Pain medicine

2014 ◽  
Author(s):  
Jeremy Prout ◽  
Tanya Jones ◽  
Daniel Martin
Keyword(s):  
Chronic Pain ◽  
Pain Management ◽  
Management Strategies ◽  
Multidisciplinary Management ◽  
Pain Medicine ◽  
Pain Pathways ◽  
Patient Groups ◽  
Chronic Pain Conditions ◽  
Sites Of Action ◽  
Specific Management

This chapter summarizes the assessment and management of acute and chronic pain for FRCA. Pain pathways and physiological consequences of pain are considered along with sites of action and the pharmacology of common analgesics. Assessment of pain for different patient groups and settings is explained. Pain management strategies, pharmacological, non-interventional and interventional techniques are described, including multidisciplinary management of chronic pain. Specific management of some common chronic pain conditions, such as trigeminal neuralgia, are discussed in more detail.

Chronic pain

2019 ◽  
pp. 141-166
Author(s):  
Manoj Sivan ◽  
Margaret Phillips ◽  
Ian Baguley ◽  
Melissa Nott
Keyword(s):  
Chronic Pain ◽  
Pain Management ◽  
Management Strategies ◽  
Prevalence Rates ◽  
Neurogenic Pain ◽  
Pain Syndromes ◽  
The Difference ◽  
Chronic Pain Conditions ◽  
Multidisciplinary Pain Management ◽  
Pharmaceutical Interventions

This chapter defines the difference between acute and chronic pain, as well as the epidemiology of chronic pain (including why prevalence rates vary widely in the literature). Nociceptive pain and neurogenic pain are both defined, alongside a summary of the mechanisms of common pain syndromes. Examination of the patient with pain is described, including ways of taking a history in those who are unable to give a complete or coherent account. Measurement of pain, management strategies, and pharmaceutical interventions are all covered, and a defence of multidisciplinary pain management programmes is included. Finally, specific chronic pain conditions are defined, and recommendations for management are highlighted.

scholarly journals The effects of propranolol on heart rate variability and quantitative, mechanistic, pain profiling: a randomized placebo-controlled crossover study

2018 ◽  
Vol 18 (3) ◽  
pp. 479-489 ◽  
Author(s):  
Kristian Kjær Petersen ◽  
Hjalte Holm Andersen ◽  
Masato Tsukamoto ◽  
Lincoln Tracy ◽  
Julian Koenig ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Heart Rate ◽  
Chronic Pain ◽  
Pain Sensitivity ◽  
Experimental Pain ◽  
Central Pain ◽  
Healthy Male ◽  
Pain Pathways ◽  
Β Blocker ◽  
Chronic Pain Conditions

AbstractBackground and aimsThe autonomic nervous system (ANS) is capable of modulating pain. Aberrations in heart rate variability (HRV), reflective of ANS activity, are associated with experimental pain sensitivity, chronic pain, and more recently, pain modulatory mechanisms but the underlying mechanisms are still unclear. HRV is lowered during experimental pain as well as in chronic pain conditions and HRV can be increased by propranolol, which is a non-selective β-blocker. Sensitization of central pain pathways have been observed in several chronic pain conditions and human mechanistic pain biomarkers for these central pain pathways include temporal summation of pain (TSP) and conditioned pain modulation (CPM). The current study aimed to investigate the effect of the β-blocker propranolol, and subsequently assessing the response to standardized, quantitative, mechanistic pain biomarkers.MethodsIn this placebo-controlled, double-blinded, randomized crossover study, 25 healthy male volunteers (mean age 25.6 years) were randomized to receive 40 mg propranolol and 40 mg placebo. Heart rate, blood pressure, and HRV were assessed before and during experimental pain tests. Cuff pressure pain stimulation was used for assessment of pain detection (cPDTs) and pain tolerance (cPTTs) thresholds, TSP, and CPM. Offset analgesia (OA) was assessed using heat stimulation.ResultsPropranolol significantly reduced heart rate (p<0.001), blood pressure (p<0.02) and increased HRV (p<0.01) compared with placebo. No significant differences were found comparing cPDT (p>0.70), cPTT (p>0.93), TSP (p>0.70), OA-effect (p>0.87) or CPM (p>0.65) between propranolol and placebo.ConclusionsThe current study demonstrated that propranolol increased HRV, but did not affect pressure pain sensitivity or any pain facilitatory or modulatory outcomes.ImplicationsAnalgesic effects of propranolol have been reported in clinical pain populations and the results from the current study could indicate that increased HRV from propranolol is not associated with peripheral and central pain pathways in healthy male subjects.

The Demise of Interdisciplinary Chronic Pain Management and Its Relationship to the Scourge of Prescription Opioid Diversion and Abuse

2018 ◽  
Author(s):  
Michael E. Schatman
Keyword(s):  
Chronic Pain ◽  
Pain Management ◽  
Healthcare Providers ◽  
Well Being ◽  
Insurance Companies ◽  
Prescription Opioid ◽  
Pain Medicine ◽  
Opioid Crisis ◽  
Opioid Medications ◽  
Opioid Diversion

Even though the efficacy of interdisciplinary pain management programs is supported, their numbers have decreased and the vast majority of Americans with chronic pain do not have access to them. Insurance companies do not want to pay for these services, hospitals believe they are financial losers, and the opioid crisis has placed a pall over the practice of pain medicine. The demise of these programs has left pain medicine in a fragmented state. Few healthcare providers who treat chronic pain patients have the time to coordinate care by multiple professionals The opioid crisis seen in certain areas, such as Appalachia, may be related to the lack of these interdisciplinary programs. There should be concerted efforts to increase access to and funding of these programs. Although they are not a panacea for all types of chronic pain, they can improve patients’ well-being and function and reduce their need for opioid medications.

scholarly journals Spider Knottin Pharmacology at Voltage-Gated Sodium Channels and Their Potential to Modulate Pain Pathways

Toxins ◽  
2019 ◽  
Vol 11 (11) ◽  
pp. 626 ◽  
Author(s):  
Yashad Dongol ◽  
Fernanda Caldas Cardoso ◽  
Richard J Lewis
Keyword(s):  
Chronic Pain ◽  
Sodium Channels ◽  
Structural Features ◽  
Voltage Gated ◽  
Subtype Selectivity ◽  
Voltage Gated Sodium Channels ◽  
Neuronal Signalling ◽  
Pain Pathways ◽  
Nav Channels ◽  
Chronic Pain Conditions

Voltage-gated sodium channels (NaVs) are a key determinant of neuronal signalling. Neurotoxins from diverse taxa that selectively activate or inhibit NaV channels have helped unravel the role of NaV channels in diseases, including chronic pain. Spider venoms contain the most diverse array of inhibitor cystine knot (ICK) toxins (knottins). This review provides an overview on how spider knottins modulate NaV channels and describes the structural features and molecular determinants that influence their affinity and subtype selectivity. Genetic and functional evidence support a major involvement of NaV subtypes in various chronic pain conditions. The exquisite inhibitory properties of spider knottins over key NaV subtypes make them the best lead molecules for the development of novel analgesics to treat chronic pain.

scholarly journals An Integrated Pain Team Model: Impact on Pain-Related Outcomes and Opioid Misuse in Patients with Chronic Pain

Pain Medicine ◽  
2020 ◽  
Vol 21 (9) ◽  
pp. 1977-1984
Author(s):  
Carolyn J Gibson ◽  
Joseph Grasso ◽  
Yongmei Li ◽  
Natalie Purcell ◽  
Jennifer Tighe ◽  
...  
Keyword(s):  
Health Care ◽  
Chronic Pain ◽  
Pain Management ◽  
Treatment Satisfaction ◽  
Subjective Experience ◽  
Pain Catastrophizing ◽  
Management Strategies ◽  
Health Administration ◽  
Opioid Misuse

Abstract Objective Biopsychosocial integrated pain team (IPT) care models are being implemented in Veterans Health Administration (VA) and other health care systems to address chronic pain and reduce risks related to long-term opioid therapy, with little evaluation of effectiveness to date. We examined whether IPT improves self-reported pain-related outcomes and opioid misuse. Design Single-group quality improvement study. Setting Large VA health care system. Subjects Veterans with chronic pain (N = 99, 84% male, mean age [SD] = 60 [13] years). Methods Using paired t tests and Wilcoxon matched-pairs signed-ranks tests, we examined pain experience (Brief Pain Inventory, Pain Catastrophizing Scale), opioid misuse (Current Opioid Misuse Measure), treatment satisfaction (Pain Treatment Satisfaction Scale), and pain management strategies among patients with chronic pain before and after three or more IPT encounters. Results After an average (SD) of 14.3 (9) weeks engaged in IPT, patients reported improvement in pain interference (mean [SD] = 46.0 [15.9] vs 40.5 [16.2], P &lt; 0.001), pain catastrophizing (mean [SD] = 22.9 [13.0] vs 19.3 [14.1], P = 0.01), treatment satisfaction (i.e., “very satisfied” = 13.1% at baseline vs 25.3% at follow-up, P = 0.01), and reduced opioid misuse (mean [SD] = 11.0 [7.5] vs 8.2 [6.1], P = 0.01). Patients reported increased use of integrative (i.e., acupuncture, 11% at baseline vs 26% at follow-up, P &lt; 0.01) and active pain management strategies (i.e., exercise, 8% at baseline vs 16% at follow-up, P &lt; 0.01) and were less likely to use only pharmacological pain management strategies after IPT engagement (19% at baseline vs 5% at follow-up, P &lt; 0.01). Conclusions Biopsychosocial, integrated pain care may improve patient-centered outcomes related to opioid misuse and the subjective experience and nonpharmacological self-management of chronic pain.

Neuropathic pain in patients with haemophilia, that is the question

2015 ◽  
Vol 35 (S 01) ◽  
pp. S5-S9 ◽  
Author(s):  
S. Krüger ◽  
T. Hilberg
Keyword(s):  
Rheumatoid Arthritis ◽  
Chronic Pain ◽  
Neuropathic Pain ◽  
Differential Diagnosis ◽  
Pain Management ◽  
Pain Mechanisms ◽  
Number Of Patients ◽  
Paindetect Questionnaire ◽  
Chronic Disorders ◽  
Chronic Pain Conditions

SummaryChronic pain caused by recurrent joint bleedings affects a large number of patients with haemophilia (PwH). The basis of this pain, nociceptive or neuropathic, has not been investigated so far. In other pain-related chronic disorders such as osteoarthritis or rheumatoid arthritis, initial studies showed nociceptive but also neuropathic pain features. 137 PwH and 33 controls (C) completed the painDETECT-questionnaire (pDq), which identifies neuropathic components in a person´s pain profile. Based on the pDq results, a neuropathic pain component is classified as positive, negative or unclear. A positive neuropathic pain component was found in nine PwH, but not in C. In 20 PwH an unclear pDq result was observed. In comparison to C the allocation of pDq results is statistically significant (p≤0.001). Despite various pDq results in PwH and C a similar appraisal pain quality, but on a different level, was determined. Summarising the results, there is a potential risk to misunderstand underlying pain mechanisms in PwH. In chronic pain conditions based on haemophilic arthopathy, a differential diagnosis seems to be unalterable for comprehensive and individualised pain management in PwH.

scholarly journals Multidisciplinary Pain Management for Pediatric Patients with Acute and Chronic Pain: A Foundational Treatment Approach When Prescribing Opioids

Children ◽  
2019 ◽  
Vol 6 (2) ◽  
pp. 33 ◽  
Author(s):  
Anava Wren ◽  
Alexandra Ross ◽  
Genevieve D’Souza ◽  
Christina Almgren ◽  
Amanda Feinstein ◽  
...  
Keyword(s):  
Chronic Pain ◽  
Pain Management ◽  
Psychological Functioning ◽  
Pediatric Patients ◽  
Multidisciplinary Treatment ◽  
Evidence Base ◽  
Opioid Therapy ◽  
Management Approach ◽  
Chronic Pain Conditions ◽  
Multidisciplinary Pain Management

Opioid therapy is the cornerstone of treatment for acute procedural and postoperative pain and is regularly prescribed for severe and debilitating chronic pain conditions. Although beneficial for many patients, opioid therapy may have side effects, limited efficacy, and potential negative outcomes. Multidisciplinary pain management treatments incorporating pharmacological and integrative non-pharmacological therapies have been shown to be effective in acute and chronic pain management for pediatric populations. A multidisciplinary approach can also benefit psychological functioning and quality of life, and may have the potential to reduce reliance on opioids. The aims of this paper are to: (1) provide a brief overview of a multidisciplinary pain management approach for pediatric patients with acute and chronic pain, (2) highlight the mechanisms of action and evidence base of commonly utilized integrative non-pharmacological therapies in pediatric multidisciplinary pain management, and (3) explore the opioid sparing effects of multidisciplinary treatment for pediatric pain.

Chronic pain – the idea of mechanism orientated treatment

Ból ◽  
2018 ◽  
Vol 19 (1) ◽  
pp. 42-49
Author(s):  
Magdalena Kocot-Kępska ◽  
Renata Zajączkowska ◽  
Jan Dobrogowski ◽  
Anna Przeklasa-Muszyńska
Keyword(s):  
Chronic Pain ◽  
Pain Management ◽  
Pain Treatment ◽  
Current Knowledge ◽  
Empiric Therapy ◽  
Pain Medicine ◽  
Significant Progress ◽  
Pain Syndromes ◽  
Pain Chronification ◽  
Rational Mechanism

Understanding the neurobiological mechanisms underlying chronic pain syndromes is a significant progress in modern pain medicine. Understanding the basic differences between acute and chronic pain processes, learning about the mechanisms of transition from acute to chronic pain, allows us to change the approach to pain management from commonly used empirical approach to more rational mechanism-oriented pain treatment. In many patients with chronic pain, empiric therapy, which does not consider the mechanisms of pain, is not fully effective. Often, when planning pharmacotherapy, current knowledge about the pain etiology and mechanisms of pain chronification is not considered. Management based on already known mechanisms of pain, using rational pharmacotherapy and non-pharmacological methods, may improve the quality and effectiveness of pain management.

Understanding transdermal buprenorphine and a practical guide to its use for chronic cancer and non-cancer pain management

2019 ◽  
Vol 15 (2) ◽  
pp. 147-158 ◽  
Author(s):  
Tony O’Brien, MB, FRCPI ◽  
Jin Seok Ahn, MD ◽  
Richard Chye, MBBS, FRACP, FFPMANZCA, FAChPM ◽  
Brian Le, MBBS (Hons), MPH, FRACP, FAChPM ◽  
Henry Lu, MD, DABPN, DPBPM ◽  
...  
Keyword(s):  
Chronic Pain ◽  
Neuropathic Pain ◽  
Pain Management ◽  
Cancer Pain ◽  
Chronic Pain Management ◽  
Cancer Pain Management ◽  
Appropriate Use ◽  
Chronic Pain Conditions ◽  
Favorable Safety ◽  
Practical Recommendations

Transdermal buprenorphine (TDB) has demonstrated effectiveness in treating a range of chronic pain conditions, including cancer pain, nociceptive pain, and neuropathic pain and has a favorable safety profile. Worldwide, clinical experience of its use is relatively limited. There is considerable misunderstanding about the pharmacology, mechanism of action, and safety of buprenorphine. There is also limited guidance on the appropriate use of TDB for chronic pain management. This article presents an overview of TDB and also provides practical recommendations for its use as part of a multifaceted strategy in chronic cancer and non-cancer pain.

scholarly journals The Examination of non-pharmacologic treatment of pain after spinal cord injury

2018 ◽  
Vol 1 (1) ◽  
Author(s):  
J. A. Piatt ◽  
L. Eldridge ◽  
J. M. Baker
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Injury ◽  
Chronic Pain ◽  
Pain Management ◽  
Psychological Health ◽  
Management Strategies ◽  
Pharmacological Intervention ◽  
Pharmacological Interventions ◽  
Convenience Sample ◽  
Cord Injury

Background: One of the primary debilitating secondary health conditions experienced by individuals living with a spinal cord injury (SCI) is chronic pain. Approximately, over 30% of SCI patients endure chronic pain after sustaining the injury, and engage in opioid pharmacotherapy as the first form of treatment. The increase in use and misuse of prescribed opioids for chronic pain can lead to both physical and psychological health risks. This danger is exacerbated by the notion that a large percentage of the SCI population have a pre-existing condition of drug and alcohol abuse and addiction. This study will examine how pain is actually being addressed through non-pharmaceutical methods among the SCI adult population.  Experimental Design: Employing a cross-sectional web survey design with a convenience sample of adults with a SCI. A Qualtrics survey is currently being administered to known individuals with SCIs via email. The survey questions will illuminate what pain management strategies are being implemented in the SCI population within the US.   Anticipated Results: The results from the data will provide insight on what non-pharmacological interventions can be employed in place of or in combination with the pharmacological management. This will allow community-based rehabilitation therapies to incorporate appropriate pain management strategies.   Potential Impact: Non-pharmacological interventions may hold the answer in treating chronic pain in the SCI population by limiting or eliminating the use of opioids. This study will help develop the most appropriate non-pharmacological intervention to test in quasi-experimental clinical trials, and ultimately minimize the use of opioids for chronic pain.

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