Life Care Planning for People with Chronic Pain*
Roger O. Weed, Debra E. Berens in Life Care Planning and Case Management Handbook, 2018
Significant pain can be experienced as a result of a multitude of medical problems. Chronic pain syndrome refers to pain that lasts more than 6 months, worsens with time, and is associated with major comorbidities, especially psychological (McMahon & Koltzenburg, 2006). Multidisciplinary therapy is often required. The Institute of Medicine (IOM) recently estimated that more than 110 million adults, over one third of the population of the United States, experience some form of chronic pain, with the symptom of pain being the most common reason for people to consult a primary care physician. It has an associated annual economic cost of $560 to $635 billion, and is a leading cause of disability worldwide (Institute of Medicine Committee on Advancing Pain Research Care and Education Board on Health Sciences Policy, 2011; Vos et al., 2012).
Gynaecology
Keith Hopcroft in Instant Wisdom for GPs, 2017
This condition may have structural, functional and psychological aspects: Heavy menstrual bleeding: In conjunction with pelvic pain, this may suggest adenomyosis, or endometriosis or both. If fibroids are the cause of HMB, they usually cause pressure symptoms, depending on their location, rather than pain.‘Sensitive bowels’: Many CPP patients with or without endometriosis complain of symptoms of IBS. Dietary adjustment such as the low FODMAP diet, mebeverine and treatment of constipation and diarrhoea can bring relief.Depression and fatigue: These are features of many chronic pain syndromes. CBT and mindfulness training have been shown to help, especially for depression associated with chronic pain.Subfertility: Due to the higher incidence of structural pelvic problems in CPP patients, fertility referral should be early, especially in women over 35 years old.
Novel imaging techniques
Harald Breivik, William I Campbell, Michael K Nicholas in Clinical Pain Management, 2008
Although a myriad of pharmacological, physical, psychological, and interventional therapies are available, few are specific for any particular chronic pain condition. Furthermore, efficacy for these therapies as measured in clinical trials is limited and their translation from the trial population and scenario to the individual patient in the clinic is not easily achieved. What we desperately need are innovative methods that aid diagnosis and provide data to inform decisions regarding choice and targeting of treatments, alongside conventional clinical measures in individual patients. Neuroimaging techniques that noninvasively provide functional or structural information regarding the central nervous system (CNS) can fulfill this need and have already shown that the brains of patients suffering chronic pain are significantly more affected than previously anticipated.
Common systemic medications that every optometrist should know
Published in Clinical and Experimental Optometry, 2022
Chronic pain is a debilitating condition, forcing patients to refrain from engaging in work, social events, and even doctor visits. One in five Australians suffer from chronic pain, generally lasting three to six months.80 Chronic pain can be caused by medical conditions, injury, surgery, or musculoskeletal conditions such as arthritis. Risk factors that can lead to chronic pain are physical inactivity, smoking, obesity, and genetic predisposition. A number of health care providers can manage chronic pain, such as general physicians, physical therapists, and social workers. A health care provider may prescribe analgesics for the temporary symptom relief of chronic pain. In 2016, 46% of adults over age 45 were prescribed analgesics. The most commonly prescribed was paracetamol, followed by codeine, aspirin, and ibuprofen.80 Patients may remain on analgesics for several years in order to function with their chronic pain, so optometrists should be cognisant of the long term and cumulative effects of these drugs on the eye and visual system.
The benefits of practical clinical trials over traditional randomized clinical trials for opioid management
Published in Expert Review of Clinical Pharmacology, 2018
Chronic pain has been defined as ‘pain that persists beyond normal tissue healing time, which is assumed to be 3 months (IASP)’. Chronic pain may occur in the context of numerous diseases and syndromes. Opioids are the most important analgesic drugs and are widely used with many indications, including acute postoperative pain, injury or trauma, chronic non-cancer pain, and cancer pain [1]. Although opioid analgesics are widely used for the treatment of chronic pain, their use is still controversial, because treatments with opioids delivered today are lacking clear evidence of effectiveness. Although evidence is limited, expert groups have recommended that chronic opioid therapy can be an effective therapy for carefully selected and monitored patients with chronic non-cancer pain [2]. Indeed, opioids are associated with potentially serious problems, including opioid-related adverse effects and potential abuse. An opioid epidemic has developed in the United States because of over-prescribing in patients with non-cancer pain. Thus, safe and effective chronic opioid therapy for chronic non-cancer pain requires clinical skills and knowledge in both the principles of opioid prescribing and on the assessment and management of risks associated with opioid abuse, addiction, and diversion [3].
Can NSAIDs and Acetaminophen Effectively Replace Opioid Treatment Options for Acute Pain?
Published in Expert Opinion on Pharmacotherapy, 2021
Joseph V. Pergolizzi, Peter Magnusson, Jo Ann LeQuang, Frank Breve, Robert Taylor, Charles Wollmuth, Giustino Varrassi
While chronic pain may be treated with conservative therapies (heat or cold therapy, bracing, rest), complementary and alternative therapies (meditation, acupuncture), psychological support (cognitive behavioral therapy, biofeedback), physical and occupational therapy, interventional pain therapy (injections, surgery) as well as adjuvant agents (antidepressants, anticonvulsants, muscle relaxants), acute pain typically demands rapid treatment that is typically pharmacological. The focus of this review is on acetaminophen (paracetamol) and NSAIDS and their potential use as monotherapy or in combination with opioids to treat acute pain. While the pharmacological treatment of acute painful conditions with opioids and/or nonopioids may be supplemented by other approaches, opioids and nonopioids (NSAIDs, acetaminophen) remain a mainstay of modern acute pain care.
Related Knowledge Centers
- Acceptance & Commitment Therapy
- Cognitive Behavioral Therapy
- Pain
- Acute
- Chronic Condition
- Analgesic
- Peripheral Neuropathy
- Acceptance & Commitment Therapy
- Opioid
- Substance Use Disorder
- Mental Disorder