International Association For The Study Of Pain Research Articles

Technology-Enabled Advances in Pain Management.

Technology-Enabled Advances in Pain Management.

Molecular basis of pain: Membrane receptors involved in pain

Pain is the most commonly reported symptom by both adult and pediatric patients, the International Association for the Study of Pain (IASP) defines pain as "An unpleasant sensory and emotional experience associated with, or similar to that associated with, actual tissue damage or potential. Pain can have a significant negative impact on quality of life in the context of human disease, in temporality physiological pain is usually acute and pathological pain is usually chronic. Nociceptors are specialized nerve fibers for pain, they are found in the skin, organ of movement, they are classified as myelin fibers that are called Aδ; and unmyelinated fibers or C fibers. Nociceptors can be stimulated by biological agents, electrical, thermal, mechanical and chemical stimuli, once the stimulus is received it will be transmitted to the brain. One of the pillars of anesthesia is analgesia, that is to say, inhibiting pain. In this bibliographic review, the aim is to explain the molecular bases, emphasizing the main membrane receptors activated in the presence of pain.

Complex Regional Pain Syndrome or Limb Pain: A Plea for a Critical Approach.

Most frequently, complex regional pain syndrome (CRPS) develops after a trauma and affects distal parts of the limbs. Early recognition and initiation of adequate treatment is crucial for a favorable outcome. On the other hand, misdiagnosing other disorders as CRPS is detrimental because more appropriate treatment may be withheld from the patients. Despite intensive research, a specific biomarker or paraclinical measure for CRPS diagnosis is still lacking. Instead, clinical criteria approved by the International Association for the Study of Pain (IASP) and latest adapted in 2019 are central for diagnosing CPRS. Thus, the CRPS diagnosis remains challenging with the risk of a “deliberate diagnosis” for unexplained pain, while at the same time a delayed CRPS diagnosis prevents early treatment and full recovery. CRPS is a diagnosis of exclusion. To clinically diagnose CRPS, a vigorous exclusion of “other diseases that would better explain the signs and symptoms” are needed before the patients should be referred to tertiary centers for specific pain treatment. We highlight red flags that suggest “non-CRPS” limb pain despite clinical similarity to CRPS. Clinical and neurological examination and paraclinical evaluation of a probably CRPS patient are summarized. Finally, we pinpoint common differential diagnoses for CRPS. This perspective might help CRPS researchers and caregivers to reach a correct diagnosis and choose the right treatment, regardless whether for CRPS mimics or CRPS itself.

Comparative study of the efficacy between 0.5% bupivacaine and 0.5% bupivacaine-dexamethasone 8mg combination in supraclavicular brachial plexus block

Background: Initially the concept of pain was emotional rather than a sensory modality. The word pain is acquired from the Greek word poine which means “penalty”.1 The International Association for the Study of Pain (IASP) described pain as “an unpleasant sensory and emotional experience associated with actual or potential tissue damage or described in terms of such damage”.2 Peripheral nerve blocks have become a popular anaesthetic option in the perioperative management of patients because nerve blocks provide better postoperative analgesia than does general anaesthesia, while avoiding the cardiopulmonary and central nervous system effects of general anaesthesia. Peripheral nerve block is a technique which uses local anaesthetic to be deposited around a target nerve and block the conduction of action potential thus not allowing pain signals to be transmitted to the pain centre in the brain. Materials & methods: A prospective randomised single blinded study was conducted at Vinayaka Missions Kirupananda Variyar Medical College & Hospitals, Salem from December 2019 to May 2021.

How Do You Treat Trigeminal Neuralgia in Your Practice?

How Do You Treat Trigeminal Neuralgia in Your Practice?

Chronic Non-Cancer Pain: New Definitions, New Paradigms and Old Myths

Chronic pain is a highly prevalent phenomenon that involves biological, psychological, and social aspects with negative effects on function, mood, and quality of life. The International Association for the Study of Pain (IASP) advocates updating the current definition of chronic pain to better recognize the diversity and complexity that is difficult to capture in a brief definition.

Imaging of Neuropathic Pain

The International Association for the Study of Pain (IASP) defined neuropathic pain as “pain arising as a direct consequence of a lesion or disease affecting the somatosensory system.” The origin of neuropathic pain (NP) could be from the brain, spinal cord, or peripheral nerves. NP represents a major neurological problem, with a prevalence of 1%-2% of the total population. It is disabling, rendering an urgent need for non-addictive, effective new therapies, and is characterized by resistance to treatment and poor patient satisfaction. We aim to review the role of modern imaging in the diagnosis of NP and the potential advantages and limitations of each modality. Functional MRI is one of the commonly used imaging modalities for NP.

TREATMENT OPTIONS FOR TRIGEMINAL NEURALGIA.

Trigeminal neuralgia causes severe to excruciating pain that often cannot be successfully reduced with current forms of treatment. The International Association for the Study of Pain (IASP) defines trigeminal neuralgia as a sudden, usually unilateral, powerful, short, stabbing, recurrent episode of pain in the distribution of one or more branches of the trigeminal nerve. Trigeminal neuralgia can be caused by vascular compression of the trigeminal nerve or a tumor process. Pressure on the nerve itself causes nerve demyelination, which is the cause of abnormal depolarization, resulting in the development of ectopic impulses. Pain can be provoked by brushing teeth, shaving, eating, cold, heat, etc. After diagnosing trigeminal neuralgia, magnetic resonance imaging should be performed to rule out multiple sclerosis, a tumor process that can secondarily cause trigeminal neuralgia. The drug of choice for treating trigeminal neuralgia is still carbamazepine. If pharmacological treatment fails, invasive surgical microvascular decompression, stereotactic radiation therapy (gamma knife), percutaneous balloon micro compression, percutaneous glycerol rhizolysis, and percutaneous radiofrequency (RF) may be used.

MODERN VIEW OF DIAGNOSIS AND APPROACHES TO THE TREATMENT OF CHRONIC PAIN IN CHILDREN WITH PARALYTIC SYNDROMES (LITERATURE REVIEW)

Over the past decades, more and more attention in medical science has been paid to the diagnosis and study of pain mechanisms in the pediatric population. According to experts in the field of chronic pain in children, it occurs in 12% of all pediatric patients, which negatively affects the quality of children’s life and life of their families. Today, a particularly important problem in most countries of the world is pain in children with paralytic syndromes of III - V level according to GMFCS. About 20-35% of children with paralytic syndromes suffer from chronic pain. Although there are means and knowledge on how to treat pain, children's pain is often not recognized, ignored, or even denied. More than 50% of children with paralytic syndromes suffer from moderate to severe pain daily and in several parts of the body. The International Association for the Study of Pain (IASP) defines pain as “an unpleasant, sensual, and emotional experience associated with actual or potential tissue damage or perceived tissue damage. The inability to communicate verbally does not negate the possibility that the individual is in pain and needs appropriate analgesic treatment. Pain is always subjective ... ". Determining the type of pain helps to identify its cause, which can guide the choice of treatment. The main cause of pain in children includes acute nociceptive pain (ie pain caused by activation of peripheral nerve endings, including somatic and visceral pain), neuropathic pain (ie due to damage or dysfunction of the somatosensory system), psychosocial - spiritual - emotional pain. Chronic pain is a continuous or intermittent pain that lasts longer than the expected normal recovery period. Chronic pain can also occur and persist in the absence of a specific pathophysiology or medical condition. The expression of pain depends on a child's age, cognitive development and socio-cultural context.

Functioning in the fibromyalgia syndrome: validity and reliability of the WHODAS 2.0

BackgroundFibromyalgia syndrome (FMS) is both a challenging and disabling condition. The International Association for the Study of Pain (IASP) classifies FMS as chronic primary pain, and it can negatively impact individuals’ functioning including social, psychological, physical and work-related factors. Notably, while guidelines recommend a biopsychosocial approach for managing chronic pain conditions, FMS assessment remains clinical. The WHODAS 2.0 is a unified scale to measure disability in the light of the International Classification of Functioning, Disability and Health. Thus, this study aimed to evaluate the reliability and validity of the Brazilian version of WHODAS 2.0 for use in individuals with FMS.MethodsMethodological study of the validity and reliability of the Brazilian version of the 36-item WHODAS 2.0 with 110 individuals with FMS. The instrument gives a score from 0 to 100, the higher the value, the worse the level of functioning. We assessed participants with Medical Outcomes Study 36-Item Short-Form Health Survey (SF-36) (0–100), Fibromyalgia Impact Questionnaire (FIQ) (0–10) and Beck Depression Inventory instrument (BDI) (0–63). The construct validity, internal consistency, and test–retest stability. We used SF-36, FIQ and BDI to study construct validity analysis. For statistical analysis, we performed the intraclass correlation (ICC), Spearman correlation, and Cronbach's alpha, with a statistical level of 5%.ResultsMost participants were female (92.27%), aged 45 (± 15) years. The test–retest reliability analysis (n = 50) showed stability of the instrument (ICC = 0.54; ρ = 0.84, p < 0.05). The test–retest correlation between the domains was moderate to strong (ρ > 0.58 and < 0.90). Internal consistency was satisfactory for total WHODAS 2.0 (0.91) and also for domains, ranging from 0.44 to 0.81. The construct validity showed satisfactory values with all moderately correlated with WHODAS 2.0 instruments (> 0.46 and < 0.64; p < 0.05). WHODAS 2.0 evaluates the functioning encompassing components of health-related quality of life, functional impact, and depressive symptoms in those with FMS.ConclusionsWHODAS 2.0 is a reliable and valid instrument to evaluate functioning of Brazilians with FMS. It provides reliable information on individuals' health through of a multidimensional perspective, that allows for individual-centered care.

Interest of registries in neuropathic pain research.

Neuropathic pain is frequent in the general population, with 7 to 10% of adults presenting with chronic neuropathic pain. To date, the gold standard to evaluate treatments is based on randomized controlled trials. Nonetheless, such design is run on a limited sample and for a limited period. Moreover, many treatments will never be compared directly in sufficiently large and representative populations. A way to overcome several of these limitations is to use real-world data. Indeed, the International Association for the Study of Pain (IASP) includes a special interest group focusing on pain registries and promoting the use of such approaches. In this short narrative review, several of the main chronic pain registries are presented. The strengths and weaknesses of this approach are presented. Indication bias is frequent in observational studies because the choice of treatment is generally influenced by the patients' characteristics. However, a propensity score can be computed to adjust for these differences. The use of propensity score is briefly explained. Some data specific to neuropathic pain are discussed.

The Effectiveness of Active Learning Approaches in a Pain Education Curriculum Within a Physical Therapy Program

Background and Purpose. Pain education within physical therapist educational programs needs to continually evolve to meet current best practice guidelines. This model presentation describes the successful implementation of a pain curriculum using various active learning approaches including VoiceThread assignments in an entry-level physical therapist educational program. Method/Model Description and Evaluation. An 8-week curriculum was developed to assist students in meeting the synthesis and evaluation learning objectives of the International Association for the Study of Pain (IASP) curricular guidelines. Active learning homework assignments allowed students to practice communicating difficult pain principles while receiving constructive feedback. Course outcomes were measured through changes in a modified version of the Pain Attitude and Beliefs Scale (PABS), the Pain Care Confidence Scale (PCCS), qualitative student feedback, and performance on both practical and written examinations. Outcomes. All students passed the practical examination where they successfully demonstrated pain principle communication skills. The students showed less biomedical beliefs in 5 of the 7 PABS biomedical subscale questions and greater biopsychosocial beliefs in 2 of the 7 biopsychosocial subsections (P &lt; .05). Student scores on the PCCS also improved significantly (P &lt; .05) from 5.0 to 8.1 on the combined confidence level for treating patients in pain. Discussion and Conclusion. Implementation of the IASP curriculum within an entry-level physical therapist education program resulting in positive results in student learning and changing beliefs using a combined lecture and active learning approach.

Co-Players in Chronic Pain: Neuroinflammation and the Tryptophan-Kynurenine Metabolic Pathway.

Chronic pain is an unpleasant sensory and emotional experience that persists or recurs more than three months and may extend beyond the expected time of healing. Recently, nociplastic pain has been introduced as a descriptor of the mechanism of pain, which is due to the disturbance of neural processing without actual or potential tissue damage, appearing to replace a concept of psychogenic pain. An interdisciplinary task force of the International Association for the Study of Pain (IASP) compiled a systematic classification of clinical conditions associated with chronic pain, which was published in 2018 and will officially come into effect in 2022 in the 11th revision of the International Statistical Classification of Diseases and Related Health Problems (ICD-11) by the World Health Organization. ICD-11 offers the option for recording the presence of psychological or social factors in chronic pain; however, cognitive, emotional, and social dimensions in the pathogenesis of chronic pain are missing. Earlier pain disorder was defined as a condition with chronic pain associated with psychological factors, but it was replaced with somatic symptom disorder with predominant pain in the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5) in 2013. Recently clinical nosology is trending toward highlighting neurological pathology of chronic pain, discounting psychological or social factors in the pathogenesis of pain. This review article discusses components of the pain pathway, the component-based mechanisms of pain, central and peripheral sensitization, roles of chronic inflammation, and the involvement of tryptophan-kynurenine pathway metabolites, exploring the participation of psychosocial and behavioral factors in central sensitization of diseases progressing into the development of chronic pain, comorbid diseases that commonly present a symptom of chronic pain, and psychiatric disorders that manifest chronic pain without obvious actual or potential tissue damage.

Nociplastic Pain Criteria or Recognition of Central Sensitization? Pain Phenotyping in the Past, Present and Future.

Recently, the International Association for the Study of Pain (IASP) released clinical criteria and a grading system for nociplastic pain affecting the musculoskeletal system. These criteria replaced the 2014 clinical criteria for predominant central sensitization (CS) pain and accounted for clinicians’ need to identify (early) and correctly classify patients having chronic pain according to the pain phenotype. Still, clinicians and researchers can become confused by the multitude of terms and the variety of clinical criteria available. Therefore, this paper aims at (1) providing an overview of what preceded the IASP criteria for nociplastic pain (‘the past’); (2) explaining the new IASP criteria for nociplastic pain in comparison with the 2014 clinical criteria for predominant CS pain (‘the present’); and (3) highlighting key areas for future implementation and research work in this area (‘the future’). It is explained that the 2021 IASP clinical criteria for nociplastic pain are in line with the 2014 clinical criteria for predominant CS pain but are more robust, comprehensive, better developed and hold more potential. Therefore, the 2021 IASP clinical criteria for nociplastic pain are important steps towards precision pain medicine, yet studies examining the clinimetric and psychometric properties of the criteria are urgently needed.

Don't tell me, show me: Reactions from those with lived experience to the 2020 revised IASP definition of pain.

In 2020, the International Association for the Study of Pain (IASP) revised the definition of pain, providing an update to IASP’s original definition in place since 1979. The origins of the field of pediatric pain, born in part in the 1980s from the advocacy of Jill Lawson, mother to Jeffrey Lawson who experienced gross inadequacies in pain care as a premature infant, emphasize the critical need to listen to and act with the voice of people living with pain and their families and caregivers. Furthermore, the field of pediatric pain emerged in the mid‐1980s marking this revised definition of pain as the first opportunity within which the experience and science of pain in childhood has been considered. This invited commentary offers two lived experience reactions to the revised IASP definition of pain, from the perspective of one's own experience with pain during childhood and as parents and family members. Together, they highlight that the value of a revised definition must be judged on its ability to directly benefit children experiencing pain and their families. Their skeptical hope reflects their lived experience backed by empirical evidence demonstrating continued inequities and inadequacies in preventing and managing pediatric pain. We must mobilize together to ensure change in culture, knowledge, and behavior. With the combined efforts of researchers, healthcare professionals, and policymakers, in partnership with diverse people with lived experience, we can ensure that more effective action is taken to rapidly improve pain for children and their families.

Pain in Decreased Consciousness Patients

The International Association for the Study of Pain (IASP) defines pain as an unpleasant sensory and emotional experience associated with potential or tissue damage or described in terms of such damage. Pain in patients with decreased consciousness is individual and needs to consider many aspects. Following the expansion pain definition according to the IASP in 2020, the inability to communicate does not exclude the possibility that humans experience pain. Therefore, a good pain assessment in patients with decreased consciousness can increase the value of disease management and improve the patient's quality of life both during the treatment period and after hospitalization. Because of the inability of patients with decreased consciousness to verbally convey their pain, this poses a challenge for the clinician. This literature review was aimed to describe how to understand the pain in decreased consciousness patients.

Pain in Decreased Consciousness Patients

The International Association for the Study of Pain (IASP) defines pain as an unpleasant sensory and emotional experience associated with potential or tissue damage or described in terms of such damage. Pain in patients with decreased consciousness is individual and needs to consider many aspects. Following the expansion pain definition according to the IASP in 2020, the inability to communicate does not exclude the possibility that humans experience pain. Therefore, a good pain assessment in patients with decreased consciousness can increase the value of disease management and improve the patient's quality of life both during the treatment period and after hospitalization. Because of the inability of patients with decreased consciousness to verbally convey their pain, this poses a challenge for the clinician. This literature review was aimed to describe how to understand the pain in decreased consciousness patients.

ICD-11時代のペインクリニック―国際疼痛学会（IASP）慢性疼痛分類に学ぶ

ICD-11時代のペインクリニック―国際疼痛学会（IASP）慢性疼痛分類に学ぶ

Chronic nociplastic pain affecting the musculoskeletal system: clinical criteria and grading system.

Chronic nociplastic pain affecting the musculoskeletal system: clinical criteria and grading system.

A national survey of publicly funded chronic pain management services in Ireland

BackgroundChronic pain management services have historically been under-resourced in Ireland. There is no agreed model of care for chronic pain management services in Ireland. Previous studies have assessed the extent of services in Ireland without examining waiting times for access to services.AimsThis study aimed to quantify the extent of, geographical distribution of and waiting times for access to publicly funded chronic pain management services in Ireland.MethodsUsing the British Pain Society’s Core Standards for Pain Management Services in the UK (2015) and International Association for the Study of Pain (IASP) recommendations, a questionnaire was devised. Publically funded departments in Ireland were contacted and questionnaires completed. Waiting list data was publicly available and obtained from the National Treatment Purchase Fund website.ResultsThere was a 100% response rate. Sixteen publicly funded chronic pain management services were identified. There are 27 chronic pain management consultants (16.6 whole time equivalents (WTE)) practicing chronic pain management, amounting to 0.55 specialists (0.34 WTEs)/100,000 of the population. There are 21 WTE for non-consultant hospital doctors (NCHDs), 26.5 WTEs for nursing, 8 WTEs for physiotherapy and 6.2 WTEs for psychology, nationally. A percentage of 93.75% of departments (n = 15) provide interventional therapies, 37.5% (n = 6) provide advanced neuromodulation and 43.75% (n = 7) are managing intrathecal pump therapies. There are five pain management programmes nationally. As of January 2020, ~ 25% patients on waiting lists for outpatient appointments were waiting > 18 months, with ~ 17% patients on waiting lists for interventional treatments waiting > 12 months.ConclusionsShortage of multidisciplinary staff is of particular concern for Irish services. Patient access is limited as evidenced by significant waiting lists. In order to improve access to care and bring services in line with international recommendations, increased resources are needed.