European journal of pain : EJP
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Fibromyalgia represents a condition still controversial in its entity, pathophysiology, diagnosis and management (Figure ). In a world where everybody is connected, and everybody is sharing their own image, fibromyalgia (FM) represents the emblematic pathology of misconnection and lack of specific biomarker. ⋯ The concept of misconnection defines FM in a different and holistic view and proposes different views of assessment, management and representation: FM pathophysiology: the desynchronization of brain and body FM recognition: the broken link between patients and physicians FM assessment: merging the body and mind for an optimal diagnosis and management FM treatment: re-establishing the good connections at different levels We hope to reconnect FM patients with all healthcare providers, help FM patients reconnect with their painful body and integrate FM into regular medical practice. SIGNIFICANCE: The concept of misconnection defines FM in a different and holistic view, and propose different views of assessment, management and representation.
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Review
Body movements as pain indicators in older people with cognitive impairment: A systematic review.
Pain assessment tools for cognitively impaired older people, unable to self-report pain, are commonly founded upon observation of pain behaviour, such as facial expressions, vocalizations and body movements. The scientific basis for claiming that body movements may indicate pain has not formerly been investigated in a systematic review. The objective was to explore research evidence for body movements being pain indicators in older people with cognitive impairment. ⋯ Pain assessment tools for older people with cognitive impairment or dementia should include valid pain behaviour items. Our review shows strong scientific evidence for the following body movements indicating pain: restlessness (agitation), rubbing, guarding, rigidity and physical aggression.
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Review
Body movements as pain indicators in older people with cognitive impairment: A systematic review.
Pain assessment tools for cognitively impaired older people, unable to self-report pain, are commonly founded upon observation of pain behaviour, such as facial expressions, vocalizations and body movements. The scientific basis for claiming that body movements may indicate pain has not formerly been investigated in a systematic review. The objective was to explore research evidence for body movements being pain indicators in older people with cognitive impairment. ⋯ Pain assessment tools for older people with cognitive impairment or dementia should include valid pain behaviour items. Our review shows strong scientific evidence for the following body movements indicating pain: restlessness (agitation), rubbing, guarding, rigidity and physical aggression.
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Review Practice Guideline
Standards for the management of cancer-related pain across Europe. A position paper from the EFIC Task Force on Cancer Pain.
Pain is a common symptom in patients who survive cancer and in those who live with progressive advanced disease. Evidence from meta-analyses suggests that pain remains poorly controlled for a large proportion of patients; barriers to good management include poor assessment of pain, inadequate support for patient self-management and late or inadequate access to strong opioid analgesia in those with advanced disease. ⋯ Pain affects up to 40% of cancer survivors and affects at least 66% of patients with advanced progressive disease, many of whom experience poor pain control. These 10 standards are aimed to improve cancer pain management, promote the quality of care of patients and reduce variation across Europe.
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Review
Mechanisms of spinal cord stimulation for the treatment of pain: Still in the dark after 50 years.
Despite the value of spinal cord stimulation (SCS) in treating some patients with focal neuropathic pain, technological advances in stimulator design and treatment protocols have not correlated with significant improvements in clinical outcomes. This may be because incomplete understanding of the mechanisms underlying SCS precludes improvement in clinical efficacy. In this brief review, we (a) review phenomenological effects of SCS, (b) review the literature on proposed spinal sites of action of SCS and (c) propose a novel hypothesis of mechanism of action. ⋯ We review possible spinal mechanisms of action of spinal cord stimulation for neuropathic pain, proposing that direct modulation of dorsal horn neurons is crucial. We suggest that mechanistic insights are needed for translation into more favourable clinical outcomes.