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Chapter Twelve
Published in Eugene Fukumoto, Advanced ICD-10 for Physicians Including Worker’s Compensation and Personal Injury, 2017
Central pain syndrome is a neurological condition caused by damage to or dysfunction of the central nervous system. This can be caused by stroke, Parkinson’s disease, tumors, epilepsy, brain or spinal cord trauma, or multiple sclerosis.
Central neuropathic pain: syndromes, pathophysiology, and treatments
Published in Peter R Wilson, Paul J Watson, Jennifer A Haythornthwaite, Troels S Jensen, Clinical Pain Management, 2008
Some general principles apply to treating central neuropathic pain, as to all types of neuropathic pain. Start with a low dosage and increase the dosage slowly, but give an adequate trial – get to a high enough dose and treat long enough – to be able to assess efficacy.Recognize that all medications have side effects. A patient with physical, cognitive, language, and sometimes emotional and/or behavioral issues as a consequence of the disorder leading to the central pain syndrome may be more prone and/or intolerant of these side effects.Recognize that patients with disorders leading to a central pain syndrome (particularly MS and CPSP) likely require multiple other medications. Polypharmacy and drug interactions are a constant challenge for the treating physician.Set realistic expectations. Central neuropathic pain states are one of the most challenging pain conditions to treat. Resolution of the pain is generally not a realistic expectation. Farrar et al.64 found that a numerical pain scale score improvement of two points or 30 percent correlated with what pain patients felt was a significant improvement on global impression of change scores. The number needed to treat (NNT) is generally based on the number of patients in a study with at least 30 percent pain improvement. Some studies provide number of patients with 50 percent pain improvement. Regardless, this defines a realistic and good outcome – 30–50 percent pain improvement is a good pain outcome for any individual medication.Rational polypharmacy, utilizing multiple medications concomitantly with different mechanisms of action, may provide additive pain relief benefit, but needs to be weighed against the invariable cumulative side effects.
Delivery of a Group Hypnosis Protocol for Managing Chronic Pain in Outpatient Integrative Medicine
Published in International Journal of Clinical and Experimental Hypnosis, 2022
Lindsey C. McKernan, Michael T. M. Finn, Leslie J. Crofford, A. Gracie Kelly, David R. Patterson, Mark P. Jensen
Table 2 details patients’ primary pain-related condition prompting referral to treatment, organized by specific condition, diagnostic code, and diagnostic grouping. We confirmed this information by using two sources in the electronic medical record, including provider referral forms containing diagnostic information, clinical notes and billed encounters, and problem list data. Results are presented for the total sample. Overall, the most common referral diagnosis was fibromyalgia (n = 22 individuals). Participants had diverse and complex chronic conditions prompting referral, including centralized or diffuse musculoskeletal pain conditions (33%, e.g., fibromyalgia, central pain syndrome), neuropathic pain conditions (6%, e.g., diabetic neuropathy, parasthesias), inflammatory conditions (7%, e.g., Bechet’s disease, psoriatic arthritis), back pain (14%, e.g., chronic low back pain, postlaminectomy syndrome), head pain (9%, e.g., migraine), and pelvic pain (13%, e.g., interstitial cystitis, vulvodynia). Participants reported having longstanding symptoms of their referral condition for an average of M(SD) = 13.59 (11.02) years. Pain duration was comparable between diagnostic conditions.
Acupuncture use for pain after traumatic brain injury: a NIDILRR Traumatic Brain Injury Model Systems cohort study
Published in Brain Injury, 2023
Mark D. Sodders, Aaron M. Martin, Jennifer Coker, Flora M. Hammond, Jeanne M. Hoffman
Chronic pain is one of the most common medical complaints after TBI (11–15). Pain after TBI can include headache (16), musculoskeletal pain (3,11,14), central pain syndrome (3,17) and be directly related to the TBI or other comorbidities. While pain is common in the acute stage after injury, pain also commonly becomes chronic, lasting three months or more (3).