Permanent End To Chronic Pain
Chronic pain was among the first conditions treated with the Gamma Knife 1 . In the 1990s, we developed a technique to perform medial thalamotomy using stereotactic magnetic resonance imaging (MRI) localization and the Gamma plan computer dose planning system 2 . The target includes portions of the medial dorsal, intralaminar, center median, and parafascicular thalamic nuclei. Lesions are now made with a single isocenter using the 4mm secondary collimator helmet of the Gamma Unit and maximum radio-surgical doses of about 140 Gy. These parameters produce, on the average, a spherical lesion of about 90 mm3 in volume that develops over a period of 3 to 6 months after treatment. Coincident with development of the lesion gradual reduction in chronic pain occurs in the contralateral body and face without any loss of normal sensory function in about two thirds of patients. Nociceptive pain responds better than neuropathic pain to medial thalamotomy. Larger lesions may be made with two or...
A dying person should be assisted to live out his or her remaining days or weeks with minimal or no pain and remain, as fully as possible, normally alert. Among all the factors associated with dying, pain is probably the most dreaded and feared. Moreover, expectation and anticipation of pain is itself self-perpetuating pain. In most cases, the pain endured by a dying person serves no useful purpose. It does not serve as a warning or protective signal or as a diagnostic aid, as in the case of injury. Sometimes, pain associated with dying is categorized as long-term, chronic pain or as terminal pain. Professionals who care for terminally ill persons frequently describe the pain experienced by patients as ''total'' pain. The designation is intended to indicate not only that pain has multiple components, but that patients may feel that ''everything is wrong,'' meaning that one's whole being is consumed by pain.
The evidence pertaining to symptom reporting decreasing after litigation resolution is very mixed. There is increasing research that PTSD symptoms persist after compensation has been settled (Brooks and McKinlay, 1992 Bryant and Harvey, in press-a Mayou, Bryant and Duthie, 1993 McFarlane, 1995), and this pattern of findings reflects evidence from studies ofback injury and chronic pain (Evans, 1984 Mendelson, 1995a). There is also evidence that symptom exaggeration is particularly prevalent in compensation-seeking individuals (Frueh, Smith and Barker, in press). There are insufficient prospective studies available that informs us about the modification of symptoms and impairment prior to and following resolution of compensation claims. The studies that are available are from very diverse jurisdictions with distinct compensation systems and provide little information concerning the mechanisms of change in any observed symptom change. The possibility that the stress associated with...
There has been anecdotal evidence of improvement in patients treated with stimulation of the motor cortex for chronic pain (22,23). This has led to the suggestion that stimulation of the motor cortex might be an effective means of treating patients with tremor-dominant PD. A group in Italy has performed motor cortex stimulation for PD in three patients (24-26). They reported that a benefit comparable to STN DBS could be achieved with low-frequency not high-frequency stimulation. Advantages of this procedure might include safer placement, without the risk of deep hemorrhage, and perhaps greater efficacy.
Acupuncture has been utilized for treatment and prevention of multiple health conditions, such as chronic pain, nausea and vomiting, obesity, substance abuse, and asthma. Stress response and cardiovascular effects of pain have reportedly been attenuated by nonpharmacological techniques such as acupuncture it modulates the body's pain system, increases the release of endogenous opioids (53), and or decreases postoperative pain (54). In a feline cardiovascular model, the utilization of electro-acupuncture induced improvements in regional cardiac wall motion activity during myocardial ischemia (55). Furthermore, acupressure applied to females undergoing elective cesarean section with spinal anesthesia displayed a reduction in nausea and vomiting (56).
Psychological and cognitive factors In accordance with current chronic pain models, there is much more to the experience of dyspareunia than the pain and its possible physiological underpinnings. This point is illustrated by a recent functional magnetic resonance imaging study of women with vulvar vestibulitis (63), demonstrating that both sensory and affective brain areas are activated in response to painful genital stimulation. These findings are consistent with
Depressive illness has to be considered in any patient with a chronic pain complaint. This common psychiatric disorder can continue to aggravate or maintain the pain even though the provoking problem has disappeared. This is more likely to occur in people who have become anxious about their problem or who are under excessive stress. Many doctors treat such patients with a therapeutic trial of antidepressant medication, for example, amitriptyline or doxepin.
Similar syndromes have attracted great interest in recent years under new names such as chronic fatigue syndrome, post-viral syndrome, and myalgic encephalomyelitis (ME). There is an association with chronic pain and 'fibromy-lagia', on the one hand, and with psychiatric disturbance including anxiety and depression, on the other hand. However, there is no agreed physical basis for these conditions for example, no objective inflammation or other pathology ('-itis') of the muscles or brain has been found to justify the use of the term encephalomyelitis.
Sometimes, however, if patients feel reticent about their emotional distress, the pain or the tiredness may be presented as the main problem. Depression of mood is the underlying problem in many patients given otherwise mystifying labels of 'chronic fatigue syndrome' or 'chronic pain syndrome'.
Although the outcome of Gestalt therapy, at least in its pure form, has received rather less research attention, there is some evidence that this approach is as effective as behavioural and cognitive therapies (Beutler et al., 1991 Cross, Sheehan & Khan, 1982 Strumpfel & Goldman, 2002). There has also been exploration of the effectiveness of particular techniques derived from Gestalt therapy. Two-chair dialogue for conflict splits has been found to be more effective in some respects than empathic reflection and focusing (Greenberg & Dompierre, 1981 Greenberg & Higgins, 1980 Greenberg & Rice, 1981) and to result in greater reduction in indecision in clients with decisional conflicts than did behavioural problem solving (Clarke & Greenberg, 1986). Further studies have investigated the mechanism of change produced by the two-chair technique (Greenberg, 1984). Empty-chair dialogue for unfinished business has also been examined by Paivio and Greenberg (1995), who found it to be more...
In summary, the effects of all virostatics given orally or intravenously are comparable concerning the resolution of virus replication, cessation of dissemination of skin lesions and reduction of acute herpes zoster pain. Concerning the incidence and or prevalence of chronic pain, ZAP and PHN valacyclovir, famci-clovir and brivudin in different dosages are comparably effective. Normally all antivirals are well-tolerated, but transient side effects such as headache, gastrointestinal and neurological complaints are possible in all antiviral drugs 31 . 4 Crooks RJ, Jones DA, Fiddian AP Zoster-associated chronic pain an overview of clinical trial with acyclovir. Scand J Infect 1991 80(suppl) 62-68. 26 Wassilew SW, Stubinski BM, Koch I, Schumacher K, St dtler G Brivudin compared to famciclovir in the treatment of herpes zoster effect on acute disease and chronic pain in immunocompetent patients - a randomized multinational study. J Europ Acad Dermatol Venereol 2005 19 47-55....
The most studied measure to index genuineness of clinical presentation is the MMPI MMPI-2 (Hathoway and McKinley, 1991). The MMPI-2 has an array of validity scales designed to index motivation underlying responses to items about psychopathology, including the F, Fb, L, K, Gough Dissimulation Index, Fp, S and Mp (for reviews, see Butcher and Miller, 1999 Greene, 1997 Pope, Butcher and Seelen, 2000). The ability of the MMPI-2 to discriminate between genuine and malingered presentations has been studied in a range of populations, including chronic pain, brain injury, and PTSD (Butcher and Miller, 1999). A number of studies have indicated the utility of the MMPI-2 to distinguish genuine from malingered PTSD (Fairbank et al., 1985). Even when malingerers are given information about PTSD,
A recent study (Stone, Shiffman, Schwartz, Broderick, & Hufford, 2002 Stone et al., 2003) examined compliance with a sampling protocol wherein chronic pain patients were to make diary entries about their pain thrice daily (10 a.m., 4 p.m., and 8 p.m.), over a 3-week period. The study used an instrumented binder that held paper diary sheets and recorded the openings and closings of the binder. By defining periods of time around each of the targeted recording hours (e.g., 15 m or 45 m) and examining the times when the diary binder was actually open, we could determine actual compliance rates. In summary, compliance rates computed by examining subjects' self-reported entry times and dates were consistent with past reports (about 90 ). However, when actual compliance was computed based on the openings, compliance dropped dramatically to 11 (30 m window) and 19 (90 m window). More detailed examination of individual records produced evidence of back-filling of paper diaries and,...
On the other hand, repeated treatment with opioids could lead to changes within the spinal cord through interactions between opioid and NMDA receptors, mimicking the condition of neuropathic pain following nerve injury. Apparently, a common factor in both directions is the activation of NMDA receptors. This concept is the basis for recommending a combined use of opioids and clinically available NMDA receptor antagonists, because these two classes of agents would complement each other in a well-balanced treatment regimen (62). Importantly, such a strategy should be integrated into treatment regimens both for managing chronic pain syndromes and preventing an evolving pain condition such as that after nerve injury (83,91).
The bio-psycho-social model, as originally derived for chronic pain patients, probably provides the most realistic overall model of causation, as we know enough to be sure that none of the above approaches is ever going to be capable alone of providing complete explanations.
Patients suffering from herpes zoster should be encouraged to see a physician as early as possible for immediate medical care based on administration of systemic antiviral therapy. In addition symptomatic local therapy and analgetic therapy in order to achieve painlessness are equally important. Since years it has become clear, that systemic antiviral therapy is indicated for most patients suffering from herpes zoster. In general the aims of therapy for herpes zoster comprise the following decrease viral replication as early as possible, thus lowering the viral load, accelerate healing, limit or relieve severity and duration of acute and chronic pain (postherpetic neuralgia, PHN). Further options are to prevent or alleviate other acute and chronic herpes zoster complications and reduce the risk of cutaneous extension and visceral dissemination of VZV, which is particularly a problem in immunocompromised patients. Alternative therapies such as hypnosis and others are definitely of...
Although there are many forms of psychological injury that can be the focus of a compensation claim (including chronic pain, cognitive impairment, postconcussive syndrome, depression), this review will focus onposttraumatic stress disorder (PTSD). This condition is diagnosed when the individual has (a) suffered a traumatic experience, and subsequently suffers (b) re-experiencing (e.g. flashbacks, nightmares), (c) avoidance (e.g. effortful avoidance of trauma-related thoughts, emotional numbing), and (d) hyperarousal (e.g. insomnia, irritability) symptoms. According to the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV American Psychiatric Association, 1994), PTSD has the distinctive feature of including a precipitating stressor as part of the disorder's definition. This establishes a straightforward connection between a triggering traumatic event and a variety of observed symptoms (Freckelton, 1997). Such a relationship enables PTSD to be susceptible to...
Dialectical behaviour therapy consists of four primary treatment stages with pre-commitment occurring prior to beginning each stage. Currently, the main body of research on DBT is on what is called Stage 1 DBT. The first stage of DBT is usually one year of treatment designed to get the client's behaviours under control. Clients in Stage 1 are usually engaging in severely out of control behaviours. They are suicidal, engaging or having the urges to engage in non-suicidal self-injurious behaviours, are substance abusing, binging and or purging, criminal behaviour, gambling, and engaging in out of control, impulsive behaviours. Once the clients' behaviours are under control, they move into Stage 2 of DBT. In Stage 2, the behaviours are under control, but the clients' level of misery is still extremely high. Usually, Stage 2 is some form of structure exposure based treatment, usually for trauma. Because the out of control behaviours that lead clients into Stage 1 DBT are usually to avoid...
The preceding health goals and targets focus mainly on physical illness and do not emphasise mental health. However, this area represents an enormous opportunity for anticipatory guidance. It includes the important problems of stress and anxiety, chronic pain, depression, crisis and bereavement, sexual problems, adolescent problems, child behavioural problems, psychotic disorders and several other psychosocial problems.
A patient with low back pain following lifting at work poses a problem that causes considerable anguish to doctors, especially when the pain becomes chronic and complex. Chronic pain may be the last straw for patients who have been struggling to cope with personal problems their fragile equilibrium is upset by the back pain. Many patients who have been dismissed as malingerers turn out to have a genuine problem. The importance of a caring, competent practitioner with an insight into all facets of his or her patient's suffering, organic and functional, becomes obvious. The tests for non-organic back pain are very useful in this context.
People with chronic physical illnesses appear to have an increased risk of developing adjustment disorders, particularly one with depressed mood. This connection has been demonstrated among cancer patients. The relationship between chronic pain (as is commonly experienced by cancer patients) and depressive symptoms is still being studied.
Chronic Pain One of the most obvious possibilities for therapeutic intervention with NMDA receptor drugs is in the treatment of chronic pain. Because NMDA receptor antagonists have the ability to prevent the development of tolerance, sensitization, and physical dependence, these drugs may be useful adjuncts to opiates in situations in which long-term administration of opiates is necessary. Administration of an NMDA receptor antagonist together with an opiate should inhibit the development of tolerance, thereby allowing the opiate to maintain effectiveness for a greater period of time. The development of physical dependence is not typically considered to be a major problem in the treatment of chronic pain, as it can easily be managed by a well-trained physician. However, decreased physical dependence should offer reassurance to both patients and physicians overly concerned about addiction and decrease the time necessary to withdraw patients from opiates when necessary....
Renal stones nephrolithiasis affects 2-10 of the population and symptoms (renal colic) arise as these calculi become impacted within the ureter as they pass toward the urinary bladder. Types of renal calculi include calcium stones (75 ), magnesium ammonium phosphate stones (15 ) and cystine stones (2 ). Plain abdominal film may diagnose and locate the stone. Treatments include extracorporeal lithotripsy, ureteroscopy, percutaneous nephrolithotomy nephrostomy, open nephrostomy and, less commonly, nephrectomy (chronic pain, large staghorn calculi, poorly functioning).
The conditions that respond favorably to DBS include failed back syndrome, causalgia, radiculopathies, peripheral neuropathies, trigeminal neuropathies, and phantom limb pain 10-12 . Conditions that respond poorly to DBS include paraplegic pain, thalamic pain syndromes, and postherpetic neuralgia. In general, nociceptive pain responds more favorably to PVG stimulation, whereas neuropathic pain responds to STh stimulation. Patients with pain syndromes who have had multiple operations to a given body area experience a greater degree of benefit than those without prior surgical intervention. Gender and age do not statistically affect the degree of pain relief. Depression is a very common accompaniment to chronic pain syndromes and needs to be treated before undertaking definitive surgery. We have found that patients who did not require therapy for depression had a better prognosis than those who did.
Many theories have been proposed for explaining the pathophysiology of chronic pain after injury to peripheral nerves, dorsal roots, or dorsal root ganglia. The various proposed mechanisms of chronic pain production remain controversial, but it is generally accepted that hyperactivity in noci-ceptive pathway neurons as well as neuronal hypersensitivity to abnormal discharges from injured peripheral ganglia or neurons are involved in the pathophysiology of chronic neuropathic pain. The DREZ lesion was designed to coagulate and destroy these second order neuronal cell bodies in the substantia gelatinosa of the posterior horn. It, eliminates the firing of pain impulses along the spinothalamic axons and often rids the patient of pain. One typically generates a zone of hypalgesia into the previously painful region, but this is rarely cause for complaint. The exact mechanisms by which chronic pain is produced have yet to be elucidated and remain somewhat controversial the phenomenon,...
The pain mechanism is essential for survival, since acute pain is a warning mechanism for threatening conditions. Chronic pain is a more complicated subject, but both conditions may be grouped together for the purposes of our discussion. Relatively little is known about the pain mechanism.
A patient with chronic pain that is expected to persist for more than 6 months should be considered for intrathecal opioid therapy. The ideal candidate is one who has already failed conventional narcotic treatment, experienced intolerable side effects, or failed other pain management modalities such as spinal cord stimulation.
Oral candidiasis is characterized by a recurrent, persistent, acute inflammatory reaction to Candida infection, which is limited to the uppermost epithelial layers of the oral mucosa. The inflammatory response to this pathogen elicits chronic pain and discomfort upon mastication, but it may also be responsible for activation of immunoef-
Stereotactic neurosurgery is outlined for other indications as well, such as chronic pain, spasticity, and epilepsy. Indications, approaches, and techniques are covered. This book provides a comprehensive approach to ste-reotactic neurosurgery, both for the neurosurgeon who needs technical details and for the neurologist who must refer patients to the neurosurgeon and evaluate the results of neurosurgical intervention. For all those involved in the care of patients who undergo functional stereotactic neurosurgery, this handbook will provide detailed information to which they can refer. This is indeed a landmark book for functional neurosurgery, which clearly has gained importance in the treatment of a variety of neurological diseases in recent years.
Although these three schemes represent the main classes used to date, a couple of comments are in order. First, one might wonder about the need for any sampling scheme whatsoever (i.e., why not have participants make recordings throughout the day when convenient ). In fact, some versions of pain diaries do just that or specify broad blocks of time (e.g., afternoon) for making recordings. The objection to this form of sampling is that participants will pick and choose the times in nonrandom ways that may be correlated with predictions or outcomes. For instance, in sampling pain levels in patients with chronic pain, patients may select times when they are in greater than average pain, believing that the investigator is interested in such times. Alternatively, periods of extreme pain might not be selected for reports, because the individual is so incapacitated that participating in research is the furthest activity from his or her mind. Either of these forms of self-selection have the...
Different modalities such as acute and chronic pain may respond to modulation at different points in these pathways. Opioid receptors are expressed in the ascending nociceptive pathways including the dorsal horn of the spinal cord, thalamus, and cortex as well as in the descending antinociceptive pathways. Complex interactions of opioid receptor activation at the different levels of these pathways may explain the remaining challenges to perfecting opioid-based therapies.
Preservative-free morphine is the only analgesic approved for the intrathecal treatment of chronic pain by the US Food and Drug Administration (FDA). Thus, morphine is the agent most widely used intrathecally, but it might not be suitable for long-term use because patients may become tolerant of the effects of the drug and require escalated doses, which in turn could increase side effects to intolerable levels.
Gabapentin is used in combination with other antiseizure (anticonvulsant) drugs to manage partial seizures with or without generalization in individuals over the age of 12. Gabapentin can also be used to treat partial seizures in children between the ages of three and 12. Off-label uses (legal uses not specifically approved by the United States Food and Drug Administration FDA ) include treatment of severe, chronic pain caused by nerve damage (such as occurs in shingles, diabetic neuropathy, multiple sclerosis, or post-herpetic neuralgia). Studies are also looking at using gabapentin to treat bipolar disorder (also known as manic-depressive disorder). Chronic pain may be treated with 300-3,600 mg per day, divided into three equal doses.
Laxity of the CMC joint of the thumb may be a manifestation of generalized ligament laxity, result as the sequela of trauma, or be a manifestation of metabolic disease such as Ehlers-Danlos syndrome. It is seen most commonly as one manifestation of generalized ligament laxity, particularly in young women in the third to fourth decades of life. They typically also have hyperextension of the elbows, knees, and finger metacar-pophalangeal (MP) joints. The symptoms are exacerbated by activity, but are not caused by trauma. A much smaller subset of patients have basal joint laxity resulting from trauma. Dislocations of the CMC joint are uncommon, but cause laxity both acutely and chronically. Irreducible dislocations, or those that remain unstable after reduction, are candidates for volar ligament reconstruction. Simorian and Trumble 8 have recommended volar ligament reconstruction for all patients who have CMC dislocations, citing improved long-term results compared with reduction without...
Peripheral neuropathic chronic pain is a severe and debilitating pathological condition which affects many millions of people. Neuropathic pain is a consequence of either neurotropic infections (most notably HIV) or injuries of peripheral nerves, which may occur following trauma, nerve compression or diabetes. The mechanisms of neuropathic pain are poorly understood and existing therapy is often ineffective. Very recently the role of glial cells, particularly microglia and to a lesser extent astroglia, as primary mediators of chronic pain, has begun to be considered and gained substantial experimental support. It is now firmly established that injury to peripheral nerve causes rapid and significant activation of microglia in the dorsal horn of the spinal cord on the side of the peripheral nerve entry (Figure 10.8). The activated microglial cells in spinal cord express pain related signalling molecules - P2X4 purinoreceptors and p38 mitogen-activated protein kinase (p38 MAPK). The...
In a recent review article, Reissing et al. have raised the question as to the extent to which the existing concept of vaginismus is correct (5). Is the increased pelvic floor muscle tension actually characteristic of vaginismus In their view, the role of the pelvic floor muscles in vaginismus is identical to the role of the muscles in chronic tension headaches an important symptom, but not of decisive importance to the diagnosis. Does this apply to the experience of pain They believe that in vaginistic patients, until now the pain or the changed sensations (dysesthesia) have been unjustly bypassed. Is vaginismus therefore a phobic reaction to penetration This is indeed the case in some vaginistic women, but it is not clear whether this fear is cause or consequence. In their view, women with vaginismus are suffering from an aversion phobia for vaginal penetration, or from a genital pain problem, or both. If the aversion phobia lies in the forefront, then cognitive behavioral therapy...
Another area for improvement for patients is, surprisingly, reporting of pain. Patients often do not report pain or will use other terms to designate functional difficulties rather than the cause (i.e., pain). This may be related to a belief that chronic pain cannot be controlled, that it is normal to have pain as one gets older, or that the physician cannot do anything about it (16). There is also a concern that the physician and staff do not have time to treat or report pain (15).
The nerve fibers that conduct impulses away from pain receptors are of two main types acute pain fibers and chronic pain fibers. The chronic pain fibers (C fibers) are thin, unmyeli-nated nerve fibers. They conduct impulses more slowly than acute pain fibers, at velocities up to 2 meters per second. These impulses cause the dull, aching pain sensation that may be widespread and difficult to pinpoint. Such pain may continue for some time after the original stimulus ceases. Although acute pain is usually sensed as coming from the surface, chronic pain is likely to be felt in deeper tissues as well as in the skin. Visceral pain impulses are usually carried on C fibers. Commonly, an event that stimulates pain receptors will trigger impulses on both types of pain fibers. This causes a dual sensation a sharp, pricking pain, then a dull, aching one. The aching pain is usually more intense and may worsen over time. Chronic pain that resists relief and control can be debilitating.
Some individuals worry, for example, that ''artificially'' extending human lives would cheapen our existence, whereas others point out that the modern medical enterprise has already drastically increased lifespans with no ill effects on society. Other subjects that the site has explored include the paucity of older people included in clinical trials the wisdom of using human growth hormone to combat symptoms of aging despite data suggesting that the substance curtails lifespan and how we might improve our flu-combating measures. It has discussed nanotech-nology, hormone replacement therapy, guidelines for keeping bones strong, and chronic pain, as well as age-related voice changes and hearing loss. SAGE Crossroads ponders such topics in News and Views articles as well as through Webcasts in which experts debate and discuss such matters.
Given the physiological, cognitive, affective, and interpersonal complexity of dyspareunia, it is likely that no one cure for dyspareunia or for other chronic pain conditions will be found. Thus, we propose a multimodal treatment approach for all types of urogenital pain discussed in this chapter, tailored to each patient, and including careful assessment of the different aspects of the pain experience. Clinicians should also educate their patients as to the multidimensional nature of chronic pain so that the treatment of so-called psychological or relationship factors is not experienced as invalidating. Although pain reduction is an important goal, sexual functioning should also be worked on simultaneously through individual or couple therapy, as it has been shown that pain reduction does not necessarily restore sexual functioning (97).
Gate Control Theory of Pain, which states that the experience of pain includes sensory and emotional components and that psychological factors play a role in pain control (17). This theory has helped explain the powerful influence of cognitive processes on pain perception via descending modulation from the brain, and scientists have since learned that the complex experience of pain cannot be simply equated with tissue damage (18). The Classification of Chronic Pain manual published by the International Association for the Study of Pain (IASP) (19) has also inspired a new multidimensional approach for dyspareunia treatment and research (16). According to the IASP classification system, pain is defined as an unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage (italics added page 210). The italicized portion of this definition is reserved for pain patients without identifiable physical pathology, as in most...
Despite the relative proximity of skilled nursing and rehabilitation services, the institutionalized senior continues to be at increased risk for chronic pain (27). Although this problem has received little attention, it is anticipated that the judicious use of physical modalities and exercise, as outlined in this chapter, not only would aid in the prevention of chronic illnesses and impairment, but also would decrease the need for pharmacological intervention.
The loss of minerals in the bones that accompanies aging reduces bone mass and increases the porosity and brittleness of bones. The result may be chronic pain in the joints of the lower spine and hips, a height reduction of several inches, other skeletal deformities (eg, dowager's hump), and an increased danger of fractures to the vertebrae, hips, ribs, and wrists. These are the symptoms of osteoporosis, a disorder that is four times more common among postmenopausal women than men in the same age range (45-50 years). Osteoporosis affects almost half of all women over 50, and as many as 90 of women over 70. It is more common among whites and Asians than among blacks and is also associated with chronic hyperthyroidism, long-term steroid therapy, and heredity.
This medication is one of several tricyclic antide-pressants, so-called because of the three-ring chemical structure common to these drugs. Amitriptyline acts to block reabsorption of neurotransmitters (chemicals that transmit nerve messages in the brain). Amitriptyline and the other tricyclic antidepressants are primarily used to treat mental depression but are increasingly being replaced by a newer and more effective group of antide-pressant drugs called selective serotonin reuptake inhibitors (SSRIs). Amitriptyline is sometimes prescribed to help treat pain associated with cancer. In addition, it is sometimes prescribed for various types of chronic pain. Tablets are available in 10, 25, 50, 70, and 150 mg.
Several factors, summarized in Table 1.4, have contributed to the maturity of the field and its potential for continued growth (Bishop, 1994 Carmody & Matarazzo, 1991 Marks, 1996 Sarafino, 1998 Taylor, 1999). The prevailing biomedical model of health has been incomplete in explaining health behavior. The model has also been limited in its focus on infectious disease, oblivious to behavioral sciences contributions to health behavior, and invariant with respect to issues pertaining to chronic care and illness prevention. The fields of behavioral medicine, behavioral health, and health psychology have made significant scientific and practical advancements in chronic pain, cardiovascular disease, neurological disorders, behavioral oncology, and the psychology of treatment adherence (Carmody & Matarazzo, 1991). Issues relating to quality of life, health care costs, and alternate approaches to traditional health care, however, have been of concern from both the biomedical and...
There is a growing body of evidence supporting the medical benefits of meditation. For example, meditation is particularly effective as a treatment for chronic pain. Researchers have found that meditation reduces symptoms of pain and reliance on drugs used to control pain. For example, in one four-year follow-up study, the
Relaxation has been used to help women during childbirth and people with chronic pain. Relaxation has also been used to treat muscle tension, muscle spasms, neck and back pain, and to decrease perspiration and respiratory rates. Furthermore, relaxation can help with fatigue, depression, insomnia, irritable bowel syndrome, high blood pressure, mild phobias, and stuttering.
A host of comorbid conditions can make it more difficult for patients to complain of pain. Beside the obvious diseases (such as strokes) that prevent effective communication, there are psychological barriers as well. Probably most common among seniors is depression. Although this may be recognized, patients and health care professionals may attribute the depression to the chronic pain. Although depression is more common in people with chronic pain, it is a mistake to think that simply treating the pain will be enough to resolve both pain and depression. Studies indicate that, without active treatment of depression, pain control is unlikely to be successful (26). Because some medications for depression have also been used to control pain and there is a desire to minimize the number of medications, choosing an antidepressant that also helps with pain control makes sense.
She, like Sandra, underwent many invasive examinations and received numerous treatments, none of which helped. Joanne found that all aspects of her life were negatively affected she had difficulties working, sleeping, and engaging in sexual activities. The pain was always on her mind, and although she obtained some relief from applying ice packs wrapped in towels to her vulva, this solution was only temporary and limited to her home environment. She lost interest in sex and began reducing her sexual activities, as they would exacerbate her pain. Desperate, she waited 1 year on a waiting list at a chronic pain service and was finally diagnosed with vulvodynia. She was prescribed a low dose of Elavil to help her sleep and to decrease the amount of pain she was experiencing, and was given a recommendation to join a vulvodynia support group to learn more about her condition and to meet others who experienced difficulties similar to hers.
To disseminate information on pain, many resources must be used. The government should collaborate with private organizations. Partners would include such organizations as the American Cancer Society, the American Chronic Pain Association, and other nationally and internationally recognized organizations that focus on pain relief. Also, local and statewide organizations should be identified to help promote a culturally sensitive educational media campaign to promote pain assessment and management. Communication within different health care systems regarding compliance and adherence to standards for pain management should also be a focus for change.
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Peace in Pain
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