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Pain Imaging: Progress in Pain Research and Management, Volume 18
... Chronic pain treatment will only become fully effective with the improved understanding of the interrelationship between different pain mechanisms, and different levels of pain integration. The neurobiology of pain is described in numerous textbooks, chapters, and review articles [Bennett, 2000; Besson, 1999; Bolay and Moskowitz, 2002; Borsook, 1997; Cesaro and Ollat, 1997; Dickenson et al., 2002; Riedel and Neeck, 2001; Wall and Melzack, 1994; Zimmermann, 2001]. Complex interactions take place between structures of the peripheral and central nervous systems with modulatory mechanisms such as N-methyl-D-aspartate (NMDA) and opioid receptors within each component ultimately resulting in sensitization and desensitization of the system [Bennett, 2000; Bolay and Moskowitz, 2002; Riedel and Neeck, 2001] . ...
Patients with both chronic pain and substance use disorders are increasingly encountered in a variety of treatment settings. The treatment of these patients raises a number of ethical and patient care issues. Consultation-liaison psychiatrists possess the knowledge and skills to constructively address these issues. This chapter provides clinicians with a review of clinical and ethical dilemmas related to opioid treatment of chronic pain in patients with substance use disorders. The core conflict of beneficence and nonmaleficence will be explored in relation to the concepts of autonomy, justice, respect for persons, confidentiality, and informed consent. The thesis of this discussion focuses on the clinician's desire to provide compassionate care and relieve suffering, which sometimes conflicts with the clinician's desire to improve functioning, extend longevity, and enrich quality of life. A harm reduction model for clinical decision making is summarized.
... Chronic pain treatment will only become fully effective with the improved understanding of the interrelationship between different pain mechanisms, and different levels of pain integration. The neurobiology of pain is described in numerous textbooks, chapters, and review articles [Bennett, 2000; Besson, 1999; Bolay and Moskowitz, 2002; Borsook, 1997; Cesaro and Ollat, 1997; Dickenson et al., 2002; Riedel and Neeck, 2001; Wall and Melzack, 1994; Zimmermann, 2001]. Complex interactions take place between structures of the peripheral and central nervous systems with modulatory mechanisms such as N-methyl-D-aspartate (NMDA) and opioid receptors within each component ultimately resulting in sensitization and desensitization of the system [Bennett, 2000; Bolay and Moskowitz, 2002; Riedel and Neeck, 2001] . ...
Evaluating and treating patients with chronic nonmalignant pain, especially with opioid medications, often causes discomfort on the part of primary care physicians. A number of patient-, physician-, and system-related issues converge to make treating chronic pain a complex matter. Patient-related issues include an inability to define a clear anatomic cause for patients' pain, comorbid psychiatric conditions, and past and current substance abuse. Physicians lack training on the appropriate evaluation and treatment of chronic nonmalignant pain, fear creating addicts, and often face intense pharmaceutical industry pressure to prescribe medications. A paucity of practical clinical practice guidelines, controversy over the effectiveness of opioids on chronic nonmalignant pain, and concern about potential legal and regulatory ramifications add to the complexity of caring for these patients. Possible multifaceted solutions exist to minimize provider discomfort and improve their ability to treat patients appropriately. Examples include comprehensive, practical multidimensional guidelines on the evaluation and treatment of chronic nonmalignant pain, Web-based teleconferenced consultations with subspecialists, reduced pharmaceutical pressure, enhanced continuing medical education and pregraduate training, multispecialty coordinated care of patients with adequate reimbursement for such care, and physician access to state-based systems to track opioid prescriptions.
... Chronic pain treatment will only become fully effective with the improved understanding of the interrelationship between different pain mechanisms, and different levels of pain integration. The neurobiology of pain is described in numerous textbooks, chapters, and review articles [Bennett, 2000; Besson, 1999; Bolay and Moskowitz, 2002; Borsook, 1997; Cesaro and Ollat, 1997; Dickenson et al., 2002; Riedel and Neeck, 2001; Wall and Melzack, 1994; Zimmermann, 2001]. Complex interactions take place between structures of the peripheral and central nervous systems with modulatory mechanisms such as N-methyl-D-aspartate (NMDA) and opioid receptors within each component ultimately resulting in sensitization and desensitization of the system [Bennett, 2000; Bolay and Moskowitz, 2002; Riedel and Neeck, 2001] . ...
In the 1991 Gulf War less than 150 of nearly 700,000 deployed US troops were killed in action. Today, however, over 1 in 7 US veterans of the war has sought federal healthcare for related-health concerns, and fully 17% of UK Gulf War veterans describe themselves as suffering from the 'Gulf War syndrome', a set of poorly defined and heterogeneous ailments consisting mainly of chronic pain, fatigue, depression and other symptoms. Even though over 250 million dollars of federally funded medical research has failed to identify a unique syndrome, the debate regarding potential causes continues and has included oil well smoke, contagious infections, exposure to chemical and biological warfare agents, and posttraumatic stress disorder. Historical analyses completed since the Gulf War have found that postwar syndromes consisting of chronic pain, fatigue, depression and other symptoms have occurred after every war in the 20th century. These syndromes have gone by a variety of names such as Da Costa's syndrome, irritable heart, shell shock, neurocirculatory asthenia, and battle fatigue. Though the direct causes of these syndromes are typically elusive, it is clear that war sets in motion an undeniable cycle of physical, emotional, and fiscal consequences for war veterans and for society. These findings lead to important healthcare questions. Is there a way to prevent or mitigate subsequent postwar symptoms and associated depression and disability? We argue that while idiopathic symptoms are certain to occur following any war, a population-based approach to postwar healthcare can mitigate the impact of postwar syndromes and foster societal, military, and veteran trust. This article delineates the model, describes its epidemiological foundations, and details examples of how it is being adopted and improved as part of the system of care for US military personnel, war veterans and families. A scientific test of the model's overall effectiveness is difficult, yet healthcare systems for combatants and their families are already being put to pragmatic tests as troops return from war in Iraq and Afghanistan and from other military challenges.
... Chronic pain treatment will only become fully effective with the improved understanding of the interrelationship between different pain mechanisms, and different levels of pain integration. The neurobiology of pain is described in numerous textbooks, chapters, and review articles [Bennett, 2000; Besson, 1999; Bolay and Moskowitz, 2002; Borsook, 1997; Cesaro and Ollat, 1997; Dickenson et al., 2002; Riedel and Neeck, 2001; Wall and Melzack, 1994; Zimmermann, 2001]. Complex interactions take place between structures of the peripheral and central nervous systems with modulatory mechanisms such as N-methyl-D-aspartate (NMDA) and opioid receptors within each component ultimately resulting in sensitization and desensitization of the system [Bennett, 2000; Bolay and Moskowitz, 2002; Riedel and Neeck, 2001] . ...
Complex regional pain syndromes (CRPS) types I and II are neuropathic pain disorders that involve dysfunction of the peripheral and central nervous system. CRPS type I and type II were known formerly as reflex sympathetic dystrophy and causalgia, respectively. Most experts believe that a multidisciplinary approach including pharmacotherapy, physiotherapy, and psychotherapy is warranted. Historically, there has been considerable controversy regarding this disease entity. In particular, the precise mechanism of the sympathetic dysfunction as well as the nature of the psychological dysfunction commonly observed in patients with CRPS has been the subject of considerable debate. Current strides in our understanding of the pathophysiology of this disease have improved treatment options.
... Chronic pain treatment will only become fully effective with the improved understanding of the interrelationship between different pain mechanisms, and different levels of pain integration. The neurobiology of pain is described in numerous textbooks, chapters, and review articles [Bennett, 2000; Besson, 1999; Bolay and Moskowitz, 2002; Borsook, 1997; Cesaro and Ollat, 1997; Dickenson et al., 2002; Riedel and Neeck, 2001; Wall and Melzack, 1994; Zimmermann, 2001]. Complex interactions take place between structures of the peripheral and central nervous systems with modulatory mechanisms such as N-methyl-D-aspartate (NMDA) and opioid receptors within each component ultimately resulting in sensitization and desensitization of the system [Bennett, 2000; Bolay and Moskowitz, 2002; Riedel and Neeck, 2001] . ...
Patterns of comorbidity among common mental disorders can be understood from the perspective of a model that regards mood, anxiety and somatization disorders as elements within an internalizing spectrum of disorder, and substance use and antisocial behavior disorders as elements within a separate externalizing spectrum of disorder. In this chapter, we evaluate the possibility of linking this model to literature on chronic pain. Evidence from psychosocial and biological perspectives points towards mechanisms that link chronic pain to internalizing disorders. Such evidence indicates that the internalizing-externalizing model may provide a useful framework for suggesting new directions for research on connections between chronic pain and mood, anxiety, and related disorders and traits.
... Chronic pain treatment will only become fully effective with the improved understanding of the interrelationship between different pain mechanisms, and different levels of pain integration. The neurobiology of pain is described in numerous textbooks, chapters, and review articles[Bennett, 2000;Besson, 1999;Bolay and Moskowitz, 2002;Borsook, 1997;Cesaro and Ollat, 1997;Dickenson et al., 2002;Riedel and Neeck, 2001;Wall and Melzack, 1994;Zimmermann, 2001]. Complex interactions take place between structures of the peripheral and central nervous systems with modulatory mechanisms such as N-methyl-D-aspartate (NMDA) and opioid receptors within each component ultimately resulting in sensitization and desensitization of the system[Bennett, 2000;Bolay and Moskowitz, 2002;Riedel and Neeck, 2001]. ...
Disability research in arthritis, as in disability research in general, has focused on functional limitations and activities of daily living/instrumental activities of daily living (ADL/IADL) disability, and has thus ignored a great deal of daily life. Unfortunately, the areas of life that have been ignored may be those that are most important to individuals, and may also be the most sensitive to the first signs of developing disability. The ability to perform valued life activities, the wide range of activities that individuals find meaningful or pleasurable above and beyond activities that are necessary for survival or self-sufficiency, has strong links to psychological well-being--in some cases, stronger links than functional limitations and disability in basic activities of daily living. A broader assessment of disability has great potential for interrupting the disablement and distress process, thereby improving the quality of life of individuals with arthritis. Assessment of the effects of arthritis, pain, or other chronic health conditions should expand beyond assessment of functional limitations and disability in basic activities to include assessment of disability in advanced, valued activities.
... Chronic pain treatment will only become fully effective with the improved understanding of the interrelationship between different pain mechanisms, and different levels of pain integration. The neurobiology of pain is described in numerous textbooks, chapters, and review articles [Bennett, 2000; Besson, 1999; Bolay and Moskowitz, 2002; Borsook, 1997; Cesaro and Ollat, 1997; Dickenson et al., 2002; Riedel and Neeck, 2001; Wall and Melzack, 1994; Zimmermann, 2001]. Complex interactions take place between structures of the peripheral and central nervous systems with modulatory mechanisms such as N-methyl-D-aspartate (NMDA) and opioid receptors within each component ultimately resulting in sensitization and desensitization of the system [Bennett, 2000; Bolay and Moskowitz, 2002; Riedel and Neeck, 2001] . ...
The psychological behaviorism theory of pain unifies biological, behavioral, and cognitive-behavioral theories of pain and facilitates development of a common vocabulary for pain research across disciplines. Pain investigation proceeds in seven interacting realms: basic biology, conditioned learning, language cognition, personality differences, pain behavior, the social environment, and emotions. Because pain is an emotional response, examining the bidirectional impact of emotion is pivotal to understanding pain. Emotion influences each of the other areas of interest and causes the impact of each factor to amplify or diminish in an additive fashion. Research based on this theory of pain has revealed the ameliorating impact on pain of (1) improving mood by engaging in pleasant sexual fantasies, (2) reducing anxiety, and (3) reducing anger through various techniques. Application of the theory to therapy improved the results of treatment of osteoarthritic pain. The psychological behaviorism theory of the placebo considers the placebo a stimulus conditioned to elicit a positive emotional response. This response is most powerful if it is elicited by conditioned language. Research based on this theory of the placebo that pain is ameliorated by a placebo suggestion and augmented by a nocebo suggestion and that pain sensitivity and pain anxiety increase susceptibility to a placebo.
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