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Query: UMLS:C0030193 (pain)
 261,466 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

A fundamental aim of the Neurosurgical Unit at Georgia Baptist Medical Center is to enable each individual to return to normal and meaningful functioning. The problem of chronic pain almost always results in a steady decrease in those activities, interests, and concerns which are essential to the normal process of living. When the process is disrupted, the result is usually a feeling of despair and uselessness. These problems will almost inevitably complicate the pain experience. In addition, the ever present stress that accompanies severe and chronic problems of any sort tends to result in related psychological difficulties such as depression, anxiety, feelings of inadequacy and a multitude of other family and personal problems. These difficulties often become major features of an individual's pain problem. A holistic approach to patient care is based on the concept that each individual needs to be considered physically, psychologically and spiritually. The active participation of the psychiatric liaison nurse as a member of the neurosurgical team helps integrate the forces that enable such an approach. By focusing on a thorough patient assessment, improved staff morale and improved well being of patients, the psychiatric liaison nurse assists the team in focusing its energy on total comprehensive patient care. The combination of clinical neurosurgical treatment and psychological care has proven effective in helping our neurosurgical team achieve the fundamental goal toward which we all work.
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PMID:Psychiatric liaison nurse for neurosurgery: an innovative approach to management of chronic pain. 16 40

The challenge of effective management of chronic pain frequently confronts the family physician. Successful management relies on the physician's skill in integrating fundamental concepts in the pathophysiology, psychodynamics, and diagnostic and therapeutic modalities associated with chronic pain syndromes. The use of time-contingent rather than pain-contingent therapy in the prevention of the chronic pain state is advocated.
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PMID:Chronic pain: a review for the family physician. 21 9

According to modern pain concepts, "pain" is the result of multifactorial influences. Planning of therapy therefore requires the diagnostic evaluation of a number of factors including delineation of an organic lesion, evaluation of the influence of pain on the individual's psychological development, situational anxiety, psychological coping style etc. The understanding and management of psychological factors is crucial in every pain syndrome as the idea the pain is either psychogenic or organic is outdated. For the treatment of mild pain salicylic acid is still unsurpassed. The rationale of its combination with a tranquillizer, and with codeine or benzomorphane for moderately severe pain, can be understood on the basis of modern pain concepts. Before strong narcotics are used a trial with combination of a phenothiazine with a tricyclic antidepressant drug is warranted. Methadone seems to have advantages over morphine for very distressing pain treated with narcotics. Biofeedback for pain due to muscle spasms, electrical stimulation of the dorsal column for intense chronic pain due to a well-delineated organic lesion, and operant conditioning applied by a well-trained team of physicians and staff are promising new treatments for pain. The place of acupuncture in future pain therapy cannot yet be judged. It must first be freed of cult-type opinions and evaluated further by studies meeting modern western standards of pain research.
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PMID:Practical problems in the treatment of pain. 23 21

In view of negative experience and the disappointing long-term results, most of the classic surgical methods for treating chronic pain are no longer indicated. Only in cancer pain is dissection of the spino-thalamic tract at the cervical or upper thoracic level frequently helpful. In selected cases the same may be said of rhizotomy. Controlled thermocoagulation of the Gasserian ganglion provides the best results in typical trigeminal pain. Other methods of surgical treatment (e.g. commissural myelotomy, thalamotomy) mentioned in this article are things of the past which are no longer used.
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PMID:[Surgical treatment of chronic pain]. 27 7

The contribution of psychiatry to the evaluation and treatment of chronic pain is described. Psychological profiles may predict the outcome of surgery, while the psychiatric interview enhances understanding and may disclose formal psychiatric disorder. The measurement of pain is dependent on factors affecting pain complaint, and the psychiatrist can only accept the patient's experience. The reaction inhibition test and Chapman's Somatic, Anxiety, Depression (SAD) index provide ways of elucidating the functional versus organic dilemma. This is further understood by attention to the concepts of operant pain, the sick role, and illness behaviour. Psychotropic medications, psychotherapy, behaviour therapy, biofeedback, and distractional methods are the tools available to the psychiatrist. The patient's attitude and a combined physical and psychiatric approach are important for successful therapy.
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PMID:Chronic pain and the psychiatrist. 27 40

We have heard today that psychological factors are extremely important in pain problems and that careful psychiatric assessment should delineate patients who have the potential of achieving good pain relief with interventional procedures. The bulwarks of the neurosurgical management of pain have been peripheral neurectomy, rhizotomy, sympathectomy, and cordotomy. We have heard each of these discussed. Peripheral neurectomy and rhizotomies are not highly successful in the treatment of pain, but are useful in carefully chosen patients. Cordotomy remains an excellent technique for the management of many patients with chronic pain or malignancy, and sympathectomy can be one of the most gratifying operations performed, as long as the patients are well chosen. The major lesson we have learned today is that there is no cure for pain at the present time. Nevertheless, neurosurgical procedures remain an important part of pain management. They should be applied after an adequate diagnosis is made, after psychiatric characterization of the entire pain problem is complete, and only when there is only a definitive pain generator which can be relieved by an interventional procedure. Perhaps the most important message we have heard is the categorization of pain patients given us by Doctor Hendler. It is important that we all identify those patients with affective or exaggerated pain behavior so that interventional procedures are carried out only on those patients who have a real possibility of benefiting from them. I believe if we all do this, we will see a significant increase in the effectiveness of surgical procedures for pain.
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PMID:Colloquium--is there a surgical cure for pain? 28 Apr 26

Patients with chronic orofacial pain must be treated with methods different from those used with patients with acute pain. If different methods are not used, the characteristics of chronic pain may become firmly entrenched. Dentists should be aware of the various methods of treatment for this separate pain entity.
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PMID:Recognition and treatment of patients with chronic orofacial pain. 29 56

A double-blind trial was done using a stimulator and a placebo device on patients who had chronic pain to determine the effectiveness of transcutaneous electrical stimulation in controlling pain. Ninety-three patients were studied, and 83 of these completed the Minnesota Multiphasic Personality Inventory (MMPI). Thirty-three patients had low-back pain and 24 had neuropathies. The stimulator was more effective than the placebo during treatment when used over the center of pain (P less than .005) or over an unrelated nerve trunk (P less than .01) and after treatment over the center of pain (P less than .05). The stimulator was significantly more effective than the placebo in neuropathies when stimulating over the related nerve trunk (P less than .005), where the stimulator response was nearly three times better than that of the placebo. The duration of subsequent relief was not significantly different after treatment with the stimulator or with the placebo device. Follow-up showed significant declines in the use and effect of the stimulator with the greatest decline noted by the depressed group.
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PMID:Transcutaneous electrical stimulation: a double-blind trial of its efficacy for pain. 29 13

Electrical stimulation for the control of pain is now a well accepted therapeutic modality. Transcutaneous application of electrical stimulation is the most common technique employed and has been used to treat chronic pain, acute surgical pain, and acute pain of other origins. Percutaneous application of electricity to the nervous system through needles electrodes is useful in predicting the efficacy of implantable stimulators and has served the same function as diagnostic nerve block. Implantable stimulators have been used for stimulation of peripheral nerves, the anterior and posterior surfaces of the spinal cord, and the brain. Peripheral nerve stimulators are the most efficacious of the implantable devices. They are used specifically for pain of peripheral nerve injury origin. Their use for pain outside the distribution of the nerve stimulated is not yet proved.
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PMID:Electrical stimulation for the control of pain. 30 34

Psychological, neurophysiological and therapeutic aspects of chronic pain are reviewed in the light of recent progress achieved in the respective fields (alpha-feedback training; gate-control theory; transcutaneous electrostimulation; percutaneous stereoactic radio-frequency cordotomy). The efficacy of selective large fibre stimulation has been evaluated in 39 spinal cord injury patients suffering from chronic intractable pain of 6 to 35 months's duration. Stimulation was applied daily for 6 consecutive hours. Pain reflief was assessed by verbal and visual analogue scales and McGill's pain questionaire. After 1 week, total or almost total relief of pain was reported by 49 per cent, moderate relief by 41 per cent and no improvement by 10 per cent of the cases; at a 3-months follow-up the figures were 28 per cent, 49 per cent and 23 per cent respectively.
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PMID:Psychological, neurophysiological and therapeutic aspects of chronic pain: preliminary results with transcutaneous electrical stimulation [proceeedings]. 30 20


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