Articles: chronic-pain.
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Multicenter Study
Cost effectiveness of intrathecal drug therapy in management of chronic nonmalignant pain.
To evaluate the cost effectiveness of intrathecal drug therapy (IDT) compared with conventional medical management (CMM) for patients with refractory chronic noncancer pain. ⋯ IDT is cost effective compared with CMM in the management of chronic noncancer pain.
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Eur J Phys Rehabil Med · Feb 2013
ReviewEducation and training of pain medicine specialists in the United States.
Many pain patients present with a complex set of symptoms and comorbidities that defy the acumen of any one specific medical specialty; thus the knowledge and skills of the pain physician must, out of necessity cross specialty borders. The competency that comes from mastering essential skills is accomplished during the pain medicine training. The goal of pain medicine training in the United States is to provide the postgraduate trainee with the exposure to multiple disciplines of medicine, as well as multiple interventions, so that upon completion of training, the pain physician will have the necessary skill set to provide competent, appropriate, comprehensive care for the often medically complicated pain patient. In the United States, many training programs are governed by guidelines that have been established by the Accreditation Council for Graduate Medical Education (ACGME).
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Pain is a complex consciousness that emerges from the brain, and is commonly a result of nociception; the physiological process initiated by activation of specialised high-threshold peripheral sensory neurons. When pain is persistent, its affective aspects can dominate and cause considerable suffering. This chronic pain state is not an inevitable consequence of physical injury or disease. ⋯ The biological bases for chronic pain can now be defined and measured by brain neuroimaging at a systems level, where penetrance of genetic variation should be higher when compared to syndromal phenotypes. To date, very few neuroimaging studies have attempted to connect brain activity associated with pain to genes. We review these together with other pertinent studies here, and suggest how neuroimaging endophenotypes might prove useful for the development of treatments for chronic pain.
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Little is known about how opioid prescriptions for chronic pain are initiated. We sought to describe patterns of prescription opioid initiation, identify correlates of opioid initiation, and examine correlates of receipt of chronic opioid therapy (COT) among veterans with persistent noncancer pain. ⋯ Opioid initiations are common among veterans with persistent pain, but most veterans are not prescribed opioids long-term. Psychiatric disorders and substance use disorders are associated with receiving COT. Many Veterans receiving COT are concurrently prescribed benzodiazepines and many do not receive urine drug screening; additional study regarding practices that optimize safety of COT in this population is indicated.
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Medication nonadherence is a frequent problem in the treatment of chronic conditions. ⋯ According to their own statements, 57% of the patients were nonadherent, while 84% exhibited some form of nonadherence on the Morisky scale. The patients reported a mean pain intensity of 6.6 ± 2.2 on a visual analog scale. The most common deviation from the prescribed therapy was self-adjustment of the dose and medical regimen based on the severity of pain. Polymedication correlated positively with nonadherence. Nonsteroidal anti-inflammatory drugs were the most frequently prescribed medications. The majority of the participants (59%) believed that higher pain intensity indicates progression of the disease, and half of the participants believed that one can easily become addicted to pain medications. Nonadherence was associated with patient attitudes about addiction to analgesics and ability of analgesics to control pain. CONCLUSION.: High pain intensity and nonadherence found in this study suggest that physicians should monitor older patients with chronic nonmalignant pain more closely and pay more attention to patients' beliefs regarding analgesics to ensure better adherence to pharmacological therapy.