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Chronic Pain Syndromes (chronic + pain_syndrome)
Selected AbstractsManagement of Chronic Pain Syndromes: Issues and InterventionsPAIN MEDICINE, Issue 2005Article first published online: 28 JUL 200 First page of article [source] Chronic pain syndromes in the emergency department: Identifying guidelines for managementEMERGENCY MEDICINE AUSTRALASIA, Issue 1 2005Kylie Baker Abstract Objectives:, To explore current literature on chronic pain syndromes and develop ED recommendations for the management and minimalization of chronic non-cancer pain. Methods:, A focused literature review. Results:, Chronic pain is a common presentation to the ED but is poorly understood and managed. Research into the psychophysiology of chronic pain shows that there are definite changes in the receptive and processing pathways in patients suffering chronic pain syndromes. Evidence shows the effectiveness of early recognition with multimodal treatment, however high level evidence is lacking. All experts recommend balanced drug therapy, cognitive and behavioural interventions. Certain interventions are appropriate to the ED setting. Conclusions:, Emergency Medicine lacks a cohesive, informed strategy for management of chronic pain. The proposed guidelines represent the first step toward establishing consistency in the management of patients with chronic pain syndromes. Further work needs to be undertaken at a national level in developing evidence based guidelines. [source] Vulvar Pain: A Phenomenological Study of Couples in Search of Effective Diagnosis and TreatmentFAMILY PROCESS, Issue 2 2008JENNIFER J. CONNOR PH.D. Vulvar vestibulitis syndrome (VVS), a vulvar pain disorder, continues to puzzle medical and mental health professionals due to its unknown etiology and lack of effective treatment. This study used transcendental phenomenology methodology to explore the experiences of couples in which the woman has a diagnosis of VVS. Sixteen in-depth semi-structured interviews were conducted with 13 heterosexual couples and 3 women. Four essences emerged: (1) In search of, the medical journey required extensive searching for knowledgeable and respectful practitioners to provide treatment. (2) The process of developing a personal understanding of this disorder led many couples to question their role in causing and maintaining VVS. (3) Developing strategies for coping with painful intercourse led to three strategies: becoming non-sexual, using alternatives to vaginal sex, and altering or enduring painful intercourse. (4) Feelings of isolation were experienced as adapting to this chronic pain syndrome was often a lonely process. Clinical suggestions included: treating the couple, not just the woman with VVS; encouraging couples to broaden definitions about the importance and primacy of vaginal intercourse and suggest alternative sexual activities less likely to cause vulvar pain; developing shared meaning as a couple, and assisting couples in locating physicians and resources. Suggestions are relevant for couples with VVS and those with chronic health problems affecting sexual relationships. RESUMEN Dolor vulvar: estudio fenomenológico de parejas que buscan un diagnóstico y tratamiento efectivos El síndrome de vestibulitis vulvar (svv), un trastono de dolor vulvar, continúa dejando perplejos a los profesionales de la salud física y mental debido a su etiología desconocida y a la inexistencia de un tratamiento efectivo. Este estudio utilizó metodología fenomenológica experimental para explorar las experiencias de parejas en que a la mujer se le ha diagnosticado el svv. Se llevaron a cabo dieciséis entrevistas (en profundidad y semiestructuradas) con 13 parejas heterosexuales y 3 mujeres, de las que se obtuvieron cuatro conclusiones esenciales: (1) En busca de , la investigación médica requería una búsqueda más exhaustiva de médicos eruditos y respetuosos que aportasen un tratamiento. (2) El proceso de desarrollar una comprensión personal del trastorno condujo a varias parejas a plantearse su papel en la causa y la prolongación del svv. (3) Desarrollar estrategias para afrontar un coito doloroso condujo a tres estrategias: prescindir del sexo, optar por alternativas al sexo vaginal y modificar o soportar el coito doloroso. (4) Se experimentaron sensaciones de aislamiento, pues el proceso de adaptación a este síndrome de dolor crónico resultó, a menudo, un proceso solitario. Entre los consejos clínicos se incluyen tratar a la pareja, y no sólo a la mujer con svv; animar a las parejas a ampliar las definiciones de la importancia y preferencia por el coito vaginal, así como sugerir actividades sexuales con menor riesgo de causar dolor vulvar; desarrollar un significado común como pareja; y ayudar a las parejas a encontrar médicos y recursos. Palabras clave: síndrome de vestibulitis vulvar; dolor vulvar; terapia de pareja. [source] Chronic Pain: Nursing Diagnosis or Syndrome?INTERNATIONAL JOURNAL OF NURSING TERMINOLOGIES AND CLASSIFICATION, Issue 4 2001Diná Almeida Lopes Monteiro Cruz PhD PROBLEM. To explore the existence of a pattern of nursing diagnoses that represents a chronic pain syndrome. METHODS. The nursing diagnoses of 68 oncologic and 46 nononcologic patients with chronic pain were submitted to univariate and multivariate analyses. Diagnoses ranked above the 75th percentile, without association with pain etiology, and presenting a pattern in cluster analyses and multidimensional scaling was accepted as possible components of chronic pain syndrome. FINDINGS. The possible components of chronic pain syndrome were disturbed sleep pattern,a constipation or risk for constipation, deficient knowledge,a impaired physical mobility, and anxiety/fear. CONCLUSIONS. Although a pattern of diagnoses has been proposed, confirmation will require further studies and the exploration of the clinical usefulness of the concept of chronic pain as a syndrome. PRACTICE IMPLICATIONS. Increased skill in the assessment and understanding of chronic pain can result in improved relief strategies. Douleur chronique: Diagnostic infirmier ou syndrome? PROBLÈME. Explorer l'existence d'un regroupement de diagnostics infirmiers représentant le syndrome de douleur chronique (SDC). MÉTHODES. Les diagnostics infirmiers présents chez 68 patients cancéreux et 46 patients non-cancéreux, souffrant de douleur chronique furent soumis à des analyses unidimensionnelles et multidimensionnelles. Les diagnostics qui furent retenus comme composantes possibles du SDC se situaient au dessus du 75e percentile, n'étaient pas associés à l'étiologie et représentaient un ensemble dans les analyses de regroupement et l'échelle multidimensionnelle. RÉSULTATS. Les composantes possibles du SDC furent perturbation des habitudes de sommeil, constipation ou risque de constipation, manque de connaissances, altération de la mobilité et anxiété/peur. CONCLUSIONS. Même si un schéma de diagnostics infirmiers a été proposé, il faudrait encore entreprendre plusieurs recherches et explorer l'utilité clinique du concept syndrome de douleur chronique, avant de confirmer la pertinence de ce syndrome. IMPLICATIONS PRATIQUES. L'amélioration de l'évaluation et de la compréhension de la douleur chronique peut conduire à de meilleures stratégies pour soulager la douleur. PROBLEMA. Explorar a existência de um padrão de diagnósticos de enfermagem que represente uma síndrome de dor crônica. MÉTODOS. Diagnóstics de enfermagem de 68 pacientes com dor crônica oncológica e 46 pacientes com dor crônica não oncológica foram submetidos a análises univariadas e multivariadas. Os diagnóstics posicionados acima do Percentil 75, sem associação com a etiologia da dor e que apresentaram um padrão na Análise de Cluster e no Escalonamento Multidimensional foram aceitos como possíveis componentes da síndrome de dor crónica. RESULTADOS. Os possíveis componentes da síndrome de dor crônica foram: distúrbio do padrão de sono, cnstipação ou risco para constipação, déficit de conhecimento, mobilidade física prejudicada e ansiedade/medo. CONCLUSÕES. Apesar de um padrão de diagnósticos ter sido proposto, a sua confirmação requer outros estudos e a exploração da utilidade clínica de se conceituar a dor crônica como uma síndrome. IMPLIAÇÕES PRÁTICAS. Melhorar a compreensão e as habilidades na avaliação da dor crônica pode resultar em melhores estratégias de alívio. Dolor crónico: Diagnóstico enfermero o síndrome? PROBLEMA. Explorar la existencia de un patrón diagnóstico de enfermería que represente el síndrome de dolor crónico (SDC). MÉTODOS. Los diagnósticos enfermeros de 68 pacientes oncológicos y 46 no-oncológicos con dolor crónico, se sometieron a análisis variable y multivariable. Se aceptaron como posibles componentes del SDC, los diagnósticos que estaban sobre el percentil 75, sin asociación con etiología de dolor y que presentaban un patrón agrupado al hacer el análisis y en la escala multidimensional. RESULTADOS. Los posibles componentes de SDC fueron alteración del patrón del sueño, estreñimiento o riesgo de estreñimiento, déficit de conocimientos, trastorno de la movilidad física y ansiedad/temor. CONCLUSIONES. Aunque un patrón de diagnósticos ha sido propuesto, la confirmación requerirá que se llevan más allá los estudios y la exploración de la utilidad clínica del concepto del dolor crónico, como un síndrome. IMPLICACIONES PARA LA PRÁCTICA. Mejorar la habilidad en la valoración y comprensión del dolor crónico pueden producir mejoras en las estrategias de alivio. [source] Intrinsic brain connectivity in fibromyalgia is associated with chronic pain intensity,ARTHRITIS & RHEUMATISM, Issue 8 2010Vitaly Napadow Objective Fibromyalgia (FM) is considered to be the prototypical central chronic pain syndrome and is associated with widespread pain that fluctuates spontaneously. Multiple studies have demonstrated altered brain activity in these patients. The objective of this study was to investigate the degree of connectivity between multiple brain networks in patients with FM, as well as how activity in these networks correlates with the level of spontaneous pain. Methods Resting-state functional magnetic resonance imaging (FMRI) data from 18 patients with FM and 18 age-matched healthy control subjects were analyzed using dual-regression independent components analysis, which is a data-driven approach for the identification of independent brain networks. Intrinsic, or resting-state, connectivity was evaluated in multiple brain networks: the default mode network (DMN), the executive attention network (EAN), and the medial visual network (MVN), with the MVN serving as a negative control. Spontaneous pain levels were also analyzed for covariance with intrinsic connectivity. Results Patients with FM had greater connectivity within the DMN and right EAN (corrected P [Pcorr] < 0.05 versus controls), and greater connectivity between the DMN and the insular cortex, which is a brain region known to process evoked pain. Furthermore, greater intensity of spontaneous pain at the time of the FMRI scan correlated with greater intrinsic connectivity between the insula and both the DMN and right EAN (Pcorr < 0.05). Conclusion These findings indicate that resting brain activity within multiple networks is associated with spontaneous clinical pain in patients with FM. These findings may also have broader implications for how subjective experiences such as pain arise from a complex interplay among multiple brain networks. [source] Chronic pain syndromes in the emergency department: Identifying guidelines for managementEMERGENCY MEDICINE AUSTRALASIA, Issue 1 2005Kylie Baker Abstract Objectives:, To explore current literature on chronic pain syndromes and develop ED recommendations for the management and minimalization of chronic non-cancer pain. Methods:, A focused literature review. Results:, Chronic pain is a common presentation to the ED but is poorly understood and managed. Research into the psychophysiology of chronic pain shows that there are definite changes in the receptive and processing pathways in patients suffering chronic pain syndromes. Evidence shows the effectiveness of early recognition with multimodal treatment, however high level evidence is lacking. All experts recommend balanced drug therapy, cognitive and behavioural interventions. Certain interventions are appropriate to the ED setting. Conclusions:, Emergency Medicine lacks a cohesive, informed strategy for management of chronic pain. The proposed guidelines represent the first step toward establishing consistency in the management of patients with chronic pain syndromes. Further work needs to be undertaken at a national level in developing evidence based guidelines. [source] Dissociable neural activity to self- vs. externally administered thermal hyperalgesia: a parametric fMRI studyEUROPEAN JOURNAL OF NEUROSCIENCE, Issue 3 2008C. Mohr Abstract Little is known regarding how cognitive strategies help to modulate neural responses of the human brain in ongoing pain syndromes to alleviate pain. Under pathological pain conditions, any self-elicited contact with usually non-painful stimuli may become painful. We examined whether the human brain is capable of dissociating self-controlled from externally administered thermal hyperalgesia in the experimental capsaicin model. Using functional magnetic resonance imaging, 17 male subjects were investigated in a parametric design with heat stimuli at topically capsaicin-sensitized skin. In contrast to external stimulation, self-administered pain was controllable. For both conditions application trials without noticeable thermal stimulation were introduced and used as high-level baseline (HLB) to account for the capsaicin-induced ongoing pain and other covariables. Following subtraction of the HLB, the anterior insula and the anterior cingulate cortex (ACC) but not the somatosensory cortices maintained parametric neural responses to thermal hyperalgesia. A stronger pain-related activity increase during self-administered stimuli was observed in the posterior insula. In contrast, prefrontal cortex showed stronger increases to uncontrollable external heat stimuli. In the state of ongoing pain (capsaicin), pain-intensity-encoding regions (anterior insula, ACC) but not those with sensory discriminative functions (SI, SII) showed graded, pain-intensity-related neural responses in thermal hyperalgesia. Some areas were able to dissociate between self- and externally administered stimuli in thermal hyperalgesia, which might be related to differences in perceived controllability. Thus, neural mechanisms maintain the ability to dissociate external from self-generated states of injury in thermal hyperalgesia. This may help to understand how cognitive strategies potentially alleviate chronic pain syndromes. [source] Allodynia in Migraine: Association With Comorbid Pain ConditionsHEADACHE, Issue 9 2009Gretchen E. Tietjen MD Background., Cutaneous allodynia (CA) in migraine is a clinical manifestation of central nervous system sensitization. Several chronic pain syndromes and mood disorders are comorbid with migraine. In this study we examine the relationship of migraine-associated CA with these comorbid conditions. We also evaluate the association of CA with factors such as demographic profiles, migraine characteristics, and smoking status that may have an influence on the relationships of CA to pain and mood. Methods., Data are from a cross-sectional multicenter study of comorbid conditions in persons seeking treatment in headache clinics. Diagnosis of migraine was determined by a physician based on the International Classification of Headache Disorders-II criteria. Participants completed a self-administered questionnaire ascertaining sociodemographics, migraine-associated allodynia, physician-diagnosed comorbid medical and psychiatric disorders, headache-related disability, current depression, and anxiety. Results., A total of 1413 migraineurs (mean age = 42 years, 89% women) from 11 different headache treatment centers completed a survey on the prevalence of comorbid conditions. Aura was reported by 38% and chronic headache by 35% of the participants. Sixty percent of the study population reported at least one migraine-related allodynic symptom, 10% reported ,4 symptoms. Symptoms of CA were associated with female gender, body mass index, current smoking, presence of aura, chronic headaches, transformed headaches, severe headache-related disability, and duration of migraine illness from onset. The prevalence of self-reported physician diagnosis of comorbid pain conditions (irritable bowel syndrome, chronic fatigue syndrome, fibromyalgia) and psychiatric conditions (current depression and anxiety) was also associated with symptoms of CA. Adjusted ordinal regression indicated a significant association between number of pain conditions and severity of CA (based on symptom count). Adjusting for sociodemographics, migraine characteristics, and current depression and anxiety, the likelihood of reporting symptoms of severe allodynia was much higher in those with 3 or more pain conditions (odds ratio = 3.03, 95% confidence interval: 1.78-5.17), and 2 pain conditions (odds ratio = 2.67, 95% confidence interval: 1.78-4.01) when compared with those with no comorbid pain condition. Conclusion., Symptoms of CA in migraine were associated with current anxiety, depression, and several chronic pain conditions. A graded relationship was observed between number of allodynic symptoms and the number of pain conditions, even after adjusting for confounding factors. This study also presents the novel association of CA symptoms with younger age of migraine onset, and with cigarette smoking, in addition to confirming several previously reported findings. [source] Chronic Pain in the Cancer Survivor: A New FrontierPAIN MEDICINE, Issue 2 2007Allen W. Burton MD ABSTRACT Objective., This monograph is intended to clarify the clinical problem of chronic pain in cancer patients. Design., A pertinent literature review on chronic pain syndromes in cancer patients was undertaken using Medline. Further, the treatment strategies for cancer versus chronic pain are contrasted and clarified. Results., With increasing cancer survivorship come new challenges in patient care. In the United States, the cancer-related death rate has dropped by 1.1% per year from 1993,2002. Seventy-five percent of children and two out of three adults will survive cancer, whereas 50 years ago just one out of four survived. The net effect of these trends and opportunities is a large and rapidly growing population of persons living longer with cancer and/or as cancer survivors. While agreement exists on the best strategies for assessment and treatment of most acute cancer pain syndromes, little consensus exists on the treatment of chronic pain in the patient with slowly progressive cancer or the cancer survivor. Conclusions., The landscape of "cancer pain" is shifting quickly into a chronic pain situation in many instances, thereby blurring previous lines of distinction in treatment strategies most suited for "chronic" versus "malignant" pain. Adopting chronic pain treatment strategies including pharmacologic and other pain control techniques, rehabilitation care, and psychological coping strategies may lead to optimal outcomes. Lastly, as cancer evolves into a chronic illness, with co-morbid conditions, recurrent cancer, and treatment toxicities from repeated antineoplastic therapies, pain management challenges in the oncologic patient continue to increase in complexity. [source] The effects of experimental muscle and skin pain on the static stretch sensitivity of human muscle spindles in relaxed leg musclesTHE JOURNAL OF PHYSIOLOGY, Issue 11 2008Ingvars Birznieks Animal studies have shown that noxious inputs onto ,-motoneurons can cause an increase in the activity of muscle spindles, and it has been proposed that this causes a fusimotor-driven increase in muscle stiffness that is believed to underlie many chronic pain syndromes. To test whether experimental pain also acts on the fusimotor system in humans, unitary recordings were made from 19 spindle afferents (12 Ia, 7 II) located in the ankle and toe extensors or peronei muscles of awake human subjects. Muscle pain was induced by bolus intramuscular injection of 0.5 ml 5% hypertonic saline into tibialis anterior (TA); skin pain was induced by 0.2 ml injection into the overlying skin. Changes in fusimotor drive to the muscle spindles were inferred from changes in the mean discharge frequency and discharge variability of spindle endings in relaxed muscle. During muscle pain no afferents increased their discharge activity: seven afferents (5 Ia, 2 II) showed a decrease and six (4 Ia, 2 II) afferents were not affected. During skin pain of 13 afferents discharge rate increased in one (Ia) and decreased in two (1 Ia, 1 II). On average, the overall discharge rate decreased during muscle pain by 6.1% (P < 0.05; Wilcoxon), but remained essentially the same during skin pain. There was no detectable correlation between subjective pain level and the small change in discharge rate of muscle spindles. Irrespective of the type of pain, discharge variability parameters were not influenced (P > 0.05; Wilcoxon). We conclude that, contrary to the ,vicious cycle' hypothesis, acute activation of muscle or skin nociceptors does not cause a reflex increase in fusimotor drive in humans. Rather, our results are more aligned with the pain adaptation model, based on clinical studies predicting pain-induced reductions of agonist muscle activity. [source] | |||||||||||||