Chronic Pain

MDNG Pain ManagementSeptember 2008
Volume 1
Issue 1

//The Educated Patient

Chronic Pain — Family Doctor

Direct your patients to this site for an easy-to-read overview of chronic pain. The site discusses how chronic pain may be treated, including medicines such as pain relievers, antidepressants, and anticonvulsants, both short-term and long-acting; and also discusses physical therapy, low-impact exercise, occupational therapy, and behavioral therapy. The site also recommends lifestyle changes and provides an extensive list of some common chronic pain conditions.

Chronic Pain Support Group

With a pastel purple background color, this site welcomes chronic pain sufferers in obtaining some key knowledge on chronic pain, specifically focusing on how to cope, what the definition of chronic pain is, and the impact of chronic pain. An article on pain and depression explains that “depression is sometimes a serious side effect of chronic pain.” Likewise, it states that “interaction is key.” Guests can become members and chat on message boards to receive support from other members.

Diagnosing Chronic Pain —

Your patients may become more familiar with typical diagnostic tests associated with chronic pain from visiting this site. The page focuses on tests for back pain, neuropathic pain, headache pain, fibromyalgia, arthritis, and more.

Chronic Pain — Ohio State University Medical Center

The Ohio State University Medical Center provides an outline of chronic pain that includes a definition, an overview of the different types of chronic pain, the causes, treatments, rehabilitation options, and more. Discussed on the page is the “terrible triad,” which is described as occurring when the condition “may cause a person to become preoccupied with the pain, depressed, and irritable.” All of the above may lead to “depression and irritability” along with insomnia, and weariness, that leads to even more depression and irritability. “This state is called the "terrible triad" of suffering, sleeplessness, and sadness.”

//Online CME

Cancer Pain

Credit: 1.00

Fee: None

Expires: July 14, 2011

Multimedia: Video/Audio

This Activity consists of two presentations: “Presentation 1: Chronic Cancer Pain: A New Disease” and “Presentation 2: Interspinal Drug Delivery: A new Algorithm.” The goals of both are to “discuss the proper use of analgesics used intrathecally, cite the rationale for an algorithmic approach to intrathecal drug use; discuss common causes of cancer pain; and describe the factors that are increasing the incidence of chronic cancer pain.”

Activity 2: Managing the Chronic Pain Patient at Risk or with a History of Addiction

Credit: 1.00

Fee: Free

Expires: November 1, 2011

Multimedia: Audio

The activity is designed to aid physicians in recognizing and addressing “challenges often encountered in the management of chronic pain patients at risk for or with a history of addiction.” Additionally, it will discuss how to monitor and document the treatment of pain patients receiving opioid medications and how to “distinguish potential ‘red flags’ of abuse and diversion of opioid medications.”

Prescribing Opioids for Chronic Pain

Credit: 1.00

Fee: $25.00

Expires: December 14, 2011

Multimedia: None

The objectives of this activity are to: “diagnose and manage chronic low back pain, utilize appropriate long-term opioid treatment; and safeguard your practice from drug abuse and diversion.”

From the Literature:

(chronic pain and depression)

Connection between Chronic Pain and Depression Affected by Early Youth Experiences

Researchers found that “early adversities predispose chronic pain patients to depression.” The study sought to understand Early Maladaptive schemas as well as their factors to “find out how they are associated with pain intensity or depression in chronic pain patients and a control sample.”

In Patients with Temporomandibular Disorders, Somatization and Scores from the Graded Chronic Pain Scale have a Correlation

Data produced from a study designed to grade a population of TMD patients on chronic pain severity and to correlate the severity with levels of depression and somatization reveal “interesting data regarding the prevalence of the different degrees of chronic pain severity and their relation with levels of depression and somatization.” Researchers measured scores from the Graded Chronic Pain Scale (GCPS) and the Symptoms Checklist-90R Depression (SCL-DEP) and Somatization (SCL-SOM) scales. “A significant correlation was found between SCL-SOM and GCPS scores, but not between SCL-DEP and GCPS.”

Int J Prosthodont. 2010 November/December;23(6):529-534.

A Majority of Chronic Musculoskeletal Pain Patients on Sick Leave From Work May Be Depressed

Researchers studying depressed mood in CMP patients on long-term sick leave uncovered that “undiagnosed psychiatric disorders were commonly seen in patients with CMP.” The team used Beck Depression Inventory scores to assess 83 “consecutive patients on sick leave.” The data revealed that 87% had psychiatric illness; depression was diagnosed in 56%; other psychiatric illness was diagnosed in 31%; and, 13% were mentally healthy. “Of all the patients, only 10% had a previous psychiatric diagnosis.” The authors suggest the test may be used to detect “distress in patients who are on long-term sick leave due to CMP and who need additional treatment.”

Chronic Low Back Pain Patients under Psychosocial Distress Don’t Always Self-Report Disability

The “relationship between psychosocial distress and self-reported disability in patients with chronic lower back pain is not uniform,” according to research studying whether or not the claim could be confirmed or refuted. The study researchers evaluated six participating rehabilitation centers and included a sample size of 293 patients. The results demonstrated that “the contributions of psychosocial distress to the models were smaller and more variable compared to pain intensity.”

//Clinical Trials

(nonsurgical, nonpharmacological therapies)

A Telephone Feedback System for Prevention of Chronic Pain Relapse

Virtual Reality Hypnosis for Chronic Pain Reduction (VRHChP)

Telehealth Therapy for Chronic Pain (TTCP)

Telephone Intervention for Pain Study (TIPS)

Peer Mentorship: An Intervention To Promote Effective Pain Self-Management In Adolescents

From the Network

Chronic Pain Assessment

(From PAINWeek)

When treating patients who are suffering from chronic pain, the diagnosis is critical, said Michael R. Clarke, MD, MPH, MBA, a psychiatrist and associate professor and director of the chronic pain treatment programs at the Johns Hopkins Medical Institutions.

N60 Could Be a Promising Non-Addictive Chronic Pain Reliever

Recent research on the powerful analgesic N60 has revealed the drug is effective in treating pain without the side effects of tolerance and addiction, according to scientists at Columbia University Medical Center.


Tiny Implantable Neurostimulator for Chronic Pain

Scientists at NICTA, an Australian research institution, have developed a microscopic implantable chip that, in combination with a small battery and computer, can detect and block pain signals traveling up the spinal cord, probably in the spinothalamic tract.

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