Articles: chronic-pain.
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Curr Pain Headache Rep · Jun 2012
ReviewEpidemiology of neuropathic pain and its impact on quality of life.
Epidemiology is an important clinical tool in designing and evaluating management and prevention strategies, and is particularly relevant to neuropathic pain. However, there is a relative lack of accurate information available. In one sense, neuropathic pain describes a symptom or a mechanism, rather than a specific disease; on the other hand, there are sufficient similarities in the effects and response to treatment between different causes to make it worthwhile to consider neuropathic pain as a distinct condition. ⋯ Estimates of prevalence that are based on specific causes of neuropathic pain tend to be lower (1-2%) than those that are based on reports of the classic symptoms (6-8%), and further methodological research is needed. All neuropathic pain is associated with poor general health, comparable with other severe chronic diseases. The importance of newly proposed risk factors, including genetic factors, still needs to be assessed at a population level.
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The safest pain treatment strategy for an individual at risk or recovering from addiction is a nonopioid and benzodiazepine-free approach. If an opioid treatment is necessary, the extent of the risk can be stratified by the use of a biopsychosocial assessment and opioid screening tools. Individuals at high risk should have the greatest amount of structure and monitoring. ⋯ Both the provider and the patient need a personal investment in the treatment plan and protocol to increase the safety of opioid treatment. New medications and treatment monitoring are being developed to provide maximal relief for the patient while protecting the public health. The optimal ingredients for safe opioid treatment include a strong provider-patient relationship and clinician training in the assessment and treatment of addiction and pain.
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Chronic pain frequently is associated with autosomal dominant polycystic kidney disease and is a significant cause of morbidity. The classic approach to treat pain in patients with this disease starts with nonpharmacologic therapy and progresses to high-dose opioid therapy and more invasive procedures, including surgery. We present the case of a 43-year-old white woman presenting in our clinic with poorly controlled chronic left flank and epigastric pain secondary to autosomal dominant polycystic kidney disease despite high-dose opioids and multiple cyst decompression procedures. After temporarily successful management with celiac plexus neurolysis and intercostal nerve radiofrequency ablations for years, the next more permanent step was dorsal column neurostimulation, affording excellent analgesia with significantly improved quality of life to this day.
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Curr Pain Headache Rep · Jun 2012
ReviewSpinal cord stimulation: neurophysiological and neurochemical mechanisms of action.
Chronic neuropathic pain can significantly reduce quality of life and place an economic burden on individuals and society. Spinal cord stimulation (SCS) is an alternative approach to the treatment of neuropathic pain when standard pharmacological agents have failed. However, an improved understanding of the mechanisms by which SCS inhibits pain is needed to enhance its clinical utility. This review summarizes important findings from recent studies of SCS in animal models of neuropathic pain, highlights current understanding of the spinal neurophysiological and neurochemical mechanisms by which SCS produces an analgesic effect, and discusses the potential clinical applicability of these findings and future directions for research.