Current review of pain最新文献

The validity of the fibromyalgia syndrome (FMS) as a distinct clinical entity has been challenged for several reasons. Many skeptics express concern about the subjective nature of chronic pain, the subjectivity of the tender point (TeP) examination, the lack of a gold standard laboratory test, and the absence of a clear pathogenic mechanism by which to define FMS. Another expressed concern has been the relative nature of the pain-distress relationship in the rheumatology clinic. The apparently continuous relationship between TePs and somatic distress across a variety of clinical disorders is said to argue against FMS as a separate clinical disorder. The most aggressive challenges of the FMS concept have been from legal defenses of insurance carriers motivated by economic concerns. Other forms of critique have presented as psychiatric dogma, uninformed posturing, suspicion of malingering, ignorance of nociceptive physiology, and occasionally have resulted from honest misunderstanding. It is not likely that a few paragraphs of data and logic will cause an unbeliever to change an ingrained opinion. Therefore, this review describes the clinical manifestations of FMS, responds to some of the theoretic arguments against it, and discusses some possible pathophysiologic mechanisms by which FMS may develop and persist as a unique syndrome.

Provocative lumbar discography was investigated in a series of clinical studies at the Stanford University of Medicine, Stanford, CA. This work demonstrated that pain intensity during disc injection is strongly influenced by the subject's emotional and psychological profiles, chronic pain behavior, and ongoing compensation claims whether the patient has any back pain illness or not. Pain reproduction was also primarily related to penetration of the dye through the outer annulus and could not reliably be used to confirm the location of the pain source.

Innervation of the ventral spinal artery from the lumbosacral region of dogs was studied using light, scanning, and transmission microscopy. Microscopy revealed myelinated fibers, a new observation, in addition to unmyelinated fibers expected on the basis of previous studies of autonomic innervation of this blood vessel. The myelinated axons may be sensory fibers.

Metastatic involvement of the bone is one of the most frequent causes of pain in cancer patients and represents one of the first signs of widespread neoplastic disease. The pain may originate directly from the bone, from nerve root compression, or from muscle spasms in the area of the lesions. The mechanism of metastatic bone pain is mainly somatic (nociceptive), even though, in some cases, neuropathic and visceral stimulations may overlap. The conventional symptomatic treatment of metastatic bone pain requires the use of multidisciplinary therapies, such as radiotherapy, in association with systemic treatment (hormonotherapy, chemotherapy, radioisotopes) with the support of analgesic therapy. Recently, studies have indicated the use of bisphosphonates in the treatment of pain and in the prevention of skeletal complications in patients with metastatic bone disease. In some patients, pharmacologic treatment, radiotherapy, and radioisotopes administered alone or in association are not able to manage pain adequately. The role of neuroinvasive techniques in treating metastatic bone pain is debated. The clinical conditions of the patient, his life expectancy, and quality of life must guide the physician in the choice of the best possible therapy.

Chronic pain is a multidimensional experience produced by multiple influences. This article examines the intervening role of psychologic and physiologic stress in the development and pathogenesis of prolonged herpes zoster and postherpetic neuralgia.

A summary of the current state of science is presented with reference to post-traumatic stress disorder (PTSD) and pain. Historical development of the diagnosis, current nosology, epidemiology, pathophysiology, and controversies are discussed. Issues of evaluation are reviewed, with specific reference to forensic assessment. Treatment outcome studies are briefly reviewed, with a review of currently accepted treatment interventions, including pharmacologic and behavioral modalities. An emphasis is placed on an integrated treatment plan in which chronic pain and PTSD both are present.

Within the literature, it appears evident that neither a univariate etiologic model nor a single-agent treatment approach is sufficient to address the many diagnostic, assessment, and therapeutic challenges posed by irritable bowel syndrome (IBS). Various scientific advances have been made over the past 5 years, particularly in the areas of nonpharmacologic management of IBS. However, further collaboration between scientists and clinicians from multiple disciplines is strongly encouraged.

Pain management can be especially difficult in patients with head and neck cancer due to the erosive nature of the neoplasms that invade the region, the rich innervation of the head and neck, and other factors. Consequently, diagnosis is a complex process that cannot be dealt with in a cursory fashion. Furthermore, tumor pain can mimic noncancer conditions, nonmalignant orofacial disorders can be suggestive of tumor growth, and antineoplastic treatment-related conditions can be difficult to distinguish from tumor recurrence. A series of case reports illustrates key elements of diagnosis and pain management in patients with head and neck cancer. These elements include 1) detailed assessment of pain intensity and characteristics; 2) appropriate use of analgesic adjuvant medications; 3) use of diagnostic and therapeutic nerve blocks and myofascial trigger point injections; and 4) a high index of suspicion regarding tumor recurrence pain.