scholarly journals Classification of Chronic Pain at a Multidisciplinary Pain Rehabilitation Clinic

1998 ◽  
Vol 3 (1) ◽  
pp. 13-22 ◽  
Author(s):  
Jan Lidbeck ◽  
Gertie IM Hautkamp ◽  
Ritva A Ceder ◽  
Urban LO Näslund
Keyword(s):  
Chronic Pain ◽  
Musculoskeletal Pain ◽  
Myofascial Pain ◽  
Pain Syndrome ◽  
Pain Clinic ◽  
Psychological Pain ◽  
Pain Syndromes ◽  
Epidemiological Surveys ◽  
Clinical Diagnoses ◽  
Chronic Pain Syndromes

OBJECTIVE: To make a detailed diagnostic analysis of patients with chronic pain syndromes, including classification according to the International Association for the Study of Pain (IASP).DESIGN: Descriptive study of consecutive referrals during a two-year period.SETTING: A multidisciplinary out-patient pain clinic focused on occupational rehabilitation.SUBJECTS: A total of 309 chronic pain patients.METHODS: After a standardized multimodal physical and psychological examination, the chronic pain syndrome of each patient was assigned one or more clinical diagnoses; assigned to an etiological pain category (nociceptive pain, non-nociceptive including idiopathic pain, and psychological pain); and coded diagnostically according to IASP taxonomy.RESULTS: In all, 397 clinical diagnoses were made (ie, a mean of 1.3 diagnoses per patient). A large majority (87%) received a diagnosis of myalgia. Myofascial pain (trigger point syndrome) was diagnosed in two-thirds of the patients and was the most frequent clinical pain syndrome. A total of 51.8% of the pain syndromes were categorized as nociceptive, 43.0% as idiopathic and less than 1% as pain of psychological origin. Classification using the IASP system yielded a very high proportion of nociceptive, musculoskeletal pain syndromes of high intensity, with widespread pain and/or pain located in the neck/shoulder/arm region, and of dysfunctional etiology.CONCLUSIONS: Musculoskeletal pain was very common in this series, and myofascial pain syndromes were the most frequent specific pain disorders. However, myofascial pain had generally gone unrecognized by the referring physician. In contrast to findings of other studies, the incidence of low back pain and of primary psychological pain was low. Comparison of the results with those of Swedish epidemiological surveys showed the frequencies of the diagnoses in this series to be representative of chronic pain syndromes in the Swedish general population.

Chronic pain syndromes

2018 ◽  
pp. 623-642
Author(s):  
Gavin Clunie ◽  
Nick Wilkinson ◽  
Elena Nikiphorou ◽  
Deepak R. Jadon
Keyword(s):  
Chronic Pain ◽  
General Practitioner ◽  
Children And Adolescents ◽  
Complex Regional Pain Syndrome ◽  
Musculoskeletal Pain ◽  
Pain Syndrome ◽  
Pain Syndromes ◽  
Pain Medications ◽  
Cross Reference ◽  
Chronic Pain Syndromes

The Oxford Handbook of Rheumatology 4th edition, has been extensively updated to thoroughly review aspects of musculoskeletal pain. Pain pathophysiology is reviewed. Chronic pain and fibromyalgia in adults and in children and adolescents is dealt with in detail. The reader is advised to cross reference from this chapter to Chapters 1–3 in the Handbook, where regional musculoskeletal pain conditions are listed and reviewed. In localized pain syndromes, the chapter has an overview of complex regional pain syndrome (CRPS), which is not infrequently encountered in rheumatology and musculoskeletal clinics. Included in detail for this edition, is the assessment and management of pain in children, which is a highly specialized clinical area of medicine and will be of use to the adult rheumatologist and general practitioner as well as paediatric specialists. Readers should cross reference to Chapter 23 on medications, for ‘pain medications’ in the Handbook

Metabolic Therapy and Pain

2016 ◽  
Author(s):  
David N. Ruskin
Keyword(s):  
Chronic Pain ◽  
Pain Syndrome ◽  
Poor Quality ◽  
Fatty Acid Supplementation ◽  
Pain Syndromes ◽  
Drug Treatments ◽  
Dietary Treatments ◽  
Dietary Modifications ◽  
Chronic Pain Syndromes

Chronic pain is associated strongly with poor quality of life. Drug treatments for pain can be problematic; with the understanding that chronic pain syndromes often involve derangement of homeostasis, there is an increased interest in applying nonpharmacological metabolic therapies. This chapter surveys clinical and animal research into the effects of fasting, calorie restriction, ketogenic diet, and polyunsaturated fatty acid supplementation on pain. These dietary treatments can significantly ameliorate pain in inflammatory and neuropathic disorders. The choice among these treatments might depend on the specific pain syndrome and the tolerance of the patient for particular dietary modifications. Several possible mechanisms are discussed, some of which might be in common among these treatments, and some treatments might engage multiple mechanisms. Multiple mechanisms acting together could be ideal for restoring the disordered metabolism underlying some pain syndromes.

Methadone as an analgesic for patients with chronic pain in methadone maintenance treatment programs (MMTPs)

2018 ◽  
Vol 5 (2) ◽  
pp. 107 ◽  
Author(s):  
Craig D. Blinderman, MD, MA ◽  
Ryuichi Sekine, MD ◽  
Baohui Zhang, MS ◽  
Matthew Nillson, MS ◽  
Lauren Shaiova, MD
Keyword(s):  
Chronic Pain ◽  
Methadone Maintenance Treatment ◽  
Maintenance Treatment ◽  
Methadone Maintenance ◽  
Pain Clinic ◽  
Treatment Programs ◽  
Methadone Dose ◽  
Pain Syndromes ◽  
The Mean ◽  
Chronic Pain Syndromes

Background: Limited case reports have suggested a role for methadone as an analgesic for chronic pain in patients maintained on methadone for treatment of opiate addiction. Patients with HIV are disproportionately represented in this population and often have severe, debilitating chronic pain syndromes of multiple etiologies, including cancer-related pain syndromes.Objective: This study evaluated the safety and efficacy of initiating and maintaining additional methadone for chronic pain in HIV-positive patients with ongoing treatment for opiate addiction in methadone maintenance treatment programs (MMTPs).Methods: We performed a retrospective chart review of 53 HIV/AIDS patients (36 male, 17 female; 24 with cancer) with diverse chronic pain syndromes who were followed in an HIV Pain Clinic and were currently enrolled in an MMTP. The outcome measure was pain, assessed using a numeric rating scale (0-10). Incidence of heroin use was also measured.Results: The mean methadone dose initially prescribed for analgesia was approximately equal to 67 percent of the methadone dose used in the MMTP for addiction. Over the 12-month retrospective observation period, methadone was titrated to approximately 200 percent of the methadone maintenance dose. The mean pain score at initial visit to the Pain Clinic was 9.4 + 1.03. After methadone for analgesia has been administered for 1 month, the mean pain score decreased to 5.35 ± 1.7 (p < 0.001), at 3 months, 4.8 ± 1.3 (p < 0.001), at 6 months, 4.2 ± 1.7 (p < 0.001), and at 12 months, 4.2 ± 1.4 (p < 0.001). No serious adverse events or side effects were observed with methadone therapy for analgesia.Conclusion: HIV/AIDS patients with chronic pain enrolled in MMTPs achieved improved analgesia with no serious side effects when additional methadone was administered for pain relief. Further controlled studies are needed to confirm our findings and to establish the safety and efficacy of methadone therapy for chronic pain in this population.

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.

Pain Syndromes Other Than Headache

2016 ◽  
Author(s):  
Edgar L. Ross
Keyword(s):  
Chronic Pain ◽  
Neuropathic Pain ◽  
Sensory Processing ◽  
Pain Syndrome ◽  
The Body ◽  
Spinal Cord Dorsal Horn ◽  
Opioid Use ◽  
Nerve Injuries ◽  
Pain Syndromes ◽  
Chronic Pain Syndromes

Pain is experienced within a complex biologic, emotional, psychological, and social context that may defy physical examination, diagnostic procedures, and laboratory tests. This chapter aims to empower internists to improve their medical practices in pain management. It provides a scientific background that covers nociception and how sensory processing occurs at multiple levels in the body. Clinical assessment is detailed, as well as diagnostic categories that include mixed or uncertain chronic pain syndromes (back pain, fibromyalgia, postamputation pain, pain from cancer and bone) and neuropathic pain syndromes (polyneuropathy, mononeuropathy multiplex, ganglionopathy, genetic disorders, focal and regional syndromes). Treatment of chronic pain can be surgical or interventional. Pharmacologic treatment for acute and chronic nociceptive pain includes special considerations for geriatric and terminal patients. For treatment of neuropathic pain, medications are the major component. One tables lists iatrogenic nerve injuries that can cause posttraumatic neuralgia and complex regional pain syndrome. Other tables detail stepwise pharmacologic management of neuropathic pain and cite recommendations on opioid use from the Centers for Disease Control and Prevention. One figure illustrates how pain transducers monitor and influence tissue conditions. Other figures show sensory processing in the spinal cord dorsal horn, physical findings in the feet of patients with bilateral foot pain from small-fiber polyneuropathy, illustrate how examination can identify specific nerve injuries causing chronic pain, and provide classification of chronic pain syndromes. This chapter contains 82 references.

Antidepressants in the Treatment of Chronic Pain

1998 ◽  
Vol 11 (5) ◽  
pp. 388-393 ◽  
Author(s):  
Cherry W. Jackson
Keyword(s):  
Chronic Pain ◽  
Neuropathic Pain ◽  
Cancer Pain ◽  
Musculoskeletal Pain ◽  
Antidepressant Activity ◽  
Controlled Trials ◽  
Analgesic Action ◽  
Pain Syndromes ◽  
Antidepressant Effects ◽  
Chronic Pain Syndromes

Antidepressants have been successfully used for chronic pain syndromes for approximately 30 years. One theory is that analgesic action is secondary to the antidepressant effects of the medications. Placebo-controlled trials have documented that antidepressants treat neuropathic pain, musculoskeletal pain, chronic pain, and cancer pain. The most frequently studied antidepressant for pain is amitriptyline. Other antidepressants that have shown analgesic activity include imipramine, citalopram, paroxetine, nortriptyline, desipramine, and mianserin. Fluoxetine and trazodone have not been shown to successfully treat pain syndromes. Venlafaxine, a new antidepressant, most recently was shown to have antidepressant activity in fibromyalgia. More studies need to be done with newer antidepressants to confirm their place in treating pain syndromes.

scholarly journals P118 Orthopaedic surgical interventions in a cohort of patients with hypermobility related disorders, compared with chronic pain syndrome patients in a tertiary referral centre

Rheumatology ◽  
2020 ◽  
Vol 59 (Supplement_2) ◽  
Author(s):  
Sarah Wright ◽  
Puja Mehta ◽  
Anisur Rahman ◽  
Hanadi Kazkaz
Keyword(s):  
Chronic Pain ◽  
Surgical Procedures ◽  
Surgical Intervention ◽  
Pain Syndrome ◽  
Referral Centre ◽  
Beighton Score ◽  
Tertiary Referral Centre ◽  
Surgical Interventions ◽  
Pain Syndromes ◽  
Chronic Pain Syndromes

Abstract Background Mechanisms of pain associated with hypermobility are poorly understood and include nociceptive pain due to structural joint changes, neuropathic pain due to disrupted proprioception, muscle weakness and central sensitisation. The influence of anxiety and low mood is also unknown. There is limited published evidence regarding orthopaedic interventions in hypermobile patients particularly following the updated 2017 Ehlers-Danlos syndrome (EDS) classification criteria. We aimed to evaluate the characteristics of a hypermobility patient cohort who had received surgical interventions and compare these with a patient population with chronic pain syndromes. Methods A retrospective analysis of medical records was conducted of patients attending a tertiary referral centre (University College London Hospital) between January 2018 and December 2018. A hypermobility-related disorders cohort was compared with a cohort of patients with chronic pain syndrome, including fibromyalgia (but without any evidence of hypermobility). Results There were 350 patients (300 females, 50 males) in the hypermobility cohort with a mean age of 36 years (range 18-71 years) at time of clinic review. 63% had hypermobility spectrum disorder or hypermobility syndrome and 37% had EDS (hypermobile, classic, vascular and other rare types). 24% of hypermobile patients had undergone orthopaedic interventions. The Beighton score did not correlate with surgical procedures. 134 patients (121 females, 13 males) with chronic pain syndromes were identified, with a mean age of 51 years (range 26-85 years). 16% of chronic pain patients had received orthopaedic surgery. 76% of hypermobile patients who had orthopaedic interventions were under 50 years old, compared to 23% in the chronic pain cohort. The total number of surgical procedures in the hypermobility cohort was 227 (0.6485 interventions per patient) compared with 25 in the chronic pain cohort (0.1865 interventions per patient); relative risk 3.477 (95% CI 2.42-4.99; P &lt; 0.0001, chi-squared test). 33% of hypermobile patients had surgery on two or more joint groups (including 8 patients who had surgery in four or more joint groups), whereas 95% of chronic patients had surgery on only one joint group. In the hypermobile group the knee (23%) and hips (24%) were the most common site of operative intervention; however in the chronic pain cohort the most common sites were the knee (32%), spine (20%) and shoulders (20%), with only 4% requiring hip surgery. Conclusion Patients with hypermobility have a greater number of surgical procedures at multiple joint sites and at a younger age than patients with chronic pain syndromes, suggesting that mechanical pathology (rather than pain alone) and anticipated surgical success may contribute to the need for surgical intervention. The Beighton score does not appear to be a reliable predictor of surgical intervention. Earlier diagnosis and a holistic, non-operative approach, including physiotherapy and pain management, may reduce the need for surgical procedures. Disclosures S. Wright None. P. Mehta None. A. Rahman None. H. Kazkaz None.

scholarly journals Low-Dose Naltrexone Use for Patients with Chronic Regional Pain Syndrome: A Systematic Literature Review

2021 ◽  
pp. E393-E406
Keyword(s):  
Chronic Pain ◽  
Complex Regional Pain Syndrome ◽  
Case Studies ◽  
Low Dose ◽  
Pain Syndrome ◽  
The United States ◽  
Qualitative Review ◽  
Pain Syndromes ◽  
Low Dose Naltrexone ◽  
Chronic Pain Syndromes

BACKGROUND: Complex regional pain syndrome is a rare, neuropathic disorder that affects fewer than 200,000 individuals in the United States annually. Current treatments often focus on pain management and fall short of relieving symptoms of pain and dystonia in patients. OBJECTIVE: The goal of this systematic qualitative review is to evaluate the evidence for the use of low-dose naltrexone in the treatment of chronic pain syndromes. STUDY DESIGN: This is a systematic review. METHODS: PubMed, Embase, and Web of Science were searched for articles containing the keywords “low-dose naltrexone” AND (“pain” OR “chronic pain” OR “fibromyalgia” OR “complex regional pain syndrome” OR “neuropathic pain” OR “nociceptive pain”) between 1950 and July 17, 2020. A total of 30 publications were systematically reviewed. Exclusion criteria were articles that were unavailable in English, focused on acute pain only, and evaluated only animal models. Case studies were included for the purposes of our qualitative review. RESULTS: Out of 29 articles, we reviewed 11 prospective studies, 10 case studies, 3 systematic reviews, 2 retrospective studies, 2 simulation models, and one combination study. Articles focused on chronic pain syndromes as well as painful rheumatologic disorders and neurological disorders. We found that low-dose naltrexone treatment was positively associated with symptom relief in patients experiencing chronic pain, dystonia, and sleep disturbances. LIMITATIONS: Due to the limited number of available articles focusing on the treatment of complex regional pain syndrome with low-dose naltrexone, the majority of studies analyzed focused on other chronic pain syndromes. CONCLUSIONS: There is a need for additional prospective and interventional studies addressing the use of low-dose naltrexone in the treatment of complex regional pain syndrome symptoms. KEY WORDS: Complex regional pain syndrome, reflex sympathetic dystrophy, low-dose naltrexone, chronic pain, opioid antagonist

scholarly journals Chronic pain syndromes: overlapping phenotypes with common mechanisms

F1000Research ◽  
2019 ◽  
Vol 8 ◽  
pp. 255 ◽  
Author(s):  
Geoffrey Owen Littlejohn ◽  
Emma Guymer
Keyword(s):  
Chronic Pain ◽  
Complex Regional Pain Syndrome ◽  
Emotional Distress ◽  
Pain Syndrome ◽  
Physical Factors ◽  
Pain Syndromes ◽  
The Common ◽  
Chronic Pain Syndromes

The common chronic pain syndromes of fibromyalgia, regional pain syndrome, and complex regional pain syndrome have been made to appear separate because they have been historically described by different groups and with different criteria, but they are really phenotypically accented expressions of the same processes triggered by emotional distress and filtered or modified by genetics, psychology, and local physical factors.

scholarly journals Myofascial pain syndrome and SARS-CoV-2: a case series

2021 ◽  
Author(s):  
Jaldhi Patel ◽  
Saba Javed
Keyword(s):  
Chronic Pain ◽  
Myofascial Pain ◽  
Case Series ◽  
Pain Syndrome ◽  
Myofascial Pain Syndrome ◽  
Trigger Points ◽  
Pain Clinic ◽  
History Of ◽  
The Relationship

SARS-CoV-2 is a novel virus that has caused a plethora of dysfunctions and changes in the human body. Our goal in this case study series was to demonstrate the relationship that coronavirus has had in newly diagnosing patients with myofascial pain syndrome (MFPS). Medical records were obtained from a pain clinic that demonstrated the effects of this virus on patients who developed MFPS between March 2020 and December 2020. Chart reviews were performed and demonstrated patients who had a history of chronic pain had subsequent episodes of worsening exacerbations of pain, more specifically trigger points, after being diagnosed with coronavirus. MFPS and SARS-CoV-2 are proposed to be correlated amongst chronic pain patients. Potential pathological mechanisms include coronavirus-induced hypoxic muscle dysfunctions as well as psychological stress triggering pain receptors, leading to myofascial pain syndrome.

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