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Palliative Medicine
Published in John S. Axford, Chris A. O'Callaghan, Medicine for Finals and Beyond, 2023
Pain may be exacerbated by psychological factors as well as physical ones. Management directed only at physical factors may fail to control pain adequately in some patients. Coexistent depression or anxiety should be addressed and, if appropriate, talking therapies (such as counselling) should be offered.
Low-Dose Naltrexone
Published in Sahar Swidan, Matthew Bennett, Advanced Therapeutics in Pain Medicine, 2020
The treatment for pain should be individualized for each patient depending on the pathology and symptoms. The goals of pain management therapy are to improve the patient’s level of functioning, decrease pain perception, reduce the use of medications when possible, and improve the quality of life. Traditional medication therapies for pain include the use of NSAIDs (e.g., ibuprofen, naproxen), non-opioid analgesics (e.g., acetaminophen), tricyclic antidepressants (e.g., amitriptyline, imipramine), and anticonvulsants (e.g., gabapentin). These treatment options focus on reducing the inflammatory response to pain stimuli as well as inhibiting afferent pain stimuli by acting as ligands of alpha-2-delta voltage-gated calcium channels in the CNS. Low-dose and ultra-low-dose naltrexone (ULDN) have been investigated for the management of pain, complex regional pain syndrome (CRPS), and painful diabetic neuropathy with encouraging results.
The Experience of Pain — Psychological Aspects
Published in Eli Ilana, Oral Psychophysiology, 2020
Pain is an emotional and usually unpleasant experience.7 The recognition and tolerance of noxious stimuli are modified by the emotional-affective system and by cognitive processes.26 There is evidence that pain and mood are related and that there may be a chemical basis for this reciprocal relationship. Mood changes can precede or follow pain, suggesting an interactive system: changes in mood can result in pain, and conversely, changes in pain can cause alterations in mood.37
Anxiety, Depression, Chronic Pain, and Quality of Life Among Older Adults in Rural China: An Observational, Cross-Sectional, Multi-Center Study
Published in Journal of Community Health Nursing, 2022
In this study, pain reflected by AS and SS was independently associated with anxiety and depression assessed by the SAS and SDS, suggesting that in older adults with pain, the higher their pain experience is, the more symptoms of anxiety and depression there are. This result corroborated some previous studies that highlighted an interaction between pain and psychological distress both in people with chronic diseases and the general population (Glette et al., 2021; Nakagawa et al., 2017). There are several explanations to address this association. First, as indicated in the current study, is the heightened prevalence of somatic comorbidity among people with chronic pain. Pain is related to a medical condition, such as diabetes, arthritis, cancer, and autoimmune disorders. Alternatively, pain can be caused by (secondary to) an underlying condition (e.g., rheumatoid arthritis). Additionally, pain is considered an appearance of psychological distress, and the link between the two may include shared neurobiology, genetics, environmental factors, and cognitive impacts. For example, at a neurobiological level, pain processing and mood are both controlled by common neurotransmitters such as serotonin, norepinephrine, glutamate, and gamma-aminobutyric acid (GABA; Goesling et al., 2013).
Managing the gastrointestinal side effects of GLP-1 receptor agonists in obesity: recommendations for clinical practice
Published in Postgraduate Medicine, 2022
Sean Wharton, Melanie Davies, Dror Dicker, Ildiko Lingvay, Ofri Mosenzon, Domenica M. Rubino, Sue D. Pedersen
Patients presenting with abdominal pain should be fully evaluated as per standard clinical practice, irrespective of GLP-1RA use. The nature of the pain and physical examination findings should direct the scope of further work-up, potentially including laboratory tests and/or diagnostic imaging. In patients with symptoms that could indicate acute pancreatitis (persistent severe abdominal pain, sometimes radiating to the back, with or without vomiting), GLP-1RA treatment should be stopped and appropriate management for suspected pancreatitis should be undertaken [2,3,8]. The GLP-1RA should not be restarted if pancreatitis is confirmed. In addition, as noted earlier, given cholelithiasis risk increases with rapid weight loss and has been reported with GLP-1RAs, if cholelithiasis is suspected appropriate gallbladder studies and clinical follow-up should be undertaken [2–4,8,13,14].
(E)-3-furan-2-yl-N-phenylacrylamide (PAM-4) decreases nociception and emotional manifestations of neuropathic pain in mice by α7 nicotinic acetylcholine receptor potentiation
Published in Neurological Research, 2021
Deniz Bagdas, Gulce Sevdar, Zulfiye Gul, Rabha Younis, Sinan Cavun, Han-Shen Tae, Marcelo O. Ortells, Hugo R. Arias, Mine Sibel Gurun
Pain has been described as a multi-dimensional state composed of sensory, affective, and cognitive components [1,2]. Furthermore, pain states that require clinical intervention are often accompanied by changes in affective behaviors [3,4]. At present, non-steroidal anti-inflammatory drugs and opioids remain the most common forms of pharmacological treatments for different types of pain. In general, these medications show low efficacy in several types of chronic pain, particularly associated with neuropathies, and opioids present high risk for addiction/abuse and death from overdose. Although chronic neuropathic pain is mainly treated with antidepressants (e.g. duloxetine and amitriptyline) and anticonvulsants (e.g. gabapentin and pregabalin), these medications also show limited efficacy and/or limited tolerability profiles across different patient populations. Hence, there is a critical need for more effective, non-opioid pharmacotherapies for pain management [5].