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Cognitive impairment in chronic pain

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... Specifically, chronic pain has been associated with impaired memory (Oosterman, Derksen, van Wijck, Veldhuijzen, & Kessels, 2011;, impaired executive functioning (Abeare et al., 2010;Glass et al., 2011), impaired processing speed (Grigsby, Rosenberg, & Busenbark, 1995), impaired psychomotor speed , and impaired attention (Moore, Keogh, & Eccleston, 2012). As noted by Kreitler and Niv (2007), these impairments warrant closer inspection because they may contribute to further suffering and reduce quality of life. ...
... Although the relationship between psychosocial factors and cognitive deficits in patients with chronic pain is not entirely understood, researchers have suggested that emotional distress may contribute independently to reduced cognitive performance. Further, additional factors commonly observed in patients with chronic pain may also affect cognition, including fatigue, apathy, disordered sleep, or medication effects (Kreitler & Niv, 2007). Although many studies have compared patients with chronic pain to healthy controls, this methodology involves extraneous psychosocial variables other than pain that are frequently present in patients with chronic pain. ...
... Additional research has shown that cognitive task impairment only occurs with high-severity pain ratings or for particularly difficult cognitive tasks (Eccleston, 1994). Further contributing to the difficulty in assessing the effects of pain on cognition is the well-established relationship between psychosocial factors and cognitive impairment in patients with chronic pain (Kreitler & Niv, 2007). ...
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Although clinicians have frequently observed that patients with chronic pain experience cognitive deficits related to memory and concentration, research on these deficits is equivocal, with some studies showing significant impairment and others suggesting minimal deficits. As such, the present study sought to examine the relationship between laboratory-induced pain and performance on the Paced Auditory Serial Addition Test (PASAT) using a mixed factorial design. Seventy-two nonclinical volunteers were randomly assigned to a pain group, who took the PASAT while experiencing cold pressor-induced pain, or a control group, who took the PASAT while experiencing painless room-temperature water immersion. To account for practice effects, all participants were administered 1 practice trial and 3 standard trials of the PASAT, with the final trial administered in cold pressor-induced pain or painless water immersion. The results revealed a significant interaction between condition and PASAT performance, F(1, 64) = 23.63, p < .001, partial η(2) = .27. The control group increased performance by 6 items while the pain group showed no such improvement. The results suggest that because the pain group did not demonstrate the same practice effects relative to the control group, their performance was impaired by cold pressor-induced pain. However, the impairment was relatively mild (about 0.5 standard deviation) and did not occur in all participants.
... Desta forma, buscam-se novas abordagens terapêuticas que visem a reabilitação funcional e a melhora da qualidade de vida dos acometidos, bem como a diminuição dos custos e o impacto social da doença 11,12 . ...
... Neste sentido, considerando que a AR é uma doença crônica de alta prevalência e que resulta em alterações físicas e emocionais significativas, constata-se que pouca atenção tem sido dada aos potenciais efeitos das alterações emocionais geradas pela progressão da doen-ça 11,12 dor. Considerou-se como dolorosa uma articulação que apresentasse algum grau de desconforto, não necessariamente dor intensa, quando avaliada por dígito pressão de sua interlinha ou por sua mobilização passiva. ...
... Sendo assim, este estudo representa uma iniciativa de estudar e caracterizar o estado de humor desta população através de uma escala breve e facilmente aplicável por profissionais de diversas áreas da saúde, podendo auxiliar na busca da melhor terapêutica e favorecendo a coleta de dados em âmbito de pesquisa 6,9,11 . ...
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Introdução: A Artrite Reumatoide (AR) é uma doença autoimune de caráterprogressivo e incapacitante, associada a perturbações de humor. Contudo,constata-se pouca atenção aos potenciais efeitos das alterações emocionais.Objetivos: Caracterizar e comparar o estado de humor de pacientes com AR, combase no nível de atividade da doença. Métodos: Foram avaliados 80 indivíduoscom AR, com 52,72 ± 15,14 anos. Para avaliação do nível de atividade de doença,foi utilizado o Disease Activity Score-28 (DAS-28). A avaliação do Estado de Humorfoi realizada com a Escala de Humor Brasileira (BRAMS). Resultados: Foramobservadas alterações de humor nos domínios raiva, tensão e vigor sendo queo grupo classificado em alta atividade da doença apresentou os piores quadrosde humor. Conclusão: Estes dados ressaltam a importância de um tratamentomultidisciplinar, visando melhora do estado de humor e da qualidade de vidadesses indivíduos, conduzindo a uma melhor gestão terapêutica da AR.
... However, the evidence does not appear to support this theory. [22][23][24][25][26] Many researchers who have reviewed the literature have concluded there is no increased risk of motor vehicle crash with chronic opioid use. 7,[27][28][29][30][31] In response to the rise in opioids use, the American College of Occupational and Environmental Medicine (ACOEM) updated its opioid guidelines from the third edition of the ACOEM Practice Guidelines. ...
... By analogy, this recommendation is extended beyond operation of motor vehicles to include other modes of transportation, forklift driving, overhead crane operation, heavy equipment operation, work with sharps, work with risk of injury (eg, heights) and tasks involving high levels of cognitive function. [19][20][21][22][23][24][25][26] Both weak and strong opioids have been consistently associated with increased risk of motor vehicle crashes (MVC) in all large epidemiological studies of working age adults sufficiently powered to detect motor vehicle crash risk with the risk estimates ranging from 29% to more than 800% increased risk. [51][52][53][54][55][56][58][59][60] There also is some evidence suggestive of a dose-response relationship. ...
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Objective: ACOEM has updated the treatment guidelines concerning opioids. This report highlights the safety-sensitive work recommendation that has been developed. Methods: Comprehensive literature reviews were accomplished with article abstraction, critiquing, grading, evidence table compilation, and guideline finalization by a multidisciplinary expert panel to develop evidence-based guidance. A total of 12 moderate-quality studies were identified to address motor vehicle crash risk, and none regarding other work among opioid-using patients. Results: Acute or chronic opioid use is not recommended for patients who perform safety-sensitive jobs. These jobs include operating motor vehicles, other modes of transportation, forklift driving, overhead crane operation, heavy equipment operation and tasks involving high levels of cognitive function and judgment. Conclusion: Quality evidence consistently demonstrates increased risk of vehicle crashes and is recommended as the surrogate for other safety-sensitive work tasks.
... There are problems in studying patients with severe and complex chronic pain, such as seen in those referred to specialist pain centers. Problems exist in extricating pain-related effects from those resulting in pain treatments, especially opioids [133]. Therefore, it has been suggested that a pragmatic approach to studying this group of patients is required [133]. ...
... Problems exist in extricating pain-related effects from those resulting in pain treatments, especially opioids [133]. Therefore, it has been suggested that a pragmatic approach to studying this group of patients is required [133]. It was inappropriate to ask patients to stop their drug regimens from a clinical perspective. ...
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Pain-related anxiety and fear are associated with increased difficulties in attention, increased awareness of pain, impaired disengagement from pain, and can moderate the effects of attentional coping attempts. Accurately assessing the direct impact of pain-related anxiety and fear on pain behavior has proved difficult. Studies have demonstrated no or limited influence of pain-related fear and anxiety on behavior but this may be due to inherent problems with the scales used. Neuroimaging has improved the understanding of neural processes underlying the factors that influence pain perception. This study aimed to establish if a Picture and Imagination Task (PIT), largely developed from the Photographs of Daily Activity (PHODA) assessment tool, could help explore how people living with chronic pain process information about daily activities. Blood oxygenation level dependent (BOLD) functional magnetic resonance imaging (fMRI) was used to compare brain responses in patients with chronic musculoskeletal pain (CMSKP) (n = 15) and healthy controls (n = 15). Subjects were asked to imagine how they would feel mentally and physically if asked to perform daily activities illustrated in PIT. The results found that a number of regions involved in pain processing saw increased BOLD activation in patients compared with controls when undertaking the task and included the insula, anterior cingulate cortex, thalamus and inferior and superior parietal cortices. Similarly, increased BOLD responses in patients compared to controls in the frontal pole, paracingulate and the supplementary motor cortex may be suggestive of a memory component to the responses The amygdala, orbitofrontal cortex, substantia nigra/ventral tegmentum, putamen, thalamus, pallidum, inferior parietal (supramarginal and angular gyrus) and cingulate cortex were also seen to have greater differences in BOLD signal changes in patients compared with controls and many of these regions are also associated with general phobic responses. Therefore, we suggest that PIT is a useful task to explore pain- and movement-related anxiety and fear in fMRI studies. Regions in the Default Mode Network remained active or were less deactivated during the PIT task in patients with CMSKP compared to healthy controls supporting the contention that the DMN is abnormal in patients with CMSKP.
... 2 An additional factor to consider is the impact that chronic pain has on cognitive and emotional processing. 78,110 The IASP published a clinical update on their website in 2007, reviewing the data surrounding the impact of chronic pain on cognitive functioning. 78 Two conclusions were drawn from their review of the literature: 1) chronic pain has a negative effect on cognition, and 2) cognitive impairment has the potential to impair patient communication of pain and reduce the effectiveness of cognitive therapies. ...
... 78,110 The IASP published a clinical update on their website in 2007, reviewing the data surrounding the impact of chronic pain on cognitive functioning. 78 Two conclusions were drawn from their review of the literature: 1) chronic pain has a negative effect on cognition, and 2) cognitive impairment has the potential to impair patient communication of pain and reduce the effectiveness of cognitive therapies. The deficits noted most commonly in the literature involved attention, memory, verbal fluency, processing speed, and mental flexibility. ...
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Chronic neuropathic pain is estimated to affect 3%-4.5% of the worldwide population. It is associated with significant loss of productive time, withdrawal from the workforce, development of mood disorders such as depression and anxiety, and disruption of family and social life. Current medical therapeutics often fail to adequately treat chronic neuropathic pain. Deep brain stimulation (DBS) targeting subcortical structures such as the periaqueductal gray, the ventral posterior lateral and medial thalamic nuclei, and the internal capsule has been investigated for the relief of refractory neuropathic pain over the past 3 decades. Recent work has identified the dorsal anterior cingulate cortex (dACC) as a new potential neuromodulation target given its central role in cognitive and affective processing. In this review, the authors briefly discuss the history of DBS for chronic neuropathic pain in the United States and present evidence supporting dACC DBS for this indication. They review existent literature on dACC DBS and summarize important findings from imaging and neurophysiological studies supporting a central role for the dACC in the processing of chronic neuropathic pain. The available neurophysiological and empirical clinical evidence suggests that dACC DBS is a viable therapeutic option for the treatment of chronic neuropathic pain and warrants further investigation.
... Memory performance is an important aspect of cognition that has been shown to be affected in patients with chronic pain, yet a comprehensive review of 36 studies concludes that not every measure of memory is impaired across all studies. Although chronic pain has been found to affect short-term and working memory in few studies, the most affected memory processes were those involved with longterm memory [27]. In the current study, only long-term memory was impaired in comparison to the pain-free control group. ...
... In the current study, only long-term memory was impaired in comparison to the pain-free control group. Our results are partly in line with the literature, which found chronic pain to reduce long-term memory, but not short-term and working memory as established in the literature [27][28][29][30][31]. This may be attributed to a number of variables, such as the inconsistency in outcome measures used in the literature, the responsiveness of the measures, or the variability of demand incurred by the task load. ...
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Background . Several studies have reported an association between chronic pain and reduction of cognitive abilities of adults living in Western cultures. No literature could be found on the relationship between chronic pain and cognition among Middle Eastern adults. Objective . To compare four of the most commonly reported cognitive domains [memory, attention, processing speed, and executive functioning] among Middle Eastern adults with and without chronic pain. Methods . This matched group comparative study included 69 community residing and functionally independent Middle Eastern adults. Forty participants had chronic pain and 29 were pain-free. We administered five standardized cognitive assessments that are independent of culture and language to measure variable tasks of memory, attention, processing speed, and executive functioning. The study was conducted in a rehabilitation research setting with a controlled environment. Results . Evidence of decreased cognitive processing was found in patients with chronic pain. The chronic pain participants performed significantly worse than the pain-free participants on the cognitive measures of long-term memory, selective attention, processing speed, and executive functioning. Conclusion . The effect of Middle Eastern culture on the cognitive abilities of patients with chronic pain was negligible. Despite the wide variations between Eastern and Western cultures, the performance of our Middle Eastern participants in this study was consistent with performance of Western adults reported in previous studies.
... Nonetheless, there are a number of limitations. There are problems in studying pain-cognition interactions in patients with severe and complex chronic pain, such as seen in those referred to specialist pain centres; extricating pain-related cognitive effects from those resulting in pain treatments, especially opioids, and separating painrelated effects on cognition from the effects of the emotional distress that is a key feature of chronic pain [82]. Therefore, it has been suggested that a pragmatic approach to studying this group of patients is required [82]. ...
... There are problems in studying pain-cognition interactions in patients with severe and complex chronic pain, such as seen in those referred to specialist pain centres; extricating pain-related cognitive effects from those resulting in pain treatments, especially opioids, and separating painrelated effects on cognition from the effects of the emotional distress that is a key feature of chronic pain [82]. Therefore, it has been suggested that a pragmatic approach to studying this group of patients is required [82]. Patients were not asked to stop their medications and therefore, the functional and structural changes as a result of taking these drugs over a long period [83] may have an impact on results. ...
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Chronic musculoskeletal pain (CMSKP) is attentionally demanding, complex and multi-factorial; neuroimaging research in the population seen in pain clinics is sparse. A better understanding of the neural activity underlying attentional processes to pain related information compared to healthy controls may help inform diagnosis and management in the future. Blood oxygenation level dependent functional magnetic resonance imaging (BOLD fMRI) compared brain responses in patients with CMSKP (n = 15) and healthy controls (n = 14) while completing a modified Stroop task using pain-related, positive-emotional, and neutral control words. Response times in the Stroop task were no different for CMSKP patients compared with controls, but patients were less accurate in their responses to all word types. BOLD fMRI responses during presentation of pain-related words suggested increases in neural activation in patients compared to controls in regions previously reported as being involved in pain perception and emotion: the anterior cingulate cortex, insula and primary and secondary somatosensory cortex. No fMRI differences were seen between groups in response to positive or control words. Using this modified Stroop tasks, specific differences were identified in brain activity between CMSKP patients and controls in response to pain-related information using fMRI. This provided evidence of differences in the way that pain-related information is processed in those with chronic complex musculoskeletal pain that were not detectable using the behavioural measures of speed and accuracy. The study may be helpful in gaining new insights into the impact of attention in those living with chronic pain.
... 2 An additional factor to consider is the impact that chronic pain has on cognitive and emotional processing. 78,110 The IASP published a clinical update on their website in 2007, reviewing the data surrounding the impact of chronic pain on cognitive functioning. 78 Two conclusions were drawn from their review of the literature: 1) chronic pain has a negative effect on cognition, and 2) cognitive impairment has the potential to impair patient communication of pain and reduce the effectiveness of cognitive therapies. ...
... 78,110 The IASP published a clinical update on their website in 2007, reviewing the data surrounding the impact of chronic pain on cognitive functioning. 78 Two conclusions were drawn from their review of the literature: 1) chronic pain has a negative effect on cognition, and 2) cognitive impairment has the potential to impair patient communication of pain and reduce the effectiveness of cognitive therapies. The deficits noted most commonly in the literature involved attention, memory, verbal fluency, processing speed, and mental flexibility. ...
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Full-text available
Object: Fifteen hundred patients have received deep brain stimulation (DBS) to treat neuropathic pain refractory to pharmacotherapy over the last half-century, but few during the last decade. Deep brain stimulation for neuropathic pain has shown variable outcomes and gained consensus approval in Europe but not the US. This study prospectively evaluated the efficacy at 1 year of DBS for phantom limb pain after amputation, and deafferentation pain after brachial plexus avulsion (BPA), in a single-center case series. Methods: Patient-reported outcome measures were collated before and after surgery, using a visual analog scale (VAS) score, 36-Item Short-Form Health Survey (SF-36), Brief Pain Inventory (BPI), and University of Washington Neuropathic Pain Score (UWNPS). Results: Twelve patients were treated over 29 months, receiving contralateral, ventroposterolateral sensory thalamic DBS. Five patients were amputees and 7 had BPAs, all from traumas. A postoperative trial of externalized DBS failed in 1 patient with BPA. Eleven patients proceeded to implantation and gained improvement in pain scores at 12 months. No surgical complications or stimulation side effects were noted. In the amputation group, after 12 months the mean VAS score improved by 90.0% ± 10.0% (p = 0.001), SF-36 by 57.5% ± 97.9% (p = 0.127), UWNPS by 80.4% ± 12.7% (p < 0.001), and BPI by 79.9% ± 14.7% (p < 0.001). In the BPA group, after 12 months the mean VAS score improved by 52.7% ± 30.2% (p < 0.001), SF-36 by 15.6% ± 30.5% (p = 1.000), UWNPS by 26.2% ± 40.8% (p = 0.399), and BPI by 38.4% ± 41.7% (p = 0.018). Mean DBS parameters were 2.5 V, 213 microseconds, and 25 Hz. Conclusions: Deep brain stimulation demonstrated efficacy at 1 year for chronic neuropathic pain after traumatic amputation and BPA. Clinical trials that retain patients in long-term follow-up are desirable to confirm findings from prospectively assessed case series.
... Most importantly, there is the potential for a substantial negative impact in areas such as public health, patient safety, and prescription practices -all with the potential to reduce an already compromised quality of life. At an individual level, the person with comorbid chronic pain and cognitive dysfunction may be: a) unable to safely manage a complex medication regimen, and b) less effective in communicating their pain symptoms to healthcare providers (Kreitler, & Niv, 2007). Pending the cognitive domains affected by pain, one can imagine a plethora of other potentially hazardous functional consequences including daily self-care, driving safety, fitness for work duty, and medical decision-making. ...
... Two of the most recent reviews are summarized here. First, Kreitler and Niv (2007) performed a systematic review of 42 studies published since 1990 that evaluated the relationship between chronic pain and neuropsychological deficits in individuals with chronic musculoskeletal pain, including whiplash injury. Results of their review are outlined in Fig. 1 and suggest deficits in the domains of: memory (particularly for measures of verbal memory with a delayed component and on measures that involve acquisition/learning recall), attention, verbal fluency, processing and psychomotor speed, and mental flexibility. ...
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Background: The pervasive disease of chronic pain is a common challenge for the clinical rehabilitation professional. Concurrent with physical and emotional symptoms, pain-related cognitive impairment has been reported. Although opioid analgesics are frequently prescribed, concern exists that opioids possess adverse cognitive effects of their own. Objectives: To review the neuropsychological and neuroanatomical sequelae of chronic non-malignant pain and opioid therapy, to clarify roles and benefits of neuropsychological assessment in a chronic pain population, and to provide recommendations for clinical practice and future research. Methods: This non-systematic review sought to provide a comprehensive synthesis of relevant neurobiology, neuroimaging, neuropsychological, and rehabilitation research literatures. We included citations from seminal and current texts as well as relevant original and review articles from 1980-2012 in PubMed and PubMedCentral online research databases. Discussion and summary/conclusions: To date, evidence from opioid studies suggests only mild deficits in specific cognitive domains (e.g., memory, attention/concentration) and only under specific conditions (e.g., dose escalations). Additionally, neuroimaging and neuropsychological evidence suggests that pain itself results in cognitive sequelae. Methodological improvements in future research will allow for better delineation of the contributing effects of pain and opioids, with an overall goal of improving evidence-based clinical treatment recommendations.
... 89 Patients with chronic pain suffer from cognitive impairment. 91 They also experience difficulty controlling fatigue, emotion, worry, and rumination, all of which indicate deficiencies in the EF. 3 When a person experiences a flare-up of the pain, cognitive difficulties are one of the first indicators that pain is interfering with EF. 10 A decline in EF with chronic pain may also manifest as psychomotor slowing. 10,92,93 In addition, patients with chronic pain may have difficulties initiating or maintaining any type of protective or new physical activity-related task without sufficient EF. 3,11,71,94 Therefore, treatment approaches that focus on cognitive improvement (e.g., graded motor imagery, 95 101 ) can be used to reduce chronic pain through cognitive channels. ...
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Executive function (EF) is a control mechanism of human cognition that provides the capability to select actions in relation to internal goals organized by the prefrontal cortex (PFC). The PFC is essential for the temporal integration of sensory information in the sequencing of optimum motor behavior to achieve an internal goal. The temporal integration of sensory information also explains why the PFC has an additional role in the central modulation of pain. Pain modulation and motor function are altered in chronic pain, and this alteration can contribute to the reduced physical activity. EF is the driver of conscious control of thought and action that is critical to rehabilitation in chronic pain. However, EF is impaired in chronic pain. Rehabilitation practitioners typically use activity modification, exercise, and movement to enhance function in patients with chronic pain; exercise has beneficial effects on EF. However, impairments in EF can be barriers to adherence to exercise, activity, and lifestyle modifications required to optimize rehabilitation. Greater awareness of EF can enhance rehabilitation. This narrative review explores current theories of EF structure and function, how impairment of EF can be assessed in a clinical context, and its implications for rehabilitation in chronic pain. Keywords: cognitive control, prefrontal cortex, sensorimotor integration
... Among these complaints, memory is one of the most common and consistent (Epker & Ogden, 2013). Other factors, such as pain intensity and pain duration, have been shown to be positively correlated with objective measures of retrospective memory impairment in patients complaining of chronic orthopedic pain (Jongsma et al., 2011;Kreitler & Niv, 2007). However, severity of pain-related impairment is questionable. ...
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Prospective memory (PM) pertains to the execution of a future goal or behavior. Initial research implies that people with multiple sclerosis (MS) are apt to show impaired prospective memory for activities of daily living. Yet, PM impairment does not occur in all people with MS. Thus, some other variable besides disease status alone may contribute to PM dysfunction in people with MS. Chronic pain may be such a variable. Approximately 50-70% of people with MS experience significant pain, and such pain has been thought to diminish memory function. To investigate this possibility, 96 patients with MS and 29 healthy subjects were administered the Memory for Intentions Screening Test (MIST; Woods, S. P., Iudicello, J. E., Moran, L. M, Carey, C. L., Dawson, M. S., & Grant, I. (2008). HIV-associated prospective memory impairment increases risk of dependence in everyday functioning. Neuropsychology, 22, 110-117.), a well-validated measure of prospective memory, and the Medical Outcomes Study Pain Effects Scale (PES; Fischer, J. S., Rudick, R. A., Cutter, G. R., & Reingold, S. C. (1999). The multiple sclerosis functional composite measure (MSFC): An integrated approach to MS clinical outcome assessment. National MS Society Clinical Outcomes Assessment Task Force. Multiple Sclerosis, 5, 244-250.) to assess chronic pain. After controlling for demographic variables and disability severity, subjective pain accounted for significant variance in PM, particularly for time-based intentions over sustained delay periods. These data accord well with assertions that pain may degrade ability to remember new intentions and suggests that pain is associated with PM dysfunction in people with MS.
... 25,26 There is a complex interplay of multiple contributory factors in the maintenance of normal cognition and it is difficult to determine the extent to which these confounding variables contribute to cognitive impairment in the clinical setting. 26,27 Tests such as the popular Mini-Mental State Examination (MMSE) were created as a convenient and useful screening tool for the development of dementia. 28 However, the MMSE was not specifically designed to look for subtle cognitive impairment in the typical pain clinic patient and not surprisingly it is too insensitive for this purpose. ...
... Multiple lines of evidence, including studies of acute and chronic pain, animal and human studies, experimental and clinical studies, and neurophysiological studies, support this conclusion regarding cognitive impairment. Other reviews report similar conclusions (e.g., Kreitler and Niv 2007). A summary of the converging evidence that supports this conclusion is presented inTable 24–1. ...
... Despite technological advances and thorough established treatments, pain in these disorders continues to defy health professionals, because it is a poorly controlled condition; partly because multiple aspects are involved in the pathogenesis of pain namely nociception (pain sensation and topography), emotion (fear and depression), and behavioural factors (catastrophism, vigilance, and somatic awareness). Pain management faces difficulties that restrict therapeutic success, such as the limited efficiency of analgesics, systemic effects, and cognitive impairment of drugs due to central effects [5] . ...
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Introduction: Body pain disorders like knee pain, low back pain and primary headache disorders impose burdens that include substantial personal suffering, impaired quality of life, and financial cost. Repeated attacks, and often fear of future attacks, affects the family life, social life, and employment. Objectives: To evaluate the Safety, Efficacy and tolerability of four types of Amrutanjan Pain Balm preparations for rapid pain relief in patients with primary type of headache and body pain disorders. Materials & Methods: This study is a randomized, multicentric, open label, interventional study conducted at a secondary care centres in Chennai and Vellore. A total of 150 patients were screened and 144 patients were enrolled who were diagnosed with either body pain disorders like knee pain, low back pain or primary type of headache disorders like migraine, tension type headache and other primary head ache disorders. All the study participants were randomized to four arms of 36 each such that each arm comprised of 12 patients with knee pain, 12 patients with low back pain and 12 patients with primary headache disorder to receive four different formulations of Amrutanjan pain balms. Efficacy was evaluated by assessing pain reduction after treatment at various time points and duration of action. Visual analogue scale questionnaires were used post study to obtain feedback on overall status of improvement. Results: Patients enrolled with headache had 75 % tension-type, 17% migraine and 8% Cluster headache; those with knee joint Pain had osteoarthritis (80%) and reactive arthritis (20%) whereas patients with low back pain had lumbar strain and lumbar spondylosis. The onset of action was 55 seconds for patients with headache disorders, while it ranged between 95 to 115 seconds for joint pain and low back pain respectively. Highly significant improvement in the VAS score, was observed after 5, 10 and 30 minutes of test product application. Conclusion: All the four types of topical Amrutanjan pain balms and roll-on were found to be effective and safe for the treatment of primary headache and body pain disorders.
... The reliability of the MDBQ according to several studies is in the range of alpha Cronbach .75-97. Evidence of validity is based on studies, such as comparisons of anorectic and healthy girls; individuals with chronic pain and healthy individuals (Kreitler & Chemerinski, 1990;Kreitler & Niv, 2007). ...
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The health capability of family caregivers has already been studied through eight factors: physical and psychological functioning, lifestyle value, self-efficacy towards health services, family support, social capital, socio-economic conditions and access to health services. Our aim was to identify new factors. Family caregivers of stroke victims living at home were recruited in the Lorraine region (France; n=8) and Luxembourg (n=6). Semi-structured interviews about their health statuses, how they currently take care of their health, and the internal resources they need to achieve optimal health were conducted face-to-face. Verbatim transcriptions were open-coded and grouped into new factors of health capability. Items reflecting the main idea of the categories were formulated. Seven women and seven men (age 63.6±10.1) participated. Statements were regrouped together into new ways, giving rise to seven new emergent factors: health knowledge, health self-efficacy, health value, life skills, health decision-making, motivation, and attitude towards the future. Of them, 76 items were generated, 51 reflecting generic abilities while 26 being specific to family caregiving. Content analysis of these factors first allows guiding the preparation of innovative supports to promote health capability. Second, this list can serve as a basis to elaborate a guide to which clinicians can refer to, in orienting family caregivers according to their needs. Further research is needed to complete the validation of the HCFC instrument.
... The reliability of the MDBQ according to several studies is in the range of alpha Cronbach .75-97. Evidence of validity is based on studies, such as comparisons of anorectic and healthy girls; individuals with chronic pain and healthy individuals (Kreitler & Chemerinski, 1990;Kreitler & Niv, 2007). ...
Chapter
Full-text available
The preparation of students’ future career trajectories is a dynamic process in relation to social and educational determinants. Our objective is to analyze the associations between generic employment capabilities, career attitudes and related factors among postgraduate students. All masters’ students registered at the Centre for Documentation and Information on Higher Education (CEDIES) database in Luxembourg were contacted by post, to participate in an online questionnaire. The five point scale questionnaire was scored as follows: 1) Dynamic Career Attitudes (DCA); 2) Employability Soft-Skills (ESS); 3) Search for Work Self-Efficacy (SWSES); 4) Quality of Life domain Autonomy (QLA); and 5) Socio-demographic characteristics. The data were analyzed using bivariate tests, correlations and multiple linear regression models. 481 of the volunteers (26.4 years; SD=5.5) were predominantly women, Luxembourgish, unemployed or had less than or equal to six months of job experience. The higher the ESS, SWSES and QLA scores, the higher the DCA score was. Nationality, being unemployed, having less than six months job experience and being in the first year of a Master’s degree programme were associated with a lower dynamic career attitude score. The Dynamic Career Attitudes scale seems to be an appropriate instrument to evaluate the efficacy of the university career services programme.
... 23 Pain impairs a patient's quality of life, 24 which improves when pain is effectively managed. 25 Long-term pain is associated with cognitive impairment 26,27 and depression. 3 The effect of pain on patients is devastating, and the socioeconomic impact of chronic pain is overwhelming. ...
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Joanne O’Brien,1 Joseph V Pergolizzi Jr,2 Mart van de Laar3, Hans-Ulrich Mellinghoff,4 Ignacio Morón Merchante,5 Srinivas Nalamachu,6 Serge Perrot,7 Robert B Raffa81Department of Pain Medicine, Beaumont Hospital, Beaumont, Dublin, Ireland; 2Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD; Association of Chronic Pain Patients, Houston, TX; Department of Pharmacology, Temple University School of Medicine, Philadelphia, PA, USA; 3Arthritis Center Twente, Enschede, The Netherlands; 4Department of Endocrinology, Diabetology and Osteology, Kantonsspital St Gallen, Switzerland; 5Centro de Salud Universitario Goya, Madrid, Spain; 6Kansas University Medical Center, Kansas City, and International Clinic Research, Leawood, KS, USA; 7Service de Médecine Interne et Consultation de la Douleur, Hôpital Hotel Dieu, Paris Descartes University, Paris, France; 8Department of Pharmaceutical Sciences, Temple University School of Pharmacy, Philadelphia PA, USAAbstract: Pain should be treated promptly and effectively to restore the patient to full function, avoid pain chronification, and preserve quality of life. A recent pain specialists' meeting discussed the use of different pharmacological treatment options, such as topical analgesics, nonopioid agents (such as paracetamol and nonsteroidal anti-inflammatory drugs), weak and strong opioids, and fixed-dose combination products in the management of moderate to severe pain from different etiologies. One of the topics discussed in, and subsequent to, this meeting was the role of fixed-dose combination products for nurse-prescribers who are in many ways at the front line of managing both acute and chronic pain syndromes. The panel agreed that proper product selection should take into account the patient's age, condition, type of pain, and comorbidities, as well as balance safety with effectiveness. Although nurse-prescribers need to be aware of cumulative paracetamol dosing, fixed-dose combination products, such as tramadol-paracetamol, may offer important advantages, eg, by providing opioid-sparing without sacrificing efficacy.Keywords: tramadol, paracetamol, fixed-dose combination analgesics, pain management
... While pain trigger factors are endured, pain degenerates to an independent response, manifesting even when it is possible to eradicate the primary stimulus. (4) Odontogenic pain is a complex cascade process initiated from dental tissue damage accompanied with heterogeneous neuronal stimuli as a consequence of neurovascular, neuroinflammation and morphologic reactions. (5) The management of dental pain in clinical practice is a complex part of dental care and requires high-level knowledge of pharmacodynamics and pharmacokinetics of analgesics and implementing the standards of rational use. ...
... The physical and emotional effects of RA can be significant; however, little attention has been given to the potential cognitive effects of chronic pain in RA patients. In addition, as noted by Kreitler and Niv [4], psychological interventions that have been shown to be effective for RA [5] often depend on the intact cognitive functioning of patients to generate changes to thoughts and behaviors. Consequently, declines in executive functioning may exacerbate suffering and lead to poorer physical, social, and emotional health. ...
Article
Rheumatoid arthritis (RA) is a chronic inflammatory disease resulting in substantial pain. The physical and emotional effects of RA are well known, but little attention has been given to the potential cognitive effects of RA pain, although intact executive functioning in patients with chronic illness is crucial for the successful completion of many daily activities. We examined the relationship between pain and executive functioning in patients with RA, and also considered the influence of positive and negative affect in the relationship between pain and executive functioning. A sample of 157 adults with RA completed measures of pain and positive and negative affect and were tested for working memory and selective attention using the Letter Number Sequencing subtest from the Wechsler Adult Intelligence Scale-Third Edition and the Stroop Color Word Test tests, respectively. Consistent with prior research, pain was inversely related to executive functioning, with higher pain levels associated with poorer performance on executive functioning tasks. This relationship was not moderated or mediated by negative affect; however, positive affect moderated the relationship between pain and executive functioning. For patients high in positive affect there was a significant inverse relationship between pain and executive functioning, whereas there was no such relationship for patients low in positive affect. These findings are discussed in the context of cognitive research on the effects of positive affect on executive functioning and functional neuroanatomical research suggesting neurocognitive mechanisms for such moderation.
... There exists a large body of research on the 'interruptive function of pain', that is, on the propensity of pain to grab attention and to interfere with ongoing activities [1]. The negative effects of chronic pain on various cognitive functions have been consistently shown [8][9][10][11][12][13][14][15][16][17] and specific recommendations as to how to improve cognitive functioning in chronic pain have been made [18]. Experimental research generally confirms that pain impairs the performance of concurrent tasks (i.e., tasks performed while feeling pain [19][20][21][22][23][24][25][26][27][28]) as well as of subsequent tasks (i.e., tasks that one switches to after a task performed under painful conditions [29]). ...
Article
Activity interruptions, namely temporary suspensions of an ongoing task with the intention to resume it later, are common in pain. First, pain is a threat signal that urges us to interrupt ongoing activities in order to manage the pain and its cause. Second, activity interruptions are used in chronic pain management. However, activity interruptions by pain may carry costs for activity performance. These costs have recently started to be systematically investigated. We review the evidence on the consequences of activity interruptions by pain for the performance of the interrupted activity. Further, inspired by literature on interruptions from other research fields, we suggest ways to improve interruption management in the field of pain, and provide a future research agenda.
... In previous studies involving patients suffering from chronic pain, cognitive complaints have been linked to pain intensity, pain catastrophizing, and depression (Kreitler & Niv, 2007;McCracken & Iverson, 2001;Roth, Geisser, Theisen-Goodvich, & Dixon, 2005). However, few studies have specifically investigated the relationship between cognitive complaints and neuropsychological performance in fibromyalgia patients, and those that have sought to do this have so far produced inconsistent results. ...
Article
Introduction: Cognitive complaints are common in fibromyalgia, but it is unclear whether they represent an objective cognitive dysfunction or whether they could be explained by depressive symptoms. Here, we aim to elucidate the frequency of subjective cognitive complaints in a sample of women with fibromyalgia, in addition to analyzing associations between these subjective complaints and objective measures linked to the attention and executive cognitive domains. Finally, we aim to investigate the ability of demographic, clinical, and psychological variables to explain the subjective complaints observed. Method: One hundred and five women aged 30-55 years diagnosed with fibromyalgia completed a neuropsychological assessment, which included measures of attention and executive functions. They also completed self-report inventories of subjective cognitive complaints, depression, anxiety, intensity of pain, sleep quality, everyday physical functioning, and quality of life. Results: Eighty-four percent of the patients reported subjective cognitive complaints. Depression scores, everyday physical functioning, and working memory performance were most strongly associated with subjective cognitive complaints. These three variables were significant predictors for subjective cognitive complaints with a final model explaining 32% of the variance. Conclusions: Cognitive complaints are very frequent in patients with fibromyalgia, and these are related to functional and cognitive impairment as well as to depressive symptoms.
... Topical analgesics drugs application have many advantages such as the ability to provide good analgesia with reduced systemic drug levels (Kreitler and Niv 2007). Long period remain at the application site and enough drug penetration and high effective are other advantages (Illum et al 1994). ...
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Abstract. Objective: To examine the analgesic and antinociceptive effect of ketamine cream in rats as an animal model. Materials and methods: Fifteen healthy adult albino rats with equal age and gender distribution of either sex were selected for this study. The animals were divided into 3 groups of 5 animals. The pain reaction time was recorded pretreatment for each animal and was taken as a basal threshold(Tayebi et al.,2008). Group 1 served as a control and was applied cream topically on fore and hind limb. Group 2 and 3 were applied topically ketamine cream 2.5%, 5% respectively on fore and hind limb. The onset and duration of analgesic effect of ketamine cream were evaluated in rats by utilizing a Hot-Plate test at 55±1˚C. Latency reaction time was recorded after 3min. and (10, 20, 30, 40, 50, 60 min.) The prolongation of latency times compared with the values of the control was used to express about antinociceptive effects of ketamine cream and the percentage of antinociceptive Maximal Possible Effect (MPE) was calculated. Results: demonstrated that the ketamine cream at concentrations (2.5, 5) % produced antinociceptive effect in rats (11.0±1.4)(16.5±9.0) second after 3 min, respectively in comparison with control (7.0±0.8) second. The percentage of maximum possible effect (MPE) was increased from (3.16) % in control group to (21.65), (42.5)% respectively according to the above concentrations of ketamine cream after 3 min. The duration of analgesia with topical application of cream (2.5, 5)% from 3-40 min and usually approached the base line (5.75±1.5) (7.0±1.4) second respectively after 60 min. Conclusions: This study concluded that ketamine cream have a good antinociceptive activity in rats after 3 minutes of topical application and prolong the duration of analgesia more than 40 minutes depending on concentration of ketamine cream. Key Words: Ketamine cream, pain, hot-plate test, antinociceptive, maximal possible effect. Copyright: This is an open-access article distributed under the terms of the Creative Commons Attribution
... В последние годы активно обсуждается роль хронической боли в развитии КН [12,13]. Хроническая боль рассматривается как фактор, который может провоцировать нейродегенеративные изменения в головном мозге, снижать активность процессов нейропластичности и ухудшать когнитивные функции [10,11,21]. В нашем исследовании, включавшем 90 пациентов с ХЕГБ, эффективное лечение головной боли сопровождалось регрессом жалоб на снижение памяти и ЛКН. ...
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Comorbidities in chronic daily headache (CDH) include emotional disorders (depression, anxiety), insomnia, and musculoskeletal pain at other sites. In CDH, the most common type is a subjective (according to patients themselves) and/or objective (based on the results of cognitive tests) reduction in cognitive functions, which can be caused by emotional disorders, insomnia and/or brain diseases, and a negative effect of chronic pain on cognitive functions. Objective: to analyze cognitive complaints and their changes in patients with CDH. Patients and methods. Subjective complaints and cognitive functions were evaluated in 90 patients (76 women and 14 men) aged 23 to 78 years (mean age, 46.712.0 years) with primary forms of CDH according to the Montreal Cognitive Assessment (MCA) for 12 months. The majority (68.9%) of patients with CHD complained of diminished memory; however, its mild disorders (25-26 MCA scores) were found in only a small proportion (23.3%). All patients with subjective diminished memory were ascertained to have neurotic disorders (depression, anxiety disorder) and/or insomnia or a concurrence of mental disorder and insomnia. Results and discussion. All the patients received treatment options, including optimal pharmacotherapy for headache and concomitant diseases, an educational conversation, cognitive-behavioral therapy, and therapeutic exercises. In cognitive impairment (CI), cognitive training was used and Ginkgo biloba extract (EGb 761R) prescribed; in sleep disorders, sleep hygiene rules were explained. Therapy declined the mean number of headache days a month from 29.12.03 (at baseline) to 9.39.35 (at 12-month follow-up) (p=0.002); while the subjective complaints regressed in the majority of patients; mild MCA changes persisted only in 6.7% of the patients. Management tactics for CHD patients having mild CI and cardiovascular risk factors and the use of EGb 761R to improve cognitive functions were considered. Conclusion. It has been ascertained that in many cases, CI is associated with emotional disorders and insomnia, as well as with pathophysiological mechanisms of chronic pain itself; CI in some patients has a vascular origin. The use of combined treatment programs can promptly and effectively reduce the frequency of headache and improve cognitive functions. EGb 761R (TanakanR) has a beneficial effect on subjective CI and mild CI. prevention; Ginkgo biloba extract (EGb 761R).
... A lot of literature has tried to identify tools that are useful to the chronic pain therapist [40], but at present minimally invasive therapies for CLBP are offered to millions of patients that often do not prove to be effective. Living with chronic pain includes a series of unpleasant social, emotional and behavioral issues that must be managed [21,23,24]. Existing research shows that pain is best understood not only as a symptom of illness but as one element in a constellation of factors that affect an individual's overall experience of pain [25]. ...
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Objectives Research was conducted to study the efficacy of analgesic infiltration treatment in a well-selected population of patients with non-specific drug-resistant chronic low back pain. It studied the pain on a numeric rating scale and the physical and mental condition of patients using a short-form health survey-36, before and six months after invasive pain treatment.DesignThis is a prospective observational single center cohort study.SettingThe study took place in the Multimodal Pain Therapy Unit of the IRCCS Institute of Neurological Sciences in Bologna, Italy.SubjectsFour hundred and thirteen out of a total 538 patients admitted to the unit with non-specific drug-resistant chronic low back pain were enrolled in the study.Method Patients were enrolled with written consent between April 2017 and November 2018. The study assessed NRS, BDI and SF-36 scores before and six months after mini-invasive treatment.ResultsThere is an inverse correlation between Mental Component Scale (MCS) and Physical component scale as measured by SF-36. Older patients in a worse physical condition but with a more positive outlook on their quality of life were more likely to improve after invasive treatment (p < 0.001). The BDI scale is more effective in the diagnosis of depression than MCS.Conclusions The prognostic value of MCS given to the patient before mini-invasive treatment could lead physicians to adopt a multimodal approach that includes consideration of the psychological features of pain and possibly antidepressant therapy.
... The coexistence of chronic pain and depression/anxiety is due to the overlapping of neural substrates, neurotransmitters, and pathophysiological mechanisms [5,23,36], and it has been widely reported [37][38][39]. Apart from the development of affective disorders, such as depression and anxiety, neuropathic pain is also associated with cognitive impairments [40,41]. CCI by either one or four ligatures impaired the recognition of the novel object in the present study, in agreement with a previous study [17]. ...
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Background: Chronic constriction injury (CCI) is a model of neuropathic pain induced by four loose ligatures around the sciatic nerve. This work aimed to investigate the sensory, affective, cognitive, and motor changes induced by an adaptation of the CCI model by applying a single ligature around the sciatic nerve. Methods: Mechanical allodynia was measured from day 1 to day 28 postsurgery by the von Frey test. The beam walking test (BWT) was conducted weekly until 28 days after surgery. Anxiety- and depression-like behaviors, and cognitive performance were assessed through the open field (OF), forced swimming (FS), and novel object recognition (NOR) tests, respectively, 21 days after surgery. Results: The two CCI models, both Bennett and Xie's model (four ligatures of the sciatic nerve) and a modification of it (one ligature), induced mechanical allodynia, increased immobility in the FS, and reduced recognition index in the NOR. The exploratory behavior and time spent in the central part of the arena decreased, while the defensive behavior increased in the OF. The animals subjected to the two CCI models showed motor alterations in the BWT; however, autotomy was observed only in the group with four ligatures and not in the group with a single ligature. Conclusions: Overall these results demonstrate that our adapted CCI model, using a single ligature around the sciatic nerve, induces sensory, affective, cognitive, and motor alterations comparable to the CCI model with four ligatures without generating autotomy. This adaptation to the CCI model may therefore represent an appropriate and more easily performed model for inducing neuropathic pain and study underlying mechanisms and effective treatments.
... Cognitive impairment is a common complication in patients with chronic neuropathic pain, and memory deterioration is the primary clinical manifestation. 1 Chronic pain predisposes patients to cognitive impairment, which affects daily activities and deteriorates the quality of life. 2 Cognitive deficits in chronic pain patients restrict the effectiveness of communicating their pain symptoms, which further constrains the application of cognitive-based therapy and may exacerbate preexisting pain. 3 Thus, the identification of effective strategies for this complication is imperative. In available literatures, numerous studies have been performed to elucidate the mechanisms of neuropathic pain and investigate the relationship between neuropathic pain and cognitive impairment. ...
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Background: Cognitive impairment is a common complication in patients with chronic neuropathic pain, without effective therapy. Recent works have indicated that curcumin (Cur) possesses antinociceptive and neuroprotective potentials, suggesting its possible effectiveness for the treatment of this complication. Objective: The aim of this study was to explore the effects of Cur on pain behaviors and cognitive impairment in rats with cobra venom-induced trigeminal neuralgia (TN). Design: This is a randomized, controlled experiment. Setting: This study was conducted at the Experimental Animal Center, Beijing Friendship Hospital, Capital Medical University. Subjects: A total of 40 adult male Sprague Dawley rats were used in this study. Methods: A cobra venom solution was injected into the sheath of infraorbital nerve. Cur was administered intragastrically at 45 mg/kg twice daily for 28 successive days from postoperative day 15. Mechanical allodynia was evaluated using von Frey filaments. Free behaviors were observed using video recording. Cognitive capacity was tested using the Morris water maze. Both morphology and ultrastructure of the CA1 hippocampal region were visualized using hematoxylin and eosin (HE) staining and transmission electron microscopy, respectively. Results: Cur treatment reduced mechanical allodynia and face-grooming activities but increased exploratory activities and improved spatial learning and memory deficits. Microscopic examination revealed nucleus pyknosis, swollen organelles, and decreased synapse density in the CA1 hippocampal region after cobra venom injection. However, chronic Cur treatment reversed damage to hippocampal neurons and synapses. Conclusion: Cur can alleviate pain, improve spatial learning and memory deficits, and restore the damage to hippocampal neurons and synapses in cobra venom-induced TN rats. Cur may be useful as an adjuvant to treat chronic neuropathic pain-induced cognitive deficits.
... Hence, the third implication of the two-systems-in interaction is considering the context, which may be the external environment (as in ecological perception) or the internal environment (as in sensorimotor cognition), or the group (as in so- hunger, cold and pain affect the thinking of the individual by decreasing concentration and reducing the creativity and possibly the rationality of the thoughts at the time (Kreitler & Niv, 2007). The interactional approach is supported by many studies showing the effects on cognition of psychological processes, such as motivations and emotions or physiological ones, such as genes (Kreitler, 2013a). ...
... The literature about osteopathy research and healthcare system reports the perception of patients as; listened by osteopathic physicians, were actively involved in physician- patient relationship, different techniques were employed to search the causative factor of disease as well suggested and made partners in decision making. The patients were happy to accept osteopathy as an effective treatment system as their mental state and overall well- being was properly explored and consulted during these sessions [107,108,109]. The literature evidence suggests; osteopathy has improved the standards of its treatment and shifted towards a PCC. ...
Article
Background: Osteopathy is widely used as an alternative, manual and drug-free system for treating various non-specific low back pains and musculoskeletal disorders throughout the world. However, the clinical effects of osteopathy are still debatable. Aims: This particular study is aimed to focus the most up-to-date and current clinical trials in osteopathy and to compare its effectiveness in treating various musculoskeletal and low back pain conditions in which various challenges and negative evaluations are witnessed from various researchers and authors. Materials and Methods: Literatures are investigated from 2012-2017. All the articles, with clinically trialed human subjects, were searched from the available data bases of Google scholar, Scopus, Springer Link, science direct and Sci Finder etc. by using the keywords randomly. For e.g.- Osteopathy cases, Clinical trials about osteopathy, Clinical status of osteopathy, Randomized controlled trials, Osteopathic manipulative treatment (OMT), Clinical evidences in osteopathy and osteopathic treatment in diseases etc. are the following key words of search. Results: 36 clinical trials were found, where different osteopathic manipulative techniques (OMT) were applied for the patients’ treatment. The clinical trials were complained mostly with suffering of pain due to non-specific conditions such as, musculoskeletal disorders, lower back pain, migraine, cystic fibrosis and irritable bowel syndrome, amongst the patients like pregnant women, children, young and old people women with urinary tract infections, ectopic pregnancies, and stress. The overall outcome for these clinical trials was effective and positive that improve the patients’ conditions. Conclusion: An improvement in osteopathy curricula, training programs, residential training venture, as well as patient-centered-treatment can enhance osteopathy healthcare zone.
... Chronická bolest souvisí se změnami v neuropsychologickém fungování. Vliv chronické bolesti na kognitivní funkce se zkoumal a zkoumá z několika důvodů: pacient s komorbiditou chronické bolesti a kognitivní dysfunkce může být neschopný dodržovat režim užívání medikace a nemusí být schopný o své bolesti se zdravotnickým personálem efektivně komunikovat (Kreitler a Niv, 2007). Kognitivní změny mohou kvůli bolesti vyvolat i spousty jiných potíží, například v denní sebeobsluze, při bezpečnosti řízení, ve způsobilosti k práci a při schopnosti rozhodovat se. ...
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SOUHRN Chronická nenádorová bolest může ovlivňovat mnoho aspektů lidské existence a směřovat k nezaměstnanosti, invaliditě, narušovat sociální role a měnit kvalitu života. V posledních deseti letech byl v řadě zemí v léčbě chronické nenádorové bolesti zaznamenán rychle rostoucí nárůst spotřeby opioidů. Obavy související s touto léčbou byly založeny hlavně na strachu ze závislosti. Nicméně při rozhodování užít v léčbě opioidy mohou vzbu-zovat obavy i další potenciálně důležité klinické otázky. Patří mezi ně zvyšování tolerance, abnormální citlivost k bolesti a dysfunkce imunitního a reprodukčního systému. Jedna z hlavních obav před zahájením dlouhodobé, někdy celoživotní, léčby opioidy u pacientů s chronickou nenádoro-vou bolestí je potenciální vznik kognitivních dysfunkcí, projevujících se například zhoršenou schopností koncentrace, nedostatky ve zpracovávání informací a paměti, pomalejším psychomotorickým tempem a reakčním časem. Dostupné přehledové studie o opioidech a kognici se pokoušely najít vztah mezi jejich dlouhodobým užíváním a kognitivními funkcemi u pacientů s chronickou nenádorovou bolestí. Výzkum zabývající se vzta-hem chronické bolesti a opioidů je prováděn napříč několika skupinami pacientů s nádorovou, nenádorovou bolestí a na zdravých kontrolních skupinách. Výchozí měření zahrnují jak globální kognici, tak specifické neuropsychologické domény jako paměť, rychlost zpracování, exekutivní funkce nebo schopnost řízení motorových vozidel. Nicméně literatura o opioidech a kognici se zdá být velmi dvojznačná: navzdory subjektivním stížnostem pacientů o mentálním útlumu a sedaci pouze malý počet studií potvrdil negativní kognitivní efekt opioidní terapie. Mnoho studií dosud neprokázalo signifikantní vliv užívání opioidů na kognici a velmi malá část výzkumů prokázala zlepšení v oblasti kognice. Cílem tohoto článku je shrnutí neuropsychologických důsledků vztahu chronické nenádorové bolesti a terapie opioidy, objasnění hlavní role a benefitů neuropsycho-logického vyšetření pro populaci trpící chronickou bolestí a poskytnutí možných doporučení jak pro klinickou praxi, tak pro budoucí výzkum. Klíčová slova: kognitivní schopnosti, opioidy, chronická nenádorová bolest, neuropsychologie SUMMARY Chronic non-cancer pain may impair numerous aspects of one's existence resulting in unemployment, disability, disruption of social roles, and impaired quality of life. In the last decade a rapidly increasing use of opioids for chronic non-cancer pain has been reported from several countries. Concerns regarding opioid treatment of chronic non-cancer pain have primarily been based on the fear of addiction and diversion. However, other potentially important clinical issues such as dependency, tolerance development, abnormal pain sensitivity and dysfunction of the immune and reproductive systems may give rise to concerns. One of the major worries of initiating long-term, sometimes lifelong , opioid treatment in patients with chronic non-cancer pain is the potential introduction of cognitive dysfunction, manifested as e.g. impaired capacity for concentration, deficits in information processing and memory, slower psychomotor speed and reaction time. Empirical research exploring the opioid-cognition relationship exists across several patient groups including cancer pain, chronic non-malignant pain conditions, and healthy controls. Outcomes measures include both global cognition and specific neuropsychological domains such as memory, processing speed, executive functioning, or driving ability. However, the opioid-cognition literature seems thus far equivocal: despite subjective reports of mental dullness and sedation, only a small number of studies have observed mild cognitive effects as a result of opioid therapy. Many studies have not yet adequately demonstrated significant cognitive effects of opioid use, and a small body of research has actually demonstrated improvements in cognitive functioning. Previous reviews of the opioid-cognition literature highlighted such disagreement across studies. The aim of this article is to review the neuropsychological sequelae of chronic non-cancer pain and opioid therapy, to clarify roles and benefits of neuropsychological assessment in a chronic pain population , and to provide recommendations for clinical practice and future research. Úvod Chronická bolest souvisí se změnami v neuropsychologic-kém fungování. Vliv chronické bolesti na kognitivní funkce se zkoumal a zkoumá z několika důvodů: pacient s komorbiditou chronické bolesti a kognitivní dysfunkce může být neschopný dodržovat režim užívání medikace a nemusí být schopný o své bolesti se zdravotnickým personálem efektivně komunikovat (Kreitler a Niv, 2007). Kognitivní změny mohou kvůli bolesti vyvolat i spousty jiných potíží, například v denní sebeobsluze, při bezpečnosti řízení, ve způsobilosti k práci a při schopnosti rozhodovat se. Stížnosti na kognici jsou u pacientů trpících chronickou bolestí velmi rozšířené: 46–62 % pacientů si stěžuje na jednu a více kognitivních potíží (Iverson a McCracken, 1997;
Article
Physiotherapy has long been part of the overall intervention for the attempted rehabilitation of patients with pain and disability following peripheral (and central) nerve damage. In musculoskeletal physiotherapy (a subspecialty), a movement-based assessment and treatment protocol has been devised that is guided by, among other things, therapists' perceptions of patients' responses to mechanical stimuli, including various tests of 'neural tension'. Recently, this process together with provocative tests of sensation has been employed to identify, and predict outcomes for, patients suspected of having a 'neural tissue' component to their pain and consequent disability (either fascicular damage or 'neuritis'). However, some of the syndromes involved are controversial, and uncertainty still surrounds the diagnosis, mechanisms and, therefore, effective treatment of the highly complex symptom, true neuropathic pain. In this review, the current basic scientific evidence for the proposed cause, and often intractable nature, of neuropathic pain is presented and discussed with reference to musculoskeletal therapy. It will be seen that peripheral nerve damage has the potential to create potentially irreversible changes in (peripheral and) central nervous system structure and function that have, to date, largely defied effective medical treatment. For musculoskeletal physiotherapy to discriminate accurately and, where appropriate, intervene (or not) responsibly, it would seem constructive to incorporate this (and other) mechanisms-related evidence into its clinical reasoning and decision-making process.
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Objective. This study reviewed opioid prescription for chronic severe nonmalignant pain in a multidisciplinary pediatric pain clinic. We looked at benefits and side effects of therapy, and compared our process of opioid prescription with the practice guidelines defined in adult literature. Design. Descriptive retrospective practice survey. Setting. Multidisciplinary pain clinic in a tertiary pediatric hospital. Patients. During a 12-month period, 104 patients were seen in the clinic, of which 49 received an opioid as part of their pain management; 11 received an opioid chronically, defined as more than 3 months in this study, and 5 of these were still on opioid at the end of the study period although data on one patient are lacking as she had been transferred to an adult clinic. Methods. Information about patients was obtained from chart review. Outcome Measures. Benefits and side effects of treatment, as well as the process of prescribing opioids and follow-up. Results. In the four patients studied, there seem to be better pain control and improved function in these patients while on opioid therapy, despite minor side effects. We identified some areas of improvement in our practice and made recommendations for the use of opioids in pediatric chronic severe nonmalignant pain. Conclusions. The evolution of our four patients seems to be in favor of treatment with an opioid for severe chronic nonmalignant pain in certain pediatric patients, in the context of prescribing in a multidisciplinary pain clinic with a multisystem approach to pain management although more data are needed to know if such therapy is safe and beneficial on a longer-term basis.
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The effects of aging present a major medical challenge in the 21st century, which will cause fundamental changes in demography. By 2031, it is estimated that 22% of the UK population will be aged over 65 years, and there will be more people in this age group than aged under 25 years. As well as implications for infrastructure and productivity, this change will alter the prevalence and impact of many illnesses and pathologies. The research priorities of many of the major funding bodies reflect this challenge. The Medical Research Council in the UK, for example, leads the Lifelong Health and Wellbeing program on behalf of all the country's research councils. This initiative aims to identify factors that affect or improve health in later life, to inform relevant policy and practice. The Wellcome Trust lists the investigation of development, aging and chronic disease as one of its five major research challenges, and the European Commission presents the health of the aging population as one of its three overarching issues of the Health Theme in its 7th Framework Program of research. Chronic pain is a major health condition associated with aging, whose management (pharmacological and nonpharmacological) is generally unsatisfactory. The International Association for the Study of Pain designated 2006/07 as its Global Year Against Pain in Older Adults. This article reviews the relevance of existing and potential research on the assessment and management of chronic pain in older adults.
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There has been an increasing focus on development of new routes of drug administration to provide tailored treatments for patients, without decreasing efficacy of analgesia, in proportion to the progression of the knowledge of pain mechanisms. While acute pain acts as an alarm, chronic pain is a syndrome requiring meticulous selection of analgesic drugs of high bioavailability for long-term use. Such criteria are challenges that topical medications aim to overcome, allowing progressive delivery of active component, maintaining stable plasma levels, with a good safety profile. This review presents recent findings regarding topical formulations of the most widely used drugs for pain treatment, such as nonsteroidal anti-inflammatory agents, anesthetics, and capsaicin, and the role of physical agents as delivery enhancers (phonophoresis and iontophoresis). Although the number of topical agents is limited for use in peripheral conditions, increasing evidence supports the efficacy of these preparations in blocking nociceptive and neuropathic pain. Patient adherence to medical treatment is also a challenge, especially in chronic painful conditions. It is known that reduction of treatment complexity and pill burden are good strategies to increase patient compliance, as discussed here. However, the role of topical presentations, when compared to traditional routes, has not yet been fully explored and thus remains unclear.
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Although the tenor of that oft-quoted sentence is dramatic, the rest of the sentiment from the humanitarian and physician reads: “We must all die. But that I can save him from days of torture, that is what I feel is my great, ever-new privilege.” In the early twentieth century, Dr. Schweitzer elegantly described in three sentences the destructive nature of pain and the obligation and privilege of the physician to relieve it. He continues, “So, when the poor, moaning creature comes, I lay my hand on his head and say to him: ‘Don’t be afraid! In an hour’s time, you shall be put to sleep, and when you wake you won’t feel any more pain.’” So begins the promise of the interventionalist.
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Objective. To investigate short- and long-term effectiveness and safety of the 5% lidocaine medicated plaster in the treatment of postherpetic neuralgia (PHN) in elderly patients (≥70 years of age). Methods. Data from three European clinical trials were compared after stratification according to age (<70 years and ≥70 years). Length of study phase investigated was 4 weeks for study 1, 8 weeks for study 2, and up to 12 months for study 3. Effectiveness outcome measures were pain intensity, pain relief, allodynia severity, Clinical Global Impression of Change, and Patient Global Impression of Change. Safety was assessed by adverse event documentation. Results. Mean average pain intensity improved in the elderly by -2.1 (SD 2.1) vs. -2.5 (SD 2.0) for <70-year-old patients after 4 weeks, by -1.4 (SD 1.8) vs. -1.7 (SD 1.3) after 8 weeks, and by -1.5 (SD 1.9) vs. -2.7 (SD 2.2) after 12 months. Most patients presented with allodynia (>85% of elderly, >78% of younger patients) which was described by >51% as painful or extremely painful. Allodynia severity was markedly reduced in both groups during all three trials. Drug-related adverse events occurred in <20% of elderly and <15% of <70-year-old patients and were mainly skin-related. Conclusions. The 5% lidocaine medicated plaster provided pain relief and marked reductions in allodynia severity in elderly PHN patients with an excellent safety profile under short- and long-term treatment supporting the addition of the plaster to the treatment armamentarium for this age group. Study limitations. All analyzed study phases were open-label and lacking a placebo control group.
Article
Background And Objective Opioid treatments are often prolonged because of the pathology causing pain. We focused on the cognitive functions in chronic pain patients treated with opioids. This topic is currently controversial, but in practice the consequences are important in patients’ daily life, social interactions, working ability and driving. Database And Data Treatment Medline and Embase databases were searched for eligible articles. We included studies: enrolling patients with chronic non‐cancer pain; under opioids treatment; with a control group not using opioids; cognitive functions evaluated with specific tests. The cognitive areas examined were: attention, reaction time, executive functions, psychomotor speed, memory and working memory. From 356 abstracts screened, nine articles satisfied eligibility criteria and were included in our review: seven observational and two experimental studies. We classified the pain treatments as follow: opioids, other drugs active on central nervous system (CNS) (antidepressants/anticonvulsants) and treatments not specifically targeted to the CNS. Results Statistically significant differences were seen only with regard to attention between opioids alone and no centrally acting treatment (Standardized mean difference ‐ SMD: ‐0.53, 95%CI: ‐0.91, ‐0.15; p=0.007; I²=23%) and between opioids combined with antidepressants and/or anticonvulsants and no centrally acting treatment (SMD: ‐0.62, 95%CI: ‐1.04, ‐ 0.20; p=0.004; I²=0%). No other significant differences were observed. Conclusions Opioids reduce attention when compared with treatments not targeted on the CNS. If opioids are used together with antidepressants and/or anticonvulsants this effect increases. Significance These findings on the neuropsychological effects of opioids could be used to generate strategies to refine pain treatments. This article is protected by copyright. All rights reserved.
Chapter
Undermanaged acute and chronic pain can lead to a cascade of negative physiological, medical, and emotional consequences. Therefore, the imperative for the proper recognition, assessment, prevention, and treatment of pain is not only an ethical one but physiological and medical as well. Fortunately, there are a great many pain management tools available to the veterinarian to mitigate these effects and improve not only patient comfort, but overall recovery and quality (and in some cases, length) of life. Unfortunately, it can be a challenge indeed to know which treatment plan can best—and most safely—meet the needs of our patients, a matter made more difficult for veterinarians since animals cannot self-report their pain. This chapter is a succinct overview of the multimodal approach to the prevention and treatment of pain in dogs, utilizing evidence-based veterinary medicine insofar as possible, and a consensus of expert opinion otherwise. Drug classes and modalities discussed include: NSAIDs, opioids, alpha-2 agonists, locoregional anesthesia, subanesthetic ketamine, and a variety of other pain-modifying analgesic drugs in common use (e.g., gabapentin, amantadine, acetaminophen, tramadol, and others). This chaper also includes tips for practical clinical use, with an emphasis on safe and responsible use of the various drug classes. In addition, descriptions of other drugs possibly on the horizon for veterinary use (some based on utility in human medicine) are included. Lastly, evidence-based approaches to managing postsurgical and varieties of chronic pain (osteoarthritis, osteosarcoma, and noninflammatory) are described, with sample cases to illustrate.
Article
Fibro fog causes serious problems for those with fibromyalgia syndrome. The mechanisms that cause it have not been well identified. Since prescription medication and other conventional medical interventions have proven less than satisfactory, and while waiting for more investigational information, research suggests that exercise might be helpful.
Article
Background: Osteopathy in Australia is a primary care limited scope practice. Practitioner surveys suggest that patients present with chronic pain and receive manual therapies, exercise and lifestyle advice. Further research is required to deepen the understanding of this intervention from the perspective of patients. Objective: To explore the experience of patients receiving osteopathic healthcare. Design: Mixed methodology. Method: A quantitative survey of a convenience sample of patients was followed by qualitative semi-structured interviews in a purposive sample of respondents with chronic non-specific low back pain. The transcripts were analysed using a phenomenological approach. Results: The survey results suggested directions of enquiry for the interviews. Eleven subjects were interviewed and reported commonalities in their clinical histories with multisystem co-morbidities. Four themes became apparent: patient decision-making, patient shared experiences of the osteopathic healthcare consultation, tailored patient-centred care, and therapeutic relationship in healthcare. Conclusion: This data suggests that patients experience osteopathic healthcare after trying other disciplines; that there are shared aspects of the consultations, with a thorough assessment, education about their condition, multiple manual therapies and lifestyle advice; that the experience is patient-centred and tailored to their context; and that the therapeutic relationship is a key aspect of the experience. These results reflect a number of aspects of osteopathic healthcare from workplace surveys.
Article
Chronic pain is defined as an unpleasant sensory and emotional expenence associated to real or potential tissue damage, sometimes described in terms of the lesion occurred. Despite the technological advances of medidne and its treatment strategies, chronic pain continues to represent a challenge for health professionals because it is a poorly controlled symptom. On the other hand, limited efficacy and adverse events of analgesics have stimulated research of new treatment strategies Recent studies have demonstrated that botulinum toxin (BTX) has analgesic properties in myofascial syndrome, headache, arthritis and neuropathic pain. BTX is produced by Clostridium botulinum and it effedively blocks acetylcholine release by cholinergic nerves, interrupting cholinergic nerves transmission, so inducing a disbalance in the autonomic nervous system. BTX blocks neuromuscular transmission and produce paralysis of motor nerve endings; for this reason BTX is useful in diseases with skeletal musde contracures or ncreased tension. The analgesic mechanism of BTX is not fully understood, however, it can have a direct analgesic atiivity besides its neuromuscular blocking action and seems like a promising strategy for pain control.
Article
Full-text available
Objective: To examine the analgesic and antinociceptive effect of ketamine cream in rats as an animal model. Materials and methods: Fifteen healthy adult albino rats with equal age and gender distribution of either sex were selected for this study. The animals were divided into 3 groups of 5 animals. The pain reaction time was recorded pretreatment for each animal and was taken as a basal threshold(Tayebi et al.,2008). Group 1 served as a control and was applied cream topically on fore and hind limb. Group 2 and 3 were applied topically ketamine cream 2.5%, 5% respectively on fore and hind limb. The onset and duration of analgesic effect of ketamine cream were evaluated in rats by utilizing a Hot-Plate test at 55±1°C. Latency reaction time was recorded after 3min. and (10, 20, 30, 40, 50, 60 min.) The prolongation of latency times compared with the values of the control was used to express about antinociceptive effects of ketamine cream and the percentage of antinociceptive Maximal Possible Effect (MPE) was calculated. Results: demonstrated that the ketamine cream at concentrations (2.5, 5) % produced antinociceptive effect in rats (11.0±1.4)(16.5±9.0) second after 3 min, respectively in comparison with control (7.0±0.8) second. The percentage of maximum possible effect (MPE) was increased from (3.16) % in control group to (21.65), (42.5)% respectively according to the above concentrations of ketamine cream after 3 min. The duration of analgesia with topical application of cream (2.5, 5)% from 3-40 min and usually approached the base line (5.75±1.5) (7.0±1.4) second respectively after 60 min. Conclusions: This study concluded that ketamine cream have a good antinociceptive activity in rats after 3 minutes of topical application and prolong the duration of analgesia more than 40 minutes depending on concentration of ketamine cream. © This is an open-access article distributed under the terms of the Creative Commons Attribution License.
Article
Traditionally, pain is regarded as a warning signal in biological life, mental maturation, and social development. It is an important incentive for medical treatment. Furthermore, acute, intermittent and especially chronic pain states have their intrinsic significance due to subjective suffering. In addition, pain exerts multiple impacts on daily life, profession, and social interactions, associated impairments and handicaps. But only in a certain portion of the cases, somatic, affective and mental lesions and diseases are associated with pain experiences. Therefore, the indicators of nociception are unreliable for the evaluation and treatment of pain patients. Consequently, the evaluation of pain must start from the consciousness and behaviour of the afflicted. Characteristics of consciousness and significant behaviour aspects of pain patients are outlined.
Article
Objective: . We aimed to systematically review the methods and instruments used to evaluate cognitive function in chronic pain (CP) patients. Methods: A sensitive search strategy was designed using five databases. Based on the objectives and methodology, we selected cross-sectional studies on adults with chronic non-cancer pain in which cognitive function was assessed using validated instruments. The characteristics of the subjects, control groups, and other variables that might affect cognitive function, and the instruments used, were extracted from each article. Results: . In the 42 articles identified, 53 instruments were used to assess cognitive function. Chronic pain criteria were defined in 83.3% of the articles and more than half (57.1%) included single diagnosis samples, with fibromyalgia being the most frequent studied (75%). Patients with prior cognitive impairment were excluded in 61.9% of the studies, and a control group was included in 64.3% of the studies. In most cases potential confounding variables were evaluated. More than 14% of the studies used self-report measures, and 73.8% used neuropsychological instruments, particularly for assessing attention (30%) and memory (27.5%). None of the instruments were specifically validated for pain patients and only five studies analyzed the psychometric properties of the instruments. Conclusions: . Various instruments and methods were used to assess cognitive function in CP patients, particularly fibromyalgia patients, but also other cohorts with well-defined CP. The instruments used had been validated, but not for pain populations, thus they require specific adaptation and validation to be used in CP patients. Certain recommendations are made in order to improve the evaluation of cognitive function in these patients.
Article
Musculoskeletal conditions are the leading cause of disability worldwide and also have a large impact on many other aspects of older people's health such as low physical activity level, poor mobility, frailty, depression, cognitive impairment, falls and poor sleep quality. Clustering of musculoskeletal pain with other pain conditions is also common, and the number of pain sites is an important prognostic factor. While musculoskeletal pain is usually nociceptive in origin, older people with musculoskeletal conditions may also experience neuropathic pain and central pain syndromes. Musculoskeletal burden of disease is increasing because of rapid ageing of populations, especially in developing countries. Interaction of musculoskeletal pain with co-existing conditions, including other types of pain, needs to be studied in longitudinal studies to identify modifiable targets for intervention. Additionally, potential impacts of musculoskeletal pain and prognostic factors need to be investigated in developing countries where evidence is scarce.
Chapter
Undermanaged acute and chronic pain can lead to a cascade of negative physiological, medical, and emotional consequences. Fortunately, there are many pain-management tools available to the veterinarian to mitigate these effects and improve not only patient comfort, but overall recovery and quality (and in some case, length) of life. Unfortunately, it can be a challenge to know which treatment plan can best-and most safely-meet the needs of our patients, a matter made more difficult for veterinarians, as animals cannot self-report their pain. This chapter is a succinct overview of the multimodal approach to the prevention and treatment of pain in dogs, utilizing evidence-based veterinary medicine (EBVM) insofar as possible, and a consensus of expert opinion otherwise. Drug classes and modalities discussed include nonsteroidal anti-inflammatory drugs (NSAIDs), opioids, alpha-2 agonists, locoregional anesthesia, subanesthetic ketamine, and a variety of other pain-modifying analgesic drugs (PMADs) in common use (e.g., tramadol, gabapentin, amantadine, and others). The discussion also includes tips for practical clinical use, with an emphasis on safe and responsible use of the various drug classes. In addition, descriptions of other drugs possibly on the horizon for veterinary use (based on use in human medicine) are included. Lastly, evidence-based approaches to managing postsurgical and different varieties of chronic pain (osteoarthritis, osteosarcoma, and noninflammatory) are described, with sample cases to illustrate.
Chapter
This chapter continues review of the excellent book by Carone and Bush (2013a) on symptom validity assessment, MTBI (mild traumatic brain injury), and malingering. The book is quite complementary to the present one. Many of the chapters provide information that parallel or add to the information already presented.
Article
Object: Chronic neuropathic pain is estimated to affect 3-4.5% of the worldwide population, posing a serious burden to society. Deep Brain Stimulation (DBS) is already established for movement disorders and also used to treat some "off-label" conditions. However, DBS for the treatment of chronic, drug refractory, neuropathic pain, has shown variable outcomes with few studies performed in the last decade. Thus, this procedure has consensus approval in parts of Europe but not the USA. This study prospectively evaluated the efficacy at three years of DBS for neuropathic pain. Methods: Sixteen consecutive patients received 36 months post-surgical follow-up in a single-center. Six had phantom limb pain after amputation and ten deafferentation pain after brachial plexus injury, all due to traumas. To evaluate the efficacy of DBS, patient-reported outcome measures were collated before and after surgery, using a visual analog scale (VAS) score, University of Washington Neuropathic Pain Score (UWNPS), Brief Pain Inventory (BPI), and 36-Item Short-Form Health Survey (SF-36). Results: Contralateral, ventroposterolateral sensory thalamic DBS was performed in sixteen patients with chronic neuropathic pain over 29 months. A postoperative trial of externalized DBS failed in one patient with brachial plexus injury. Fifteen patients proceeded to implantation but one patient with phantom limb pain after amputation was lost for follow-up after 12 months. No surgical complications or stimulation side effects were noted. After 36 months, mean pain relief was sustained, and the median (and interquartile range) of the improvement of VAS score was 52.8% (45.4%) (p = 0.00021), UWNPS was 30.7% (49.2%) (p = 0.0590), BPI was 55.0% (32.0%) (p = 0.00737), and SF-36 was 16.3% (30.3%) (p = 0.4754). Conclusions: DBS demonstrated efficacy at three years for chronic neuropathic pain after traumatic amputation and brachial plexus injury, with benefits sustained across all pain outcomes measures and slightly greater improvement in phantom limb pain.
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