Brain and nerve = Shinkei kenkyū no shinpo
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Pain is a common reason for seeking health care and chronic pain is a common comorbidity in psychiatric disorders. In clinical practice, we encounter many patients with chronic pain; however, before initiating pain treatment, we should conduct detailed analysis of psychiatric symptoms, such as perception, memory, thought and mood disturbances or behavioral problems. We should also determine the frequency of occurrence of mental disorders in patients with pain, especially those with chronic pain, such as in mood, anxiety, pain, personality, and developmental disorders, and dementia. Current understanding of the intricate relationship between chronic pain and psychiatric issues not only provides opportunities for designing appropriate treatment but also raises good and new questions for future pain research.
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Review
[Pharmacological treatment strategy and mirror visual feedback treatment for neuropathic pain].
Neuropathic pain is a debilitating condition, and pharmacotherapy is the most established treatment strategy. A variety of pharmacotherapies is used for neuropathic pain management: however, pharmacotherapies with evidence for analgesic potency are less common. ⋯ We have treated pharmacotherapy-resistant neuropathic pain with neurorehabilitation techniques such as mirror visual feedback (MVF) treatment. Further to our clinical experience using MVF, we discuss the cerebral mechanism associated with neuropathic pain in this study.
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Musculoskeletal disorders are the most common causes of severe long-term pain and physical disability, affecting hundreds of millions of people around the world. In industrialized countries, which have increasingly aging populations, chronic musculoskeletal pain has become a significant health care burden and major issue in the 1980s and 1990s. On January 13, 2000, The Bone and Joint Decade was formally launched at the headquarters of the World Health Organization in Geneva, Switzerland. ⋯ Chronic pain had a significant impact on the occupational and social relationships, and it seriously affected their psychological conditions and quality of life. Such disabling chronic pain is regarded as the result of interrelated physical, psychological, and social or occupational factors requiring multidisciplinary intervention. We introduce a multidisciplinary clinical approach and report on novel multimodal methodologies -- for patients with chronic musculoskeletal pain.
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Detection of unmyelinated epidermal nerve fibers allows objective, pathologic, and minimally invasive assessment of small myelinated A-delta and unmyelinated C primary afferent fibers. This procedure is especially valuable for diagnosing small fiber neuropathy; this condition is characterized by sensory symptoms and pain in the lower extremities but standard nerve conduction fails to show abnormalities in this condition. ⋯ In this review, we discuss standard technical aspects of skin biopsy introduced for evaluation of epidermal nerve fibers and the feasibility of skin biopsy for diagnosing small fiber neuropathy and neuronopathy. We also describe the usefulness of skin biopsy in diagnosing peripheral neuropathies and other neurological disorders.
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Pain is classified into physical and psychological pain. Physical pain is nociceptive, inflammatory, or neuropathic. Pain can be categorized into acute or chronic pain depending on the duration of pain and mechanism of onset. ⋯ Chronic pain is caused by incurable conditions or requires a long time to heal and is persistent: it includes chronic nociceptive pain, established neuropathic pain, and psychogenic pain. The therapeutic strategies for pain depend on the underlying pathological conditions: (1) For nociceptive pain, analgesics, narcotic analgesics, and nerve block are indicated. (2) For neuropathic pain, supplementary analgesics, but not analgesics, are indicated, and some narcotic analgesics are also effective: the recommended supplementary analgesics include calcium channel alpha-2-delta ligands, tricyclic antidepressants (TCAs), and serotonin-noradrenaline reuptake inhibitors (SNRIs). (3) For psychogenic pain, analgesics and nerve block are not indicated, except in the setting of a placebo effect: in paticular, narcotic analgesics should not be used. Psychological therapy, tranquilizer administration, cognitive behavior therapy, and patient education are indicated for this kind of pain.