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.

Acute Pain Management and Tissue Pain

2017 ◽  
Author(s):  
Ignacio Badiola
Keyword(s):  
Pain Management ◽  
Acute Pain ◽  
Pain Treatment ◽  
Pain Medicine ◽  
Acute Pain Management ◽  
Certification Exam ◽  
Adults And Children

This chapter on acute pain medicine examines the themes represented on the American Board of Anesthesiology’s pain medicine certification exam. It covers Part 6 (tissue pain), Section 1 (acute pain). In detail, the epidemiology of acute pain, current inadequacy of acute pain therapies, the physiology of acute pain, and both pharmacologic and nonpharmacologic aspects of acute pain treatment are discussed. Tools for assessing acute pain are reviewed, as well as the roles of both patient and family as they relate to adults and children in acute pain.

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.

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 Acute and Chronic Pain Learning and Teaching in Medical School—An Observational Cross-Sectional Study Regarding Preparation and Self-Confidence of Clinical and Pre-Clinical Medical Students

Medicina ◽  
2019 ◽  
Vol 55 (9) ◽  
pp. 533 ◽  
Author(s):  
Kacper Lechowicz ◽  
Igor Karolak ◽  
Sylwester Drożdżal ◽  
Maciej Żukowski ◽  
Aleksandra Szylińska ◽  
...  
Keyword(s):  
Chronic Pain ◽  
Pain Management ◽  
Medical Students ◽  
Acute Pain ◽  
Pain Treatment ◽  
Cross Sectional Study ◽  
Clinical Group ◽  
Sectional Study ◽  
Cross Sectional ◽  
Actual Knowledge

Background and objectives: Adequate pain management is a major challenge of public health. The majority of students graduating from medical schools has insufficient education and experience with patients suffering pain. Not enough is being taught regarding pain in non-verbal patients (children, critically ill in the intensive care unit, demented). Chronic pain is the most difficult to optimize and requires appropriate preparation at the level of medical school. Our aim was to evaluate attitudes, expectations and the actual knowledge of medical students at different levels of their career path regarding the assessment and treatment of acute and chronic pain. Materials and Methods: We performed an observational cross-sectional study that was based on a survey distributed among medical students of pre-clinical and post-clinical years at the Pomeranian Medical University in Szczecin, Poland. The survey included: demographic data, number of hours of formal pain teaching, actual knowledge of pain assessment, and pain treatment options in adults and children. Results: We received responses from 77/364 (21.15%) students and 79.2% of them rated the need to obtain knowledge regarding pain as very important (10/10 points). Post-clinical group declared having on average 11.51 h of acute pain teaching as compared to the 7.4 h reported by the pre-clinical group (p = 0.012). Graduating students also reported having significantly more classes regarding the treatment of chronic pain (6.08 h vs. 3.79 h, p = 0.007). The average level of comfort in the post-clinical group regarding treatment of acute pain was higher than in the pre-clinical group (6.05 vs. 4.26, p = 0.006), similarly with chronic pain treatment in adults (4.33 vs. 2.97, p = 0.021) and with pain treatment in children (3.14 vs. 1.97, p = 0.026). Conclusions: This study shows that education about pain management is a priority to medical students. Despite this, there continues to be a discrepancy between students’ expectations and the actual teaching and knowledge regarding effective pain management, including the vulnerable groups: chronic pain patients, children, and critically ill people.

Pain assessment and post-operative pain management in orthopedic patients

2017 ◽  
Vol 16 (1) ◽  
pp. 181-181
Author(s):  
W. Schmelling ◽  
J.N. Poulsen ◽  
L. Christrup ◽  
P. Gazerani
Keyword(s):  
Chronic Pain ◽  
Pain Management ◽  
Postoperative Pain ◽  
Potential Risk ◽  
Health Care Professionals ◽  
Sleep Disturbances ◽  
Pain Treatment ◽  
Early Mobilization ◽  
Postoperative Pain Management ◽  
Orthopedic Patients

Abstract Aims A fast-track based surgical treatment reduces morbidity and hospital stay by providing early mobilization. Sufficient postoperative pain management is mandatory for early mobilization and optimal utilization of rehabilitation measures. Insufficient postoperative pain management is however a widespread problem. Lack of knowledge about pain and pain treatment among health care professionals and general community has been considered as a major potential contributor in insufficient pain management. It has been suggested that severe postoperative pain might imply a potential risk of developing chronic pain. The purpose of this study was to examine this problem in acute and elective surgical patients in department of orthopedic surgery at Bispebjerg Hospital in order to identify obstacles and possibilities for future improvement. Methods Questionnaires were developed and distributed to patients consisted of 10 acute admitted and 10 elective orthopedic patients. The patients’ pain scores were recorded with a 0–10 NRS scale. The scores were obtained for current pain in rest, current pain in activity, and the highest and lowest pain intensity for the last 24 hours. Data were handled using descriptive statistics. Results The goal for sufficient pain treatment was patients with pain score at ≤ 3 NRS at rest and ≤ 5 in activity. For pain at rest 45% of the patients were within the goal range and 55% for the current pain in activity. For the mildest pain experienced in the last 24 h, 75% and for the worst pain experienced 30% of the patients reached the goal. Conclusions Corresponding to similar studies, half of the patients received a sufficient pain treatment at the time of examination. The consequences for insufficient pain management would be reduced effect of the physiotherapy, reduced ability to handle every day activity, sleep disturbances, and potential risk of developing chronic pain.

scholarly journals Toward Gamified Pain Management Apps: Mobile Application Rating Scale–Based Quality Assessment of Pain-Mentor’s First Prototype Through an Expert Study

10.2196/13170 ◽  
2020 ◽  
Vol 4 (5) ◽  
pp. e13170
Author(s):  
Alexandra Hoffmann ◽  
Corinna A Faust-Christmann ◽  
Gregor Zolynski ◽  
Gabriele Bleser
Keyword(s):  
Chronic Pain ◽  
Pain Management ◽  
Mobile Application ◽  
Rating Scale ◽  
Pain Treatment ◽  
Semistructured Interview ◽  
Content Quality ◽  
Management Techniques ◽  
Health Experts

Background The use of health apps to support the treatment of chronic pain is gaining importance. Most available pain management apps are still lacking in content quality and quantity as their developers neither involve health experts to ensure target group suitability nor use gamification to engage and motivate the user. To close this gap, we aimed to develop a gamified pain management app, Pain-Mentor. Objective To determine whether medical professionals would approve of Pain-Mentor’s concept and content, this study aimed to evaluate the quality of the app’s first prototype with experts from the field of chronic pain management and to discover necessary improvements. Methods A total of 11 health professionals with a background in chronic pain treatment and 2 mobile health experts participated in this study. Each expert first received a detailed presentation of the app. Afterward, they tested Pain-Mentor and then rated its quality using the mobile application rating scale (MARS) in a semistructured interview. Results The experts found the app to be of excellent general (mean 4.54, SD 0.55) and subjective quality (mean 4.57, SD 0.43). The app-specific section was rated as good (mean 4.38, SD 0.75). Overall, the experts approved of the app’s content, namely, pain and stress management techniques, behavior change techniques, and gamification. They believed that the use of gamification in Pain-Mentor positively influences the patients’ motivation and engagement and thus has the potential to promote the learning of pain management techniques. Moreover, applying the MARS in a semistructured interview provided in-depth insight into the ratings and concrete suggestions for improvement. Conclusions The experts rated Pain-Mentor to be of excellent quality. It can be concluded that experts perceived the use of gamification in this pain management app in a positive manner. This showed that combining pain management with gamification did not negatively affect the app’s integrity. This study was therefore a promising first step in the development of Pain-Mentor.

scholarly journals The Role of Neurologists in Pain Management – Based on the Survey Conducted by the Korean Neurological Association in 2020

2021 ◽  
Vol 39 (3) ◽  
pp. 165-171
Author(s):  
Kyomin Choi ◽  
Ohyun Kwon ◽  
Sang Beom Kim ◽  
Yang-Ki Minn ◽  
Kee Duk Park ◽  
...  
Keyword(s):  
Pain Management ◽  
Pain Treatment ◽  
Pain Medicine ◽  
Pain Education ◽  
Spine Pain ◽  
Background Pain ◽  
Chief Complaints ◽  
Interventional Pain Management

Background: Pain is one of the most common chief complaints in neurological field. Authors try to inform the current situation of pain medicine in neurological practice and present an effective method for pain-related education during neurology residency and for practicing neurologists.Methods: A survey was conducted from November 16 to November 27, 2020 for members of the Korean Neurological Association, and the results were analyzed.Results: About two-thirds of neurologists replied that more than 25% of their patients were suffered from diverse pain including headache, spine pain or neuropathic pain. Despite many patients are visiting to neurologist for pain treatment, most neurologists are aware that they have not received sufficient practical pain education in the past and present. Therefore, they want more educational opportunities in pain medicine including interventional pain management and physical and pharmacologic therapies for more effective treatment.Conclusions: More follow-up studies on pain treatment and education should be conducted. It is also essential that the members of the society continue to interest and participate in the change of the pain education program.

Role of Sex Hormones on Pain

2019 ◽  
Author(s):  
Dayna L. Averitt ◽  
Rebecca S. Hornung ◽  
Anne Z. Murphy
Keyword(s):  
Chronic Pain ◽  
Pain Management ◽  
Temporomandibular Joint ◽  
Sex Hormones ◽  
Molecular Mechanisms ◽  
Current Knowledge ◽  
Protective Effects ◽  
Temporomandibular Joint Disorder ◽  
Preclinical Research ◽  
Joint Disorder

The modulatory influence of sex hormones on acute pain, chronic pain disorders, and pain management has been reported for over seven decades. The effect of hormones on pain is clearly evidenced by the multitude of chronic pain disorders that are more common in women, such as headache and migraine, temporomandibular joint disorder, irritable bowel syndrome, chronic pelvic pain, fibromyalgia, rheumatoid arthritis, and osteoarthritis. Several of these pain disorders also fluctuate in pain intensity over the menstrual cycle, including headache and migraine and temporomandibular joint disorder. The sex steroid hormones (estrogen, progesterone, and testosterone) as well as some peptide hormones (prolactin, oxytocin, and vasopressin) have been linked to pain by both clinical and preclinical research. Progesterone and testosterone are widely accepted as having protective effects against pain, while the literature on estrogen reports both exacerbation and attenuation of pain. Prolactin is reported to trigger pain, while oxytocin and vasopressin have analgesic properties in both sexes. Only in the last two decades have neuroscientists begun to unravel the complex anatomical and molecular mechanisms underlying the direct effects of sex hormones and mechanisms have been reported in both the central and peripheral nervous systems. Mechanisms include directly or indirectly targeting receptors and ion channels on sensory neurons, activating pain excitatory or pain inhibitory centers in the brain, and reducing inflammatory mediators. Despite recent progress, there remains significant controversy and challenges in the field and the seemingly pleiotropic role estrogen plays on pain remains ambiguous. Current knowledge of the effects of sex hormones on pain has led to the burgeoning of gender-based medicine, and gaining further insight will lead to much needed improvement in pain management in women.

scholarly journals American Burn Association Guidelines on the Management of Acute Pain in the Adult Burn Patient: A Review of the Literature, a Compilation of Expert Opinion, and Next Steps

2020 ◽  
Vol 41 (6) ◽  
pp. 1129-1151
Author(s):  
Kathleen S Romanowski ◽  
Joshua Carson ◽  
Kate Pape ◽  
Eileen Bernal ◽  
Sam Sharar ◽  
...  
Keyword(s):  
Pain Management ◽  
Pain Control ◽  
English Language ◽  
Pain Treatment ◽  
Current Knowledge ◽  
Standard Of Care ◽  
Expert Consensus ◽  
Medline Search ◽  
Burn Care ◽  
Burn Patient

Abstract The ABA pain guidelines were developed 14 years ago and have not been revised despite evolution in the practice of burn care. A sub-committee of the American Burn Association’s Committee on the Organization and Delivery of Burn Care was created to revise the adult pain guidelines. A MEDLINE search of English-language publications from 1968 to 2018 was conducted using the keywords “burn pain,” “treatment,” and “assessment.” Selected references were also used from the greater pain literature. Studies were graded by two members of the committee using Oxford Centre for Evidence-based Medicine—Levels of Evidence. We then met as a group to determine expert consensus on a variety of topics related to treating pain in burn patients. Finally, we assessed gaps in the current knowledge and determined research questions that would aid in providing better recommendations for optimal pain management of the burn patient. The literature search produced 189 papers, 95 were found to be relevant to the assessment and treatment of burn pain. From the greater pain literature 151 references were included, totaling 246 papers being analyzed. Following this literature review, a meeting to establish expert consensus was held and 20 guidelines established in the areas of pain assessment, opioid medications, nonopioid medications, regional anesthesia, and nonpharmacologic treatments. There is increasing research on pain management modalities, but available studies are inadequate to create a true standard of care. We call for more burn specific research into modalities for burn pain control as well as research on multimodal pain control.

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