Permanent End To Chronic Pain

MindBody Matrix Pain Cream

MindBody Matrix Pain Cream is a pain relieving product created by a pharmacist known by the names Dr. Tk Huynh. The product is composed of a botanical blend including 9 calming elements such as Aloe Vera, Arnica, Calendula Oil, Boswellia, lavender, and lemon balm to name just a few. In addition to these calming ingredients, MindBody Matrix Pain Cream also has powerful neurotransmitter supporters in the name of GABA and L-theanine. The cream has no harmful side effects, requires no surgery, medication or any pill to function, and lastly, it does not have unpleasant menthol smell like the majority of pain-relieving creams. Despite the fact that the product is proven and backed by piles of scientific research, its effectiveness depends on your efforts and patience. At first try, the product may fail to yield any tangible results; therefore, you need to exercise patience as you apply the cream over and over again. It doesn't guarantee results also, and it can be risky to purchase it online where shipping is applied. Regardless of a few cons, the MindBody Matrix Pain Cream works perfectly, and the manufactures even go an extra mile to provide two bonuses including 60 seconds video with stretches and 3 methods of eradicating inflammation. Read more here...

MindBody Matrix Pain Cream Summary


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Transition From Acute To Chronic Pain Anxiety To Depression

The laboratory findings of a one-to-one correlation between the intensity of short-lasting, noxious stimulation and reported pain do not hold true for chronic pain. With most chronic pain patients, the intensity of the pain is not correlated with the intensity of the wound or lesion. The psychological or emotional significance of the pain may be the primary determinant of its perceived intensity. Even acute pain is not a simple matter of stimulus intensity in the clinical situation. Beecher (1946, 1959) observed, on the Anzio beachhead during World War II, that wounded soldiers did not typically report pain as they waited to be removed from the battlefield, in spite of gunshot and shrapnel wounds that eventually may have needed major surgery, amputation, and long-term convalescence. He contrasted the wounded soldier's mild euphoria with similarly injured civilians in a hospital emergency setting, who typically expressed considerable pain and suffering. The soldier knew he was going...

Management Of Chronic Pain

The proper management of the patient presenting with chronic pain includes a proper diagnosis followed by the most effective therapeutic strategy. This requires knowledge of the aetiology, mechanism, pathophysiology and symptomatology of the various pain syndromes, and the availability of the various modes of therapy. In most cases, success will depend on multidisciplinary collaboration (Working Party on Management of Severe Pain, 1988). Sternbach (1968) pointed out the importance of determining whether there are treatable psychological or physical abnormalities, particularly in chronic intractable pain in which both forms of disorder usually are present. Adequate management of patients with chronic pain requires much time and effort, without which optimal results will be difficult to achieve, and iatrogenic problems may well be produced. In Australia, excellent teaching programmes for doctors, dentists and psychologists in hypnosis, are run by the Australian Society of Hypnosis in...

Clinical assessment of chronic pain

The correct management of the patient with chronic pain is based upon the basic principles of taking a full history and performing a physical examination prior to ordering investigations and initiating treatment. Chronic pain is a specific condition that must be recognized and treated, rather than a diagnosis of exclusion because nothing else will account for the pain. Patients' symptoms may previously have been dismissed listening and understanding are as important as any prescription.

Hypnosis And Chronic Pain Management Useful Clinical Strategies

The typical chronic pain patient will be taking several medications, and will have been treated unsuccessfully by several specialists before considering hypnosis. These may have included neurologists and (neuro)surgeons ('when in doubt, cut it out'), manipulative procedures by orthopedic and chiropractic specialists ('when in doubt, pound it out'), physical therapists ('when in doubt, walk it out'), mental health professionals ('when in doubt, talk it out'), and extensive pharmacological intervention ('when in doubt, medicate'). For these patients, the demand, 'hypnotize me and get rid of my pain', is often an invitation to failure. When the burden of cure is abrogated to the implicit magic of the technique, any initial attempt to use hypnosis at best would be unsuccessful, and at worst, would precipitate an early termination of the therapeutic encounter. Most pain patients have been unable to accept their current reduced functionality, and angrily demand to be helped 'return to the...

Paul J Christo and Peter S Staats

A multidisciplinary diagnostic effort by a trained team best serves patients suffering from chronic pain. After reaching a diagnosis, the team can determine the best strategy to treat the underlying disease and the pain. Chronic Pain t the spine), and zygapophyseal (facet) joint abnormalities. We can also use oblique x-rays to expose the neural foramina and flexion extension views to assess spinal stability. Because this diagnostic tool is noninva-sive, most people with chronic pain accept it readily. Several classes of analgesics are effective in chronic pain. They should be considered as tools in a toolbox, however, not as a list of medications that must be tried prior to initiating interventional therapies.

Neurophysiological Evidence For Hypnotic Analgesia Effects

Hypnosis is one of the best documented behavioral interventions for controlling acute and chronic pain in adults and children (for reviews, see Barber & Adrian, 1982 Chaves, 1989, 1994 Crawford, 1994a, 1995a,b Crawford, Knebel & Vendemia, 1998 Crawford, Knebel, Vendemia, Horton & Lamas, 1999 Evans, 1987 Evans & Rose, chapters 18a, 18b this volume Ewin, chapter 19 this volume Gardner & Olness, 1981 Hilgard & Hilgard, 1994 J. R. Hilgard & LeBaron, 1984). The reader is referred to two special issues (October 1997 January 1998) on 'Hypnosis in the Relief of Pain' in the International Journal of Clinical and Experimental Hypnosis (Chaves, Perry & Frankel, 1997, 1998). This section will address (a) recent advances in the understanding of the neurophysiology of pain relevant to our understanding the effectiveness of hypnotic analgesia interventions and (b) neurophysiological studies of hypnotic analgesia. Furthermore, of particular relevance to clinicians, we documented the development of...

Relieving Chronic Severe Pain

Subcutaneously, intramuscularly, IV, and rectally in the form of a suppository allows tremendous versatility. Medication for chronic pain should be scheduled around the clock and not given on a PRN (as needed) basis. Most patients with cancer can be treated with 30 to 60 mg morphine orally every 4 hours. The oral route is preferred as long as the patient is able to swallow or can tolerate sublingual administration. Respiratory depression is less likely to occur when the drug is given orally.

Difficult pain problems

Patients in whom there is evidence of regular opi-oid use preoperatively, for example drug addicts, cancer and chronic pain patients and those patients with a previous bad pain experience, will pose a particular problem postoperatively. They are best managed using a team approach that will include

Table 151 Characteristics of different pain types

Assessing the pain type and characteristics requires an adequate history and physical examination. In addition, any medical risk factors should be well understood. Table 15.2 gives general inclusion and exclusion criteria for intraspinal opioid therapy. The patient should have progressed to level 3 of the World Health Organization (WHO) pain ladder (Table 15.3) and should have demonstrated opiate responsivity.19 Psychological assessment has become an important part of ongoing management for chronic pain patients as well as an integral part of selection for implantable therapies. The question asked of the neuropsy-chologist or psychiatrist is whether any untreated psychosocial problems exist that might lead to a bad outcome from the therapy. The question of whether a patient is a candidate for implantable therapy is answered by the implanter, generally not by the psychologist. However, certain psychiatric diagnoses such as psychosis or conflicting motives and expectations may lead to...

Pain Stress And The Immune System

Most data describe the physiological effects of acute pain. We know much less about the physiological effects of chronic pain. On the other hand, the effects of chronic pain on psychological health are well known. Chronic pain produces depression, anxiety and fear. These adverse psychological consequences affect the person, the family, and, because of the great costs of medical and social care, all of society. To treat chronic pain, which has such devastating psychological and social effects, we must use all the techniques at our disposal, but we often fail to do so, producing the tragedy of needless pain. (Melzack, 1990)

Flexibility In The Hypnotic Management Of Pain

Hypnosis frequently contributes to anxiety reduction but this effect can be distinguished from pain reduction. Anxiety is strongly associated with pain but separate from it a person in acute pain will often be anxious whereas chronic pain is usually associated with depression. Benzodiazepine drugs have been shown to reduce pain by relieving anxiety but they do not affect the pain threshold or the physical sensation of pain. Pain tolerance is something beyond sensory pain and suffering so that, in some cases, hypnosis substitutes for a tranquillizer rather than acting as an analgesic.

Pain Management Centers

In recent years, anesthesiologists have become involved in pain management of persons suffering from intractable pain. Anesthesiologists who specialize in pain management are physicians who have received additional training in this area after completion of anesthesiology training. According to the American Board of Medical Specialties, certification in pain management recognizes that these physician anesthesiologists have demonstrated competence to provide a high level of care either as a primary physician or as a consultant to patients experiencing either acute or chronic pain. Table 4-10. Impact and Extent of Chronic Pain Number of Americans who have chronic pain Most common types of chronic pain that physicians treat For others, chronic pain defined as that which no longer serves a biologically useful function is terribly debilitating and, according to researchers, can actually change the wiring in the brain, spinal cord, and nerve cells by triggering the release of proteins that...

Treatments for lumbar disc degeneration

While arthrodesis often successfully relieves pain with an acceptably low rate of complications, it can also cause mechanical stress that may lead to degeneration of adjacent vertebral levels and joints, with consequent motion problems. There are also limitations with respect to restored function. The results of arthrodesis are significantly worse for patients who have had prior spinal surgeries 51 . Overall, despite almost 80 improvement in the short-term follow-up for large case series 52-54 , a longer-term follow-up of patients up to 10 years demonstrated high rates of pain, medication use, and further surgery 55,56 . A systematic review of 47 different nonrandomized studies revealed that roughly two-thirds of patients had successful (usually defined as absence of reoperation, removal, or revision) spinal fusion (range 16-95 of patients). The two most common complications were failed fusion (i.e. pseudoarthrosis, 14 ) and chronic pain at the bone graft donor site (9 ) 57 .

Psychological assessment

An assessment of mood is important and frequently reveals evidence of depression. This may be related to the pain itself, but is also associated with frustration or anger at many previous attempts at treatment or the failure of treatment, lack of a clear diagnosis or disease, and loss of social and financial status. These are all common with chronic pain. The assistance of a psychologist is invaluable to explore emotional issues associated with, or caused by, the pain. Wherever possible, patients should be seen with a partner in order to assess independently the degree of physical and emotional disturbance at home and with the family. Depression is a normal human response to an uncertain future full of pain.

Hall Drill And Saline Coolant

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S.A., a 38-year-old teacher, was admitted for surgery for degenerative joint disease (DJD) of her right temporomandibular joint (TMJ). She has experienced chronic pain in her right jaw, neck, and ear since her automobile accident the previous year. S.A.'s diagnosis was confirmed by CT scan and was followed up with conservative therapy, which included a bite plate, NSAIDs, and steroid injections. She had also tried hypnosis in an attempt to manage her pain but was not able to gain relief. Her doctor referred her to an oral surgeon who specializes in TMJ disorders. S.A. was scheduled for an arthroplasty of the right TMJ to remove diseased bone on the articular surface of the right mandibular condyle.

Vertebroplasty and Kyphoplasty

Overall, vertebroplasty appears to be a reasonable method by which to treat a symptomatic vertebral compression fracture that has failed to respond to time-limited conservative care. Certainly, in a patient with multiple levels and significant debility, this may be the procedure of choice. However, a potential theoretical limitation of vertebroplasty is its inability to address the aspect of persistent deformity, which is accompanied by a theoretical increased risk of adjacent segment degeneration, or possible fracture, as well as chronic pain related not to the fracture per se but, rather, to the postural concerns raised by deformity.

Transcutaneous electrical nerve stimulator TENS therapy is helpful in some cases

Invasive intervention should be contemplated when there is a failure of conservative therapy and there is a radiographically demonstrable anatomic defect that could explain the pain, or when malignancy or infection cannot be excluded with noninvasive techniques. The timing of surgery is critical it should rarely be performed before 2 months of conservative therapy (except in circumstances noted above that require urgent intervention, such as persistent or worsening neurologic deficit). However, a delay of more than 6 months can lead to the development of a chronic pain syndrome and decrease the likelihood of a good surgical outcome. Types of surgical intervention include the following E. Chronic pain arises from a failure of standard therapy, and patients with this problem are a very difficult group to treat. A subset of this group has fibromyalgia, and these patients are identified by poor sleep, fatigue, and widespread pain and tender points. They may respond well to low doses of...

Intervertebral Discs in Spinal Pain

Theories for the exact pathophysiology of the pain mechanism abound, but most revolve around pathological tears of the posterior annulus of the disc and mechanical or chemical stimulation of noci-ceptive fibers located in and around the posterior annulus fibrosus and relayed through the sinuvertebral nerve. The present therapy for persistent axial back pain begins with conservative pain management regimens including elements such as rest, physical therapy, anti-inflammatory agents and analgesics, epidural steroids, chiropractic, and acupuncture. Patients who report persistent and debilitating pain after a 6-month course of conservative measures would be considered to have chronic pain and would be candidates for more aggressive intervention.

The Pathophysiology Of Pain Production

The sensation of pain represents a complex series of events designed to protect the central nervous system (CNS). The integration of multiple components of the neuroaxis begins with activation of specific nociceptors, signaling potential injury to sensory fibers and potential damage to the CNS. This type of neuropathic pain is considered maladaptive, yielding harmful sequelae. Nocice-ptive pain is, however, more of a warning to the rest of the body, indicating some form of injury, signifying that further investigation and action is warranted (5). Nociceptors are not specialized pain receptors, but rather they are simply bare nerve endings in the periphery. In 1965, Melzack and Wall first described the gate control theory of pain, which integrates the anatomic pain pathways and several psychological pain models (6). The gate control theory of pain proposes a neural mechanism in the dorsal horn of the spinal cord that acts like a gate, blocking or allowing the transmission of pain...

Cervical and Thoracic Epidurography and Epidurolysis

Similar symptoms in the cervical and thoracic spine can be safely treated by means of epidurography and epidurolysis. Cervical disc disruption, degenerative disc disease, spondylosis, and postherpetic neuralgia are all capable of producing epidural fibrosis and chronic pain. The pain pathologies that accompany these syndromes can be identified by epidurography and effectively treated by epidurolysis. It is generally held that cervical and thoracic procedures respond exceptionally well to this approach (Figures 10.14 and 10.15).

Proximal Adductor Injury

Obturator Externus Tear Mri

Routine myotendinous muscle strains of adductor complex should be differentiated from acute or chronic bone-tendon interface injuries (ie, insertional avulsion) or tenoperiosteal injuries (Figs. 15, 16). These latter type injuries are probably sources of chronic pain that do not resolve and more likely associated with chronic groin pain or athletic pubalgia 16 .

Hypnotizabilityand Clinical Populations

Although some investigators have reported a relationship between high hypnotiz-ability and good outcome with hypnotic treatment the results have not been uniform among all disorders. Hypnotizability has been related positively to the degree of improvement in chronic pain problems, psychosomatic conditions such as asthma, and various dermatological conditions (Hilgard, 1975) and dental phobic disorders (Gerschman, Burrows & Reade, 1987).

Graham D Burrows and Sandra G Boughton

Depression is a frequently occurring disorder with estimates of the lifetime risk for Major Depressive Disorder varying from 10 to 25 for women and from 5 to 12 for men. Significant levels of depression are also associated with many other major disorders, such as chronic pain. There appears to be a widespread assumption that hypnosis has no role, indeed is inappropriate, in the management of depression. In Australia, over the past 10 years, material presented for examination by the Australian Hypnosis Society or for publication in the Australian and New Zealand Journal of Hypnosis has not included any detailed description of clinical or experimental work on the use of hypnosis in the treatment of depression. The understanding has been that expert opinion regards hypnosis as contraindicated for the management of individuals presenting with depression. It would seem that the situation has not significantly changed since Burrows (1980) concluded that

Outcomes After Laparoscopic Adhesiolysis

Adhesions are a common sequela after abdominal surgery and may also form after intraabdominal inflammatory diseases. Adhesions are an important etiology of acute or chronic intestinal obstruction or even chronic pain, and must be suspected as a leading cause of abdominal pain whenever the patient has undergone previous abdominal surgery. Ray et al.1 reported an estimated 303,836 hospitalizations for adhesiolysis-related procedures in the United States in 1994. Although this frequency may herald the importance of adhesions leading to hospitalizations or surgery, primary adhesiolysis was required only in 19 of all cases.

Vertebral Fractures And Vertebroplasty

Planar bone scintigraphy is useful in predicting pain relief from percutaneous vertebroplasty in patients with osteoporotic vertebral fractures (31). Current vertebro-plasty practice includes the evaluation of patients with chronic pain who have multiple fractures of uncertain age. In many patients the physical examination does not reliably identify the fracture that is responsible for the pain. Maynard et al. (31) used planar bone scintigraphy to guide patient selection for vertebroplasty. Significant pain relief was noted in 26 of 28 treatment sessions.

Compression Fractures

Thoracic Vertebral Compression Fracture

History In most cases, the patient can recall the exact moment he or she developed symptoms. In the acute phase, the fragments may compromise nerve fibers in the central canal or foramen, causing pain that may be severe, disabling, and lasting up to 6 wk. When the pain extends beyond 6 wk this indicates poor healing, and the patients may experience a persistent dull ache. With movement the pain is aggravated and may become excruciating. Additional fractures or refracturing of the initial injury may occur (24). Fractures may result in loss of height, kyphosis, and chronic pain. In the chronic phase, bone overgrowth with remodeling into the posterior or lateral canals can compromise the lateral recesses, central canal, or foramen.

Herpes Virus Infections 51 Varicella Zoster

Because PHN is often refractory to treatment, efforts have been directed toward prevention using antivirals and corticosteroids. Five controlled trials have evaluated the use of corticosteroids to prevent PHN. Two studies showed a benefit, but the other two did not (86). The fifth study was done in 208 persons over age 50 with localized zoster of less than 72 h duration. Treatments included acyclovir, 800 mg, five times a day for 21 d, and prednisone, starting at 60 mg d, with a taper over 21 d. Four treatment arms include acyclovir and prednisone, acyclovir alone, prednisone alone, and placebo. The acyclovir-plus-prednisone group showed accelerated time to cessation of acute pain, time to uninterrupted sleep and time to return to daily activities (90). Of note, no effect on chronic pain at 6 mo was observed. The new antivirals, famciclovir and valacyclovir, also show significant reduction in the duration of zoster pain in placebo-controlled trials (88,91). However, 20 of patients in...

Advanced Workshop Approved And Acceptable By Aschandsceh

Four months later, an advanced workshop in Clinical Methods in Hypnosis and Psychotherapy Integration and Applications is offered. The art of psychotherapy depends on the individual therapist as well as his or her individual patients. The advanced workshop as given is different from the workshops usually given in annual meetings of the National Constituent Societies of the International Society of Hypnosis. Usually an intermediate workshop is given to further one's experience with deepening techniques and using hypnosis in more complicated clinical cases, before advanced workshops in treating specific syndromes such as chronic pain, cancer, post-traumatic stress disorders, sexual problems, anxiety disorders, and dissociative identity disorders (formerly Multiple Personality Disorders) are presented. My own advanced workshop, presented here, shifts the emphasis from the problems of the patient client to the professional development of the therapist. Let us examine what an 'ideal'...

Side Effects and Complications

Technical problems due to the limited life of batteries. The most important problem the Leuven-Antwerp team was confronted with initially was the battery power source of the stimulation devices. It needed to be replaced surgically every four to twelve months. This kind of surgery can be undertaken as outpatient treatment and under local anaesthetic, but puts the patient at risk of infections and can damage the extension cables. In patients 7, 9 and 10 the amplitudes employed approached the level of amplitudes used for the electrical brain stimulation in movement disorders and chronic pain. However, it is too early to state that the battery problem has been solved. On the other hand, Medtronic Inc. has built a stimulator with a rechargeable battery, which is being tested in patients with chronic neuropathic pain, and which could be recharged by wearing a belt now and then for a period of


Hypnotic interventions have been particularly successful in managing both acute and chronic pain, reducing the need for medication and improving the quality of life in many ways. Hypnotherapy for burn patients can influence the immune response to the degree that there is no need for antibiotics, and a life-saving reduction in the need for fluid to retain blood pressure. From the psychological


Cannabis has been used medicinally, especially as a mild analgesic and tranquillzer, but more effective and reliable agents replaced it, and even controlled prescribing was discontinued. In recent times, cannabis has been shown to have valuable anti-emetic properties, which help to reduce the side-effects of nausea and vomiting caused by cancer chemotherapeutic agents. This activity stems from THC, and has resulted in some use of THC (dronabinol) and the prescribing of cannabis for a small number of patients. A synthetic THC analogue, nabilone (Figure 3.53), has been developed as an anti-emetic drug for reducing cytotoxic-induced vomiting. Some of the psychoactive properties of THC, e.g. euphoria, mild hallucinations, and visual disturbances, may be experienced as side-effects of nabilone treatment. Cannabis has also been shown to possess properties which may be of value in other medical conditions. There is now ample evidence that cannabis can give relief to patients suffering from...


The injured athlete often reduces the dislocated finger. If not, usually gentle traction will suffice to reduce the subluxated PIP joint. Reduction of a true dislocation requires reproduction of the original angle of injury to realign the joint surfaces and traction on the middle phalanx with volarly directed pressure at its base. Regional blocks, muscle relaxants, finger-trap traction and arm-loaded countertraction facilitate the difficult reductions, unless there is a hindering soft tissue entrapment. The ease of reduction is proportional to the quantity of intact ligament and inversely proportional to the size of the fragment. Fragments greater than 40 of the base herald instability. Joint congruity takes precedence over anatomic reduction of the fracture, for the subtlest incongruities may lead to chronic pain, degenerative changes, and ankylosis. The goal is stable, smooth, and pain-free range of motion of the affected joint. This may be surprisingly difficult to attain.


Acrylic cements have been used for the augmentation of weakened or partially destroyed bones for decades (63). The term vertebroplasty originally described an open surgical procedure that introduces bone graft or acrylic cement to mechanically augment weakened vertebral bodies. Polymethyl methacrylate (PMMA) is the acrylic most commonly used as a bone filler. The first image-guided percutaneous vertebral augmentation or percutaneous vertebroplasty (PVP) was performed in France in 1984, when Deramond and Galibert injected PMMA into a C2 vertebra that had been partially destroyed by an aggressive hemangioma (64). The procedure relieved the patient's chronic pain. Shortly thereafter, PVP was used to treat vertebral compression fractures caused by osteoporosis (65). The interest in PVP has continued to grow since its introduction in Europe and its subsequent introduction in the United States (66). In 1993, the first vertebroplasty procedure in the United States was performed at the...


Pain is defined in terms of acute and chronic. There is no precise definition of pain, which is often loosely defined as an unpleasant sensory and emotional experience, and typically includes psychosocial experiences such as the patient's culture, prior pain experiences, and to some degree the patient's motivation. Acute pain is a natural physiologic response designed to remove the subject from harm, and generally resolves as the offending stimulus is removed. Chronic pain is defined in a variety of terms, but typically is defined as a pain that continues for more than 1 mo beyond the usual recovery period for an illness or injury. Obviously in the setting of a chronic condition, pain may last for months or years. Pain represents the single most common reason for seeking medical attention. More than 50 million people in the United States suffer from severe chronic pain, and an additional 25 million people experience acute pain from injuries or surgery (1). Each year, more than 4...


Therapeutic magnets or pulsed magnetic fields are offered in numerous forms, including magnetic jewelry, magnetic insoles, shoes, mattresses, wraps, and devices to provide pulsed magnetic fields. Magnets are variously advertised on websites and in printed advertisements to prevent, reduce, or relieve pain and stress, thereby warding off problems such as headaches, hypertension, gastritis, arrhythmias, depression, fatigue, arthritis flairs, and immune deficiencies. Pulsed magnetic fields also reportedly help by improving oxygenation of tissues, improving circulation, reducing pain (including acute pain, chronic pain, wound pain, pain from cramps, and pain from burns), slowing the aging process, and enhancing energy levels. One website describes a pulsed magnetic field device that will give the user more energy


The MEDLINE database via PUBMED was searched for English literature published since 1990. The MeSh terms adhesiolysis and surgery were used for the search. All abstracts found in the literature were evaluated. Individual case reports and small case series (less than 30) were excluded. Included were all other case series, case-control, cohort, or randomized studies. Studies were separated in two groups Surgery for chronic pain and surgery for intestinal obstruction. If the pain was caused by intestinal obstruction, the study was included in the obstruction group. The overall quality of the studies is low, thus all conclusions should be drawn cautiously. Most studies are retrospective2-8 or prospective9-11 case series. Because difficult cases would be biased toward conversion to laparotomy (or were primarily operated on using an open method), a valid comparison between the laparoscopic and conventional approach is actually not feasible analyzing the available data. In addition, the...


Is laparoscopy justified for chronic abdominal pain not related to bowel obstruction If diagnostic laparoscopy is performed for chronic pain, a pathology is found in a high percentage of patients in some nonrandomized studies, in which authors suggest that the pain score is markedly reduced after surgery or even completely diminished in almost 50 .22-24 Patients in these reports are likely a highly selected group. The value of adhesiolysis was questioned by only one randomized trial.13 In this study, if a patient was thoroughly explored by a diagnostic laparoscopy and a pathology excluded, then additional adhesiolysis did not improve long-term outcome. Thus, it remains controversial whether surgery of any type (laparoscopic or open) should be performed for chronic abdominal pain.


There are many treatments for chronic pain such as physical therapy, massage, chiropractic, electrical therapy, nerve injections and blocks, implantable pain devices, neuromuscular conditioning, biofeedback, and group and individual psychotherapy. People who suffer from chronic pain need a relaxing, comforting environment in which to receive medical treatment. Lighting is especially important. All attempts should be made to do away with 2-x4-foot fluorescent lighting in favor of indirect lighting around the perimeter of the room or from wall sconces or other semiconcealed sources.


Morphine is commonly used in the management of acute pain and has a major role in control of chronic pain. In the latter, it is frequently taken orally the dose might start at 10 mg every 4h, but eventually range up to 2000mg per 24h in some patients. Large daily doses are conveniently given as a long-acting sustained-release preparation once or twice a day depending on the formulation. Additional breakthrough doses of morphine solution or immediate release tablets, usually 10 of the total daily dose, are made available for extra or in tramadol, codeine or dihydrocodeine are commonly prescribed for chronic pain. They have the same effects and side-effects as morphine but the maximum analgesic effect is limited.


It is unusual for patients to present with chronic pain without distress or depression. This is often as a result of the frustration of limited activity and many failed attempts at treatment. Psychologists are essential in helping to overcome these problems. Common obstacles to coping with chronic benign pain are


Back pain is the most common pain complaint resulting in physician office visits. Most back pain resolves spontaneously with conservative treatment, although in some patients, pain persists, and the condition is termed chronic.1 The intervertebral disc has long been thought to be one source of chronic back pain, and in recent years the concept of a disco-genic pain source has become well accepted. Internal disc disruption is now thought to be causative in a large number, if not the majority, of instances of chronic low back pain.2-4 While some patients' symptoms and functional capacity will respond to aggressive conservative measures (rest, epidural steroids, physical therapy), these measures will fail in others. Surgical treatment for these patients, including interbody fusion techniques, has yielded mixed results in management of chronic pain and carries the risk of morbidity at surgery.5-10 In addition, inter-body fusion changes the mechanics of the weight-bearing spinal segment,...

John C Oakley

Drug Delivery Pump

The programming unit is essentially a laptop computer, printer, and a programming wand, as illustrated in Figure 15.3. The programming wand establishes a two-way radiofrequency link with the implanted pump. The programmer transmits interrogation and programming signals to the pump and receives information from the pump. This capability has established the implantable, programmable pump as the ideal approach for patients with chronic pain.

Pain Disorders

We may therefore hypothezised that the hypocretin system interacts with acute or chronic pain disorders. CSF hypocretin-1 was measured in only few central pain case reports in the literature with result within the normal range.11,14 However, no lumbar puncture was performed during asymptomatic and symptomatic episodes. The relationship between central pain disorders (including migraine and cluster headache) and the dysfunction of the hypocretin system remains to be determined.

Acupuncture needles

Ancient Japan And Medicine

Menstrual pain, or to treat chronic medical conditions, such as arthritis or asthma. It is now recommended or prescribed by some MDs or DOs for their patients who have, for instance, nausea from chemotherapy or chronic pain. Auricular acupuncture is also used in conjunction with conventional practices in detoxification programs and in addiction treatment. Table 21.2 shows approved or cleared medical devices that are used in acupuncture, based on searching the public 510(k) database 8 . The acupuncture needle is now defined in regulations as a hospital and general personal use device This change was largely based on a workshop held by the Office of Alternative Medicine (now NCCAM) in 1994 to investigate the current state of knowledge on the safety and effectiveness of acupuncture needles 1 . After the workshop, petitioners filed with the FDA to reclassify acupuncture needles. The FDA agreed to this change, although they did not agree that there was adequate clinical information to...

Psychogenic symptoms

Tlit complain of chronic polyarthralgia or myalgia, which is constant day and night and does not conform to any dear pattern, should raise the suspicion that this may be a somatic presentation of an underlying psychological or psychosocial problem, for which an explanation should be sought. Other clues include lack of objective abnormal clinical findings, such as reduced movement or joint swelling, and the prominence of features such as tiredness, lack of energy, change in mood, sleep patterns or appetite although such features may be the consequence of chronic pain.


Stern and associates (1991) reviewed 134 TKAs in 98 patients with preoperative valgus deformities greater than 10 degrees with an average follow-up of 4.5 years.8 Posterior-stabilized implants were used in the vast majority of cases (118 of 134), and valgus release consisted of release of the lateral structures from the lateral aspect of the femur. Postoperatively, the knees in their series had valgus alignment of 5 to 9 degrees, and a lateral retinacular release for patellar maltracking was required in 76 of cases. The authors reported 91 good or excellent results. However, only 71 were classified as excellent compared to 88 excellent in the standard TKA population.25 Complications included peroneal nerve palsies in 5 knees (3 ), aseptic loosening requiring revision in 3 knees, and one patient with chronic pain requiring revision.

Local Anesthetics

The frequency of administration is variable between institutions and specific patient requirements. Acute painful conditions may require daily lumbar epidural nerve blocks with both local anesthetics and steroids (35). Lumbar radiculopathy and diabetic neuropathy are examples of chronic pain syndromes treated on various schedules, from every other day, to once a week, to every few weeks, and are dictated by the results and the patient's clinical status.

John M Mathis

Percutaneous vertebroplasty is indicated in patients who exhibit pain resulting from vertebral compression fractures (VCFs) that are due to the weakening associated with bone mineral loss secondary to osteoporosis and who are not effectively treated by medical or conservative therapy (i.e., analgesics, bed rest, external bracing, etc.).16,17,21-33 Without PV, chronic pain in these individuals typically lasts from 2 weeks to 3 months.34 The chronic debilitation, limitation of activity, and decline in quality of life resulting from these fractures has been shown to result in depression, loss of self-esteem, and physical impairment. Recent data reveal that vertebral compression fractures are associated with an increased mortality of 25 to 30 compared with age-matched controls.35


The concept of spinal disc internal derangement9 with or without discogenic pain has gained widespread international recognition as a result of research that has correlated disc pathology observed on MR imaging with discography in both lifelong asymptomatic subjects and nonlitigious chronic pain sufferers.5,17,22,40 These investigations have revealed the limitations of MR imaging in the evaluation of spinal origin pain. Sensitivity to MR procedures has been proven to be low in the detection of symptomatic internal disc disruption and annular tears in the thoracic region22 and even worse in the cervical spine.18,19


Although numerous studies have argued the efficacy of epidural steroid injections,10,12-21 many of these trials are flawed in design. Unfortunately, double-blind controlled and randomized studies are difficult to perform in the clinical area. Despite this, there are a number of investigations that provide convincing evidence that epidural steroid injections are effective. Coomes and coworkers showed that epidural injections with anesthetic agents are more effective than bed rest for the treatment of low back pain.16 Burn and Langdon showed improvement in two thirds of the patients at 6 months (complete resolution of symptoms or significantly decreased pain).14 These investigators stratified patients based on age and duration of symptoms and found the best responses when symptoms were less than one year in duration and patient age was greater than 40 years. Heyse-Moore reported 120 consecutive patients who received epidural steroid injections with local anesthetic and found an overall...


Fractures of the hook occur at the base, often as a result of racquet sports or golf. Presentation is with local tenderness and the injury is best visualized on a carpal tunnel radiograph. When diagnosed acutely, treatment in a cast for 6 weeks is appropriate. Left untreated, non-union is common, which may cause chronic pain, ulnar nerve symptoms, or flexor tendon attrition. Treatment is by excision, or ORIF and bone grafting.

Training In Hypnosis

This chapter also reports on preliminary neurophysiological research in the role of opioid and nonopioid neurotransmitters and modulators which may be involved in hypnoanalgesia. Recent fMRI research by the author (Crawford, Knebel & Vendemia, 1998) has certainly found shifts in thalamic, insular and other brain structure activity. Future neuroimaging and neurochemical studies will greatly contribute to our expanded knowledge of how hypnotic analgesia is so effective as a behavioural intervention for acute and chronic pain. The several chapters dealing with painful conditions highlight the differences between acute and chronic pain, and therefore the need for different strategies in their management. Whereas acute pain is best managed by anxiety-reducing strategies, chronic pain requires strategies that deal with effective handling of one's psychological environment. In many cases chronic pain may have no clear organic basis, but secondary gain issues typically exist with the chronic...

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