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Results for “chronic pain”

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The pharmacologic approach in differential diagnosis of chronic pain.

Chronic pain of unknown cause below waist level was evaluated in 100 patients by using the Differential Spinal Block (DSB) in a multidisciplinary pain clinic setting. The classic DSB approach, refined for better control of psychologic variables, was found to be a safe and effective means of differentiating various pain mechanisms. We found that, of all patients tested, 55% had pain of central or psychogenic origin and 30% had sympathetically mediated pain, as compared with 15% who had somatic pain. A long-term follow-up of these patients confirmed this impression. These results substantiated the importance of psychologic variables, in dicating the necessity for use of behavioral-based therapies in conjunction with the routine use of the refined diagnostic DSB procedure in patients with chronic pain.

Adolescent↗

PubMed1979

Reinterpretative cognitive strategies in chronic pain management.

This preliminary study was conducted to test the effectiveness of cognitive treatment of clinical pain. Chronic pain patients were trained in a self-control cognitive strategy procedure. Specifically, they were provided with a conceptualization of their pain, instructed in an awareness of their thoughts prior to and during their experience of pain, and trained in the use of several cognitive strategies to replace these thoughts and relabel their pain experience. Training was provided in a group setting to further consolidate the use of the instructions by enabling patients to roleplay the instructions to one another. Patients were also encouraged to verbally reinforce themselves each time they used the procedure. The experience of pain was measured by the McGill pain questionnaire, a behavioral checklist and staff reports. Results suggest that cognitive strategies can effectively alter the experience of clinical pain. Moreover, pain as a cognitive label for a nonspecific state of arousal is suggested.

Cognition↗

PubMed2026

The Effect of Pain Catastrophizing on Acupuncture Treatment for Chronic Pain in Cancer Survivors.

CONTEXT: Pain catastrophizing (PC) predicts worse pain outcomes in cancer survivors. However, little is known whether PC influences pain outcomes of nonpharmacological treatments such as acupuncture. OBJECTIVES: This study aimed to assess the impact of PC on acupuncture efficacy for chronic pain in cancer survivors. METHODS: This secondary analysis of PEACE trial used two-sample t-test and Pearson's chi-squared test to analyze the pain outcomes of cancer survivors who received electroacupuncture (EA) or battlefield acupuncture (BFA). PC was measured using Pain Catastrophizing Scale (PCS). The Brief Pain Inventory (BPI) was used to measure pain severity and interference at the primary endpoint (week 12). RESULTS: Among 266 participants, 41 (15.41%) had a high baseline PC. Among those receiving EA, high PC patients had greater reductions in pain severity (-3.9 vs. -2.1, P = 0.006) and pain interference (-3.8 vs. -2.6, P = 0.04) than low PC. PC was not associated with pain outcomes in BFA group (P > 0.05 for both severity and interference). Among patients with high PC, a greater proportion were responders in the EA group than those in BFA group (83.3% vs. 43.5%, P = 0.009). Among low PC patients, there was no significant difference in the proportion of responders between the EA and BFA groups (66.1% vs. 64.5%, P = 0.8). CONCLUSION: We found that cancer survivors with high baseline PC had greater pain reductions with EA than BFA and compared to low PC patients. These findings suggest that EA may serve as a targeted treatment option for vulnerable patients with high PC and further support precision pain management.

Humans↗

PubMed1978

The pain profile: a computerized system for assessment of chronic pain.

A computer-based system to assess and quantify three components of the chronic pain experience is described. The system produces a Pain Profile and classification for each patient based on a mathematical comparison of the pathophysiologic, psychological and behavioral aspects of chronic pain. This computer-based evaluation assists the researcher in analyzing the relative importance of the chronic pain components and helps direct the clinician to the appropriate emphasis of therapy.

Diagnosis, Computer-Assisted↗

PubMed1978

The dissatisfied patient with chronic pain.

Patients with chronic pain may become dissatisfied because of their lack of improvement. Thirteen such patients, encountered in a pain-management program, registered formal complaints of their dissatisfaction. From their histories they were found to be the most chronic and treatment-refractory patients encountered, with problems of medication dependency, accident proneness, and dissatisfaction with previous treatment efforts. During hospitalization they opposed psychologic approaches, further manifested their dependency on medication, and some of them had circumscribed delusions. The pain-management program was difficult to apply to these patients; and further, they resisted other recommendations for treatment and even resisted discharge in in some instances. Further psychiatric screening is necessary to avoid the complications presented by this type of patient.

Adult↗

PubMed1978

Sodium amytal in the diagnosis of chronic pain.

The diagnosis of chronic pain cases is now an important problem for psychiatrists and many authors have presented strong evidence for the influence of psychological factors in chronic pain conditions. The author is reporting his experience with 75 consecutive out-patient consultations. Many of the patients were foreign-born and had significant language difficulties. The main diagnostic technique described is the use of sodium amytal given intravenously over a 45 minute-period while the patient is examined physically and psychologically; his responses noted during light, midrange and deeper levels of sodium amytal sedation. Most patients fell comfortably into one of the following diagnostic groups: psychogenic regional pain, organic pain, mixed group (organic plus psychogenic regional pain), and malingering. The author suggests that sodium amytal helps to overcome language barriers, reduces the time required for proper assessment and allows the patient and the examiner to appreciate more precisely, the level of pain and the limits of physical performance as well as permitting an effective exploration of important psychodynamic issues.

Adult↗

PubMed1979

Are the endorphins active in clinical pain states? Narcotic antagonism in chronic pain patients.

To test the possibility of endorphin release in clinical pain states naloxone was given, alternate with saline, in a double-blind study to 10 patients with chronic neuralgia or low back pain. There was no significant alteration of the levels of spontaneous pain or heat pain thresholds. The results suggest that the endorphin system does not offer protection of any importance in chronic pain.

Adult↗

PubMed2026

Disentangling the association between chronic pain and sarcopenia-related traits: A bidirectional Mendelian randomization study.

ObjectiveThis study aimed to investigate the potential causal relationships between chronic pain and three key sarcopenia-related quantitative traits: (a) hand grip strength; (b) usual walking pace; and (c) appendicular lean mass, using bidirectional two-sample Mendelian randomization.MethodsWe conducted bidirectional two-sample Mendelian randomization using summary-level data from large-scale genome-wide association studies to assess the genetically predicted associations between chronic pain, including multisite chronic pain and chronic widespread musculoskeletal pain, and the aforementioned sarcopenia-related traits.ResultsMendelian randomization revealed that multisite chronic pain was significantly associated with an increased risk of low hand grip strength (odds ratio = 1.70; p < 0.001) and decreased usual walking pace (odds ratio = 0.81; p < 0.001); chronic widespread musculoskeletal pain was also significantly associated with decreased usual walking pace (odds ratio = 0.15; p < 0.001). Additionally, higher left hand grip strength was significantly associated with a lower risk of multisite chronic pain (odds ratio = 0.90; p< 0.001) and chronic widespread musculoskeletal pain (odds ratio = 0.99; p = 0.002); higher right hand grip strength was significantly associated with a lower risk of multisite chronic pain (odds ratio = 0.91; p = 0.002); and higher usual walking pace was significantly associated with a lower risk of multisite chronic pain (odds ratio = 0.49; p < 0.001) and chronic widespread musculoskeletal pain (odds ratio = 0.92; p < 0.001). No significant causal associations were detected for appendicular lean mass in either direction (all p > 0.05).ConclusionThis study provides genetic evidence supporting potential causal links between chronic pain and key phenotypic components of sarcopenia.

Humans↗

PubMed1976

Acupuncture and chronic pain mechanisms.

Forty patients with chronic pain below the waist level not amenable to conventional medical and/or surgical treatment were randomly assigned to one or two different methods of acupuncture, after studying the underlying pain mechanisms using a Multidisciplinary Pain Clinic approach and the differential spinal block (DSB). One group received acupuncture needling in the classical acupuncture points referred to as meridian loci needling (MLN) and the other group received tender area needling (TAN) with needles inserted in the dermatomal distribution of the painful areas. The responses between the two groups showed no significant difference. Results were then related to the predetermined somatopsychological basis of the individual's pain problems as classified by the DSB. A group of patinets in whom pain relief occurred upon subarachnoid injection of 0.25% procaine followed by sympathetic blockade or 0.5% procaine injection followed by hypalgesia without motor loss, also reported maximum subjective improvement in their pain level following acupuncture therapy performed at a later time. The other group of patients in whom pain persisted despite sensory and motor blockade (1% procaine) responded very poorly to acupuncture therapy. DSB was found to be complimentary to acupuncture therapy in that it facilitated patient selection for the therapy.

Acupuncture Therapy↗

PubMed1979

Drug abuse and dependency in patients with chronic pain.

Of 144 patients with chronic pain of nonmalignant cause, 35 (24%) were drug-dependent, 59 (41%) drug abusers, and 50 (35%) nonabusers. Codeine and oxycodone (Percodan) were most frequently abused. In regard to characteristics tested, differences between the groups were not great; but there was a significant difference in outcome between nonabuse and dependent groups. Early detection and treatment of drug abuse should minimize some of the difficulties involved in management of treatment-resistive patients with chronic pain.

Age Factors↗

PubMed2025

Biosafety and efficacy of Kv7 activating rdHSV-CA8∗ analgesic gene therapy for chronic pain via the intra-articular route in mice.

Chronic pain remains a global health challenge, often resistant to available treatments with socioeconomic and psychological burdens. All chronic pain is believed due to neuronal signaling imbalances, resulting in increased excitability. Gene therapy represents a promising molecular therapy targeting molecular pain processing pathways, by offering precise, localized, long-lasting neuromodulation while minimizing systemic exposure and side effects. In model systems, replication-defective, disease-free, herpes simplex virus (rdHSV) gene therapy expressing an analgesic carbonic anhydrase-8 (CA8∗) peptide variant corrects somatosensory hyperexcitability by activating Kv7 voltage-gated potassium channels, produces profound, long-lasting analgesia and treats chronic pain from knee osteoarthritis (OA). In these studies, we provide the first non-glucagon-like peptide (GLP) biosafety, efficacy, biodistribution, shedding, and histopathology examination of this rdHSV-CA8∗. Naive mice were examined for clinical safety, biodistribution across all major tissues, knee histopathology, and analgesic efficacy via the intra-articular knee route of administration. We observed no signs of persistent toxicity, viral genomes remained where they were injected, and there was no evidence of shedding. Profound analgesia persisted for 6 months without functional impairments. These initial biosafety and efficacy data support further development of rdHSV-CA8∗ for treating chronic knee pain due to moderate to severe OA.

Animals↗

PubMed1976

Evaluation of the pain suppressive effect of different frequencies of peripheral electrical stimulation in chronic pain conditions.

The pain suppressive effect of low (2/s) and high (50-100/s) frequency electrical stimulation was studied in 12 patients with severe chronic pain in the back and/or the legs. All patients were subjected to a thorough physical examination before and 2-3 weeks after a series of stimulation sessions. The stimulation was applied via surface electrodes to areas both segmentally related and segmentally unrelated to the regions of chronic pain. Low frequency stimulation induced a partial pain relief in only one patient whereas stimulation with high frequency gave a suppression of pain in seven patients. The effect was short-lasting in most cases and the pain started to increase usually within 30 min. It is concluded that the observed pain suppression is not due to psychological factors but to more basic neurophysiological mechanisms. Augmentation of the effect after repeated stimulation sessions was not observed, neither was there any alteration in the neuro-orthopedic status nor any lasting pain relief in any patient.

Adult↗

PubMed1978

A therapeutic milieu for chronic pain patients.

Traditional means of treating chronic pain have been unsuccessful in a discouraging number of cases. Pain centers have appeared within the last few years, offering a more comprehensive view of the whole pain problem. Pain centers address pain as a multifaceted event with social, economic, physiological, and psychological representations. In addition, the pain center constructs an atmosphere that provides every opportunity for reduction of pain, while minimizing those factors that tend to encourage its expression. Such a venture calls for a multidisciplinary approach; it further demands a rather sophisticated grasp of numerous factors which do not necessarily lend themselves to discussion with a single vocabulary. This paper will attempt to describe a number of conceptual models of chronic pain and to demonstrate how each of these models is addressed therapeutically in a multidisciplinary pain center millieu.

Humans↗

PubMed1978

Compensation for work-related injuries and rehabilitation of patients with chronic pain.

A group of 61 patients with problems of chronic pain were managed though a rehabilitation program based on the principles of operant conditioning. Of these patients, 35 were receiving compensation for work-related accidents, and 26 were receiving no financial compensation for their chronic pain. Of the patients not receiving compensation, 69% (18) made significant increases in their functional performances, while only 43% (15) of the compensation group made similar increases.

Back Pain↗

PubMed1978

Chronic pain: a review for the family physician.

The challenge of effective management of chronic pain frequently confronts the family physician. Successful management relies on the physician's skill in integrating fundamental concepts in the pathophysiology, psychodynamics, and diagnostic and therapeutic modalities associated with chronic pain syndromes. The use of time-contingent rather than pain-contingent therapy in the prevention of the chronic pain state is advocated.

Anxiety↗

PubMed1979

New concepts of chronic pain and their implications.

When chronic pain fails to respond to therapy, the approach often have been based on outmoded concepts of the nature of pain. The current unified pain theory takes into account recent biochemical advances and can serve as a basis for more effective diagnostic and therapeutic approaches. Various treatment modalities are reviewed in the context of the psychology as well as the physiology of severe intractable pain.

Analgesics↗

PubMed1978

Endorphins in chronic pain. I. Differences in CSF endorphin levels between organic and psychogenic pain syndromes.

A series of 37 patients with chronic pain was investigated with regard to neurologic and psychiatric variables. Twenty of the patients were classified as having mainly organic (= somatogenic) pain syndromes while 17 patients were rather suffering from psychogenic pain syndromes. Samples of lumbar cerebrospinal fluid (CSF) were obtained from the patients and analyzed for the presence of opiate receptor-active material, here called endorphins. Patients classified as having mainly organic pain syndromes were found to have significantly lower endorphin levels than patients with predominantly psychogenic pain syndromes. In the total group of patients as well as in the two subgroups, there was a significant correlation between CSF endorphin levels and the depth of depressive symptomatology as reported by the patients. On the other hand, there was no correlation between CSF endorphin levels and extent of anxiety or motor retardation. It is concluded that CSF endorphins reflect central processes involved in chronic pain syndromes.

Adult↗

PubMed2026

40 Hz light flickering alleviates chronic pain via adenosine signaling in the retina-amygdala pathway.

Chronic pain affects over 20% of the global population, yet frontline treatments remain limited in efficacy and are often hampered by serious side effects. In search of novel and effective neuromodulation alternatives, we discovered that 40 Hz flickering light effectively alleviates inflammatory and neuropathic pain in mice. We identified the retina-central amygdala (CeA) pathway as a critical conduit for the analgesic effects of 40 Hz flickering light. Using circuit-specific manipulations, we demonstrated that activation of the retina-CeA pathway is both sufficient to mimic and necessary to mediate the analgesic outcomes of 40 Hz light stimulation. In terms of mechanism, we found that 40 Hz light flickering significantly increases extracellular adenosine levels in the CeA. Local pharmacological blockade of equilibrative nucleoside transporters prevented this adenosine increase and abolished the analgesic effects of 40 Hz light flickering, whereas focal adenosine infusion phenocopied the light-induced analgesia. Both interventions required A2A receptor signaling to suppress nociceptive responses. Furthermore, we found that hyperalgesia could be destabilized in the CeA and reversed by 40 Hz light stimulation or adenosine infusion, mirroring memory reconsolidation processes and implicating the CeA as a key locus for pain memory erasure. Collectively, our findings demonstrate the multifaceted therapeutic benefits of 40 Hz light flickering as a novel non-invasive approach for pain management and reveal a distinct retina-CeA circuit and adenosine signaling mechanism for control of chronic pain and pain memory.

Animals↗