The Clinical journal of pain
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Pain management is a serious problem for individuals with spinal cord injury (SCI). Recent developments in pain assessment indicate that multiaxial approaches, assessing medical, psychosocial, and behavioral/functional dimensions, are necessary to measure adequately the impact of chronic pain. The application of this multiaxial system to persons with SCI and chronic pain is presented. ⋯ The assessment task is further confounded by the functional limitations and psychosocial impairments that may accompany SCI. Recommendations are made for adapting established pain measures for use with SCI individuals. The choice of assessment tools for these patients is guided by the multidimensional nature of the pain experience, functional limitations, and the goals of treatment.
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Currently, no literature is available regarding the clinical efficacy and treatment outcome of psychological interventions for chronic pain among spinal cord injured (SCI) persons. The present article provides a framework for cognitive-behavioral interventions used with other pain populations and suggested application for the SCI population with chronic pain. ⋯ SCI rehabilitation has traditionally relied upon self-management strategies, as have recent psychological treatment approaches for chronic pain. In addition, recommendations for treatment outcome research are provided with the emphasis on using existing standardized assessment and measurement protocols.
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The problem of severe chronic pain following spinal cord injury (SCI) has been well delineated for many years. However, progress has been slow in determining which treatment procedures work for which type of SCI pain in a particular individual at a particular time. ⋯ Design limitations of many existing studies that can be remedied in future investigations are reviewed. Finally, discussion of two conceptual models of SCI pain is presented and an argument raised for the utility of both.
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Randomized Controlled Trial Clinical Trial
Plasma beta-endorphin is not affected by treatment with imipramine or paroxetine in patients with diabetic neuropathy symptoms.
To determine the possible role of endogenous opioid peptides in the action of imipramine and paroxetine in painful diabetic neuropathy, beta-endorphin concentrations in plasma were measured in 20 patients during a double-blind, placebo-controlled randomized three-way crossover trial. Despite a significant reduction in neuropathy symptoms during both imipramine and paroxetine treatment, the beta-endorphin level was unaltered throughout the study. The plasma concentration of beta-endorphin was not related to plasma drug concentrations. Thus, this study does not provide evidence of a role of endogenous opioid peptides in the mechanism of action of imipramine and paroxetine in painful diabetic neuropathy.
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It is claimed that a significant percentage of chronic pain patients suffer from drug/alcohol abuse/dependency/addiction. To address this question, 24 articles alluding to chronic pain patient drug/alcohol dependence/addiction were reviewed according to the following criteria: method for drug misuse diagnosis, which drug misuse diagnosis used (abuse, dependence, or addiction), and percentage of patients within each diagnostic category of drug misuse. ⋯ It is concluded that these diagnoses occur in a significant percentage of chronic pain patients. However, there is little evidence in these studies that addictive behaviors are common within the chronic pain population.