Pain research & management : the journal of the Canadian Pain Society = journal de la société canadienne pour le traitement de la douleur
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Practice Guideline
Pharmacological management of chronic neuropathic pain: revised consensus statement from the Canadian Pain Society.
Neuropathic pain (NeP), redefined as pain caused by a lesion or a disease of the somatosensory system, is a disabling condition that affects approximately two million Canadians. ⋯ These guidelines provide an updated, stepwise approach to the pharmacological management of NeP. Treatment should be individualized for each patient based on efficacy, side-effect profile and drug accessibility, including cost. Additional studies are required to examine head-to-head comparisons among analgesics, combinations of analgesics, long-term outcomes and treatment of pediatric, geriatric and central NeP.
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Adjudication of disability claims related to fibromyalgia (FM) syndrome can be a challenging and complex process. A commentary published in the current issue of Pain Research & Management makes suggestions for improvement. The authors of the commentary contend that: previously and currently used criteria for the diagnosis of FM are irrelevant to clinical practice; the opinions of family physicians should supersede those of experts; there is little evidence that trauma can cause FM; no formal instruments are necessary to assess disability; and many FM patients on or applying for disability are exaggerating or malingering, and tests of symptoms validity should be used to identify malingerers. ⋯ The available evidence does not support many of the suggestions presented in the commentary. Caution is advised in adopting simple solutions for disability adjudication in FM because they are generally incompatible with the inherently complex nature of the problem.
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The way in which individuals with chronic pain habitually approach activity engagement has been shown to impact daily functioning, with both avoidance of one's daily activities and overactivity (activity engagement that significantly exacerbates pain) associated with more pain, higher levels of physical disability and poorer psychological functioning. ⋯ These results provide preliminary support for the suggestion that insecure attachment may be a source of vulnerability to the development of disabling activity patterns in chronic pain.
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The medicolegal challenges surrounding fibromyalgia (FM) arise from the subjectivity of symptoms, causal attribution and reported symptoms sufficiently severe to cause disablement. In the present article, the authors have endeavoured to provide clarification of some current issues by referencing the current literature, including the 2012 Canadian Fibromyalgia Guidelines. ⋯ Although some individuals may experience severe symptoms, the prevalent societal concept of disablement due to FM must be tempered with the knowledge that working contributes to psychosocial wellbeing. Evidence provided in the present report may assist the courts in reaching decisions concerning FM.
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Pregabalin administration is occasionally abandoned due to adverse events such as somnolence, dizziness, unsteadiness, weight gain and edema. However, the exact causes of these differences in adverse events associated with pregabalin have not been elucidated. ⋯ The results of the present study indicate that care is warranted regarding long durations of therapy for somnolence, advanced age rather than dose-dependent adverse events for unsteadiness, elevated serum creatinine level for weight gain, and elevated serum creatinine level and combination use of neurotropin for edema. The safety of the combined use of pregabalin and nonsteroidal anti-inflammatory drugs were also suggested.