The Clinical journal of pain
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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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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.
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Individuals with chronic pain frequently experience a complex and convoluted journey through the health care system that is often unrewarding for all involved. Excessive pain behavior may lead to unnecessary diagnostic testing or invasive procedures and result in iatrogenic complications and prolonged disability. ⋯ Often there is no direct correlation between objective impairment and an individual's request for disability status. As job satisfaction and financial security diminish during our economic recession, the impact of the disability epidemic becomes more profound.
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Patients experience oral pain in ways that make an accurate diagnosis difficult. The same complaints can be caused by either dental or nonodontogenic diseases. The author systematically explores symptoms and etiologies to direct the health care provider to an accurate diagnosis and treatment.