Strategy For Management Of Chronic Pain Research Articles

Radiofrequency of suprascapular nerve as an analgesic strategy for chronic pain management. Systematic review and meta-analysis

IntroductionChronic shoulder pain is highly prevalent in the general population. Many different analgesic strategies have been described, including radiofrequency treatment to the suprascapular nerve (RFS); however, the effectiveness this approach remains unclear, and no strong recommendation can be made. The aim of this systematic review is to analyse the latest clinical trials evaluating the effectiveness of RFS techniques applied to the suprascapular nerve in terms of management of chronic shoulder pain, post-procedural functionality, and adverse effects. MethodsWe performed a systematic review of clinical trials retrieved from Medline, Embase and the CENTRAL databases. We included trials comparing RFS with other strategies, including placebo, that had as their primary outcome measures pain rated on a visual analogue scale, functionality rated on a shoulder pain and disability index (SPADI), and the incidence of adverse events. Risk of bias was analysed using the Cochrane RoB2 tool. Evidence was analysed using a random effects model and heterogeneity was quantified using the I2 test. ResultsWe identified 3030 trials, of which 8 met the inclusion criteria (n = 408). Seven had a high risk of bias. Pain intensity at 1 and 3 months was lower in patients receiving RFS, with a standardised mean difference (SMD) of −0.9 (95% CI [−1.1, 0.33], p = 0.29; I2 88%, p < 0.001) and −1.17 (95% CI [−2.49, 0.14], p = 0.08; I2 97%, p < 0.001), respectively. Functional compromise at 1 and 3 months decreased in patients receiving RFS, with an SMD of −0.31 (95% CI [−0.91, 0.29], p = 0.31; I2 80%, p < 0.001) and −1.54 (95% CI [−3.26, 0.19], p = 0.08; I2 98%, p < 0.001), respectively. No RFS-related adverse events were described. ConclusionThe evidence suggests that RFS reduces pain and improves functionality. However, the certainty of the evidence is low.

Radiofrequency of suprascapular nerve as an analgesic strategy for chronic pain management. systematic review and meta-analysis

IntroductionChronic shoulder pain is highly prevalent in the general population. Many different analgesic strategies have been described, including radiofrequency treatment to the suprascapular nerve (RFS); however, the effectiveness this approach remains unclear, and no strong recommendation can be made. The aim of this systematic review is to analyse the latest clinical trials evaluating the effectiveness of RFS techniques applied to the suprascapular nerve in terms of management of chronic shoulder pain, post-procedural functionality, and adverse effects. MethodsWe performed a systematic review of clinical trials retrieved from Medline, Embase and the CENTRAL databases. We included trials comparing RFS with other strategies, including placebo, that had as their primary outcome measures pain rated on a visual analogue scale, functionality rated on a shoulder pain and disability index (SPADI), and the incidence of adverse events. Risk of bias was analysed using the Cochrane RoB2 tool. Evidence was analysed using a random effects model and heterogeneity was quantified using the I2 test. ResultsWe identified 3030 trials, of which 8 met the inclusion criteria (n = 408). Seven had a high risk of bias. Pain intensity at 1 and 3 months was lower in patients receiving RFS, with a standardised mean difference (SMD) of -0.9 (95% CI [-1.1, 0.33], p = 0.29; I2 88%, p < 0.001) and -1.17 (95% CI [-2.49, 0.14], p = 0.08; I2 97%, p < 0.001), respectively. Functional compromise at 1 and 3 months decreased in patients receiving RFS, with an SMD of -0.31 (95% CI [-0.91, 0.29], p = 0.31; I2 80%, p < 0.001) and -1.54 (95% CI [-3.26, 0.19], p = 0.08; I2 98%, p < 0.001), respectively. No RFS-related adverse events were described. ConclusionThe evidence suggests that RFS reduces pain and improves functionality. However, the certainty of the evidence is low.

Framework for Personalized Chronic Pain Management: Harnessing AI and Personality Insights for Effective Care

This paper introduces a cutting-edge framework for personalized chronic pain management, leveraging the power of artificial intelligence (AI) and personality insights. It explores the intricate relationship between personality traits and pain perception, expression, and management, identifying key correlations that influence an individual's experience of pain. By integrating personality psychology with AI-driven personality assessment, this framework offers a novel approach to tailoring chronic pain management strategies for each patient's unique personality profile. It highlights the relevance of well-established personality theories such as the Big Five and the Myers-Briggs Type Indicator (MBTI) in shaping personalized pain management plans. Additionally, the paper introduces multimodal AI-driven personality assessment, emphasizing the ethical considerations and data collection processes necessary for its implementation. Through illustrative case studies, the paper exemplifies how this framework can lead to more effective and patient-centered pain relief, ultimately enhancing overall well-being. In conclusion, the paper positions the need of an "AI-Powered Holistic Pain Management Initiative" which has the potential to transform chronic pain management by providing personalized, data-driven solutions and create a multifaceted research impact influencing clinical practice, patient outcomes, healthcare policy, and the broader scientific community's understanding of personalized medicine and AI-driven interventions.

Association between HDL-C and chronic pain: data from the NHANES database 2003-2004.

High-density lipoprotein cholesterol (HDL-C) has been reported to be associated with pain symptoms of various diseases, and its anti-inflammatory and antioxidant mediation is related to the pathogenesis of chronic pain. This study aims to evaluate the relationship between HDL-C levels and chronic pain in American adults. This cross-sectional study used data from American adults aged 20 and above during the 2003-2004 National Health and Nutrition Examination Survey (NHANES) cycle. Participants were divided into 4 groups based on HDL-C quartiles. We used chi-square tests and Student's t-tests or Mann-Whitney U tests to analyze categorical variables and continuous variables to compare differences between groups. Multivariate logistic regression analysis was used to study the association between HDL-C levels and the risk of chronic pain. Likelihood ratio tests were used to assess interactions between subgroups, and sensitivity analyses were conducted. Our final analysis included 4,688 participants, of which 733 (16.4%) had chronic pain. In the multivariate logistic regression model adjusted for covariates, there was a negative correlation between HDL-C levels and chronic pain. Specifically, for every 20 unit increase in HDL-C, the risk of chronic pain decreased by 26%. Compared with the lowest HDL-C quartile (< 43 mg/dL), the highest HDL-C quartile (≥ 64 mg/dL) was associated with a 24% reduction in the risk of chronic pain. No interaction factors affecting the relationship between HDL-C and chronic pain were found in the subgroup analysis. This study demonstrates a negative association between HDL-C levels and chronic pain in US adults, providing insights into the pathogenesis of chronic pain and potential improvements in chronic pain management strategies.

Multimodal management strategies for chronic pain after spinal surgery: a comprehensive review.

"Chronic pain after spinal surgery" (CPSS) is a nonspecific term for cases in which the end result of surgery generally does not meet the preoperative expectations of the patient and surgeon. This term has replaced the previous term i.e., failed back surgery syndrome. CPSS is challenging for both patients and doctors. Despite advancements in surgical techniques and technologies, a subset of patients continue to experience persistent or recurrent pain postoperatively. This review provides an overview of the multimodal management for CPSS, ranging from conservative management to revision surgery. Drawing on recent research and clinical experience, we aimed to offer insights into the diverse strategies available to improve the quality of life of CPSS patients.

Characteristics of Telehealth Interventions for Adult Patients with Chronic Pain and Family Care Partners.

Objectives: This review aimed to assess characteristics of telehealth in pain management for adult patients with chronic pain and their family care partners and review current evidence of the effectiveness of telehealth for pain management. Based on the Revised Symptom Management model, this review identified types of chronic pain management strategies and symptom management outcomes delivered by telehealth. Methods: We conducted a systematic review of four electronic databases, PubMed, Cumulative Index to Nursing and Allied Health Literature, PsycINFO, and Embase, using combinations of keywords, including "telehealth," "caregivers," and "pain." Only interventions delivered online, including websites, mobile applications, phone calls, and videoconferencing, were included. To accurately characterize the features of each telehealth pain intervention, we employed a standardized checklist. Additionally, a summary table of the evidence was created. Results: We analyzed 17 studies that met the inclusion criteria, of which 14 were randomized controlled trials, 1 was a cohort study, and 2 were qualitative cohort studies. We grouped interventions based on content of the intervention for pain management (education, psychotherapy, reporting and consultation, and multicomponent intervention). The quality rating of studies was mostly moderately strong. Findings of interventions' effectiveness were showing heterogenous effects on variables, possibly due to different pain measurements and varying follow-up times. Significance of Results: Telehealth interventions can potentially increase access to care for patients with chronic pain and their families in a limited resource area. Telehealth technology is a feasible tool that may enhance clinicians' pain management efforts for patients with chronic pain and their family care partners. The results of this review can be used to guide telehealth pain assessment and evaluation for care partners, clinicians, and researchers and inform the design of future telehealth systems.

Mediterranean Diet and Oxidative Stress: A Relationship with Pain Perception in Endometriosis.

Endometriosis is a chronic and inflammatory disease associated with pelvic pain. Dietary changes may be therapeutic for chronic inflammatory processes, reducing visceral input. The aim was to evaluate the role of dietary changes according to the Mediterranean Diet (MD) on pain perception in endometriosis and their relationship with oxidative stress. in this prospective study, we included 35 endometriosis women. At baseline (T0) and after 3 (T1) and 6 (T2) months from the start of the diet, we investigated pain intensity with VAS (Visual Analogue Scale, from 0 to 10), vitamin profile, and oxidative stress. we found a significant increase in the diet score (p < 0.001). At T1, patients reduced pain in terms of dyspareunia (p = 0.04), non-menstrual pelvic pain (p = 0.06), dysuria (p = 0.04), and dyschezia (p < 0.001). Dyspareunia (p = 0.002) and dyschezia (p < 0.001) were further significantly reduced also at T2. We observed a significant positive correlation between lipid peroxidation and VAS non-menstrual pelvic pain and dysuria and a significant negative correlation between Oxygen radical absorbance capacity and VAS non-menstrual pain and dyschezia. our findings show a clear tendency toward a relationship between pain relief in endometriosis and MD. This appears promising to treat endometriosis-related symptoms and could be considered a new effective strategy for chronic pain management in the long term.

In Conversation With Chronic Pain: An Integrative Framework for Understanding and Treating Chronic Pain

Chronic pain as an entity presents a challenge across many domains of life. It fails to serve adaptive or physiological functions. Beyond the exorbitant economic burden and strain on our healthcare system, chronic pain takes a heavy toll on the psychosocial and emotional wellbeing of sufferers and their relationships. As a complex biopsychosocial condition, routine treatments can ignore important variables, rendering them insufficient in relieving patient suffering. Research examining psychological management strategies for chronic pain is largely dominated by cognitive-behavioural models of therapy. Psychodynamic psychotherapeutic models have been substantially less explored. Through a relational lens, this theoretical essay explores aetiological influences of chronic pain. Consideration of the intersection of trauma, attachment, and pain then grounds an argument for a psychodynamic approach to chronic pain management.

Quantifying implementation strategy and dissemination channel preferences and experiences for pain management in primary care: a novel implementer-reported outcome.

Precision implementation science requires methods to evaluate and select implementation strategies. This study developed and evaluated a novel measure of concordance between current and preferred dissemination channels (DC) and implementation strategies (IS) to guide efforts to improve the adoption of evidence-based management strategies for chronic pain. We conducted a one-time electronic survey of Pennsylvania primary care practitioners (PCPs) about current vs. preferred chronic pain management DC and IS use. Survey items were selected based on preliminary data, the Model for Dissemination of Research, and the Evidence-Based Recommendations for Implementing Change taxonomy of implementation strategies. We used Cohen's kappa (κ) to assess the agreement between participant-level current and preferred DC/IS. We calculated % preferred minus % experienced for each DC/IS and assessed the equality of proportions to determine whether this difference significantly departed from zero. We categorized DC and IS based on the degree of use and preference, to evaluate alignment. The current sample included 101 Pennsylvania PCPs primarily in urban (94.06%), non-academic (90.10%) settings who self-identified as mostly female (66.34%) and white (85.15%). The greatest difference between preferred and experienced DCs, or "need," was identified by participants as workshops, clinical experts, seminars, and researchers. Similarly, participants reported the greatest IS gaps as multidisciplinary chronic pain workgroups, targeted support for clinicians, and a chronic pain clinical champion. Participating PCPs had moderate DC concordance (kappa = 0.45, 95% CI = 0.38-0.52) and low IS concordance (kappa = 0.18, 95% CI = 0.13-0.23). DC and IS concordance were both greater than that expected by chance. We further identified well-aligned DC and IS, including professional organizations, briefs, and guidelines. We identified a novel implementer-reported outcome of dissemination channel and implementation strategy concordance that allows implementation scientists to quantify the magnitude of the gap between the current and preferred experience of implementers. This quantitative measure can help with the selection and evaluation of dissemination channels and implementation strategies. Future research should leverage this measure to understand the degree to which preference concordance influences clinical outcomes and performance.

Online multidisciplinary interventions for paediatric chronic pain: A content analysis.

Many online interventions for paediatric chronic pain have been developed and evaluated. In accordance with the biopsychosocial model, the recommended treatment approach for chronic pain is multidisciplinary. Despite this, multidisciplinary components within existing online interventions have not been examined. The objective of the present review was to summarise and evaluate the content of existing online interventions for paediatric chronic pain by mapping intervention content to evidence-based guidelines for chronic pain management. Interventions were identified using an updated systematic review. Nine chronic pain management strategies that reflect evidence-based guidance for multidisciplinary chronic pain management were defined by the authors, examples of which include 'pain education', 'activity pacing' and 'physiotherapy'. Identified interventions were then coded against the target strategies. These codes were compiled descriptively to provide an overview of how well each chronic pain management strategy was represented across the dataset, and which interventions represented the most strategies. Thirty-five articles, relating to 13 unique interventions for paediatric chronic pain management were identified; few encompassed a complete multidisciplinary approach. Many CBT-based interventions included multidisciplinary elements. Across interventions, physiotherapy and non-pharmacological physical therapies were the least represented chronic pain management strategies. The content analysis revealed a lack of online interventions encompassing complete multidisciplinary pain management. It is important that new interventions for paediatric chronic pain management are evidence-based and reflect current best practice guidelines. Established intervention development approaches should be utilised and include a process evaluation to help identify which intervention components are effective in which contexts. This content analysis of online interventions for paediatric chronic pain highlights the need for multidisciplinary practices in pain management to be translated into online interventions. Improving the availability of pain management resources is essential for many families who cannot attend specialist pain clinics, particularly in the context of the COVID-19 pandemic. There is potential for new resources, as well as for established resources, to be further developed to deliver a broader range of pain management content.

Prevalence of chronic pain among adults in the United States.

Chronic pain is associated with reduced quality of life, increased medical expenditures, and significant economic costs. Chronic pain is among the most common chronic conditions in the United States, although estimates vary widely regarding its precise prevalence. Understanding the scope of the problem using the most contemporaneous data is therefore an important goal. This study sought to determine the prevalence of chronic pain and its impacts among adults in the United States using the National Health Interview Survey, a household-based annual survey of self-reported health status of U.S. adults that can be used to generate national-level estimates. Using a chronic pain module introduced in the 2019 edition of National Health Interview Survey, we found that 50.2 million adults (20.5%) reported pain on most days or every day. The most common pain locations were back pain and hip, knee, or foot pain. The most commonly used management strategies for chronic pain were physical therapy and massage. Respondents with chronic pain reported limitations in daily functioning, including social activities and activities of daily living. Respondents with chronic pain reported significantly more workdays missed compared with those without chronic pain (10.3 vs 2.8, P < 0.001). Overall, these findings indicate that more than 1 in 5 adults in America experiences chronic pain; additional attention to managing the burden of this disease is warranted.

Teamwork in chronic pain management and the way forward in low and middle-income countries

Assessment and management of patients with chronic pain is a challenging task due to its complex multidimensional nature and biopsychosocial impact. It requires a collaborative effort by an interdisciplinary team. Evidence showed that in low and middle-income countries (LMICs), 33% patients among general adult population, and 56% of general elderly population, suffer from chronic painful conditions. Women are more likely to report chronic pain than men. In this narrative review, we attempted to search published literature to know the status of assessment and management of patients with chronic pain in low resource countries and to know the most appropriate chronic pain management strategies used in developed countries. We used broad electronic database (January 2010- December 2020) through common search engines.&#x0D; Lack of trained pain physicians and staffs, lack of interest, empathy and lack of integrated multidisciplinary approach are some of the barriers to achieve teamwork in chronic pain management. Authors strongly recommend the need of further research in this area, improvement in training programs for physicians and nursing staff for proper pain assessment and management of patients with chronic pain in low resource countries.&#x0D; Key words: Chronic pain management; Teamwork; Low resource; Multidisciplinary team; Interdisciplinary approach; Low and middle-income countries&#x0D; Citation: Siddiqui AS, Usman B. Teamwork in chronic pain management and the way forward in low and middle-income countries. Anaesth pain intensive care 2021;25(2):229-235. DOI: 10.35975/apic.v25i2.1477&#x0D; Received: 18 January 2021, Reviewed: 20 January, 10 February 2021, Accepted: 9 March 2021

Cognitive behavioural therapy and acceptance and commitment therapy as management strategies for chronic pain

Background:Chronic pain is a debilitating condition that affects the individual in complex ways. However, it is a subjective experience that can be unresponsive to medical treatment, requiring psychological interventions to address its complex and multidimensional nature. Cognitive behavioural therapy (CBT) and acceptance and commitment therapy (ACT) are recommended, yet there is a need to further our understanding on how these management strategies are effective. The present review aims to improve our understanding of the role of CBT and ACT in the management of chronic pain.Method:A literature search was conducted using PsycInfo, Medline, and CINAHL complete, followed by a narrative synthesis and critical appraisal.Findings:CBT and ACT have beneficial effects across several domains of chronic pain, but methodological issues limit our understanding of how this is achieved.Discussion:Future research should focus more on how CBT and ACT lead to positive changes for people with chronic pain. Specifically, there is a need for more detailed explanations of how the interventions are designed. Also, a wider consideration of individual preferences (treatment goals and preferred outcomes) as a desired outcome, and the impact of therapist and group effects.

Exploring physiotherapy practice within hospital-based interprofessional chronic pain clinics in Ontario

ABSTRACT Background: Chronic pain affects one in five persons and is a leading contributor to years lived with disability and high health care costs. In 2016, the government of Ontario increased public funding for pediatric and adult hospital-based interprofessional chronic pain clinics (HICPCs) in Ontario, Canada, expanding the role of physiotherapy in chronic pain management in the province. This role has yet to be described in the literature. Aim: The aim of this study was to explore physiotherapy practice within HICPCs in Ontario. Methods: We conducted an interpretive description qualitative study based on semistructured interviews with physiotherapists employed in pediatric and adult HICPCs in Ontario. Interviews were audio recorded, transcribed verbatim, and reviewed for accuracy. We analyzed interview data using thematic analysis. Results: Ten physiotherapists who practiced in pediatric and adult HICPCs (n = 4 pediatric; n = 6 adult) in Ontario were interviewed between February and April 2020. We constructed five themes related to physiotherapy practice in this setting. Themes included (1) contributing a functional lens to care; (2) empowering through pain education; (3) facilitating participation in physical activity and exercise; (4) supporting engagement in self-management strategies; and (5) implementing a collaborative approach to whole-person care. Conclusions: Our results illuminate how physiotherapy practice within HICPCs in Ontario focuses on providing a collaborative and whole-person approach to care, with an emphasis on supporting patients to increase their functional capacity by promoting engagement in active chronic pain management strategies.

Ultrasound and management strategies in chronic pain

Pain is the most common reason for seeking medical advice. Chronic pain remains a significant major problem. Imaging techniques are essential tools in interventional pain management (IPM). Ultrasound (US) has been comparatively a recent technology and its wider use has and an increased interest in imaging in IPM. This editorial briefly introduces the application of the US in chronic pain management strategies, and highlights its application, benefits, evidence and limitations in IPM.&#x0D; Keywords: Chronic pain; Interventional pain management; Ultrasound; Imaging&#x0D; Citation: Hidayati HB. Ultrasound and management strategies in chronic pain. Anaesth. pain intensive care 2020;24(6):__&#x0D; Received: 15 September 2020, Reviewed: 26 September 2020, Accepted: 15 November 2020

Preclinical evidence of enhanced analgesic activity of duloxetine complexed with succinyl-β-cyclodextrin: A comparative study with cyclodextrin complexes

Chronic pain represents one of the most important public health problems, with a great prevalence of comorbidity with depression and cognitive decline. Antidepressants such as duloxetine, a serotonin-norepinephrine reuptake inhibitor, represent an essential part of the therapeutic strategy for chronic pain management in addition to classical analgesics. Duloxetine is endowed with good efficacy and a good profile of safety and tolerability. Yet, duloxetine is metabolized by the cytochrome P450 system 2D6 and 1A2 (CYP2D6 and CYP1A2) and it exhibits moderate inhibitory activity on CYP2D6, resulting in side effects and metabolic interactions that may occur on a long term therapeutic schedule.Cyclodextrins (CyDs) are used in pharmaceutical applications for numerous purposes, including the improvement of drug bioavailability. In order to evaluate their effects on the activity of duloxetine, we first spectrophotometrically studied the host–guest complexes obtained combining duloxetine and different β-CyD derivatives (β-CyD, β-CyDen-c-(Glu-Glu), and succinyl-β-CyD) and then performed in vivo and in vitro studies. Among duloxetine/CyDs complexes, succinyl-β-CyD ameliorated the analgesic activity of duloxetine in the tail flick test and in the formalin test in mice and significantly protected the drug from CYP2D6 metabolism.

Samoobvladovanje kronične bolečine

Uvod: Strategija stimulacije, namenjena pacientom s kronično bolečino, je aktivnost samoobvladovanja bolečine, pri čemer se posameznik nauči najti ravnotežje med časom za fizične aktivnosti in časom za počitek. Cilj strategije stimulacije je ohraniti kakovost življenja in zmanjšati simptome kronične bolečine. Za strategijo še ni razvite enotne definicije, prav tako še ni aplicirana v prakso.Metode: Uporabili smo opisno metodo dela, metodo analize in sinteze literature ter smernice PRISMA. Izmed skupno identificiranih 789 zadetkov smo v končno analizo vključili 19 zadetkov. Tako smo izvedli pregled relevantne znanstvene literature ter analizo koncepta stimulacije, ki v slovenskem prostoru še ni bila izvedena in poteka v devetih korakih.Rezultati: Strategijo obvladovanja kronične bolečine je najbolj smiselno deliti v tri skupine: (1) predhodniki: bolečina in neznanje; (2) atributi: aktivnost, čas, ravnovesje, učenje in samonadzor in (3) posledice koncepta: zdravljenje bolečine in povečana učinkovitost pri aktivnostih.Diskusija in zaključek: Pred aplikacijo v prakso je treba opraviti testiranje strategije v kliničnem okolju ter ponovno oceniti prednosti in pomanjkljivosti uporabe koncepta. Mnenja o aplikaciji koncepta v prakso so različna: nekateri menijo, da koncept lahko privede do negativnih posledic, drugi, da uspešno prispeva k zdravljenju kronične bolečine. Strategija bi bila uporabna pri pacientih, ki imajo diagnosticirano kronično bolečino (kronične bolečine po poškodbah, degenerativnih spremembah, kronične bolečine v hrbtu, kronični glavobol, fibromialgija, nevropatska bolečina itd.), ki ni posledica onkološkega obolenja.

The opioid epidemic and pregnancy: implications for anesthetic care.

This review summarizes evolving knowledge regarding adverse maternal, fetal, and neonatal effects of opioid exposure during pregnancy, and current treatment options for opioid use disorder (OUD). Maternal and fetal implications of maternal opioid maintenance with methadone and buprenorphine are described. Finally, acute and chronic pain management strategies in opioid-tolerant parturients are reviewed. Opioid use among parturients has risen dramatically, with opioid use during pregnancy as high as 20%. Of women with chronic pain, most continue to take opioids during pregnancy. Medication-assisted therapy with methadone or buprenorphine is currently the standard for treatment of opiate use disorder. Buprenorphine has unique pharmacologic properties that account for its preference over methadone. It has also been shown to produce more favorable neonatal outcomes compared with methadone. Increased clearance and volume of distribution associated with pregnancy require adjustment of dosing regimens of both medications. Multimodal adjuncts can be important alternatives for treatment of pain in opioid-tolerant parturients. The dramatic rise in OUD in pregnancy has had staggering socioeconomic consequences, carrying with it profound maternal and fetal health problems. Medication-assisted treatment utilizing either methadone, or more commonly buprenorphine, is considered the standard of care for OUD during pregnancy. Peripartum pain management for opioid-tolerant patients is challenging and requires consideration for regional anesthesia along with multimodal pharmacotherapy.

The cost of pain

Prescription opioid use has historically been a regular component of the management of chronic nonmalignant pain in Canada. However, the economic implications of high rates of addiction and abuse have motivated consideration of more cost-effective management strategies for chronic pain. The economic burden imposed by prescription opioid use relates in part to lost workplace productivity, increased addiction treatment program costs, and increased overall healthcare expenditure for these patients. In this article, we present research on the economic implications of the current rates of opioid prescription, and report on the specific economic advantages realized in alternative therapeutic approaches to pain management.

Pain management in the Ehlers-Danlos syndromes.

Chronic pain in the Ehlers-Danlos syndromes (EDS) is common and may be severe. According to one study, nearly 90% of patients report some form of chronic pain. Pain, which is often one of the first symptoms to occur, may be widespread or localized to one region such as an arm or a leg. Studies on treatment modalities are few and insufficient to guide management. The following is a discussion of the evidence regarding the underlying mechanisms of pain in EDS. The causes of pain in this condition are multifactorial and include joint subluxations and dislocations, previous surgery, muscle weakness, proprioceptive disorders, and vertebral instability. Affected persons may also present with generalized body pain, fatigue, headaches, gastrointestinal pain, temporomandibular joint pain, dysmenorrhea, and vulvodynia. Pain management strategies may be focused around treating the cause of the pain (e.g., dislocation of a joint, proprioceptive disorder) and minimizing the sensation of pain. Management strategies for chronic pain in EDS includes physical therapy, medications, as well as durable medical equipment such as cushions, compressive garments, and braces. The different modalities are discussed in this paper. © 2017 Wiley Periodicals, Inc.