Current review of pain最新文献

Interdisciplinary treatment care must address more than the physical pathology. Chronic pain comprises a range of interdependent variables including biologic, cognitive, affective, behavioral, and social factors. This article discusses these psychosocial issues, as well as the four levels of pain management programs, and the characteristics and goals of interdisciplinary treatment. Finally, recent clinical studies demonstrating the efficacy and cost benefits of interdisciplinary pain management programs are reviewed.

Facet joints have been described as an important source of low back pain. The value of medial branch blocks in the diagnosis of facet joint mediated pain is considered important. However, the therapeutic value of medial branch blocks has not been determined. This study was designed to evaluate the duration of relief obtained and therapeutic value following controlled medial branch blocks with or without adjuvant agents Sarapin (High Chemical Company, Levittown, PA) and Depo-medrol (Pharmacia and Upjohn Company, Kalamazoo, MI). The study population consisted of 180 consecutive patients seen in a single pain management practice, divided into three groups with 60 patients in each group. Group I was treated with local anesthetic only, Group II with the addition of Sarapin, and Group III with the addition of Depo-medrol along with Sarapin. The prevalence of facet joint pain in chronic low back pain was determined as 36%, with a false-positive rate of 25%. Comparison of duration of relief in days with each block in the three groups showed that the relief was significantly superior in Group III compared with Group I and Group II, whereas Group II was superior to Group I.

Because of the controversy concerning the manner in which the sympathetic nervous system is involved in reflex sympathetic dystrophy (RSD), its name was changed to one having no mechanistic connotations. This article reviews the relevant literature in support of not only the taxonomical changes to complex regional pain syndrome (CRPS) but also provides evidence of sympathetic dysfunction demonstrated in animal models of neuropathic pain.

Individuals with fibromyalgia (FM) and/or chronic fatigue syndrome (CFS) report arthralgias and myalgias. However, only persons with FM alone exhibit abnormal pain responses to mild levels of stimulation, or allodynia. We identify the abnormalities in the neuroendocrine axes that are common to FM and CFS as well as the abnormalities in central neuropeptide levels and functional brain activity that differentiate these disorders. These two sets of factors, respectively, may account for the similarities and differences in the pain experiences of persons with FM and CFS.

The temporomandibular disorders (TMDs) comprise a constellation of symptoms affecting the joints and muscles involved in jaw movement. Patients complain of orofacial pain, limited jaw opening, and clicking or popping sounds. Although pain is generally the defining characteristic of TMD, patients often report marked degrees of stress and interference in daily life. This article reviews recent studies on epidemiology, sex differences, pediatric TMD, classification systems, comparisons to other chronic pain disorders of uncertain etiology, psychological assessment, depression, central modulation and hypervigilance, sleep disturbances, stress, and the management of TMD by conservative physical interventions and cognitive behavioral therapy. Both the assessment and the management of TMD requires a multidisciplinary perspective with strong emphasis on psychosocial variables.

Failed back surgery syndrome is continued low back pain with or without radicular pain after lumber surgery. The syndrome is difficult to treat due to the variability of pain generators. By examining the anatomy and pathophysiology of the pain mechanisms, a logical progression for an algorithm for treatment is presented.

Coagulation abnormalities and bleeding disorders are frequently encountered in patients undergoing invasive procedures. These are of particular importance in the pain management setting where even small amounts of excessive bleeding can result in devastating complications. It is imperative that physicians treating those patients under-stand the basic concepts of coagulation and be able to identify and manage the common bleeding disorders. This article provides a brief overview of the coagulation system and describes the use of appropriate screening tests and management strategies to limit bleeding in pain management procedures.