The Clinical journal of pain
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This was a preliminary investigation of patients' beliefs about cannabinoids and the associations between those beliefs, beliefs about medication, and personal and pain variables with regard to patients' willingness to try cannabinoids as analgesics. ⋯ The concerns of patients with chronic pain about taking cannabinoids as analgesics may reduce their utility and efficacy; accurate information is required to counter this effect.
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The prevalence and excessive cost of pain, especially when the pain becomes chronic, remains a major health-care problem in the United States. Currently, a biopsychosocial perspective of pain has been found to be the most heuristic approach to understanding and managing it. Using this perspective, an important advance has been made in the possibility of individually tailoring treatment for each patient, with the result being better outcomes. ⋯ The papers by Praeger, Jacobs, and Robinson et al. in this special topics series describe the approach to pretreatment assessment for these modalities in detail. Finally, the author presents a stepwise, biopsychosocial approach as the basis for assessment before decisions regarding surgery, opioid maintenance therapy, and implantable pain-management modalities. The author suggests that systematic pretreatment interventions will facilitate a more structured standard of care in the evaluation and treatment of patients with pain and ultimately better outcomes.
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A 73-year-old woman with bilateral severe pain in her legs and feet was admitted to the hospital. The pain had started spontaneously without any known trauma a year earlier and had progressively worsened to the point that she was unable to walk. The patient complained of pain, discoloration, and sweating of the lower extremities. Physical examination revealed swollen, cold, wet, and blue extremities, with both allodynia and hyperalgesia, fulfilling criteria for a diagnosis of complex regional pain syndrome (CRPS) type 1. Laboratory findings demonstrated a hemoglobin level of 180 g/L(-1) and a hematocrit of 47%, leading to a diagnosis of polycythemia vera (PCV). Her condition slowly improved after repeated venesection, mild analgesics, and amitriptyline. ⋯ Polycythemia vera has not been described previously as a contributing factor in CRPS. In the present case, the diagnosis of PCV was important, because its treatment also improved the CRPS.