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Pain Management

  • John B. Winfield

Abstract

All too often in office-based practice, treatment of pain is secondary to diagnosis and treatment of the disease state. This is unfortunate because pain, especially chronic pain, is among the most disabling and costly medical problems in Western countries (1). Patients suffering with chronic diffuse pain who lack objective clinical and laboratory findings (e.g., fibromyalgia) frequently are dismissed as not having “real” pain, which only perpetuates their illness. Presence of pain should be specifically sought and evaluated in all patients and, if present, relief of pain should be a primary focus of the physician’s efforts. Indeed, pain should be addressed as a disease entity, not as a sensory entity (2).

Keywords

Chronic Pain Neuropathic Pain Irritable Bowel Syndrome Complex Regional Pain Syndrome Chronic Pain Syndrome 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

References

  1. 1.
    Koleva D, Krulichova I, Bertolini G, Caimi V, Garattini L. Pain in primary care: an Italian survey. Eur J Public Health 2005;15:475–479.CrossRefPubMedGoogle Scholar
  2. 2.
    Siddall PJ, Cousins MJ. Persistent pain as a disease entity: implications for clinical management. Anesth Analg 2004;99:510–520, table.CrossRefPubMedGoogle Scholar
  3. 3.
    International Association for the Study of Pain. Classification of chronic pain. Description of chronic pain syndromes and definitions of pain terms. New York: Elsevier; 1994.Google Scholar
  4. 4.
    Yunus MB. Fibromyalgia and overlapping disorders: the unifying concept of central sensitivity syndromes and the issue of nosology. Semin Arthritis Rheum 2007;36:339–356.CrossRefPubMedGoogle Scholar
  5. 5.
    Diatchenko L, Slade GD, Nackley AG, et al. Genetic basis for individual variations in pain perception and the development of a chronic pain condition. Hum Mol Genet 2005;14:135–143.CrossRefPubMedGoogle Scholar
  6. 6.
    Winfield JB. Pain in fibromyalgia. Rheum Dis Clin North Am 1999;25:55–79.CrossRefPubMedGoogle Scholar
  7. 7.
    Burckhardt C, Goldenberg D, Crofford LJ, et al. Guideline for the management of fibromyalgia syndrome pain in adults and children. APS clinical practice guidelines series, no. 4. Glenview, IL: American Pain Society; 2005:1–109.Google Scholar
  8. 8.
    Keefe FJ, Bonk V. Psychosocial assessment of pain in patients having rheumatic diseases. Rheum Dis Clin North Am 1999;25:81–103.CrossRefPubMedGoogle Scholar
  9. 9.
    Pincus T, Swearingen C, Wolfe F. Toward a multidimensional Health Assessment Questionnaire (MDHAQ): assessment of advanced activities of daily living and psychological status in the patient-friendly health assessment questionnaire format. Arthritis Rheum 1999;42:2220–2230.CrossRefPubMedGoogle Scholar
  10. 10.
    Winfield JB. Psychological determinants of fibromyalgia and related syndromes. Curr Rev Pain 2000;4:276–286.PubMedGoogle Scholar
  11. 11.
    Turk DC. The potential of treatment matching for subgroups of patients with chronic pain: lumping versus splitting. Clin J Pain 2005;21:44–55.CrossRefPubMedGoogle Scholar
  12. 12.
    Goodwin JL, Kraemer JJ, Bajwa ZH. The use of opioids in the treatment of osteoarthritis: when, why, and how? Curr Pain Headache Rep 2005;9:390–398.CrossRefPubMedGoogle Scholar
  13. 13.
    Arnold LM, Lu Y, Crofford LJ, et al. A double-blind, multicenter trial comparing duloxetine with placebo in the treatment of fibromyalgia patients with or without major depressive disorder. Arthritis Rheum 2004;50:2974–2984.CrossRefPubMedGoogle Scholar
  14. 14.
    Sindrup SH, Jensen TS. Efficacy of pharmacological treatments of neuropathic pain: an update and effect related to mechanism of drug action. Pain 1999;83:389–400.CrossRefPubMedGoogle Scholar
  15. 15.
    Crofford LJ, Rowbotham MC, Mease PJ, et al. Pregabalin for the treatment of fibromyalgia syndrome: results of a randomized, double-blind, placebo-controlled trial. Arthritis Rheum 2005;52:1264–1273.CrossRefPubMedGoogle Scholar
  16. 16.
    Bradley LA, Alberts KR. Psychosocial and behavioral approaches to pain management for patients with rheumatic disease. Rheum Dis Clin North Am 1999;25:215–232.CrossRefPubMedGoogle Scholar
  17. 17.
    Lorig KR, Mazonson PD, Holman HR. Evidence suggesting that health education for self-management in patients with chronic arthritis has sustained health benefits while reducing health care costs. Arthritis Rheum 1993;36:439–446.CrossRefPubMedGoogle Scholar
  18. 18.
    Zempsky WT, Schechter NL. Office-based pain management. The 15-minute consultation [review; 65 refs]. Pediatr Clin North Am 2000;47:601–615.CrossRefPubMedGoogle Scholar
  19. 19.
    Ferrell BA, et al. Pain in the nursing home. J Am Geriatr Soc 1990;38:409–414.PubMedGoogle Scholar
  20. 20.
    AGS panel on Chronic Pain in Older Persons. The management of chronic pain in older persons. J Am Geriatrics Soc 1998;46:635–651.Google Scholar

Copyright information

© Springer Science+Business Media, LLC 2008

Authors and Affiliations

  • John B. Winfield
    • 1
  1. 1.Department of MedicineUniversity of North CarolinaChapel HillUSA

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