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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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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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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A physical medicine and rehabilitation approach to acute and chronic pain syndromes includes a wide spectrum of treatment focus. Whether assessing or treating acute or chronic pain syndromes, management should include a biopsychosocial approach. Assessment may include a focused joint and functional examination including more global areas of impairment (ie, gait, balance, and endurance) and disability. ⋯ Treatment goals generally emphasize achieving analgesia, improving psychosocial functioning, and reintegration of recreational or leisure pursuits (ie, community activities and sports). Progress in all therapies necessitates close monitoring by the health care provider and necessitates ongoing communication between members of the treatment team. Although this article focuses on diagnoses related to acute and chronic low back pain, OA, and musculoskeletal disorders, assessment and treatment recommendations may be generalized to most other pain conditions.
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Determining the causes of neuropathic pain is more than an epistemological exercise. At its essence, it is a quest to delineate mechanisms of dysfunction through which treatment strategies can be created that are effective in reducing, ameliorating, or eliminating symptomatology. To date, predictors of which patients will develop neuropathic pain or who will respond to specific therapies are lacking, and present therapies have been developed mainly through trial and error. ⋯ Higher scores for these symptoms correlated with greater clinician certainty of the presence of neuropathic pain mechanisms. Considering each individual patient's chronic pain as being somewhere on a continuum between "purely nociceptive" and "purely neuropathic" may have diagnostic and therapeutic relevance by enhancing specificity, but this requires clinical confirmation. Thus, symptom assessment remains indispensable in the evaluation of neuropathic pain, ancillary testing notwithstanding