Common Chronic Pain Conditions Research Articles

Treatment of postherpetic neuralgia

Postherpetic neuralgia (PHN) remains one of the most troublesome common chronic neuropathic pain conditions. Many controlled trials have been published showing good efficacy and reasonable tolerability. These include gabapentinoids, opioids, tricyclic antidepressants, and topical lidocaine and capsaicin. Combination therapies are possible, but have not been proven, and long-term follow-up is limited. Only few case series exist for surgical and other invasive therapies and their role remains uncertain.

Pain in women: Presenting characteristics of women referred to a multidisciplinary pain management centre for diverse chronic pain conditions

The objective was to assess the relationship between presenting characteristics and pain related disability in women referred to a multidisciplinary pain management centre. Common chronic pain conditions in women referred to the Wasser Pain Management Centre (WPMC), a hospital based outpatient multidisciplinary tertiary treatment centre, were determined from the database system. Charts of consecutive patients identified in the different pain groups were reviewed to confirm diagnosis and verify completeness of information. A convenience sample of 20 cases per group was chosen for initial chart audit. At entry to the WPMC patient's completed questionnaires including: McGill Pain Questionnaire (MPQ), Pain Disability Index (PDI), coping level (0-6), age of pain onset, drug addiction, abuse (sexual, physical and/or emotional). Drug addiction and disability coverage was determined from clinical records. Six common chronic pain conditions were identified from the WPMC database included: pelvic pain, pelvic pain with drug addiction, fibromyalgia, undiagnosed total body pain, facial pain and headache. Pain scores were moderate (20-35) for most groups, except for FM (42.4) and UTBP (41.7) groups, which were severe. A high percentage of patients in these two groups were receiving some form of disability compensation. Most cases did not have a drug addiction component except for the PP with drug addiction (100%) and UTBP (85%) groups. These groups were also the only groups that had a high percentage of abuse (75% for both). Disability scores were higher for patients reporting higher pain intensity. Most indicated disability in a variety of aspects whereas disability in the PP and FP groups was domain specific. Women with diverse chronic pain conditions attending a multidisciplinary CNCP reported similar levels of pain intensity but varying rates of drug abuse/addiction, abuse and pain related disability. Further assessments are needed to understand how complex backgrounds of patients with complex chronic disease conditions relate to subsequent pain related disability and disability coverage.

Prevalence of Cervical Facet Joint Pain in Chronic Neck Pain

Neck pain is considered to be one of the most common chronic pain conditions in modern society. Various structures identified as capable of transmitting pain in the cervical spine include facet joints, intervertebral discs, nerve root dura, ligaments, fascia, and muscles. The prevalence of cervical facet joint pain in patients with chronic pain after whiplash has been determined as 54% to 60%. However, the prevalence of chronic cervical facet joint pain has not yet been determined in a heterogenous population or in patients with cervical spine pain of idiopathic origin in a controlled environment. This study evaluated 160 patients seen in one interventional pain management practice in a non-university setting. Cervical facet joints were investigated with diagnostic blocks using lidocaine 1% preservative free initially, followed by bupivacaine 0.25%, usually 2 to 4 weeks apart. The study population consisted of 76 women and 30 men aged 43 +/- 13 years of age (mean +/- SD). Mode of onset of neck pain was determined as following a traumatic incident in 48% of the patients, whereas it was with gradual onset without an identifiable specific incident in the remaining 55 patients (52%). Eighty-one or 70% of the patients (70%) reported a definite response to lidocaine blocks. Confirmatory blocks with bupivacaine were performed in 81 patients with 64 patients with 60% of the total sample, or 79%, of the lidocaine-positive group reporting definite response with improvement in their pain. Thus, a prevalence rate of facet joint pain in chronic neck pain was determined to be 60% (95% CI, 50%-70%), with a false positive rate of controlled diagnostic blocks of 40% (95% CI, 34%-46%).

Physiotherapy Management of Fibromyalgia: What do we know and how may this Affect Clinical Practice?

Fibromyalgia (FM) is a common chronic musculoskeletal pain condition. In addition to pain, patients also complain of excessive fatigue, sleep problems and depression. They also experience exercise-induced pain that probably reduces their physical activity level during their leisure time and limits their activities at home or at the workplace. This is probably the main reason that these patients are often referred to physiotherapy. Several authors suggest that a hypersensitivity of the central nervous system explains the patients' perception of pain to non-painful stimuli, and a hyporesponsiveness of the hypothalamus–pituitary–adrenal mechanisms may explain their feeling of exhaustion. The effects of several non-medical modalities have been examined, and exercise and patient education can be recommended. The purpose of the present paper is to review the scientific literature on FM and assess the consequences this knowledge may have for physiotherapists' management of FM.

Physiotherapy Management of Fibromyalgia: What do we know and how may this Affect Clinical Practice?

Fibromyalgia (FM) is a common chronic musculoskeletal pain condition. In addition to pain, patients also complain of excessive fatigue, sleep problems and depression. They also experience exercise-induced pain that probably reduces their physical activity level during their leisure time and limits their activities at home or at the workplace. This is probably the main reason that these patients are often referred to physiotherapy. Several authors suggest that a hypersensitivity of the central nervous system explains the patients' perception of pain to non-painful stimuli, and a hyporesponsiveness of the hypothalamus–pituitary–adrenal mechanisms may explain their feeling of exhaustion. The effects of several non-medical modalities have been examined, and exercise and patient education can be recommended. The purpose of the present paper is to review the scientific literature on FM and assess the consequences this knowledge may have for physiotherapists' management of FM.

Perspectives on the Interaction of Biological, Psychological and Social Factors in TMD

Temporomandibular disorders remain a poorly understood but related collection of clinical syndromes involving pain and function limitations. This article discusses TMD from the perspective of a chronic pain illness, which shares some features found in common chronic pain conditions, such as tension headache and benign back pain. From these perspectives, TMD may be viewed as a self-limiting chronic pain illness not associated with progressive physical deterioration.

Temporomandibular disorders and chronic pain: Disease or illness?

Temporomandibular disorders (TMD) are examined from a biopsychosocial or illness perspective. Data are reviewed in accordance with the concept that TMD is a chronic pain condition that shares many features with other common chronic pain conditions. TMD is placed within the same biopsychosocial model currently used to study and manage all common chronic pain conditions. The concept of chronic pain dysfunction, which has emerged as a critical consideration for chronic pain research and management, is also reviewed. Most chronic pain patients seem to bear their condition adequately and thus maintain adaptive levels of psychosocial function. By contrast, a psychosocially dysfunctional segment of the chronic pain population appears unable to cope as well and demonstrate higher rates of depression, somatization, and health care use, even though persons in this segment are not different from their functional peers on the basis of observable organic pathology. Finally, data are reviewed from longitudinal, epidemiologic, and experimental intervention studies that substantiate these two perspectives.