Articles: chronic-pain.
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Chronic headache is a significant medical and socioeconomic problem resulting in severe disability and impairment. The term "cervicogenic headache" was coined by Sjaastad in 1983, who also proposed criteria for its diagnosis. Cervicogenic headache as described by Sjaastad et al is characterized as recurrent, long lasting, severe unilateral headache arising from the neck. ⋯ Because of the numerous potential pain generators, neither uniform clinical findings, nor a pathophysiology has been defined for the entity known as cervicogenic headache. Sequential diagnostic injections may elucidate pain generators and differentiate it from other types of headaches. This review describes the epidemiological and clinical aspects of cervicogenic headache, pathophysiology, diagnostic strategies to differentiate it from other common headaches and describes various non-operative treatment strategies.
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Caudal epidural administration of corticosteroids is one of the commonly used interventions in managing chronic low back pain. Reports of the effectiveness of all types of epidural steroids have varied from 18% to 90%. Sicard, a radiologist, was the first to describe injection of dilute solutions of cocaine through the sacral hiatus into the epidural space in 1901, to treat patients suffering from severe, intractable sciatic pain or lumbago. ⋯ The clinical effectiveness evaluations fill the literature with various types of reports including randomized clinical trials, prospective trials, retrospective studies, case reports, and meta-analyses. Evidence from all types of evaluations with regards to the clinical and cost-effectiveness of caudal epidural injections is encouraging. This review discusses various aspects of the role of caudal epidural injections in the management of chronic low back pain, including pathophysiology of low back pain, indications, clinical effectiveness and complications.
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This paper reviews data supporting the existence of individual, predictable, and unpredictable fluctuations in the severity of chronic pain and spasticity. It also evaluates what is known on the use of implantable programmable drug delivery systems for the management of predictable fluctuations in pain and spasticity. In addition to fixed rate infusion pumps, programmable drug delivery systems have been developed over the past 20 years for the management of predictable pain or spasticity fluctuations. ⋯ Ideally, the patient should be able to treat unpredictable fluctuations in symptoms, and a combination of patient controlled analgesia (PCA) with programmable drug delivery systems is currently in development. The future management of unpredictable fluctuations in the intensity of chronic pain and spasticity was subjected to critical evaluation. There seems to be a general agreement on the clinical importance of these phenomena, but stronger evidence is needed for a widespread change in the current management of most chronic pain patients.
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The illness behavior questionnaire (IBQ) is a test battery developed by Pilowsky to detect what he has termed abnormal illness behavior, which includes malingering. The IBQ has been widely utilized in patients with chronic pain (PWCP). Clayer developed a 21-item scale out of the IBQ, which he termed the conscious exaggeration (CE) scale. He proposed that the CE scale could detect conscious deception, i.e., malingering. The purpose of the present study is to test the CE scale in PWCP alleged to have secondary gain and thereby at greater risk for poor pain treatment outcome. It was postulated that the CE scale should generate scores in these groups significantly different from a comparison group and should predict treatment outcome in the secondary gain groups. ⋯ PWCP characterized by the alleged secondary gain variables of Workers' compensation status, litigation, and having a lawyer did not differentially respond to the CE scale versus the comparison group. The CE scale, therefore, does not appear to be a valid instrument for identifying exaggeration in PWCP.
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Around-the-clock (ATC) dosing of opioid analgesics is the established approach for the management of chronic cancer pain. The purposes of this study were to determine whether there were differences in pain intensity scores and pain duration between oncology outpatients who were taking opioid analgesics on an around-the-clock (ATC) compared with an as needed (PRN) basis and to determine differences in opioid prescription and consumption between the 2 groups during a period of 5 weeks. Oncology patients (n = 137) with pain from bone metastasis were recruited from 7 outpatient settings. ⋯ No significant differences in average, least, or worst pain intensity scores or number of hours per day in pain were found between the 2 groups. However, the average total opioid dose, prescribed and taken, was significantly greater for the ATC group than for the PRN group. These findings suggest the need for further investigations in the following areas: the appropriate treatments for pain related to bone metastasis, the use of various pain measures to evaluate the effectiveness of analgesic medications, and the need to evaluate how analgesics are prescribed and titrated for patients with cancer-related pain.