The Clinical journal of pain
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Review
Detoxification of nonopiate drugs in the chronic pain setting and clonidine opiate detoxification.
Although the pain physician is most familiar with the treatment of the opiate withdrawal syndrome, other drugs are abused by the chronic pain patient. The pain physician should then be familiar with the withdrawal syndromes associated with other drug groups. ⋯ Drug detoxification protocols for these drugs are reviewed. Additionally, the rationale for clonidine opiate detoxification is discussed, and current clonidine detoxification protocols are reviewed.
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Spinal cord injury (SCI) can cause paralysis; sensory impairment; autonomic nervous system dysfunction; and bowel, bladder, and sexual dysfunction. These impairments may lead to immobility, physical dependence, and alterations in lifestyle and self-esteem. The addition of chronic, intractable pain to these impairments can be truly devastating. ⋯ Thus, it may become impossible for the individual to escape his or her pain even temporarily. The various medical, physical, and surgical treatments considered to be efficacious in treating this pain are reviewed. However, although chronic pain in SCI may be managed by these therapies, a permanent cure may not result.
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With the medical progress that has given spinal cord injured individuals greater longevity and better overall health, chronic pain has emerged as a major challenge in treating this population. Over the past 40 years, estimates of prevalence of severe/disabling chronic pain in spinal cord injury (SCI) patients have ranged from 18% to 63%. Beyond this finding, the extant literature is extremely limited. ⋯ A major purpose of the present article is to expand the scope of inquiry to include these factors and to emphasize the importance of employing a biopsychosocial model. Evidence is reviewed which suggests that chronic pain is associated with psychosocial impairment in this population. It is concluded that rather than being a minor problem in comparison to the other limitations imposed by SCI, chronic pain represents a significant additional challenge to the SCI patient that may be best addressed by a multidisciplinary approach.
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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.