Current Perspectives on the Etiology and Emerging Treatments of Interstitial Cystitis/Bladder Pain Syndrome: A Review

Beyond the needle: expanding the role of anesthesiologists in the management of chronic non-malignant pain.

ONE potential adverse outcome from surgery is chronic pain. Analysis of predictive and pathologic factors is important to develop rational strategies to prevent this problem. Additionally, the natural history of patients with and without persistent pain after surgery provides an opportunity to improve the understanding of the physiology and psychology of chronic pain. Ideally, studies of chronic postoperative pain should include (1) sufficient preoperative data (assessment of pain, physiologic and psychologic risk factors for chronic pain); (2) detailed descriptions of the operative approaches used (location and length of incisions, handling of nerves and muscles); (3) the intensity and character of acute postoperative pain and its management; and (4) follow-up at intervals to 1 yr or more. In addition, there would be information about postoperative interventions that may influence pain, such as radiation therapy or chemotherapy. At long-term follow-up visits, patient function, physical signs, and symptoms would be evaluated using a standardized algorithm, including quantitative and descriptive pain assessments. We found no studies that contain all of these data. For this review, we specifically sought population data that reflect the incidence of chronic postoperative pain or predictors (medical, physiologic, and psychologic) of chronic pain. We selected five groups of surgeries (limb amputations, breast surgery, gallbladder surgery, lung surgery, and inguinal hernia surgery). These surgeries were selected because the incidence of pain is known to be high, thus improving the probability of detecting predictive factors. They also represent a range of major surgical procedures.

Exercise as a Treatment for Chronic Pain

OBJECTIVE: We sought to examine the independent and interactive effects of common mental health disorders and chronic pain conditions on employment and work outcomes among individuals younger than 65 years of age. METHODS: We analyzed cross-sectional data from the second wave of Healthcare for Communities (HCC2), a household telephone survey of U.S. civilian adults conducted in 2000 to 2001 (N=5328). Common mental disorders were assessed using the short-form versions of the World Health Organization’s Composite International Diagnostic Interview (CIDI-SF). Chronic pain conditions and labor market outcomes were identified by self report. Logistic and linear regression analysis was used to provide estimates for work impairment based on the presence of a mental health disorder and/or a chronic pain condition. RESULTS: The interaction between presence of a mental health disorder and presence of a chronic pain condition was significantly associated with no work for pay in the past 12 months (OR 2.3 [1.2–4.2]) and number of days of work missed in the past month due to health (regression coefficient 1.5 [0.6]). In stratified analyses, this effect persisted in women but not men. The presence of a mental health disorder or chronic pain condition were each independently associated with limitations in work and any work missed in the past 30 days due to health, although the interaction was not significant. CONCLUSION: Mental health disorders and chronic pain are each associated with work disability. Mental health disorders are more highly associated with some work disability outcomes when accompanied by chronic pain, especially in women.

Chronic pain and narcotics: a dilemma for primary care.

We had high or moderate confidence in the evidence contributing to most review findings. Further research, especially into families' experiences of treatments and services, could strengthen the evidence for low or very low confidence findings. Future research should also explore families' experiences in low- to middle-income contexts; of pain treatments including opioid use in children, which remains controversial; and of social care services. We need development and testing of family-centred interventions and services acceptable to families. Future trials of children's chronic non-cancer pain interventions should include family-centred outcomes.

SP35 Transitional pain and prevention of pain chronification

Relationships Among Depression, Chronic Pain, Chronic Disabling Pain, and Medical Costs

Opioids for the treatment of acute pain and the pain of malignancy have been strongly encouraged for more than 25 years.1 In the past 2 decades, the treatment of chronic noncancer pain using long-term opioid therapy has become more common. However, recent studies have revealed the astonishing rapidi

Cross-sectional studies have demonstrated an association between menopausal symptoms and chronic pain, but the direction of the association remains unknown. We assessed whether chronic pain is associated with subsequent clusters of menopausal symptoms. We used data from the National Child Development Study, a birth cohort of people born in 1958 in England, Scotland and Wales, which has included a biomedical sweep at age 44 when chronic pain was assessed and a 20-item menopause symptom questionnaire at age 50. Chronic pain was defined as lasting longer than 3months, and chronic widespread pain was defined as chronic contralateral upper and lower quadrant pain and spinal pain. Latent class analysis was used to define menopause symptom classes (n=4897) and structural equation models (n=3308) to relate chronic pain and chronic widespread pain to these classes, adjusting for confounding variables. We found four latent classes of menopause symptom experience at 50years. These were a low symptom burden class, one defined by vasomotor symptoms, one by psychological symptoms and one with high symptom burden. Chronic pain and chronic widespread pain at 44years were related to greater odds of being in the higher symptom burden classes compared with the low burden group. For example, the odds ratio (95% confidence interval) for the high symptom burden class was 2.90 (2.21, 3.81) for chronic pain and 3.50 (2.23, 5.49) for chronic widespread pain, and for the vasomotor symptom class 1.50 (1.16, 1.94) for chronic pain and 1.93 (1.19, 3.13) for chronic widespread pain. Women with chronic pain and chronic widespread pain earlier in life may experience greater burden of menopausal symptoms and this should be considered in their clinical management.

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4450869/

To examine a possible association of parental chronic pain with chronic pain in the adolescent and young adult and to explore whether a relationship could be explained by socioeconomic and psychosocial factors or may be affected by differences in family structure. Unselected, population-based, cross-sectional study. Nord-Trøndelag County, Norway. All inhabitants of Nord-Trøndelag County who were 13 years or older were invited to enroll in the study. In total, 8200 of 10 485 invitees (78.2%) participated in the investigation. Among 7913 participants in the target age group (age range, 13-18 years), 7373 (93.2%) completed the pain questions. The final study population consisted of 5370 adolescents or young adults for whom one or both parents participated in the adult survey. The primary outcome measure was chronic nonspecific pain in adolescents and young adults, defined as pain in at least 1 location, unrelated to any known disease or injury, experienced at least once a week during the past 3 months. Chronic multisite pain was defined as chronic pain in at least 3 locations. Maternal chronic pain was associated with chronic nonspecific pain and chronic multisite pain in adolescents and young adults (odds ratio, 1.5; 95% CI, 1.3-1.8). Paternal chronic pain was associated with increased odds of pain in adolescents and young adults. The odds of chronic nonspecific pain and chronic multisite pain in adolescents and young adults increased when both parents reported pain. Adjustments for socioeconomic and psychosocial factors did not change the results, although differences in family structure did. Among offspring living primarily with their mothers, clear associations were observed between maternal pain and pain in adolescents and young adults, but no association was found with paternal pain. Parental chronic pain is associated with chronic nonspecific pain and especially with chronic multisite pain in adolescents and young adults. Family structure influences the relationship, indicating that family pain models and shared environmental factors are important in the origin of chronic pain.

Introduction. Two-thirds of primary care patients with depression also have somatic symptoms present, making detection of depression more difficult. Primary health care is the first level of screening for depression, and early detection is key to treatment success. Anxiety also has a high comorbidity rate with chronic pain conditions. Generalized anxiety disorder (GAD) is common among patients with “medically unexplained” chronic pain and chronic physical illness and is also a predictor of chronic musculoskeletal pain after trauma. Belonging to different ethnic groups and ignorance of these differences by primary care physicians can be an obstacle to good health care, especially early recognition of depressive symptoms. Aim. The aim of this proposed, systematic work was to draw conclusions from empirical research dealing with the processes involved in the examination of depression, anxiety, and chronic non malignant pain. The research question for this review paper was to examine the correlation of depression and anxiety with chronic non-malignant pain. The aim was to examine the role of primary health care in recognizing, preventing, and treating depression and anxiety in patients with chronic non-malignant pain, and whether there is a difference in the correlation between depression, anxiety, and chronic non-malignant pain according to ethnicity. Methods. Methods for identifying the study were derived from the Medline database (via PubMed). The analysis included all scientific papers in English, regardless of methodology, published since 2011. The papers dealt with the correlation between depression, anxiety, and chronic non-malignant pain, and included the population of primary care patients over 18 years of age who suffer from chronic nonmalignant pain and at the same time have symptoms of depression and anxiety present or are members of ethnic groups. 403 articles were found, original and review papers, of which, after a detailed reading, 10 were selected that meet the inclusion criteria for the purposes of this review. Results. Depression and anxiety are significantly more present in people with chronic pain (23%), compared to those who do not have chronic pain (12%). The most common is chronic musculoskeletal pain, with one-third of patients having depression. Depression and anxiety are significantly associated with the intensity and duration of pain. Chronic pain and depression also differ according to ethnic groups, with cultural differences and language barriers being a barrier to early detection of depression. Conclusion. Depression is the most common mental health disorder associated with chronic pain. It is extremely important to treat both depression and pain, in order to prevent the development of severe depression and chronic pain at an early stage. The integrated program at the level of primary health care is expected to have positive effects on both the physical and mental condition of patients. Cultural differences and ethnicity, which can significantly reduce the detection of depressive symptoms at the primary health care level, should certainly be taken into account.

Low peak alpha frequency (PAF) is an electroencephalography (EEG) outcome associated reliably with high acute pain sensitivity. However, existing research suggests that the relationship between PAF and chronic pain is more variable. This variability could be attributable to chronic pain groups typically being examined as homogenous populations, without consideration being given to potential diagnosis-specific differences. Indeed, while emerging work has compared individuals with chronic pain to healthy controls, no previous studies have examined differences in PAF between diagnoses or across chronic pain subtypes. To address this gap, we reanalysed a dataset of resting state EEG previously used to demonstrate a lack of difference in PAF between individuals with chronic pain and healthy controls. In this new analysis, we separated patients by diagnosis before comparing PAF across three subgroups: chronic widespread pain (n = 30), chronic back pain (n = 38), and healthy controls (n = 87). We replicate the original finding of no significant difference between chronic pain groups and controls, but also find that individuals with widespread pain had significantly higher global average PAF values than those of people with chronic back pain [p = 0.028, β = 0.25 Hz] after controlling for age, sex, and depression. These novel findings reveal PAF values in individuals with chronic pain may be diagnosis-specific and not uniformly shifted from the values of healthy controls. Future studies should account for diagnosis and be cautious with exploring homogenous 'chronic pain' classifications during investigations of PAF. Our work suggests that, contrary to previous hypotheses, inter-individual differences in PAF reflect diagnosis-specific mechanisms rather than the general presence of chronic pain, and therefore may have important implications for future work regarding individually-tailored pain management strategies.

Chronic pain is a major source of suffering. It interferes with daily functioning and often is accompanied by distress. Yet, in the International Classification of Diseases, chronic pain diagnoses are not represented systematically. The lack of appropriate codes renders accurate epidemiological investigations difficult and impedes health policy decisions regarding chronic pain such as adequate financing of access to multimodal pain management. In cooperation with the WHO, an IASP Working Group has developed a classification system that is applicable in a wide range of contexts, including pain medicine, primary care, and low-resource environments. Chronic pain is defined as pain that persists or recurs for more than 3 months. In chronic pain syndromes, pain can be the sole or a leading complaint and requires special treatment and care. In conditions such as fibromyalgia or nonspecific low-back pain, chronic pain may be conceived as a disease in its own right; in our proposal, we call this subgroup "chronic primary pain." In 6 other subgroups, pain is secondary to an underlying disease: chronic cancer-related pain, chronic neuropathic pain, chronic secondary visceral pain, chronic posttraumatic and postsurgical pain, chronic secondary headache and orofacial pain, and chronic secondary musculoskeletal pain. These conditions are summarized as "chronic secondary pain" where pain may at least initially be conceived as a symptom. Implementation of these codes in the upcoming 11th edition of International Classification of Diseases will lead to improved classification and diagnostic coding, thereby advancing the recognition of chronic pain as a health condition in its own right.