Problems with Chronic Opioid Therapy and the Need for a Multidisciplinary Approach
John D. Loeser in Chronic Pain Management, 2007
Opioid therapy became a necessary component of pain management and often the only option left if injections, nonopioid medications, and other adjuncts failed. Physicians expecting to be able to treat pain simply and successfully may be unable to cope with the complex biopsychosocial problems associated with opioid dependence. Addiction is a chronic neurobiological disease produced by repeated exposure to an addictive drug, characterized by loss of control over drug use. The circumstances that combine to produce drug and opioid addiction can be considered in three categories: psychosocial factors, drug-related factors and genetic factors. Randomized controlled trials (RCTs) have been conducted to test the analgesic efficacy of opioids for various chronic pain conditions, including the arthitides and various neuropathic pain conditions. Measured pain scales from the RCTs show a statistically significant improvement across all the studies, both in cases of painful arthitides and neuropathic pain.
The Impact of Interventional Approaches when used Within the Context of Multidisciplinary Chronic Pain Management
John D. Loeser in Chronic Pain Management, 2007
This chapter provides strong support for the efficacy and cost-efficiency of multidisciplinary chronic pain management. Interventional approaches to the management of chronic pain are commonly used, despite the extremely weak empirical support for their long-term efficacy. Much of the overall benefit associated with using interventional measures within the context of a comprehensive multidisciplinary chronic pain management program is likely at least partially due to a placebo effect. Patient expectations regarding the efficacy of a multidisciplinary chronic pain management program are also thought to be related to outcomes, and these can be positively affected through the use of interventional techniques. Practitioners involved in the multidisciplinary treatment of individuals with chronic pain face significant challenges in causing their patients to adopt life-changing habits in order to assist them in reducing the disabling impact of symptoms. These include, exercise, smoking cessation, dietary changes, and sometimes change of vocation.
Approaches to Psychological Assessment Prior to Multidisciplinary Chronic Pain Management
John D. Loeser in Chronic Pain Management, 2007
The multidisciplinary evaluation and treatment approach is widely practiced today and considered to be the standard of care. The psychological evaluation and assessment of chronic pain patients has evolved from one-dimensional to multidimensional models and the utility of the approaches has increased exponentially. The clinical interview is ideally suited to review the patient’s pain complaints. This initial focus on pain helps establish rapport by focusing the agenda of the interview on pain and may allay the fears and defensiveness that pain patients have about seeing a mental-health professional. The Beck Depression Inventory is one of the most widely used tests with chronic pain patients because it is a relatively quick measure of depression, a mood state closely interlinked with chronic pain. The most prevalent psychological characteristic of chronic pain patients is depression. The Minnesota Multiphasic Personality Inventory, one of the most widely used and researched tests of all time, is used quite extensively with chronic pain patients.
Chronic periodontitis, inflammatory cytokines, and interrelationship with other chronic diseases
Published in Postgraduate Medicine, 2018
Elsa Maria Cardoso, Cátia Reis, Maria Cristina Manzanares-Céspedes
ABSTRACT Periodontal diseases, such as chronic periodontitis, share common inflammatory risk factors with other systemic and chronic inflammatory disorders. Mucosal tissues, such as oral epithelia, are exposed to environmental stressors, such as tobacco and oral bacteria, that might be involved in promoting a systemic inflammatory state. Conversely, chronic disorders can also affect oral health. This review will summarize recent evidence for the interrelationship between chronic periodontitis and other prevalent chronic diseases such as cardiovascular diseases, diabetes, cancer and chronic respiratory diseases. The association with pregnancy is also included due to possible obstetric complications. We will focus on inflammatory cytokines such as TNF-alpha, IL-1, and IL-6, because they have been shown to be increased in patients with chronic periodontitis, in patients with chronic systemic diseases, and in patients with both chronic periodontitis and other chronic diseases. Therefore, an imbalance towards a proinflammatory immune response could underline a bidirectional link between chronic periodontitis and other chronic diseases. Finally, we highlight that a close coordination between dental and other health professionals could promote oral health and prevent or ameliorate other chronic diseases.
Applying Cluster Analysis to Define a Typology of Chronic Fatigue Syndrome in a Medically-Evaluated, Random Community Sample
Published in Psychology & Health, 2002
This study involved a randomly selected, medically-evaluated, community-based sample of 166 individuals with chronic fatigue. Participants diagnosed with chronic fatigue syndrome and medically-explained chronic fatigue reported significantly more severe fatigue following exertion than the idiopathic chronic fatigue group, and participants with medically-explained chronic fatigue also reported significantly more severe fatigue following exertion than the psychiatrically-explained chronic fatigue group. A cluster analysis was performed to define a typology of chronic fatigue symptomatology for participants diagnosed with chronic fatigue syndrome. Three clusters emerged. Cluster 1 contained only one participant with chronic fatigue syndrome and was characterized by relatively low post-exertional fatigue. Cluster 2 contained a small proportion of individuals with chronic fatigue syndrome and was characterized by most severe post-exertional fatigue and most improvement in fatigue following rest. Cluster 3 contained the highest proportion of individuals with chronic fatigue syndrome, and was characterized by high post-exertional fatigue and fatigue not alleviated by rest.
Chronic Insomnia and Health Care Utilization in Young Adults
Published in Behavioral Sleep Medicine, 2012
Chronic insomnia is prevalent, contributes a significant economic burden, and people with insomnia have increased health care utilization (HCU). The purpose of this study was to investigate the relationship between chronic insomnia and HCU in a population with fewer medical/mental health problems, using current operational definitions of chronic insomnia and multiple measures of HCU. Participants with chronic insomnia had greater HCU than normal sleepers. Participants with chronic insomnia plus a comorbid condition had greater HCU than normal sleepers with a medical/mental health problem and participants with only chronic insomnia. The relationship between chronic insomnia and HCU was moderated by comorbid medical/mental health problems. Early identification and intervention of chronic insomnia may help reduce HCU and costs associated with chronic insomnia.