Articles: chronic-pain.
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Curr Pain Headache Rep · Oct 2011
ReviewUnderstanding multisymptom presentations in chronic pelvic pain: the inter-relationships between the viscera and myofascial pelvic floor dysfunction.
Patients presenting with chronic pelvic pain frequently complain of multiple symptoms that appear to involve more than one organ system, creating diagnostic confusion. The multisymptom presentation of chronic pelvic pain has been frequently described. This article describes four proposed explanations for the clinical observation of multisymptom presentations of patients with chronic pelvic pain. These include the concepts of viscerovisceral convergence; viscerosomatic convergence; hypertonicity of pelvic floor muscles creating visceral symptoms along with somatovisceral convergence; and central sensitization with expansion of receptive fields.
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Central sensitization provides an evidence-based explanation for many cases of 'unexplained' chronic musculoskeletal pain. Prior to commencing rehabilitation in such cases, it is crucial to change maladaptive illness perceptions, to alter maladaptive pain cognitions and to reconceptualise pain. This can be accomplished by patient education about central sensitization and its role in chronic pain, a strategy known as pain physiology education. ⋯ Written information about pain physiology should be provided as homework in between session 1 and 2. The second session can be used to correct misunderstandings, and to facilitate the transition from knowledge to adaptive pain coping during daily life. Pain physiology education is a continuous process initiated during the educational sessions and continued within both the active treatment and during the longer term rehabilitation program.
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Oral fluid compliance monitoring of chronic pain patients is an analytical challenge because of the limited specimen volume and the number of drugs that require detection. This study evaluated oral fluid for monitoring pain patients and compared results to urine studies of similar populations. Oral fluid specimens were analyzed from 6441 pain patients from 231 pain clinics in 20 states. ⋯ The prevalence of confirmed positive drug groups was as follows: opiates > oxycodone > benzodiazepines > methadone ≈ carisoprodol > fentanyl > cannabinoids ≈ tramadol > cocaine > amphetamines ≈ propoxyphene ≈ buprenorphine > barbiturates > methamphetamine. Approximately 11.5% of the study population of pain patients apparently used one or more illicit drugs (cannabis, cocaine, methamphetamine and/or MDMA). Overall, the pattern of licit and illicit drugs and metabolites observed in oral fluid paralleled results reported earlier for urine, indicating that oral fluid is a viable option for use in compliance monitoring programs of chronic pain patients.
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About 2-5% of patients undergoing laparoscopic inguinal repair experience persistent pain influencing everyday activities. However, compared with persistent pain after open repair, the combined clinical and neurophysiological characteristics have not been described in detail. Thus, the aim of the study was to describe and classify patients with severe persistent pain after laparoscopic herniorrhaphy. ⋯ These results suggest that patients with severe persistent pain after laparoscopic inguinal herniorrhaphy belong to distinctive subgroups with indicators of either neuropathic, inflammatory, or mechanical irritation from the mesh, or a combination of these symptoms. The findings of a number of pain localizations outside the inguinal region demarcate it from persistent pain following open groin hernia repair. A classification based on a larger study group is required in order to define mechanism-based treatment strategies.
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Behav Cogn Psychother · Oct 2011
Imagery and pain: the prevalence, characteristics, and potency of imagery associated with pain.
There is a dearth of information about imagery in pain sufferers. ⋯ It was concluded that imagery is a prevalent, often "unobserved" but potent cognition in pain sufferers. The implications for CBT approaches to chronic pain, including image rescripting, are considered.