Articles: chronic-pain.
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While drug therapy is one of the most commonly used modalities of treatment in managing persistent or chronic pain, controversy continues with regards to the appropriate use of controlled substances, specifically opioid analgesics, in interventional pain medicine settings. This study included 100 randomly selected patients receiving opioids in an interventional pain medicine setting. The patient's controlled substance profile was evaluated using multiple means. ⋯ There were no significant differences noted either in demographic characteristics or psychological characteristics, except for a higher prevalence of depression in the abuse group. In conclusion, there was significant abuse of opioids in an interventional pain medicine setting, with an incidence of 24%, with frequent abuse seen in almost half of these patients. Thus, it is important for interventional pain physicians to recognize this possibility and also to recognize that there is no definite physiologic, psychologic or demographic information to suggest abuse, even though depression was more prevalent in abuse patients.
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An attempt was made to determine the relative contribution of various structures to chronic low back pain, including facet joint(s), disc(s), and sacroiliac joint(s) in a prospective evaluation. Precision diagnostic blocks, including disc injections, facet joint blocks, and sacroiliac joint injections, are frequently used. ⋯ One hundred and twenty patients with a chief complaint of low back pain were evaluated with precision diagnostic injections, which included medial branch blocks, provocative discography and sacroiliac joint injections. In 40% (95% CL, 31%, 49%), of the patients, facet joint pain was diagnosed; and in 26% (95% CL, 18%, 34%) of the patients discogenic pain was diagnosed; and 2% of the patients were diagnosed with sacroiliac joint pain.
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To review the pathophysiology of fibromyalgia syndrome. ⋯ Multiple abnormal findings in fibromyalgia patients strongly indicate a neuropathic pain syndrome, reminiscent of complex regional pain syndrome or postherpetic neuralgia. In addition, fibromyalgia syndrome seems to share similar characteristics with these neuropathic pain syndromes, including ineffective response to many analgesics.
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Mexilitine is an anti-arrhythmic agent used to treat neuropathic pain. The drug has a low side-effect profile with gastritis as the predominant complaint. The following two cases suggest that mexilitine can potentially cause persistent ophthalmic changes and should be used with caution in chronic pain patients with preexisting ocular disease.
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Dissociation disorders are a group of conditions characterized by a disruption of integrated function of consciousness, memory, or perception. The purpose of this report is to describe the impact of increased pain levels on the genesis of two types of dissociation disorders, dissociative fugue ( DF) and dissociative identity disorder ( DID), in patients with chronic pain ( PWCP). DESIGN/PATIENTS/INTERVENTIONS/OUTCOME MEASURES: From November 1992 to July 2000, 2 DID and 4 DF patients were identified from 2,544 consecutive PWCP evaluated and/or treated at the University of Miami Comprehensive Pain and Rehabilitation Center. The salient features of these six dissociation PWCP are presented. All four DF PWCP completed a dissociation experience scale first at the time of identification of the dissociation disorder (with chronic pain) and one alleging their experiences with dissociation predevelopment of chronic pain. ⋯ The frequency percentage for dissociation within PWCP is small compared with psychiatric populations. There may be an etiological association between the development of dissociation episodes and the development of chronic pain and/or increases in chronic pain.