Physical medicine and rehabilitation clinics of North America
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Phys Med Rehabil Clin N Am · May 2006
Review Comparative StudyComplementary medicine in chronic pain treatment.
This chapter looks at therapies that are considered "alternative" to conventional medical approaches. A definition of "complementary and alternative" medicine is considered in the context of the complex and clinically challenging field of pain medicine. A rationale for studying unorthodox treatments of chronic pain is presented. The challenges of an evidence-based approach to incorporating complementary therapies are explored, and a brief survey of several commonly available complementary medicine therapies is provided.
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As a biopsychosocial understanding of chronic pain has become more sophisticated during recent decades, a variety of psychologically based treatment approaches have been developed and empirically validated for helping people better manage their pain. These approaches to pain management have much to offer persons with chronic pain in terms of enhancing quality of life and pain-related coping, as well as reducing disability and pain-related interference with functioning. Although some treatments, like hypnotic analgesia, may require referral to a specialized provider, several of the principles of other psychologically based treatment approaches for pain management (eg, operant behavioral therapy, cognitive-behavioral therapy, motivational interviewing) can easily be integrated into work with persons with pain in a rehabilitation setting. Rehabilitation providers who are interested in incorporating these treatment strategies into their clinical work who do not have prior exposure to these approaches are encouraged to review the suggested references and to seek out related training opportunities.
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Phys Med Rehabil Clin N Am · May 2006
Review Comparative StudyCentral hypersensitivity in chronic pain: mechanisms and clinical implications.
The available literature consistently shows increased pain sensitivity after sensory stimulation of healthy tissues in patients who have various chronic pain conditions. This indicates a state of hypersensitivity of the CNS that amplifies the nociceptive input arising from damaged tissues. Experimental data indicate that central hypersensitivity is probably induced primarily by nociceptive input arising from a diseased tissue. ⋯ Possible therapy modalities for central hypersensitivity in chronic pain of musculoskeletal origin are largely unexplored. The limited evidence available and everyday practice show, at best, modest efficacy of the available treatment modalities for central hypersensitivity. The gap between basic knowledge and clinical benefits remains large and should stimulate further intensive research.
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Phys Med Rehabil Clin N Am · May 2006
Review Comparative StudyTreatment of fibromyalgia, myofascial pain, and related disorders.
Chronic muscle pain is a common complaint among patients who seek care for musculoskeletal disorders. A spectrum of clinical presentations exists, ranging from focal or regional complaints that usually represent myofascial pain syndromes to more wide spread pain that may meet criteria for a diagnosis of fibromyalgia. This article addresses the epidemiology, pathophysiology, and clinical management of myofascial pain syndrome and fibromyalgia. These conditions are challenging to treat and require physiatrists to be aware of the wide range of pharmacologic, rehabilitative,and psychosocial interventions that can be helpful.
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Phys Med Rehabil Clin N Am · May 2006
ReviewOpioids in the treatment of chronic pain: legal framework and therapeutic indications and limitations.
The most important message that physicians must communicate to persons with chronic pain is that, currently, no medication exists that will take away more than 30% of the pain they experience. Chronic pain is a chronic disease and, like diabetes or hypertension, requires chronic concessions and lifestyle modifications. In controlled trials of short duration and small sample size with highly selected patients, patients sustaining moderate-to-severe pain still experience moderate pain even on opioid medication. ⋯ Screening for substance abuse by history taking, observing behavior, obtaining old medical records,and using UDS in patients before initiating opioid therapy is important to identify patients with comorbid addictive disease who require coincident or antecedent treatment. Familiarity with federal and state controlled substance legislation and state health care provider and pain treatment acts is a mundane but essential educational endeavor for all physicians prescribing opioids. If physicians educate their patients with chronic pain about the limited efficacy of the medications, patients' expectations for drug treatment can be more realistic.