Headaches and Chronic Pain

2008 ◽  
Author(s):  
Michael R. Clark
Keyword(s):  
Chronic Pain ◽  
Emotional Experience ◽  
Simple Algorithm ◽  
Varicella Zoster ◽  
Patients With Cancer ◽  
Disease States ◽  
Pain Clinics ◽  
Prevalence Of Pain ◽  
Pain Experiences ◽  
Pain Symptoms

Pain has been defined as ‘‘an unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage’’ (Lindblom et al., 1986). Table 5–1 contains definitions of terms commonly used to describe pain sensations (Merskey et al., 1986). Pain is the most common reason a patient presents to a physician for evaluation. The U.S. Center for Health Statistics found that 32.8% of the general population suffers from chronic pain symptoms (Magni et al., 1993). Many factors can influence patients’ reports of pain, including medical and psychiatric disorders, social circumstances, disease states, personality traits, memory of past pain experiences, and personal interpretations of the meaning of pain (Clark and Treisman, 2004). There is no simple algorithm for determining whether the cause of pain is psychologic or neurologic (Clark and Chodynicki, 2005). The clinical evaluation of patients complaining of pain should be comprehensive and incorporate the patient’s descriptions of pain (ie, location, intensity, duration, precipitants, ameliorators); observations of pain-related behaviors (eg, limping, guarding, moaning); descriptions of problems performing activities; and neurologic and psychiatric examinations (Clark and Cox, 2002). Post-herpetic neuralgia (PHN) is defined as pain persisting or recurring at the site of shingles at least 3 months after the onset of the acute varicella zoster viral rash. PHN occurs in about 10% of patients with acute herpes zoster. More than 50% of patients older than 65 years of age with shingles develop PHN, and it is more likely to occur in patients with cancer, diabetes mellitus, and immunosuppression. During the acute episode of shingles, characteristics such as more severe pain and rash, presence of sensory impairment, and higher levels of emotional distress are associated with developing PHN (Schmader, 2002). Most cases gradually improve, with only about 25% of patients with PHN experiencing pain 1 year after diagnosis. Approximately 15% of patients referred to pain clinics suffer from PHN. Early treatment of varicella zoster with low-dose amitriptyline (25–100mg QD) can reduce the prevalence of pain at 6 months by 50% (Bowsher, 1997).

scholarly journals The Challenge of Chronic Pain Management by PM&R Specialist

2018 ◽  
Vol 7 (01) ◽  
pp. 1
Author(s):  
Maria Regina Rachmawati
Keyword(s):  
Chronic Pain ◽  
Low Back Pain ◽  
International Association ◽  
Emotional Experience ◽  
Rehabilitation Medicine ◽  
Low Back ◽  
Chronic Pain Management ◽  
Prevalence Of Pain ◽  
Sedentary Life ◽  
Sedentary Life Style

According to the definition from international association for the study of pain (IASP), pain is an unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage. Besides, there are many term of unpleasant sensory that complaint by patient as a pain, such as allodynia, hyperalgesia, and hyperesthesia. The pain is one of the most cases that came to seeking a doctor. The data from Indonesian National Health Insurance (JKN) from 2014-2017 have revealed that pain cases were the most frequent in Rehabilitation Medicine Services, i.e. low back pain, knee pain, and shoulder pain. The prevalence of pain is increasing along with ageing, sedentary life style, obesity and chronic diseases.

scholarly journals The prevalence of pain among adult patients attending outpatient clinics in Trinidad

2018 ◽  
Author(s):  
Seetharaman Hariharan ◽  
Deryk Chen ◽  
Candice Sampath ◽  
Valishti Pundit ◽  
Akash Dhanai ◽  
...  
Keyword(s):  
Chronic Pain ◽  
Rating Scale ◽  
Financial Burden ◽  
Adult Patients ◽  
Lower Limbs ◽  
Outpatient Clinics ◽  
Pain Patient ◽  
Public Healthcare ◽  
Pain Clinics ◽  
Prevalence Of Pain

Objectives To determine the prevalence of pain among adult patients attending outpatient clinics in Trinidad and the factors associated with the higher prevalence of chronic pain. Methods A direct face-to face survey was conducted in adult patients of the medical and surgical outpatient clinics of the major hospitals. Data recorded included demographics, clinical information. A Numerical Pain Rating Scale (NRS) was used to quantify the intensity of pain. Patient perceptions regarding the chronic pain was captured by a 6-item questionnaire in a 5-point Likert Scale. Results A total of 621 adult patients were studied. Overall, acute pain was prevalent in 13% and chronic pain in 56% of the outpatients. Majority of the patients ranked their pain severity as 8 and 10 on the NRS. Pain was commonly affecting back and lower limbs. Older age, female gender, East Indian ethnicity and surgical conditions predisposed to higher prevalence of pain. Although 90% of the patients were treated with analgesics, 33% were dissatisfied with the management. More than 80% of patients felt that their chronic pain affected their quality of life and 64% felt it caused financial burden in their life. Conclusion The prevalence of pain is high in adult Trinidadian outpatients. Pain was of severe intensity, commonly affected the back and lower limbs. Many patients were not satisfied with their current treatment. There is a need for establishing pain clinics in the public healthcare system of Trinidad & Tobago.

scholarly journals Venlafaxine as an analgesic in the treatment of chronic pain in patients with depression – scientific evidence and clinical cases

2021 ◽  
Vol 21 (1) ◽  
pp. 71-77
Author(s):  
Anna Antosik-Wójcińska ◽  
Keyword(s):  
Chronic Pain ◽  
Tricyclic Antidepressants ◽  
Scientific Evidence ◽  
Analgesic Efficacy ◽  
Disease States ◽  
Migraine Headaches ◽  
Pain Syndromes ◽  
Favourable Safety Profile ◽  
Pain Symptoms ◽  
Clinical Cases

Depression is sometimes referred to as the state of “mental pain” as its symptoms generate a state of generalised suffering. Mental distress is very often accompanied by physical pain. The prevalence of somatic symptoms in the population of patients with depression varies significantly depending on the study population and ranges from 30 to 95%. The incidence and severity of pain are correlated with the aging process and they tend to increase with age. The most common pain symptoms in depression include headache, back and lower back pain, pain of joints and limbs, migraine headaches and abdominal pain. The pain may sometimes mask depression by coming to the fore in the clinical picture and making it difficult to establish an accurate diagnosis. The fact that antidepressants are effective in chronic pain syndromes, while not all antidepressants show the same analgesic efficacy, is the direct evidence for the common pathogenetic mechanisms of chronic pain and depression. Tricyclic antidepressants were the first antidepressants to be used in the treatment of pain symptoms in various disease states. Numerous studies have confirmed the analgesic efficacy of serotonin and noradrenaline reuptake inhibitors, which are characterised by a much better tolerance and a more favourable safety profile compared to tricyclic antidepressants; however, their analgesic effect is clearly marked only at doses that, in addition to the effect on serotonergic transmission, also affect the noradrenergic transmission. The article summarises the scientific evidence for the purposefulness of the use of venlafaxine in the treatment of chronic pain, in particular pain syndromes associated with depression, and presents two clinical cases with a commentary.

scholarly journals Asymmetric Lateralization during Pain Processing

Symmetry ◽  
2021 ◽  
Vol 13 (12) ◽  
pp. 2416
Author(s):  
Carolina Roza ◽  
Anabel Martinez-Padilla
Keyword(s):  
Chronic Pain ◽  
Right Hemisphere ◽  
Emotional Experience ◽  
Cellular Level ◽  
Pain Processing ◽  
Brain Areas ◽  
Functional Studies ◽  
Functional Lateralization ◽  
Pain Symptoms ◽  
The Right

Pain is defined as “an unpleasant sensory and emotional experience associated with, or resembling that associated with, actual or potential tissue damage”. This complex perception arises from the coordinated activity of several brain areas processing either sensory–discriminative or affective–motivational components. Functional studies performed in healthy volunteers revealed that affective–emotional components of pain are processed bilaterally but present a clear lateralization towards the right hemisphere, regardless of the site of stimulation. Studies at the cellular level performed in experimental animal models of pain have shown that neuronal activity in the right amygdala is clearly pronociceptive, whilst activation of neurons in the left amygdala might even exert antinociceptive effects. A shift in lateralization becomes evident during the development of chronic pain; thus, in patients with neuropathic pain symptoms, there is increased activity in ipsilateral brain areas related with pain. These observations extend the asymmetrical left–right lateralization within the nervous system and provide a new hypothesis for the pathophysiology of chronic forms of pain. In this article, we will review experimental data from preclinical and human studies on functional lateralization in the brain during pain processing, which will help to explain the affective disorders associated with persistent, chronic pain.

Chronic Pain Experiences Survey

2005 ◽  
Author(s):  
Marisa Nguyen ◽  
Carlos Ugarte ◽  
Ivonne Fuller ◽  
Gregory Haas ◽  
Russell K. Portenoy
Keyword(s):  
Chronic Pain ◽  
Pain Experiences

Differences in Reward and Persistency characterise Behavior in Chronic Pain for the Iowa Gambling Task in a Web-based Lab-in-the-field study (Preprint)

2020 ◽  
Author(s):  
Lili Zhang ◽  
Himanshu Vashisht ◽  
Alekhya Nethra ◽  
Brian Slattery ◽  
Tomas Ward
Keyword(s):  
Decision Making ◽  
Social Media ◽  
Chronic Pain ◽  
Iowa Gambling Task ◽  
Learning Curves ◽  
Self Report ◽  
Healthy Controls ◽  
Gambling Task ◽  
Convenience Sample ◽  
Pain Experiences

BACKGROUND Chronic pain is a significant world-wide health problem. It has been reported that people with chronic pain experience decision-making impairments, but these findings have been based on conventional lab experiments to date. In such experiments researchers have extensive control of conditions and can more precisely eliminate potential confounds. In contrast, there is much less known regarding how chronic pain impacts decision-making captured via lab-in-the-field experiments. Although such settings can introduce more experimental uncertainty, it is believed that collecting data in more ecologically valid contexts can better characterize the real-world impact of chronic pain. OBJECTIVE We aim to quantify decision-making differences between chronic pain individuals and healthy controls in a lab-in-the-field environment through taking advantage of internet technologies and social media. METHODS A cross-sectional design with independent groups was employed. A convenience sample of 45 participants were recruited through social media - 20 participants who self-reported living with chronic pain, and 25 people with no pain or who were living with pain for less than 6 months acting as controls. All participants completed a self-report questionnaire assessing their pain experiences and a neuropsychological task measuring their decision-making, i.e. the Iowa Gambling Task (IGT) in their web browser at a time and location of their choice without supervision. RESULTS Standard behavioral analysis revealed no differences in learning strategies between the two groups although qualitative differences could be observed in learning curves. However, computational modelling revealed that individuals with chronic pain were quicker to update their behavior relative to healthy controls, which reflected their increased learning rate (95% HDI from 0.66 to 0.99) when fitted with the VPP model. This result was further validated and extended on the ORL model because higher differences (95% HDI from 0.16 to 0.47) between the reward and punishment learning rates were observed when fitted on this model, indicating that chronic pain individuals were more sensitive to rewards. It was also found that they were less persistent in their choices during the IGT compared to controls, a fact reflected by their decreased outcome perseverance (95% HDI from -4.38 to -0.21) when fitted using the ORL model. Moreover, correlation analysis revealed that the estimated parameters had predictive value for the self-reported pain experiences, suggesting that the altered cognitive parameters could be potential candidates for inclusion in chronic pain assessments. CONCLUSIONS We found that individuals with chronic pain were more driven by rewards and less consistent when making decisions in our lab-in-the-field experiment. In this case study, it was demonstrated that compared to standard statistical summaries of behavioral performance, computational approaches offered superior ability to resolve, understand and explain the differences in decision- making behavior in the context of chronic pain outside the lab.

The occurrence of internalizing problems and chronic pain symptoms in early childhood: what comes first?

2021 ◽  
Author(s):  
Gerasimos Kolaitis ◽  
Jan van der Ende ◽  
Foivos Zaravinos-Tsakos ◽  
Tonya White ◽  
Ivonne Derks ◽  
...  
Keyword(s):  
Chronic Pain ◽  
Early Childhood ◽  
Internalizing Problems ◽  
Pain Symptoms

Sleep disturbance in patients attending specialized chronic pain clinics in Denmark: a longitudinal study examining the relationship between sleep and pain outcomes

2021 ◽  
Vol 0 (0) ◽  
Author(s):  
Henrik Bjarke Vaegter ◽  
Mette Terp Høybye ◽  
Frederik Hjorth Bergen ◽  
Christine E. Parsons
Keyword(s):  
Quality Of Life ◽  
Chronic Pain ◽  
Sleep Quality ◽  
Pain Intensity ◽  
Sleep Disturbances ◽  
Pain Disability ◽  
Pain Clinics ◽  
Pain Outcomes

Abstract Objectives Sleep disturbances are highly prevalent in patients with chronic pain. However, the majority of studies to date examining sleep disturbances in patients with chronic pain have been population-based cross-sectional studies. The aims of this study were to 1) examine the frequency of sleep disturbances in patients referred to two interdisciplinary chronic pain clinics in Denmark, 2) explore associations between sleep disturbances and pain intensity, disability and quality of life at baseline and follow-up, and 3) explore whether changes in sleep quality mediated the relationships between pain outcomes at baseline and pain outcomes at follow-up. Methods We carried out a longitudinal observational study, examining patients enrolled in two chronic pain clinics assessed at baseline (n=2,531) and post-treatment follow-up (n=657). Patients reported on their sleep disturbances using the sleep quality subscale of the Karolinska Sleep Questionnaire (KSQ), their pain intensity using 0–10 numerical rating scales, their pain-related disability using the Pain Disability Index (PDI), and quality of life using the EuroQol-VAS scale. The average time between baseline and follow-up was 207 days (SD=154). Results At baseline, the majority of patients reported frequent sleep disturbances. We found a significant association at baseline between self-reported sleep disturbances and pain intensity, pain-related disability, and quality of life, where greater sleep disturbance was associated with poorer outcomes. At follow-up, patients reported significant improvements across all pain and sleep outcomes. In two mediation models, we showed that changes in sleep disturbances from baseline to follow-up were significantly associated with (i) pain intensity at follow-up, and (ii) pain disability at follow-up. However, baseline pain intensity and disability scores were not associated with changes in sleep disturbances and, we did not find evidence for significant mediation of either pain outcome by changes in sleep disturbances. Conclusions Self-reported sleep disturbances were associated with pain outcomes at baseline and follow-up, with greater sleep disturbances associated with poorer pain outcomes. Changes in sleep quality did not mediate the relationships between baseline and follow-up scores for pain intensity and disability. These findings contribute to a growing body of evidence confirming an association between sleep and chronic pain experience, particularly suggestive of a sleep to pain link. Our data following patients after interdisciplinary treatment suggests that improved sleep is a marker for a better outcome after treatment.

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