Chronic Benign Pain Research Articles

Estimation of methadone clearance: application in the management of cancer pain

The long half-life and wide inter-patient variability in clearance of methadone make this drug difficult to use optimally. If a patient's methadone clearance is known, however, dose regimens can be devised to maintain any desired blood concentration and hence, since the effect of methadone is related to its concentration in the blood, pain relief. We investigated methods for determining methadone clearance. In 25 patients, clearance was estimated by monitoring blood methadone concentrations following an intravenous infusion. Estimates of clearance adequate for clinical purposes could be obtained by assaying only 10–12 blood samples collected over 30 h following the infusion. The blood sampling schedules were such that it was not necessary to collect samples during the night, so the procedure could be done on an outpatient basis. An advantage of this procedure is that it also allows estimation of the blood methadone concentration required to relieve pain. We also conducted a retrospective study of data from 185 patients whose methadone clearance we had determined, to identify factors which may give rise to the large inter-patient variation in clearance. Clearance tended to be high in patients taking phenytoin, spironolactone, verapamil or oestrogens, and low in patients taking amitriptyline. Patients with malignant disease as opposed to chronic benign pain, and patients 65 years of age or older, tended to have low clearance. Clearance was positively associated with haematocrit. An equation was constructed allowing methadone clearance to be predicted from knowledge of these factors. The predicted clearance, however, showed only a moderately strong correlation with measured clearance ( r = 0.75), indicating that factors not investigated also had a major influence on methadone clearance.

Selected tricyclic antidepressants in the management of chronic benign pain.

Depression is often considered a symptom of intractable benign pain and is usually a situational or exogenous subtype. At our four hospital-based pain management centers we have evaluated and treated more than 5,000 patients for chronic pain. The treatment of more than 2,000 of these patients has included the administration of doxepin or amitriptyline. This article reviews the therapeutic use of selected tricyclic antidepressants in the treatment of chronic benign pain and depression, and emphasizes the blockage of serotonin reuptake as the mechanism of action. The benefits of doxepin and amitriptyline include sleep facilitation, low cardiotoxicity and incidence of anticholinergic effects, and anxiolytic properties.

Changing chronic pain experience

Training in relaxation is a prominent component in multi-disciplinary approaches to the management of chronic pain, although its specific potency in modulating pain has not yet been established. Using a within-session design, the specific effects of relaxation induction were evaluated in a group of benign chronic pain patients ( n = 24), and compared to similar patients undergoing a control procedure ( n = 22). The results indicated that irrespective of the focus of pain complaint, induction of relaxation over a 20 min period led to significant and sizeable reductions in both sensory and affective pain experience. The overall intensity of pain was significantly reduced. These effects were shown to be reliable and independent of onset level of sensory experience or depression. No significant changes occurred in the control group over a comparable period. The implications of these results were discussed with respect to the process by which relaxation reduces pain.

The behavioral management of pain: a criticism of a response

In response to an earlier published paper by Fordyce, some assumptions underlying the behavior management paradigm of chronic pain are critically discussed. While operant treatment has proved successful, the conclusion that operant factors play an important role in the development and maintenance of chronic benign pain is debated. Some empirical studies, regularly used to demonstrate this role, are re-evaluated. An alternative theory is proposed for chronic pain behavior, in which the role of a lower tolerance to proprioceptive stimuli, which may include more than just pain stimuli, is emphasized.

Chronic Pain Management: The Occupational Therapist's Role

This paper describes the contribution the occupational therapist makes in improving the quality of life of the patient with chronic benign pain. Working closely with medical specialists, the occupational therapist is able to contribute much towards the rehabilitation of the patient. Occupational therapists are currently providing pain patient services from specialist pain clinics, community centres, general hospitals and private practice settings. The role of the occupational therapist in chronic pain management is highlighted by a case history.

Drug management of chronic benign pain.

Chronic benign pain usually requires treatment with drugs. Three main classes of drugs are used: opiates, non-steroidal anti-inflammatory drugs, and a miscellaneous group which includes psychoactive drugs and a variety of specific agents for individual conditions. The careful selection and combination of drugs, with adequate and appropriate dosage, will bring pain relief in the majority of patients.

Male-female differentiation of verbal and nonverbal pain descriptors and mpo scores in chronic benign head and neck pain

Male-female differentiation of verbal and nonverbal pain descriptors and mpo scores in chronic benign head and neck pain

Physical findings in patients with chronic intractable benign pain of the back or neck

Physical findings in patients with chronic intractable benign pain of the back or neck

Physical, Psychologic, and Social Function in Chronic Pain Patients After Epidural Spinal Electrical Stimulation

The overall function, pain, and mood disturbance of 54 patients with benign chronic pain were studied as to their response to epidural spinal electrical stimulation (ESES) more than 12 months after the implantation of ESES electrodes. Both responder (n = 23) and nonresponder (n = 31) pain patients demonstrated extensively worse physical and psychosocial function on the Sickness Impact Profile (SIP) and worse self-rated mood disturbance on the Mood Adjective Check List (MACL) than a control population sample. Responders to ESES were insignificantly less impaired in physical functions of daily life than nonresponders, but clearly less inhibited in the social pattern of contact. Self-rated pain sensation differed 36% between responders and nonresponders, and the pain measures of all pain patients correlated with total mood disturbance on the MACL and with its dimensions for depression and fatigue. Social characteristics, sex, diagnoses, comorbidity, and duration of pain did not discriminate. In a supplementary prospective short-term study, pain ratings had improved by 30% 3 weeks after implantations. The night sleep and general psychic balance (SIP category emotional behavior) were then also significantly improved. A shortened SIP version of 8 items optimizing responder-nonresponder differences and 12 items of mood disturbance are suggested to supplement pain ratings for overall assessment of chronic pain patients. A wider usage of ESES is recommended for pain patients who can comply to the regimen, because the surgical technique is now simple and safe.

A rating system for use with patient pain drawings

Patients entering treatment for chronic benign pain often are asked to complete drawings indicating the intensity and location of their pain as part of the diagnostic process. While inferences have been made from pain drawings about the relative contributions of physiological and psychological factors to the patient's experience of pain, previous research has provided only equivocal support for this practice. A reliable method for assessing pain drawings is needed both for clinical use and to assess the validity of such interpretations. While a number of systems for using such drawings have been proposed, it is not always clear exactly what aspect of the drawing is being quantified. In this study, 101 patients who presented with chronic pain were asked to complete pain drawings which were than scored for the presence or absence of pain in each of 45 body areas. Scorers achieved a high rate of inter-rater agreement with relatively little training. The body surface scores obtained were shown to correlate highly with the penalty point system developed by Ransford et al., suggesting that extent of pain may account for much of the variance in this system. The results are discussed in relation to the clinical and experimental uses for such a system.

The treatment of chronic benign pain by means of low frequency pulsating magnetic fields

The Authors give an account of their experiences in the treatment of chronic benign pain by means of pulsating magnetic fields. Of the 311 patients treated, 210 were females and 101 were males. The following results were obtained: 147 patients showed results which were positive on the whole; 97 showed slight results; 67 showed no results at all.

Comparison of Cancer Pain and Chronic Benign Pain Patients on Dimensions of Pain Intensity, Affect, and Approach to Treatment

Comparison of Cancer Pain and Chronic Benign Pain Patients on Dimensions of Pain Intensity, Affect, and Approach to Treatment

Family treatment for chronic pain: State of the art

A variety of family therapy techniques have been used to treat chronic pain. In this paper, an attempt is made to examine those familytherapy methods. It is noted that to date there is virtually a total absence of research to determine the efficacy of family therapy to treat chronic benign pain. From a clinical perspective family therapy must be offered to famiies with chronic pain patients to counteract the negative impact of chronic pain on the entire family system.

The use of cervical epidural nerve blocks in the management of chronic head and neck pain.

Cervical epidural blocks were used as part of a comprehensive multimodal treatment programme for patients with chronic benign pain in the head and neck. Forty-five patients had 141 blocks without major complications. The indications and role of blocks in pain management are discussed.

Serotoninic headache from epidural dorsal cord stimulation. A case report that raises questions

A case of chronic benign pain due to spondylarthrosis secondary to infantile poliomyelitis, in which dorsal cord stimulation (DCS) produced analgesia but precipitated severe migraine, is reported. 5-HIAA and HVA in CSF and the R III spinal reflexes were studied during D.C.S.

Patient evaluation of a cognitive behavioral group program for patients with chronic low back pain

Traditional approaches to curing patients with chronic benign pain have had only limited success. Rehabilitation becomes therefore more important and in recent years management programs have been developed to achieve this goal. This study was based on the hypothesis that a program can be more effective with its structure according to the comments of patients with respect to the various components of the program. After testing this hypothesis we conclude that such subjective evaluation of treatment is an important factor which merits receiving more attention than previous work has suggested.

Amitriptyline versus peacebo in chronic benign pain: A double-blind study

Amitriptyline versus peacebo in chronic benign pain: A double-blind study

Occupational Therapy and the Patient with Pain

The characteristics, implications, consequences and costs of pain, particularly those of chronic benign pain syndrome, are presented, and current approaches to treatment are briefly discussed. Contributions which occupational therapists are uniquely qualified to offer are described. Occupational therapists are grounded in the concept that mind, body and spirit are integrally related and that the patient must participate actively in the planning and implementation of any treatment program. The occupational therapist is a specialist in role functions and is skilled in assisting clients to plan and re-create structure for their lives that has been lost by virtue of their illness, disability, or pain. The occupational therapist provides an environmental laboratory in which people can experiment with new behaviors and attitudes to restructure and regain control of their lives and to reestablish hope, competence, confidence and success as part of their daily activities. These concepts are basic to the successful treatment of the patient with chronic benign pain syndrome.

Cognitive dimensions of chronic pain

Behavioral interventions have now found widespread acceptance in the treatment of chronic benign pain. Among those with demonstrated therapeutic efficacy are operant conditioning, biofeedback and cognitive-behavior therapy. Since these interventions are based on different assumptions about the etiology of chronic pain, behavioral clinicians are often in the position of using different causal models to justify the use of different treatment procedures. In an effort to address this problem, the present paper proposes an explanatory framework based on the principles of cognitive psychology. Such a framework is parsimonious, empirically-based and offers an internally-consistent approach to understanding the development and maintenance of chronic pain symptoms. An important implication of this approach is that all behavioral interventions may exert an influence on chronic pain through a common mechanism, namely by changing the way clients think about their pain. Specific patterns of dysfunctional thinking are proposed to account for each of the major symptoms of chronic pain. These cognitive patterns include: awfulizing; low frustration tolerance; self-downing; and overgeneralizing. A conceptual analysis of biofeedback and operant conditioning found no evidence to suggest that either modality can effect changes in clients through noncognitive means. It was concluded that behavioral interventions are effective because they facilitate the development of new thinking skills that explicitly challenge the cognitive causes of chronic pain.

The analgesic efficacy of a serotonin reiftake blocker, zimelidine, in the treatment of chronic benign pain

The analgesic efficacy of a serotonin reiftake blocker, zimelidine, in the treatment of chronic benign pain