Ann Acad Med Singap
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Fibromyalgia syndrome (FMS) is a chronic and debilitating musculoskeletal pain disorder of unknown aetiology with usual accompanying features of fatigue, sleep disturbances and stiffness. Its place in medical textbooks was controversial with rheumatologists holding the helm of its management for many years. Over the last decade, abnormalities have been identified at multiple levels in the peripheral, central, and sympathetic nervous systems as well as the hypothalomo-pituitary-adrenal axis stress response system. ⋯ The United States Food and Drug Administration (FDA) has also successively approved 3 drugs for the management of fibromyalgia--pregabalin, duloxetine and milnacipran. Non-pharmacological modalities showed aerobic exercise, patient education and cognitive behavioural therapy to be most effective. Overall, management of FMS requires a multi-disciplinary approach.
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Spinal cord stimulation (SCS) is one of the most effective modalities for management of refractory neuropathic pain unresponsive to conservative therapies. The SCS has been successful in providing analgesia, improving function, and enhancing quality of life for patients suffering from chronic pain conditions such as failed back surgery syndrome, complex regional pain syndrome, ischaemic and phantom limb pain, and coronary artery disease. This technique has proven to be cost effective in the long term despite its high initial cost. In this review article, we discuss the history of SCS development, mechanism of action, and indications for SCS.
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Ann Acad Med Singap · Nov 2009
Complex regional pain syndrome (CRPS) impairs visuospatial perception,whereas post-herpetic neuralgia does not: possible implications for supraspinal mechanism of CRPS.
Complex regional pain syndrome (CRPS) patients show impaired visuospatial perception in the dark, as compared to normal patients with acute nociceptive pain. The purpose of this study is 2-fold: (i) to ascertain whether this distorted visuospatial perception is related to the chronicity of pain, and (ii) to analyse visuospatial perception of CRPS in comparison with another neuropathic pain condition. ⋯ We demonstrated that chronic pain does not always impair visuospatial perception. The aetiology of PHN is limited to the peripheral nervous system, whereas the distorted visuospatial perception suggests a supraspinal aetiology of CRPS.
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Ann Acad Med Singap · Nov 2009
Intrathecal analgesia in patients with cancer pain--an audit in a tertiary institution.
Cancer pain is one of the most frequently encountered pain syndromes. With the application of the World Health Organization analgesic ladder, adequate analgesia is achieved in 75% to 90% of patients. The remaining patients suffer from intractable pain requiring intrathecal analgesia. The aim of this study was to retrospectively analyse the pain intensity before and after intrathecal analgesia and review the complications associated with the implantation and the care of the intrathecal device. ⋯ Intractable cancer pain could be managed effectively by intrathecal analgesia with a significant decrease in pain intensity and reduced opioid-related side effects. The side effects due to intrathecal opioids and complications from intrathecal catheter were minimal.
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The prevalence of chronic pain is well described in various parts of the world; primarily in Western societies such as Europe, America and Australia. Little is known of the prevalence of chronic pain within Asia or Southeast Asia. In view of the cultural and genetic variation in pain causation, manifestation and reporting, the findings of previous studies cannot be translated to Asian countries. Prevalence studies needed to be carried out to quantify the magnitude and impact of chronic pain within Asian countries to properly allocate precious health funds to deal with this important healthcare issue. We report the findings of the prevalence study within one Asian country: Singapore. ⋯ Though the prevalence of chronic pain was marginally lower compared other studies, the impact of pain was just as significant. In a rapidly ageing population such as Singapore, chronic pain is an important emerging healthcare problem which will likely exert increasing toll on the existing social infrastructure within the next 5 to 10 years.