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[[Pain management]] is the branch of medicine employing an interdisciplinary approach to the relief of [[pain]] and improvement in the [[quality of life]] of those living with pain.<ref>{{cite book |last1= Hardy |first1= Paul A. J. |title= Chronic pain management: the essentials |year= 1997 |publisher= Greenwich Medical Media |location= U.K.|isbn= 1-900151-85-5 |url= http://books.google.com/?id=EtZ-4eb_aDUC&pg=PA10&lpg=PA10&dq=%22the+reduction+of+suffering+and+enhanced+quality+of+life+%22&q=%22the%20reduction%20of%20suffering%20and%20enhanced%20quality%20of%20life%20%22}}</ref> The typical pain management team includes [[medical practitioner]]s, [[clinical psychologist]]s, [[physiotherapist]]s, [[occupational therapist]]s, and [[nurse practitioner]]s.<ref>{{cite book |last1= Main |first1= Chris J. |last2= Spanswick |first2= Chris C. |title= Pain management: an interdisciplinary approach |year= 2000 |publisher= Churchill Livingstone |isbn= 0-443-05683-8}}</ref> [[Acute pain]] usually resolves with the efforts of one practitioner; however, the management of chronic pain frequently requires the coordinated efforts of the treatment team.<ref>{{cite book |last1= Thienhaus |first1= Ole |last2= Cole|first2= B. Eliot |editor1-first= Richard S, |editor1-last= Weiner |title= Pain management: A practical guide for clinicians|url= http://books.google.com/?id=L2CSdeiMZi4C&pg=PA27&dq=%22the+classification+of+pain%22+thienhaus&q=%22chronic%20pain%20frequently%20requires%20the%20coordinated%20efforts%20of%20a%20broadly%20based%20treatment%20team%22 |year= 2002 |publisher= CRC Press |isbn= 0-8493-0926-3|page= 29 |chapter= The classification of pain}}</ref><ref name="Henningsen P, Zipfel S.">{{cite journal |author=Henningsen P, Zipfel S, Herzog W |title=Management of functional somatic syndromes |journal=Lancet |volume=369 |issue=9565 |pages=946–55 |year=2007 |pmid=17368156 |doi=10.1016/S0140-6736(07)60159-7}}</ref><ref name="Stanos S, Houle TT.">{{cite journal |author=Stanos S, Houle TT |title=Multidisciplinary and interdisciplinary management of chronic pain |journal=Physical medicine and rehabilitation clinics of North America |volume=17 |issue=2 |pages=435–50, vii |year=2006 |pmid=16616276 |doi=10.1016/j.pmr.2005.12.004}}</ref>
[[Pain management]] is the branch of medicine employing an interdisciplinary approach to the relief of [[pain]] and improvement in the [[quality of life]] of those living with pain.<ref>{{cite book |last1= Hardy |first1= Paul A. J. |title= Chronic pain management: the essentials |year= 1997 |publisher= Greenwich Medical Media |location= U.K.|isbn= 1-900151-85-5 |url= http://books.google.com/?id=EtZ-4eb_aDUC&pg=PA10&lpg=PA10&dq=%22the+reduction+of+suffering+and+enhanced+quality+of+life+%22&q=%22the%20reduction%20of%20suffering%20and%20enhanced%20quality%20of%20life%20%22}}</ref> The typical pain management team includes [[medical practitioner]]s, [[clinical psychologist]]s, [[physiotherapist]]s, [[occupational therapist]]s, and [[nurse practitioner]]s.<ref>{{cite book |last1= Main |first1= Chris J. |last2= Spanswick |first2= Chris C. |title= Pain management: an interdisciplinary approach |year= 2000 |publisher= Churchill Livingstone |isbn= 0-443-05683-8}}</ref> [[Acute pain]] usually resolves with the efforts of one practitioner; however, the management of chronic pain frequently requires the coordinated efforts of the treatment team.<ref>{{cite book |last1= Thienhaus |first1= Ole |last2= Cole|first2= B. Eliot |editor1-first= Richard S, |editor1-last= Weiner |title= Pain management: A practical guide for clinicians|url= http://books.google.com/?id=L2CSdeiMZi4C&pg=PA27&dq=%22the+classification+of+pain%22+thienhaus&q=%22chronic%20pain%20frequently%20requires%20the%20coordinated%20efforts%20of%20a%20broadly%20based%20treatment%20team%22 |year= 2002 |publisher= CRC Press |isbn= 0-8493-0926-3|page= 29 |chapter= The classification of pain}}</ref><ref name="Henningsen P, Zipfel S.">{{cite journal |author=Henningsen P, Zipfel S, Herzog W |title=Management of functional somatic syndromes |journal=Lancet |volume=369 |issue=9565 |pages=946–55 |year=2007 |pmid=17368156 |doi=10.1016/S0140-6736(07)60159-7}}</ref><ref name="Stanos S, Houle TT.">{{cite journal |author=Stanos S, Houle TT |title=Multidisciplinary and interdisciplinary management of chronic pain |journal=Physical medicine and rehabilitation clinics of North America |volume=17 |issue=2 |pages=435–50, vii |year=2006 |pmid=16616276 |doi=10.1016/j.pmr.2005.12.004}}</ref>

Psychological treatments including [[cognitive behavioral therapy]]<ref>{{cite journal|coauthors=Sveinsdottir V, Eriksen HR, Reme SE|title=Assessing the role of cognitive behavioral therapy in the management of chronic nonspecific back pain.|journal=Journal of Pain Research|year=2012|pmid=23091394|url=http://www.ncbi.nlm.nih.gov/pubmed/23091394}}</ref><ref>{{cite journal|pmid=23175199|url=http://www.ncbi.nlm.nih.gov/pubmed/23175199}}</ref> and [[acceptance and commitment therapy]]<ref>{{cite journal|coauthors=Wicksell RK, Kemani M, Jensen K, Kosek E, Kadetoff D, Sorjonen K, Ingvar M, Olsson GL|title=Acceptance and commitment therapy for fibromyalgia: A randomized controlled trial.|journal=European Journal of Pain|year=2012|pmid=23090719|url=http://www.ncbi.nlm.nih.gov/pubmed/23090719}}</ref> have been shown effective for improving quality of life in those suffering from chronic pain. Clinical hypnosis, including self-hypnosis, has been shown effective not only for improving quality of life, but for direct improvement of chronic pain symptoms.<ref>{{cite journal|coauthors=Elkins G, Johnson A, Fisher W|title=Cognitive Hypnotherapy for Pain Management|journal=American Journal of Clinical Hypnosis|year=2012|doi=10.1080/00029157.2011.654284|url=http://www.tandfonline.com/doi/full/10.1080/00029157.2011.654284}}</ref><ref>{{cite journal|coauthors=Appel P, Bleiberg J|title=Pain Reduction is Related to Hypnotizability but Not to Relaxation or to Reduction in Suffering: A Preliminary Investigation|journal=American Journal of Clinical Hypnosis|year=2005|doi=10.1080/00029157.2005.10401512|url=http://www.tandfonline.com/doi/abs/10.1080/00029157.2005.10401512}}</ref><ref>{{cite journal|coauthors=Sachs L, Feuerstein M, Vitale JH|title=Hypnotic Self-Regulation of Chronic Pain|journal=American Journal of Clinical Hypnosis|doi=10.1080/00029157.1977.10403912|url=http://www.tandfonline.com/doi/abs/10.1080/00029157.1977.10403912}}</ref>


The emergence of studies relating chronic pain to neuroplasticity also suggest the utilization of [[Neurofeedback#Training process|neurofeedback]] rehabilitation techniques to resolve maladaptive cortical changes and patterns.<ref name="Jensen, M.P. 2009"/> The proposed goal of neurofeedback intervention is to abolish maladaptive neuroplastic changes made as a result of chronic nociception, as measured by abnormal EEG, and thereby relieve the individual's pain. However, this field of research lacks randomized control trials, and therefore requires further investigation.
The emergence of studies relating chronic pain to neuroplasticity also suggest the utilization of [[Neurofeedback#Training process|neurofeedback]] rehabilitation techniques to resolve maladaptive cortical changes and patterns.<ref name="Jensen, M.P. 2009"/> The proposed goal of neurofeedback intervention is to abolish maladaptive neuroplastic changes made as a result of chronic nociception, as measured by abnormal EEG, and thereby relieve the individual's pain. However, this field of research lacks randomized control trials, and therefore requires further investigation.

Revision as of 02:17, 3 February 2013

Chronic pain

Chronic pain is pain that has lasted for a long time. In medicine, the distinction between acute and chronic pain has traditionally been determined by an arbitrary interval of time since onset; the two most commonly used markers being 3 months and 6 months since onset,[1] though some theorists and researchers have placed the transition from acute to chronic pain at 12 months.[2] Others apply acute to pain that lasts less than 30 days, chronic to pain of more than six months duration, and subacute to pain that lasts from one to six months.[3] A popular alternative definition of chronic pain, involving no arbitrarily fixed durations is "pain that extends beyond the expected period of healing."[1]

Classification

Main article: Pain § Classification

Chronic pain may be divided into "nociceptive" (caused by activation of nociceptors), and "neuropathic" (caused by damage to or malfunction of the nervous system).[4]

Nociceptive pain may be divided into "superficial" and "deep", and deep pain into "deep somatic" and "visceral". Superficial pain is initiated by activation of nociceptors in the skin or superficial tissues. Deep somatic pain is initiated by stimulation of nociceptors in ligaments, tendons, bones, blood vessels, fasciae and muscles, and is dull, aching, poorly-localized pain. Visceral pain originates in the viscera (organs). Visceral pain may be well-localized, but often it is extremely difficult to locate, and several visceral regions produce "referred" pain when damaged or inflamed, where the sensation is located in an area distant from the site of pathology or injury.[5]

Neuropathic pain is divided into "peripheral" (originating in the peripheral nervous system) and "central" (originating in the brain or spinal cord).[6] Peripheral neuropathic pain is often described as “burning,” “tingling,” “electrical,” “stabbing,” or “pins and needles.”.[7]

Pathophysiology

Under persistent activation nociceptive transmission to the dorsal horn may induce a wind up phenomenon. This induces pathological changes that lower the threshold for pain signals to be transmitted. In addition it may generate nonnociceptive nerve fibers to respond to pain signals. Nonnociceptive nerve fibers may also be able to generate and transmit pain signals. In chronic pain this process is difficult to reverse or eradicate once established.[8]

Chronic pain of different etiologies has been characterized as a disease affecting brain structure and function. Magnetic resonance imaging studies have shown abnormal anatomical[9] and functional connectivity, even during rest [10][11] involving areas related to the processing of pain. Also, persistent pain has been shown to cause grey matter loss, reversible once the pain has resolved.[12][13]

These structural changes can be explained by the phenomenon known as neuroplasticity. In the case of chronic pain, the somatototic representation of the body is inappropriately reorganized following peripheral and central sensitization. This maladaptative change results in the experience of allodynia and/or hyperalgesia. Brain activity in individuals suffering from chronic pain, measured via electroencephalogram (EEG), has been demonstrated to be altered, suggesting pain-induced neuroplastic changes. More specifically, the relative beta activity (compared to the rest of the brain) is increased, the relative alpha activity is decreased, and the theta activity both absolutely and relatively is diminished.[14]

Management

Main article: Pain management

Complete and sustained remission of many neuropathies and most idiopathic chronic pain (pain that extends beyond the expected period of healing, or chronic pain that has no known underlying pathology) is rarely achieved, but much can be done to reduce suffering and improve quality of life.[15]

Pain management is the branch of medicine employing an interdisciplinary approach to the relief of pain and improvement in the quality of life of those living with pain.[16] The typical pain management team includes medical practitioners, clinical psychologists, physiotherapists, occupational therapists, and nurse practitioners.[17] Acute pain usually resolves with the efforts of one practitioner; however, the management of chronic pain frequently requires the coordinated efforts of the treatment team.[18][19][20]

Psychological treatments including cognitive behavioral therapy[21][22] and acceptance and commitment therapy[23] have been shown effective for improving quality of life in those suffering from chronic pain. Clinical hypnosis, including self-hypnosis, has been shown effective not only for improving quality of life, but for direct improvement of chronic pain symptoms.[24][25][26]

The emergence of studies relating chronic pain to neuroplasticity also suggest the utilization of neurofeedback rehabilitation techniques to resolve maladaptive cortical changes and patterns.[14] The proposed goal of neurofeedback intervention is to abolish maladaptive neuroplastic changes made as a result of chronic nociception, as measured by abnormal EEG, and thereby relieve the individual's pain. However, this field of research lacks randomized control trials, and therefore requires further investigation.

Epidemiology

In a recent large-scale telephone survey of 15 European countries and Israel, 19% of respondents over 18 years of age had suffered pain for more than 6 months, including the last month, and more than twice in the last week, with pain intensity of 5 or more for the last episode, on a scale of 1(no pain) to 10 (worst imaginable). 4839 of these respondents with chronic pain were interviewed in depth. Sixty six percent scored their pain intensity at moderate (5–7), and 34% at severe (8–10); 46% had constant pain, 56% intermittent; 49% had suffered pain for 2–15 years; and 21% had been diagnosed with depression due to the pain. Sixty one percent were unable or less able to work outside the home, 19% had lost a job, and 13% had changed jobs due to their pain. Forty percent had inadequate pain management and less than 2% were seeing a pain management specialist.[27]

In a systematic literature review published by the International Association for the Study of Pain (IASP), 13 chronic pain studies from various countries around the world were analyzed.  (Of the 13 studies, there were three in the United Kingdom, two in Australia, one each in France, the Netherlands, Israel, Canada, Scotland, Spain, and Sweden, and a multinational.) The authors found that the prevalence of chronic pain was very high and that chronic pain consumes a large amount of healthcare resources around the globe. Chronic pain afflicted women at a higher rate than men. They determined that the prevalence of chronic pain varied from 10.1% to 55.2% of the population.[28]

In the United States, the prevalence of chronic pain has been estimated to be approximately 30%. According to the Institute of Medicine, there are about 116 million Americans living with chronic pain.[29] The Mayday Fund estimate of 70 million Americans with chronic pain is slightly more conservative.[30] In an internet study, the prevalence of chronic pain in the United States was calculated to be 30.7% of the population: 34.3% for women and 26.7% for men.[31] These estimates are in reasonable agreement and indicate a prevalence of chronic pain in the US that is relatively comparable to that of other countries.[citation needed]

Comorbidities and sequelae

Chronic pain is associated with higher rates of depression and anxiety.[32] Sleep disturbance, and insomnia due to medication and illness symptoms are often experienced by those with chronic pain.[33] Chronic pain may contribute to decreased physical activity due to fear of exacerbating pain.[32]

Psychology

Personality

Two of the most frequent personality profiles found in chronic pain patients by the Minnesota Multiphasic Personality Inventory (MMPI) are the conversion V and the neurotic triad. The conversion V personality, so called because the higher scores on MMPI scales 1 and 3, relative to scale 2, form a "V" shape on the graph, expresses exaggerated concern over body feelings, develops bodily symptoms in response to stress, and often fails to recognize their own emotional state, including depression. The neurotic triad personality, scoring high on scales 1, 2 and 3, also expresses exaggerated concern over body feelings and develops bodily symptoms in response to stress, but is demanding and complaining.[34]

Some investigators have argued that it is this neuroticism that causes acute pain to turn chronic, but clinical evidence points the other way, to chronic pain causing neuroticism. When long term pain is relieved by therapeutic intervention, scores on the neurotic triad and anxiety fall, often to normal levels.[35][36][37][38] Self-esteem, often low in chronic pain patients, also shows striking improvement once pain has resolved. [38]

Effect on cognition

Chronic pain's impact on cognition is an under-researched area, but several tentative conclusions have been published. Most chronic pain patients complain of cognitive impairment, such as forgetfulness, difficulty with attention, and difficulty completing tasks. Objective testing has found that people in chronic pain tend to experience impairment in attention, memory, mental flexibility, verbal ability, speed of response in a cognitive task, and speed in executing structured tasks. In 2007, Shulamith Kreitler and David Niv advised clinicians to assess cognitive function in chronic pain patients in order to more precisely monitor therapeutic outcomes, and tailor treatment to address this aspect of the pain experience.[39]

See also

Conditions related to pain
Drugs

References

  1. ^ a b Turk, D.C.; Okifuji, A. (2001). "Pain terms and taxonomies". In Loeser, D.; Butler, S. H.; Chapman, J.J.; Turk, D. C. (eds.). Bonica's management of pain (3 ed.). Lippincott Williams & Wilkins. pp. 18–25. ISBN 0-683-30462-3. {{cite book}}: External link in |chapterurl= (help); Unknown parameter |chapterurl= ignored (|chapter-url= suggested) (help)
  2. ^ Main, C.J.; Spanswick, C.C. (2001). Pain management: an interdisciplinary approach. Elsevier. p. 93. ISBN 0-443-05683-8.
  3. ^ Thienhaus, O.; Cole, B.E. (2002). "Classification of pain". In Weiner, R.S. (ed.). Pain management: A practical guide for clinicians (6 ed.). American Academy of Pain Management. ISBN 0-8493-0926-3. {{cite book}}: External link in |chapterurl= (help); Unknown parameter |chapterurl= ignored (|chapter-url= suggested) (help)
  4. ^ Keay, KA; Clement, CI; Bandler, R (2000). "The neuroanatomy of cardiac nociceptive pathways". In Horst, GJT (ed.). The nervous system and the heart. Totowa, New Jersey: Humana Press. p. 304. ISBN 089603. {{cite book}}: Check |isbn= value: length (help); External link in |chapterurl= (help); Unknown parameter |chapterurl= ignored (|chapter-url= suggested) (help)
  5. ^ Coda, BA; Bonica, JJ (2001). "General considerations of acute pain". In Loeser, D; Bonica, JJ (eds.). Bonica's management of pain (3 ed.). Philadelphia: Lippincott Williams & Wilkins. ISBN 0-443-05683-8.
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  17. ^ Main, Chris J.; Spanswick, Chris C. (2000). Pain management: an interdisciplinary approach. Churchill Livingstone. ISBN 0-443-05683-8.
  18. ^ Thienhaus, Ole; Cole, B. Eliot (2002). "The classification of pain". In Weiner, Richard S, (ed.). Pain management: A practical guide for clinicians. CRC Press. p. 29. ISBN 0-8493-0926-3.{{cite book}}: CS1 maint: extra punctuation (link) CS1 maint: multiple names: editors list (link)
  19. ^ Henningsen P, Zipfel S, Herzog W (2007). "Management of functional somatic syndromes". Lancet. 369 (9565): 946–55. doi:10.1016/S0140-6736(07)60159-7. PMID 17368156.{{cite journal}}: CS1 maint: multiple names: authors list (link)
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  22. ^ . PMID 23175199 http://www.ncbi.nlm.nih.gov/pubmed/23175199. {{cite journal}}: Cite journal requires |journal= (help); Missing or empty |title= (help)
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  36. ^ JESS,, P. (1 January 1998). "Neuroticism in Relation to Recovery and Persisting Pain after Laparoscopic Cholecystectomy". Scandinavian Journal of Gastroenterology. 33 (5): 550–553. doi:10.1080/00365529850172151. {{cite journal}}: Unknown parameter |coauthors= ignored (|author= suggested) (help)CS1 maint: extra punctuation (link)
  37. ^ Jess, P (1994). "The validity of Eysenck's neuroticism dimension within the Minnesota Multiphasic Personality Inventory in patients with duodenal ulcer. The Hvidovre Ulcer Project Group". Psychotherapy and psychosomatics. 62 (3–4): 168–75. PMID 7846260. {{cite journal}}: Unknown parameter |coauthors= ignored (|author= suggested) (help)
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External links

Retrieved from "https://en.wikipedia.org/w/index.php?title=Chronic_pain&oldid=536287714"