Articles: pain-management-methods.
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Purpose: Neck muscle vibration immediately improves cervical joint position sense and dynamic postural control but increases pressure pain thresholds in neck pain patients. The aim of this study was to explore longer lasting effects of neck muscle vibration on sensorimotor control and pressure pain threshold. Materials and methods: Five series of neck muscle vibration were delivered to 15 neck pain patients and 11 healthy controls in this case control study. ⋯ Neck muscle vibration improves arm-matching acuity in neck pain patients. Neck muscle vibration increases pressure pain thresholds at the stimulated place but decrease pressure pain thresholds more distally. Neck muscle vibration shows distinct effects in neck pain patients and healthy control.
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Curr Pain Headache Rep · Jul 2019
ReviewTreatment Strategies and Effective Management of Phantom Limb-Associated Pain.
Phantom sensations are incompletely understood phenomena which take place following an amputation or deafferentation of a limb. They can present as kinetic, kinesthetic, or exteroceptive perceptions. It is estimated that phantom limb pain (PLP) affects anywhere from 40 to 80% of amputees. ⋯ Psychiatric illnesses such as depression, anxiety, and mood disorders have higher prevalence in amputees than in the general population. Pharmacologic treatment has been used as first-line therapy for amputees suffering from PLP with agents including gabapentinoids, amitriptyline, and other tricyclic anti-depressants, opioids, and local anesthetics. Non-invasive treatment modalities exist for PLP including sensory motor training, mirror visual therapy, and non-invasive neuromodulation. Non-invasive neuromodulation includes interventions like transcutaneous electrical nerve stimulation (TENS) and transcranial magnetic stimulation. While many promising therapies for PLP exist, more clinical trials are required to determine the efficacy and protocols needed for maximum benefit in patients suffering from PLP.
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Curr Pain Headache Rep · Jul 2019
ReviewAdvances in the Understanding and Management of Chronic Pain in Multiple Sclerosis: a Comprehensive Review.
Multiple sclerosis (MS) is an autoimmune disorder of the central nervous system that can lead to severe physical, cognitive, and neurological deficits that often manifest in young adults. Central neuropathic pain is a common presenting symptom, often prompting patients to seek treatment with opioids, NSAIDS, antiepileptics, and antidepressants despite minimal effectiveness and alarming side-effect profiles. Additionally, spasticity occurs in more than 80% of MS patients and is an important consideration for further study in treatment. ⋯ Related to inconsistencies in pain presentation and clinical reporting, current studies continue to investigate clinical patient presentation to define chronic pain characteristics to optimize treatment plans. Although often neuropathic in origin, the complex nature of such pain necessitates a multimodal approach for adequate treatment. While psychiatric comorbidities typically remain unchanged in their severity over time, physical conditions may lead to worsening chronic pain long-term, often due to decreased quality of life. The prevalence of neuropathic pain is ~ 86% in patients with multiple sclerosis and most commonly presents as extremity pain, trigeminal neuralgia, back pain, or headaches. As MS symptoms are frequently unremitting and poorly responsive to conventional medical management, recent attention has been given to novel interventions for management of pain. Among these, medicinal cannabis therapy, targeted physical therapy, and neuromodulation offer promising results. In this review, we provide a comprehensive update of the current perspective of MS pathophysiology, symptomatology, and treatment.
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Randomized Controlled Trial Multicenter Study
Remote electrical neuromodulation (REN) in the acute treatment of migraine: a comparison with usual care and acute migraine medications.
There is a significant unmet need for new, effective and well tolerated acute migraine treatments. A recent study has demonstrated that a novel remote electrical neuromodulation (REN) treatment provides superior clinically meaningful pain relief with a low rate of device-related adverse events. The results reported herein compare the efficacy of REN with current standard of care in the acute treatments of migraine. ⋯ REN is an effective acute treatment for migraine with non-inferior efficacy compared to current acute migraine therapies. Together with a very favorable safety profile, these findings suggest that REN may offer a promising alternative for the acute treatment of migraine and could be considered first line treatment in some patients.
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Curr Pain Headache Rep · Jul 2019
ReviewAn Update on Cognitive Therapy for the Management of Chronic Pain: a Comprehensive Review.
Psychological approaches to the management of chronic pain have proven to be very effective in allowing patients to better manage their symptoms and with overall functioning. ⋯ Cognitive functional therapy (CFT) is centered on a three-step process, beginning with cognitive training, then progressing to functional movement training and exposure with control, and ending with physical activity and lifestyle changes. Cognitive behavioral therapy (CBT) as a technique focuses on identifying and changing maladaptive behaviors, thought patterns, and situations that contribute to psychiatric dysfunction, which may lead to further progression of pain. The purpose of this review is to provide a comprehensive update of recent advances in the use of both CFT and CBT for the management of chronic pain conditions.