Pain practice : the official journal of World Institute of Pain
-
Observational Study
Chronic pain in breast cancer survivors: nociceptive, neuropathic or central sensitization pain?
The differentiation between acute and chronic pain can be insufficient for appropriate pain management. The aim of this study was to evaluate the prevalence of the predominant pain type (nociceptive, neuropathic, or central sensitization [CS] pain) in breast cancer survivors (BCS) with chronic pain. The secondary aims were to examine (1) differences in health-related quality of life (HRQoL) between the different pain groups; and (2) the associations between patient-, disease-, and treatment-related factors and the different pain types. ⋯ Neuropathic pain is most frequent in BCS. Strong associations were found between CS pain and hormone therapy.
-
Observational Study
Differences in Characteristics and Downstream Drug Use among Opioid Naïve and Prior Opioid Users with Low Back Pain.
Recent clinical practice guidelines have suggested conservative treatment approaches, including physical therapy, are indicated as first-line treatment for patients with low back pain (LBP); however, LBP continues to be managed with opioids, despite decreases in function, morbidity, and insignificant improvements in pain. ⋯ In patients presenting with LBP, prior opioid exposure appears to be related to increased analgesic use (opioid and non-opioid) and longitudinal analgesic utilization at 1 year after the index date.
-
Recent systematic reviews show promising effects for multidisciplinary biopsychosocial (BPS) interventions in patients with chronic low back pain (CLBP). Nowadays, BPS interventions have also been developed for primary care physiotherapy settings. Our aim was to systematically review the evidence on the effectiveness of primary care BPS interventions in improving functional disability, pain, and work status for patients with CLBP. Secondly, we aimed to provide an elaborated overview of BPS intervention designs, physiotherapist training programs, and process-related factors (practical implementation). ⋯ BPS interventions seem more effective than education/advice and were found to be as effective as physical activity interventions in patients with CLBP. BPS interventions with a clear focus on psychosocial factors (understanding pain, unhelpful thoughts, coping styles, and goal setting) seem most promising. Sufficient delivery of BPS elements is expected when physiotherapists participate in training programs with extensive support prior and during delivery (manual, supervision, and informative resources).
-
The early phase of complex regional pain syndrome (CRPS) is characterized by an inflammatory state and therefore often treated with anti-inflammatory acting glucocorticoids. Recently, we demonstrated that remote ischemic conditioning (RIC), a cyclic application of nondamaging ischemia on a remote extremity, reduces blood flow and increases oxygen extraction in the CRPS-affected extremity. ⋯ Confirming previous results, RIC presumably unmasks luxury perfusion in untreated CRPS patients. In accordance with the clinical improvement, the short-term pain treatment with glucocorticoids as major component normalizes impaired perfusion. These results might underline the rationale for anti-inflammatory treatment in early-phase CRPS.
-
Long-term opioid therapy for chronic pain management requires regularly assessing and documenting benefits and side effects. Opioid-induced sex hormone disturbances are a complication that needs to be assessed routinely and perhaps not only when suspected. There is abundant literature about its prevalence, clinical consequences, and treatment, yet routine hormone screening and appropriate treatment are seldom performed in pain clinics. Ignorance, skepticism, and/or indifference are possible reasons explaining why opioid-induced hypogonadism (OIH) remains underdiagnosed among chronic pain patients. ⋯ Knowledge and attitudes towards OIH varied among this population of pain clinicians invited to participate in the research. Lack of knowledge and incertitude seem to impact the attitudes towards screening and treating OIH. Better medical training at undergraduate and postgraduate levels as well as continuous medical education may contribute to raising awareness about this complication and providing early treatment.