Examples of such treatment include correction of structural deformity, disease modifying antirheumatic treatments, or maintaining adherence with hydration and hydroxyurea treatment. Targeted disease-specific treatment may reduce or possibly eliminate the need for analgesic drugs (algorithm 1).
Full Answer
Are patients unsatisfied with their pain management?
Up to 79% of chronic pain patients are unsatisfied with their pain management. Meeting patients’ expectations is likely to produce greater satisfaction with care. The challenge is to explore patients’ genuine expectations and needs.
What are patients’ ideal expectations of pain treatment?
Patients’ ideal expectations are higher than their predicted expectations; some patients hope for, or desire, a full cure, but predict to gain little or nothing from pain management.
Does treatment expectancy and credibility affect outcome in chronic back pain?
Treatment expectancy and credibility are associated with the outcome of both physical and cognitive‐behavioral treatment in chronic low back pain. Clin J Pain. 2008;24:305–315.
What has changed in the past decade in the pain field?
The past decade has seen advances in our understanding of the mechanisms underlying pain and in the availability of technically advanced diagnostic procedures; however, the most notable … Treatment of chronic non-cancer pain Lancet.
What is the preferred treatment for chronic pain?
1. Nonpharmacologic therapy and nonopioid pharmacologic therapy are preferred for chronic pain. Clinicians should consider opioid therapy only if expected benefits for both pain and function are anticipated to outweigh risks to the patient.
Which of the following would be a good treatment option for mild chronic pain?
Acetaminophen. Acetaminophen is usually recommended as a first line treatment for mild to moderate pain, such as from a skin injury, headache or musculoskeletal condition. Acetaminophen is often prescribed to help manage osteoarthritis and back pain.
How do you treat mild pain?
Milder forms of pain may be relieved by over-the-counter medications such as Tylenol (acetaminophen) or nonsteroidal anti-inflammatory drugs (NSAIDs) such as aspirin, ibuprofen, and naproxen.
What are treatment options for acute pain?
Initial treatment may include some of the following:Resting the affected part of the body.Application of heat or ice.Nonsteroidal anti-inflammatory drugs (NSAIDs) such as aspirin, ibuprofen, or naproxen; or acetaminophen.Physical therapy.Exercise.Bioelectric therapy (using local electrical stimulation to moderate pain)More items...•
Background
Chronic pain is a major economic and social health problem. Up to 79% of chronic pain patients are unsatisfied with their pain management. Meeting patients’ expectations is likely to produce greater satisfaction with care. The challenge is to explore patients’ genuine expectations and needs.
Objective
This review aimed to systematically collect information on types and subject of patients’ expectations for chronic pain management.
Search strategy
We searched for quantitative and qualitative studies. Because of the multidimensional character of the term “expectations,” the search included subject headings and free text words related to the concept of expectations.
Data extraction and synthesis
A framework for understanding patients’ expectations was used to map types of expectations within structure, process or outcome of health care.
Main results
Twenty‐three research papers met the inclusion criteria: 18 quantitative and five qualitative. This review found that assessment of patients’ expectations for treatment is mostly limited to outcome expectations (all 18 quantitative papers and four qualitative papers).
Discussion and conclusions
For health‐care providers, for pain management and for pain research purposes, the awareness that patients express different types of expectations is important. For shared decision making in clinical practice, it is important that predicted expectations of the patient are known to the treating physician and discussed.
Abstract
Chronic pain is a major economic and social health problem. Up to 79% of chronic pain patients are unsatisfied with their pain management. Meeting patients’ expectations is likely to produce greater satisfaction with care. The challenge is to explore patients’ genuine expectations and needs.
1 INTRODUCTION
In Europe, chronic non‐cancer pain of moderate to severe intensity occurs in approximately 19% of the adult population. 1 The international society for the study of pain defines chronic non‐cancer pain (CNCP) as non‐malignant pain lasting 3 months or more, or as pain persisting beyond the time of expected healing.
2 METHODS
The main objective of this systematic review was to classify patients’ expectations regarding CNCP management according to the framework of understanding expectations (Figure 1 ). Secondary objective of this study was exploration of the subject of patients’ expectations.
3 RESULTS
Figure 2 shows a flow diagram of the study selection, procedure and results. The full text of 172 papers was assessed according to the inclusion and exclusion criteria. The most frequent reason for exclusion in this review was when papers did not describe pain management expectations but for instance experiences.
4 DISCUSSION
In this review, we systematically searched for quantitative and qualitative studies addressing expectations of chronic pain patients regarding CNCP management and categorized expectations according to the type of expectation and Donabedian's health‐care model of structure, process and outcome.
What are the physical modalities?
Physical modalities — Physical modalities (eg, transcutaneous nerve stimulation [TENS], transcranial neurostimulation, occipital nerve stimulation) are of uncertain benefit for most types of chronic pain, but may serve as an adjunct to other more active treatments.
What is acupuncture for chronic pain?
Acupuncture has been a widely used treatment of chronic pain for thousands of years, and continues to be a frequently sought treatment for chronic pain relief.
What is ROM in exercise?
Stretching intends to restore range of motion (ROM); ROM exercises can progress from passive (in which there is no voluntary muscle contraction and with the application of total external force) to active assisted (in which there is partial contraction and external force).
What is PT in medical terms?
Physical therapy (PT) includes specific exercise training that addresses both fear avoidance and severe deconditioning commonly seen in patients with chronic pain, and so intrinsically differs from the routine advice given to patients with acute pain (eg, injured athletes, post-op joint replacement surgeries).
Why is ongoing monitoring important?
As with all other chronic diseases, ongoing monitoring of treatments for chronic pain is essential, to deliver effective and safe long-term outcomes. Follow-up evaluation involves monitoring for efficacy and side effects of medications, and reinforcement of the value of non-pharmacologic therapy.
What is the National Pain Strategy?
The United States National Pain Strategy [ 11] and the Institute of Medicine's influential 2010 Relieving Pain in America [ 12] both recommend education as a central component to the transformation of pain care.
Why do people seek medical attention?
Chronic pain is one of the most common reasons that patients seek medical attention. Chronic pain results from combined biologic, psychologic, and social factors, and most often requires a multifactorial approach to management. This topic will discuss an approach to the management of chronic non-cancer pain, and an overview ...
What is spinal cord stimulation?
Spinal-cord stimulation involves the implantation of electrodes near the spine or into peripheral nerves to modulate pain processing, resulting in inhibition of nociceptive signals. The use of this technique in carefully selected patients with refractory neuropathic pain (complex regional pain syndrome [CRPS] and radicular back pain) has been shown to reduce pain, improve quality of life, reduce analgesic consumption, and allow some patients to return to work.
What is interventional pain medicine?
Interventional pain medicine involves application of various techniques that can be used to diagnose or locate an individual's source of pain or provide therapeutic pain relief. Interventional medicine is most frequently used when a specific area of the spine is thought to be contributing to an individual's pain (ie, discogenic or sacroiliac joint pain) and there is no consensus with respect to optimum diagnostic criteria. The focus of our review is therapeutic intervention, so we will not address diagnostic uses of interventional pain medicine. We refer readers to Chou and colleagues
What is topical agent?
They have the potential advantage of avoiding the systemic side-effects that are often associated with oral drugs. Capsaicin is an alkaloid derived from chilli peppers, and repeated application is thought to deplete substance P from primary afferent neurons. By comparison with placebo, topical agents effectively reduce pain in both neuropathic pain and musculoskeletal disorders including osteoarthritis.
What is nerve block?
Nerve blocks involve the delivery of various anaesthetics to visceral and peripheral nerves and muscles to interrupt nociceptive input, reduce inflammation, or destroy neurons at the source of pain. The procedures vary with respect to patient-selection criteria, location (epidural, facet joint, local site), agent, and dose. The deviations in methods make assessment of outcomes difficult. There is no consensus about technical aspects of injection therapies, and no guidelines for optimum diagnostic criteria for patient selection, frequency, number, or timing of injections.
What are the mechanisms of action of anticonvulsants?
The primary mechanisms of action of anticonvulsant drugs include modulation of voltage-gated calcium or sodium channels, glutamate antagonism, enhancement of the γ-aminobutyric acid (GABA) inhibitory system, or a combination of these effects. The best evidence supports the efficacy of three drugs mainly used for the treatment of chronic non-cancer pain—gabapentin, pregabalin, and carbamazepine or oxcarbazepine.
What is the longest track record of antidepressants?
Scopus (698) Google Scholar. Tricyclic antidepressants (TCAs), such as amitriptyline and cyclobenzaprine, have the longest track record of any antidepressants in treatment of chronic non-cancer pain. They primarily work by directly blocking the reuptake of serotonin and noradrenaline.
What are the effects of antidepressants?
Antidepressants have diverse effects that might contribute to their analgesic effect, including effects on N-methyl-D-aspartate (NMDA) and adenosine receptors, sodium channels, and serotonin, noradrenaline, and opioid systems. Meta-analyses suggest that antidepressants are superior to placebo for the treatment of chronic non-cancer pain, resulting in moderate symptom reduction.