Current review of pain
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Over the years, a number of treatments for persistent low back pain following spine surgery, the failed back surgery syndrome (FBSS), have been developed. The complexity of the clinical problem, the multidimensional nature of chronic pain, and general lack of rigorous study design, however, have obscured outcome assessment and hampered efforts to optimize patient selection criteria. Recent work has focused on refinement of existing therapies for FBSS and identification of factors that influence outcome and improve patient selection criteria. In combination with more rigorous study methodology, these efforts have led to improved understanding of the clinical response to a number of pharmacologic, surgical, and neuromodulation therapies for FBSS.
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Current review of pain · Jan 2000
ReviewReflex sympathetic dystrophy: a sympathetically mediated pain syndrome or not?
Because of the controversy concerning the manner in which the sympathetic nervous system is involved in reflex sympathetic dystrophy (RSD), its name was changed to one having no mechanistic connotations. This article reviews the relevant literature in support of not only the taxonomical changes to complex regional pain syndrome (CRPS) but also provides evidence of sympathetic dysfunction demonstrated in animal models of neuropathic pain.
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Current review of pain · Jan 2000
ReviewIs lumbar discography a determinate of discogenic low back pain: provocative discography reconsidered.
Provocative lumbar discography was investigated in a series of clinical studies at the Stanford University of Medicine, Stanford, CA. This work demonstrated that pain intensity during disc injection is strongly influenced by the subject's emotional and psychological profiles, chronic pain behavior, and ongoing compensation claims whether the patient has any back pain illness or not. Pain reproduction was also primarily related to penetration of the dye through the outer annulus and could not reliably be used to confirm the location of the pain source.
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This article reviews the objectives of psychological evaluations, as well as the standard pain center evaluation protocol that uses a pain questionnaire, a structured clinical interview, and pain assessment measures that include pain intensity rating scales and the McGill Pain Questionnaire. The most frequently used measures of psychological status, such as the Beck Depression Inventory and the Minnesota Multiphasic Personality Inventory (MMPI), are reviewed. Psychological predictors of invasive procedures and of disability are also outlined. The importance of listening to the patient in a multidisciplinary setting is emphasized.
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Sex-related differences in the experience of both clinical and experimentally induced pain have been widely reported. Specifically, females are at greater risk for developing several chronic pain disorders, and women exhibit greater sensitivity to noxious stimuli in the laboratory compared with men. Several mechanisms have been proposed to account for these sex differences. ⋯ Sex hormones are also known to affect pain responses, which may mediate the sex differences. Although the magnitude of these effects has not been well characterized, there are potentially important practical implications of sex differences in pain responses. These implications are discussed, and directions for future research are delineated.