DOCSLIB.ORG

Chronic Pain: Treatment Barriers and Strategies for Clinical Practice

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Chronic Pain: Treatment Barriers and Strategies for Clinical Practice MEDICAL PRACTICE Chronic Pain: Treatment Barriers and Strategies for J Am Board Fam Pract: first published as on 1 May 2001. Downloaded from Clinical Practice Myra Glajchen, DSW Background: Chronic pain is a clinical challenge for the practicing physician. Lack of knowledge about opioids, negative attitudes toward prescribing opioids, and inadequate pain-assessment skills combine to create major barriers to pain relief. Patient-related barriers, such as lack of communication and un- warranted fears of addiction, further complicate pain assessment and treatment. The health care system itself can hinder pain relief through practical constraints in the community and fear of regulatory scru- tiny by the physician. Methods: Information was gathered by doing a literature search, collating clinical information from practice and additional research findings from national meetings, and reviewing the Bulletin of the American Pain Society. Key search terms included “pain,” “chronic pain,” “pain management,” “pain assessment,” “pain treatment,” and “barriers to pain management.” Results and Conclusions: Concrete steps for the clinician engaged in the treatment of chronic pain include selection and administration of an effective opioid, dose titration, short- vs long-acting opioids, opioid rotation, ongoing assessment, and consideration of patient preferences. In addition, communica- tion, coping behaviors, and pain education play important roles in the pain equation. (J Am Board Fam Pract 2001;14:211–18.) The prevalence of chronic pain among adults in the For all these reasons, it is essential that primary United States has been estimated to range from 2% care physicians become knowledgeable in the area http://www.jabfm.org/ to 40% of the general population1–3 and from 45% of pain management. Because pain is such a sub- to 80% among nursing home patients,4 and it has jective experience, influenced by a host of nonmed- been found in up to 75% of patients with advanced ical factors, including age, sex, culture, communi- cancer.5 Because more than 40% to 50% of pa- cation style, and fear of addiction, these tients in routine practice settings fail to achieve demographic and behavioral barriers must be con- sidered in assessment and treatment.9,10 This arti- adequate relief, chronic pain is now considered to on 2 October 2021 by guest. Protected copyright. be a public health problem of major proportions.6 cle presents an overview of the major barriers to Chronic pain can dramatically affect quality of life, chronic pain management, with strategies for over- a multidimensional concept that includes physical, coming them in clinical practice. psychological, spiritual, and social domains.7 Un- remitting pain is associated with anxiety, depres- Methods sion, loss of independence, and interference with Information was gathered by doing a literature search, collating clinical information from practice, work and relationships. The annual cost of chronic as well as additional research findings from national pain, including medical expenses, lost income, and meetings, and referring to the Bulletin of the Amer- lost productivity, is an estimated $100 billion.3,8 ican Pain Society. Key search terms included “pain,” “chronic pain,” “pain management,” “pain assess- ment,” “pain treatment,” and “barriers to pain Submitted, revised, 3 December 2000. From the Institute for Education and Research in Pain management.” and Palliative Care (MG), Department of Pain Medicine and Palliative Care, Beth Israel Medical Center, New York. Address reprint requests to Myra Glajchen, DSW, Institute Barriers to Effective Pain Management for Education and Research in Pain and Palliative Care, Undertreatment of Pain Beth Israel Medical Center, Department of Pain Medicine and Palliative Care, First Avenue at 16th Street, New York, In a recent study of 805 chronic pain sufferers, it NY 10003. was reported that more than 50% found it neces- Chronic Pain 211 sary to change physicians in their quest for pain Cooperative Oncology Group, and all had patient relief. Specific reasons for changing physicians in- care responsibilities. Approximately three fourths cluded lack of physicians’ willingness to treat the of the physicians (76%) cited their own sense of low J Am Board Fam Pract: first published as on 1 May 2001. Downloaded from pain aggressively, failure to take the pain seriously, competence in patient assessment as the major bar- and lack of knowledge about pain management.3 In rier to effective pain management. Reluctance to a study of 1,308 outpatients with metastatic can- prescribe opioids was cited by 61% of the respon- cer,11 67% (871) of the patients reported that they dents as the second most important barrier.15 had pain or had taken analgesic drugs daily during These clinician-related barriers have been borne the week preceding the study, and 36% (475) had out by subsequent research, and they tend to be pain severe enough to impair their ability to func- compounded in the treatment of nonmalignant tion. Forty-two percent of those with pain were not pain.12 given adequate analgesic therapy. A discrepancy between patient and physician in judging the sever- Patient-Related Barriers ity of the patient’s pain was predictive of inadequate Patient-related barriers include communication, pain management. One third of practitioners re- psychological, and attitudinal issues. In a sample ported that they would wait until the patient had survey of cancer patients receiving services from an less than 6 months to live before starting the max- outpatient social service agency, patients who re- imal tolerated analgesia for severe pain. ported communication problems with their physi- Although opioid use in the treatment of chronic cians had significantly worse pain than those who cancer pain has gained increasing acceptance did not.18 Several psychological factors can influ- worldwide, the debate continues regarding the use ence pain assessment and treatment, such as anxi- of these analgesics in the treatment of chronic non- ety, distress, depression, anger, and dementia, all of malignant pain.2,12,13 A recent review concludes which can complicate assessment by masking symp- that the reluctance to use opioids for noncancer toms. Ward and colleagues19 measured the extent pain treatment has resulted in ineffective relief for to which patients’ attitudes toward pain and opioids a large group of patients. Several researchers have pose barriers to treatment. Fear of addiction, tol- found physician resistance to treating chronic non- erance, and side effects were described by patients http://www.jabfm.org/ malignant pain with opioids. Regulatory concerns, as their most important concerns. Fatalism and the beliefs about the inevitability of tolerance, concern desire to please the clinician were also cited by a about long-term safety and durability of response— majority of respondents. Some patients expressed all combine to reduce the willingness of primary the belief that pain was inevitable, indicating that care physicians to prescribe opioids for chronic they did not expect medication to relieve their pain. 14 nonmalignant pain. In addition, patients associated pain with worsening on 2 October 2021 by guest. Protected copyright. disease. Such concerns can result in patients’ reluc- Clinician Barriers tance to report pain or comply with a regimen that Gaps in knowledge, negative attitudes toward pre- involves opioid medication. scribing opioids, inadequate assessment skills, and timidity in prescribing are barriers that clinicians Health Care System Barriers can unwittingly bring to clinical encounters with The health care system itself can pose barriers to patients.15,16 The problem might begin with the effective pain relief in the form of practical con- low priority given to pain treatment in medical straints. The lack of a neighborhood pharmacy, the schools and residency training programs. When lack of transportation to the physician or pharmacy, asked about their training in pain management, an absence of high doses of opioids at the phar- 88% of physicians reported that their medical macy, and the lack of a home caregiver to assist school education in pain management was poor, with administering drugs pose major obstacles to and 73% reported that residency training was fair pain treatment. Changes in reimbursement policies or poor.15,17 In a study of physician attitudes and impose barriers, especially for older patients whose practice, Von Roenn and associates15 asked physi- Medicare benefits do not pay the costs of outpatient cians to describe barriers to pain relief in their prescription drugs.20 In addition, patients and care- practice settings. The 897 physicians who com- givers might confront increasing co-payments, out- pleted the survey were members of the Eastern of-pocket expenses, limits on the number of pre- 212 JABFP May–June 2001 Vol. 14 No. 3 scriptions filled per month, and limits on refills. Race Finally, fear of regulatory scrutiny for prescribing In the same study, the percentage of patients with controlled substances has been shown to discourage negative scores was three times higher in commu- J Am Board Fam Pract: first published as on 1 May 2001. Downloaded from physicians from prescribing opioids of sufficient nity clinical oncology programs that treated pre- strength for the patient’s pain, especially for dominantly minority patients, primarily African chronic nonmalignant pain.11 Such fears can result Americans and Hispanics. Minority patients were in the selection
Load more

Recommended publications
  • Pain Management of Inmates
    PAIN MANAGEMENT OF INMATES Federal Bureau of Prisons Clinical Guidance JUNE 2018 Federal Bureau of Prisons (BOP) Clinical Guidance is made available to the public for informational purposes only. The BOP does not warrant this guidance for any other purpose, and assumes no responsibility for any injury or damage resulting from the reliance thereof. Proper medical practice necessitates that all cases are evaluated on an individual basis and that treatment decisions are patient- specific. Consult the BOP Health Management Resources Web page to determine the date of the most recent update to this document: http://www.bop.gov/resources/health_care_mngmt.jsp Federal Bureau of Prisons Pain Management of Inmates Clinical Guidance June 2018 TABLE OF CONTENTS 1. PURPOSE OF THIS GUIDANCE.................................................................................................................. 1 2. INTRODUCTION TO PAIN MANAGEMENT IN THE BOP .................................................................................. 1 The Prevalence of Chronic Pain ........................................................................................................ 1 General Principles of Pain Management in the BOP .......................................................................... 2 Multiple Dimensions of Pain Management ................................................................................... 2 Interdisciplinary Pain Rehabilitation (IPR) .................................................................................... 2 Roles
    [Show full text]
  • DSM-IV Pain Disorder in the General Population an Exploration of the Structure and Threshold of Medically Unexplained Pain Symptoms
    DSM-IV pain disorder in the general population An exploration of the structure and threshold of medically unexplained pain symptoms Christine Fröhlich,· Frank Jacobi, Hans-Ulrich Wittchen Received: 18 March 2005 / Accepted: 12 September 2005 / Published online: 18 November 2005 Abstract Background Despite an abundance of questionnaire data, the prevalence of clinically significant and medically unexplained pain syndromes in the general population has rarely been examined with a rigid personal-interview methodology. Objective To examine the prevalence of pain syndromes and DSM- IV pain disorder in the general population and the association with other mental disorders, as well as effects on disability and health-care utilization. Methods Analyses were based on a community sample of 4.181 participants 18–65 years old; diagnostic variables were assessed with a standardized diagnostic interview (M-CIDI). Results The 12-month prevalence for DSM-IV pain disorder in the general population was 8.1%; more than 53% showed concurrent anxiety and mood disorders. Subjects with pain disorder revealed significantly poorer quality of life, greater disability, and higher health-care utilization rates compared to cases with pain below the diagnostic threshold. The majority had more than one type of pain, with excessive headache being the most frequent type. Conclusions Even when stringent diagnostic criteria are used, pain disorder ranks among the most prevalent conditions in the community. The joint effects of high prevalence in all age groups, substantial disability, and increased health services utilization result in a substantial total burden, exceeding that of depression and anxiety. Key words: DSM-IV pain disorder, pain syndromes, comorbidity, impairment, Composite International Diagnostic Interview (CIDI) Introduction Chronic pain is well known as a highly prevalent condition in the general population.
    [Show full text]
  • Fibromyalgia in Migraine: a Retrospective Cohort Study Mark Whealy1* , Sanjeev Nanda2, Ann Vincent2, Jay Mandrekar3 and F
    Whealy et al. The Journal of Headache and Pain (2018) 19:61 The Journal of Headache https://doi.org/10.1186/s10194-018-0892-9 and Pain SHORT REPORT Open Access Fibromyalgia in migraine: a retrospective cohort study Mark Whealy1* , Sanjeev Nanda2, Ann Vincent2, Jay Mandrekar3 and F. Michael Cutrer1 Abstract Background: Migraine is a common and disabling disorder. Fibromyalgia has been shown to be commonly comorbid in patients with migraine and can intensify disability. The aim of this study was to determine if patients with co-morbid fibromyalgia and migraine report more depressive symptoms, have more headache related disability, or report higher intensity of headache as compared to patients with migraine only. Cases of comorbid fibromyalgia and migraine were identified using a prospectively maintained headache database at Mayo Clinic Rochester. One-hundred and fifty seven cases and 471 controls were identified using this database and the Mayo Clinic electronic medical record. Findings: Depressive symptoms as assessed by PHQ-9, intensity of headache, and migraine related disability as assessed by MIDAS were primary measures used to compare migraine patients with comorbid fibromyalgia versus those without. Patients with comorbid fibromyalgia reported significantly higher PHQ-9 scores (OR 1.08, p < .0001) and headache intensity scores (OR 1.149, p = .007). There was no significant difference in migraine related disability (OR 1.002, p = .075). Patients with fibromyalgia were more likely to score in a higher category of depression severity (OR 1.467, p < .0001) and more likely to score in a higher category of migraine related disability (OR 1.23, p = .004).
    [Show full text]
  • Pain Management & Palliative Care
    Guidelines on Pain Management & Palliative Care A. Paez Borda (chair), F. Charnay-Sonnek, V. Fonteyne, E.G. Papaioannou © European Association of Urology 2013 TABLE OF CONTENTS PAGE 1. INTRODUCTION 6 1.1 The Guideline 6 1.2 Methodology 6 1.3 Publication history 6 1.4 Acknowledgements 6 1.5 Level of evidence and grade of guideline recommendations* 6 1.6 References 7 2. BACKGROUND 7 2.1 Definition of pain 7 2.2 Pain evaluation and measurement 7 2.2.1 Pain evaluation 7 2.2.2 Assessing pain intensity and quality of life (QoL) 8 2.3 References 9 3. CANCER PAIN MANAGEMENT (GENERAL) 10 3.1 Classification of cancer pain 10 3.2 General principles of cancer pain management 10 3.3 Non-pharmacological therapies 11 3.3.1 Surgery 11 3.3.2 Radionuclides 11 3.3.2.1 Clinical background 11 3.3.2.2 Radiopharmaceuticals 11 3.3.3 Radiotherapy for metastatic bone pain 13 3.3.3.1 Clinical background 13 3.3.3.2 Radiotherapy scheme 13 3.3.3.3 Spinal cord compression 13 3.3.3.4 Pathological fractures 14 3.3.3.5 Side effects 14 3.3.4 Psychological and adjunctive therapy 14 3.3.4.1 Psychological therapies 14 3.3.4.2 Adjunctive therapy 14 3.4 Pharmacotherapy 15 3.4.1 Chemotherapy 15 3.4.2 Bisphosphonates 15 3.4.2.1 Mechanisms of action 15 3.4.2.2 Effects and side effects 15 3.4.3 Denosumab 16 3.4.4 Systemic analgesic pharmacotherapy - the analgesic ladder 16 3.4.4.1 Non-opioid analgesics 17 3.4.4.2 Opioid analgesics 17 3.4.5 Treatment of neuropathic pain 21 3.4.5.1 Antidepressants 21 3.4.5.2 Anticonvulsant medication 21 3.4.5.3 Local analgesics 22 3.4.5.4 NMDA receptor antagonists 22 3.4.5.5 Other drug treatments 23 3.4.5.6 Invasive analgesic techniques 23 3.4.6 Breakthrough cancer pain 24 3.5 Quality of life (QoL) 25 3.6 Conclusions 26 3.7 References 26 4.
    [Show full text]
  • Factsheet: Chronic Pain and Related Functional Impairment Interagency Collaboration
    SHNIC Specialized Health Needs Factsheet: Chronic Pain and Related Functional Impairment Interagency Collaboration What is it? Pediatric chronic can present in a variety of ways and often overlaps with psychological effects. It represents a developmental health issues because of its ability to significantly impair a student’s functional ability. Chronic pain can be persistent and episodic with both an underlying health condition (E.g. Sickle cell disease) and pain that is the pain disorder itself (E.g. Complex Regional Pain Disorder.) The symptoms extend beyond the expected healing period and is commonly described as persisting for at least 3 months. The three most common pain disorders in children include primary headaches, abdominal pain, and recurrent musculoskeletal and joint pain. A child’s developmental perspective affects how he/she will perceive and respond to pain. Psychological variables influencing pain prevalence include anxiety, depression, low self esteem, low socio-economic status, and other chronic health conditions. Chronic pain may peak during adolescence; related to puberty and the physical, emotional, social, and cognitive changes during this stage. Pediatric chronic pain can affect all aspects of daily living including appetite, sleep, socialization, school attendance, academic performance, and peer relationships. A child’s perception of pain and response to pain can also be influenced by parental characteristics like emotional function, behavior, health history, and environment. Pediatric chronic pain can also surface without clear medical evidence to a broader syndrome or condition. Functional somatic symptoms, like pain and fatigue, are physical symptoms not fully explained by a well-defined medical psychiatric or somatic illness. A growing number of patients are seeking pain treatments for sensory processing disorders.
    [Show full text]
  • Chronic Pelvic Pain & Pelvic Floor Myalgia Updated
    Welcome to the chronic pelvic pain and pelvic floor myalgia lecture. My name is Dr. Maria Giroux. I am an Obstetrics and Gynecology resident interested in urogynecology. This lecture was created with Dr. Rashmi Bhargava and Dr. Huse Kamencic, who are gynecologists, and Suzanne Funk, a pelvic floor physiotherapist in Regina, Saskatchewan, Canada. We designed a multidisciplinary training program for teaching the assessment of the pelvic floor musculature to identify a possible muscular cause or contribution to chronic pelvic pain and provide early referral for appropriate treatment. We then performed a randomized trial to compare the effectiveness of hands-on vs video-based training methods. The results of this research study will be presented at the AUGS/IUGA Joint Scientific Meeting in Nashville in September 2019. We found both hands-on and video-based training methods are effective. There was no difference in the degree of improvement in assessment scores between the 2 methods. Participants found the training program to be useful for clinical practice. For both versions, we have designed a ”Guide to the Assessment of the Pelvic Floor Musculature,” which are cards with the anatomy of the pelvic floor and step-by step instructions of how to perform the assessment. In this lecture, we present the video-based training program. We have also created a workshop for the hands-on version. For more information about our research and workshop, please visit the website below. This lecture is designed for residents, fellows, general gynecologists,
    [Show full text]
  • Pain: Assessment, Non-Opioid Treatment Approaches and Opioid Management
    Health Care Guideline Pain: Assessment, Non-Opioid Treatment Approaches and Opioid Management How to Cite this Document Hooten M, Thorson D, Bianco J, Bonte B, Clavel Jr A, Hora J, Johnson C, Kirksson E, Noonan MP, Reznikoff C, Schweim K, Wainio J, Walker N. Institute for Clinical Systems Improvement. Pain: Assess- ment, Non-Opioid Treatment Approaches and Opioid Management. Updated August 2017. ICSI Members, Sponsors and organizations delivering care within Minnesota borders, may use ICSI documents in the following ways: • ICSI Health Care Guidelines and related products (hereinafter “Guidelines”) may be used and distributed by ICSI Member and Sponsor organizations as well as organizations delivering care within Minnesota borders. The guidelines can be used and distributed within the organization, to employees and anyone involved in the organization’s process for developing and implementing clinical guidelines. • ICSI Sponsor organizations can distribute the Guidelines to their enrollees and those care delivery organizations a sponsor holds insurance contracts with. • Guidelines may not be distributed outside of the organization, for any other purpose, without prior written consent from ICSI. • The Guidelines may be used only for the purpose of improving the health and health care of Member’s or Sponsor’s own enrollees and/or patients. • Only ICSI Members and Sponsors may adopt or adapt the Guidelines for use within their organizations. • Consent must be obtained from ICSI to prepare derivative works based on the Guidelines. • Appropriate attribution must be given to ICSI on any and all print or electronic documents that reference the Guidelines. All other copyright rights for ICSI Health Care Guidelines are reserved by the Institute for Clinical Systems Improvement.
    [Show full text]
  • A Matter of Record (301) 890-4188 FOOD and DRUG
    1 1 FOOD AND DRUG ADMINISTRATION 2 CENTER FOR DRUG EVALUATION AND RESEARCH 3 4 5 JOINT MEETING OF THE ANESTHETIC AND ANALGESIC 6 DRUG PRODUCTS ADVISORY COMMITTEE (AADPAC) 7 AND THE DRUG SAFETY AND RISK MANAGEMENT 8 ADVISORY COMMITTEE (DSaRM) AND THE 9 PEDIATRIC ADVISORY COMMITTEE (PAC) 10 11 Friday, September 16, 2016 12 8:07 a.m. to 2:39 p.m. 13 14 15 FDA White Oak Campus 16 10903 New Hampshire Avenue 17 Building 31 Conference Center 18 The Great Room (Rm. 1503) 19 Silver Spring, Maryland 20 21 22 A Matter of Record (301) 890-4188 2 1 Meeting Roster 2 DESIGNATED FEDERAL OFFICER (Non-Voting) 3 Stephanie L. Begansky, PharmD 4 Division of Advisory Committee and Consultant 5 Management 6 Office of Executive Programs, CDER, FDA 7 8 ANESTHETIC AND ANALGESIC DRUG PRODUCTS ADVISORY 9 COMMITTEE MEMBERS (Voting) 10 Brian T. Bateman, MD, MSc 11 Associate Professor of Anesthesia 12 Division of Pharmacoepidemiology and 13 Pharmacoeconomics 14 Department of Medicine 15 Brigham and Women’s Hospital 16 Department of Anesthesia, Critical Care, and Pain 17 Medicine 18 Massachusetts General Hospital 19 Harvard Medical School 20 Boston, Massachusetts 21 22 A Matter of Record (301) 890-4188 3 1 Raeford E. Brown, Jr., MD, FAAP 2 (Chairperson) 3 Professor of Anesthesiology and Pediatrics 4 College of Medicine 5 University of Kentucky 6 Lexington, Kentucky 7 8 David S. Craig, PharmD 9 Clinical Pharmacy Specialist 10 Department of Pharmacy 11 H. Lee Moffitt Cancer Center & Research Institute 12 Tampa, Florida 13 14 Charles W. Emala, Sr., MS, MD 15 Professor and Vice-Chair for Research 16 Department of Anesthesiology 17 Columbia University College of Physicians & 18 Surgeons 19 New York, New York 20 21 22 A Matter of Record (301) 890-4188 4 1 Anita Gupta, DO, PharmD 2 (via telephone on day 1) 3 Vice Chair and Associate Professor 4 Division of Pain Medicine & Regional 5 Anesthesiology 6 Department of Anesthesiology 7 Drexel University College of Medicine 8 Philadelphia, Pennsylvania 9 10 Jennifer G.
    [Show full text]
  • Co-Players in Chronic Pain: Neuroinflammation and the Tryp- Tophan-Kynurenine Metabolic Pathway
    Preprints (www.preprints.org) | NOT PEER-REVIEWED | Posted: 4 June 2021 doi:10.20944/preprints202106.0128.v1 Review Co-players in Chronic Pain: Neuroinflammation and the Tryp- tophan-Kynurenine Metabolic Pathway Masaru Tanaka1,2, Nóra Török1,2, Fanni Tóth2, László Vécsei1,2,* 1 MTA-SZTE, Neuroscience Research Group, Semmelweis u. 6, Szeged, H-6725 Hungary 2 Department of Neurology, Interdisciplinary Excellence Centre, Faculty of Medicine, University of Szeged, Semmelweis u. 6, H-6725 Szeged, Hungary * Correspondence: [email protected]; Tel.: +36-62-545-351 Abstract: Chronic pain is an unpleasant sensory and emotional experience that persists or recurs more than three months and may extend beyond the expected time of healing. Recently nociplastic pain has been introduced as a descriptor of mechanism of pain, which is due to disturbance of neural processing without actual or potential tissue damage, appearing to replace a concept of psychogenic pain. An interdisciplinary task force of the International Association for the Study of Pain (IASP) compiled a systematic classification of clinical conditions associated with chronic pain, which was published in 2018 and will officially come into effect in 2022 in the 11th revision of the International Statistical Classification of Diseases and Related Health Problems (ICD-11) by the World Health Organization. ICD-11 offers the option for recording the presence of psychological or social factors in chronic pain; however, cognitive, emotional, and social dimensions in the patho- genesis of chronic pain are missing. Earlier pain disorder was defined as a condition with chronic pain associated with psychological factors, but it was replaced with somatic symptom disorder with predominant pain in Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5) in 2013.
    [Show full text]
  • Pain Management Clinical Practice Guideline Hs-1064
    PAIN MANAGEMENT CLINICAL PRACTICE GUIDELINE HS-1064 Pain Management Clinical Practice Guideline OBJECTIVE The objective of this Clinical Practice Guideline (CPG) is to provide evidence-based practice recommendations for the management of pain. The CPG discusses the assessment and treatment of acute and chronic, neuropathic and nociceptive pain, as well as behavioral health implications of chronic pain. In addition, the CPG outlines the organizations that WellCare aligns with regarding pain management and relevant Measurements of Compliance and Measureable Health Outcomes. WellCare has a separate “Palliative Care (HS-1045)” Clinical Practice Guideline that more broadly addresses best-practices for improving quality of life and anticipating/minimizing suffering caused by a chronic and / or life-threatening illness. OVERVIEW Pain is cited as the most common reason Americans seek health care and is a major contributor to health care costs. Approximately one in every four Americans has suffered from pain lasting longer than 24 hours, and an estimated 25 million adults (11%) have reported a pain event that occurred every day for at least a 3-month period. Chronic pain is the most common cause of long-term disability.1,2 Pain is defined by the International Association for the Study of Pain as “an unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage."3 The characterization of pain as a temporal process (continuum of pain) begins with an acute stage and potentially progresses to a chronic state:4 • Acute pain: a time limited and expected physiologic effect of trauma, disease, surgery or illness that may progress to a chronic pathological state4 • Chronic Pain: a complex biopsychosocial condition that has a distinct pathology with biological, psychological, and cognitive correlates that may interfere with many aspects of a person’s life (high impact chronic pain)4 Pain is categorized along various dimensions; one of the most useful is the division of nociceptive vs.
    [Show full text]
  • Neck Pain, Joint Quality of Life (2)
    National Health Statistics Reports Number 98 October 12, 2016 Use of Complementary Health Approaches for Musculoskeletal Pain Disorders Among Adults: United States, 2012 by Tainya C. Clarke, M.P.H., Ph.D., National Center for Health Statistics; Richard L. Nahin, M.P.H., Ph.D., National Institutes of Health; Patricia M. Barnes, M.A., National Center for Health Statistics; and Barbara J. Stussman, National Institutes of Health Abstract Introduction Objective—This report examines the use of complementary health approaches Pain is a leading cause of disability among U.S. adults aged 18 and over who had a musculoskeletal pain disorder. and a major contributor to health care Prevalence of use among this population subgroup is compared with use by persons utilization (1). Pain is often associated without a musculoskeletal disorder. Use for any reason, as well as specifically to treat with a wide range of injury and disease. musculoskeletal pain disorders, is examined. It is also costly to the United States, not Methods—Using the 2012 National Health Interview Survey, estimates of the just in terms of health care expenses use of complementary health approaches for any reason, as well as use to treat and disability compensation, but musculoskeletal pain disorders, are presented. Statistical tests were performed to also with respect to lost productivity assess the significance of differences between groups of complementary health and employment, reduced incomes, approaches used among persons with specific musculoskeletal pain disorders. lost school days, and decreased Musculoskeletal pain disorders included lower back pain, sciatica, neck pain, joint quality of life (2). The focus of this pain or related conditions, arthritic conditions, and other musculoskeletal pain report is on somatic pain affecting disorders not included in any of the previous categories.
    [Show full text]
  • Phantom Tooth Pain: the Atypical Facial Pain
    [Downloaded free from http://www.indianjpain.org on Saturday, March 05, 2016, IP: 117.194.98.119] Review Article Phantom tooth pain: The atypical facial pain Subrata Ray, Parvin Banu1, Subrata Goswami2, Ramapati Sanyal2, Basu SM2 Department of Anaesthesia and Pain, KPC Medical College and Hospital, 1Department of Anaesthesia and Critical Care, CNMC and Hospital, 2Department of Pain Management, ESI Institute of Pain Management, Kolkata, West Bengal, India ABSTRACT Chronic pain is more prevalent in the head and neck region than other parts of the body. Almost one-third of patients attending a facial pain clinic have history of undergoing some dental procedures often without success. Literature review reveals that atypical odontalgia, atypical facial pain or if teeth have been extracted phantom tooth pain are used to describe a common pain syndrome. At present, chronic pain disorders are diagnosed mainly on the basis of clinical signs and symptoms, since the mechanism underlying the pathophysiology is not well understood. Many diagnostic criteria for atypical facial pain has been proposed without much benefi t however, it remains a diagnosis of exclusion after ruling out all other pathologies of the head and neck. Clinically, phantom tooth pain is similar in many essential characteristics to deafferentation pain syndrome. In the absence of controlled clinical trials specifi cally directed to phantom tooth pain, treatment should be guided by standards used for other neuropathic pain disorders. Key words: Chronic, neuropathic, pain, phantom tooth Introduction pain. Atypical facial pain was fi rst coined by Frazier and Russell to diff erentiate it from trigeminal neuralgia.[4] It was Chronic pain is more prevalent in the head and neck region also included in the classifi cation system of international [1] than other parts of the body.
    [Show full text]