30s who were chronic back pain patients. [Methods] A 3-D motion analysis system was used to measure the changes in their gait patterns between pre and post-gyrokintic exercise. The SPSS 21.0 statistics program was used to perform the paired t-test, to compare the gait patterns of pre-post-gyrokinesis exercise. [Results] In the gait analysis, pre-post-gyrokinesis exercise gait patterns showed statistically significant differences in right and left step length, stride length, right-left step widths, and stride speed. [Conclusion] Gait pattern analysis revealed increases in step length, stride length, and stride speed along with a decrease in step width after 8 weeks of gyrokinesis exercise, demonstrating it improved gait pattern.

  20. Change in trunk muscle activities with prone bridge exercise in patients with chronic low back pain.

    Science.gov (United States)

    Kong, Yong-Soo; Park, Seol; Kweon, Mi-Gyong; Park, Ji-Won

    2016-01-01

    [Purpose] The aim of this study was to determine the effect of three different bridge exercises on internal oblique, external oblique, transverse abdominis, and erector spinae activities. [Subjects and Methods] Forty-five subjects with chronic low back pain participated in this study. The training outcome was evaluated with three different testing methods: supine bridge exercise, supine bridge on Swiss ball exercise, and prone bridge exercise. The activities of the transverse abdominis, internal oblique, external oblique, and erector spinae were measured using surface electromyography. [Results] There were significant differences in the internal oblique, external oblique, and erector spinae according to the three kinds of bridging exercises. The internal oblique, external oblique and transverse abdominis activities were highest in the prone bridge exercise, followed by those in the supine bridge on Swiss ball exercise, and supine bridge exercises. The activity of erector spine was highest in the supine bridge on Swiss ball exercise followed by the supine bridge exercise and prone bridge exercise. [Conclusion] These results suggest that prone bridge exercise is more effective than conventional supine bridge exercise and supine bridge on Swiss ball in increasing trunk muscle activity of chronic low back pain patients.

  1. The relationship between pain severity and patient-reported outcomes among patients with chronic low back pain in Japan

    OpenAIRE

    Montgomery W; Vietri J; Shi J; Ogawa K; Kariyasu S; Alev L; Nakamura M

    2016-01-01

    William Montgomery,1 Jeffrey Vietri,2 Jing Shi,3 Kei Ogawa,4 Sawako Kariyasu,4 Levent Alev,4 Masaya Nakamura5 1Eli Lilly Australia Pty Ltd., Sydney, NSW, Australia; 2Health Outcomes Practice, Kantar Health, Horsham, PA, 3Health Outcomes Practice, Kantar Health, Princeton, NJ, USA; 4Eli Lilly Japan K.K., Kobe, Japan; 5Department of Orthopedic Surgery, Keio University School of Medicine, Tokyo, Japan Objective: The aim of this study was to quantify the impact of pain severity on patient-report...

  2. 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...

  3. Better Quality Sleep Promotes Daytime Physical Activity in Patients with Chronic Pain? A Multilevel Analysis of the Within-Person Relationship

    OpenAIRE

    Tang, Nicole K. Y.; Sanborn, Adam N.

    2014-01-01

    BACKGROUND: Promoting physical activity is key to the management of chronic pain, but little is understood about the factors facilitating an individual's engagement in physical activity on a day-to-day basis. This study examined the within-person effect of sleep on next day physical activity in patients with chronic pain and insomnia. METHODS: 119 chronic pain patients monitored their sleep and physical activity for a week in their usual sleeping and living environment. Physical activity was ...

  4. Better Quality Sleep Promotes Daytime Physical Activity in Patients with Chronic Pain? A Multilevel Analysis of the Within-Person Relationship

    OpenAIRE

    Tang, Nicole K. Y.; Sanborn, Adam N.

    2014-01-01

    Background Promoting physical activity is key to the management of chronic pain, but little is understood about the factors facilitating an individual’s engagement in physical activity on a day-to-day basis. This study examined the within-person effect of sleep on next day physical activity in patients with chronic pain and insomnia. Methods 119 chronic pain patients monitored their sleep and physical activity for a week in their usual sleeping and living environment. Physical activity was me...

  5. 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

  6. 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

  7. ROLE OF PSYCHOLOGICAL PROBLEMS IN EFFICACY OF TRANSCUTANEOUS ELECTRICAL NERVE STIMU-LATION IN PATIENTS SUFFERING FROM CHRONIC PAIN

    Directory of Open Access Journals (Sweden)

    S. M. Mirzamani

    2006-07-01

    Full Text Available Patients afflicted with chronic pain have both physical and psychological problems. This research investigated the impact of the psychological factors in the treatment results of transcutaneous electrical nerve stimulation (TENS in the patients afflicted with chronic diseases. The subjects were 37 individuals (20 males and 17 females with the mean age of 46 who had referred to two centers of physiotherapy treatment to receive TENS treatment process. Subjects were suffering from chronic pain in upper part of their body, hands and legs. The subjects were tested and screened psychologically by PDQ4+, MPQ, MPI, and BDI questionnaires. On the basis of the personality disorder and the intensity of the depression, they were divided into two groups: 1 patients with psychological symptoms (n = 14; and 2 patients without psychological symptoms (n = 23. In order to study the rate of the pain intensity reduction in both groups, the MPQ questionnaire was used in three stages (before beginning, in the middle and at the end of the treatment. Also, the MPI questionnaire was used in order to review the inter-personal problems, the interference of the pain in life, daily performance and the rate of social support. Results showed that in each group, the pain intensity had significantly reduced as a result of the impact of TENS treatment and the psychological factors did not have meaningful impacts. Also there was statistically significant correlation between the rate of social support of the family members and the reduction of pain intensity.

  8. 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

  9. The Evaluation of Satisfaction Level of Stability Training Exercises in the Patients with Mechanical Nonspecific Chronic Low Back Pain

    Directory of Open Access Journals (Sweden)

    N. Karimi

    2009-07-01

    Full Text Available Introduction & Objective: There is limited evidence on chronic low back patients' perception and satisfaction of the treatment with spinal stabilization exercises and their overall experience of the treatment program. The objective of this study was to evaluate the satisfaction level of patients with mechanical nonspecific chronic low back pain after participating in a stability training program. Materials & Methods: At first, a methodological study was designed to develop a satisfaction questionnaire, and then content validity and test-retest reliability of it were determined. All patients (n=43 participated in a stability training program within a randomized controlled trial. Finally they filled in satisfaction questionnaire. Results: Distribution of demographic variables were normal (P>0.43. 53.5% of the patients had solitary type occupations. 58.1% had history of sport activities. Also, pain location and extension in 46.5% and 65.2% were in lumbar region only. After stability training program, pain decreased (p<0.001 and functional ability as Oswestry and Quebec scales scores increased (p<0.002 significantly. Overall score of satisfaction questionnaire was 16±4.07.Conclusion: Patients with chronic mechanical low back pain were satisfied after participation in stability training program. Pain reduction and better functional ability may be two factors contributing to the satisfaction of these patients.

  10. [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).

  11. MR aspect of the prostate in CPPS patients (chronic pelvic pain syndrome); MR-Befundmuster der Prostata bei Patienten mit CPP Syndrom (chronic pelvic pain syndrome)

    Energy Technology Data Exchange (ETDEWEB)

    Wiesinger, B.; Lichy, M.P.; Claussen, C.D.; Schlemmer, H.P. [Abt. fuer Radiologische Diagnostik, Universitaetsklinikum Tuebingen (Germany); Naegele, U.; Anastasiadis, A. [Abt. fuer Urologie, Universitaetsklinikum Tuebingen (Germany)

    2008-07-15

    Purpose: to describe typical morphological patterns of abacterial prostatitis using magnetic resonance imagine (MRI) in chronic pelvic pain syndrome patients including spectroscopy. Materials and methods: 18 patients (age range between 25 and 67 years, average 46.2 years) with recurrent chronic pelvic pain syndrome for at least 3 months were evaluated clinically in the urological department and included if there were no suspicious findings from endorectal digital palpation and if their PSA values were < 5 ng/ml. A retrospective analysis of these 18 patients with 30 contrast-enhanced MRI investigations with endorectal coils in 28 of 30 cases was performed with a 1.5T MRI. T2w signal intensity (SI) and spectroscopy data (9/18 patients) were acquired for the normal peripheral zone, the central zone, for the peripheral zone suspected of inflammation and for the muscle including SI ratios for the unaltered and the suspicious inflammatory peripheral zone. Results: typical MR patterns of signal alterations suspected of inflammation of CPPS patients were able to be detected as T2w hypointense triangular, stringy (n = 12, 66.6%) contrast-enhancing signal alterations without a nodular shape with well circumscribed margins of the capsula and without pericapsular signal alterations. In 6 patients changes also had a triangular but more homogeneous aspect (33.3%). Three patients had an additional periurethral uptake (16.6%). T2w SI measurements and T2w SI ratios showed much lower values for the peripheral zone suspected of inflammation as compared to the normal peripheral zone of the prostate (277.29 STD 77.5 to 432.9 STD 112.02 and 4.94 STD 1.47 to 7.58 STD 2.01 respectively). The spectroscopic analysis of the signal alterations suspected of inflammation showed normal Cholin+ Creatin/Citrate SI ratio values in 3 patients (SI < 0.5), ratios suspected of low grade cancer in 3 patients (SI 0.5 and < 0.7) and ratios suspected of intermediate grade prostate cancer in 3 patients (SI

  12. Intrathecal ziconotide: a review of its use in patients with chronic pain refractory to other systemic or intrathecal analgesics.

    Science.gov (United States)

    Sanford, Mark

    2013-11-01

    Ziconotide (Prialt(®)) is a synthetic conopeptide analgesic that acts by selectively antagonizing N-type voltage-gated calcium channels. Intrathecal ziconotide is the only non-opioid intrathecal analgesic that is FDA-approved for use in patients with treatment-refractory, chronic pain. The efficacy of intrathecal ziconotide was demonstrated in randomized, double-blind, placebo-controlled trials in patients with treatment-refractory noncancer-related pain or cancer- or AIDS-related pain. Across trials, ziconotide recipients had significantly greater reductions in pain intensity during ziconotide treatment than those receiving placebo (primary endpoint). At the end of the titration period, approximately one-sixth to one-third of patients with noncancer chronic pain and one-half with cancer- or AIDS-related pain who received ziconotide reached a pain response threshold (≥30 % reduction in the pain intensity score). In ziconotide responders, analgesic effects were enduring, with some patients continuing treatment over extended periods. Across trials, the chief tolerability concerns in ziconotide recipients during the titration phase and during extended treatment were related to CNS adverse events. These were mostly of mild to moderate intensity, although serious adverse events were commonly attributed to ziconotide treatment, especially in trials with rapid ziconotide titration and that permitted higher dosages. In general, clinically important non-CNS adverse events were infrequent, and during the ziconotide titration phase, relatively few patients discontinued treatment because of adverse events. Ongoing research will assess various strategies for selecting patients for ziconotide treatment and for enhancing its efficacy and tolerability. At the present time, intrathecal ziconotide provides a treatment option for patients with severe, unremitting pain who have failed to respond to other intensive analgesic regimens. PMID:23999971

  13. Tetrahydrocannabinol (Delta 9-THC Treatment in Chronic Central Neuropathic Pain and Fibromyalgia Patients: Results of a Multicenter Survey

    Directory of Open Access Journals (Sweden)

    Janet Weber

    2009-01-01

    Full Text Available Central neuropathic pain is difficult to treat, but delta 9-Tetrahydrocannabinol (delta 9-THC may be a promising therapeutic agent. We administered in 172 patients on average 7.5 mg delta 9-THC over 7 months. Of these, 48 patients prematurely withdrew due to side effects, insufficient analgesia, or expense of therapy. Thus, 124 patients were assessed retrospectively in a multicenter telephone survey. Reported changes in pain intensity, recorded on a numeric rating scale (NRS, Pain Disability Index (PDI, Medical Outcomes Short-Form (SF-12, Quality of Life Impairment by Pain (QLIP, Hospital Anxiety Depression Scale (HADS, and amount of concomitant pain medication were recorded. Psychometric parameters (PDI, SF-12, QLIP, HADS and pain intensity improved significantly during delta 9-THC treatment. Opioid doses were reduced and patients perceived THC therapy as effective with tolerable side effects. About 25% of the patients, however, did not tolerate the treatment. Therapy success and tolerance can be assessed by a transient delta 9-THC titration and its maintained administration for several weeks. The present survey demonstrates its ameliorating potential for the treatment of chronic pain in central neuropathy and fibromyalgia. A supplemental delta 9-THC treatment as part of a broader pain management plan therefore may represent a promising coanalgesic therapeutic option.

  14. Time to gain trust and change--experiences of attachment and mindfulness-based cognitive therapy among patients with chronic pain and psychiatric co-morbidity.

    Science.gov (United States)

    Peilot, Birgitta; Andréll, Paulin; Samuelsson, Anita; Mannheimer, Clas; Frodi, Ann; Sundler, Annelie J

    2014-01-01

    The treatment of patients with chronic pain disorders is complex. In the rehabilitation of these patients, coping with chronic pain is seen as important. The aim of this study was to explore the meaning of attachment and mindfulness-based cognitive therapy (CT) among patients with chronic pain and psychiatric co-morbidity. A phenomenological approach within a lifeworld perspective was used. In total, 10 patients were interviewed after completion of 7- to 13-month therapy. The findings reveal that the therapy and the process of interaction with the therapist were meaningful for the patients' well-being and for a better management of pain. During the therapy, the patients were able to initiate a movement of change. Thus, CT with focus on attachment and mindfulness seems to be of value for these patients. The therapy used in this study was adjusted to the patients' special needs, and a trained psychotherapist with a special knowledge of patients with chronic pain might be required.

  15. 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.

  16. Caloric Vestibular Stimulation Reduces Pain and Somatoparaphrenia in a Severe Chronic Central Post-Stroke Pain Patient: A Case Study.

    Directory of Open Access Journals (Sweden)

    Grazia Fernanda Spitoni

    Full Text Available Central post-stroke pain is a neuropathic syndrome characterized by intolerable contralesional pain and, in rare cases, somatic delusions. To date, there is limited evidence for the effective treatments of this disease. Here we used caloric vestibular stimulation to reduce pain and somatoparaphrenia in a 57-year-old woman suffering from central post-stroke pain. Resting-state functional magnetic resonance imaging was used to assess the neurological effects of this treatment. Following vestibular stimulation we observed impressive improvements in motor skills, pain, and somatic delusions. In the functional connectivity study before the vestibular stimulation, we observed differences in the patient's left thalamus functional connectivity, with respect to the thalamus connectivity of a control group (N = 20, in the bilateral cingulate cortex and left insula. After the caloric stimulation, the left thalamus functional connectivity with these regions, which are known to be involved in the cortical response to pain, disappeared as in the control group. The beneficial use of vestibular stimulation in the reduction of pain and somatic delusion in a CPSP patient is now documented by behavioral and imaging data. This evidence can be applied to theoretical models of pain and body delusions.

  17. 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...

  18. Reasons for drop-out from rehabilitation in patients of Turkish and Moroccan origin with chronic low back pain in the Netherlands : a qualitative study

    NARCIS (Netherlands)

    Sloots, Maurits; Dekker, Jos H. M.; Pont, Menno; Bartels, Edien A. C.; Geertzen, Jan H. B.; Dekker, Joost

    2010-01-01

    Objective: To explore which factors led to drop-out in patients of Turkish and Moroccan origin with chronic nonspecific low back pain who participated in a rehabilitation programme. Subjects: Patients of Turkish or Moroccan origin with chronic non-specific low back pain (n=23) from 2 rehabilitation

  19. Efficacy of the Pilates method for pain and disability in patients with chronic nonspecific low back pain: a systematic review with meta-analysis

    Directory of Open Access Journals (Sweden)

    Gisela C. Miyamoto

    2013-12-01

    Full Text Available OBJECTIVE: To systematically review the available evidence on the efficacy of the Pilates method in patients with chronic nonspecific low back pain. METHOD: Searches were performed in MEDLINE, EMBASE, PEDro, SciELO, LILACS, CINAHL and CENTRAL in March 2013. Randomized controlled trials that tested the effectiveness of the Pilates method (against a nontreatment group, minimal intervention or other types of interventions in adults with chronic low back pain were included regardless the language of publication. The outcome data were extracted from the eligible studies and were combined using a meta-analysis approach. RESULTS: The searches identified a total of 1,545 articles. From these, eight trials were considered eligible, and seven trials were combined in the meta-analysis. The comparison groups were as follows: Pilates versus other types of exercises (n=2 trials, and Pilates versus no treatment group or minimal intervention (n=4 trials for short term pain; Pilates versus minimal intervention for short-term disability (n=4.We determined that Pilates was not better than other types of exercises for reducing pain intensity. However, Pilates was better than a minimal intervention for reducing short-term pain and disability (pain: pooled mean difference=1.6 points; 95% CI 1.4 to 1.8; disability: pooled mean difference=5.2 points; 95% CI 4.3 to 6.1. CONCLUSIONS: Pilates was better than a minimal intervention for reducing pain and disability in patients with chronic low back pain. Pilates was not better than other types of exercise for short-term pain reduction.

  20. ANALYSIS OF THE PATHOGENETIC MECHANISMS OF CHRONIC JOINT PAIN IN PATIENTS WITH RHEUMATOID ARTHRITIS AND KNEE OSTEOARTHRITIS

    Directory of Open Access Journals (Sweden)

    E. S. Filatova

    2014-01-01

    Full Text Available Objective: to reveal neurogenic mechanisms in the pathogenesis of chronic pain syndrome in rheumatoid arthritis (RA and knee osteoarthritis (OA in order to develop individualized pharmacotherapy.Subjects and methods. One hundred and eighty-three patients with RA and 80 with knee OA were examined. By using the neuropathic pain diagnostic questionnaire (DN4, all the patients were divided into 2 groups with and without a neuropathic pain component (NPC.Results. NPC was found in 43% of the patients with RA and it was connected with involvement of the peripheral somatosensory system. In RA, NPC was common in older patients with longer disease duration, higher X-ray stage, and severe functional insufficiency. 30% of patients with knee OA also had NPC, however the signs of nervous system involvement were absent. In OA, NPC was associated with hyperalgesia, higher pain intensity, more marked joint dysfunction on the WOMAC, and anxiety.Discussion. This investigation revealed a mixed pattern of chronic pain syndrome in patients with RA and knee OA; some patients were found to have a NPC in the presence of predominantly a nociceptive component

  1. 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

  2. Cognitive-Behavioral Classifications of Chronic Pain in Patients with Multiple Sclerosis

    Science.gov (United States)

    Khan, Fary; Pallant, Julie F.; Amatya, Bhasker; Young, Kevin; Gibson, Steven

    2011-01-01

    The aim of this study was to replicate, in patients with multiple sclerosis (MS), the three-cluster cognitive-behavioral classification proposed by Turk and Rudy. Sixty-two patients attending a tertiary MS rehabilitation center completed the Pain Impact Rating questionnaire measuring activity interference, pain intensity, social support, and…

  3. The effect of lumbar stabilization exercises and thoracic mobilization and exercises on chronic low back pain patients.

    Science.gov (United States)

    Heo, Min-Yeong; Kim, Kyoung; Hur, Beom-Young; Nam, Chan-Woo

    2015-12-01

    [Purpose] To investigate whether pain, balance, and stabilization of the lumbar region can be improved through thoracic mobilization in addition to lumbar stabilizaing exercises. [Subjects and Methods] This study recruited 36 subjects with chronic low back pain lasting more than 12 weeks. The subjects recruited for this study participated voluntarily, and provided their signed consent to participation. [Results] Improvement in balance was largest in the lumbar stabilization exercise group, followed by the thoracic mobilization and exercise group, and the traditional physical therapy group, in decreasing order of effect. [Conclusion] In conclusion, lumbar stabilization exercises combined with thoracic mobilization had greater effects on stabilization of the lumbar region pain relief, and improvement of the function of the patients with chronic low back pain.

  4. Self-management of chronic pain in Malaysian patients: effectiveness trial with 1-year follow-up.

    Science.gov (United States)

    Cardosa, Mary; Osman, Zubaidah Jamil; Nicholas, Michael; Tonkin, Lois; Williams, Amanda; Abd Aziz, Khuzaimah; Mohd Ali, Ramli; Dahari, Norhana Mohd

    2012-03-01

    Self-management of chronic illnesses has been widely recognised as an important goal on quality of life, health service utilisation and cost grounds. This study describes the first published account on the application of this approach to people suffering from chronic pain conditions in a Southeast Asian country, Malaysia. A heterogeneous sample of chronic pain patients in Malaysia attended a 2-week cognitive-behavioural pain management programme (PMP) aimed at improving daily functional activities and general psychological well-being. Complete datasets from 70 patients out of 102 patients who attended 11 programmes conducted from 2002 to 2007, as well as the 1-month and 1-year follow-up sessions at the hospital clinic, are reported. The pre- to post-treatment results on self-report measures indicate that significant gains were achieved on the dimensions of pain, disability and psychological well-being. These gains were maintained at both 1-month and 1-year follow-ups. The results mirror those reported from similar interventions in Europe and North America and indicate the concept of self-management of a chronic illness is acceptable and meaningful to Asian patients. Importantly, the achieved outcomes were independent of gender and ethnic group status.

  5. Psychological Interventions in the Rehabilitation of Patients with Chronic Low Back Pain: Evidence and Recommendations from Systematic Reviews and Guidelines

    Science.gov (United States)

    Reese, Christina; Mittag, Oskar

    2013-01-01

    The purpose of the article is to summarize evidence and recommendations for psychological interventions in the rehabilitation of patients with chronic low back pain. We carried out a systematic literature search in several databases and on the websites of professional associations to identify relevant reviews and guidelines. In addition to the…

  6. Do analgesics improve functioning in patients with chronic low back pain? An explorative triple-blinded RCT

    NARCIS (Netherlands)

    Schiphorst Preuper, Henrica; Geertzen, Jan. H. B.; van Wijhe, Marten; Boonstra, Anne M.; Molmans, Barbara H. W.; Dijkstra, Pieter U.; Reneman, Michiel F.

    2014-01-01

    Treatment of patients with chronic low back pain (CLBP) aims to reduce disability, improve functional capacity, and participation. Time contingent prescription of analgesics is a treatment modality in CLBP. The impact of analgesics on functional capacity is unknown. Aim of the study was to explore t

  7. Which Instruments Can Detect Submaximal Physical and Functional Capacity in Patients With Chronic Nonspecific Back Pain? A Systematic Review

    NARCIS (Netherlands)

    van der Meer, Suzan; Trippolini, Maurizio A.; van der Palen, Job; Verhoeven, Jan; Reneman, Michiel F.

    2013-01-01

    Study Design. Systematic review. Objective. To evaluate the validity of instruments that claim to detect submaximal capacity when maximal capacity is requested in patients with chronic nonspecific musculoskeletal pain. Summary of Background Data. Several instruments have been developed to measure ca

  8. Tapentadol prolonged release for severe chronic cancer-related pain: effectiveness, tolerability, and influence on quality of life of the patients

    OpenAIRE

    Schikowski A; Krings D; Schwenke K

    2014-01-01

    Artur Schikowski,1 Doris Krings,2 Karla Schwenke2 1Neurology and Specialist Pain Therapy, Specialist Center Düsseldorf, Düsseldorf, 2Grünenthal GmbH, Aachen, Germany Background: Clinical trials have shown the efficacy and good tolerability of tapentadol prolonged release (PR) for severe chronic pain of different etiologies. This study investigated the influence of tapentadol PR on pain control and quality of life of patients with severe chronic cancer-related pain ...

  9. Chronic pain in patients with the hypermobility type of Ehlers-Danlos syndrome: evidence for generalized hyperalgesia.

    Science.gov (United States)

    Rombaut, Lies; Scheper, Mark; De Wandele, Inge; De Vries, Janneke; Meeus, Mira; Malfait, Fransiska; Engelbert, Raoul; Calders, Patrick

    2015-06-01

    Chronic widespread pain is highly present in patients with the Ehlers-Danlos syndrome hypermobility type (EDS-HT), but up to now, evidence for generalized hyperalgesia is lacking. The aim of this study is to investigate whether pressure pain thresholds (PPTs) at both symptomatic and asymptomatic body areas differ in EDS-HT patients compared to healthy subjects. Twenty-three women with EDS-HT and 23 gender- and age-matched healthy controls participated. All subjects marked on Margolis Pain Diagram where they felt pain lasting longer than 24 h in the past 4 weeks. Then, they completed several questionnaires assessing pain cognitions, fatigue, disability, and general health status, in order to take the possible influence of these factors on PPTs into account. Patients also completed a form concerning the type of pain they experienced. Thereupon, a blinded researcher assessed PPTs at 14 body locations on the trunk and extremities. PPTs were compared for the two complete groups. In addition, PPTs of patients and controls who did not report pain in a respective zone were compared. PPTs of the patients were significantly lower compared to those of the control group, also when pain-free samples per zone were compared. The mean (SD) PPT was 2.9 (1.62) kg/cm(2) in the EDS-HT patients and 5.2 (1.88) kg/cm(2) in the controls (P pain component was likely present. This study provides evidence for the existence of hyperalgesia even in asymptomatic areas (generalized secondary hyperalgesia). The generalized hyperalgesia may represent the involvement of a sensitized central nervous system, which inquires an adapted pain management for this patient group. PMID:24487572

  10. 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...

  11. The effects of lumbar stabilization exercise with thoracic extension exercise on lumbosacral alignment and the low back pain disability index in patients with chronic low back pain.

    Science.gov (United States)

    Woo, Seong-Dae; Kim, Tae-Ho

    2016-01-01

    [Purpose] To determine the effects of lumbar stabilization exercise with thoracic extension exercise on chronic low back pain patients. [Subjects and Methods] Thirty patients with chronic low back pain were randomly divided into a lumbar stabilization exercise group (group A) and a lumbar stabilization exercise with thoracic extension exercise group (group B). Group B did 15 min of lumbar stabilization exercises and 15 min of thoracic extension exercises, while group A did 30 min of lumbar stabilization exercises five times a week for 4 weeks. For assessing lumbosacral alignment, the lordotic angle, lumbosacral angle, and sacral angle were evaluated. The Oswestry disability index was used for assessment of disability due to low back pain. [Results] Both groups showed improvement in lumbosacral alignment and in the disability index. Group B showed greater changes in the lordotic angle and in the Oswestry disability index than group A, although the differences were not statistically significant. [Conclusion] Lumbar stabilization exercise with thoracic extension exercise can be recommended for improvement of chronic low back pain, although the improvements seen in lumbosacral alignment and low back pain disability index in this study did not achieve statistical significance.

  12. Physical therapists should integrate illness perceptions in their assessment in patients with chronic musculoskeletal pain; a qualitative analysis.

    Science.gov (United States)

    van Wilgen, Paul; Beetsma, Anneke; Neels, Hedwig; Roussel, Nathalie; Nijs, Jo

    2014-06-01

    In the past decade, scientific evidence has shown that the biomedical model falls short in the treatment of patients with musculoskeletal pain. To understand musculoskeletal pain and a patient's health behavior and beliefs, physical therapists should assess the illness perceptions of their patients. In this quantitative study, we audiotaped the assessments of 19 primary care physical therapists on 27 patients and analyzed if and how illness perceptions were assessed. The Common Sense Model was used as the theoretical framework. We conclude that some of the domains of the Common Sense Model were frequently asked for (identity, causes and consequences), while others (timeline, treatment control, coherence, emotional representation) were used less frequently or seldom mentioned. The overall impression was that the assessments of the physical therapists were still bio-medically oriented in these patients with chronic musculoskeletal pain.

  13. Antineuropathic and Antinociceptive Drugs Combination in Patients with Chronic Low Back Pain: A Systematic Review

    OpenAIRE

    Carlo Luca Romanò; Delia Romanò; Marco Lacerenza

    2012-01-01

    Purpose. Chronic low back pain (LBP) is often characterized by both nociceptive and neuropathic components. While various monotherapies have been reported of only limited efficacy, combining drugs with different mechanisms of action and targets appears a rational approach. Aim of this systematic review is to assess the efficacy and safety of different combined pharmacological treatments, compared to monotherapy or placebo, for the pharmacological treatment of chronic LBP. Methods. Published p...

  14. 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

  15. Kinesio Taping® is not better than placebo in reducing pain and disability in patients with chronic non-specific low back pain: a randomized controlled trial

    Directory of Open Access Journals (Sweden)

    Maurício A. Luz Júnior

    2015-12-01

    Full Text Available Background: Kinesio Taping® has been widely used in clinical practice. However, it is unknown whether this type of tape is more effective than placebo taping in patients with chronic lower back pain. Objective: To compare the effectiveness of Kinesio Taping® in patients with chronic non-specific low back pain against a placebo tape and a control group. Method: This is a 3-arm, randomized controlled trial with a blinded assessor. Sixty patients with chronic non-specific low back pain were randomized into one of the three groups: Kinesio Taping® group (n=20, Micropore® (placebo group (n=20 and control group (n=20. Patients allocated to both the Kinesio Taping® group and the placebo group used the different types of tape for a period of 48 hours. The control group did not receive any intervention. The outcomes measured were pain intensity (measured by an 11-point numerical rating scale and disability (measured by the 24-item Roland Morris Disability Questionnaire. A blinded assessor measured the outcomes at baseline, 48 hours and 7 days after randomization. Results: After 48 hours, there was a statistically significant difference between the Kinesio Taping® group versus the control group (mean between-group difference = -3.1 points, 95% CI=-5.2 to -1.1, p=0.003, but no difference when compared to the placebo group (mean between-group difference= 1.9 points, 95% CI=-0.2 to 3.9, p=0.08. For the other outcomes no differences were observed. Conclusions: The Kinesio Taping® is not better than placebo (Micropore® in patients with chronic low back pain.

  16. Kinesio Taping® is not better than placebo in reducing pain and disability in patients with chronic non-specific low back pain: a randomized controlled trial

    Science.gov (United States)

    Luz, Maurício A.; Sousa, Manoel V.; Neves, Luciana A. F. S.; Cezar, Aline A. C.; Costa, Leonardo O. P.

    2015-01-01

    Background: Kinesio Taping ® has been widely used in clinical practice. However, it is unknown whether this type of tape is more effective than placebo taping in patients with chronic lower back pain. Objective: To compare the effectiveness of Kinesio Taping ® in patients with chronic non-specific low back pain against a placebo tape and a control group. Method: This is a 3-arm, randomized controlled trial with a blinded assessor. Sixty patients with chronic non-specific low back pain were randomized into one of the three groups: Kinesio Taping ® group (n=20), Micropore® (placebo) group (n=20) and control group (n=20). Patients allocated to both the Kinesio Taping ® group and the placebo group used the different types of tape for a period of 48 hours. The control group did not receive any intervention. The outcomes measured were pain intensity (measured by an 11-point numerical rating scale) and disability (measured by the 24-item Roland Morris Disability Questionnaire). A blinded assessor measured the outcomes at baseline, 48 hours and 7 days after randomization. Results: After 48 hours, there was a statistically significant difference between the Kinesio Taping ® group versus the control group (mean between-group difference = -3.1 points, 95% CI=-5.2 to -1.1, p=0.003), but no difference when compared to the placebo group (mean between-group difference= 1.9 points, 95% CI=-0.2 to 3.9, p=0.08). For the other outcomes no differences were observed. Conclusions: The Kinesio Taping ® is not better than placebo (Micropore®) in patients with chronic low back pain. PMID:26647750

  17. Treatment of chronic low back pain in patients with spinal deformities using a sagittal re-alignment brace

    Directory of Open Access Journals (Sweden)

    Weiss Hans-Rudolf

    2009-03-01

    Full Text Available Abstract Background For adult scoliosis patients with chronic low back pain bracing is initially indicated before spinal surgery is considered. Until recently there has been a lack of research into the effect upon pain reductions in the mid and long-term. Promising results have been documented in short-term studies for the application of a sagittal re-alignment brace in patients with spinal deformities and along with pain; however mid-term and long-term results are not yet available. The purpose of this study is to investigate the mid-term effects of this brace with respect to pain control. Materials and methods 67 patients (58 females and 9 males with chronic low back pain (> 24 months and the diagnosis of scoliosis or hyperkyphosis were treated with a sagittal re-alignment brace (physio-logic brace™ between January 2006 and July 2007. The indication for this kind of brace treatment was derived from a positive sagittal re-alignment test (SRT and the exclusion of successful conservative treatment during the last 24 months. The aim of this type of conservative intervention was to avoid surgery for chronic low back pain. Results The average pain intensity was measured on the Roland and Morris VRS (5 steps before treatment. This was 3.3 (t1, at the time of brace adjustment it was 2.7 (t2 and after at an average observation time of 18 months it was 2.0 (t3. The differences were highly significant in the Wilcoxon test. Discussion Short-term measurements showed that a significant pain reduction is possible in chronic postural low back pain using a sagittal re-alignment brace inducing lumbar re-lordosation. In a preliminary report at adjustment (t2, highly significant improvements of pain intensity have also been demonstrated. At 6 months of treatment however, no improvement was measured. The improvement of the mid-term effects (18 months found in this study compared to the preliminary report may be due to the changed approach to compliance: whilst

  18. 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…

  19. 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.

  20. A comparison of self-hypnosis versus progressive muscle relaxation in patients with multiple sclerosis and chronic pain.

    Science.gov (United States)

    Jensen, Mark P; Barber, Joseph; Romano, Joan M; Molton, Ivan R; Raichle, Katherine A; Osborne, Travis L; Engel, Joyce M; Stoelb, Brenda L; Kraft, George H; Patterson, David R

    2009-04-01

    Twenty-two patients with multiple sclerosis (MS) and chronic pain we recruited into a quasi-experimental trial comparing the effects of self-hypnosis training (HYP) with progressive muscle relaxation (PMR) on pain intensity and pain interference; 8 received HYP and the remaining 14 participants were randomly assigned to receive either HYP or PMR. HYP-condition participants reported significantly greater pre- to postsession as well as pre- to posttreatment decreases in pain and pain interference than PMR-condition participants, and gains were maintained at 3-month follow-up. Most of the participants in both conditions reported that they continued to use the skills they learned in treatment and experienced pain relief when they did so. General hypnotizability was not significantly related to treatment outcome, but treatment-outcome expectancy assessed before and after the first session was. The results support the efficacy of self-hypnosis training for the management of chronic pain in persons with MS. PMID:19234967

  1. A Comparison of Self-Hypnosis Versus Progressive Muscle Relaxation in Patients With Multiple Sclerosis and Chronic Pain1

    Science.gov (United States)

    Jensen, Mark P.; Barber, Joseph; Romano, Joan M.; Molton, Ivan R.; Raichle, Katherine A.; Osborne, Travis L.; Engel, Joyce M.; Stoelb, Brenda L.; Kraft, George H.; Patterson, David R.

    2009-01-01

    Twenty-two patients with multiple sclerosis (MS) and chronic pain we recruited into a quasi-experimental trial comparing the effects of self-hypnosis training (HYP) with progressive muscle relaxation (PMR) on pain intensity and pain interference; 8 received HYP and the remaining 14 participants were randomly assigned to receive either HYP or PMR. HYP-condition participants reported significantly greater pre- to postsession as well as pre- to posttreatment decreases in pain and pain interference than PMR-condition participants, and gains were maintained at 3-month follow-up. Most of the participants in both conditions reported that they continued to use the skills they learned in treatment and experienced pain relief when they did so. General hypnotizability was not significantly related to treatment outcome, but treatment-outcome expectancy assessed before and after the first session was. The results support the efficacy of self-hypnosis training for the management of chronic pain in persons with MS. PMID:19234967

  2. 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...

  3. Fear and difficulty perceived when visualizing therapeutic exercise in patients with chronic low back pain: A cross-sectional study

    OpenAIRE

    Pérez-Fernández, Marcos; Lerma-Lara, Sergio; Ferrer-Peña, Raúl; Gil-Martínez, Alfonso; López-de-Uralde-Villanueva, Ibai; Paris-Alemany, Alba; Beltrán-Alacreu, Héctor; La Touche, Roy

    2015-01-01

    The main aim of this study was to evaluate the perceived level of difficulty and fear of movement among patients with chronic low back pain (CLBP) compared with asymptomatic subjects when they visualized motor control therapeutic exercises (MCTEs) commonly used in physiotherapy. Our secondary objective was to analyse the correlation between fear of MCTEs and other psychological and disability variables. Thirty patients with CLBP comprised the treatment group, and 30 asymptomatic subjects comp...

  4. 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.

  5. 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.

  6. Perceived success and failure of intrathecal infusion pump implantation in chronic pain patients.

    Science.gov (United States)

    Corrado, Philip; Alperson, Burton; Wright, Michelle

    2008-04-01

    Objectives.  Over the past few years, there has been an increased reliance on the intrathecal delivery of drugs for patients suffering from intractable pain. We sought to demonstrate the effectiveness of the intrathecal pain pump by examining self-reported pre- and postimplantation pain levels. Methods.  Eighty-four patients who had elected to implant a Medtronic SynchroMed 1 or 2 system in order to control their pain were asked to complete a survey. The survey consisted of pain ratings before implantation, pain ratings postimplantation, medications used before and after implantation, and patient satisfaction with the procedure. Results.  Perceived success rate for implantation is 68%, when measured by the ability to reduce reliance on oral medication. When measured by willingness to undergo the procedure again, the success rate is 86%. Conclusions.  Overall, the implantation of an intrathecal pain pump is an effective way for most people to manage their intractable pain and reduce reliance on oral medications. PMID:22151041

  7. 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...

  8. 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

  9. The effects of prone bridge exercise on the Oswestry disability index and proprioception of patients with chronic low back pain.

    Science.gov (United States)

    Kong, Yong-Soo; Jang, Gwon-Uk; Park, Seol

    2015-09-01

    [Purpose] The purpose of this study was to investigate the effect of bridge exercises on the Oswestry disability index (ODI) scores and proprioception among patients with chronic low back pain (CLBP). [Subjects and Methods] A total of 38 patients participated in this study. After eight weeks of bridge exercise, the joint position angle of the body trunk was measured and the ODI was used in survey form to investigate the intensity of the patients' low back pain. [Results] After eight weeks of exercise, the ODI showed significant differences in all three groups. Subjects' joint position sense of the trunk in both lumbar flexion and extension was also significantly different after completing the exercise program; this was true for all three groups. [Conclusion] Performing the prone bridge exercise for eight weeks improved proprioceptive function and reduced pain and impediment of activity, showing it a more effective exercise than other bridge exercises.

  10. 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.

  11. Reliability of lumbar movement dysfunction tests for chronic low back pain patients.

    Science.gov (United States)

    Bauer, Christoph Michael; Heimgartner, Martin; Rast, Fabian Marcel; Ernst, Markus Josef; Oetiker, Sarah; Kool, Jan

    2016-08-01

    Assessment of lumbar movement dysfunction commonly comprises trunk range of motion (ROM), movement or control impairment (MCI), and reposition error (RE). Those assessments are typically based on visual observation. Consequently it is not possible to reliably quantify back movements for intersubject comparisons, or for monitoring changes before and after an intervention. Inertial measurement unit (IMU)-systems could be used to quantify these movement dysfunctions in clinical settings. The aim of this study was to evaluate the reliability of movement dysfunction tests when measured with a novel IMU-system. The reliability of eleven movement dysfunction tests (four ROM, six MCI and one RE tests) were analysed using generalizability-theory and minimal detectable change, measuring 21 chronic low back pain patients in seven trials on two days. Reliability varied across tests and variables. Four ROM and selected MCI tests and variables were identified as reliable. On average, ROM test were more reliable, compared to MCI and RE tests. An attempt should be made to improve the reliability of MCI and RE measures, for example through better standardizations. Subsequently these measures should be studied further for intersubject comparisons and monitoring changes after an intervention. PMID:26980560

  12. The effects of prone bridge exercise on trunk muscle thickness in chronic low back pain patients.

    Science.gov (United States)

    Kong, Yong-Soo; Lee, Woo-Jin; Park, Seol; Jang, Gwon-Uk

    2015-07-01

    [Purpose] This study aimed to investigate the effects of prone bridge exercise on trunk muscle thickness. [Subjects and Methods] Thirty-seven chronic low back pain patients participated in this study. Each participant was randomly assigned to one of three exercise groups, namely, a prone bridge exercise group, supine bridge exercise on a Swiss ball group, and supine bridge exercise group. The thicknesses of the transverse abdominis (TrA), internal oblique (IO), and external oblique (EO) were measured using ultrasound. [Results] After eight weeks of training, the three groups showed significant increases in the thicknesses of the TrA, IO, and EO. Among the groups, TrA and IO showed significantly different muscle thicknesses. [Conclusion] The prone bridge exercise significantly affected the thicknesses of the TrA, IO, and EO unlike the supine bridge exercises. Based on the results of this study, the prone bridge exercise is a more effective method to improve trunk stability than conventional supine bridge exercises.

  13. 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.

  14. A double-blind comparison between epidural morphine and epidural clonidine in patients with chronic non-cancer pain.

    Science.gov (United States)

    Glynn, C; Dawson, D; Sanders, R

    1988-08-01

    In a randomised double-blind study of 20 patients with chronic pain, epidural morphine 5 mg in 5 ml of saline was compared with epidural clonidine 150 micrograms in 5 ml of saline. Thirteen patients had a clinical and radiological diagnosis of arachnoiditis, 6 had low back pain and 1 had post-operative scar pain. There were 18 females and 2 males with an average age of 52 years, range 22-76 years. There was no difference found between the 2 solutions in the resultant analgesia measured by the visual analogue scale for pain, pain relief or the pain word score during the 3 h period of the study. No difference was found in the patient's mood which was also measured with the visual analogue scale. Two patients had no analgesia from either injection, 2 patients did not obtain any relief from clonidine and another 2 obtained no relief from morphine. Six patients reported that clonidine was better than morphine, 5 reported that morphine and clonidine were the same and 3 reported that morphine was better than clonidine. The duration of analgesia from the clonidine varied from 6 h to 1 month; the duration of analgesia from morphine varied from 6 to 24 h. Clonidine was associated with sedation and a fall in blood pressure of greater than 20 mm Hg in all patients, 1 patient required ephedrine to treat hypotension. Twelve patients had pruritus, 7 nausea and 2 vomiting following the morphine. Statistically there was no difference found between morphine and clonidine for short-term (3 h) analgesia in these patients.(ABSTRACT TRUNCATED AT 250 WORDS)

  15. Effects of Mindfulness-Based Cognitive Therapy on Body Awareness in Patients with Chronic Pain and Comorbid Depression

    Science.gov (United States)

    de Jong, Marasha; Lazar, Sara W.; Hug, Kiran; Mehling, Wolf E.; Hölzel, Britta K.; Sack, Alexander T.; Peeters, Frenk; Ashih, Heidi; Mischoulon, David; Gard, Tim

    2016-01-01

    Body awareness has been proposed as one of the major mechanisms of mindfulness interventions, and it has been shown that chronic pain and depression are associated with decreased levels of body awareness. We investigated the effect of Mindfulness-Based Cognitive Therapy (MBCT) on body awareness in patients with chronic pain and comorbid active depression compared to treatment as usual (TAU; N = 31). Body awareness was measured by a subset of the Multidimensional Assessment of Interoceptive Awareness (MAIA) scales deemed most relevant for the population. These included: Noticing, Not-Distracting, Attention Regulation, Emotional Awareness, and Self-Regulation. In addition, pain catastrophizing was measured by the Pain Catastrophizing Scale (PCS). These scales had adequate to high internal consistency in the current sample. Depression severity was measured by the Quick Inventory of Depressive Symptomatology—Clinician rated (QIDS-C16). Increases in the MBCT group were significantly greater than in the TAU group on the “Self-Regulation” and “Not Distracting” scales. Furthermore, the positive effect of MBCT on depression severity was mediated by “Not Distracting.” These findings provide preliminary evidence that a mindfulness-based intervention may increase facets of body awareness as assessed with the MAIA in a population of pain patients with depression. Furthermore, they are consistent with a long hypothesized mechanism for mindfulness and emphasize the clinical relevance of body awareness. PMID:27445929

  16. Assessment of the quality of life through the SF-36 questionnaire in patients with chronic nonspecific low back pain.

    Science.gov (United States)

    Adorno, Marta Lúcia Guimarães Resende; Brasil-Neto, Joaquim Pereira

    2013-07-01

    The objective of this study was to evaluate the quality of life (QL) with the use of the SF-36 Questionnaire in patients with chronic nonspecific low back pain (CNLBP). Thirty patients with CNLBP were randomly assigned to one of three groups (Iso group (Isostretching), GPR group (Global Postural Reeducation), and the Iso+GPR group. Patients underwent physical therapy assessment with the use of the Vertebral Spine Assessment, the Visual Analog Scale of Pain (VASP), and the SF-36 life quality questionnaire before the first session (first assessment), after three months of treatment (second assessment) and reassessed two months after the final session in the follow-up (third assessment). The results indicated that both physical therapy techniques reduced pain (p<0.001); when the techniques (Iso+GPR) were combined, the reduction in pain was significantly greater; and, in the follow-up assessment, the GPR method was more efficient. As for the QL, physical therapy techniques were effective after the interventions (p<0.001), and the Iso method was more effective when patients were reassessed in the follow-up. We conclude that the physical therapy techniques used in this study were efficient to treat CNLBP in the patients since they reduced pain and increased QL according to the results of the SF-36 questionnaire. Level of Evidence II, Randomized Controlled Clinical Trial.

  17. Comparing Physical Therapy Accompanying Exercise with Only Exercise Treatments in Patients with Chronic Mechanical Low Back Pain

    Directory of Open Access Journals (Sweden)

    Özlem Yılmaz

    2015-08-01

    Full Text Available Objective: Investigating and comparing the effects of exercise and physical therapy accompanying exercise treatments in patients with chronic low back pain. Materials and Methods: Twenty three patients with mechanical type low back existing more than 3 months were included one of the exercise or the physical therapy+exercise groups according to their application sequence. Both of the groups performed lumbar flexion and extension exercises, strengthening of the lumbar and abdominal muscle exercises and iliopsoas, hamstring and quadriceps stretching exercises two times a day for 14 days. The physical therapy group was given hot pack+therapeutic ultrasound+ interferential current for 10 days additionally. Degree of the low back pain was evaluated with visual analog scale (VAS, range of joint motion was evaluated with hand finger floor distance (HFFD and Modified Schober test, functional status was evaluated with Modified Oswestry Low Back Pain Scale and quality of life was evaluated with Short form-36 (SF-36 before and a month after the treatments. Results: In both groups (exercise group: average age 59 years, 21 females, 2 males; physical therapy group: average age 60 years, 20 females, 3 males pain intensity and HFFD decreased and Modified Schober increased, functionality recovered, pain and physical functions of SF-36 improved after the treatments. SF-36-physical role difficulty also improved in the exercise group. Decrease in pain, increase in HFFD andimproving of the functional status were all significantly more in the physical therapy group. There were no difference between the groups in terms of Modified Schober measurement and changes of the quality of life. Conclusions: Exercises and exercise+physical therapy are both effective in chronic low back pain. Successful results can be taken by addition of the physical therapy in patients who do not benefit sufficiently from exercise therapy. (Turkish Journal of Osteoporosis 2015;21: 73-8

  18. 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.

  19. 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

  20. Psychometric evaluation of the sleep hygiene index: a sample of patients with chronic pain

    OpenAIRE

    Cho, Sungkun; Kim, Gye-Seok; Lee, Jang-Han

    2013-01-01

    Background Sleep Hygiene Index (SHI) was designed to assess sleep hygiene. Although the SHI has shown adequate psychometric properties in a nonclinical sample, it has not been validated in a sample with chronic pain. Also, its factor structure, measurement error, and incremental validity over and above other factors affecting sleep quality have not been investigated in a nonclinical sample. Thus, this present study aimed to extend prior psychometric investigation of the SHI. Specifically, we ...

  1. Change in trunk muscle activities with prone bridge exercise in patients with chronic low back pain

    OpenAIRE

    Kong, Yong-Soo; Park, Seol; Kweon, Mi-Gyong; Park, Ji-Won

    2016-01-01

    [Purpose] The aim of this study was to determine the effect of three different bridge exercises on internal oblique, external oblique, transverse abdominis, and erector spinae activities. [Subjects and Methods] Forty-five subjects with chronic low back pain participated in this study. The training outcome was evaluated with three different testing methods: supine bridge exercise, supine bridge on Swiss ball exercise, and prone bridge exercise. The activities of the transverse abdominis, inter...

  2. Evidence of Physiotherapy Interventions for Patients with Chronic Neck Pain: A Systematic Review of Randomised Controlled Trials

    OpenAIRE

    Damgaard, Pia; Bartels, Else Marie; Ris, Inge; Christensen, Robin; Juul-Kristensen, Birgit

    2013-01-01

    Chronic neck pain (CNP) is common and costly, and the effect of physiotherapeutic interventions on the condition is unclear. We reviewed the literature for evidence of effect of physiotherapy interventions on patients with CNP. Five bibliographic databases (MEDLINE, EMBASE, CINAHL, Cochrane Library, and PEDro) were systematically searched. Randomised, placebo and active-treatment-controlled trials including physiotherapy interventions for adults with CNP were selected. Data were extracted pri...

  3. Interactive Sections of an Internet-Based Intervention Increase Empowerment of Chronic Back Pain Patients: Randomized Controlled Trial

    OpenAIRE

    Riva, Silvia; Camerini, Anne-Linda; Allam, Ahmed; Schulz, Peter Johannes

    2014-01-01

    Background Chronic back pain (CBP) represents a significant public health problem. As one of the most common causes of disability and sick leave, there is a need to develop cost-effective ways, such as Internet-based interventions, to help empower patients to manage their disease. Research has provided evidence for the effectiveness of Internet-based interventions in many fields, but it has paid little attention to the reasons why they are effective. Objective This study aims to assess the im...

  4. 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.

  5. 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.

  6. 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, ...

  7. 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...

  8. [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

  9. Neurofeedback therapy in patients with non pain syndromes of chronic and paroxysmal character-literature review and own experience.

    Science.gov (United States)

    Kubik, Alicja; Kaciński, Marek

    2013-01-01

    Neurofeedback has been used in treatment of many other than pain clinical syndromes. This group includes chronic as well as paroxysmal syndromes previously treated pharmacologically. However due to non satisfactory results of this treatment introduction of non-pharmacological therapy has been examined. Observations from our 9-year experience of neurofeedback therapy used in children and adult patients with epilepsy, Asperger syndrome, depression, neurosis, personality disorders, drug addiction and other (not pain) syndromes have been presented in this paper. Positive influence of neurofeedback therapy on symptoms intensity, frequency, duration and social relations of treated patients has been confirmed by our own and other authors observations. Neurofeedback therapy has been tried by patients with other difficult life problems and has been effective in some of them. The effectiveness of the therapy has been confirmed by patients, their relatives and also by neurophysiological results. Additionally, preliminary results of neurofeedback therapy used in management of computer addiction in children and adolescents have been presented herein.

  10. Costs of moderate to severe chronic pain in primary care patients – a study of the ACCORD Program

    Directory of Open Access Journals (Sweden)

    Lalonde L

    2014-07-01

    Full Text Available Lyne Lalonde,1–4 Manon Choinière,3,5 Élisabeth Martin,2,3 Djamal Berbiche,2,3 Sylvie Perreault,1,6 David Lussier7–91Faculty of Pharmacy, Université de Montréal, Montreal, QC, Canada; 2Équipe de recherche en soins de première ligne, Centre de santé et de services sociaux de Laval, Laval, QC, Canada; 3Centre de recherche du Centre hospitalier de l'Université de Montréal (CRCHUM, Montreal, QC, Canada; 4Sanofi Aventis Endowment Chair in Ambulatory Pharmaceutical Care, Université de Montréal and Centre de santé et de services sociaux de Laval, QC, Canada; 5Department of Anesthesiology, Faculty of Medicine, Université de Montréal, Montreal, QC, Canada; 6Sanofi Aventis Endowment Research Chair in Optimal Drug Use, Université de Montréal, Montreal, QC, Canada; 7Institut universitaire de gériatrie de Montréal, Montreal, QC, Canada; 8Division of Geriatric Medicine and Alan-Edwards Centre for Research on Pain, McGill University, Montreal, QC, Canada; 9Department of Medicine, Faculty of Medicine, Université de Montréal, Montreal, QC, CanadaBackground: The economic burden of chronic noncancer pain (CNCP remains insufficiently documented in primary care.Purpose: To evaluate the annual direct health care costs and productivity costs associated with moderate to severe CNCP in primary care patients taking into account their pain disability.Materials and methods: Patients reporting noncancer pain for at least 6 months, at a pain intensity of 4 or more on a 0 (no pain to 10 (worst possible pain intensity scale, and at a frequency of at least 2 days a week, were recruited from community pharmacies. Patients' characteristics, health care utilization, and productivity losses (absenteeism and presenteeism were documented using administrative databases, pharmacies' renewal charts, telephone, and self-administered questionnaires. Patients were stratified by tertile of pain disability measured by the Brief Pain Inventory questionnaire

  11. 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.

  12. A crisis in chronic pain care: an ethical analysis. Part three: Toward an integrative, multi-disciplinary pain medicine built around the needs of the patient.

    Science.gov (United States)

    Giordano, James; Schatman, Michael E

    2008-01-01

    A number of variables have contributed to the current crisis in chronic pain care and are affected by, and affect, the philosophies and politics that influence the socio-economic climate of the American healthcare system. Thus, we posit that managing the crisis in chronic pain care in the United States is contingent upon the development of a multi-focal healthcare paradigm that more thoroughly enables and fortifies research, its translation (in education and practice), and the implementation of, and support for, both the curative and healing approaches in medicine in general, and pain care specifically. These steps necessitate re-examination, if not revision of the health care system and its economics. The ethical imperative to consider and prudently employ cutting-edge diagnostic and therapeutic technologies in pain medicine is obligatory. However, "supply side prudence" is of little value if "demand side accessibility" is lacking. Revisions to health insurance plans advocated by the in-coming administration seek to create uniformity in basic health care services based upon re-assessment of the clinical effectiveness (versus merely cost) of treatments, including those that are "high tech." These plans attempt to allow every patient a more complete ability to deliberatively work with physicians to access those services and resources that maximize health functioning and goals. But even given these revisions, authentic pain care must take into account the interactive contexts of the painient individual. The biopsychosocial model of chronic pain management may have significant practical and ethical worth in this regard. A system of pain treatment operating from a biopsychosocial perspective necessitates integrative multi-disciplinarity. We propose a tiered, multi-disciplinary paradigm based upon the differing needs of each specific patient. But establishing such a system does not guarantee access, and distribution of these services and resources requires economic

  13. A crisis in chronic pain care: an ethical analysis. Part three: Toward an integrative, multi-disciplinary pain medicine built around the needs of the patient.

    Science.gov (United States)

    Giordano, James; Schatman, Michael E

    2008-01-01

    A number of variables have contributed to the current crisis in chronic pain care and are affected by, and affect, the philosophies and politics that influence the socio-economic climate of the American healthcare system. Thus, we posit that managing the crisis in chronic pain care in the United States is contingent upon the development of a multi-focal healthcare paradigm that more thoroughly enables and fortifies research, its translation (in education and practice), and the implementation of, and support for, both the curative and healing approaches in medicine in general, and pain care specifically. These steps necessitate re-examination, if not revision of the health care system and its economics. The ethical imperative to consider and prudently employ cutting-edge diagnostic and therapeutic technologies in pain medicine is obligatory. However, "supply side prudence" is of little value if "demand side accessibility" is lacking. Revisions to health insurance plans advocated by the in-coming administration seek to create uniformity in basic health care services based upon re-assessment of the clinical effectiveness (versus merely cost) of treatments, including those that are "high tech." These plans attempt to allow every patient a more complete ability to deliberatively work with physicians to access those services and resources that maximize health functioning and goals. But even given these revisions, authentic pain care must take into account the interactive contexts of the painient individual. The biopsychosocial model of chronic pain management may have significant practical and ethical worth in this regard. A system of pain treatment operating from a biopsychosocial perspective necessitates integrative multi-disciplinarity. We propose a tiered, multi-disciplinary paradigm based upon the differing needs of each specific patient. But establishing such a system does not guarantee access, and distribution of these services and resources requires economic

  14. Neck exercises, physical and cognitive behavioural-graded activity as a treatment for adult whiplash patients with chronic neck pain: Design of a randomised controlled trial

    DEFF Research Database (Denmark)

    Ris Hansen, Inge; Christensen, Robin Daniel Kjersgaard; Thomsen, Bente;

    2011-01-01

    ABSTRACT: BACKGROUND: Many patients suffer from chronic neck pain following a whiplash injury. A combination of cognitive, behavioural therapy with physiotherapy interventions has been indicated to be effective in the management of patients with chronic whiplash-associated disorders. The objective...... is to present the design of a randomised controlled trial (RCT) aimed at evaluating the effectiveness of a combined individual physical and cognitive behavioural-graded activity program on self-reported general physical function, in addition to neck function, pain, disability and quality of life in patients...... with chronic neck pain following whiplash injury compared with a matched control group measured at baseline and 4 and 12 months after baseline. METHODS: The design is a two-centre, RCT-study with a parallel group design. Included are whiplash patients with chronic neck pain for more than 6 months, recruited...

  15. An outpatient program in behavioral medicine for chronic pain patients based on the practice of mindfulness meditation: theoretical considerations and preliminary results.

    Science.gov (United States)

    Kabat-Zinn, J

    1982-04-01

    The practice of mindfulness meditation was used in a 10-week Stress Reduction and Relaxation Program to train chronic pain patients in self-regulation. The meditation facilitates an attentional stance towards proprioception known as detached observation. This appears to cause an "uncoupling " of the sensory dimension of the pain experience from the affective/evaluative alarm reaction and reduce the experience of suffering via cognitive reappraisal. Data are presented on 51 chronic pain patients who had not improved with traditional medical care. The dominant pain categories were low back, neck and shoulder, and headache. Facial pain, angina pectoris, noncoronary chest pain, and GI pain were also represented. At 10 weeks, 65% of the patients showed a reduction of greater than or equal to 33% in the mean total Pain Rating Index (Melzack) and 50% showed a reduction of greater than or equal to 50%. Similar decreases were recorded on other pain indices and in the number of medical symptoms reported. Large and significant reductions in mood disturbance and psychiatric symptomatology accompanied these changes and were relatively stable on follow-up. These improvements were independent of the pain category. We conclude that this form of meditation can be used as the basis for an effective behavioral program in self-regulation for chronic pain patients. Key features of the program structure, and the limitations of the present uncontrolled study are discussed.

  16. 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.

  17. Estimating the Risk of Chronic Pain: Development and Validation of a Prognostic Model (PICKUP for Patients with Acute Low Back Pain.

    Directory of Open Access Journals (Sweden)

    Adrian C Traeger

    2016-05-01

    Full Text Available Low back pain (LBP is a major health problem. Globally it is responsible for the most years lived with disability. The most problematic type of LBP is chronic LBP (pain lasting longer than 3 mo; it has a poor prognosis and is costly, and interventions are only moderately effective. Targeting interventions according to risk profile is a promising approach to prevent the onset of chronic LBP. Developing accurate prognostic models is the first step. No validated prognostic models are available to accurately predict the onset of chronic LBP. The primary aim of this study was to develop and validate a prognostic model to estimate the risk of chronic LBP.We used the PROGRESS framework to specify a priori methods, which we published in a study protocol. Data from 2,758 patients with acute LBP attending primary care in Australia between 5 November 2003 and 15 July 2005 (development sample, n = 1,230 and between 10 November 2009 and 5 February 2013 (external validation sample, n = 1,528 were used to develop and externally validate the model. The primary outcome was chronic LBP (ongoing pain at 3 mo. In all, 30% of the development sample and 19% of the external validation sample developed chronic LBP. In the external validation sample, the primary model (PICKUP discriminated between those who did and did not develop chronic LBP with acceptable performance (area under the receiver operating characteristic curve 0.66 [95% CI 0.63 to 0.69]. Although model calibration was also acceptable in the external validation sample (intercept = -0.55, slope = 0.89, some miscalibration was observed for high-risk groups. The decision curve analysis estimated that, if decisions to recommend further intervention were based on risk scores, screening could lead to a net reduction of 40 unnecessary interventions for every 100 patients presenting to primary care compared to a "treat all" approach. Limitations of the method include the model being restricted to using prognostic

  18. Turn-Amplitude Analysis as a Diagnostic Test for Myofascial Syndrome in Patients with Chronic Pelvic Pain

    Directory of Open Access Journals (Sweden)

    Fernando Itza

    2015-01-01

    Full Text Available BACKGROUND: Myofascial pain syndrome of the pelvic floor (MPSPF is a common disease in the context of chronic pelvic pain (CPP; however, there is currently no gold-standard test to diagnose it.

  19. 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

  20. Controlling the Midfield: Treating Patients With Chronic Pain Using Alternative Payment Models.

    Science.gov (United States)

    Haig, Andrew J

    2015-11-01

    The entire American health care system is turning upside down, except for the parts that aren't--yet. For physiatrists who manage pain problems, the future is complex. The usual challenge of treating these devastating and costly problems that cannot be measured physiologically is compounded by the requirement to do so in a health care system that doesn't know what it wants to be yet. Payment, regulation, and the very structure of practice are changing at a pace that is halting and unpredictable. Nonetheless, knowledge about some structures is necessary, and some themes almost certainly emerge. I propose that the role of the pain physiatrist is best understood through a soccer analogy. Whereas the casual spectator of the past might note the goals scored by surgical colleagues and shots missed by primary care partners, sophisticated health care systems of the future will learn that the pain game is won by creating a strong physiatry midfield. Physiatrists can reach to the backfield to help primary care with tough cases, send accurate referrals to surgeons, and reorganize the team when chronic pain complicates the situation. Current and emerging payment structures include insurance from government, employers, or individuals. Although the rules may change, certain trends appear to occur: Individuals will be making more choices, deductibles will increase, narrow groups of practitioners will work together, pricing will become important, and the burden on primary care colleagues will increase. Implications of each of these trends on pain medicine and specific strategy examples are addressed. A general concept emerges that, although procedure- and activity-based practice is still important, pain physiatrists can best prepare for the future by leading programs that create value for their health care system. PMID:26568504

  1. Chronic pain management in non-oncologic patients: multicentric study on adult patients referring to the centers for pain management in the Lazio Region (Italy)

    OpenAIRE

    LATINA, ROBERTO

    2013-01-01

    Introduction Chronic pain is a complex phenomenon usually associated with psychological stress, which implies falling back on the National Health Service and reducing work capacities, indeed affecting Activities of Daily Living. Studies based on efficacy have identified the multidisciplinary approach as the most effective means to obtain therapeutic results. These programs can be provided by the Centers for Pain Management (CPMs), where multidisciplinary teams are likely to pro...

  2. A primary care, multi-disciplinary disease management program for opioid-treated patients with chronic non-cancer pain and a high burden of psychiatric comorbidity

    Directory of Open Access Journals (Sweden)

    Malone Robert M

    2005-01-01

    Full Text Available Abstract Background Chronic non-cancer pain is a common problem that is often accompanied by psychiatric comorbidity and disability. The effectiveness of a multi-disciplinary pain management program was tested in a 3 month before and after trial. Methods Providers in an academic general medicine clinic referred patients with chronic non-cancer pain for participation in a program that combined the skills of internists, clinical pharmacists, and a psychiatrist. Patients were either receiving opioids or being considered for opioid therapy. The intervention consisted of structured clinical assessments, monthly follow-up, pain contracts, medication titration, and psychiatric consultation. Pain, mood, and function were assessed at baseline and 3 months using the Brief Pain Inventory (BPI, the Center for Epidemiological Studies-Depression Scale scale (CESD and the Pain Disability Index (PDI. Patients were monitored for substance misuse. Results Eighty-five patients were enrolled. Mean age was 51 years, 60% were male, 78% were Caucasian, and 93% were receiving opioids. Baseline average pain was 6.5 on an 11 point scale. The average CESD score was 24.0, and the mean PDI score was 47.0. Sixty-three patients (73% completed 3 month follow-up. Fifteen withdrew from the program after identification of substance misuse. Among those completing 3 month follow-up, the average pain score improved to 5.5 (p = 0.003. The mean PDI score improved to 39.3 (p Conclusions A primary care disease management program improved pain, depression, and disability scores over three months in a cohort of opioid-treated patients with chronic non-cancer pain. Substance misuse and depression were common, and many patients who had substance misuse identified left the program when they were no longer prescribed opioids. Effective care of patients with chronic pain should include rigorous assessment and treatment of these comorbid disorders and intensive efforts to insure follow up.

  3. MRI of paraspinal muscles in lumbar degenerative kyphosis patients and control patients with chronic low back pain

    International Nuclear Information System (INIS)

    Aim: To compare lumbar musculature in lumbar degenerative kyphosis (LDK) patients and chronic low-back pain (CLBP) patients. Materials and methods: The study group comprised LDK patients (54 women, aged 44-74 years, mean 60 years) and a control group with CLBP (54 women, aged 45-73 years, mean 60 years). The cross-sectional areas (CSA) of psoas, erector spinae, multifidus, and disc, were measured at the L4-L5 level using magnetic resonance imaging (MRI). Lumbar muscularity was expressed as three ratios: the ratio between CSA of psoas, erector spinae, multifidus and CSA of disc (PS:disc, ES:disc, MF:disc). Multifidus and erector spinae atrophy were evaluated at the L3-L4 level and the degree of fatty atrophy was estimated using three grades: mild, moderate, and severe. The shapes of thoracolumbar fascia were analysed at the L5-S1 level and were classified as flat or convex. Results: Lumbar muscularity was found to be significantly smaller (p < 0.001) in LDK patients (PS:disc = 0.79, SD 0.22; ES:disc = 1.36, SD 0.49; MF:disc = 0.55, SD 0.21) than the control group patients (PS:disc = 0.98, SD 0.23; ES:disc = 1.71, SD 0.46; MF:disc = 0.86, SD 0.30). Patients with LDK had a higher proportion of fat deposits in the multifidus and erector spinae muscle (p < 0.001), and the thoracolumbar fascia at the L5-S1 level was more commonly flat (p < 0.01). Conclusion: Evaluation of paraspinal musculature should be considered when assessing MRI images of the lumbar spine. Measurement of the CSA, visual grading of fatty atrophy and the assessment of the fascia may help physician and radiologist reach a more confident diagnosis for the patients with clinically suspicious LDK

  4. MRI of paraspinal muscles in lumbar degenerative kyphosis patients and control patients with chronic low back pain

    Energy Technology Data Exchange (ETDEWEB)

    Kang, C.H. [Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Poongnap-dong, Songpa-Ku, Seoul (Korea, Republic of); Shin, M.J. [Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Poongnap-dong, Songpa-Ku, Seoul (Korea, Republic of)]. E-mail: mjshin@amc.seoul.kr; Kim, S.M. [Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Poongnap-dong, Songpa-Ku, Seoul (Korea, Republic of); Lee, S.H. [Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Poongnap-dong, Songpa-Ku, Seoul (Korea, Republic of); Lee, C.-S. [Department of Orthopaedic Surgery, University of Ulsan College of Medicine, Asan Medical Center, Poongnap-dong, Songpa-Ku, Seoul (Korea, Republic of)

    2007-05-15

    Aim: To compare lumbar musculature in lumbar degenerative kyphosis (LDK) patients and chronic low-back pain (CLBP) patients. Materials and methods: The study group comprised LDK patients (54 women, aged 44-74 years, mean 60 years) and a control group with CLBP (54 women, aged 45-73 years, mean 60 years). The cross-sectional areas (CSA) of psoas, erector spinae, multifidus, and disc, were measured at the L4-L5 level using magnetic resonance imaging (MRI). Lumbar muscularity was expressed as three ratios: the ratio between CSA of psoas, erector spinae, multifidus and CSA of disc (PS:disc, ES:disc, MF:disc). Multifidus and erector spinae atrophy were evaluated at the L3-L4 level and the degree of fatty atrophy was estimated using three grades: mild, moderate, and severe. The shapes of thoracolumbar fascia were analysed at the L5-S1 level and were classified as flat or convex. Results: Lumbar muscularity was found to be significantly smaller (p < 0.001) in LDK patients (PS:disc = 0.79, SD 0.22; ES:disc = 1.36, SD 0.49; MF:disc = 0.55, SD 0.21) than the control group patients (PS:disc = 0.98, SD 0.23; ES:disc = 1.71, SD 0.46; MF:disc = 0.86, SD 0.30). Patients with LDK had a higher proportion of fat deposits in the multifidus and erector spinae muscle (p < 0.001), and the thoracolumbar fascia at the L5-S1 level was more commonly flat (p < 0.01). Conclusion: Evaluation of paraspinal musculature should be considered when assessing MRI images of the lumbar spine. Measurement of the CSA, visual grading of fatty atrophy and the assessment of the fascia may help physician and radiologist reach a more confident diagnosis for the patients with clinically suspicious LDK.

  5. A STUDY ON ADJUVANT HEAD CORING IN PATIENTS UNDERGOING LONGITUDINAL PANCREATICOJEJUNOSTOMY AND ITS AID IN PAIN REDUCTION IN CHRONIC PANCREATITIS

    Directory of Open Access Journals (Sweden)

    Sudhansu Sekhar Mohanty

    2016-07-01

    Full Text Available BACKGROUND The condition manifests as recurrent intractable abdominal pain. 1 This is the most important indication for surgical procedures. The pain is caused by increased pancreatic parenchymal and ductal pressure. Another cause is that chronic inflammation of the pancreas may lead to fibrosis of the peripancreatic capsule and perilobular parenchyma, which impairs local and regional blood flow, therefore causing pain through tissue ischaemia and acidosis. 2 This is the rationalisation behind adding the head coring to the decompression surgeries that had been classically in practice. METHODS This is a retrospective study. The study period spans over from January 2003 to December 2013, which is a 10-year period. Patients with intractable and non-relenting abdominal pain and a diagnosis of chronic pancreatitis with evidence of fibrosis of head of pancreas in imaging studies were included. 35 patients were randomly allocated for Head coring and LPJ by lottery method. The patients were analysed for duration of surgery, hospital stay, operative/postoperative complications and assessment of postoperative pain relief. Pain relief was assessed as complete (No analgesic required, satisfactory (Tolerable pain with normal daily activities and unsatisfactory (Hospitalisation and hampered daily activities. RESULTS Alcohol consumption (65.71% was the main cause of pancreatitis in the study group, followed by gallstones (14.28% and idiopathic (20% cause. Head coring (120 minutes takes a median operative time of 30 minutes more when done adjuvant to LPJ (90 minutes. Incidence of complications were comparable in both the surgeries. The common complications of prolonged ileus and wound infection are in the percentage of 12.5% in only LPJ and 15.78% in adjuvant head coring surgeries. Pain relief was good when the complete and satisfactory groups were compared. But there is not much of difference in unsatisfactory group comparison. CONCLUSION A 30 minutes

  6. Translation, cross-cultural adaptation, and validity of the Korean version of the pain sensitivity questionnaire in chronic pain patients.

    Science.gov (United States)

    Kim, Ho-Joong; Ruscheweyh, Ruth; Yeo, Ji-Hyun; Cho, Hyeon-Guk; Yi, Je-Min; Chang, Bong-Soon; Lee, Choon-Ki; Yeom, Jin S

    2014-11-01

    The purpose of this study was to translate pain sensitivity questionnaires (PSQ) into the Korean language, perform a cross-cultural adaption of the PSQ, and validate the Korean version of PSQ in patients with degenerative spinal disease. The PSQ was translated forward and backward, cross-culturally adapted by 2 independent translators, and approved by an expert committee. The final Korean version of the PSQ was tested on 72 patients with degenerative spinal disease. Test-retest reliability was evaluated for 60 patients (83%) who completed the second assessment in an interval of 4 weeks. The mean PSQ-minor, PSQ-moderate, and PSQ-total (standard deviation [SD]) were 5.40 (2.02), 6.46 (1.98), and 5.93 (1.93), respectively. The PSQ-total, PSQ-minor, and PSQ-moderate of the Korean version showed very good internal consistencies determined by the Cronbach's α of 0.926, 0.869, and 0.877, respectively. For convergent validity, the PSQ scores of the Korean version showed significant correlations with pain catastrophizing scale (PCS) (r = 0.377, P = 0.002; r = 0.365, P = 0.003; r = 0.362, P = 0.003 for PSQ-total, PSQ-minor, and PSQ-moderate of the Korean version, respectively). For test-retest reliability, the intraclass correlation coefficients were 0.782 for PSQ-total, 0.752 for PSQ-minor, and 0.793 for PSQ-moderate. In conclusion, the validated Korean version of PSQ is a transculturally equivalent, reliable, and valid tool to assess individual pain sensitivity.

  7. Chronic pleuritic pain in four patients with asbestos induced pleural fibrosis.

    OpenAIRE

    Miller, A

    1990-01-01

    Four patients occupationally exposed to asbestos, each suffering at least eight years of disabling, persistent, and often bilateral pleuritic pain are described. Radiographic evidence of pleural disease ranged from plaques seen only on computed tomography to typical bilateral plaques or diffuse thickening to extensive diffuse and circumscribed pleural fibrosis and calcification. There was no history or evidence of acute pleuritis or pleural effusion in three patients. Intermittent pleural fri...

  8. 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.

  9. Patient vs provider reports of aberrant medication-taking behavior among opioid-treated patients with chronic pain who report misusing opioid medication.

    Science.gov (United States)

    Nikulina, Valentina; Guarino, Honoria; Acosta, Michelle C; Marsch, Lisa A; Syckes, Cassandra; Moore, Sarah K; Portenoy, Russell K; Cruciani, Ricardo A; Turk, Dennis C; Rosenblum, Andrew

    2016-08-01

    During long-term opioid therapy for chronic noncancer pain, monitoring medication adherence of patients with a history of aberrant opioid medication-taking behaviors (AMTB) is an essential practice. There is limited research, however, into the concordance among existing monitoring tools of self-report, physician report, and biofluid screening. This study examined associations among patient and provider assessments of AMTB and urine drug screening using data from a randomized trial of a cognitive-behavioral intervention designed to improve medication adherence and pain-related outcomes among 110 opioid-treated patients with chronic pain who screened positive for AMTB and were enrolled in a pain program. Providers completed the Aberrant Behavior Checklist (ABC) and patients completed the Current Opioid Misuse Measure (COMM) and the Chemical Coping Inventory (CCI). In multivariate analyses, ABC scores were compared with COMM and CCI scores, while controlling for demographics and established risk factors for AMTB, such as pain severity. Based on clinical cutoffs, 84% of patients reported clinically significant levels of AMTB and providers rated 36% of patients at elevated levels. Provider reports of AMTB were not correlated with COMM or CCI scores. However, the ABC ratings of experienced providers (nurse practitioners/attending physicians) were higher than those of less experienced providers (fellows) and were correlated with CCI scores and risk factors for AMTB. Associations between patient- and provider-reported AMTB and urine drug screening results were low and largely nonsignificant. In conclusion, concordance between patient and provider reports of AMTB among patients with chronic pain prescribed opioid medication varied by provider level of training. PMID:27082008

  10. Patient vs provider reports of aberrant medication-taking behavior among opioid-treated patients with chronic pain who report misusing opioid medication.

    Science.gov (United States)

    Nikulina, Valentina; Guarino, Honoria; Acosta, Michelle C; Marsch, Lisa A; Syckes, Cassandra; Moore, Sarah K; Portenoy, Russell K; Cruciani, Ricardo A; Turk, Dennis C; Rosenblum, Andrew

    2016-08-01

    During long-term opioid therapy for chronic noncancer pain, monitoring medication adherence of patients with a history of aberrant opioid medication-taking behaviors (AMTB) is an essential practice. There is limited research, however, into the concordance among existing monitoring tools of self-report, physician report, and biofluid screening. This study examined associations among patient and provider assessments of AMTB and urine drug screening using data from a randomized trial of a cognitive-behavioral intervention designed to improve medication adherence and pain-related outcomes among 110 opioid-treated patients with chronic pain who screened positive for AMTB and were enrolled in a pain program. Providers completed the Aberrant Behavior Checklist (ABC) and patients completed the Current Opioid Misuse Measure (COMM) and the Chemical Coping Inventory (CCI). In multivariate analyses, ABC scores were compared with COMM and CCI scores, while controlling for demographics and established risk factors for AMTB, such as pain severity. Based on clinical cutoffs, 84% of patients reported clinically significant levels of AMTB and providers rated 36% of patients at elevated levels. Provider reports of AMTB were not correlated with COMM or CCI scores. However, the ABC ratings of experienced providers (nurse practitioners/attending physicians) were higher than those of less experienced providers (fellows) and were correlated with CCI scores and risk factors for AMTB. Associations between patient- and provider-reported AMTB and urine drug screening results were low and largely nonsignificant. In conclusion, concordance between patient and provider reports of AMTB among patients with chronic pain prescribed opioid medication varied by provider level of training.

  11. [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

  12. 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 ...

  13. 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 ...

  14. Psychosocial management of chronic pain in patients with rheumatoid arthritis: challenges and solutions

    Directory of Open Access Journals (Sweden)

    Sharpe L

    2016-03-01

    Full Text Available Louise SharpeSchool of Psychology, The University of Sydney, Sydney, NSW, AustraliaAbstract: There are numerous reviews and meta-analyses that confirm that psychological therapy is efficacious for patients with rheumatoid arthritis (RA in terms of managing pain. Therefore, the literature has moved on to answer additional questions: 1 What types of interventions are most strongly supported by the current evidence? 2 Do different patients benefit from different approaches? 3 When is it best to intervene? 4 What modalities are best for administering the intervention? 5 What model of care should we be proposing that will result in widespread implementation and will ensure access for patients with RA? This review concludes that cognitive behavioral therapy (CBT is the most efficacious treatment for pain management in RA; however, there are indications that mindfulness may have particular benefits for patients with a history of depression. CBT is most effective when administered early in the course of the disease. However, there is at present little evidence to confirm whether or not psychosocial interventions are effective for patients with comorbid psychological disorders. One of the major challenges is ensuring access to effective interventions for patients, particularly early on in the course of the disease, with a view to preventing physical and psychological morbidity. A stepped-care model is proposed; however, we urgently need more, better-quality trials of minimal interventions, particularly in Internet-delivered CBT, which appears promising and may form the cornerstone of future stepped-care models for providing psychosocial care to patients with RA.Keywords: pain, pain management, cognitive behavioral therapy, psychosocial treatment, coping, psychosocial, psychotherapy

  15. Do MRI findings identify patients with chronic low back pain and Modic changes who respond best to rest or exercise

    DEFF Research Database (Denmark)

    Jensen, Rikke K; Kent, Peter; Hancock, Mark

    2015-01-01

    or with large Modic changes Type 1 were all potentially important in size (-0.99 (95 % CI -3.28 to 1.29), -1.49 (-3.73 to 0.75), -1.49 (-3.57 to 0.58), respectively) but the direction of the effect was the opposite to what we had hypothesized-that people with these findings would benefit more from rest than...... changes. METHODS: This study is a secondary analysis of a randomised controlled trial comparing rest with exercise. Patients were recruited from a specialised outpatient spine clinic and included in a clinical trial if they had chronic low back pain and an MRI showing Modic changes. All patients received......BACKGROUND: No previous clinical trials have investigated MRI findings as effect modifiers for conservative treatment of low back pain. This hypothesis-setting study investigated if MRI findings modified response to rest compared with exercise in patients with chronic low back pain and Modic...

  16. 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...

  17. [Chronic refractory pain in cancer patients. Value of the spinal injection of lysine acetylsalicylate. 60 cases].

    Science.gov (United States)

    Pellerin, M; Hardy, F; Abergel, A; Boule, D; Palacci, J H; Babinet, P; Wingtin, L N; Glowinski, J; Amiot, J F; Mechali, D

    1987-09-19

    Several animal studies have demonstrated that pain is modulated by spinal mechanisms involving prostaglandins and that acetylsalicylic acid (ASA) administered intrathecally has an analgesic effect. We report our experience of this treatment in 60 patients with proven and advanced cancer. An isobaric solution of lysine acetylsalicylate was administered by lumbar puncture in doses ranging from 120 to 720 mg of ASA. The results were evaluated using the habitual criteria: scoring system, behaviour, consumption of analgesic drugs. In this trial the method proved astonishingly effective (78% of the cases). Analgesia was strong, almost immediate and without influence on motricity. No thermic or neurovegetative changes were noted. The effect of one injection lasted from 3 weeks to 1 month on average; it was reproduced and often more prolonged after a repeat injection. Pain associated with bone metastases seems to constitute the best indication, notably in breast and lung cancer and in myeloma. Visceral (pancreas) or neural pain requires higher doses to respond. Failures (22%) were due to such factors as insufficient dosage at the very beginning of our experience or severe depressive syndrome. The perineal and sphincteral pain of rectal cancer often resists treatment. This simple, inexpensive and very effective method with no other complication than a frequent tendency to fatigue should rank among other analgesic measures in cancer. The lack of respiratory depression is a major advantage over catheter spinal opiate analgesia. We consider that its main indications are pain associated with osteolytic metastases of adenocarcinomas, and myelomas. Owing to the absence of formal toxicological data, its use must be limited to cancer pain and to patients with a life expectancy of less than 2 years. PMID:2957675

  18. Noninterventional study of transdermal fentanyl (fentavera) matrix patches in chronic pain patients: analgesic and quality of life effects.

    Science.gov (United States)

    Heim, Manuel

    2015-01-01

    Fentanyl is considered to be an effective, transdermal treatment of chronic, cancer, and noncancer pain. This noninterventional, clinical practice-based study, on 426 patients attending 42 practices, assessed a proprietary, Aloe vera-containing, transdermal fentanyl matrix patch (Fentavera), for its analgesic effects, patients' quality of life (QoL) effects, tolerability, and adhesiveness. Study outcomes were mean changes from baseline of patient (11-point scales) and physician (5-point scales) ratings. After 1 and 2 months treatment, there were significant (P walking, general activity, sleep quality, and QoL. For each parameter, the patient response rate was >30% at 2 months (response = 2-point decrease on 11-point rating scale). In a large majority of patients, the physicians rated the matrix patch as good or very good for analgesic effect, systemic and local tolerance, and adhesiveness. There were 30 adverse events in 4.2% of patients and analgesic comedications were reduced during treatment compared to before treatment. It is concluded, from this population-based data, that the proprietary, transdermal fentanyl matrix patch is effective and safe for chronic pain management in clinical practice, with significant positive analgesic and QoL effects, while being well tolerated and exhibiting good or very good adhesiveness. PMID:25861472

  19. Antineuropathic and Antinociceptive Drugs Combination in Patients with Chronic Low Back Pain: A Systematic Review

    Directory of Open Access Journals (Sweden)

    Carlo Luca Romanò

    2012-01-01

    Full Text Available Purpose. Chronic low back pain (LBP is often characterized by both nociceptive and neuropathic components. While various monotherapies have been reported of only limited efficacy, combining drugs with different mechanisms of action and targets appears a rational approach. Aim of this systematic review is to assess the efficacy and safety of different combined pharmacological treatments, compared to monotherapy or placebo, for the pharmacological treatment of chronic LBP. Methods. Published papers, written or abstracted in English from 1990 through 2011, comparing combined pharmacological treatments of chronic LBP to monotherapy or placebo were reviewed. Results. Six articles met the inclusion criteria. Pregabalin combined with celecoxib or opioids was shown to be more effective than either monotherapy. Oxycodone-paracetamol versus previous treatments and tramadol-paracetamol versus placebo were also reported as effective, while morphine-nortriptyline did not show any benefit over any single agent. Conclusions. In spite of theoretical advantages of combined pharmacological treatments of chronic LBP, clinical studies are remarkably few. Available data show that combined therapy, including antinociceptive and antineuropathic agents is more effective than monotherapy, with similar side effects.

  20. Antineuropathic and Antinociceptive Drugs Combination in Patients with Chronic Low Back Pain: A Systematic Review

    Science.gov (United States)

    Romanò, Carlo Luca; Romanò, Delia; Lacerenza, Marco

    2012-01-01

    Purpose. Chronic low back pain (LBP) is often characterized by both nociceptive and neuropathic components. While various monotherapies have been reported of only limited efficacy, combining drugs with different mechanisms of action and targets appears a rational approach. Aim of this systematic review is to assess the efficacy and safety of different combined pharmacological treatments, compared to monotherapy or placebo, for the pharmacological treatment of chronic LBP. Methods. Published papers, written or abstracted in English from 1990 through 2011, comparing combined pharmacological treatments of chronic LBP to monotherapy or placebo were reviewed. Results. Six articles met the inclusion criteria. Pregabalin combined with celecoxib or opioids was shown to be more effective than either monotherapy. Oxycodone-paracetamol versus previous treatments and tramadol-paracetamol versus placebo were also reported as effective, while morphine-nortriptyline did not show any benefit over any single agent. Conclusions. In spite of theoretical advantages of combined pharmacological treatments of chronic LBP, clinical studies are remarkably few. Available data show that combined therapy, including antinociceptive and antineuropathic agents is more effective than monotherapy, with similar side effects. PMID:22619711

  1. EFFECTS OF STABILIZATION EXERCISE USING A BALL ON MUTIFIDUS CROSS-SECTIONAL AREA IN PATIENTS WITH CHRONIC LOW BACK PAIN

    Directory of Open Access Journals (Sweden)

    SinHo Chung

    2013-09-01

    Full Text Available The purpose of this study was to compare the effects of lumbar stabilization exercises using balls to the effects of general lumbar stabilization exercises with respect to changes in the cross section of the multifidus (MF, weight bearing, pain, and functional disorders in patients with non-specific chronic low back pain. Twelve patients participated in either a 8 week (3 days per week stabilization exercise program using balls and control group (n = 12. The computer tomography (CT was used to analyze MF cross-sectional areas (CSA and Tetrax balancing scale was used to analyze left and right weight bearing differences. Both groups had significant changes in the CSA of the MF by segment after training (p < 0.05 and the experimental group showed greater increases at the L4 (F = 9.854, p = 0.005 and L5 (F = 39. 266, p = 0.000. Both groups showed significant decreases in weight bearing, from 9.25% to 5.83% in the experimental group and from 9.33% to 4.25% in the control group (p < 0.05, but did not differ significantly between the two groups. These results suggests that stabilization exercises using ball can increases in the CSA of the MF segments, improvement in weight bearing, pain relief, and recovery from functional disorders, and the increases in the CSA of the MF of the L4 and L5 segments for patients with low back pain

  2. 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.

  3. 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

  4. Altered pressure pain thresholds and increased wind-up in adult patients with chronic back pain with a history of childhood maltreatment: a quantitative sensory testing study.

    Science.gov (United States)

    Tesarz, Jonas; Eich, Wolfgang; Treede, Rolf-Detlef; Gerhardt, Andreas

    2016-08-01

    Childhood maltreatment (CM) has been associated with an increased risk of nonspecific chronic low back pain (nsCLBP). However, the mechanisms underlying this association are unclear. Therefore, this study considered whether distinct types of CM are accompanied by specific alterations in somatosensory function. A total of 176 subjects with nsCLBP and 27 pain-free controls (PCs) were included. The Childhood Trauma Questionnaire (CTQ) was used to categorize patients into 2 groups (abused/neglected vs nonabused/nonneglected) for 5 types of CM (emotional abuse, physical abuse, sexual abuse, emotional neglect, and physical neglect). The standardized quantitative sensory testing protocol of the "German Research Network on Neuropathic Pain" was performed to obtain comprehensive profiles on somatosensory function, including detection and pain thresholds, pain sensitivity, and assessments of temporal summation (wind-up). Between 17.7% and 51.4% of subjects with nsCLBP reported CM, depending on the type of CM. Childhood Trauma Questionnaire subscores for emotional and sexual abuse were significantly higher in subjects with nsCLBP than in PCs. Compared with PCs, subjects with CM showed reduced pressure pain thresholds (PPTs), irrespective of the type of CM. Regarding distinct types of CM, subjects with nsCLBP with emotional abuse reported significantly higher wind-up than those without, and sexual abuse was accompanied by enhanced touch sensitivity. Our findings suggest that CM is nonspecifically associated with a decreased PPT in nsCLBP. Emotional abuse apparently leads to enhanced spinal pain summation, and sexual abuse leads to enhanced touch sensitivity. These results emphasize the importance of emotional abuse in nsCLBP and suggest that CM can induce long-term changes in adult somatosensory function. PMID:27075429

  5. 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...

  6. Pain Coping Strategies in Osteoarthritis Patients.

    Science.gov (United States)

    Keefe, Francis J.; And Others

    1987-01-01

    Investigated the relation of pain coping strategies to pain, health status, and psychological distress in a group of osteoarthritis patients with chronic pain. Patients completed various questionnaires. Medical status variables were also used. The Pain Control and Rational Thinking factor derived from the Coping Strategies Questionnaire proved to…

  7. 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

  8. Atrophy of sacrospinal muscle groups in patients with chronic, diffusely radiating lumbar back pain

    Energy Technology Data Exchange (ETDEWEB)

    Laasonen, E.M.

    1984-01-01

    After surgery necessitated by lumbar back pain syndromes, radiolucency verified by CT may appear in the sacrospinal muscle group on the operate side. This radiolucency represents muscular atrophy and is in its most severe form a result of the replacement of muscle tissue with adipose tissue. Such muscular atrophy appeared in the present series in 31 out of all 156 patients (19.9%) and in 29 out of 94 patients operated on because of radiating lumbar back pain (30.9%). The radiological appearance, extent, and HU values of this muscular atrophy are presented in detail. Only weak correlations with the multitude of clinical symptoms and signs were found in this retrospective study. The effects of irreversible muscular atrophy on the indications for surgery and physiotherapy are discussed.

  9. Psychosocial management of chronic pain in patients with rheumatoid arthritis: challenges and solutions.

    Science.gov (United States)

    Sharpe, Louise

    2016-01-01

    There are numerous reviews and meta-analyses that confirm that psychological therapy is efficacious for patients with rheumatoid arthritis (RA) in terms of managing pain. Therefore, the literature has moved on to answer additional questions: 1) What types of interventions are most strongly supported by the current evidence? 2) Do different patients benefit from different approaches? 3) When is it best to intervene? 4) What modalities are best for administering the intervention? 5) What model of care should we be proposing that will result in widespread implementation and will ensure access for patients with RA? This review concludes that cognitive behavioral therapy (CBT) is the most efficacious treatment for pain management in RA; however, there are indications that mindfulness may have particular benefits for patients with a history of depression. CBT is most effective when administered early in the course of the disease. However, there is at present little evidence to confirm whether or not psychosocial interventions are effective for patients with comorbid psychological disorders. One of the major challenges is ensuring access to effective interventions for patients, particularly early on in the course of the disease, with a view to preventing physical and psychological morbidity. A stepped-care model is proposed; however, we urgently need more, better-quality trials of minimal interventions, particularly in Internet-delivered CBT, which appears promising and may form the cornerstone of future stepped-care models for providing psychosocial care to patients with RA. PMID:27042139

  10. 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.

  11. 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...

  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. Noninterventional Study of Transdermal Fentanyl (Fentavera Matrix Patches in Chronic Pain Patients: Analgesic and Quality of Life Effects

    Directory of Open Access Journals (Sweden)

    Manuel Heim

    2015-01-01

    Full Text Available Fentanyl is considered to be an effective, transdermal treatment of chronic, cancer, and noncancer pain. This noninterventional, clinical practice-based study, on 426 patients attending 42 practices, assessed a proprietary, Aloe vera-containing, transdermal fentanyl matrix patch (Fentavera, for its analgesic effects, patients’ quality of life (QoL effects, tolerability, and adhesiveness. Study outcomes were mean changes from baseline of patient (11-point scales and physician (5-point scales ratings. After 1 and 2 months treatment, there were significant (P30% at 2 months (response = 2-point decrease on 11-point rating scale. In a large majority of patients, the physicians rated the matrix patch as good or very good for analgesic effect, systemic and local tolerance, and adhesiveness. There were 30 adverse events in 4.2% of patients and analgesic comedications were reduced during treatment compared to before treatment. It is concluded, from this population-based data, that the proprietary, transdermal fentanyl matrix patch is effective and safe for chronic pain management in clinical practice, with significant positive analgesic and QoL effects, while being well tolerated and exhibiting good or very good adhesiveness.

  14. The Influence of Demographic and Psychosocial Factors on the Intensity of pain Among Chronic Patients Receiving Home-based Nursing Care

    Science.gov (United States)

    Antony, T; Merghani, Tarig Hakim

    2016-01-01

    Aim: To determine the influence of the demographic and the psychosocial factors on the intensity of pain manifestation among the chronic ill patients. Materials and Methods: A descriptive, cross-sectional study was carried out among 328 chronic patients under home-based nursing care in Southern State of Kerala, India, from July to August 2015. Each patient was interviewed during a scheduled home visit by a trained health professional. The translated version of the assessment tool questionnaire Medical Outcome Study-Short Form Health Survey was used for the data collection. Results: Sixty-four (19.5%) out of 328 patients reported pain as one of the primary symptoms of their disease. The percentage of the patients who were suffering from pain increases with the improvements in both the educational level and the monthly income (P = 0.002 and 0.019, respectively). The social interaction with the relatives and other community members was significantly related to pain manifestation (P = 0.013). A higher degree of social interaction was associated with lower pain intensity (P = 0.019). Conclusion: The results of this study showed that certain demographic and psychosocial factors carry a significant level of influence on the pain manifestation and its intensity among the chronic patients. Hence, improvements in education, economic status, and psychosocial support should be considered for the management of the chronic patients. PMID:27559269

  15. Application Overview of Self-management in Patients with Chronic Pain%慢性疼痛患者自我管理的应用概况

    Institute of Scientific and Technical Information of China (English)

    梁颖

    2015-01-01

    自我管理对慢性疼痛患者预防和控制的应用越来越广泛,对慢性疼痛患者进行自我管理可有效地控制疼痛,提高患者的生活质量,该文对慢性疼痛患者自我管理应用的对策、促进和实施等方面进行综述。%Self-management of chronic pain patients wider application of prevention and control, for self-management of chronic pain patients can effectively control pain and improve the patients’ quality of life. This article reviewed on self-management countermeasures, promote and the implementation of chronic pain patients.

  16. Exercise therapy and custom-made insoles are effective in patients with excessive pronation and chronic foot pain

    DEFF Research Database (Denmark)

    Andreasen, Jane; Mølgaard, Carsten; Christensen, Marianne;

    2013-01-01

    Background: Excessive foot pronation is a causal mechanisms described in relation to injuries of the lower extremities. Evidence to support an effective treatment is insufficient. Objective: To investigate the effect of exercise and custom-made insoles to patients with excessive pronation...... and chronic pain conditions in the foot at short and long term follow-up. Methods: Single blinded Randomized Controlled Trial with 80 subjects randomized: (1) Standard Intervention, (2) Insole, (3) Exercise, and (4) Insole + Exercise. Exercise – 12 week supervised program. Insoles – individually molded...

  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. Tapentadol prolonged release for severe chronic cancer-related pain: effectiveness, tolerability, and influence on quality of life of the patients

    Directory of Open Access Journals (Sweden)

    Schikowski A

    2014-12-01

    Full Text Available Artur Schikowski,1 Doris Krings,2 Karla Schwenke2 1Neurology and Specialist Pain Therapy, Specialist Center Düsseldorf, Düsseldorf, 2Grünenthal GmbH, Aachen, Germany Background: Clinical trials have shown the efficacy and good tolerability of tapentadol prolonged release (PR for severe chronic pain of different etiologies. This study investigated the influence of tapentadol PR on pain control and quality of life of patients with severe chronic cancer-related pain in routine clinical practice in Germany. Patients and methods: During a 3-month observation period, 45 physicians (mainly palliative care specialists documented dosage and tolerability of tapentadol PR, previous and concomitant analgesic treatment, pain intensity, pain-related restrictions of daily activities and quality of life, and general state of health of 123 patients with chronic cancer-related pain in the context of a prospective noninterventional study. Results: All patients (mean age 63.9±13.2 years, 93.5% in constant pain had received analgesic long-term treatment (42.3% strong opioids prior to the start of tapentadol PR treatment. During the observation period, tapentadol PR significantly reduced the average pain intensity by 2.4 points (from a mean 6.1±1.7 to 3.7±2.0, P<0.001; half of the patients (52% achieved a pain score ≤3 at the end of observation. At the same time, mental and emotional well-being, pain-related impairments of daily activities, sleep quality, and quality of life improved, while the overall intake of analgesic concomitant medication could be reduced. Improvements in general state of health were significant (P<0.001. Overall, tapentadol PR was well tolerated. Conclusion: Good pain control with tapentadol PR was accompanied by markedly reduced pain-related mental and physical burden and quality of life improved. Overall, the general state of health of these patients with chronic cancer-related pain improved significantly despite the underlying

  19. Investigation of head repositioning accuracy as a measure of cervicocephalic kinaesthetic sensibility in patients with chronic neck pain

    OpenAIRE

    Rix, George D.W.

    2008-01-01

    The majority of people can expect to experience neck pain in their lifetime and some will go on to develop prolonged or repetitive episodes of neck pain or related symptoms. These persistent complaints have become a major cause of disability around the world. Although chronic ‘mechanical’ neck pain can be defined in clinical terms, the underlying pathology remains unclear. Research has failed to demonstrate a consistent relationship between the presence of neck pain and patholo...

  20. A Controlled and Retrospective Study of 144 Chronic Low Back Pain Patients to Evaluate the Effectiveness of an Intensive Functional Restoration Program in France

    Directory of Open Access Journals (Sweden)

    Isabelle Caby

    2016-04-01

    Full Text Available Study Design: A controlled and retrospective study of 144 chronic low back pain patients to evaluate the effectiveness of an intensive functional restoration program in France. Objective: Evaluating the efficiency of an intensive, dynamic and multidisciplinary functional restoration program in patients with chronic low back pain (LBP, during 6 and 12 months follow up. Summary of background data: Chronic low back pain disease has a multifactor nature, involving physical, psychological professional and social factors. A functional restoration program (FRP has been included in a multidisciplinary training program which provides an efficient therapeutic solution. However, the effectiveness of an FRP has not been yet established. Methods: 144 subjects (71 males, 73 females with chronic low back pain were included in a functional restoration program. The FRP includes physiotherapy and occupational therapy interventions together with psychological counselling. Patients participated as in- or outpatients 6 h per day, 5 days a week over 5 weeks. Pain intensity, trunk flexibility, trunk strength, lifting ability, quality of life and return to work were recorded before, immediately after, and at 6 months and 12 months after the treatment period. Results: All outcome measures were significantly higher just after the FRP (144 patients and at 6 and 12 months (from available data in 31 subjects compared to pre-treatment values. This FRP for chronic low back pain maintained its benefits whatever the patient’s activities. Conclusions: The effects reflected on all outcome measures, both on short and long term follow-up. The multidisciplinary FRP for chronic low back pain patients durably stopped the de-conditioning syndrome and involved new life-style habits for the patient, daily pain management and a return to work.

  1. Stability of clonidine in clonidine-hydromorphone mixture from implanted intrathecal infusion pumps in chronic pain patients.

    Science.gov (United States)

    Rudich, Zvia; Peng, Philip; Dunn, Edward; McCartney, Colin

    2004-12-01

    Clonidine is frequently added to opioids in implantable intrathecal pumps for the management of chronic pain. In such devices, a small non-retrievable volume is always present in the reservoir, and its effect on drug stability is unknown. Furthermore, stability of clonidine, when mixed with hydromorphone, has not been previously determined. This study examined the stability of clonidine when co-administered with hydromorphone in implanted intrathecal pumps. Samples of hydromorphone-clonidine before pump refill and from residual solution at subsequent refill were obtained from chronic pain patients. Clonidine concentration was measured using HPLC. Twenty paired samples from 3 patients were analyzed. All 3 patients had a SynchroMed pump implanted for 3-5 years. We found no loss in clonidine concentration during the time between refills (35 +/- 13 days), and no correlation between clonidine concentration and time interval between refills. In conclusion, clonidine, mixed with hydromorphone, is stable when delivered by implantable intrathecal pump for long-term use. PMID:15589085

  2. Pain management in patients with hidradenitis suppurativa

    NARCIS (Netherlands)

    Horvath, Barbara; Janse, Ineke C.; Sibbald, Gary R.

    2015-01-01

    Hidradenitis suppurativa (HS) is a chronic, relapsing, and painful inflammatory disease. HS patients' quality of life is severely impaired, and this impairment correlates strongly with their pain. Pain in HS can be acute or chronic and has both inflammatory and noninflammatory origins. The purpose o

  3. Virtual Visual Effect of Hospital Waiting Room on Pain Modulation in Healthy Subjects and Patients with Chronic Migraine

    Directory of Open Access Journals (Sweden)

    Marina de Tommaso

    2013-01-01

    Full Text Available Environmental context has an important impact on health and well being. We aimed to test the effects of a visual distraction induced by classical hospital waiting room (RH versus an ideal room with a sea view (IH, both represented in virtual reality (VR, on subjective sensation and cortical responses induced by painful laser stimuli (LEPs in healthy volunteers and patients with chronic migraine (CM. Sixteen CM and 16 controls underwent 62 channels LEPs from the right hand, during a fully immersive VR experience, where two types of waiting rooms were simulated. The RH simulated a classical hospital waiting room while the IH represented a room with sea viewing. CM patients showed a reduction of laser pain rating and vertex LEPs during the IH vision. The sLORETA analysis confirmed that in CM patients the two VR simulations induced a different modulation of bilateral parietal cortical areas (precuneus and superior parietal lobe, and superior frontal and cingulate girus, in respect to controls. The architectural context may interfere with pain perception, depending upon the status of subject. Many variables may change patients’ outcome and support the use of VR technology to test the best conditions for their management.

  4. 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 ...

  5. 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…

  6. 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

  7. The construct validity of the Short Form-36 Health Survey for patients with nonspecific chronic neck pain.

    Science.gov (United States)

    de Vries, Grietje E; Jorritsma, Wim; Dijkstra, Pieter U; Geertzen, Jan H B; Reneman, Michiel F

    2015-06-01

    Self-reported disability related to neck pain can be measured using general health questionnaires. The validity of the Medical Outcomes Study 36-Item Short-Form Health Survey (SF-36) in patients with nonspecific chronic neck pain (CNP) in a tertiary outpatient rehabilitation setting is unknown. This study investigates construct validity of the SF-36 in these patients using 16 a-priori formulated hypotheses. Ninety-one patients admitted for rehabilitation completed the SF-36 before the rehabilitation program. SF-36 domain scores of patients with CNP were compared with general population reference values and standardized differences were calculated. For both the SF-36 physical and the mental component summary (PCS and MCS), differences between primary and tertiary care setting, men and women, age groups, litigants and nonlitigants, patients with and without compensation, and with ≥3 versus≤2 concomitant complaints were analyzed using independent t-tests. Differences between PCS and MCS scores were analyzed using a paired t-test. Twelve hypotheses were not rejected and four were rejected. All SF-36 domain scores were significantly lower than the general population references values. The domain scores 'role physical', 'bodily pain', 'vitality', 'social functioning,' and 'role emotional' were relevantly (≥1 SD) lower. SF-36-PCS and SF-36-MCS scores were significantly lower in tertiary care. The SF-36-PCS score was significantly lower for patients with workers compensation and patients with at least three concomitant complaints. The SF-36-MCS score was significantly lower for the age group of at least 39 years. The SF-36 has good construct validity and can be used to measure self-reported general health in patients with nonspecific CNP in outpatient tertiary rehabilitation.

  8. Turn-amplitude analysis as a diagnostic test for myofascial syndrome in patients with chronic pelvic pain

    Science.gov (United States)

    Itza, Fernando; Zarza, Daniel; Salinas, Jesus; Teba, Fernando; Ximenez, Carmen

    2015-01-01

    BACKGROUND: Myofascial pain syndrome of the pelvic floor (MPSPF) is a common disease in the context of chronic pelvic pain (CPP); however, there is currently no gold-standard test to diagnose it. OBJECTIVE: To validate the turns-amplitude analysis (TAA) as a diagnostic test for MPSPF in patients with CPP. METHODS: A case-control study was performed, and patients were consecutively sampled within a specified period of time. A total of 128 patients were included: 64 patients with CPP (32 men and 32 women) and 64 control patients (32 men and 32 women). The same operator conducted all tests. Electromyography of the TAA is based on the collection of motor unit potentials that measure the number of changes in the signal and the mean amplitude of the changes. The electromyogram transfers the data to a graphical point cloud, which enables the patient’s results to be compared with the results of the healthy subjects. RESULTS: In patients and control subjects, the sensitivity and specificity of the proposed diagnostic test showed a marked clinical significance: the sensitivity was 83%, and the specificity was 100%. A positive predictive value of 1 (95% CI 1 to 1) and a negative predictive value of 0.85 (95% CI 0.77 to 0.93) were observed. CONCLUSION: TAA is a reliable diagnostic test to detect MPSPF. Further studies are needed to reproduce these results. PMID:25848846

  9. Readiness to adopt the self-management approach to cope with chronic pain in fibromyalgic patients.

    Science.gov (United States)

    Dijkstra, A; Vlaeyen, J W; Rijnen, H; Nielson, W

    2001-02-01

    The effectiveness of cognitive-behavior therapy aimed at helping patients with the acquisition of self-management skills to cope with pain, is thought to depend partly on the patients' willingness to adopt a self-management approach. Some patients may not believe that self-management will be helpful while others have decided to adopt it and others already apply the self-management skills in their daily lives. The present study explored the concept of 'Readiness to change' in a population of Dutch fibromyalgic patients. A self-report questionnaire was completed by 321 patients. Factor analysis revealed three scales, each assessing the characteristic of one stage of readiness to change, the Precontemplation, Contemplation and Action scale. Firstly, the reliabilities of these scales were 0.61, 0.86 and 0.61, respectively, and only the latter two scales correlated significantly (r=0.14). Secondly, the scales were validated using subscales from the Multidimensional Pain Inventory, beliefs on the credibility of the self-management approach and subscales from the Illness Perception Questionnaire. These subscales explained 5, 22 and 8% of the variance of the scores on the Precontemplation, Contemplation and the Action scales, respectively. Thirdly, on the basis of the three scale scores, over 80% of the fibromialgia patients could be classified into one of five potentially psychological relevant subgroups: Precontemplation, Contemplation, Preparation, Action and Relapse. The data suggest that improvements in operationalizations of the Precontemplation and Action dimensions of readiness to change are needed and that the theoretical foundation of readiness to change needs further development.

  10. 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.

  11. 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

  12. 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

  13. Effects of lumbar stabilization exercise on functional disability and lumbar lordosis angle in patients with chronic low back pain.

    Science.gov (United States)

    Cho, Igsoo; Jeon, Chunbae; Lee, Sangyong; Lee, Daehee; Hwangbo, Gak

    2015-06-01

    [Purpose] This study examined the effects of lumbar stabilization exercises on the functional disability and lumbar lordosis angles in patients with chronic low back pain. [Subjects] The subjects were 30 patients with chronic low back pain divided into a lumbar stabilization exercise group (n = 15) and a conservative treatment group (n = 15). [Methods] The lumbar stabilization exercise and conservative treatment groups performed an exercise program and conservative physical treatment, respectively. Both programs were performed 3 times a week for 6 weeks. The degree of functional disability was assessed by the Oswestry disability index, and lumbar lordosis angles were measured by plain radiography. [Results] The Oswestry disability index decreased significantly in the both groups; however, it was significantly lower in the lumbar stabilization exercise group. The lumbar lordosis angle increased significantly in the lumbar stabilization exercise group after treatment and was also significantly greater than that in the conservative treatment group. [Conclusion] Lumbar stabilization exercise is more effective than conservative treatment for improving functional disability and lumbar lordosis angles.

  14. Time to gain trust and change—Experiences of attachment and mindfulness-based cognitive therapy among patients with chronic pain and psychiatric co-morbidity

    Directory of Open Access Journals (Sweden)

    Birgitta Peilot

    2014-08-01

    Full Text Available The treatment of patients with chronic pain disorders is complex. In the rehabilitation of these patients, coping with chronic pain is seen as important. The aim of this study was to explore the meaning of attachment and mindfulness-based cognitive therapy (CT among patients with chronic pain and psychiatric co-morbidity. A phenomenological approach within a lifeworld perspective was used. In total, 10 patients were interviewed after completion of 7- to 13-month therapy. The findings reveal that the therapy and the process of interaction with the therapist were meaningful for the patients’ well-being and for a better management of pain. During the therapy, the patients were able to initiate a movement of change. Thus, CT with focus on attachment and mindfulness seems to be of value for these patients. The therapy used in this study was adjusted to the patients’ special needs, and a trained psychotherapist with a special knowledge of patients with chronic pain might be required.

  15. Altered pain modulation in patients with persistent postendodontic pain.

    Science.gov (United States)

    Nasri-Heir, Cibele; Khan, Junad; Benoliel, Rafael; Feng, Changyong; Yarnitsky, David; Kuo, Fengshen; Hirschberg, Craig; Hartwell, Gary; Huang, Ching-Yu; Heir, Gary; Korczeniewska, Olga; Diehl, Scott R; Eliav, Eli

    2015-10-01

    Persistent pain may follow nerve injuries associated with invasive therapeutic interventions. About 3% to 7% of the patients remain with chronic pain after endodontic treatment, and these are described as suffering from painful posttraumatic trigeminal neuropathy (PTTN). Unfortunately, we are unable to identify which patients undergoing such procedures are at increased risk of developing PTTN. Recent findings suggest that impaired endogenous analgesia may be associated with the development of postsurgical chronic pain. We hypothesized that patients with PTTN display pronociceptive pain modulation, in line with other chronic pain disorders. Dynamic (conditioned pain modulation, temporal summation) and static (response to mechanical and cold stimulation) psychophysical tests were performed intraorally and in the forearm of 27 patients with PTTN and 27 sex- and age-matched controls. The dynamic sensory testing demonstrated less efficient conditioned pain modulation, suggesting reduced function of the inhibitory endogenous pain-modulatory system, in patients with PTTN, mainly in those suffering from the condition for more than a year. The static sensory testing of patients with PTTN demonstrated forearm hyperalgesia to mechanical stimulation mainly in patients suffering from the condition for less than a year and prolonged painful sensation after intraoral cold stimulus mainly in patients suffering from the condition for more than a year. These findings suggest that PTTN is associated more with the inhibitory rather than the facilitatory arm of pain modulation and that the central nervous system has a role in PTTN pathophysiology, possibly in a time-dependent fashion. PMID:26098442

  16. Effectiveness of anodal transcranial direct current stimulation in patients with chronic low back pain: Design, method and protocol for a randomised controlled trial

    Directory of Open Access Journals (Sweden)

    Luedtke Kerstin

    2011-12-01

    Full Text Available Abstract Background Electrical stimulation of central nervous system areas with surgically implanted stimulators has been shown to result in pain relief. To avoid the risks and side effects of surgery, transcranial direct current stimulation is an option to electrically stimulate the motor cortex through the skull. Previous research has shown that transcranial direct current stimulation relieves pain in patients with fibromyalgia, chronic neuropathic pain and chronic pelvic pain. Evidence indicates that the method is pain free, safe and inexpensive. Methods/Design A randomised controlled trial has been designed to evaluate the effect of transcranial direct current stimulation over the motor cortex for pain reduction in patients with chronic low back pain. It will also investigate whether transcranial direct current stimulation as a prior treatment enhances the symptom reduction achieved by a cognitive-behavioural group intervention. Participants will be randomised to receive a series of 5 days of transcranial direct current stimulation (2 mA, 20 mins or 20 mins of sham stimulation; followed by a cognitive-behavioural group programme. The primary outcome parameters will measure pain (Visual Analog Scale and disability (Oswestry Disability Index. Secondary outcome parameters will include the Fear Avoidance Beliefs Questionnaire, the Funktionsfragebogen Hannover (perceived function, Hospital Anxiety Depression Scale, bothersomeness and Health Related Quality of Life (SF 36, as well as Patient-Perceived Satisfactory Improvement. Assessments will take place immediately prior to the first application of transcranial direct current stimulation or sham, after 5 consecutive days of stimulation, immediately after the cognitive-behavioural group programme and at 4 weeks, 12 weeks and 24 weeks follow-up. Discussion This trial will help to determine, whether transcranial direct current stimulation is an effective treatment for patients with chronic low back

  17. Estimating the Risk of Chronic Pain: Development and Validation of a Prognostic Model (PICKUP) for Patients with Acute Low Back Pain

    OpenAIRE

    Traeger, Adrian C; Nicholas Henschke; Markus Hübscher; Williams, Christopher M.; Kamper, Steven J; Maher, Christopher G.; G Lorimer Moseley; McAuley, James H

    2016-01-01

    Background Low back pain (LBP) is a major health problem. Globally it is responsible for the most years lived with disability. The most problematic type of LBP is chronic LBP (pain lasting longer than 3 mo); it has a poor prognosis and is costly, and interventions are only moderately effective. Targeting interventions according to risk profile is a promising approach to prevent the onset of chronic LBP. Developing accurate prognostic models is the first step. No validated prognostic models ar...

  18. 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

  19. 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…

  20. 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

  1. 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...

  2. The psychometric properties of the Roland Morris disability questionnaire for patients with chronic mechanical low back pain

    Directory of Open Access Journals (Sweden)

    H. Buchanan

    2007-02-01

    Full Text Available Purpose: Functional status measures are currently not widelyused in South Africa to facilitate clinical decision-making or document treatment outcomes for patients with low back pain (LBP. This study investigated the internal consistency and clinical utility of a back-specific functional status measure, the Roland Morris Disability Questionnaire (RMDQ, and determined its ability to confirm the need for spinal fusion surgery. Method: Aretrospective, descriptive design was used with 42 patients with chronic mechanical low back pain who consulted a private Orthopaedic surgeon in Cape Town over a one year  period. All patients completed the RMDQ prior to their consultation. On completion of the medical examination, a rating for surgery was determined for each patient. The completed questionnaires were analysed using Statistical Package for the Social Sciences (SPSS. Results: The mean RMDQ score was 8.6 (N=42; median=9.0; range=2-21. Cronbach’s alpha showed a high internal consistency between items (.92. A categorical principal component analysis (CATPCA identified two distinct dimensions in the RMDQ. Item reduction improved the internal consistency and thus the construct validity of the RMDQ. There was a low correlation between the surgeon’s rating for surgery and RMDQ scores (r=.40; P<.01. Conclusion: The RMDQ shows some good psychometric properties but some adjustments could improve it. The RMDQ cannot be used to predict the need for spinal fusion surgery.

  3. Finding Ways to Lift Barriers to Care for Chronic Pain Patients: Outcomes of Using Internet-Based Self-Management Activities to Reduce Pain and Improve Quality of Life.

    Science.gov (United States)

    Rod, Kevin

    2016-01-01

    Background. Chronic pain is prevalent, disabling, costly, and undertreated. There is clearly a need to improve patient understanding of ways to manage their pain. Internet-based programs are continually being developed to facilitate mental health improvement, providing tailored content for patients to manage their pain, anxiety, and depression. Objective. To evaluate the impact of Internet-based patient self-management education and activities on patients' pain, anxiety, and quality of life in patients who could not access multidisciplinary pain management. Design. Observational study. Subjects. Two hundred (200) patients (61% females, 39% males, between 18 and 75 years old) from one community pain clinic in Toronto, Canada (Toronto Poly Clinic), participated. Patients had moderate to severe pain, depression, and anxiety. These patients committed to study from a group of 515 patients with chronic noncancer pain of different origins who were stable on their levels of pain, anxiety, and depression for 12 consecutive months before start of study and could not afford noninsured treatment modalities like physiotherapy, psychology, nutrition, or exercise therapy consultation. Methods. Patients were encouraged to visit two Internet sites (a blog and Twitter postings) for educational postings written by the author about exercise, nutrition, mindfulness meditation, disease management methods, evidence-based supplements, daily relaxation exercises, and overall self-management methods 15 minutes per day for six months. Patients were also encouraged to share their ideas and comments on a blog. Activity logs were kept by patients and reviewed by physician at follow-up visits. Compliance was encouraged via weekly email reminders and phone calls during the observation period. Results. Modest improvements were noted in pain, anxiety, depression, and quality of life. Of the patients with moderate or severe pain before treatment, 45% reported mild levels of pain after treatment

  4. Finding Ways to Lift Barriers to Care for Chronic Pain Patients: Outcomes of Using Internet-Based Self-Management Activities to Reduce Pain and Improve Quality of Life.

    Science.gov (United States)

    Rod, Kevin

    2016-01-01

    Background. Chronic pain is prevalent, disabling, costly, and undertreated. There is clearly a need to improve patient understanding of ways to manage their pain. Internet-based programs are continually being developed to facilitate mental health improvement, providing tailored content for patients to manage their pain, anxiety, and depression. Objective. To evaluate the impact of Internet-based patient self-management education and activities on patients' pain, anxiety, and quality of life in patients who could not access multidisciplinary pain management. Design. Observational study. Subjects. Two hundred (200) patients (61% females, 39% males, between 18 and 75 years old) from one community pain clinic in Toronto, Canada (Toronto Poly Clinic), participated. Patients had moderate to severe pain, depression, and anxiety. These patients committed to study from a group of 515 patients with chronic noncancer pain of different origins who were stable on their levels of pain, anxiety, and depression for 12 consecutive months before start of study and could not afford noninsured treatment modalities like physiotherapy, psychology, nutrition, or exercise therapy consultation. Methods. Patients were encouraged to visit two Internet sites (a blog and Twitter postings) for educational postings written by the author about exercise, nutrition, mindfulness meditation, disease management methods, evidence-based supplements, daily relaxation exercises, and overall self-management methods 15 minutes per day for six months. Patients were also encouraged to share their ideas and comments on a blog. Activity logs were kept by patients and reviewed by physician at follow-up visits. Compliance was encouraged via weekly email reminders and phone calls during the observation period. Results. Modest improvements were noted in pain, anxiety, depression, and quality of life. Of the patients with moderate or severe pain before treatment, 45% reported mild levels of pain after treatment

  5. 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…

  6. Real-world treatment patterns and opioid use in chronic low back pain patients initiating duloxetine versus standard of care

    Directory of Open Access Journals (Sweden)

    Andrews JS

    2013-11-01

    Full Text Available Jeffrey Scott Andrews,1 Ning Wu,2 Shih-Yin Chen,2 Xia Yu,2 Xiaomei Peng,1 Diego Novick1 1Global Health Outcomes, Eli Lilly and Company, Indianapolis, IN, USA; 2Evidera, Lexington, MA, USA Abstract: To describe the use of pain medications in patients with chronic low back pain (CLBP after initiating duloxetine or standard of care (SOC [muscle relaxants, gabapentin, pregabalin, venlafaxine, and tricyclic antidepressants] for pain management, pharmacy and medical claims from Surveillance Data, Inc (SDI Health were analyzed. Adult patients with CLBP who initiated duloxetine or SOC between November 2010 and April 2011 were identified. Treatment initiation was defined as no pill coverage for duloxetine or SOC in the previous 90 days. Included patients had no opioid use in the 90 days before initiation. Propensity score matching was used to select patients with similar baseline demographic and clinical characteristics for duloxetine and SOC cohorts. Compliance with index medication was assessed via medication possession ratio (MPR and proportion of days covered (PDC for 6 months after initiation. The proportion of patients receiving opioids and days on opioids after index date were assessed, and regression models were estimated to compare opioid use between cohorts. A total of 766 patients initiated duloxetine and 6,206 patients initiated SOC. After matching, 743 patients were selected for the duloxetine (mean age 57 years; female 74% and SOC (mean age 57 years; female 75% cohorts, respectively. Of the duloxetine cohort, 92% started on or below recommended daily dose (≤60 mg. The duloxetine cohort had significantly higher MPR (0.78 versus [vs] 0.60 and PDC (0.50 vs 0.31, were less likely to use opioids (45% vs 61%, and had fewer days on opioids (median 0 vs 7 days than the SOC cohort (all P < 0.001. After adjusting for demographic and clinical characteristics, the duloxetine cohort initiated opioids later than the SOC cohort (hazard ratio 0.77, 95

  7. 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.

  8. Symptoms and side effects in chronic non-cancer pain patients

    DEFF Research Database (Denmark)

    Olsen, T S; Jonsson, T; Højsted, J;

    2015-01-01

    pain of non-cancer origin for more than 6 months, were asked to fill in two questionnaires: QSSE-41 or QSSE-33 and SF-36. The first part of the study (QSSE-41) included an age- and sex-matched control group. RESULTS: A total of 67 patients were included in QSSE-41 and 60 patients in QSSE-33. In QSSE-41......, the mean number of symptoms reported by the patient group (12.3) was significantly higher than those reported by the controls (6.8) (P effects caused by analgesics, and out of those 61.3% were reported as acceptable and 38.......7% as unacceptable side effects. In the QSSE-33, the mean number of symptoms reported by the patient group was 13.6. Out of the total number of symptoms, 46.3% were reported to be side effects caused by analgesics, and out of those 56.4% were reported as acceptable and 43.6% as unacceptable side effects. CONCLUSIONS...

  9. Cut-Off Points for Mild, Moderate, and Severe Pain on the Numeric Rating Scale for Pain in Patients with Chronic Musculoskeletal Pain: Variability and Influence of Sex and Catastrophizing

    Science.gov (United States)

    Boonstra, Anne M.; Stewart, Roy E.; Köke, Albère J. A.; Oosterwijk, René F. A.; Swaan, Jeannette L.; Schreurs, Karlein M. G.; Schiphorst Preuper, Henrica R.

    2016-01-01

    Objectives: The 0–10 Numeric Rating Scale (NRS) is often used in pain management. The aims of our study were to determine the cut-off points for mild, moderate, and severe pain in terms of pain-related interference with functioning in patients with chronic musculoskeletal pain, to measure the variability of the optimal cut-off points, and to determine the influence of patients’ catastrophizing and their sex on these cut-off points. Methods: 2854 patients were included. Pain was assessed by the NRS, functioning by the Pain Disability Index (PDI) and catastrophizing by the Pain Catastrophizing Scale (PCS). Cut-off point schemes were tested using ANOVAs with and without using the PSC scores or sex as co-variates and with the interaction between CP scheme and PCS score and sex, respectively. The variability of the optimal cut-off point schemes was quantified using bootstrapping procedure. Results and conclusion: The study showed that NRS scores ≤ 5 correspond to mild, scores of 6–7 to moderate and scores ≥8 to severe pain in terms of pain-related interference with functioning. Bootstrapping analysis identified this optimal NRS cut-off point scheme in 90% of the bootstrapping samples. The interpretation of the NRS is independent of sex, but seems to depend on catastrophizing. In patients with high catastrophizing tendency, the optimal cut-off point scheme equals that for the total study sample, but in patients with a low catastrophizing tendency, NRS scores ≤ 3 correspond to mild, scores of 4–6 to moderate and scores ≥7 to severe pain in terms of interference with functioning. In these optimal cut-off schemes, NRS scores of 4 and 5 correspond to moderate interference with functioning for patients with low catastrophizing tendency and to mild interference for patients with high catastrophizing tendency. Theoretically one would therefore expect that among the patients with NRS scores 4 and 5 there would be a higher average PDI score for those with low

  10. Finding Ways to Lift Barriers to Care for Chronic Pain Patients: Outcomes of Using Internet-Based Self-Management Activities to Reduce Pain and Improve Quality of Life

    Directory of Open Access Journals (Sweden)

    Kevin Rod

    2016-01-01

    Full Text Available Background. Chronic pain is prevalent, disabling, costly, and undertreated. There is clearly a need to improve patient understanding of ways to manage their pain. Internet-based programs are continually being developed to facilitate mental health improvement, providing tailored content for patients to manage their pain, anxiety, and depression. Objective. To evaluate the impact of Internet-based patient self-management education and activities on patients’ pain, anxiety, and quality of life in patients who could not access multidisciplinary pain management. Design. Observational study. Subjects. Two hundred (200 patients (61% females, 39% males, between 18 and 75 years old from one community pain clinic in Toronto, Canada (Toronto Poly Clinic, participated. Patients had moderate to severe pain, depression, and anxiety. These patients committed to study from a group of 515 patients with chronic noncancer pain of different origins who were stable on their levels of pain, anxiety, and depression for 12 consecutive months before start of study and could not afford noninsured treatment modalities like physiotherapy, psychology, nutrition, or exercise therapy consultation. Methods. Patients were encouraged to visit two Internet sites (a blog and Twitter postings for educational postings written by the author about exercise, nutrition, mindfulness meditation, disease management methods, evidence-based supplements, daily relaxation exercises, and overall self-management methods 15 minutes per day for six months. Patients were also encouraged to share their ideas and comments on a blog. Activity logs were kept by patients and reviewed by physician at follow-up visits. Compliance was encouraged via weekly email reminders and phone calls during the observation period. Results. Modest improvements were noted in pain, anxiety, depression, and quality of life. Of the patients with moderate or severe pain before treatment, 45% reported mild levels of pain

  11. External Validation of a Referral Rule for Axial Spondyloarthritis in Primary Care Patients with Chronic Low Back Pain.

    Directory of Open Access Journals (Sweden)

    Lonneke van Hoeven

    Full Text Available To validate and optimize a referral rule to identify primary care patients with chronic low back pain (CLBP suspected for axial spondyloarthritis (axSpA.Cross-sectional study with data from 19 Dutch primary care practices for development and 38 for validation.Primary care patients aged 18-45 years with CLBP existing more than three months and onset of back pain started before the age of 45 years.The number of axSpA patients according to the ASAS criteria.The referral rule (CaFaSpA referral rule was developed using 364 CLBP patients from 19 primary care practices and contains four easy to use variables; inflammatory back pain, good response to nonsteriodal anti-inflammatory drugs, family history of spondyloarthritis and a back pain duration longer than five years. This referral rule is positive when at least two variables are present. Validation of the CaFaSpA rule was accomplished in 579 primary care CLBP patients from 38 practices from other areas. Performance of the referral rule was assessed by c-statistic and calibration plot. To fit the final referral rule the development and validation datasets were pooled leading to a total study population of 943 primary care participants.The referral rule was validated in 579 patients (41% male, mean age 36 (sd7.0. The percentage of identified axSpA patients was 16% (n=95. External validation resulted in satisfactory calibration and reasonable discriminative ability (c-statistics 0.70 [95% CI, 0.64-0.75]. In the pooled dataset sensitivity and specificity of the referral rule were 75% and 58%.The CaFaSpA referral rule for axSpA consists of four easy to use predictors for primary care physicians and has a good predictive value in this validation study. The referral rule has the potential to be a screening tool for primary care by identifying CLBP patients suspected for axSpA.

  12. Dry needling in patients with chronic heel pain due to plantar fasciitis: A single-blinded randomized clinical trial

    Science.gov (United States)

    Eftekharsadat, Bina; Babaei-Ghazani, Arash; Zeinolabedinzadeh, Vahideh

    2016-01-01

    Background: This study examined the effects of dry needling on chronic heel pain due to plantar fasciitis. Methods: During this single-blinded clinical trial, 20 eligible patients were randomized into two groups: A case group treated with dry needling and a control group. Patients’ plantar pain severity, (using modified visual analog scale [VAS] scoring system), range of motion of ankle joint in dorsiflexion [ROMDF] and plantar extension[ROMPE] and foot function index (using standard questionnaires of SEM5 and MDC7) were assessed at baseline, four weeks after intervention and four weeks after withdrawing treatment. Independent sample t-test, Mann-Whitney U test, paired t-test, Wilcoxon signed rank tests, and chi square test were used for data analysis. Results: The mean VAS scores in the case group was significantly lower than the control group after four weeks of intervention (pdry needling, by improving the severity of heel pain, can be used as a good alternative option before proceeding to more invasive therapies of plantar fasciitis. PMID:27683642

  13. Does a combination of physical training, specific exercises and pain education improve health-related quality of life in patients with chronic neck pain? A randomised control trial with a 4-month follow up

    DEFF Research Database (Denmark)

    Ris Hansen, Inge; Søgaard, Karen; Gram, Bibi;

    2016-01-01

    controlled trial of 200 neck pain patients receiving pain education. The exercise group received additional exercises for neck/shoulder, balance and oculomotor function, plus graded physical activity training. Patient-reported outcome measures (Short Form-36 Physical and Mental component summary scores, Euro...... anterior and cervical spine, Cranio-cervical Flexion, Cervical Extension muscle function, and oculomotion) were recorded at baseline and after 4 months. Results The exercise group showed statistically significant improvement in physical HR-QoL, mental HR-QoL, depression, cervical pressure pain threshold......Abstract Aim To investigate the effect of combining pain education, specific exercises and graded physical activity training (exercise) compared with pain education alone (control) on physical health-related quality of life (HR-QoL) in chronic neck pain patients. Methods A multicentre randomised...

  14. Sense of social support in chonic pain patients

    OpenAIRE

    Ancane G.; Rudzite I.; Smite D.

    2012-01-01

    Statistical data show that one in five adults of the European citizen suffer from some type of chronic pain. One of the most common types of chronic pain is chronic low back and neck pain. Emotional factors are currently viewed as important determinants in pain perception and behaviour. The perceived social and emotional support have impact to the individual’s adaptation to chronic disease (Cohen, Wills, 1985). The material: 110 chronic low back pain (CLBP) patients (48 male and 62 female; in...

  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. Is one better than another?: A randomized clinical trial of manual therapy for patients with chronic neck pain.

    Science.gov (United States)

    Izquierdo Pérez, Honorio; Alonso Perez, Jose Luis; Gil Martinez, Alfonso; La Touche, Roy; Lerma-Lara, Sergio; Commeaux Gonzalez, Noelia; Arribas Perez, Hector; Bishop, Mark D; Fernández-Carnero, Josue

    2014-06-01

    Our purpose was to compare the effectiveness of three manual therapy techniques: high velocity, low amplitude (HVLA), mobilization (Mob) and sustained natural apophyseal glide (SNAG) in patients with chronic neck pain (CNP). The randomized controlled trial included patients with mechanically reproducible CNP, who were randomized to the treatment group. Outcome measures were the Visual Analogue scale (VAS), Neck Disability Index (NDI), Global Rating of Change (GROC) and Cervical Range of Motion (CROM). Two-way repeated measures analysis of variance compared outcomes at baseline, at the end of treatment and 1, 2 and 3 months after treatment. A total of 51 subjects completed the trial. No significant differences were found between HVLA, Mob and SNAG at the end of treatment and during the follow-up in any of the analysed outcomes. There were no differences in satisfaction for all techniques. The results lead to the conclusion that there is no long-term difference between the application of HVLA, Mob and SNAG in pain, disability and cervical range of motion for patients with CNP.

  17. The periodontal pain paradox: Difficulty on pain assesment in dental patients (The periodontal pain paradox hypothesis

    Directory of Open Access Journals (Sweden)

    Haryono Utomo

    2006-12-01

    Full Text Available In daily dental practice, the majority of patients’ main complaints are related to pain. Most patients assume that all pains inside the oral cavity originated from the tooth. One particular case is thermal sensitivity; sometimes patients were being able to point the site of pain, although there is neither visible caries nor secondary caries in dental radiograph. In this case, gingival recession and dentin hypersensitivity are first to be treated to eliminate the pain. If these treatments failed, pain may misdiagnose as pulpal inflammation and lead to unnecessary root canal treatment. Study in pain during periodontal instrumentation of plaque-related periodontitis revealed that the majority of patients feel pain and discomfort during probing and scaling. It seems obvious because an inflammation, either acute or chronic is related to a lowered pain threshold. However, in contrast, in this case report, patient suffered from chronic gingivitis and thermal sensitivity experienced a relative pain-free sensation during probing and scaling. Lowered pain threshold which accompanied by a blunted pain perception upon periodontal instrumentation is proposed to be termed as the periodontal pain paradox. The objective of this study is to reveal the possibility of certain factors in periodontal inflammation which may involved in the periodontal pain paradox hypothesis. Patient with thermal hypersensitivity who was conducted probing and scaling, after the relative pain-free instrumentation, thermal hypersensitivity rapidly disappeared. Based on the successful periodontal treatment, it is concluded that chronic gingivitis may modulate periodontal pain perception which termed as periodontal pain paradox

  18. 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

  19. "Professional Helper" or "Helping Professional?" The Patient-Physician Relationship in the Chronic Pain Setting, With Special Reference to the Current Opioid Debate.

    Science.gov (United States)

    Bäckryd, Emmanuel

    2016-01-01

    There seems to be a strong cultural expectation among patients for effective pain relief. As a result, physicians often find themselves trying to bridge the gap between the chronic pain patient's expectations and harsh biomedical reality. The typology of Emanuel and Emanuel of four models for the patient-physician relationship is used in this article as a conceptual tool to examine the possible roles of physicians in the context of chronic noncancer pain. Their typology is reconceptualized as a "pathway" along which the physician is able to walk more or less far, starting from the "information" end of the path. The other end of the pathway is "caring deliberation." I then propose that, in pain medicine today, consumerism is a powerful incentive for physicians to stay at the information end of the spectrum. Against this background, I discuss the current opioid epidemic in the United States and the need for what has been called a new medical professionalism. I conclude by challenging educators involved in pain medicine continuing professional development to not only design adequate biomedical-educational programs, but also consider issues like professionalism, personal development, critical self-reflection, and the ethics of engaging in caring deliberation with chronic pain patients. PMID:27116642

  20. 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.

  1. 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.

  2. [Pain Management in geriatric patients].

    Science.gov (United States)

    Eiche, Jürgen; Schache, Florian

    2016-04-01

    Pains belong to the most frequent reasons for a doctor's visit. In elderly people, it is the result of progressive degenerative processes (e. g. , arthrosis, Osteoarthritis, degenerative spinal changes) and a higher prevalence of cancer disease to a further increase of the patients who suffer unnecessarily from pains. By the increasing polymorbidity (e.g. diabetes mellitus, vascular disease) and a declining immune competence, the prevalence of polyneuropathy and post-herpetic neuralgia rises. Insufficiently treated chronic or periodically returning pain can lead to serious interferences of the physical, cognitive and social everyday competence and therefore to a limited quality of life. These facts shows the relevance of a sufficient pain therapy in geriatric patients. Nevertheless, on account of existing comorbidity, polypharmacy as well as of impaired organ function, the pharmacological pain therapy in old patients also poses a potential hazard. Although pain prevalence is higher with geriatric than with younger patients, significantly less analgesics are prescribed in the elderly population. This results from existing uncertainties at the treating doctors as well as the complicated pain capture, in particular with cognitive affected patients. The present article should indicate options of treatment for geriatric pain patients. PMID:27123730

  3. The effects of kinesio taping on potential in chronic low back pain patients anticipatory postural control and cerebral cortex.

    Science.gov (United States)

    Bae, Sea Hyun; Lee, Jeong Hun; Oh, Kyeong Ae; Kim, Kyung Yoon

    2013-11-01

    [Purpose] This study aimed to examine the effects of kinesio tape applied to chronic low back pain (CLBP) patients on anticipatory postural control and cerebral cortex potential. [Subjects and Methods] Twenty patients whose low back pain had continued for more than 12 weeks were selected and assigned to a control group (n=10) to which ordinary physical therapy was applied and an experimental group (n=10) to which kinesio tape was applied. Anticipatory postural control was evaluated using electromyography, and movement-related cortical potential (MRCP) was assessed using electroencephalography. Clinical evaluation was performed using a visual analogue scale and the Oswestry disability index. [Results] According to the analysis results for anticipatory postural control, there were significant decreases in the transversus abdominis (TrA) muscle and the external oblique muscle in both groups. Among them, the TrA of the experimental group exhibited the greatest differences. According to the results of a between-group comparison, there was significant difference in the TrA between the two groups. There was also a significant decrease in the MRCP of both groups. In particular, changes in the movement monitoring potential (MMP) of the experimental group were greatest at Fz, C3, Cz, and C4. According to the between-group comparison, there were significant differences in MMP at F3, C3, and Cz. Both groups saw VAS and ODI significantly decrease. Among them, the ODI of the experimental group underwent the greatest change. [Conclusion] Kinesio tape applied to CLBP patients reduced their pain and positively affected their anticipatory postural control and MRCP.

  4. The Effects of Kinesio Taping on Potential in Chronic Low Back Pain Patients Anticipatory Postural Control and Cerebral Cortex

    Science.gov (United States)

    Bae, Sea Hyun; Lee, Jeong Hun; Oh, Kyeong Ae; Kim, Kyung Yoon

    2013-01-01

    [Purpose] This study aimed to examine the effects of kinesio tape applied to chronic low back pain (CLBP) patients on anticipatory postural control and cerebral cortex potential. [Subjects and Methods] Twenty patients whose low back pain had continued for more than 12 weeks were selected and assigned to a control group (n=10) to which ordinary physical therapy was applied and an experimental group (n=10) to which kinesio tape was applied. Anticipatory postural control was evaluated using electromyography, and movement-related cortical potential (MRCP) was assessed using electroencephalography. Clinical evaluation was performed using a visual analogue scale and the Oswestry disability index. [Results] According to the analysis results for anticipatory postural control, there were significant decreases in the transversus abdominis (TrA) muscle and the external oblique muscle in both groups. Among them, the TrA of the experimental group exhibited the greatest differences. According to the results of a between-group comparison, there was significant difference in the TrA between the two groups. There was also a significant decrease in the MRCP of both groups. In particular, changes in the movement monitoring potential (MMP) of the experimental group were greatest at Fz, C3, Cz, and C4. According to the between-group comparison, there were significant differences in MMP at F3, C3, and Cz. Both groups saw VAS and ODI significantly decrease. Among them, the ODI of the experimental group underwent the greatest change. [Conclusion] Kinesio tape applied to CLBP patients reduced their pain and positively affected their anticipatory postural control and MRCP. PMID:24396190

  5. Better quality sleep promotes daytime physical activity in patients with chronic pain? A multilevel analysis of the within-person relationship.

    Directory of Open Access Journals (Sweden)

    Nicole K Y Tang

    Full Text Available BACKGROUND: Promoting physical activity is key to the management of chronic pain, but little is understood about the factors facilitating an individual's engagement in physical activity on a day-to-day basis. This study examined the within-person effect of sleep on next day physical activity in patients with chronic pain and insomnia. METHODS: 119 chronic pain patients monitored their sleep and physical activity for a week in their usual sleeping and living environment. Physical activity was measured using actigraphy to provide a mean activity score each hour. Sleep was estimated with actigraphy and an electronic diary, providing an objective and subjective index of sleep efficiency (A-SE, SE and a sleep quality rating (SQ. The individual and relative roles of these sleep parameters, as well as morning ratings of pain and mood, in predicting subsequent physical activity were examined in multilevel models that took into account variations in relationships at the 'Day' and 'Participant' levels. RESULTS: Of the 5 plausible predictors SQ was the only significant within-person predictor of subsequent physical activity, such that nights of higher sleep quality were followed by days of more physical activity, from noon to 11 pm. The temporal association was not explained by potential confounders such as morning pain, mood or effects of the circadian rhythm. CONCLUSIONS: In the absence of interventions, chronic pain patients spontaneously engaged in more physical activity following a better night of sleep. Improving nighttime sleep may well be a novel avenue for promoting daytime physical activity in patients with chronic pain.

  6. 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

  7. 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.

  8. The psychometric properties of the Finnish Young Schema Questionnaire in chronic pain patients and a non-clinical sample.

    Science.gov (United States)

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

    2009-03-01

    We investigated the latent factor structure of the Finnish Young Schema Questionnaire (YSQ-S2-extended; short form) in samples of chronic pain patients (n=271) and controls (n=331) with confirmatory factor analysis (CFA). The data in the total sample supported the 18-factor structure as hypothesized by Young, J. E., Klosko, J., & Weishaar, M. E. (2003). Schema therapy: A practitioner's guide. New York: Guilford Press. The diagonally weighted least squares estimation method gave repeatable parameter estimates in successive confirmatory factor analyses (CFA). The internal consistency of the YSQ-S2-extended was adequate to high in both samples and the groups showed equal goodness-of-fit statistics in CFA. This study consisted of the oldest population so far (mean age 47 years) and supported the use of the Finnish version of the YSQ-S2-extended in clinical practice.

  9. 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...

  10. Effects of ozone applied by spinal endoscopy in patients with chronic pain related to failed back surgery syndrome: a pilot study

    Directory of Open Access Journals (Sweden)

    Magalhães FNO

    2013-11-01

    Full Text Available Francisco Nêuton de Oliveira Magalhães, Sandra Correia Soares, Jaqueline Melo Torres, Arthur Ungaretti, Mariana Fillipi Cacciacarro, Manoel Jacobsen Teixeira, Erich Talamoni FonoffPain Center and Division of Functional Neurosurgery, Department of Neurology, School of Medicine, University of São Paulo, São Paulo, BrazilIntroduction: In the last two decades, ozone has emerged as a treatment for low back pain, applied by means of minimally invasive techniques. Objective: The aim of this study is to assess the effect and safety of ozone therapy applied in the epidural space for chronic pain related to failed back surgery syndrome.Methods: The investigators studied 13 sequential patients of both sexes, between 18 and 70 years old, with persistent chronic pain (more than six months in the lumbar region and in the lower limbs related to failed back surgery syndrome (FBSS. Pain was classified as neuropathic and non-neuropathic regarding the topography (lumbar and lower limb, based on the DN4 questionnaire. The patients received the ozone gas in the lumbar epidural space via spinal-sacral endoscopy. Clinical evaluation was performed before, immediately after (24 hours, and 1, 3, and 6 months after intervention with visual analog scale and Oswestry Disability Index (ODI.Results: Overall, the patients had 43.7% reduction of lumbar pain, 60.9% reduction in leg pain in six months followed by 44.0% of improvement in ODI. The reduction of pain and in the disability index was markedly greater in patients with non-neuropathic predominant pain, 95.2%, 80.6%, and 75.3% improvement in lumbar, leg pain, and ODI respectively, while neuropathic predominant pain patients experienced only 12.5%, 42.4%, and 20.9% improvement, also respectively. No neurological or infectious complications were observed acutely or during the follow-up. The present data suggests that epidural ozone might be a therapeutic option for persistent low back pain, especially in non

  11. 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

  12. 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.

  13. 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.

  14. 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...

  15. The influence of a series of five dry cupping treatments on pain and mechanical thresholds in patients with chronic non-specific neck pain - a randomised controlled pilot study

    Directory of Open Access Journals (Sweden)

    Dobos Gustav J

    2011-08-01

    Full Text Available Abstract Background In this preliminary trial we investigated the effects of dry cupping, an ancient method for treating pain syndromes, on patients with chronic non-specific neck pain. Sensory mechanical thresholds and the participants' self-reported outcome measures of pain and quality of life were evaluated. Methods Fifty patients (50.5 ± 11.9 years were randomised to a treatment group (TG or a waiting-list control group (WL. Patients in the TG received a series of 5 cupping treatments over a period of 2 weeks; the control group did not. Self-reported outcome measures before and after the cupping series included the following: Pain at rest (PR and maximal pain related to movement (PM on a 100-mm visual analogue scale (VAS, pain diary (PD data on a 0-10 numeric rating scale (NRS, Neck Disability Index (NDI, and health-related quality of life (SF-36. In addition, the mechanical-detection thresholds (MDT, vibration-detection thresholds (VDT, and pressure-pain thresholds (PPT were determined at pain-related and control areas. Results Patients of the TG had significantly less pain after cupping therapy than patients of the WL group (PR: Δ-22.5 mm, p = 0.00002; PM: Δ-17.8 mm, p = 0.01. Pain diaries (PD revealed that neck pain decreased gradually in the TG patients and that pain reported by the two groups differed significantly after the fifth cupping session (Δ-1.1, p = 0.001. There were also significant differences in the SF-36 subscales for bodily pain (Δ13.8, p = 0.006 and vitality (Δ10.2, p = 0.006. Group differences in PPT were significant at pain-related and control areas (all p Conclusions A series of five dry cupping treatments appeared to be effective in relieving chronic non-specific neck pain. Not only subjective measures improved, but also mechanical pain sensitivity differed significantly between the two groups, suggesting that cupping has an influence on functional pain processing. Trial registration The trial was registered at

  16. 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…

  17. [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

  18. 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...

  19. Characterisation of the bacterial community in expressed prostatic secretions from patients with chronic prostatitis/chronic pelvic pain syndrome and infertile men: a preliminary investigation

    Institute of Scientific and Technical Information of China (English)

    Dong-Sheng Hou; Wen-Min Long; Jian Shen; Li-Ping Zhao; Xiao-Yan Pang; Chen XU

    2012-01-01

    The expressed prostatic secretions (EPSs) of men with chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS),infertile men and normal men were subjected to microbiological study.EPSs were collected from the subjects,which included 26 normal men,11 infertile patients and 51 CP/CPPS patients.DNA was extracted from each specimen,and the V3 regions of the 16S rRNA genes were amplified using universal bacterial primers.The results showed that the EPS 16S rRNA gene-positive rate in the CP/CPPS and infertile patients was much higher than in the normal men,but without any difference among the three patient groups.The denaturing gradient gel electrophoresis (DGGE) method was used to characterize the EPS bacterial community structure of the prostate fluid from patients with CP/CPPS or infertility issues.Principal component analysis (PCA) and partial least squares (PLS) analyses of PCR-DGGE profiles revealed that the EPS bacterial community structure differed among the three groups.Three bands were identified as the key factors responsible for the discrepancy between CP/CPPS patients and infertile patients (P<0.05).Two bands were identified as priority factors in the discrepancy of category ⅢA and category ⅢB prostatitis patients (P<0.05).According to this research,the ecological balance of the prostate and low urethra tract,when considered as a microenvironment,might play an important role in the maintenance of a healthy male reproductive tract.

  20. Use of the UPOINT phenotype system in treating Chinese patients with chronic prostatitis/chronic pelvic pain syndrome:a prospective study

    Institute of Scientific and Technical Information of China (English)

    Xiao Guan; Cheng Zhao; Zhen-Yu Ou; Long Wang; Feng Zeng; Lin Qi; Zheng-Yan Tang; Jin-Geng Dun; Long-Fei Liu

    2015-01-01

    The urinary, psychosocial, organ‑specific, infection, neurological/systemic and tenderness (UPOINT) phenotype system has been validated to be an effective phenotype system in classifying patients with chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) in western populations. To validate the utility of the UPOINT system and evaluate the effect of multimodal therapy based on the UPOINT system in Chinese patients with CP/CPPS, we performed this study. Chinese patients with CP/CPPS were prospectively offered multimodal therapy using the UPOINT system and re‑examined after 6 months. A minimum 6‑point drop in National Institutes of Health‑Chronic Prostatitis Symptoms Index (NIH‑CPSI) was set to be the primary endpoint. Finally, 140 patients were enrolled in the study. The percentage of patients with each domain was 59.3%, 45.0%, 49.3%, 22.1%, 37.9%, and 56.4% for the UPOINT, respectively. The number of positive domains significantly correlated with symptom severity, which is measured by total NIH‑CPSI scores (r = 0.796, P < 0.001). Symptom duration was associated with a greater number of positive domains (r = 0.589, P < 0.001). With 6 months follow‑up at least, 75.0% (105/140) had at least a 6‑point improvement in NIH‑CPSI after taking the therapy. All NIH‑CPSI scores were significantly improved from original ones: pain 10.14 ± 4.26 to 6.60 ± 3.39, urinary 6.29 ± 2.42 to 3.63 ± 1.52, quality of life 6.56 ± 2.44 to 4.06 ± 1.98, and total 22.99 ± 7.28 to 14.29 ± 5.70 (all P < 0.0001). Our study indicates that the UPOINT system is clinically feasible in classifying Chinese patients with CP/CPPS and directing therapy.

  1. 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 ...

  2. 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

  3. Influence of the actions observed on cervical motion in patients with chronic neck pain: a pilot study.

    Science.gov (United States)

    de-la-Puente-Ranea, Lucía; García-Calvo, Beatriz; La Touche, Roy; Fernández-Carnero, Josué; Gil-Martínez, Alfonso

    2016-08-01

    The aim of the present pilot study was to prove if the action-observation (AOb) improved the cervical range of motion (CROM) in patients with nonspecific chronic neck pain (CNP). Double blind pilot study. A total of 28 subjects were randomly assigned to an effective-movement group (n=14) and an ineffective-movement group (n=14). The follow-up consisted of: pretreatment, posttreatment and 10 min after second measurement (motor imagery). Outcome measures were CROM, and pres-sure pain detection thresholds (PPDTs). No statistical differences were found in baseline on CROM and on the PPDT. Test for independent groups revealed significant changes in cervical rotation movement. Both groups in posttreatment (P=0.042; Cohen d=0.81) and after 10 min (P=0.019; Cohen d=0.9). For intragroup PPDT, the Wilcoxon test revealed significant effects in the effective movement at C2 of the pre to 10-min post (P=0.040). However, the ineffective movement revealed a significant reduction in PPDT in zygapophyseal joint of C5-C6 as the pre to post (P=0.010) as the pre to 10-min post (P=0.041) periods. In conclusions this pilot study demonstrated that the effective AOb produced significant changes versus ineffective AOb in the CROM and it could influences in PPT in subject with CNP immediately. PMID:27656633

  4. Effect of exhalation exercise on trunk muscle activity and oswestry disability index of patients with chronic low back pain.

    Science.gov (United States)

    Kang, Jeong-Il; Jeong, Dae-Keun; Choi, Hyun

    2016-06-01

    [Purpose] This study investigated the effect of exhalation exercises on trunk muscle activity and Oswestry Disability Index by inducing trunk muscle activity through increasing intra-abdominal pressure and activating muscles, contributing to spinal stability. [Subjects and Methods] This intervention program included 20 male patients with chronic low back pain. A total of 10 subjects each were randomly assigned to an exhalation exercise group as the experimental group and a spinal stabilization exercise group as the control group. [Results] There were significant differences in the activities of the rectus abdominis, transverse abdominis, external oblique abdominal, and erector spinae muscles as well as in the Oswestry Disability Index within the experimental group. There were meaningful differences in the activities of the rectus abdominis, external oblique abdominal, and erector spinae muscles and in the Oswestry Disability Index within the control group. In addition, there was a meaningful intergroup difference in transverse abdominis muscle activity alone and in the Oswestry Disability Index. [Conclusion] The breathing exercise effectively increased muscle activity by training gross and fine motor muscles in the trunk. Moreover, it was verified as a very important element for strengthening body stability because it both released and prevented low back pain. PMID:27390406

  5. Effect of exhalation exercise on trunk muscle activity and oswestry disability index of patients with chronic low back pain.

    Science.gov (United States)

    Kang, Jeong-Il; Jeong, Dae-Keun; Choi, Hyun

    2016-06-01

    [Purpose] This study investigated the effect of exhalation exercises on trunk muscle activity and Oswestry Disability Index by inducing trunk muscle activity through increasing intra-abdominal pressure and activating muscles, contributing to spinal stability. [Subjects and Methods] This intervention program included 20 male patients with chronic low back pain. A total of 10 subjects each were randomly assigned to an exhalation exercise group as the experimental group and a spinal stabilization exercise group as the control group. [Results] There were significant differences in the activities of the rectus abdominis, transverse abdominis, external oblique abdominal, and erector spinae muscles as well as in the Oswestry Disability Index within the experimental group. There were meaningful differences in the activities of the rectus abdominis, external oblique abdominal, and erector spinae muscles and in the Oswestry Disability Index within the control group. In addition, there was a meaningful intergroup difference in transverse abdominis muscle activity alone and in the Oswestry Disability Index. [Conclusion] The breathing exercise effectively increased muscle activity by training gross and fine motor muscles in the trunk. Moreover, it was verified as a very important element for strengthening body stability because it both released and prevented low back pain.

  6. A review of chronic pain impact on patients, their social environment and the health care system

    OpenAIRE

    Duenas, María

    2016-01-01

    María Dueñas,1 Begoña Ojeda,2 Alejandro Salazar,2 Juan Antonio Mico,3 Inmaculada Failde,2 1Nursing Faculty “Salus Infirmorum”, The Observatory of Pain, University of Cádiz, Cádiz, Spain; 2Preventive Medicine and Public Health Area, The Observatory of Pain, University of Cádiz, Cádiz, Spain; 3Department of Neuroscience, Pharmacology, and Psychiatry, CIBER of Ment...

  7. Neurophysiologic effects of spinal manipulation in patients with chronic low back pain

    Directory of Open Access Journals (Sweden)

    Walkowski Stevan

    2011-07-01

    Full Text Available Abstract Background While there is growing evidence for the efficacy of SM to treat LBP, little is known on the mechanisms and physiologic effects of these treatments. Accordingly, the purpose of this study was to determine whether SM alters the amplitude of the motor evoked potential (MEP or the short-latency stretch reflex of the erector spinae muscles, and whether these physiologic responses depend on whether SM causes an audible joint sound. Methods We used transcranial magnetic stimulation to elicit MEPs and electromechanical tapping to elicit short-latency stretch reflexes in 10 patients with chronic LBP and 10 asymptomatic controls. Neurophysiologic outcomes were measured before and after SM. Changes in MEP and stretch reflex amplitude were examined based on patient grouping (LBP vs. controls, and whether SM caused an audible joint sound. Results SM did not alter the erector spinae MEP amplitude in patients with LBP (0.80 ± 0.33 vs. 0.80 ± 0.30 μV or in asymptomatic controls (0.56 ± 0.09 vs. 0.57 ± 0.06 μV. Similarly, SM did not alter the erector spinae stretch reflex amplitude in patients with LBP (0.66 ± 0.12 vs. 0.66 ± 0.15 μV or in asymptomatic controls (0.60 ± 0.09 vs. 0.55 ± 0.08 μV. Interestingly, study participants exhibiting an audible response exhibited a 20% decrease in the stretch reflex (p Conclusions These findings suggest that a single SM treatment does not systematically alter corticospinal or stretch reflex excitability of the erector spinae muscles (when assessed ~ 10-minutes following SM; however, they do indicate that the stretch reflex is attenuated when SM causes an audible response. This finding provides insight into the mechanisms of SM, and suggests that SM that produces an audible response may mechanistically act to decrease the sensitivity of the muscle spindles and/or the various segmental sites of the Ia reflex pathway.

  8. Evaluation of Blood Pressure and Heart Rate in Patients with Hypertension Who Received Tapentadol Extended Release for Chronic Pain: A Post Hoc, Pooled Data Analysis

    OpenAIRE

    Biondi, David M.; Xiang, Jim; Etropolski, Mila; Moskovitz, Bruce

    2014-01-01

    Background and Objectives Hypertension is one of the most common co-existing conditions in patients with chronic pain, and the potential effects of an analgesic on heart rate and blood pressure are of particular concern for patients with hypertension. The purpose of this analysis was to evaluate changes in blood pressure and heart rate with tapentadol extended release (ER) treatment in patients with hypertension. Methods We performed a post hoc analysis of data pooled from three randomized, p...

  9. 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...

  10. The Maastricht Ultrasound Shoulder pain trial (MUST: Ultrasound imaging as a diagnostic triage tool to improve management of patients with non-chronic shoulder pain in primary care

    Directory of Open Access Journals (Sweden)

    Cals Jochen WL

    2011-07-01

    Full Text Available Abstract Background Subacromial disorders are considered to be one of the most common pathologies affecting the shoulder. Optimal therapy for shoulder pain (SP in primary care is yet unknown, since clinical history and physical examination do not provide decisive evidence as to the patho-anatomical origin of the symptoms. Optimal decision strategies can be furthered by applying ultrasound imaging (US, an accurate method in diagnosing SP, demonstrating a clear relationship between diagnosis and available therapies. Yet, the clinical cost-effectiveness of applying US in the management of SP in primary care has not been studied. The aim of this paper is to describe the design and methods of a trial assessing the cost-effectiveness of ultrasound imaging as a diagnostic triage tool to improve management of primary care patients with non-chronic shoulder pain. Methods/Design This randomised controlled trial (RCT will involve 226 adult patients with suspected subacromial disorders recruited by general practitioners. During a Qualification period of two weeks, patients receive care as usual as advised by the Dutch College of General Practitioners, and patients are referred for US. Patients with insufficient improvement qualify for the RCT. These patients are then randomly assigned to the intervention or the control group. The therapies used in both groups are the same (corticosteroid injections, referral to a physiotherapist or orthopedic surgeon except that therapies used in the intervention group will be tailored based on the US results. Ultrasound diagnosed disorders include tendinopathy, calcific tendinitis, partial and full thickness tears, and subacromial bursitis. The primary outcome is patient-perceived recovery at 52 weeks, using the Global Perceived Effect questionnaire. Secondary outcomes are disease specific and generic quality of life, cost-effectiveness, and the adherence to the initial applied treatment. Outcome measures will be assessed

  11. Voices that may not otherwise be heard: a qualitative exploration into the perspectives of primary care patients living with chronic pain

    Directory of Open Access Journals (Sweden)

    Wallace LS

    2014-06-01

    Full Text Available Lorraine S Wallace,1 Randell K Wexler,1 Leon McDougle,1 W Frederick Miser,1 J David Haddox2,3 1Department of Family Medicine, the Ohio State University, Columbus, OH, USA; 2Health Policy, Purdue Pharma L.P., Stamford, CT, USA; 3Department of Public Health and Community Medicine, Tufts University School of Medicine, Boston, MA, USA Background: Although psychometrically sound pain assessment tools are available, there is a paucity of research that comprehensively defines chronic pain from the perspective of patients. The purpose of this study was to examine the utility of a combination of qualitative methods (Photovoice, one-on-one interviews, and focus groups in examining the daily experiences of primary care patients living with chronic pain. Methods: A sample of English-speaking primary care patients aged 30 years or older, who had been prescribed an opioid for long-term, noncancer pain management, participated in the study. Each patient took photographs that best reflected both his/her experiences with chronic pain and what he/she would like his/her life to be without chronic pain. Results: Patients submitted an average of 20.2±3.1 photographs (range =8–27 photographs. Analysis of one-on-one interviews illuminated five dominant themes: daily need for multiple medications, including opioids; difficulties climbing a flight of stairs; struggling to get out of bed in the morning; extreme challenges with participating in day-to-day life activities; and experiencing feelings of hopelessness and helplessness on a regular basis. Seven themes emerged from the focus groups: undesired effects/burdens of medications, loss of/striving for independence, effect on social interactions/relationships, pain effect on activities of daily living, constant search for convenience/a better situation, interactions with physicians, and frustration/depression with pain. Conclusion: The qualitative methods employed in this study provide deep insight into perceptions

  12. 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...

  13. Chronic pelvic pain.

    Science.gov (United States)

    Herbert, Bettina

    2010-01-01

    Though there are myriad etiologies of CPP, common therapeutic targets include inflammation, somatic dysfunction, and psychological disturbances. Inflammation may be addressed not only with dietary changes including nutritional and botanical supplements but also with mind-body therapies. Somatic dysfunction may respond to manipulative therapies provided by osteopaths, naturopaths, chiropractors, and some physical therapists. Therapists may also offer visceral, craniosacral, myofascial, and other whole-body therapies, as can highly trained massage therapists and bodyworkers. Mental health care may be key in many cases. Integrative medicine heralds the return to a sense of the human being's intrinsic capacity for healing, incorporating the vitalism of many of the therapies' origins (traditional Chinese medicine, indigenous medicine, ayurveda, osteopathy, chiropractic, etc) with the gains made by a more reductionistic tradition. Given the complexity and wide variation of etiologies and symptoms of CPP, using an integrative approach may offer expanded therapeutic solutions. We must expand our capacity to listen to each patient-with ears, eyes, mind, heart, and hands. Each treatment plan may then be tailored to the unique history and perspective that lie within the individual. Doing so requires the essential elements of time, skill, and love. PMID:20085175

  14. Neck exercises, physical and cognitive behavioural-graded activity as a treatment for adult whiplash patients with chronic neck pain: Design of a randomised controlled trial

    Directory of Open Access Journals (Sweden)

    Hansen Inge

    2011-12-01

    Full Text Available Abstract Background Many patients suffer from chronic neck pain following a whiplash injury. A combination of cognitive, behavioural therapy with physiotherapy interventions has been indicated to be effective in the management of patients with chronic whiplash-associated disorders. The objective is to present the design of a randomised controlled trial (RCT aimed at evaluating the effectiveness of a combined individual physical and cognitive behavioural-graded activity program on self-reported general physical function, in addition to neck function, pain, disability and quality of life in patients with chronic neck pain following whiplash injury compared with a matched control group measured at baseline and 4 and 12 months after baseline. Methods/Design The design is a two-centre, RCT-study with a parallel group design. Included are whiplash patients with chronic neck pain for more than 6 months, recruited from physiotherapy clinics and an out-patient hospital department in Denmark. Patients will be randomised to either a pain management (control group or a combined pain management and training (interventiongroup. The control group will receive four educational sessions on pain management, whereas the intervention group will receive the same educational sessions on pain management plus 8 individual training sessions for 4 months, including guidance in specific neck exercises and an aerobic training programme. Patients and physiotherapists are aware of the allocation and the treatment, while outcome assessors and data analysts are blinded. The primary outcome measures will be Medical Outcomes Study Short Form 36 (SF36, Physical Component Summary (PCS. Secondary outcomes will be Global Perceived Effect (-5 to +5, Neck Disability Index (0-50, Patient Specific Functioning Scale (0-10, numeric rating scale for pain bothersomeness (0-10, SF-36 Mental Component Summary (MCS, TAMPA scale of Kinesiophobia (17-68, Impact of Event Scale (0-45, EuroQol (0

  15. [The moderator role of family type in the relationship between functional disability and quality of life in patients with chronic low back pain].

    Science.gov (United States)

    Ferreira, Maria Salomé Martins; Pereira, Maria da Graça

    2016-01-01

    Chronic low back pain is a disease that interferes with quality of life and the patient's functional capability. This study aimed to identify the moderating effect of the "Type of Family" in the relationship between functional disability and quality of life in patients with chronic low back pain. Two hundred and three patients with low back pain for longer than 3 months participated in the study. The instruments used were: Medical Outcome Study (MOS 20); Roland Morris Disability Questionnaire (RMDO; Family Adaptability and Cohesion Evaluation Scales (FACES II). Regression analyses were performed in order to test the moderating effect of the type of family. The results showed that patients with lower levels of disability presented better quality of life in the intermediate and balanced families, and this relationship was even stronger in balanced families. According to the results, intervention programs in chronic low back pain, besides the patient, should include the family particularly in balanced families since they are the ones that feel the impact of the disease on their quality of life the most.

  16. 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

  17. 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.

  18. 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...

  19. Pain in burn patients.

    Science.gov (United States)

    Latarjet, J; Choinère, M

    1995-08-01

    While severe pain is a constant component of the burn injury, inadequate pain management has been shown to be detrimental to burn patients. Pain-generating mechanisms in burns include nociception, primary and secondary hyperalgesia and neuropathy. The clinical studies of burn pain characteristics reveal very clear-cut differences between continuous pain and pain due to therapeutic procedures which have to be treated separately. Some of the main features of burn pain are: (1) its long-lasting course, often exceeding healing time, (2) the repetition of highly nociceptive procedures which can lead to severe psychological disturbances if pain control is inappropriate. Pharmaco-therapy with opioids is the mainstay for analgesia in burned patients, but non-pharmacological techniques may be useful adjuncts. Routine pain evaluation is mandatory for efficient and safe analgesia. Special attention must be given to pain in burned children which remains too often underestimated and undertreated. More educational efforts from physicians and nursing staff are necessary to improve pain management in burned patients.

  20. Multi-segment analysis of spinal kinematics during sit-to-stand in patients with chronic low back pain.

    Science.gov (United States)

    Christe, Guillaume; Redhead, Lucy; Legrand, Thomas; Jolles, Brigitte M; Favre, Julien

    2016-07-01

    While alterations in spinal kinematics have been frequently reported in patients with chronic low back pain (CLBP), a better characterization of the kinematics during functional activities is needed to improve our understanding and therapeutic solutions for this condition. Recent studies on healthy subjects showed the value of analyzing the spine during sit-to-stand transition (STST) using multi-segment models, suggesting that additional knowledge could be gained by conducting similar assessments in CLBP patients. The objectives of this study were to characterize three dimensional kinematics at the lower lumbar (LLS), upper lumbar (ULS), lower thoracic (LTS) and upper thoracic (UTS) joints during STST, and to test the hypothesis that CLBP patients perform this movement with smaller angle and angular velocity compared to asymptomatic controls. Ten CLBP patients (with minimal to moderate disability) and 11 asymptomatic controls with comparable demographics (52% male, 37.4±5.6 years old, 22.5±2.8kg/m(2)) were tested using a three-dimensional camera-based system following previously proposed protocols. Characteristic patterns of movement were identified at the LLS, ULS and UTS joints in the sagittal plane only. Significant differences in the form of smaller sagittal-plane angle and smaller angular velocity in the patient group compared to the control group were observed at these three joints. This indicated a more rigid spine in the patient group and suggested that CLBP rehabilitation could potentially be enhanced by targeting movement deficits in functional activities. The results further recommended the analysis of STST kinematics using a pelvis-lumbar-thoracic model including lower and upper lumbar and thoracic segments. PMID:27262182

  1. 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

  2. Comparison of Dry Needling versus Orthopedic Manual Therapy in Patients with Myofascial Chronic Neck Pain: A Single-Blind, Randomized Pilot Study.

    Science.gov (United States)

    Campa-Moran, Irene; Rey-Gudin, Etelvina; Fernández-Carnero, Josué; Paris-Alemany, Alba; Gil-Martinez, Alfonso; Lerma Lara, Sergio; Prieto-Baquero, Almudena; Alonso-Perez, José Luis; La Touche, Roy

    2015-01-01

    Objective. The aim of this study was to compare the efficacy of three interventions for the treatment of myofascial chronic neck pain. Methods. Thirty-six patients were randomly assigned to one of three intervention groups: orthopedic manual therapy (OMT), dry needling and stretching (DN-S), and soft tissue techniques (STT). All groups received two treatment sessions with a 48 h time interval. Outcome measures included neck pain intensity measured using a visual analogue scale, cervical range of motion (ROM), pressure pain threshold for measuring mechanical hyperalgesia, and two self-reported questionnaires (neck disability index and pain catastrophizing scale). Results. The ANOVA revealed significant differences for the group × time interaction for neck disability, neck pain intensity, and pain catastrophizing. The DN-S and OMT groups reduced neck disability. Only the OMT group showed decreases in mechanical hyperalgesia and pain catastrophizing. The cervical ROM increased in OMT (i.e., flexion, side-bending, and rotation) and DN-S (i.e., side-bending and rotation) groups. Conclusions. The three interventions are all effective in reducing pain intensity. Reduction in mechanical hyperalgesia and pain catastrophizing was only observed in the OMT group. Cervical ROM improved in the DN-S and OMT groups and also neck disability being only clinically relevant for OMT group. PMID:26640708

  3. Comparison of Dry Needling versus Orthopedic Manual Therapy in Patients with Myofascial Chronic Neck Pain: A Single-Blind, Randomized Pilot Study

    Directory of Open Access Journals (Sweden)

    Irene Campa-Moran

    2015-01-01

    Full Text Available Objective. The aim of this study was to compare the efficacy of three interventions for the treatment of myofascial chronic neck pain. Methods. Thirty-six patients were randomly assigned to one of three intervention groups: orthopedic manual therapy (OMT, dry needling and stretching (DN-S, and soft tissue techniques (STT. All groups received two treatment sessions with a 48 h time interval. Outcome measures included neck pain intensity measured using a visual analogue scale, cervical range of motion (ROM, pressure pain threshold for measuring mechanical hyperalgesia, and two self-reported questionnaires (neck disability index and pain catastrophizing scale. Results. The ANOVA revealed significant differences for the group × time interaction for neck disability, neck pain intensity, and pain catastrophizing. The DN-S and OMT groups reduced neck disability. Only the OMT group showed decreases in mechanical hyperalgesia and pain catastrophizing. The cervical ROM increased in OMT (i.e., flexion, side-bending, and rotation and DN-S (i.e., side-bending and rotation groups. Conclusions. The three interventions are all effective in reducing pain intensity. Reduction in mechanical hyperalgesia and pain catastrophizing was only observed in the OMT group. Cervical ROM improved in the DN-S and OMT groups and also neck disability being only clinically relevant for OMT group.

  4. 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)

  5. The Effect of the Neurac Sling Exercise on Postural Balance Adjustment and Muscular Response Patterns in Chronic Low Back Pain Patients

    OpenAIRE

    Kim, Ji Hae; Kim, Young Eok; Bae, Sea Hyun; Kim, Kyung Yoon

    2013-01-01

    [Purpose] This study aimed to examine the effects of the Neurac sling exercise on postural balance adjustment and muscular response patterns in chronic low back pain (CLBP) patients. [Subjects and Methods] Sixteen CLBP patients participated in this study. They were randomly and equally assigned to group I, whose members received ordinary physical therapy (40 minutes per time, four times per week), and group II, whose members performed a lumbar stabilization exercise using the Neurac sling aft...

  6. Investigation of chronic pain in maintenance hemodialysis patients%维持性血液透析患者慢性疼痛的调查

    Institute of Scientific and Technical Information of China (English)

    高芳; 刘功俭; 孙东

    2011-01-01

    目的 调查维持性血液透析( MHD)患者慢性疼痛的发生率,并探讨疼痛发生的原因及其对生活质量的影响.方法 以徐州医学院附属医院血液净化中心70例MHD患者为对象,根据是否有慢性疼痛,分为疼痛组32例和非疼痛组38例.疼痛组应用疼痛数字分级法(NRS,1~10)判定疼痛强度.检测两组患者的甲状旁腺素(PTH)、骨密度(BMD)和β2微球蛋白(β2-MG)水平;用贝克德抑郁指数(BDI)自评量表判断抑郁程度;用匹兹堡睡眠质量指数( PSQI)判断失眠程度.对疼痛组患者疼痛强度与PTH、BMD、β2-MG、BDI和PSQI评分进行相关性分析.结果 MHD患者疼痛的发生率为45.7%;NRS值为5.71±1.86 (95%CI,5.04~6.38).两组的PTH、BMD和β2-MG、BDI评分、PSQI评分差异均有统计学意义(均P<0.01).疼痛组的疼痛强度与PTH、β2-MG、PSQI评分、BDI评分均呈正相关,与BMD呈负相关.结论 MHD患者常常有慢性疼痛,疼痛的部位不同定,且大多数表现为中度疼痛.慢性疼痛加重患者的抑郁、失眠.疼痛的发生可能与PTH、β2-MG和BMD水平变化有关.%Objective To investigate the incidence and the cause of chronic pain in maintenance hemodialysis (MHD) patients,and the effect of chronic pain on quality of life.Methods Seventy MHD patients in dialysis centre of our hospital were enrolled in the study and divided into 2 groups according to pain symptoms.There were 32 patients with chronic pain in pain group,and 38 patients without chronic pain in painless group.Pain degree was evaluated by numerical rating scale (NRS,1 to 10) in pain group.Parathyroid hormone (PTH),β2-microglobulin (β2-MG) and bone mineral density (BMD) of all the patients were measured.Depression and insomnia degrees were examined by Beck depression index (BDI) and Pittsburgh sleep quality index (PSQI) respectively.Correlations were performed among parameters. Results The incidence of chronic pain in MHD patients was 45.7% and the

  7. Cerebral responses to innocuous somatic pressure stimulation following aerobic exercise rehabilitation in chronic pain patients: a functional magnetic resonance imaging study

    Directory of Open Access Journals (Sweden)

    Micalos PS

    2014-08-01

    Full Text Available Peter S Micalos,1 Mayuresh S Korgaonkar,2 Eric J Drinkwater,3 Jack Cannon,3 Frank E Marino3 1School of Biomedical Sciences, Charles Sturt University, Bathurst, 2Brain Dynamics Centre, Westmead Millennium Institute, University of Sydney Medical School, Sydney, 3School of Human Movement Studies, Charles Sturt University, Bathurst, NSW, Australia Objective: The purpose of this research was to assess the functional brain activity and perceptual rating of innocuous somatic pressure stimulation before and after exercise rehabilitation in patients with chronic pain. Materials and methods: Eleven chronic pain patients and eight healthy pain-free controls completed 12 weeks of supervised aerobic exercise intervention. Perceptual rating of standardized somatic pressure stimulation (2 kg on the right anterior mid-thigh and brain responses during functional magnetic resonance imaging (fMRI were assessed at pre- and postexercise rehabilitation. Results: There was a significant difference in the perceptual rating of innocuous somatic pressure stimulation between the chronic pain and control groups (P=0.02 but no difference following exercise rehabilitation. Whole brain voxel-wise analysis with correction for multiple comparisons revealed trends for differences in fMRI responses between the chronic pain and control groups in the superior temporal gyrus (chronic pain > control, corrected P=0.30, thalamus, and caudate (control > chronic, corrected P=0.23. Repeated measures of the regions of interest (5 mm radius for blood oxygen level-dependent signal response revealed trend differences for superior temporal gyrus (P=0.06, thalamus (P=0.04, and caudate (P=0.21. Group-by-time interactions revealed trend differences in the caudate (P=0.10 and superior temporal gyrus (P=0.29. Conclusion: Augmented perceptual and brain responses to innocuous somatic pressure stimulation were shown in the chronic pain group compared to the control group; however, 12-weeks of exercise

  8. Chronic Pain in the Emergency Department: A Pilot Mixed-Methods Cross-Sectional Study Examining Patient Characteristics and Reasons for Presentations

    Directory of Open Access Journals (Sweden)

    Patricia A. Poulin

    2016-01-01

    Full Text Available Background. Chronic pain (CP accounts for 10–16% of emergency department (ED visits, contributing to ED overcrowding and leading to adverse events. Objectives. To describe patients with CP attending the ED and identify factors contributing to their visit. Methods. We used a mixed-method design combining interviews and questionnaires addressing pain, psychological distress, signs of opioid misuse, and disability. Participants were adults who attended the EDs of a large academic tertiary care center for their CP problem. Results. Fifty-eight patients (66% women; mean age 46.5, SD = 16.9 completed the study. The most frequently cited reason (60% for ED visits was inability to cope with pain. Mental health problems were common, including depression (61% and anxiety (45%. Participants had questions about the etiology of their pain, concerns about severe pain-related impairment, and problems with medication renewals or efficacy and sometimes felt invalidated in the ED. Although most participants had a primary care physician, the ED was seen as the only or best option when pain became unmanageable. Conclusions. Patients with CP visiting the ED often present with complex difficulties that cannot be addressed in the ED. Better access to interdisciplinary pain treatment is needed to reduce the burden of CP on the ED.

  9. COMPARISON OF ACTIVE RELEASE TECHNIQUE AND MYOFASCIAL RELEASE TECHNIQUE ON PAIN, GRIP STRENGTH & FUNCTIONAL PERFORMANCE IN PATIENTS WITH CHRONIC LATERAL EPICONDYLITIS

    Directory of Open Access Journals (Sweden)

    Parth Trivedi

    2014-06-01

    Full Text Available Background & Purpose: Lateral epicondylitis is the most common lesion of the elbow. Tennis elbow or lateral epicondylitis is defined as a syndrome of pain in the wrist extensor muscles at or near their lateral epicondyle origin or pain directly over the lateral epicondyle. So, the aim of this study was to compare the effectiveness of Active Release Technique (ART and Myofascial Release Technique (MFR in the treatment of Chronic Lateral Epicondylitis (CLE. Methodology: The study included thirty-six patients with Chronic Lateral Epicondylitis of age group range between 30 to 45 years. Patients were randomly divided into three groups: Control Group (A, Active Release Technique Group (B and Myofascial Release Technique Group (C. The patients were treated for 4 weeks and three outcome measures: 0-10 NPRS, Hand Dynamometer and PRTEE were taken for assessment and analysis at baseline and after 4th weeks was done. Result: In this study the result showed that Active Release Technique and Myofascial Release Technique were effective in all three outcome measures when compared to Control Group. Myofascial Release Technique was more effective in improving grip strength & reducing pain & disability when compared to Active Release Technique.(p<0.05 Conclusion: Active Release Technique and Myofascial Release Technique are effective in patients with Chronic Lateral Epicondylitis. Myofascial Release Technique demonstrated better outcomes than Active Release Technique in the management of Chronic Lateral Epicondylitis.

  10. 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

  11. 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...

  12. 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.

  13. 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

  14. 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...

  15. The Effectiveness of Mindfulness-Based Stress Reduction on Perceived Pain Intensity and Quality of Life in Patients With Chronic Headache.

    Science.gov (United States)

    Bakhshani, Nour Mohammad; Amirani, Ahmadreza; Amirifard, Hamed; Shahrakipoor, Mahnaz

    2015-08-06

    The aim of this study was to determine the effectiveness of Mindfulness-Based Stress reduction (MBSR) on perceived pain intensity and quality of life in patients with chronic headache. Thus, forty patients based on the diagnosis of a neurologist and diagnostic criteria of the International Headache Society (IHS) for migraine and chronic tension-type headache were selected and randomly assigned to the intervention group and control group, respectively. The participants completed the Pain and quality of life (SF-36) questionnaire. The intervention group enrolled in an eight-week MBSR program that incorporated meditation and daily home practice, per week, session of 90-minutes. Results of covariance analysis with the elimination of the pre-test showed significantly improvement of pain and quality of life in the intervention group compared with the control group. The findings from this study revealed that MBSR can be used non-pharmacological intervention for improvement the quality of life and development of strategies to cope with pain in patients with chronic headache. And can be used in combination with other therapies such as pharmacotherapy.

  16. 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

  17. 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...

  18. Effectiveness of mat Pilates or equipment-based Pilates in patients with chronic non-specific low back pain: a protocol of a randomised controlled trial

    Directory of Open Access Journals (Sweden)

    da Luz Maurício Antônio

    2013-01-01

    Full Text Available Abstract Background Chronic low back pain is an expensive and difficult condition to treat. One of the interventions widely used by physiotherapists in the treatment of chronic non-specific low back pain is exercise therapy based upon the Pilates principles. Pilates exercises can be performed with or without specific equipment. These two types of Pilates exercises have never been compared on a high-quality randomised controlled trial. Methods/design This randomised controlled trial with a blinded assessor will evaluate eighty six patients of both genders with chronic low back pain, aged between 18 and 60 years, from one Brazilian private physiotherapy clinic. The patients will be randomly allocated into two groups: Mat Group will perform the exercises on the ground while the Equipment-based Group will perform the Pilates method exercises on the following equipment: Cadillac, Reformer, Ladder Barrel, and Step Chair. The general and specific disability of the patient, kinesiophobia, pain intensity and global perceived effect will be evaluated by a blinded assessor before randomisation and at six weeks and six months after randomisation. In addition, the expectation of the participants and their confidence with the treatment will be evaluated before randomisation and after the first treatment session, respectively. Discussion This will be the first study aiming to compare the effectiveness of Mat and Equipment-based Pilates exercises in patients with chronic non-specific low back pain. The results may help health-care professionals in clinical decision-making and could potentially reduce the treatment costs of this condition. Trial registration Brazilian Registry of Clinical Trials RBR-7tyg5j

  19. 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.

  20. 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

  1. Effectiveness of cognitive behavioural therapy on pain of patients with low back pain

    OpenAIRE

    Banth, Sudha; Maryam Didehdar ARDEBiL

    2014-01-01

    Background: Chronic low back pain is a major health problem and has high comorbidity with psychological related disorders. As there is no consensus about the effectiveness of psychotherapy methods for chronic pain, so our target in this study was to assess the efficacy of cognitive behavioral therapy (CBT) as a psychological intervention on pain of female patients with nonspecific chronic low back pain (NSCLBP). Methods: 88 patients suffering from NSCLBP were randomly assigned ...

  2. 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.

  3. A double-blinded randomised controlled study of the value of sequential intravenous and oral magnesium therapy in patients with chronic low back pain with a neuropathic component.

    Science.gov (United States)

    Yousef, A A; Al-deeb, A E

    2013-03-01

    Persistent mechanical irritation of the nerve root sets up a series of events mediating sensitisation of the dorsal roots and dorsal horns in the spinal cord. Current evidence supports the role of magnesium in blocking central sensitisation through its effect on N-methyl-d-aspartate receptors. We studied the role of sequential intravenous and oral magnesium infusion in patients with chronic low back pain with a neuropathic component. We recruited a cohort of 80 patients with chronic low back pain with a Leeds Assessment of Neuropathic Signs and Symptoms pain scale score ≥ 12, who were receiving a physical therapy programme. All patients were treated with anticonvulsants, antidepressants and simple analgesics; in addition 40 patients received placebo for 6 weeks (control group), while the other 40 patients received an intravenous magnesium infusion for 2 weeks followed by oral magnesium capsules for another 4 weeks (magnesium group). Patients were asked to rate their pain using a numerical rating scale. Lumbar spine range of motion was also determined using a long-arm goniometer. In the magnesium group, the patients' numerical rating scales revealed a significant reduction in pain intensity. The mean (SD) pre-treatment value was 7.5 (2.2) compared with 4.7 (1.8) at 6 months (p = 0.034). The reduction in pain intensity was accompanied by significant improvement in lumbar spine range of motion during the follow-up period. The mean (SD) values of flexion, extension and lateral flexion movements before treatment and at 6-month follow up were 22.2 (8.4) vs 34.7 (11.5) (p = 0.018), 11.8 (3.4) vs 16.9 (3.5) (p = 0.039), 11.4 (3.6) vs 17.2 (4.4) (p = 0.035), respectively. Our findings show that a 2-week intravenous magnesium infusion followed by 4 weeks of oral magnesium supplementation can reduce pain intensity and improve lumbar spine mobility during a 6-month period in patients with refractory chronic low back pain with a neuropathic component.

  4. Dor crônica em pacientes esquizofrênicos: prevalência e características Chronic pain in schizophrenic patients: prevalence and characteristics

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    Jouce Gabriela de Almeida

    2010-03-01

    Full Text Available A prevalência de dor crônica entre pacientes com transtornos psiquiátricos é, possivelmente, no mínimo igual à encontrada entre a população geral. Para estimar a prevalência de dor crônica em pacientes com esquizofrenia, comparar os grupos com e sem dor crônica e caracterizar a dor foi realizado um estudo transversal, com uma amostra probabilística de 205 pacientes adultos, com diagnóstico de esquizofrenia (idade média 37 anos; 65% homens; média de escolaridade de nove anos; 87% sem companheiro(a; 65% residentes com os pais, atendidos em hospital público do Município de São Paulo, Brasil. A prevalência de dor foi de 36,6%; a dor foi mais presente no abdômen (30,7%, seguida da dor de cabeça, face e boca (24% e região lombar, sacra e cóccix (14,7%. Com relação à freqüência, 24% dos entrevistados referiram ter dor todos os dias. O tempo médio de dor foi de 41 meses, com intensidade moderada. A prevalência de dor crônica em pacientes esquizofrênicos foi semelhante à encontrada para a população geral, e o quadro álgico foi significativo em termos de duração, intensidade e freqüência dos episódios dolorosos.Chronic pain may be at least as prevalent in psychiatric patients as in the general population. To estimate the prevalence of chronic pain in schizophrenic patients, compare the groups with and without chronic pain, and characterize the pain, a cross-sectional study was performed on a probabilistic sample of 205 adult patients with a diagnosis of schizophrenia (mean age 37 years; 65% men; mean schooling nine years; 87% single; 65% living with parents, treated at a public hospital in the city of São Paulo, Brazil. Prevalence of pain was 36.6%, and the most frequent sites were abdomen (30.7%, head, face, and mouth (24%, and lower back (14.7%. Twenty-four percent of patients reported feeling pain every day. Mean duration of pain was 41 months, with moderate intensity. Prevalence of chronic pain in

  5. 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.

  6. 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.…

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

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    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

  8. The Effect of Fatigue and Instability on Postural Control Parameters in Standing Posture in Healthy Adults and Patients with Chronic Low Back Pain

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    Amir Hosein Kahlaee

    2012-06-01

    Full Text Available Background: This study aims at analyzing the effect of fatigue and instability on postural control parameters in both healthy people and patients with the chronic nonspecific low-back pain.Materials and Methods: In this non-experimental case-control study, oscillations of center of pressure were statistically analyzed in 16 healthy people and 15 patients with the chronic nonspecific low back pain. The analysis was conducted through two stages: before and after fatigue and under both stable and unstable surfaces. Results: Under the pre-fatigue, stable condition, there was not any difference between the two groups. Both fatigue and unstable surface changed our variables (sway area, range, velocity, frequency and total power of the signal. All the changes in variables were significant in the low-back pain group; while changes in the healthy group only covered the time-domain variables. The effect of instability was higher than that of fatigue. Conclusion: The postural control system for patients with low-back pain before fatigue and under stable condition, revealed sufficient competence to provide postural stability and its function cannot be differentiated from that in healthy people. Meanwhile, different mechanisms were used by these patients to confront stability challenging factors and further neural activity was required to counteract such factors.

  9. 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.

  10. Comparing core stability and traditional trunk exercise on chronic low back pain patients using three functional lumbopelvic stability tests.

    Science.gov (United States)

    Shamsi, Mohammad Bagher; Sarrafzadeh, Javad; Jamshidi, Aliashraf

    2015-02-01

    It is a matter of controversy whether core stability exercise is preferred to other types of exercise for chronic low back pain. Lumbopelvic stability is an important element in low back pain. No study was found using lumbopelvic stability tests in comparing core stability and other exercises. The single leg squat, dip test, and runner pose test appear to be suitable as tests for lumbopelvic stability. The aim of this study was to compare "core stability" and "traditional trunk exercise" using these tests and also the Oswestry disability questionnaire and pain intensity. Twenty-nine non-specific chronic low back pain subjects were alternately allocated in one of the two exercise groups. For both groups, a 16-sessions exercise program was provided. Before and after training: (1) video was recorded while subjects performed the tests; (2) Oswestry disability questionnaire was completed; and (3) pain intensity was measured by visual analogue scale. The test videos were scored by three physiotherapists. Statistical analysis revealed a significant improvement in stability test scores (p = 0.020 and p = 0.041) and reduction in disability (p pain (p < 0.001) within each group. No significant difference was seen between two groups in the three outcomes p = 0.41, p = 0.14, and p = 0.72. Insignificant differences between the two groups may indicate either non-specificity of CSE to increase lumbopelvic stability or equal effectiveness of TTE and CSE on improving LPS. The non-significant differences may also be attributable to the lack of sensitivity of our tests to assess stability change in two groups after training given the relatively small sample size.

  11. Do medical student attitudes towards patients with chronic low back pain improve during training? a cross-sectional study

    Directory of Open Access Journals (Sweden)

    Morris Hayley

    2012-03-01

    Full Text Available Abstract Background Health care professionals with positive attitudes towards the functional abilities of patients with low back pain are more likely to encourage activity and avoidance of rest as per recommended guidelines. This study investigated whether medical student training fosters positive attitudes towards patients with back pain and their ability to function. Methods First (n = 202 and final (n = 146 year medical students at the University of Glasgow completed the Health Care Professionals' Pain and Impairment Relationship Scale (HC-PAIRS questionnaire. This measures attitudes of clinicians towards the functional ability of patients with back pain. A group of first (n = 62 and final year (n = 61 business students acted as non-health care controls. Attitudes were compared using two-way ANOVA with year of study and discipline of degree as independent variables. Results Both year of study [F(1,465 = 39.5, p Conclusions Undergraduate medical training promotes positive attitudes towards the functional ability of patients with back pain, suggesting that students may be more likely to develop an evidence-based approach to this patient group after qualification. Some adjustments to training may be warranted to encourage a more positive shift in attitudes.

  12. 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…

  13. Ready Conversion of Patients with Well-Controlled, Moderate to Severe, Chronic Malignant Tumor–related Pain on Other Opioids to Tapentadol Extended Release

    OpenAIRE

    Imanaka, Keiichiro; Tominaga, Yushin; Etropolski, Mila; Ohashi, Hiroki; Hirose, Keiichiro; Matsumura, Taka

    2014-01-01

    Background and Objectives The effectiveness and tolerability of tapentadol extended release (ER), a centrally acting analgesic with μ-opioid receptor agonist and norepinephrine (noradrenaline) reuptake inhibitor activities, have been demonstrated in patients with chronic pain, including those switching directly from prior opioid therapy. The objective of the current study was to evaluate the effectiveness and safety of conversion to oral tapentadol ER (50–250 mg twice daily) from previous aro...

  14. 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,

  15. A comparison of two lifting assessment approaches in patients with chronic low back pain

    NARCIS (Netherlands)

    Soer, Remko; Poels, Bas J. J.; Geertzen, Jan H. B.; Reneman, Michiel F.

    2006-01-01

    The Progressive Isoinertial Lifting Evaluation (PILE) and the lifting test of the WorkWell Systems Functional Capacity Evaluation (WWS) are well known as lifting performance tests. The objective of this study was to study whether the PILE and the WWS can be used interchangeably in patients with Chro

  16. [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

  17. 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...

  18. 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...

  19. 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

  20. 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 )

  1. Development of a screening tool predicting the transition from acute to chronic low back pain for patients in a GP setting: Protocol of a multinational prospective cohort study

    Directory of Open Access Journals (Sweden)

    Bajracharya Suraj

    2008-12-01

    Full Text Available Abstract Background Low back pain (LBP is by far the most prevalent and costly musculoskeletal problem in our society today. Following the recommendations of the Multinational Musculoskeletal Inception Cohort Study (MMICS Statement, our study aims to define outcome assessment tools for patients with acute LBP and the time point at which chronic LBP becomes manifest and to identify patient characteristics which increase the risk of chronicity. Methods Patients with acute LBP will be recruited from clinics of general practitioners (GPs in New Zealand (NZ and Switzerland (CH. They will be assessed by postal survey at baseline and at 3, 6, 12 weeks and 6 months follow-up. Primary outcome will be disability as measured by the Oswestry Disability Index (ODI; key secondary endpoints will be general health as measured by the acute SF-12 and pain as measured on the Visual Analogue Scale (VAS. A subgroup analysis of different assessment instruments and baseline characteristics will be performed using multiple linear regression models. This study aims to examine 1. Which biomedical, psychological, social, and occupational outcome assessment tools are identifiers for the transition from acute to chronic LBP and at which time point this transition becomes manifest 2. Which psychosocial and occupational baseline characteristics like work status and period of work absenteeism influence the course from acute to chronic LBP 3. Differences in outcome assessment tools and baseline characteristics of patients in NZ compared with CH. Discussion This study will develop a screening tool for patients with acute LBP to be used in GP clinics to access the risk of developing chronic LBP. In addition, biomedical, psychological, social, and occupational patient characteristics which influence the course from acute to chronic LBP will be identified. Furthermore, an appropriate time point for follow-ups will be given to detect this transition. The generalizability of our

  2. Patients' perspectives on pain.

    Science.gov (United States)

    Norrbrink, Cecilia; Löfgren, Monika; Hunter, Judith P; Ellis, Jaqueline

    2012-01-01

    Nociceptive and neuropathic pain (NP) are common consequences following spinal cord injury (SCI), with large impact on sleep, mood, work, and quality of life. NP affects 40% to 50% of individuals with SCI and is sometimes considered the major problem following SCI. Current treatment recommendations for SCI-NP primarily focus on pharmacological strategies suggesting the use of anticonvulsant and antidepressant drugs, followed by tramadol and opioid medications. Unfortunately, these are only partly successful in relieving pain. Qualitative studies report that individuals with SCI-related long-lasting pain seek alternatives to medication due to the limited efficacy, unwanted side effects, and perceived risk of dependency. They spend time and money searching for additional treatments. Many have learned coping strategies on their own, including various forms of warmth, relaxation, massage, stretching, distraction, and physical activity. Studies indicate that many individuals with SCI are dissatisfied with their pain management and with the information given to them about their pain, and they want to know more about causes and strategies to manage pain. They express a desire to improve communication with their physicians and learn about reliable alternative sources for obtaining information about their pain and pain management. The discrepancy between treatment algorithms and patient expectations is significant. Clinicians will benefit from hearing the patient´s voice. PMID:23459087

  3. 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.

  4. 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.

  5. 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

  6. Effects of nurse-led motivational interviewing of patients with chronic musculoskeletal pain in preparation of rehabilitation treatment (PREPARE) on societal participation, attendance level, and cost-effectiveness: study protocol for a randomized controlled trial.

    NARCIS (Netherlands)

    Mertens, V.C.; Goossens, M.E.J.B.; Verbunt, J.A.; Koke, A.J.; Smeets, R.J.P.

    2013-01-01

    BACKGROUND: Non-adherence and drop-out are major problems in pain rehabilitation. For patients with various health problems, motivational interviewing (MI) has shown promising effects to tackle these problems. In chronic pain patients, the effectiveness of MI is however unknown. Therefore, a MI-base

  7. Cost-effectiveness analysis of pregabalin for treatment of chronic low back pain in patients with accompanying lower limb pain (neuropathic component) in Japan

    Science.gov (United States)

    Igarashi, Ataru; Akazawa, Manabu; Murata, Tatsunori; Taguchi, Toshihiko; Sadosky, Alesia; Ebata, Nozomi; Willke, Richard; Fujii, Koichi; Doherty, Jim; Kobayashi, Makoto

    2015-01-01

    Objective To assess the cost-effectiveness of pregabalin for the treatment of chronic low back pain with accompanying neuropathic pain (CLBP-NeP) from the health care payer and societal perspectives. Methods The cost-effectiveness of pregabalin versus usual care for treatment of CLBP-NeP was evaluated over a 12-month time horizon using the incremental cost-effectiveness ratio (ICER). Quality-adjusted life years (QALYs), derived from the five-dimension, five-level EuroQol (EQ-5D-5L) questionnaire, was the measure of effectiveness. Medical costs and productivity losses were both calculated. Expected costs and outcomes were estimated via cohort simulation using a state-transition model, which mimics pain state transitions among mild, moderate, and severe pain. Distributions of pain severity were obtained from an 8-week noninterventional study. Health care resource consumption for estimation of direct medical costs for pain severity levels was derived from a physician survey. The ICER per additional QALY gained was calculated and sensitivity analyses were performed to evaluate the robustness of the assumptions across a range of values. Results Direct medical costs and hospitalization costs were both lower in the pregabalin arm compared with usual care. The estimated ICERs in the base case scenarios were approximately ¥2,025,000 and ¥1,435,000 per QALY gained with pregabalin from the payer and societal perspectives, respectively; the latter included indirect costs related to lost productivity. Sensitivity analyses using alternate values for postsurgical pain scores (0 and 5), initial pain severity levels (either all moderate or all severe), and the actual EQ-5D-5L scores from the noninterventional study showed robustness of results, with ICERs that were similar to the base case. Development of a cost-effectiveness acceptability curve showed high probability (≥75%) of pregabalin being cost-effective. Conclusion Using data and assumptions from routine clinical

  8. Trastornos del sueño en el paciente con dolor crónico Sleep disturbances in patients with chronic pain

    Directory of Open Access Journals (Sweden)

    A. B. Mencías Hurtado

    2012-12-01

    Full Text Available Padecer dolor crónico supone un importante impacto sobre la calidad del sueño del paciente que lo sufre. Una mayor intensidad de dolor se ha asociado a una mayor prevalencia de trastornos del sueño, siendo esta relación recíproca y que perpetúa un círculo vicioso entre ambos. Teniendo en cuenta que algunos de los fármacos que manejamos habitualmente para el control analgésico, fundamentalmente opioides, pueden modificar la arquitectura del sueño, tanto positiva como negativamente, consideramos importante empezar a valorar la calidad del sueño del paciente con dolor crónico como un indicador de calidad en el manejo del tratamiento analgésico.Having chronic pain is a significant impact on sleep quality of the patient who suffers. Higher pain intensity was associated with a higher prevalence of sleep disorders, this being a mutual and perpetuating a vicious circle between them. Given that some of the drugs commonly used to manage pain control, mainly opioids, may alter the sleep architecture, both positively and negatively, we consider important to begin to assess this quality of sleep of patients with chronic pain as an indicator of quality management of analgesic treatment.

  9. Tratamiento multidisciplinar en pacientes con dolor crónico en situación de baja laboral Multidisciplinary therapy for patients with chronic pain on sick leave

    Directory of Open Access Journals (Sweden)

    A. Collado

    2004-05-01

    Full Text Available Objetivo: Analizar la eficacia de un programa de tratamiento multidisciplinar en pacientes seleccionados con dolor crónico incapacitante en situación de baja laboral refractario a tratamiento convencional. Material y métodos: Ciento cuatro pacientes con dolor crónico incapacitante recibieron tratamiento multidisciplinar (médico, psicológico, físico y ocupacional intensivo de cinco horas al día, durante cuatro días a la semana y durante cuatro semanas. Se programaron revisiones al alta y a los 6 y 12 meses de finalizar el tratamiento. Resultados: Al alta del tratamiento se observaron reducciones significativas de la sintomatología dolorosa, depresiva y de ansiedad, así como un incremento significativo de la capacidad funcional (dolor (EVA: 7,4±1,6 vs 3,4±2 cm (pObjective: To analyze the effectiveness of a multidisciplinary therapeutic regime in selected patients with disabling chronic pain requiring sick leave and refractory to standard therapies. Materials and methods: One hundred and four patients with disabling chronic pain received multidisciplinary intensive treatment (medical, psychological, physical and occupational therapies five hours a day, four days a week, over 4 weeks. Revisions were scheduled at discharge and at 6 and 12 months after the end of the treatment. Results: At discharge after the treatment, significant reductions of painful, depressive and anxious symptoms were observed, as well as a significant increase of the functional capacity (Pain (VAS: 7.4±1.6 vs 3.4±2 cm (p<0.0001; Depression (BDI: 17±9 vs 10±8 points (p<0.0001; Anxiety (HARS: 19±8 vs 14±7 points (p<0.0001; Disability (HAQ: 1.7±0.4 vs 0,6±0,5 points (p<0.0001. The sizes of the effect ranged between a maximum value of 2.5 (VAS pain and a minimum value of 0.6 (HARS, suggesting in all the cases a wide to moderate clinical change. At that time, 75 (78% patients have returned to their work activity. During the follow-up, the significant

  10. Diagnostic criterial to differentiate medial meniscal injury from degenerative changes on 99mTc-MDP knee SPECT in patients with chronic knee pain

    International Nuclear Information System (INIS)

    In patients with chronic knee pain, the diagnostic performance of 99mTc-MDP knee SPECT for internal derangement of knee is deteriorated due to degenerative changes. In this study, we tried to establish diagnostic criteria to differentiate medial meniscal injury (MMI) from degenerative change (DC) when the uptake in increased in medial compartment. A total of 49 knee SPECT of the patients with chronic(more than 3 months) knee pain, which showed increased 99mTc-MDP uptake in the medial compartment, were included in this study. The diagnosis was confirmed by arthroscopy. On knee SPECT, 3 diagnosic criteria for MMI were investigated. In Criterion, I, MMI was diagnosed when crescentic uptake was observed in the medial tibial plateau. In Criterion II, crescentic uptake was further classified into anterior, mid, posterior, and diffuse patterns, according to the location of maximal uptake; and only crescentic mid, posterior, and diffuse patterns were diagnosed as MMI. In Criterion III, MMI was diagnosed when medial tibial plateau showed higher activity then medial femoral condyle. The diagnostic performance of the 3 criteria was compared. The sensitivity and specificity were 93% and 14% in Criterion I, 89% and 38% in Criterion II, and 75% and 67% in Criterion III, respectively. Criterion III had significantly improve diagnostic performance, especially, specificity. In this study, we established a practical diagnostic criterion to differentiate MMI from DC on knee SPECT. The