The Clinical journal of pain
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The objective of this article is to provide a brief overview of the major psychosocial risk factors impacting recovery from spine surgery. ⋯ Presurgical psychological screening should be included in the medical diagnostic process of spine surgery candidates, especially when the major goal is pain reduction, or when the surgeon recognizes the existence of psychosocial risk factors. Suggestions for future directions in the development of presurgical psychological screening procedures are also given.
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The proper medicinal use of opioids, in light of their notorious history and current relation to social ills, continues to be debated and remains unclear in several areas of medicine. This article will review several areas and points of controversy related to screening for potential problematic opioid behavior in chronic nonmalignant pain patients. Controversy over the prescription of opioids for chronic nonmalignant pain continues, despite the growing acceptance of this practice. ⋯ Although clinical observations exist about risk factors for opioid misuse in chronic pain patients, there is limited research. Further, the area of prescreening for problematic drug behavior is in its infancy. However, researchers have begun to delve into this challenging area and the application of rigorous empirical research will bring us closer to identifying those patients at risk so that their pain is managed without destructive outcomes in other areas of their life.
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The specific use of psychological screenings to determine appropriateness for lumbar discectomy surgery and predict outcomes is not well understood. Data from spine surgery as a whole are not likely generalizable to the patient with a significant disc herniation considering surgery. As opposed to most "back pain syndromes," acute and subacute sciatica from disc hemiation has a very high chance of dramatic and lasting improvement with surgery. ⋯ However, the same psychometric profile in those patients with chronic sciatica pain and disability does predict worse outcomes compared with chronic pain in less emotionally distressed patients. The data suggest that the ability to rapidly relieve pain in the case of disc herniation may limit the morbid effects of psychological distress seen in many back pain syndromes. With prolonged pain and emotional distress, however, adverse and possibly self-perpetuating psychological and social changes may significantly decrease the impact of disc surgery.
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The only agent approved by the U.S. Food and Drug Administration for chronic intrathecal infusion for the treatment of chronic pain is morphine sulfate. In patients who do not experience adequate relief from intrathecal opioids, bupivacaine is frequently added to increase efficacy. The studies reported here were conducted to demonstrate the stability and compatibility of bupivacaine in a commonly used implantable infusion system and the long-term clinical safety of this therapy. ⋯ Bupivacaine is stable and compatible with a commonly used implantable drug infusion system. In this study, chronic supplementation of intrathecal opioids with bupivacaine was a safe method for providing continued management of chronic pain of cancer or noncancer origin.
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Comparative Study
A comparison of blacks and whites seeking treatment for chronic pain.
Most conceptualizations of chronic pain acknowledge the importance of culture and social circumstances. Cultural and social influences may differ for persons of different racial or ethnic groups, and this circumstance may lead them to experience and adjust differently to pain. The current study compared adjustment to chronic pain by blacks and whites seeking treatment for chronic pain. ⋯ These results show that blacks and whites with chronic pain experience pain differently. Several factors may underlie these differences, including family situation, health care experiences, or other unmeasured behavioral, environmental, or social influences. Other investigators should attempt to replicate these findings and more closely examine variables that may explain them.