Chronic Pain Episodes Research Articles

Successful treatment of spondylolisthesis with medicinal herbs

It has been reported that some herbal medicines may be effective for acute episodes of chronic nonspecific lower back pain. Spondylolisthesis is one of the causes of lower back or neck pain. To our knowledge, successful treatment of symptomatic spondylolisthesis with medicinal herbs has not been previously reported in the published work. A 63-year-old female had suffered from back pain for 4 years. Radiographs revealed spondylolisthesis at the L3 level. In another case, an 82-year-old female suffered from neck pain. X-ray examinations revealed cervical spondylolisthesis at the C4 level. Several herbs were administered to these patients with symptomatic spondylolisthesis according to the guidelines for herbal medicine. Significant improvements in pain were obtained within 4 weeks in both patients. The pain completely disappeared after 20 weeks (case 1) and 6 weeks (case 2) of treatment. Although surgical treatment is often performed for symptomatic spondylolisthesis, the findings of the present cases imply the therapeutic potential of herbal medicine in selected patients.

The efficacy of oxycodone for management of acute pain episodes in chronic neck pain patients

Most treatments of acute pain associated with non-malignant chronic pains are not satisfactory. The aim of this study is to evaluate the efficacy and side effects of oxycondone controlled release (Oxy-CR) in managing chronic neck pain with acute pain episodes. Randomised, double-blind, stand controlled study. A total of 116 patients were evenly divided into an oxycodone group (Oxy-CR, 5-10 mg and q12 h/day) and a placebo group (placebo, q12 h/day). Patients were assessed for the frequency of pain flares, visual analgesia score (VAS), quality of life (QOL), quality of sleep (QOS) and adverse effects before the treatment and on days 1, 3, 7, 14, 21 and 28 after the treatment. Withdrawal symptoms were monitored during the study, also on the completion of the entire study. The SF-36 was administered at the beginning and the end of the study for each patient. Compared with the baselines of Oxy-CR and the placebo groups, the frequency of pain episodes and VAS were decreased significantly starting on day 3 of administration of Oxy-CR (p<0.05). Improvements in QOL and QOS were significant on day 3 after treatment with Oxy-CR (p<0.05). The patients who were treated with Oxy-CR reported significantly higher side effects than the patients in the placebo group (p<0.05). However, these side effects started to diminish after day 7 of the treatment. Withdrawal symptoms did not emerge in this study. Most domains of SF-36 were improved in the treated patients at the end of study (p<0.05). Oxycondone controlled release could be an important optional drug for the management of refractory and frequent acute episodes of chronic neck pain in patients who failed to respond to non-opioid conservative treatment.

The difficult patient in gastroenterology: chronic pelvic pain, adhesions, and sub occlusive episodes

Chronic pelvic pain (CPP) with or without adhesions and symptoms of intestinal occlusion is a complex but relatively common complaint. The etiology and pathophysiology of CPP and adhesions are unclear, as is their possible relation. However, it is evident that continuous abdominal pain leads to evident suffering and disability. Unfortunately, there is little proof or evidence of success for many of the currently used diagnostic and therapeutic interventions. Laparoscopy is neither the ultimate evaluation nor the panacea for CPP or intra abdominal adhesions. An integral approach to CPP has shown beneficial results. In this multidisciplinary approach dealing with the pain is far more important than finding an organic cause and cure for the pain. Equal and simultaneous attention is paid to psychosocial, sexual and somatic aspects. The treatment of adhesions depends on the extent of symptoms and complaints. Because of the questionable relation between adhesions and pain, and the probability of reformation and de novo adhesion formation after surgery, adhesiolysis should be avoided. Even for patients with signs and symptoms of small bowel obstruction a conservative treatment is often justified. These patients require careful evaluation and management. Frequent reassessment is important to rule out impending strangulation, complete obstruction or perforation. Water soluble contrast can be useful to justify prolongation of conservative treatment and by that postpone unnecessary surgery. Most adhesive small bowel obstructions resolve following conservative treatment. The unsolved questions about etiology, diagnosis, treatment and prevention, and the great individual and community burden of CPP and adhesions clearly show that further research is needed.

Role of the Cannabinoid System in Pain Control and Therapeutic Implications for the Management of Acute and Chronic Pain Episodes

Cannabis extracts and synthetic cannabinoids are still widely considered illegal substances. Preclinical and clinical studies have suggested that they may result useful to treat diverse diseases, including those related with acute or chronic pain. The discovery of cannabinoid receptors, their endogenous ligands, and the machinery for the synthesis, transport, and degradation of these retrograde messengers, has equipped us with neurochemical tools for novel drug design. Agonist-activated cannabinoid receptors, modulate nociceptive thresholds, inhibit release of pro-inflammatory molecules, and display synergistic effects with other systems that influence analgesia, especially the endogenous opioid system. Cannabinoid receptor agonists have shown therapeutic value against inflammatory and neuropathic pains, conditions that are often refractory to therapy. Although the psychoactive effects of these substances have limited clinical progress to study cannabinoid actions in pain mechanisms, preclinical research is progressing rapidly. For example, CB(1)mediated suppression of mast cell activation responses, CB(2)-mediated indirect stimulation of opioid receptors located in primary afferent pathways, and the discovery of inhibitors for either the transporters or the enzymes degrading endocannabinoids, are recent findings that suggest new therapeutic approaches to avoid central nervous system side effects. In this review, we will examine promising indications of cannabinoid receptor agonists to alleviate acute and chronic pain episodes. Recently, Cannabis sativa extracts, containing known doses of tetrahydrocannabinol and cannabidiol, have granted approval in Canada for the relief of neuropathic pain in multiple sclerosis. Further double-blind placebo-controlled clinical trials are needed to evaluate the potential therapeutic effectiveness of various cannabinoid agonists-based medications for controlling different types of pain.

Pancreatic surgery

Over the past year considerable progress has been made in the field of pancreatic surgery. Innovative diagnostic techniques continue to improve the preoperative staging of pancreatic cancer. For patients with cancer and biliary obstruction, preoperative biliary stenting appears to increase the incidence of wound infection after pancreatoduodenectomy but has no effect on other perioperative complications. New information about the molecular biology of pancreatic cancer may begin to influence the surgical approach to the disease. More cases of intraductal papillary mucinous neoplasms are being diagnosed and studied. The impact of adjuvant chemotherapy and chemoradiation on survival has been more clearly defined in a large, randomized trial. In patients with sterile acute necrotizing pancreatitis, conservative nonsurgical management has continued to produce favorable results. For chronic pancreatitis, surgery appears to diminish both chronic pain and recurrent episodes of acute pain.

Treating sickle cell pain: An update from the Georgia comprehensive sickle cell center

Sickle cell disease, a common genetic disorder in the United States, is characterized by chronic hemolytic anemia, increased severity of infections, end-organ damage, and intermittent episodes of acute and chronic pain. In this disease, crystallized hemoglobin elongates and deforms the red cell into a rigid “sickle” shape, causing early red cell hemolysis and blockage of small blood vessels.1

Personality and behavioural characteristics in pediatric migraine.

SYNOPSISPersonality and behavioural features in pediatric migraine were investigated in a comparison study of 20boys and girls with migraine, matched for age and sex with a “pain” control group of 20 children withmusculoskeletal pain, and with a “no‐pain” control group of 20 children. When the amount of pain experiencedby children was controlled, the only discriminating variable was that of somatic complaints which includedvomiting, nausea, and perceptual disturbances, all migraine‐related phenomena. The inclusion of the “pain” control group in this investigation yielded results which indicated that the behavioural and personality featuresthought to be characteristic of childhood migraine are common to a chronic pain disorder and in fact, themanifestation of many of these features correlate directly with the amount of pain experienced. It is suggestedthat the personality and behavioural characteristics evident in many children with migraine may result from therecurrent chronic pain episodes rather than in some way being causative of the pain.

Therapeutic effects of delta-sleep-inducing peptide (DSIP) in patients with chronic, pronounced pain episodes. A clinical pilot study.

Experimental results suggested a modulation or 'programming' interaction of delta sleep-inducing peptide (DSIP) with endogenous opioid-peptidergic systems and exogenous intracerebrally or systemically administered morphine and amphetamine. The induction of cerebral MAO-A activity, a pronounced influence on the circadian rhythms of locomotion and intracerebral neurotransmitter as well as plasma protein and cortisol concentrations has been reported. DSIP was also shown to counteract experimentally induced stress situations in animals. An improvement of the psychomotor performance and the concentration capacity in humans beside sleep normalization and pronounced effects on withdrawal symptoms including pain states in alcoholics and opiate addicts was discovered. This encouraged a pilot study for a possible action of the peptide in humans suffering from chronic pronounced pain episodes. We investigated the therapeutic effect in 7 patients with migraine episodes and vasomotor headaches, chronic tinnitus and psychogenic pain attacks. The anamnestic (baseline) values were statistically compared with the katamnestic control period. DSIP lowered significantly the pain levels of 6 out of 7 patients after intravenous administration on 5 consecutive days followed by 5 injections every 48-72 h. Remarkably, a simultaneous significant reduction of the concomitantly occurring depressive states was observed.