The Medical clinics of North America
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Painful conditions of the musculoskeletal system, including myofascial pain syndrome, constitute some of the most important chronic problems encountered in a clinical practice. A myofascial trigger points is a hyperirritable spot, usually within a taut band of skeletal muscle, which is painful on compression and can give rise to characteristic referred pain, motor dysfunction, and autonomic phenomena. ⋯ Invasive treatments for myofascial trigger points include injections with local anesthetics, corticosteroids, or botulism toxin or dry needling. The etiology, pathophysiology, and treatment of myofascial trigger points are addressed in this article.
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Med. Clin. North Am. · Mar 2007
ReviewDocumentation and potential tools in long-term opioid therapy for pain.
The field of pain medicine is experiencing increased pressure from regulatory agencies and other sources regarding the continuation, or even initial use, of opioids in pain patients. Therefore, it is essential that pain clinicians provide rationale for engaging in this modality of treatment and provide ample documentation in this regard. Thus, assessment and documentation are cornerstones for both protecting your practice and obtaining optimal patient outcomes while on opioid therapy. Several potential tools and documentation strategies re discussed that will aid clinicians in providing evidence for the continuation of this type of treatment for their patients.
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Vertebral compression fractures occur more frequently than hip and ankle fractures combined. These fragility fractures frequently result in both acute and chronic pain, but more importantly are a source of increased morbidity and possibly mortality. ⋯ The history, technique, and results of vertebroplasty and kyphoplasty are reviewed. Both methods allow for the introduction of bone cement into the fracture site with clinical results indicating substantial pain relief in approximately 90% of patients.
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This article reviews the evidence for several common interventional techniques for the treatment of chronic pain, including: intraspinal delivery of analgesics, reversible blockade with local anesthetics, augmentation with spinal cord stimulation, and ablation with radiofrequency energy or neurolytic agents. The role of these techniques is defined within the framework of a multidisciplinary approach to the neurobehavioral syndrome of chronic pain. Challenges to the study of the analgesic efficacy of procedural interventions are explored, as are the practical issues raised by their clinical implementation, with the aim of helping nonspecialist physicians identify the patients most likely to benefit from these approaches.
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Opioids are extensively used in the management of all types of pain and their use is underpinned by extensive trial evidence and an abundance of practical experience. We are still amassing insight into how they achieve their pain-relieving effects, however, and this understanding becomes more complex as time progresses and shows that opioids are medications with complex and diverse central and peripheral nervous system effects. Despite the 200 years that have passed since the chemical isolation of morphine, every year brings new understanding of the mode of action, propensity to cause side effects, and appropriate clinical use of opioids. This article concentrates on this "new" evidence as disclosed by recent publications.