what are barriers to effective pain management concerning the physician?
- Believing patients always tell when having pain
- Lack of training/knowledge
- Fear of regulatory scrutiny
- Concerns about addiction and side effects
- Time consuming
- Pain management is secondary to disease management
- Believing pain is a symptom, not a disease
- Failure to define goals and expectations
what are barriers to effective pain management concerning the patient?
- Misconception that pain is normal
- Unwillingness to report pain
- Fear of side effects and addiction
- Believing that therapy may prevent control of more severe pain in the future
- Cognitive impairment, depression
- Passive coping strategies
what are barriers to effective pain management concerning the system?
- Failure to recognize/admit the magnitude of the problem
- Lack of resources
- Wrongful use of existing resources
- Lack of education
- Permissive compensatory system
what are the major CNCP categories?
- Primary pain (fibromyalgia)
- Post-traumatic pain
- Post-surgical pain
- Headache
- Orofacial pain
- Musculoskeletal pain
explain palliative therapy
The traditional approach to CNCP
- Pharmacotherapy
- Invasive interventions
- Behavioral therapy
- Hands on therapy
- Complementary & alternative medecine
explain effectiveness of duloxetine
anti-depressant
- study: -3 to 0 change
- Placebo went down 2 notches, which is clinically significant
- Difference is 0.8 notches between placebo and meds, which is not clinically significant
explain effectiveness of pregabalin for fibromyalgia
placebo works similarly, so not very significant
Analgesic selection should be based on pain characteristics:
Onset
Provocation/palliation
Quality
Region and radiation
Severity
Time
what are invasive methods?
- trigger point injections
- nerve blocks
- spinal axis interventions
super invasive:
- Peripheral nerve, spinal cord & brain stimulation
- Implanted spinal pump
what are the outcomes of invasive treatments?
- Not enough scientific evidence justifying nerve block therapy for chronic LBP1
- Most high quality studies show minimal long-term effect to spine interventions
what is Complementary & alternative medicine?
- Treatment approaches that fall outside the realm of conventional medicine
- Practices neither taught widely in medical schools nor generally available in hospitals
- Underutilized due to lack of scientific evidence/funding
what are the outcomes of palliative therapeutic for CNCP?
4-year community study1:
- Increased prevalence (45.5 to 53.8%)
- 79% still reported pain after 4 years
Retrospective study of patients with CRPS2:
- None had recovered
- In most- only modest symptom improvement
- Improvement not necessarily associated with therapy
The death rate from cancer in the U.S., adjusted for population size and age, dropped by only ___ from 1950 to 2005
5%
- While palliation is effective for certain cancers, it ranks far behind both early detection and risk-factor modification in its potential to reduce cancer mortality
what are the Similarities between cancer and chronic pain?
- High prevalence
- Multi-factorial etiologies
- Multitude of palliative therapeutic approaches
- Although frequently beneficial most current approaches have, so far, failed to change outcome
what were the results of Immunization against CNCP?
Early vaccination resulted in:
- Reduced incidence of HZ by 51.3%
- Reduced burden of illness by 61.1%
- Reduced incidence of PHN by 66.5%
what were the results of Following fMRI-guided training?
- Humans could learn how to control activation of rostral anterior cingulate cortex1
- In chronic pain patients: one day training resulted in a significant pain reduction (64% MPQ, 44% VAS)
how should we approach the future of preventing CNCP?
identify environmental factors + phenotype and genotype patients at risk –> explore preventative analgesia –> prevention of CNCP
