Treatment of chronic non-cancer pain.
ABSTRACT 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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ABSTRACT: Chronic pain is commonly associated with disability and poor quality of life (QOL). This condition has a significant impact on the physical, psychological, and social well-being of older adults. However, the studies carried out in Brazil are insufficient to represent the multicultural characteristics of the country. It is believed that cultural/environmental differences may influence health management quality, with implications for older adults' health and QOL. Therefore, the aim of this study was to assess the factors related to bodily pain in older female participants in a recreational program in Brazil.04/2015; DOI:10.1016/j.jcgg.2015.02.005
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ABSTRACT: Total knee replacement can be a successful operation for pain relief. However, 10-34% of patients experience chronic postsurgical pain. Our aim was to synthesise evidence on the effectiveness of applying predictive models to guide preventive treatment, and for interventions in the management of chronic pain after total knee replacement. We conducted a systematic review of randomised controlled trials using appropriate search strategies in the Cochrane Library, MEDLINE and EMBASE from inception to October 2014. No language restrictions were applied. Adult patients receiving total knee replacement. Predictive models to guide treatment for prevention of chronic pain. Interventions for management of chronic pain. Reporting of specific outcomes was not an eligibility criterion but we sought outcomes relating to pain severity. No studies evaluated the effectiveness of predictive models in guiding treatment and improving outcomes after total knee replacement. One study evaluated an intervention for the management of chronic pain. The trial evaluated the use of a botulinum toxin A injection with antinociceptive and anticholinergic activity in 49 patients with chronic postsurgical pain after knee replacement. A single injection provided meaningful pain relief for about 40 days and the authors acknowledged the need for a large trial with repeated injections. No trials of multidisciplinary interventions or individualised treatments were identified. Our systematic review highlights a lack of evidence about the effectiveness of prediction and management strategies for chronic postsurgical pain after total knee replacement. As a large number of people are affected by chronic pain after total knee replacement, development of an evidence base about care for these patients should be a research priority. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.BMJ Open 05/2015; 5(5):e007387. DOI:10.1136/bmjopen-2014-007387 · 2.06 Impact Factor
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ABSTRACT: As recognized by law no. 38 of March 15, 2010 patients with chronic pain should have access to an appropriate diagnostic and therapeutic path with continuity of care. In addition to clinical guidelines it is necessary to implement a multidisciplinary care to manage patients with osteoarticular chronic pain to start an early analgesic treatment and to optimize the health system resources. Through a triage territorial of patients with pain we identify the most complex cases to be sent to the network of pain (Spoke and Hub), and we differentiate those that must be managed in a territorial path. The proposal by National Association Osteoarticular Specialists (ASON) suggests a multidisciplinary personalized path, coordinated by general practitioners and specialists, aims to improve patient-health system relationship.Recenti progressi in medicina 03/2015; 106(3):118-24. DOI:10.1701/1806.19700