Treatment of Chronic Non-Cancer Pain

Department of Anesthesiology and Pain Medicine, University of Washington, Seattle, WA 98195, USA.
The Lancet (Impact Factor: 45.22). 06/2011; 377(9784):2226-35. DOI: 10.1016/S0140-6736(11)60402-9
Source: PubMed


Chronic pain is a pervasive problem that affects the patient, their significant others, and society in many ways. The past decade has seen advances in our understanding of the mechanisms underlying pain and in the availability of technically advanced diagnostic procedures; however, the most notable therapeutic changes have not been the development of novel evidenced-based methods, but rather changing trends in applications and practices within the available clinical armamentarium. We provide a general overview of empirical evidence for the most commonly used interventions in the management of chronic non-cancer pain, including pharmacological, interventional, physical, psychological, rehabilitative, and alternative modalities. Overall, currently available treatments provide modest improvements in pain and minimum improvements in physical and emotional functioning. The quality of evidence is mediocre and has not improved substantially during the past decade. There is a crucial need for assessment of combination treatments, identification of indicators of treatment response, and assessment of the benefit of matching of treatments to patient characteristics.

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    • "Pain management has been the subject of many studies and is often undertreated by those responsible for a patient's well-being (Turk, Wilson, Cahana, 2011; Wu, Raja, 2011). A virtual reality game entitled SnowWorld transports the player from the confines of a hospital room to an open glacier canyon where the player can interact with snowmen, penguins, igloos, and robots. "
    Issues in Mental Health Nursing 02/2015; 36(2):156-60. DOI:10.3109/01612840.2014.978961
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    • "A multidimensional and interdisciplinary treatment approach is an effective and cost-effective setting for the treatment of chronic pain (Sanders, Harden, & Vicente, 2005). Psychological interventions such as Cognitive-Behavioural Therapy (CBT) and Acceptance and Commitment Therapy (ACT) are core elements within such treatment plans (Kerns, Sellinger, & Goodin, 2011; Turk, Wilson, & Cahana, 2011). In contrast to CBT, ACT focusses on the process and functions of emotions, thoughts or behaviour rather than on their form, frequency or appearance alone (McCracken & Vowles, 2014). "
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    ABSTRACT: Acceptance and Commitment Therapy (ACT) is an effective intervention for the treatment of chronic pain. Internet-based pain interventions might be an effective and cost-effective way to overcome treatment barriers of traditional face-to-face pain interventions such as the lack of availability and accessibility. However, little is known about the general (cost-)effectiveness of internet-based pain interventions and the specific (cost-) effectiveness of guided and unguided pain interventions. Therefore, the aim of this study is to investigate the effectiveness and cost-effectiveness of a guided and unguided ACT-based online intervention for persons with chronic pain (ACTonPain).
    Internet Interventions 11/2014; 2(1). DOI:10.1016/j.invent.2014.11.005
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    • "Pharma- 61 cological therapeutics such as opioids, and nonsteroidal anti- 62 inflammatory drugs (NSAIDs) such as cyclooxygenase-2 (COX-2) 63 inhibitors, are often prescribed as the standard treatment regimens 64 for patients with chronic pain [3] [27]. However, although these and 65 a huge range of other treatment options are available, their efficacy 66 often proves at best modest, and their use is limited by unwanted 67 side effects [13] [49]. There is therefore an urgent need to better 68 understand the molecular systems that mediate chronic pain and 69 to use this knowledge to develop improved therapeutics. "
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    ABSTRACT: Understanding the molecular mechanisms associated with disease is a central goal of modern medical research. As such, many thousands of experiments have been published that detail individual molecular events that contribute to a disease. Here we use a semi-automated text mining approach to accurately and exhaustively curate the primary literature for chronic pain states. In so doing, we create a comprehensive network of 1,002 contextualised protein-protein interactions (PPIs) specifically associated with pain. The PPIs form a highly interconnected and coherent structure, and the resulting network provides an alternative to those derived from connecting genes associated with pain using interactions that have not been shown to occur in a painful state. We exploit the contextual data associated with our interactions to analyse sub-networks specific to inflammatory and neuropathic pain, and to various anatomical regions. Here, we identify potential targets for further study and several drug-repurposing opportunities. Finally, the network provides a framework for the interpretation of new data within the field of pain.
    Pain 06/2014; 155(11). DOI:10.1016/j.pain.2014.06.020 · 5.21 Impact Factor
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