Talk:Chronic pain

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Sorry[edit]

Sorry, I am not sure if this is where I need to make a comment. The link to "Living with Chronic Pain" I feel is a good link because it gives a personal story. It is very informative and people can really benefit from it.

Thanks. —The preceding unsigned comment was added by 71.134.227.231 (talk) 04:44, August 23, 2007 (UTC)

Recent edits to medications ==[edit]

I have restored the advice of the NSW Health Department on the options for Chronic Pain. It seems to me they are at least moderately qualified to make recommendations. The full link is on the entry please consider reading it before simply deleting it. Yes some people need opiates, some peolpe can manages with less. Why not mention all of the options. I am just trying to help as many people as possible and I am sure you are as well. The points mentioned along the lines of thoughtless comments are acknowledged. Tim Timh2007 10:34, 3 May 2007 (UTC)

I have removed them.Ukmc rjk 01:43, 9 May 2007 (UTC)

Recent links to allaboutchronicpain[edit]

The site in question is a fairly hardcore Christian site. I've added warnings to the links on the front page, but I think the links just don't belong here at all. I'd like to hear other people's opinions though. BTW, I'm a Chronic Pain sufferer, and an active Christian, and I don't like the idea of using this article to proselytise the Faith. Johnpf 11:28, 3 December 2006 (UTC)

Links to Mensana.com[edit]

[User:Docnelse] keeps adding links to the www.mensana.com website. This website does not actually have any information about Chronic Pain that isn't already in the article, althougfh it does have a few references to journals that would be good on this page. The Site itself is a purely-pay-per-view site where you pay to do an on-line test that purports to evaluate if you have been misdiagnosed. You have to agree to a disclaimer that (a) you are not a US citizen (suggesting that it is illegal to offer such a service to Americans!!) and (b) that you realise this is not medical advice you're paying $45US a shot for.

WP is NOT an appropriate place to be soliciting for business. If Mensana have information that they believe is appropriate for linking to a free, public and open community based encyclopedia, then they should make this information freely available, and not require payment for it. Johnpf 06:12, 13 March 2007 (UTC)


Topic Rewritten[edit]

I have significantly revised the content and section titles as well as added references and external links.Robert J. Kaplan MD 11:58, 18 April 2007 (UTC)Rkapla02

reversion of DeadlyTab's edits[edit]

I've reverted back to JoanneB's reversion, as the medications section had been replaced with editoralising, opinions and politics. The opinion of one user's attitude relating to opiods has nothing to do with medications for Chronic Pain sufferers. The whole "opiods are only appropriate for long term use in terminal cases" is cruel and clueless. A person who has a non-terminal, uncurable Chronic Pain problem will probably see opiods as one of the few options to suicide. Addiction is simply not an issue, as it's merely the price for being able to function at all, at least in my case, and in the opinion of most other sufferers of disabling pain which does not respond to non-narcotic analgesics. Yes, I know I'm raving, but I get so pi##3d at people pushing politics on this topic. I realise that opiods are terribly dangerous when used recreationally. But Chronic Pain sufferers are not taking opiods recreationally - they are trying to regain their lives, function within their families and communities, and just get through another day. Sometimes I wish the people pushing the political agenda of "all opiods are evil, and if you take them for a long time you're just a junky" would experience unremitting agony for a few weeks just for them to get some kind of perspective. Yes there are side affects - but in context they are annoyances. You might want to learn the difference between dependency (a physical condition) and addiction (a psychological behaviour). Johnpf 23:50, 28 April 2007 (UTC)


I wasn't the one pushing politics! it was 211.30.78.228 or 220.239.247.231 making the bold statements about opiods only being relavent in terminal patients. I just made a poor attempt to clean up the article. I posted this

I have reverted it back to a concise discussion based on the overall summary of opioid medications as entered by Rkapla02. It is more accurate.Ukmc rjk 01:46, 9 May 2007 (UTC)ukmc rjk

Chronic pain can be treated with an array medications. Nearly all are analgesic, and less commonly, anesthetic (for localized pain). Some classes of these medications include: Opiates Opiod Analgesics relieve moderate to severe pain, especially in chronic pain sufferers. However, this commonly leads to tolerance and addiction. There are also unpleasant side effects associated with opiates such as urinary retention and constipation. When used for a long period of time, these side effects may off. Possible allergies to opiates, semi-synthetic, natural or both, are also something to be aware of before starting opiate therapy. NSAIDs and Over the Counter Analgesics NSAID stands for Non-Steroidal Anti-Inflammatory Drug. These work by reducing inflammation and pain by blocking enzymes and proteins made by the body. These drugs should not be used for more than 10 days continuously without consulting a physician. They are less effective and treat mild to moderate pain. Ibuprofen and Asprin are examples of NSAIDs. Other over the counter analgesics include acetaminophen. When used in large doses or over a long period of time, acetaminophen can cause liver damage.


which i agree was horrible because it wasn't cited and yours was a lot better


My apologies if I attributed the wrong bit to you. I should have dug deeper into the History to differentiate your edits from other ppls. Johnpf 22:49, 29 April 2007 (UTC)

No, I disagree the content which was submitted by Rkapla02 is well written, accurate, cited and referenced. The NSW entry is not pratcularly relevant. The sections were composed by Rkapla02 are exemplary. The content is not horrible and it is fine as written without bias and reflects the current peer reviewed literature. The suggested medication revision content is not better as alluded to aboveUkmc rjk 01:49, 9 May 2007 (UTC)ukmc rjk

Thank you[edit]

To all the people that worked on this since I tagged it for needing improvement.Lonjers 05:48, 2 May 2007 (UTC)

How about "hardware"?[edit]

There also other ways now for treating chronic pain through what I'll simply call "hardware", like the implatable infusion pump and neurostimulators from Medtronic and other companies? OracleDude 11:25, 26 September 2007 (UTC)

Good point; I can't believe that area was missing; I added a couple entries. MeekMark (talk) 13:46, 31 December 2007 (UTC)

Brain damage[edit]

I read somewhere that, according to a study carried out in late 2004, chronic pain may lead to brain damage, especially the grey matter areas. Should we point this out in the article? --Taraborn (talk) 14:23, 24 January 2008 (UTC)

If you can find the study and it's a medically reliable source, sure. As heresay, it's not as useful. WLU (talk) 14:54, 24 January 2008 (UTC)
It is certainly not heresay that pain can produce reduced grey matter. It is well accepted by the scientific community and if you put it in Google Scholar you will find many sources to cite. However, it is very important to note that saying "chronic pain can produce reductions in cerebral grey matter" is NOT the same as saying "chronic pain can lead to brain damage". The latter is not accurate, while the former is. 132.216.43.98 (talk) 21:39, 1 March 2012 (UTC)
Indeed, reduction of grey matter that is reversible is far from brain damage. Thanks for whoever repaired that issue in the article.Wzrd1 (talk) 00:31, 15 August 2012 (UTC)

CBT[edit]

A section on cognitive behavioural therapy needs to be added if someone can find the time.

I would love to tell many of my patients that the pain has given them brain damage! LOL, it would go down well! I think it's certainly likely that you get changes in your brain, as you do in your spinal cord, but I would call them more maladaptive physiological changes rather than damage. —Preceding unsigned comment added by 59.101.234.20 (talk) 10:21, 5 February 2008 (UTC)

Hello. Regarding CBT. It's pretty ineffective:
"First, there is a substantial proportion of patients who do not appear to benefit from treatment interventions available. Second, although the effect sizes of most cognitive-behavioral treatments for chronic pain are comparable to those in psychopathology, they are quite modest." (P.1)
I don't think we should get patients' hopes up.
Vlaeyen, J.W.S. & Morley, S. (2005) Cognitive-Behavioral Treatments for Chronic Pain: What Works for Whom? Clinical Journal of Pain. Special Topic Series: Cognitive Behavioral Treatment for Chronic Pain 21(1) 1-8

Anthony (talk) 14:13, 8 April 2008 (UTC)

Pain management[edit]

I wonder if the section on management would be better off in it's own article (i.e. merged with the current Pain management), since the section here has better formed content and the issue deserves it's own article? LeeVJ (talk) 07:26, 3 April 2008 (UTC)

Cognitive impairment in chronic pain[edit]

Hi.

Very little work has been done on the cognitive effects of chronic pain. In a soon to be published review, Kreitler and Niv note that 95% of the papers published on “pain and cognition” deal with the effect of cognition on pain and 5% address the impact of pain on cognition. I think they’re being generous. My estimate is 98% : 2%.

For a preview of their upcoming paper see: Kreitler, S. & Niv, D. (2007) Cognitive impairment in chronic pain. Pain: Clinical Updates Vol. IV(4)[1].

However, Eccleston [1995] has shown that chronic pain impairs control of attention: "... chronic pain patients suffering high intensity pain show significantly impaired performance on an attentionally demanding task when compared to low pain patients and normal controls" [p. 391]. And Astrid von Bueren and colleagues [2005] have found that chronic pain patients exhibit marked deficiencies in alertness, vigilance, visual search and selective attention, compared to the pain free. Bruce Dick and Saifudin Rashiq, in their small recent [2007] study, point to a specific cognitive mechanism, the maintenance of the memory trace, (an element of working memory) that is also impaired by chronic pain. So, pain diminishes working memory.

References (I can't figure out how to do reference lists properly)

Dick, B.D. & Rashiq, M.B. (2007) Disruption of attention and working memory traces in individuals with chronic pain. Anesthesia and Analgesia, 104:1223 - 1229.

Eccleston C, (1995) Chronic pain and distraction: an experimental investigation into the role of sustained and shifting attention in the processing of chronic persistent pain. Behaviour Research and Therapy, 33 (4), 391-405.

Von Bueren Jarchow, Radanov & Jancke (2005) Pain influences several levels of attention. Zeitschrift fur Neuropsychologie 16 (4) 235 - 42.


Anthony (talk) 06:28, 10 April 2008 (UTC)

Nice edit WLU. I'm pretty convinced chronic pain causes "executive dysfunction"; that is, impairment of the frontal lobes. Executive function consists of control of attention, self-regulation and working memory. I've found serious disruption of working memory and control of attention in the chronic pain literature, but nothing on chronic pain's effect on self-regulation. Acute social distress causes impaired self-regulation (Baumeister & DeWall, 2005; Baumeister et al. 2005), and I'm convinced that distress (suffering and the urge to escape suffering) is distress - regardless of its cause. So I'm comfortable attaching impaired self-regulation to chronic pain. But, though I believe this argument for impaired self-regulation in pain is sound, it is flimsy. If anybody has peer-reviewed proof that chronic pain impairs self-regulation, could you please throw it into this discussion?
Baumeister, R.F. & de Wall, C.N. (2005). The inner dimension of social exclusion: intelligent thought and self-regulation among rejected persons in K.D. Williams, J.P. Forgas & W. Von Hippel, (Eds.). The Social Outcast: Ostracism, Social Exclusion, Rejection, and Bullying (pp. 109-127): Psychology Press
Baumeister, R., DeWall, C.N. Ciarocco, N.J. & Twenge, J.N., (2005) Social exclusion impairs self-regulation Journal of personality and social psychology 88 (4) 589-604

—Preceding unsigned comment added by Anthonyhcole (talkcontribs) 09:32, 24 April 2008 (UTC)

Medicinal Marijuana ?[edit]

I haven't seen any articles, or realy any mention about chronic pain and using medicinal mj. I am a Prop 215 patient in CA and I suffer from PTSD and chronic pain due to multiple ankle surgeries. I have been using mj for a while now and it is much better than any opiates I have been prescribed. These days with the potency and the clean ways to inhale mj, it just makes sense. —Preceding unsigned comment added by 67.187.161.224 (talk) 03:55, 28 June 2009 (UTC)

Hi. Medical cannabis could be included in a list of treatments for chronic pain. Anthony (talk) 14:03, 17 August 2009 (UTC)

A couple of images[edit]

Uploaded:

--CopperKettle 15:01, 27 August 2009 (UTC)

Nice images CopperKettle. They'll come in handy. Anthony (talk) 06:24, 16 December 2009 (UTC)

Introduction[edit]

The introductory definition

Chronic pain is defined as pain that persists longer than the temporal course of natural healing, associated with a particular type of injury or disease process

cites a journal article that doesn't actually define chronic pain. I'd like to propose this instead

Chronic pain has several different meanings in medicine. Traditionally, the distinction between acute and chronic pain has relied upon an arbitrary interval of time from onset; the two most commonly used markers being 3 months and 6 months since the initiation of pain, though some theorists and researchers have placed the transition from acute to chronic pain at 12 months. Still 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.
A popular alternative definition of chronic pain, involving no arbitrarily fixed durations is "pain that extends beyond the expected period of healing."

I think it is important to explain the inconsistent usage and include the "duration-based" definitions, because many textbooks and researchers still use them and our readers will encounter them. Comments? Thoughts? Anthony (talk) 06:24, 16 December 2009 (UTC)

Move "Pain in the nervous system" to Pain[edit]

This section is relevant to pain but not chronic pain. If it discussed neural theories of idiopathic chronic pain or the neuroanatomy of central pain syndrome, it would belong here but, as it stands, I believe it fits better into the Pain article which lacks such a description. Comments? Anthony (talk) 12:08, 22 December 2009 (UTC)
Done. Anthony (talk) 09:31, 28 December 2009 (UTC)

Move "Management" to Pain management[edit]

Can I propose reducing Management to a summary paragraph (with a "Main article" link to Pain management) and adding the bulk of this subsection to Pain management which is bereft of this kind of content? Anthony (talk) 08:06, 28 December 2009 (UTC)

Definitely! --Robert Daoust (talk) 15:31, 28 December 2009 (UTC)

Temporary free access to IASP journal Pain[edit]

The top journal on pain is open to the public for a free trial period. Anthony (talk) 02:13, 7 May 2010 (UTC) That's expired now. Anthony (talk) 16:20, 10 June 2010 (UTC)

New external link[edit]

[2] Is this appropriate? I don't know what the guidelines are. Anthony (talk) 16:20, 10 June 2010 (UTC)

See also section[edit]

I'd like to delete the See also section and find a way of directing the reader to Suffering from within the article or a hatnote. I can't see the point of the rest of the items. Anthony (talk) 08:22, 28 October 2010 (UTC)

Do you mean that a wikilinked list of usual kinds of chronic pain or drugs or therapies cannot be useful to readers of this article? I cannot see why there shouldn't be a See also section for this important article... --Robert Daoust (talk) 16:35, 28 October 2010 (UTC)

I'm thinking a list of conditions related to pain would be more than 500 items long (as it is, it is an arbitrary list of 12) and the remaining items belong in Pain management. Anthony (talk) 18:15, 28 October 2010 (UTC)

What's the purpose of a See also section, if not for directing the reader toward more (not necessarily exhaustive) information on the topic? --Robert Daoust (talk) 23:45, 28 October 2010 (UTC)

Good question. The relevant bit of WP:LAYOUT is

A reasonable number of relevant links that would be in the body of a hypothetical perfect article are suitable to add to the "See also" appendix of a less developed one. Links already integrated into the body of the text are generally not repeated in a "See also" section, and navigation boxes at the bottom of articles may substitute for many links (see the bottom of Pathology for example). However, whether a link belongs in the "See also" section is ultimately a matter of editorial judgment and common sense. Indeed, a good article might not require a "See also" section at all. Thus, although some links may not naturally fit into the body of text they may be excluded from the "See also" section due to article size constraints. Links that would be included if the article were not kept relatively short for other reasons may thus be appropriate, though should be used in moderation, as always. Links included in the "See also" section may be useful for readers seeking to read as much about a topic as possible, including subjects only peripherally related to the one in question. The "See also" section should not link to pages that do not exist (red links). Portal and Wikipedia-Books links are usually placed in this section.
(Emphasis mine.)

So, it advises the use of common sense, but leans towards minimal use. My proposal wasn't based on this policy, though (I hadn't read it until now), I just felt they didn't belong here, but maybe in other articles. The list was constructed between April and June 2007 when Pain management was a 3 paragraph start class article. Perhaps there could be a list article, List of conditions featuring pain, which this and other pain-related articles could link to, and I'd like to see the treatment options worked into Pain management, if they aren't already. Anthony (talk) 05:56, 29 October 2010 (UTC)

Okay, then I'd suggest to bring the various therapies under a somewhat extended Management section (it is too short right now), and to move drugs under a new Drugs section or subsection, leaving only a list of selected conditions related to pain, which would include suffering. --Robert Daoust (talk) 12:59, 29 October 2010 (UTC)
I think the detail of chronic pain management belongs at the separate Pain management article. We could merge that article into this one - but then we'd have nowhere for acute pain management. We should avoid having a large pain management section here, simply duplicating Pain management, and, equally, avoid having some PM information here and some there. --Anthony (talk) 20:33, 29 October 2010 (UTC)

The epidemiology of chronic pain in children and adolescents revisited: a systematic review[edit]

  • King S, Chambers CT, Huguet A et al. (December 2011). "The epidemiology of chronic pain in children and adolescents revisited: a systematic review". Pain 152 (12): 2729–38. doi:10.1016/j.pain.2011.07.016. PMID 22078064. 
I can't access this at the moment but it says something about the poor quality of present knowledge of prevalence in adolescents and children (matching the quality of such information for adults). When I've read the article I might propose a small addition to Chronic pain#Epidemiology, unless someone beats me to it. I don't know if the telephone survey this article presently uses for its adult epidemiology has been reviewed for quality. --Anthonyhcole (talk) 08:28, 26 February 2012 (UTC)