Canadian journal of psychiatry. Revue canadienne de psychiatrie
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To review the problem of chronic pain in patients with substance use disorders, focusing on the prevalence of chronic pain in patients with substance dependence disorders, especially prescription opioid dependence, associated comorbidities, and the impact on drug abuse treatment response. ⋯ Substance abuse treatment programs should expand their services to address the comorbidities likely to pose barriers to successful drug rehabilitation. Given the high prevalence and negative impact of chronic pain, new pain management services should be integrated within the drug treatment program and adapted as patients demonstrate the need for more intensive treatment. If applied to the problem of chronic pain, a model substance abuse treatment program of integrated stepped care would improve outcomes for patients with both devastating disorders.
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Chronic pain is a prevalent and costly problem that eludes adequate treatment. Persistent pain affects all domains of people's lives and in the absence of cure, success will greatly depend on adaptation to symptoms and self-management. ⋯ Psychosocial and behavioural factors play a significant role in the experience, maintenance, and exacerbation of pain. Self-management is an important complement to biomedical approaches. Cognitive-behavioural therapy alone or within the context of an interdisciplinary pain rehabilitation program has the greatest empirical evidence for success. As none of the most commonly prescribed treatment regimens are sufficient to eliminate pain, a more realistic approach will likely combine pharmacological, physical, and psychological components tailored to each patient's needs.
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To review the relation between chronic pain and psychological comorbidities, and the influence on course and prognosis, based on epidemiologic and population studies. ⋯ In assessment of chronic pain, the evidence from epidemiologic studies makes it clear that chronic pain can best be understood in the context of psychosocial factors.
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This article offers examples of the ways in which qualitative methods have informed, and may inform, mental health policy in Canada and beyond. Three initial uses of these methods are identified: to generate hypotheses to be tested by other means; to explore the subjective experiences and everyday lives of people with mental illnesses; and to investigate processes of recovery and the active role of the individual in recovery. Given the recent focus in mental health policy in Canada, the United States, and around the world on transforming mental health systems to promote recovery and the emphasis recovery places on the individual's own first-hand perspective, we argue that qualitative methods will become increasingly useful as psychiatry shifts away from symptom reduction to enabling people to live satisfying, hopeful, and meaningful lives in the community.
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Converging lines of evidence indicate that defects in the mitochondrial electron transport chain (ETC) are associated with bipolar disorder (BD), and that mood-stabilizing drugs produce neuroprotective effects. Our objective is to review the most recent findings regarding this research. ⋯ These findings indicate that the process of oxidative damage could be a significant therapeutic target for the treatment of BD with mood-stabilizing drugs.