Acute Neuropathic Pain
Pamela E. Macintyre, Stephan A. Schug in Acute Pain Management, 2021
Acute neuropathic pain often goes undiagnosed and is therefore undertreated. It may develop immediately after the initial injury or some time later but often still in the phase of acute pain treatment. Nociceptive pain is the most common type of pain seen in the acute clinical setting, and its treatment is therefore the primary focus of this book. Most studies that look at the treatment of neuropathic pain investigate the management of chronic neuropathic pain. In contrast with the recommendations given for the treatment of acute neuropathic pain, these list gabapentinoids, TCAs, and SNRIs as the first-line treatment options for chronic neuropathic pain and relegate tramadol and opioids to secondor third-line choices. However, if it has more neuropathic qualities or does not respond to this approach, then treatment options for acute neuropathic pain in general should be tried. Treatment options for phantom limb pain also include those mentioned previously for the management of acute neuropathic pain in general.
Mechanisms of Pain
Benjamin Apichai in Chinese Medicine for Lower Body Pain, 2021
Nociceptive pain is caused by damage to body tissues. The noxious stimuli that cause tissue damage activate the nociceptors, which are the pain receptors located on the surface of the body or in the musculoskeletal tissues. Somatic nociceptive pain originates from the nociceptors located on the surface of the body or in the musculoskeletal tissues. A-fibers are thinly myelinated and associated with fast conduction and response, such as first acute pain and heat. C-fibers are unmyelinated and associated with longer-lasting and dull pain such as reactions to chemicals and thermal and mechanical stimuli. Neuropathic pain is caused by injury to the nerves that send the wrong pain signals to the brain. Visceral pain originates from pain receptors located in the internal organs. This type of pain is usually described as cramping, deep, aching, squeezing, constant, and pressure-like, but it is localized because it may refer, as with appendicitis or gallstones.
Acute neuropathic and persistent postacute pain
Pamela E. Macintyre, Stephan A. Schug in Acute Pain Management, 2014
The diagnosis of neuropathic pain is a clinical one and can be based on careful history taking and a basic clinical examination looking for negative and positive neurological signs. Nociceptive pain is the most common type of pain seen in the acute clinical setting. The diagnosis of neuropathic pain can usually be made on the basis of a complete history and basic physical examination. Patients will typically describe their pain as “strange” and different from “normal” wound pain. Neuropathic pain is most obvious when the pain occurs in an area of complete neurological deficit, for example, below the level of the lesion after spinal cord injury or in a flaccid arm after brachial plexus injury. Complex regional pain syndrome is not a straightforward manifestation of neuropathic pain, but excellently described as a “disease of neuronal systems”. The diagnosis is currently made according to the Budapest criteria. The patient has continuing pain disproportionate to an inciting event.
Clinical reasoning for manual therapy management of tension type and cervicogenic headache
Published in Journal of Manual & Manipulative Therapy, 2014
César Fernández-de-las-Peñas, Carol A. Courtney
In recent years, there has been an increasing knowledge in the pathogenesis and better management of chronic headaches. Current scientific evidence supports the role of manual therapies in the management of tension type and cervicogenic headache, but the results are still conflicting. These inconsistent results can be related to the fact that maybe not all manual therapies are appropriate for all types of headaches; or maybe not all patients with headache will benefit from manual therapies. There are preliminary data suggesting that patients with a lower degree of sensitization will benefit to a greater extent from manual therapies, although more studies are needed. In fact, there is evidence demonstrating the presence of peripheral and central sensitization in chronic headaches, particularly in tension type. Clinical management of patients with headache needs to extend beyond local tissue-based pathology, to incorporate strategies directed at normalizing central nervous system sensitivity. In such a scenario, this paper exposes some examples of manual therapies for tension type and cervicogenic headache, based on a nociceptive pain rationale, for modulating central nervous system hypersensitivity: trigger point therapy, joint mobilization, joint manipulation, exercise, and cognitive pain approaches.
Balanced anaesthesia 2005: Avoiding the Transition from Acute to Chronic Pain
Published in Southern African Journal of Anaesthesia and Analgesia, 2005
When general anaesthesia consisted of the administration of a volatile anaesthetic agent according to clinical parameters usually preceded by premedication, was chronic post-operative pain a significant problem? Have we, by working hard to deliver balanced anaesthesia and rapid recovery lost sight of the fundamental importance of abolishing noxious reflexes at the spinal level? We need to identify, ameliorate and manage specific features and risk factors, including the severity of the acute pain experience, for individuals at risk for the development of a chronic pain syndrome. Anaesthetists' actions and the drugs they use have multiple and profound effects to be taken into account, appropriately modified and controlled, combined with excellent postoperative analgesia, particularly for those patients or procedures at high risk to minimise the transition of acute to chronic pain following surgery. Acute nociceptive pain is the risk for the transition to chronic neuropathic pain.
Mechanisms of chronic pain – key considerations for appropriate physical therapy management
Published in Journal of Manual & Manipulative Therapy, 2017
Carol A. Courtney, César Fernández-de-las-Peñas, Samantha Bond
In last decades, knowledge of nociceptive pain mechanisms has expanded rapidly. The use of quantitative sensory testing has provided evidence that peripheral and central sensitization mechanisms play a relevant role in localized and widespread chronic pain syndromes. In fact, almost any patient suffering with a chronic pain condition will demonstrate impairments in the central nervous system. In addition, it is accepted that pain is associated with different types of trigger factors including social, physiological, and psychological. This rational has provoked a change in the understanding of potential mechanisms of manual therapies, changing from a biomechanical/medical viewpoint, to a neurophysiological/nociceptive viewpoint. Therefore, interventions for patients with chronic pain should be applied based on current knowledge of nociceptive mechanisms since determining potential drivers of the sensitization process is critical for effective management. The current paper reviews mechanisms of chronic pain from a clinical and neurophysiological point of view and summarizes key messages for clinicians for proper management of individuals with chronic pain.