scholarly journals Current terminology of chronic pain

2021 ◽  
Vol 15 (1) ◽  
pp. 9-17
Author(s):  
Viktor A. Koriachkin ◽  
Arina P. Spasova ◽  
Vladimir V. Khinovker ◽  
Yaakov I. Levin ◽  
Dmitry O. Ivanov
Keyword(s):  
Chronic Pain ◽  
Visceral Pain ◽  
International Association ◽  
Pain Syndrome ◽  
Multimodal Analgesia ◽  
Epidemiological Studies ◽  
Cochrane Library ◽  
Adequate Funding ◽  
Current Terminology

BACKGROUND: Chronic pain is a common problem that exerts a significant impact on individuals and society as a whole. Pain syndrome is one of the most common explanations for patients need for medical care, and it causes major suffering in humans. Thus far, chronic pain lacks a generally accepted terminology and classification. The review aimed to present the current terminology and classification of chronic pain. MATERIALS AND METHODS: Two independent researchers searched for publications for the period of January 2010 to October 2020 in the databases PubMed, MEDLINE, EMBASE, The Cochrane Library, Google Scholar, and the International Association for the Study of Pain. The last search query was performed on October 25, 2020. The search identified 423 studies, and 397 of them were excluded because they described the pathophysiology and treatment of chronic pain syndromes. The remaining 26 publications formed the basis of this review. RESULTS: The review presents the current terminology and classification of chronic pain, which is defined as pain that lasts for 3 months or more after the underlying pathology is cured. The work presents the description of terms such as chronic primary pain, chronic secondary pain, cancer-associated chronic pain, chronic postoperative or post-traumatic pain, chronic neuropathic pain, chronic secondary cephalgia or orofacial pain, chronic secondary visceral pain, and chronic secondary musculoskeletal pain. Additional characteristics of chronic pain, including the intensity of pain, the severity of suffering, and physical dysfunction, are also given. CONCLUSION: The presented modern terminology and classification of chronic pain will contribute not only to the correct formulation of diagnosis established in a patient with chronic pain but also to the implementation of multimodal analgesia, epidemiological studies and, ultimately, the choice of proper strategy for addressing chronic pain by healthcare organizers. The result is also expected to lead to adequate funding for resolving this intricate problem.

Chronic pain associated with malignant neoplasm. Modern terms and classification

2021 ◽  
Vol 22 (1) ◽  
pp. 146-151
Author(s):  
V. V. Khinovker ◽  
◽  
A. P. Spasova ◽  
V. A. Koryachkin ◽  
D. V. Zabolotskiy ◽  
...  
Keyword(s):  
Chronic Pain ◽  
Radiation Therapy ◽  
Visceral Pain ◽  
International Association ◽  
Malignant Neoplasm ◽  
Pain Syndrome ◽  
International Classification Of Diseases ◽  
Malignant Neoplasms ◽  
Common Symptom

According to 2019 data, the incidence of cancer in Russia increases by 1.5% annually, 8.5 million people die from malignant neoplasms. Pain is the most common symptom when diagnosed with a malignant neoplasm. In the final stage of the disease, about 66% of patients experience pain, and in most cases the intensity of pain syndrome is regarded as moderate to severe pain. In the international classification of diseases 11 revisions (μb-11), the diagnosis of chronic pain is supposed to be reflected in a separate section. The aim of the review was to present a modern classification of chronic pain associated with malignancy. The search for publications has been carried out by two independent researchers since 01.2010. until 12.2020. in the databases PubMed, MEDLINE, EMBASE, Cochrane, as well as the International Association for the Study of Pain. The International Association for the Study of Pain has established a special group, which, in close collaboration with WHO representatives, has developed a new classification of chronic pain. Chronic pain caused by malignancy: chronic visceral pain caused by malignancy; chronic bone pain caused by malignancy; chronic neuropathic pain caused by malignancy; other chronic pain caused by malignancy. Chronic pain due to treatment of malignant neoplasm: chronic pain caused by drug treatment of malignant neoplasm Chronic polyneuropathy due to chemotherapy; chronic pain caused by radiation therapy of malignant neoplasm; chronic neuropathy due to radiation therapy; Chronic pain caused by surgical treatment of malignant neoplasm. Other chronic pain caused by treatment of malignant neoplasm. Thus, the inclusion in the MKB-11 of a separate classification of chronic pain associated with malignancy will lead to the correct formulation of the diagnosis, which will contribute to individualized treatment (antitumor therapy, surgery), psychological support, the involvement of algologists (intervention methods of therapy), intensified research on the prevention and treatment of pain syndromes, as well as standardization of chronic assessment of pain.

scholarly journals Persistent Spinal Pain Syndrome: a proposal for Failed Back Surgery Syndrome and ICD-11

Pain Medicine ◽  
2021 ◽  
Author(s):  
Nick Christelis ◽  
Brian Simpson ◽  
Marc Russo ◽  
Michael Stanton-Hicks ◽  
Giancarlo Barolat ◽  
...  
Keyword(s):  
Chronic Pain ◽  
Spine Surgery ◽  
Pain Syndrome ◽  
Spinal Pain ◽  
Failed Back Surgery Syndrome ◽  
Medical Professionals ◽  
Failed Back Surgery ◽  
Back Surgery ◽  
Spinal Pain Syndrome

Abstract Objective For many medical professionals dealing with patients with persistent pain following spine surgery, the term failed back surgery syndrome (FBSS) as a diagnostic label is inadequate, misleading and potentially troublesome. It misrepresents causation. Alternative terms have been suggested but none has replaced FBSS. The International Association for the Study of Pain (IASP) published a revised classification of chronic pain, as part of the new International Classification of Diseases (ICD-11), which has been accepted by the World Health Organization (WHO). This includes the term Chronic pain after spinal surgery (CPSS), which is suggested as a replacement for FBSS. Methods This article provides arguments and rationale for a replacement definition. In order to propose a broadly applicable yet more precise and clinically informative term, an international group of experts was established. Results 14 candidate replacement terms were considered and ranked. The application of agreed criteria reduced this to a shortlist of four. A preferred option – Persistent spinal pain syndrome – was selected by a structured workshop and Delphi process. We provide rationale for using Persistent spinal pain syndrome and a schema for its incorporation into ICD-11. We propose the adoption of this term would strengthen the new ICD-11 classification. Conclusions This project is important to those in the fields of pain management, spine surgery and neuromodulation, as well as patients labelled with FBSS. Through a shift in perspective it could facilitate the application of the new ICD-11 classification and allow clearer discussion amongst medical professionals, industry, funding organisations, academia, and the legal profession.

scholarly journals Neuropathic pain

2021 ◽  
pp. 58-64
Author(s):  
V. A. Koriachkin ◽  
A. P. Spasova ◽  
V. V. Khinovker
Keyword(s):  
Chronic Pain ◽  
Neuropathic Pain ◽  
Correct Diagnosis ◽  
Epidemiological Studies ◽  
Chronic Neuropathic Pain ◽  
Official Document ◽  
Adequate Treatment ◽  
Pain Syndromes ◽  
Recent Classification

Background Chronic neuropathic pain is a common occurrence, its prevalence ranges from 7 to 10% of the total population. Currently, the only official document that includes neuropathic pain is the International Classification of Headaches Disorders (ICHD-3), in which this type of pain is associated with traumatic brain injury and neuralgia. Until now, there has been no generally accepted terminology and classification of chronic neuropathic pain.Objective To provide the current terminology, classification and additional characteristics of neuropathic chronic pain.Results The review of modern terminology and classification of neuropathic chronic pain describes the terms included in the concept of chronic peripheral and central neuropathic pain, identifies pain subtypes, as well as its additional characteristics such as the intensity of neuropathic pain, the severity of suffering and disability.Conclusions Thus, the presented recent classification of chronic neuropathic pain is an exhaustive list of the most common neuropathic pain syndromes. The inclusion of classification into clinical practice will help to draw attention to the problem of treatment of chronic neuropathic pain by WHO members, carrying out epidemiological studies and making a correct diagnosis, and therefore the appointment of adequate treatment methods.

Characteristics of patients with chronic pain accessing treatment with medical cannabis in Washington State

2018 ◽  
Vol 5 (5) ◽  
pp. 257 ◽  
Author(s):  
Sunil K. Aggarwal, PhD, MD Candidate ◽  
Gregory T. Carter, MD, MS ◽  
Mark D. Sullivan, MD, PhD ◽  
Craig ZumBrunnen, PhD ◽  
Richard Morrill, PhD ◽  
...  
Keyword(s):  
Chronic Pain ◽  
Myofascial Pain ◽  
Visceral Pain ◽  
Pain Syndrome ◽  
Pain Clinic ◽  
Phantom Pain ◽  
Medical Cannabis ◽  
Treatment Access ◽  
Common Diagnosis ◽  
Cord Injury

Objectives: This study was conducted to better understand the characteristics of chronic pain patients seeking treatment with medicinal cannabis (MC).Design: Retrospective chart reviews of 139 patients (87 males, median age 47 years; 52 females, median age 48 years); all were legally qualified for MC use in Washington State.Setting: Regional pain clinic staffed by university faculty.Participants: Inclusion criteria: age 18 years and older; having legally accessed MC treatment, with valid documentation in their medical records. All data were de-identified.Main Outcome Measures: Records were scored for multiple indicators, including time since initial MC authorization, qualifying condition(s), McGill Pain score, functional status, use of other analgesic modalities, including opioids, and patterns of use over time.Results: Of 139 patients, 15 (11 percent) had prior authorizations for MC before seeking care in this clinic. The sample contained 236.4 patientyears of authorized MC use. Time of authorized use ranged from 11 days to 8.31 years (median of 1.12 years). Most patients were male (63 percent) yet female patients averaged 0.18 years longer authorized use. There were no other gender-specific trends or factors. Most patients (n = 123, 88 percent) had more than one pain syndrome present. Myofascial pain syndrome was the most common diagnosis (n = 114, 82 percent), followed by neuropathic pain (n = 89, 64 percent), discogenic back pain (n = 72, 51.7 percent), and osteoarthritis (n = 37, 26.6 percent). Other diagnoses included diabetic neuropathy, central pain syndrome, phantom pain, spinal cord injury, fibromyalgia, rheumatoid arthritis, HIV neuropathy, visceral pain, and malignant pain. In 51 (37 percent) patients, there were documented instances of major hurdles related to accessing MC, including prior physicians unwilling to authorize use, legal problems related to MC use, and difficulties in finding an affordable and consistent supply of MC.Conclusions: Data indicate that males and females access MC at approximately the same rate, with similar median authorization times. Although the majority of patient records documented significant symptom alleviation with MC, major treatment access and delivery barriers remain.

scholarly journals Co-Players in Chronic Pain: Neuroinflammation and the Tryptophan-Kynurenine Metabolic Pathway

2021 ◽  
Author(s):  
Masaru Tanaka ◽  
Nóra Török ◽  
Fanni Tóth ◽  
László Vécsei
Keyword(s):  
Chronic Pain ◽  
Social Factors ◽  
Tissue Damage ◽  
Task Force ◽  
International Association ◽  
Emotional Experience ◽  
World Health ◽  
Peripheral Sensitization ◽  
Systematic Classification

Chronic pain is an unpleasant sensory and emotional experience that persists or recurs more than three months and may extend beyond the expected time of healing. Recently nociplastic pain has been introduced as a descriptor of mechanism of pain, which is due to disturbance of neural processing without actual or potential tissue damage, appearing to replace a concept of psychogenic pain. An interdisciplinary task force of the International Association for the Study of Pain (IASP) compiled a systematic classification of clinical conditions associated with chronic pain, which was published in 2018 and will officially come into effect in 2022 in the 11th revision of the International Statistical Classification of Diseases and Related Health Problems (ICD-11) by the World Health Organization. ICD-11 offers the option for recording the presence of psychological or social factors in chronic pain; however, cognitive, emotional, and social dimensions in the pathogenesis of chronic pain are missing. Earlier pain disorder was defined as a condition with chronic pain associated with psychological factors, but it was replaced with somatic symptom disorder with predominant pain in Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5) in 2013. Recently clinical nosology is trending toward highlighting neurological pathology of chronic pain, discounting psychological or social factors in the pathogenesis of pain. This review article discusses components of the pain pathway, the component-based mechanisms of pain, central and peripheral sensitization, roles of chronic inflammation, and the involvement of tryptophan-kynurenine pathway metabolites, exploring participations of psychosocial and behavioral factors in central sensitization of diseases progressing into development of chronic pain, comorbid diseases that commonly present a symptom of chronic pain, and psychiatric disorders that manifest chronic pain without obvious actual or potential tissue damage.

scholarly journals Co-Players in Chronic Pain: Neuroinflammation and the Tryptophan-Kynurenine Metabolic Pathway

Biomedicines ◽  
2021 ◽  
Vol 9 (8) ◽  
pp. 897
Author(s):  
Masaru Tanaka ◽  
Nóra Török ◽  
Fanni Tóth ◽  
Ágnes Szabó ◽  
László Vécsei
Keyword(s):  
Chronic Pain ◽  
Social Factors ◽  
Tissue Damage ◽  
Task Force ◽  
International Association ◽  
Emotional Experience ◽  
World Health ◽  
Peripheral Sensitization ◽  
Systematic Classification

Chronic pain is an unpleasant sensory and emotional experience that persists or recurs more than three months and may extend beyond the expected time of healing. Recently, nociplastic pain has been introduced as a descriptor of the mechanism of pain, which is due to the disturbance of neural processing without actual or potential tissue damage, appearing to replace a concept of psychogenic pain. An interdisciplinary task force of the International Association for the Study of Pain (IASP) compiled a systematic classification of clinical conditions associated with chronic pain, which was published in 2018 and will officially come into effect in 2022 in the 11th revision of the International Statistical Classification of Diseases and Related Health Problems (ICD-11) by the World Health Organization. ICD-11 offers the option for recording the presence of psychological or social factors in chronic pain; however, cognitive, emotional, and social dimensions in the pathogenesis of chronic pain are missing. Earlier pain disorder was defined as a condition with chronic pain associated with psychological factors, but it was replaced with somatic symptom disorder with predominant pain in the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5) in 2013. Recently clinical nosology is trending toward highlighting neurological pathology of chronic pain, discounting psychological or social factors in the pathogenesis of pain. This review article discusses components of the pain pathway, the component-based mechanisms of pain, central and peripheral sensitization, roles of chronic inflammation, and the involvement of tryptophan-kynurenine pathway metabolites, exploring the participation of psychosocial and behavioral factors in central sensitization of diseases progressing into the development of chronic pain, comorbid diseases that commonly present a symptom of chronic pain, and psychiatric disorders that manifest chronic pain without obvious actual or potential tissue damage.

Post-surgical analgesia and acute pain management

2017 ◽  
Author(s):  
Francis Bonnet ◽  
Marc E. Gentili ◽  
Christophe Aveline
Keyword(s):  
Chronic Pain ◽  
Pain Intensity ◽  
Acute Pain ◽  
Surgical Procedure ◽  
Pain Treatment ◽  
Pain Syndrome ◽  
Multimodal Analgesia ◽  
Opioid Administration ◽  
Pain Sensitization ◽  
Sparing Effect

Postoperative and acute pain remains uncontrolled in many instances, leading to the risk of development of chronic pain syndromes. After tissue damage, activation of postsynaptic NMDA receptors, also induced by opioid administration, plays a key role in postoperative pain sensitization, allodynia, and hyperalgesia. Pain intensity may depend on sex, age, anxiety, and genetic factors but in clinical practice, surgical procedure is the main determinant of pain, although pain may vary from one patient to one another. Serial pain measurements are mandatory to assess pain intensity and to guide pain treatment. They are based on unidimensional simple pain scales. Multimodal analgesia combining opioid and non-opioid agent and regional block or infiltration is the rule postoperatively, although evidence is sometimes lacking to support all the combinations commonly used. Opioids should be used on demand while other agents are administered systematically. Non-steroidal anti-inflammatory drugs decrease opioid demand as well as paracetamol although to a less extend. Antihyperalgesic agents including NMDA blockers (ketamine) and α‎2-δ‎ ligands (gabapentin, pregabalin) have an opioid-sparing effect and may prevent the occurrence of chronic pain syndrome after surgery. Regional blocks and infiltration provide good quality analgesia but the balance between advantages and drawbacks of central block need to be evaluated carefully for each surgical procedure.

scholarly journals The role of B vitamins in the treatment of back pain

2018 ◽  
pp. 38-43
Author(s):  
N. Svyrydova
Keyword(s):  
Risk Factors ◽  
Chronic Pain ◽  
Back Pain ◽  
Pain Syndrome ◽  
Epidemiological Studies ◽  
B Vitamins ◽  
Chronic Pain Syndrome ◽  
Occupational Risk Factors ◽  
Inflammatory Drugs

In 2018, an analysis of epidemiological studies was conducted that provided information on the prevalence of back pain and identified individual, psychosocial and occupational risk factors for the onset of this pathology. It is important that when choosing the tactics of treatment, it is necessary to take into account the risk of complications in the presence of multimorbid pathology in patients with acute or chronic pain syndrome. Increasing the effectiveness and safety of therapy based on the use of nonsteroidal anti-inflammatory drugs, the risk of which can be minimized, is associated with the inclusion of B vitamins. The results of various clinical studies on the use of the B complex of vitamins showed a significant decrease in the severity of the pain syndrome and a significant improvement in motor functions, regression of sensitive disorders.

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