Showing papers on "Pain medicine published in 2006"
224 citations
TL;DR: It appears that acceptance-related processes will at least expand the range of psychologic treatment methods for chronic pain sufferers and, at best, significantly improve them.
Abstract: The experience of chronic pain can be associated with significant distress and disability; however, this is not always the case. Although attempts to control or reduce pain can be helpful for many pain sufferers, on some occasions this is not an effective option and a different response is required. This different response can include a flexible mix of control and acceptance. The acceptance part of this mix entails a willingness to have pain, or other uncomfortable private experiences, without taking action to control or eliminate them. At least 15 laboratory and clinical studies make the growing case for the role of acceptance in the functioning of people with chronic pain, and evidence from treatment outcome studies is promising. It appears that acceptance-related processes will at least expand our range of psychologic treatment methods for chronic pain sufferers and, at best, significantly improve them.
181 citations
TL;DR: Studies concerning evaluation of patients with cancer pain treated according to The World Health Organization (WHO) analgesic ladder provide insufficient evidence to grant the effectiveness of the WHO guidelines because a controlled clinical trial of this intervention has never been published.
Abstract: Introduction
Pain is a major problem in the treatment of patients with cancer. This article reviews studies concerning evaluation of patients with cancer pain treated according to The World Health Organization (WHO) analgesic ladder.
161 citations
160 citations
TL;DR: The American Society of Regional Anesthesia and Pain Medicine (ASRA) Acute Pain Summit 2005 as discussed by the authors was held to examine the perceptions of physicians about current methods used to control postoperative pain and to compare those perceptions with the available scientific evidence.
154 citations
TL;DR: High dose nabilone in the presence of morphine patient controlled analgesia is associated with an increase in pain scores in patients undergoing major surgery, contrary to the main hypothesis.
Abstract: Purpose
Cannabinoids have been shown to have analgesic properties in animal studies, but a potential role for these drugs in acute pain management has not been established It was hypothesized that nabilone, an oral cannabinoid synthetic tetrahydrocannabinol analogue, decreases morphine consumption, pain scores, nausea and vomiting following major surgery
148 citations
146 citations
TL;DR: The results suggest that the previously reported associations between genetic polymorphisms in the monoamine neurotransmitter systems and the interindividual variability in pain responses cannot be replicated in a clinically relevant pain phenotype.
Abstract: Background: Candidate gene studies on the basis of biological hypotheses have been a practical approach to identify relevant genetic variation in complex traits. Based on previous reports and the roles in pain pathways, we have examined the effects of variations of loci in the genes of monoamine neurotransmitter systems including metabolizing enzymes, receptors and transporters on acute clinical pain responses in humans. Results: Variations in the catecholamine metabolizing enzyme genes (MAOA and COMT) showed significant associations with the maximum post-operative pain rating while the serotonin transporter gene (SLC6A4) showed association with the onset time of post-operative pain. Analgesic onset time after medication was significantly associated with the norepinephrine transporter gene (SLC6A2). However, the association between COMT genetic variation and pain sensitivity in our study differ from previous studies with small sample sizes, population stratification and pain phenotype derived from combining different types of pain stimuli. Correcting for multiple comparisons did not sustain these genetic associations between monoamine neurotransmitter systems and pain sensitivity even in this large and homogeneous sample. Conclusion: These results suggest that the previously reported associations between genetic polymorphisms in the monoamine neurotransmitter systems and the interindividual variability in pain responses cannot be replicated in a clinically relevant pain phenotype.
127 citations
113 citations
TL;DR: The physician's perception of whether a patient was exaggerating symptoms was associated with the patient's ethnic background and with both the physician's and patient's perceptions of the interaction between them, as well as whether demographic characteristics were associated with these perceptions.
Abstract: Objectives: Previous studies have reported that pain is undertreated in the emergency department (ED), but few physician-dependent risk factors have been identified. In this study, the authors determine whether pain treatment and relief in ED patients are negatively associated with the physician's perception of whether the patient was exaggerating symptoms, and with the patient and physician's perceptions of the interaction between them, as well as whether demographic characteristics were associated with these perceptions.
Methods:This was a prospective observational study of patients who were undergoing treatment for painful disorders in the ED. Before treatment for pain, patients were asked to complete a 100-mm visual analog scale (VAS) describing their pain. Demographic information and pain treatments administered were recorded. Patients completed a second pain VAS before discharge from the ED. Patients were then asked to complete three queries describing their perception of their interaction with the physician. After the patient had left the department, the patient's physician was asked to complete a query describing his or her perception of the interaction and to complete a VAS describing how likely it was that the patient was exaggerating symptoms to obtain pain medicines for nonmedical purposes.
Results: There were 1,695 patients enrolled in the study; 32 patients were excluded because of missing or incomplete data, leaving 1,663 for analysis. Of these patients, 71.9% received a pain medication while in the ED. There was no association between the physician's VAS for perceived exaggeration of symptoms, the queries describing physician–patient interactions, and patient ethnicity and whether patients received pain treatment in the ED. There was a negative correlation between the physician's VAS for perceived exaggeration of symptoms and the change in the patient's pre- and posttreatment pain VAS scores. The physician's VAS score for perceived exaggeration of symptoms was higher among Native American patients than among other ethnic groups (p ≤ 0.001). The patient and physician queries rating their interaction show a decreased absolute reduction of VAS pain scores (p ≥ 0.001) and a reduction in the number of patients having at least a 50% reduction in their pain VAS score when interactions were rated “bad” and “very bad” (p ≤ 0.001).
Conclusions: The physician's perception of whether a patient was exaggerating symptoms was associated with the patient's ethnic background and with both the physician's and patient's perception of their interaction. These perceptions were negatively associated with the achievement of pain relief and the change in the patient's pain VAS scores, but not with whether a patient was treated with a pain medication.
107 citations
TL;DR: Functional magnetic resonance imaging findings that have informed current understanding of pain, analgesia and related phenomena are summarized, and the potential role of fMRI in improved therapeutic approaches to pain is discussed.
Abstract: This review summarizes functional magnetic resonance imaging (fMRI) findings that have informed our current understanding of pain, analgesia and related phenomena, and discusses the potential role of fMRI in improved therapeutic approaches to pain. It is divided into 3 main sections: (1) fMRI studies of acute and chronic pain. Physiological studies of pain have found numerous regions of the brain to be involved in the interpretation of the 'pain experience'; studies in chronic pain conditions have identified a significant CNS component; and fMRI studies of surrogate models of chronic pain are also being used to further this understanding. (2) fMRI studies of endogenous pain processing including placebo, empathy, attention or cognitive modulation of pain. (3) The use of fMRI to evaluate the effects of analgesics on brain function in acute and chronic pain. fMRI has already provided novel insights into the neurobiology of pain. These insights should significantly advance therapeutic approaches to chronic pain.
TL;DR: This paper examines terminology and regional anatomy as it pertains to functional and dysfunctional states of the temporomandibular joint and muscles of mastication.
Abstract: Pain caused by temporomandibular disorders originates from either muscular or articular conditions, or both. Distinguishing the precise source of the pain is a significant diagnostic challenge to clinicians, and effective management hinges on establishing a correct diagnosis. This paper examines terminology and regional anatomy as it pertains to functional and dysfunctional states of the temporomandibular joint and muscles of mastication. A review of the pathophysiology of the most common disorders is provided. Trends in evaluation, diagnosis, treatment, and research are presented.
TL;DR: It is suggested that the TRPV1 receptor may be involved in pain processing in higher brain structures, such as the anterior cingulate cortex, and reviewed research on the expression and function of TRpV1 receptors in supraspinal structures.
Abstract: Two major approaches have been employed for the development of novel drugs to treat chronic pain. The most traditional approach identifies molecules involved in pain as potential therapeutic targets and has focused mainly on the periphery and spinal cord. A more recent approach identifies molecules that are involved in long-term plasticity. Drugs developed through the latter approach are predicted to treat chronic, but not physiological or acute, pain. The TRPV1 (transient receptor potential vanilloid-1) receptor is involved in nociceptive processing, and is a candidate therapeutic target for pain. While most research on TRPV1 receptors has been conducted at the level of the spinal cord and peripheral structures, considerably less research has focused on supraspinal structures. This short paper summarizes progress made on TRPV1 receptors, and reviews research on the expression and function of TRPV1 receptors in supraspinal structures. We suggest that the TRPV1 receptor may be involved in pain processing in higher brain structures, such as the anterior cingulate cortex. In addition, some regions of the brain utilize the TRPV1 receptor for functions apparently unrelated to pain.
TL;DR: In this article, the authors present rationale and principals for the multidrug therapy of neuropathic pain based on best understandings of the underlying mechanisms of the disease processes and the actions of drugs, the goal being to maximize benefits and minimize adverse effects.
Abstract: Multidrug therapy (MDT) has been widely accepted and used as a standard of practice in most areas of medical practice, including neuropathic pain. Because neuropathic pain is a new field of medical science and practice, standards for its treatment including MDT are still evolving. In this article, we present rationale and principals for the MDT of neuropathic pain based on our best understandings of the underlying mechanisms of the disease processes and the actions of drugs, the goal being to maximize benefits and minimize adverse effects. MDT for neuropathic pain is based on a comprehensive clinical neuropathic pain assessment and ongoing monitoring of the drug therapy’s efficacy and adverse effects, administering one drug at the time.
TL;DR: Gabapentin and pregabalin for the treatment of neuropathic pain: A review of laboratory and clinical evidence.
Abstract: 1Clinical Pain Research, Departments of Anesthesiology and Pharmacology & Toxicology, Queen’s University, Kingston, Ontario; 2Pain Research Center, Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, USA Correspondence: Dr Ian Gilron, Clinical Pain Research Departments of Anesthesiology and Pharmacology & Toxicology, Queen’s University, 76 Stuart Street, Kingston, Ontario K7L 2V7. Fax 613-548-1375, e-mail gilroni@post.queensu.ca I Gilron, SJL Flatters. Gabapentin and pregabalin for the treatment of neuropathic pain: A review of laboratory and clinical evidence. Pain Res Manage 2006;11( Suppl A):16A-29A.
TL;DR: Groin pain is a common and often frustrating problem in athletes who engage in sports involving kicking, rapid accelerations and decelerations, and sudden direction changes, with rehabilitation focused on functional closed-chain strengthening and core stability.
Abstract: Groin pain is a common and often frustrating problem in athletes who engage in sports involving kicking, rapid accelerations and decelerations, and sudden direction changes. The most common problems are adductor strain, osteitis pubis, and sports hernia. Other causes must be considered, including nerve pain, stress fractures, and intrinsic hip pathology. There is significant overlap and multiple problems frequently coexist. Accurate diagnosis leads to directed treatment, with rehabilitation focused on functional closed-chain strengthening and core stability.
TL;DR: The definition of neuropathic pain is reviewed and the reader is introduced to the evidence-based literature on these new medications available for the treatment of neuropathy.
Abstract: Neuropathic pain is a common problem in our society affecting nearly 1.5% of the US population. There currently are five medications approved by the US Food and Drug Administration (FDA) for the treatment of neuropathic pain, which include gabapentin, pregabalin, duloxetine, 5% lidocaine patch, and carbamazepine. Other agents with proven efficacy in multiple randomized, placebo-controlled trials include opioids, tricyclic antidepressants, venlafaxine, and tramadol. All of these agents, both FDA-approved and off-label, have been recommended as first-line treatments for neuropathic pain. This article discusses these agents in detail as they relate to the treatment of neuropathic pain.
TL;DR: Cancer patients do not correlate CAM use with spiritual concerns but expect their physicians to attend to spiritual themes, and health care providers involved in oncology cancer care should emphasize spiritual as well as CAM themes.
Abstract: Background
Complementary and alternative medicine (CAM) is increasingly being used by patients with cancer.
TL;DR: Genomic analysis of longitudinal studies of pain, depression, and anxiety in patients undergoing pain-relieving surgery may help to identify molecules through which pain alters mood.
Abstract: Background: Pain patients are often depressed and anxious, and benefit less from psychotropic drugs than pain-free patients. We hypothesize that this partial resistance is due to the unique neurochemical contribution to mood by afferent pain projections through the spino-parabrachial-hypothalamic-amygdalar systems and their projections to other mood-mediating systems. New psychotropic drugs for pain patients might target molecules in such brain systems. We propose a method to prioritize molecular targets by studying polymorphic genes in cohorts of patients undergoing surgical procedures associated with a variable pain relief response. We seek molecules that show a significant statistical interaction between (1) the amount of surgical pain relief, and (2) the alleles of the gene, on depression and anxiety during the first postoperative year. Results: We collected DNA from 280 patients with sciatica due to a lumbar disc herniation, 162 treated surgically and 118 non-surgically, who had been followed for 10 years in the Maine Lumbar Spine Study, a large, prospective, observational study. In patients whose pain was reduced >25% by surgery, symptoms of depression and anxiety, assessed with the SF-36 Mental Health Scale, improved briskly at the first postoperative measurement. In patients with little or no surgical pain reduction, mood scores stayed about the same on average. There was large inter-individual variability at each level of residual pain. Polymorphisms in three pre-specified pain-mood candidate genes, catechol-O-methyl transferase (COMT), serotonin transporter, and brain-derived neurotrophic factor (BDNF) were not associated with late postoperative mood or with a pain-gene interaction on mood. Although the sample size did not provide enough power to persuasively search through a larger number of genes, an exploratory survey of 25 other genes provides illustrations of pain-gene interactions on postoperative mood – the mu opioid receptor for short-term effects of acute sciatica on mood, and the galanin-2 receptor for effects of unrelieved post-discectomy pain on mood one year after surgery.
TL;DR: How pain diagnosis, pain mechanisms, pain phenomenology, medication efficacy, and risk profile influence medication selection in pain medicine practice is reviewed, with a selective focus on the treatment of neuropathic pain.
Abstract: The concept of rational polypharmacy is now well established in the field of pain management. This concept has evolved in concert with progress in understanding the pathophysiologic mechanisms of pain diseases and disorders and how medications affect these processes. Other clinical factors must be considered in formulating the pain management strategy most likely to succeed in both controlling pain and improving function in a given patient. This article will review how pain diagnosis, pain mechanisms, pain phenomenology, medication efficacy, and risk profile influence medication selection in pain medicine practice, with a selective focus on the treatment of neuropathic pain. In addition, the role of psychosocial factors as they affect pain management will be discussed.
TL;DR: Given the incomplete efficacy of currently available non-opioid analgesics, and the identified benefits of opioid sparing, anticonvulsant medications may be useful adjuncts for postoperative analgesia.
Abstract: Anticonvulsant drugs are effective in the treatment of chronic neuropathic pain but were not, until recently, thought to be useful in more acute conditions such as postoperative pain. However, similar to nerve injury, surgical tissue injury is known to produce neuroplastic changes leading to spinal sensitization and the expression of stimulus-evoked hyperalgesia and allodynia. Pharmacological effects of anticonvulsant drugs which may be important in the modulation of these postoperative neural changes include suppression of sodium channel, calcium channel and glutamate receptor activity at peripheral, spinal and supraspinal sites. The purpose of this article is to review preclinical evidence and clinical trial data describing the efficacy and safety of anticonvulsant drugs in the setting of postoperative pain management. A Medline search was performed to retrieve available literature on the basic and clinical pharmacology of anticonvulsant drugs as they pertain to postoperative pain management. Numerous laboratory studies have described analgesic effects of different anticonvulsant drugs in experimental pain models. Furthermore, several recent clinical trials have shown that anticonvulsants may reduce spontaneous and movement-evoked pain, as well as decrease opioid requirements postoperatively. Some early findings suggest further that anticonvulsant drugs may alleviate postoperative anxiety, accelerate postoperative functional recovery and reduce chronic postsurgical pain. Given the incomplete efficacy of currently available non-opioid analgesics, and the identified benefits of opioid sparing, anticonvulsant medications may be useful adjuncts for postoperative analgesia. Further research in this field is warranted.
TL;DR: The neuropathic pain model of migraine pathophysiology not only paves the way for mechanism-based treatment strategies that can improve the acute and preventive management of migraine attacks, but also opens the door for the discovery of novel therapeutic targets.
Abstract: The understanding of migraine pathophysiology has evolved from the belief that migraine is a vascular disorder, to evidence that better defines migraine as a neurogenic disorder associated with secondary changes in brain perfusion. There is evidence to suggest that the early phase of migraine pain results from neurogenic inflammation affecting cranial blood vessels and dura. Allodynia, hyperalgesia, and expansion of nociceptive fields occur during most well-established migraine attacks. These clinical features of migraine are evocative of those traditionally associated with neuropathic pain. A hypothesis that defines migraine pain as a unique neuropathic pain disorder can imply the potential for neural plasticity and may provide insight into the mechanisms that underlie the transformation of episodic to chronic forms of migraine. The neuropathic pain model of migraine pathophysiology not only paves the way for mechanism-based treatment strategies that can improve the acute and preventive management of migraine attacks, but also opens the door for the discovery of novel therapeutic targets. It also lends momentum to an understanding of clinically intriguing topics such as opiate-induced hyperalgesia and medication-overuse headache (rebound headache), opioid resistance in the treatment of chronic headache, and disease modification in defending against the potential for migraine transformation.
TL;DR: There has been little impetus or effort among agencies of influence to promote, no less uphold, an acceptable standard of pain care among all groups of patients.
Abstract: Note from editor: The following is the report and newest recommendations from the AAPM Council on Ethics, which are now included in the “AAPM Ethics Charter.” All comments are welcome.
The American Academy of Pain Medicine (AAPM) endorses the World Health Organization declaration that pain relief is a human right. The Academy advocates strongly for access to high-quality pain care for all persons, seeking to overcome any and all inequities that exist. The AAPM embraces the American Medical Association's statement on disparities, affirming that “disparities in medical care based on immutable characteristics such as race must be avoided. Whether such disparities in health care are caused by treatment decisions, differences in income and education, sociocultural factors, or failures by the medical profession, they are unjustifiable and must be eliminated. Physicians should examine their own practices to ensure that racial prejudice does not affect clinical judgment in medical care”[1]. While federal agencies have paid increasing attention to health care disparities in recent years [2], the impact of pain on individual patient's lives, their families, and society are notably absent in most federal research agency's strategic plans and position statements. The reality today is that there has been little impetus or effort among agencies of influence to promote, no less uphold, an acceptable standard of pain care among all groups of patients.
There continue to be major disparities based on patient sociodemographic factors (e.g., race, ethnicity, socioeconomic status [SES], age, gender) for all types of pain (i.e., nociceptive and neuropathic pain) and across all settings (i.e., inpatient and outpatient settings) [3]. Overall, minorities report significantly more psychological and physical morbidity (e.g., post-traumatic stress disorder and disability) than non-Hispanic whites across the age continuum [4,5]. Respondents of an American Pain Society (APS) and AAPM survey …
TL;DR: Serum melatonin concentrations were determined by enzyme-linked immunosorbent assay and the Acute Physiology And Chronic Health Evaluation (APACHE) II score and Therapeutic Intervention Scoring System (TISS) were assessed.
Abstract: Sir: Disturbances of pineal function are well known in critically ill humans [1], but it is unclear whether melatonin blood concentrations are related to severity of illness. We measured serum melatonin concentrations at 2 a.m. in the first night in hospital in 302 patients consecutively admitted to the medical ICU of the University Hospital in Lübeck, Germany. At the same time the Acute Physiology And Chronic Health Evaluation (APACHE) II score and Therapeutic Intervention Scoring System (TISS) were assessed. Serum melatonin concentrations were determined by enzyme-linked immunosorbent assay
TL;DR: Hand hygiene of health care workers (HCW) is of paramount importance to prevent crosstransmission of micro-organisms among hospital inpatients, but the compliance to HH recommendations among HCW is often low.
Abstract: Sir: Hand hygiene (HH) of health care workers (HCW) is of paramount importance to prevent crosstransmission of micro-organisms among hospital inpatients. However, the compliance to HH recommendations among HCW is often low [1, 2, 3]. Compliance to HH recommendations is generally assessed by an identified observer during open sessions, and the real impact of the Hawthorne effect in this setting is a matter of debate. A recent study reported that the awareness of being observed was a strong indicator of
TL;DR: It is found that key diagnostic criteria for NDD were incorporated inconsistently in the guidelines from Canadian ICUs and OPOs, which reinforces the need to standardize the practice of the neurological determination of death in Canadian centres, which has the potential to reduce practice variation.
Abstract: Purpose
Variability has been reported in the practices to determine death by neurological criteria for adults and children. The objective of this study was to determine if this variability exists in the Canadian context.
TL;DR: Although self-reported health, satisfaction with life and psychological well-being were similar or even better in long-term breast cancer survivors compared to those in population controls, survivors more often attended a specialist, physical therapist and complementary caregiver in the past 12 months.
Abstract: Objective
We investigated self-reported health care utilisation of women who survived breast cancer for 10 years and identified predictors of health care utilisation.