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Chronic Nonmalignant Pain (chronic + nonmalignant_pain)
Selected AbstractsIdentifying the Activities Affected by Chronic Nonmalignant Pain in Older Veterans Receiving Primary CareJOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue 4 2005Bao D. Duong MD Objectives: To identify the specific types of activities affected by chronic pain in older persons and the extent to which older individuals modify, perform less frequently, or terminate activities because of pain. Design: Cross-sectional survey. Setting: Primary care practice at a Veterans Affairs Medical Center in New England. Participants: Two hundred forty-four patients (aged 65,90) with chronic nonmalignant pain. Measurements: Open-ended questions were used to identify the activities affected by pain; participants' responses were subsequently organized into distinct categories (e.g., climbing stairs under higher-order physical activities and going out to dinner under social/recreational activities). Participants were also asked to indicate whether they had modified, performed less frequently, or terminated these activities because of pain. Results: Participants had a mean age±standard deviation of 75.4±5.2, were mostly male (84%), and had an average pain intensity score of 6.2±1.9 on a 0- to 10-scale. Two hundred three participants (83%) reported that pain affected one or more higher-order physical activities, and the corresponding percentages for the categories of social/recreational activities, instrumental activities of daily living, and basic activities of daily living were 74%, 57%, and 3%, respectively. The proportions of participants who modified, performed less frequently, or terminated one or more activities because of pain were 71%, 69%, and 22%, respectively. Conclusion: Assessing the effects of chronic pain across multiple functional domains is indicated in older primary care patients, particularly higher-order physical and social/recreational activities. Inquiring about whether the activities are modified, reduced, or terminated may also help to expand understanding of pain-related disability in older persons. [source] Phenol Neurolysis for Severe Chronic Nonmalignant Pain: Is the Old also Obsolete?PAIN MEDICINE, Issue 4 2007Natan Weksler MD ABSTRACT Objective., Our purpose was to reassess the effectiveness of phenol 4% in aqueous solution for neurolysis in patients with severe chronic nonmalignant pain syndromes who did not achieve adequate pain control (visual analog scale [VAS] ,3) with conventional pain treatment. Design., Forty-two patients with severe nonmalignant pain persisting for 6 months or longer were followed for more than 6 months after phenol neurolysis in this prospective observational study. All patients had previously received narcotic drugs, with or without nonsteroidal anti-inflammatory agents or adjuvants, without adequate pain relief. An aqueous solution of phenol 4% was used for chemical neurolysis. A fluoroscopically guided technique was used for chemical lumbar sympathectomy, medial branch destruction, and sacroiliac injections. Anatomic-landmarks technique was used for intercostal neurolysis, greater occipital nerve destruction, genitofemoral neuroablation, and paracoccygeal infiltration. Results., Good pain relief (VAS ,3) was achieved in 35 patients after neurolysis with phenol, and the mean VAS decreased from 8.74 ± 1.08 (range 7,10) before treatment to 1.93 ± 2.41 after treatment (P < 0.0001). The mean VAS for assessment of the quality of pain relief after phenol neurolysis was 8.4 ± 2.39, ranging from 0 (no relief at all) to 10 (complete relief ). No major complications were seen. Conclusion., The use of phenol 4% in aqueous solution is an effective and safe technique for neurolysis. Because of the potential risk of flaccid paralysis, this technique should be used in selected cases, far removed from motor nerves and the spinal cord. [source] Methadone in the Treatment of Chronic Nonmalignant Pain: A 2-Year Follow-upPAIN MEDICINE, Issue 3 2000William F. Taylor MD Objective. To examine the longitudinal use of methadone in a pain clinic. Design. Follow-up study of 40 patients initially treated with methadone and re-evaluated 2 years later, comparing those maintained on methadone with those who were switched to other opioids. Setting. Pain clinic at a university hospital. Results. The 14 patients (35%) who stayed on methadone for the duration of the study, had higher employment rates (P < .05) and higher functional ratings (P < .02) than those on other opioids. Side effects were the most common reason (33.4%) for discontinuation of methadone. Dose escalation occurred in 11 of 14 patients (78.6%). Conclusions. Chronic pain patients may be safely and effectively treated with methadone. Those not responding or tolerating methadone may be benefited by treatment with other opioids. [source] Update on Adjuvant Medications for Chronic Nonmalignant PainPAIN PRACTICE, Issue 4 2003Florian Strasser MD First page of article [source] Reduction in Medication Costs for Patients with Chronic Nonmalignant Pain Completing a Pain Rehabilitation Program: A Prospective Analysis of Admission, Discharge, and 6-Month Follow-Up Medication CostsPAIN MEDICINE, Issue 5 2009Julie L. Cunningham PharmD ABSTRACT Objective., Chronic nonmalignant pain (CNMP) is both a prevalent and a costly health problem in our society. Pain rehabilitation programs have been shown to provide cost-effective treatment. A treatment goal for some rehabilitation programs is reduction in the use of pain-related medication. Medication costs savings from pain rehabilitation programs have not been analyzed in previous studies. Design., This prospective cohort study of 186 patients with CNMP addresses the costs of medications at admission to a 3-week outpatient pain rehabilitation program, at discharge, and at 6-month follow-up. Medication use was determined through a detailed pharmacist interview with patients at admission and discharge. Patients were sent questionnaires 6 months after program completion, which obtained current medication information. Results., Statistically significant medication cost savings were seen for program completers at discharge and at 6-month follow-up (P < 0.05). The mean (standard deviation) daily prescription medication cost reduction from admission to discharge was $9.31 ($12.70) using the average wholesale price of medications. From the original study cohort, 121 patients completed the 6-month follow-up survey. The mean daily prescription medication cost savings from admission to 6-month follow-up was $6.68 ($14.40). Conclusion., Patients benefited from significant medication cost savings at the completion of the 3-week outpatient pain rehabilitation program and maintained significant savings after 6 months. This study adds to the current literature on the economic value of comprehensive pain rehabilitation programs. [source] Chronic Pain and Obstetric Management of a Patient with Tuberous SclerosisPAIN MEDICINE, Issue 2 2007Louise M. Byrd MRCOG ABSTRACT Chronic nonmalignant pain is very disabling and carries a heavy financial strain on the individual and society as a whole. This case describes a woman with tuberous sclerosis, in her fourth pregnancy. Approximately 18 months prior to pregnancy, intractable left loin pain, thought to be secondary to hemorrhage within a tuberous lesion in the left kidney, had led to the siteing of an intrathecal morphine pump. The risks of system failure (dislodgement, dislocation), escalating dosage, infection, use in labor, and neonatal opioid withdrawal are all explored and discussed. While data are limited, with increasing use of intrathecal opioids for nonmalignant pain, such patients may be seen more regularly in obstetric clinics. With a multidisciplinary team approach, risks can be minimized and outcome for mother and baby optimized. [source] Once-daily OROS®,hydromorphone for the management of chronic nonmalignant pain: a dose-conversion and titration studyINTERNATIONAL JOURNAL OF CLINICAL PRACTICE, Issue 10 2007M. Wallace Summary Background:, The use of opioid analgesics for patients with chronic nonmalignant pain is becoming more widely accepted, and long-acting formulations are an important treatment option. Aim:, To assess conversion to extended-release OROS® hydromorphone from previous stable opioid agonist therapy in patients with chronic nonmalignant pain of moderate-to-severe intensity. Methods:, In this open-label multicentre trial, patients were stabilised on their previous opioid therapy before being switched to OROS® hydromorphone at a ratio of 5 : 1 (morphine sulphate equivalent to hydromorphone hydrochloride). The OROS® hydromorphone dose was titrated over 3,16 days to achieve effective analgesia, and maintenance treatment continued for 14 days. Results:, Study medication was received by 336 patients; 66% completed all study phases. Stabilisation of OROS® hydromorphone was achieved by 94.6% of patients, the majority in two or fewer titration steps (mean time, 4.2 days). Mean pain intensity scores, as determined by the Brief Pain Inventory, decreased during OROS® hydromorphone treatment (p , 0.001). The percentage of patients rating their pain relief as ,good' or ,complete' increased, and the use of rescue analgesics for breakthrough pain decreased. The interference of pain with everyday activities (e.g. walking or work), and the effects on mood and enjoyment of life, also improved during the study (all p < 0.001). OROS® hydromorphone was well tolerated, and adverse events were those expected for opioid agonist therapy. Conclusion:, Patients with chronic nonmalignant pain who had been receiving opioid therapy easily underwent conversion to OROS® hydromorphone, with no loss of efficacy or increase in adverse events. [source] Identifying the Activities Affected by Chronic Nonmalignant Pain in Older Veterans Receiving Primary CareJOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue 4 2005Bao D. Duong MD Objectives: To identify the specific types of activities affected by chronic pain in older persons and the extent to which older individuals modify, perform less frequently, or terminate activities because of pain. Design: Cross-sectional survey. Setting: Primary care practice at a Veterans Affairs Medical Center in New England. Participants: Two hundred forty-four patients (aged 65,90) with chronic nonmalignant pain. Measurements: Open-ended questions were used to identify the activities affected by pain; participants' responses were subsequently organized into distinct categories (e.g., climbing stairs under higher-order physical activities and going out to dinner under social/recreational activities). Participants were also asked to indicate whether they had modified, performed less frequently, or terminated these activities because of pain. Results: Participants had a mean age±standard deviation of 75.4±5.2, were mostly male (84%), and had an average pain intensity score of 6.2±1.9 on a 0- to 10-scale. Two hundred three participants (83%) reported that pain affected one or more higher-order physical activities, and the corresponding percentages for the categories of social/recreational activities, instrumental activities of daily living, and basic activities of daily living were 74%, 57%, and 3%, respectively. The proportions of participants who modified, performed less frequently, or terminated one or more activities because of pain were 71%, 69%, and 22%, respectively. Conclusion: Assessing the effects of chronic pain across multiple functional domains is indicated in older primary care patients, particularly higher-order physical and social/recreational activities. Inquiring about whether the activities are modified, reduced, or terminated may also help to expand understanding of pain-related disability in older persons. [source] Opioid Rotation in the Management of Chronic Pain: Where Is the Evidence?PAIN PRACTICE, Issue 2 2010K.C.P. Vissers MD Abstract The management of chronic pain remains a challenge because of its complexity and unpredictable response to pharmacological treatment. In addition, accurate pain management may be hindered by the prejudice of physicians and patients that strong opioids, classified as step 3 medications in the World Health Organization ladder for cancer pain management, are reserved for the end stage of life. Recent information indicates the potential value of strong opioids in the treatment of chronic nonmalignant pain. There are, up until now, insufficient data to provide indications about which opioid to use to initiate treatment or the dose to be used for any specific pain syndrome. The strong inter-patient variability in opioid receptor response and in the pharmacokinetic and pharmacodynamic behavior of strong opioids justifies an individual selection of the appropriate opioid and stepwise dose titration. Clinical experience shows that switching from one opioid to another may optimize pain control while maintaining an acceptable side effect profile or even improving the side effects. This treatment strategy, described as opioid rotation or switch, requires a dose calculation for the newly started opioid. Currently, conversion tables and equianalgesic doses are available. However, those recommendations are often based on data derived from studies designed to evaluate acute pain relief, and sometimes on single dose studies, which reduces this information to the level of an indication. In daily practice, the clinician needs to titrate the optimal dose during the opioid rotation from a reduced calculated dose, based on the clinical response of the patient. Further research and studies are needed to optimize the equianalgesic dosing tables. [source] Effects of a distance learning program on physicians' opioid- and benzodiazepine-prescribing skillsTHE JOURNAL OF CONTINUING EDUCATION IN THE HEALTH PROFESSIONS, Issue 4 2006Deana Midmer BScN Abstract Introduction: Opioid misuse is common among patients with chronic nonmalignant pain. There is a pressing need for physicians to increase their confidence and competence in managing these patients. Methods: A randomized controlled trial of family physicians (N = 88) attending 1 of 4 continuing medical education events helped to determine the effectiveness of e-mail case discussions in changing physician behavior. Before random assignment, participants completed a pretest and attended a 3-hour didactic session on prescribing opioids and benzodiazepines. The intervention group participated in 10 weeks of e-mail case discussions, with designated participants responding to questions on cases. An addictions physician facilitated the discussion. Several months after the e-mail discussion, participants took part in a mock telephone consultation; a blinded researcher posing as a medical colleague asked for advice about 2 cases involving opioid and benzodiazepine prescribing. Using a checklist, the researcher recorded the questions asked and advice given by the physician. Results: On post-testing, both groups expressed greater optimism about treatment outcomes and were more likely to report using a treatment contract and providing advice about sleep hygiene. There were no significant differences between pretesting and post-testing between the groups on the survey. During the telephone consultation, the intervention group asked significantly more questions and offered more advice than the control group (odds ratio for question items, 1.27 [p = .03]; advice items, 1.33 [p = .01). Discussion: Facilitated by electronic mail and a medical expert, case discussion is an effective means of improving physician performance. Telephone consultation holds promise as a method for evaluating physicians' assessment and management skills. [source] | ||||||||||