Towards an Integrative Pain Medicine

Should safe and effective CAM therapies be integrated into pain clinic services Are they cost effective A 2005 survey of 39 US academic health centers found that while 23 offered CAM services (particularly acupuncture, massage, dietary supplements, mind-body therapies, and music therapy), none had written policies concerning malpractice liability or credentialing practices 61 Nothing is currently known of the policy issues regarding integration of such practices in chronic pain centers in...

The Evidence for Prescription Drug Use in the Management of Chronic Pain

Despite significant developments in pharmacological technology over time, very little has changed with regards to drug options for the management of pain. Derivatives of the poppy and the bark of the willow continue to play a prominent role. Cannabinoids have continued to be used as traditional remedies in many parts of the world and, with increasing evidence for analgesic and other therapeutic effects, are now receiving increased attention in Europe and North America 2-5 . The main additions...

Preemptive Preventive Analgesia

As we saw in Chapter 6, the old concept that pain is the end-product of a passive system that faithfully transmits a peripheral pain signal from receptor to a pain centre in the brain like a series of electrical cables is now thoroughly discredited 57 . Basic science and clinical data show instead that cutting tissue, nerve, and bone induces major changes in central neural function that persist well after the cutting has stopped and the injury has healed 48, 50 . The allied idea of it being...

Define An Optimal Vision of the Organization of Services

Just as marketing and business plans are defined in the commercial sector, it appeared critical for our undertaking to properly define an overall vision of the desired organization of services. This vision took the form of an operational document entitled, Programme national d'evaluation, de traitement et de gestion de la douleur chronique param tres d'organisation, 1er mars 2006,3) which is summarized on the following pages. It should be noted that this document takes into account the work...

Common Pain Conditions

Pain may be divided into different types, depending on the underlying mechanisms. It may be musculoskeletal if it arises from muscles, bones, or joints. It may be visceral if it arises from hollow organs within the body, such as the gut. It may be neuropathic if it arises from damaged nerves or nerves that are not functioning normally. In practice, most pains are a mixture often involving more than one mechanism. This may be seen in spinal pain, which often presents with both a musculoskeletal...

Health System Organization

Boothroyd Two healthcare systems, the national healthcare system in France and the Veterans Administration in the United States, have successfully reorganized pain services into integrated systems of care for this population. Common structural features include a hierarchy of services, primary care services for timely diagnosis and treatment, a gradation of specialized services including comprehensive multidisciplinary care, and education programs. Common process...

Prepare an Operational Plan to Progressively Systematically and Carefully Implement The Vision and Selected

The operational planning exercise was carried out based on the following development strategy 1. Gradually deploy each link in the chain of services, beginning with the creation of the centers highest in the hierarchy. 2. Establish formal ties from one link to the next. 3. Deploy the means designed to enhance program effectiveness and efficiency and continually improve it. This planning also required the contribution of the following stakeholders in accordance with their respective...

Introduction

People in pain are all around us-they speak through literature, in scholarly writing, through visual art and, increasingly, in electronic form on the internet. Too often the individual in pain remains unacknowledged, isolated in a downward spiral of suffering. Common themes ofexperiential accounts emphasize doubt, invisibility, and unpredictability. Confronting lived experiences of pain and these themes directly in health education may promote compassion in health care providers that can...

Natural Health Products

The active components of many natural health products (NHPs) are metabolized by similar pathways to modern medicines. It is therefore important to recognize whether NHPs are being taken, and specifically which ones, and to be aware of potential interactions. While many people appear to take NHPs safely, potential interactions have been identified 54 . For example, non-steroidal anti-inflammatory drugs (NSAIDs) have the potential to interact with herbs that have antiplatelet activity (e.g....

Inform Decision Makers of the Advocated Organizational Parameters and the Relevant Recommendations for Action

Decision makers were informed by means of periodic presentations of the results of the committee' s work to the various hierarchical levels within the Ministry. These presentations served to obtain backing in principle from the authorities for going ahead with the first steps for deploying the program proposed by the advisory committee. Ministry approval came with a request to prepare a strategic plan identifying all the required steps, the entities responsible for carrying them out, and an...

Coping

For most patients with chronic pain there is no cure, so they have to cope with their pain. Some patients seem to cope well despite their pain problem and others clearly do not. Those who cope well may not consult the healthcare system very much, if at all. It is those who appear not to cope well who consult and require 8.6 Why Do Family Physicians Refer Patients to Specialists 97 frequent support and reassurance. There are a number of factors that differentiate good copers from poor copers....

Coordination of Care

Care coordination plays an important role in stepped care, an approach to disease management in which patients progressively receive more complex, specialized and, often, costly interventions according to need 29 . We found little specific information pertaining to this aspect of management of chronic pain in the documents reviewed from France. In the VHA, an Office of Care Coordination was established in 2003 to support system-wide implementation of case management and to ensure the right care...

Policy Strategies Post Licensure

Post-licensure education, in the form of in-service education provided by hospitals and other agencies, is also determined by a number of influences. While far less formally regulated than pre-licensure education, these policy elements need to be understood to create the best possible strategies to enhance health professionals' knowledge of pain management. Knowledge of assessment and management strategies needs to relate to the diversity of pain issues, including persistent problems. Like...

Proposed Systems Level Changes

In a universal health care system that is free at the point of delivery, like that of Canada, disparities in management of comorbid chronic pain and psychopathol-ogy may contribute to excess morbidity and healthcare spending. Further research into the association between pain and psychopathology may eventually contribute to remedying such disparity. Advocating for increased efforts in psychopathology screening and management in pain clinic settings, and for optimal pain management in mental...

Recent Studies

An updated search conducted in 2007 identified 21 additional studies that passed an initial screen similar to that used for the Ospina and Harstall 3 review, prompting the suggestion that an update is advisable. Here we present the results for two large scale international surveys to support the contention that country culture may be a major determiner of CP prevalence. Breivik and colleagues 21 conducted a two stage telephone survey about chronic pain across 15 European countries and Israel. A...

Equity

The notion of equity has received considerable attention in the literature, as have discussions relating to schemes and policies designed to erode inequities and inequalities in health status and the availability and accessibility of health services. The availability and accessibility of good quality services for all patients is highly desirable and should form part of the decision-making process. However, a survey of 105 hospitals from 17 European countries showed that only 34 of hospitals had...

References

1 Brennan, F., Carr, D. and Cousins, M. Management, Vol. 16 (eds M. Devor, M.C. Rowbotham and Z. Wisenfield-Hallin), IASP Press, Seattle, pp. 9-18. (2007) Pain management a fundamental human right. Anesthesia and Analgesia, 105 (1), 205-21. B Lebovitz, A., Florence, I., Bathina, R. Hunko, V., Fox, M. and Bramble, C. (1997) Pain knowledge and attitudes of health care providers practice characteristic differences. The Clinical Journal of Pain, 13, 237-43. 2 Sessle, B. (2000) Incoming President's...

Lumbar Sympathetic Block

Lumbar sympathetic blocks with local anesthetics may be used to determine whether a painful lower limb has a sympathetically mediated pain component. Lumbar sympathetic plexus blocks should always be performed with diagnostic imaging to ensure accurate placement. There is possibly a place for lumbar sympathetic blockade in patients with severe peripheral ischemia, rest pain and ulcers. The use of neurolytic agents in such cases is justified as the patients are often not fit enough to undergo...

Inter Discipline and Inter Level Communication

A consistent problem in many healthcare systems is lack of communication, both between healthcare professionals (e.g. between GP and physiotherapist) and between levels of care (e.g. between GP and medical specialist). This problem can negatively impact patient outcomes if diagnostic test results are not received in a timely manner, or if no one is tracking the various professionals a patient has seen, and the treatments tried, when making referrals or treatment decisions. In France,...

Justice and Social Responsibility

The principle of justice and social responsibility requires healthcare providers to act fairly and consider the impacts of medical decisions on society as a whole. This principle requires consideration of the impact beyond the individual patient and health care provider. The World Health Organization and International Association for the Study of Pain have declared that pain is an important factor in health status, regardless of its etiology 21 , and that pain relief is a universal human right...

Multidisciplinary Pain Clinic Treatment 141

12.1 What Constitutes Multidisciplinary Care for Chronic Pain 142 12.2.2 Exercise and Other Physical Modalities 143 12.2.3 Patient Education and Back Schools 143 12.2.4 Multidisciplinary Treatment (but Without Workplace Intervention) 143 12.3.2 Active versus Passive Treatment 144 12.5 Temporomandibular Joint Pain and Dysfunction 145 12.6 Fibromyalgia Chronic Fatigue Syndrome 146 12.7 Unspecified or Mixed Pain Disorders 146 12.7.1 Various Behavioral and Cognitive-Behavioral Treatments 146 12.7.2...

Scope and Historical Context

Historically, pain in children has been misunderstood, sometimes ignored, and even denied 1 . Even relatively recently, the critical importance of recognizing the prevalence and impact of pain in children as well as the multifactorial nature of pain in children still had to be specifically targeted in the research literature 2 . There is considerable evidence that significant negative long.erm physical and psychological effects on children result from inadequately managed pain 3, 4 . Possibly...

Systematic Reviews

The systematic review is a widely used method to synthesize the results of multiple studies in the scientific literature. It includes a comprehensive search, selection of studies using criteria established a priori, critical appraisal of the quality of the selected studies, and pooled analysis, either qualitative or quantitative, of the results. Verhaak and colleagues 1 conducted a systematic review of studies on the epidemiology of CP among adults. The primary aim of the review was to...

Conclusion

Interventional therapies are widely performed for chronic pain, but the evidence for their efficacy is poor, and many of them can cause devastating complications. They appeal most strongly to the patient and clinician who believe that chronic pain is principally attributable to a physical defect in the painful body part but, as we learn more about these conditions, this model becomes increasingly difficult to uphold. These therapies are also often performed as first-line specialist therapy by...

The Advocated Development Strategy

When selecting a strategy for completing its task, the ministerial committee drew on the experience acquired through the development of continuums of services for other client groups within Qu bec ' s network of health and social services. It therefore described its strategy as the made-to-measure application, based on the objective needs of the target patients and the established best practices, ofa project management framework incorporating a continuum of services. This continuum is to cover...

Autonomy

The principle of autonomy requires that patients control decisions about their own treatment. It requires health care providers to fully inform patients of the treatment alternatives, including the risks and benefits. Patients must consent before treatment can take place. Since about 1950, there has been increasing recognition of the importance of patient autonomy, to the extent that some ethicists believe that it should be considered the most important ethical principle 7 . In practice,...

Beneficence

The principle of beneficence places a high value on acting for the benefit of others. The primary focus is benefit to patient, but healthcare decisions may also provide benefits to family members, employers, a variety of others, or even society as a whole, provided that they are also in the best interest of the patient. The most obvious and direct benefit of pain management is the alleviation of suffering, and other benefits may include improved physical, psychological, and social function,...

Role of Compensation Insurance Systems

Besides the influence of personal and workplace factors, broader societal systems also influence pain- related work disability. Individuals experiencing pain that is caused or exacerbated by work activities are often eligible for workers' compensation benefits. Most industrialized nations have some form of workers' compensation or insurance system to assist injured workers. These systems provide wage replacement benefits and payment for healthcare in patients who are unable to perform regular...

Topical Lidocaine Patch

Subequent to initial data suggesting that a topical gel containing 5 lidocaine led to a significant decrease in the pain of post herpetic neuralgia, a topical 5 lidocaine patch has been developed. There are three randomized controlled trials examining the lidocaine patch in post herpetic neuralgia 77-79 and one in patients with a variety of peripheral neuropathic pain syndromes 80 , all have found the lidocaine 5 patch provides significantly better analgesia than a vehicle placebo patch. The...

Chronic Pain and Addictions

Katherine Diskin and Nady el-Guebaly The prevalence of patients with remote or current addiction within the chronic pain population is likely to be in the range of 15 to 30 . This is largely due to lifestyle risks among those with addictions rather than addictions initiated by medical prescription of opioids. There are strong ethical arguments for using opioids to treat chronic pain where it can be done safely. There are well developed strategies that can be employed to safely manage opioid...

The Perspective of People with Pain

Brenda is 52 years old and worked for a number of years as a medical receptionist prior to being involved in a car accident where she was badly injured and was unable to return to work. She experiences back pain and has had multiple interventions including Facet joint injections, physiotherapy and TENS. Her current medication is dihydrocodeine, co-proxomol, buprenorphine (Temgesic) for flare-ups, and diazepam for muscle spasms. Brenda lives with her dog who she credits with keeping her...

Patient Education and Back Schools

For both short- and long-term findings, results tended to favor patient education when compared to placebo or no treatment 6 . Tulder et al. 4 found evidence that an intensive back school program within an occupational setting was more effective than no treatment. However, there is limited evidence for greater efficacy on follow-up when group education is compared to other active treatment, on measures of pain recurrence, pain intensity, pain duration, and duration of sick leave 4, 6 .

Stellate Ganglion Block

Stellate ganglion blocks have been used for the treatment of many conditions, from hay fever, angina, headache, deafness and vasospasm in peripheral vessels to persistent pain in the upper limb. There is no evidence to support the long- term use of stellate ganglion block with local anesthetics in upper limb pain In skilled hands it is a safe procedure, but the side effects can be significant and the patient should be warned regarding the potential for rare but serious or catastrophic...

Continuums of Care

Efforts at reducing long-term disability have focused on identifying patients at risk of developing chronic problems on whom appropriate interventions can be focused 40, 41 . While results have been promising, current methods are of modest accuracy and some at-risk patients remain unidentified 21 . Recognizing that screening tools are underdeveloped, another alternative is to intervene early on all patients. Unfortunately, extensive early intervention leads to treatment being directed to...

Use of Innovative Technology

In the VHA system the use of videoconferencing to deliver clinic follow-up services was recently tested in a small group of 36 consecutive, stable chronic pain patients over a 29-month period 35 . Both patients and staff (a pain medicine physician, a behavioral medicine psychologist and a clinical nurse specialist) completed questionnaires pertaining to their satisfaction with this means of providing pain management. The majority of both groups found it to be a very good or excellent means of...

Problem Medication

FPs recommend and prescribe a wide range of medications for both acute and chronic pain. Some of these have the potential for addiction. Although the risk of addiction is small, a number of patients develop problem medication use. This is exemplified by an apparent loss of control. The patient may begin to use more than the recommended dose and often escalates the dose without any major benefit (see Chapter 15) . Helping these patients manage this situation requires skill and time, often with...

Conclusions

Due to its magnitude as a health problem in the general population, its associated burden, and the viability of modes of intervention (despite their complexity in terms of need for coordination and integration), chronic pain should be considered a priority within healthcare systems. It is clear that appropriate resources are required to support the structures and processes involved in providing evidence-based management of chronic pain and monitoring outcomes. The example jurisdictions we...

Structure

A hierarchy of services is an appropriate structure to assist patients to be treated by the right health professional, at the right time. This structure facilitates stepped care. Primary care structures need to be put in place to provide timely diagnosis and treatment. Among specialized structures it is advisable to have a gradation of services, the most comprehensive type involving multidisciplinary patient care. As highlighted in Chapter 22 of this book, education for physicians and allied...

Elements That Helped to Germinate the Qubec Strategy

Several factors converged and provided an argument for recognizing the importance of addressing the issue of chronic pain in Quebec. First, citizens wrote letters to the Ministry, relating their problems and requesting that action be taken to help them find relief for their pain. These letters sowed the seeds for an early awareness that chronic pain is an issue. This awareness was subsequently augmented by requests from hospitals and clinicians to the Ministry for funding to bring in the new...

Complex Regional Pain Syndrome

The International Association for the Study of Pain has attempted to clarify the diagnosis of complex regional pain syndrome (CRPS). Two types are described type 1, without evidence of nerve injury and type 2 with evidence of nerve injury 25 . This syndrome has been known by a multitude of names (reflex sympathetic dystrophy, Sudek' s atrophy, hand-shoulder syndrome, causalgia to name a few). It is a very distressing and poorly understood condition. CRPS Type 1 may occur following an apparently...

Post Herpetic Neuralgia

Post herpetic neuralgia (PHN) is a condition following an infection with the varicella virus (the chickenpox virus). The acute infection is commonly called shingles. The virus remains dormant in the nervous system following the usual childhood infection (chickenpox). It can re -emerge later in life, more commonly in people over the age of 50, as shingles. The precise reasons for this are not fully understood, but it is thought to be due to decreases in immunity 21 . The infection tends to...

Referral

Within healthcare systems in general, a chronic pain patient who wishes to access a specialist or be admitted to a pain clinic must be referred by a GP. Several management issues arise with the referral process, whether for diagnostic testing or treatment. One relates to the primary healthcare provider knowing when and where to refer a patient. A second relates to timely patient access to the next level of care, which can be problematic. For some types of chronic pain (e.g. back pain, complex...

Dealing with the Evidence

What strategies will help healthcare providers and policy makers appreciate the role of lived experience in effective programming for chronic pain We have identified diverse sources for gaining access to the patient' s voice. What remains is knowledge translation -developing healthcare workers' and policy makers' receptivity to and awareness oflived experience. Knowledge translation strategies make explicit the benefits of the evidence available through qualitative inquiry. For example, the...

Help with Patient Management

Patients with chronic pain can be intellectually and emotionally challenging, even for the most seasoned physicians. Sometimes the family physician needs moral support if they continue to manage the patient in the community. It is important to offer such support to primary care physicians to prevent burnout. Some patient's problems need the skills ofmore than one profession and referral to an interdisciplinary clinic is not only appropriate but essential if progress is to be made.

Trigeminal Neuralgia Tic Douloureux

Trigeminal neuralgia is a unilateral (single-sided) facial pain, which is characteristically a recurrent severe, brief, stabbing pain. It is usually experienced in the area served by the trigeminal nerve. The underlying cause is not fully understood, although there does seem to be an association with a blood vessel being in close contact with the nerve within the skull 19 More recent surgical treatments are aimed at decompressing or moving the vessel away from the nerve. Trigeminal neuralgia is...

Pain Management Strategies

The burden of suffering that pain imposes on individuals, and the enormous costs which societies have to bear as a result, clearly demonstrate that policy makers and health care decision- makers need to adopt a broad, strategic and coherent perspective in determining issues relating to service provision and resource allocation. Fragmented, budgetary-based interventions and programs based on, at best, inadequate evidence do little to alleviate chronic pain and suffering, and also deprive...

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Why Do Patients Consult

Although chronic pain is very common, not everyone with chronic pain consults his or her family physician. Many seem to manage with over-the-counter medications and minimal use of healthcare. Some patients have undoubtedly been bruised by their previous experiences of the healthcare system, particularly if they have not been believed or have been treated dismissively. Patients who do consult do so for a number of reasons. The severity of pain might be the most obvious and important factor, but...

Research on Cam A Matter of Control

It is clear from most systematic reviews that the methodological weaknesses of CAM trials hamper the ability to draw solid conclusions from such work. The gold standard RCT relies on the existence of a credible control group (active or inert placebo) and the fact that the subject, and ideally the investigator, are blinded to the allocation. Such an approach is unquestionably difficult with many CAM treatments, and while methodological issues must not be used as an excuse not to do CAM research,...

Policy Initiatives Internationally

Unrelieved pain is an international challenge. The International Association for the Study of Pain in collaboration with the World Health Organization has established a yearly pain awareness day stating that the relief of pain should be a human right 24 . The United States Congress passed the Decade of Pain Control and Research Bill, beginning in January 2001, which declared adequate pain care research, education and treatment as national public health priorities - 31 - The Canadian Senate also...

Active versus Passive Treatment

For acute whiplash pain there is one large high quality study - 11 that suggests that recommending activity as tolerated, and avoidance of premature physical therapy or immobilization during the first month reduces time to recovery. A systematic review - 12 identified 23 studies ofwhiplash patients choosing a nonsurgical and nonpharmacological treatment. Only one study included multimodal treatment but ten studies compared passive to a more active treatment. In the single study of multimodal...

Basic Science Contributions to Pain Management

The data that emerge from basic science research on pain mechanisms are yielding ever clearer and simplified explanations for what we see in humans and animal models. The landmark Gate Control Theory of Ronald Melzack (Canada- s preeminent scientific pain researcher) and Patrick Wall in 1965 -8 set the stage for theories of pain transmission, and this spurred much research into understanding the nature of pain. Yet, these hypotheses oversimplify the complex mechanisms involved and overlook...

Background

Chronic pain frequently coexists with a range of emotional symptoms, varying degrees of psychopathology and with mental disorders, and may be an associated symptom of a number of psychiatric illnesses. Pain is widely recognized 1, 2 to have both psychological and physical components, and one of the early pioneers of psychiatry, Sigmund Freud, elaborated on the existence of a mind-body connection at a time when it was not widely endorsed 3 . Chronic pain patients with pronounced psychopathology...

Chronic Pain in Elderly Persons

Thomas Hadjistavropoulos and Gregory P. Marchildon The Canadian population is aging and older people have high rates of pain. Pain is poorly assessed and managed in older people. Funding for better pain assessment and management in long- term care (LTC) facilities should be provided Specialized LTC pain assessment and management training should be expanded within health professional curricula. Pain management teams within LTC facilities should be established. Provinces should facilitate the...

Chronic Pain in Indigenous Populations

Cultural perspectives and biases of both aboriginal patients and their non-aboriginal providers create barriers to effective care. Although there is little relevant Canadian data to draw from, best estimates suggest that chronic pain is even more common in the aboriginal community and the Canadian population as a whole. Educate health practitioners to acknowledge and respect the cultural practices and choices of indigenous clients. More data is needed about indigenous communities and about the...

Healthcare Seeking Behavior

Despite the high frequency of pain complaints in workers, management strategies vary considerably. It appears that many sufferers cope independently and do not seek care for their pain. In the Swedish working population, only 5 of individuals experiencing a new episode of back pain sought care for the condition 10 . Within the Alberta survey mentioned above, 12 of people reported doing little to treat or otherwise manage their last episode of back pain 4 . They simply continued their regular...

Consequences of Unvoiced Pain

I did, I felt like a cow or something I just felt less than human almost. Credits There are negative consequences when patients feel they are doubted by their physician and when physicians express distrust of their patients 21 . Physicians, frustrated when treatment isn' t working, can begin to blame the patient and the patient can become angry and withdrawn, understanding that the physician doubts their honesty '22, 23 t Existing social stereotypes about...

Effectiveness

The evidence-base for the effectiveness of interventions and strategies in managing pain is large 36-38 although the issue of what works, where and when remains inconclusive 39-41 . While the evidence base is continuously being updated, incorporating potential new therapeutic areas, interventions and management programs 25, 42-46 , questions remain relating to the quality of studies and their relevance for policy and practice 47, 48 . Further, the nature and extent of adverse events associated...

Intrathecal Medication Pumps

The use of intrathecal (IT) medications delivered from an implanted pump has been advocated in clinical scenarios where other routes of medication administration and other modalities of treatment have failed. This has been regarded as the last chance or last hope care. There is some evidence from case series that IT medication pumps can be helpful but no RCT evidence. These are generally of short.term use (less than 1 year) 44 . Most existing evidence is for patients who have cancer pain. There...

Other Antidepressants

There are several additional chemical groups of anti-depressants. To date, only the serotonin norepinephrine reuptake inhibitors (SNRIs) have exhibited potential as analgesics in randomized controlled trials. The two antidepressants available from this group include venlafaxine (Effexor) and duloxetine. Both are effective antidepressants with strong inhibition of 5-HT and NA reuptake. This balanced neurotransmitter profile is similar to that found with the TCAs. There are six randomized...

Pharmacotherapeutic Considerations

The development of pragmatic solutions and effective protocols for managing chronic pain in the mentally ill is imperative. An integral part of mental health care and pain management is a longitudinal integrated psychosocial focus combined with pharmacotherapy. Considerations for medication management of pain in persons with mental illness include (i) Risk of abuse, (ii) addictive potential of a drug, (iii) the potential of the drug to exacerbate existing psychopathology and (iv) the potential...

Physical Social Functioning

Most patients begin to experience some financial strain. Frequently, the partner will have to increase their working hours to make up any reduction in family income, as well as take on or continue with the responsibility of running the home. This will often put a strain on the relationship. The enjoyment soon disappears from family life. The children and partners often become irritable and the patient frequently feels guilty and misunderstood. Chronic pain patients, as a group, are known to be...

Scope and Context of the Issue

For millennia mankind has sought relief from pain by using medicines. Ancient texts refer to the use of many herbal remedies for pain. In the first century Emperor Claudius' personal physician recorded detailed instructions on the preparation of opium and Galen recommended the juice of the poppy for the relief of pain in older persons. Cannabis was a remedy with known pain relieving effects in use in Ancient China 1 , Persia, India, Egypt, Greece and Rome. The bark of the willow (from which...

First Nations Healing Traditions and Pain

Little is known of the prevalence of the use of herbal medicine for pain among Canadian First Nations peoples. The compounding of herbal preparations is not regulated under the Natural Health Products regulations. The use of healing rituals such as sweat lodges, smudging, pipe smoking, the use of song, sun dances and prayer, the concept of the medicine wheel , and herbs such as sage, sweetgrass and cedar have all been described. It is interesting to note that the use of herbs such as echinacea,...

The Victoria Work Cover Authority Back Campaign Australia 19971999

In 1997 the Victoria WorkCover Authority (VWA), the manager of the workers ' compensation system in the Australian state of Victoria, began a state-wide public health campaign aimed at shifting the general population' s attitudes and beliefs about back pain (henceforth called the VWA Back Campaign). The VWA Back Campaign was developed according to messages in The Back Book, an educational booklet for patients based on the biopsychosocial model 42 . Various unambiguous messages were included,...

Mass Media Campaigns for Back Pain

A summary of the key campaign elements and evaluation strategies of four back pain mass media campaigns are shown in Table 21.1 and are described below. Back pain, don't take it lying down Working backs Scotland Back It Active back Back pain, don't take it lying down Working backs Scotland Back It Active back Vestfold and Aust-Agder counties (325 000) Healthcare provision for the general population Dual system of universal healthcare (Medicare) and private health insurance Dual system of...

Two Jurisdictions That Have Prioritized Management of Chronic Pain

Jurisdictions (i.e. countries, states provinces or specific health systems) differ with regard to how they administer and finance services for patients with chronic pain. In the following section we provide a description of the commitment made to the management of chronic pain in the two example jurisdictions, selected because (i) they have made a clear commitment to chronic pain health services and their quality control (ii) they provide services to all members of a specific region or group...

The Prevalence of Psychopathology with Chronic Pain

Pain is both an emotional and a physical experience, and a range of expected emotional responses to chronic pain may arise, including anxiety, depressed mood, anger, bereavement, frustration, irritation, and isolation. These symptoms may or may not reach the threshold for the diagnosis of a mental disorder. There are a variety of characteristics of patients with chronic pain 7 2. Strong and ambivalent dependency needs 3. Feelings of isolation and loneliness 5. Inability to take care of self...

Pain Voices in Electronic Media

Electronic media allow people with pain and their significant others to share experiences and information across continents and time -zones via the internet. Brenda is an example. Brenda- s story and more than a hundred others are freely accessible from the DIPEx website (www.DIPEx.org). This very rich resource contains audio-video clips of people talking about living with a chronic condition. The viewer can select by type of health condition and or by type of life issue (family, employment,...

Surgical Factors Associated with CPSP

CPSP is more likely to develop in certain circumstances. Long operations 24, 25 , operations performed in centres with a low annual procedure volume 22 , open vs. laparoscopic procedures 26 and operations involving nerve damage 5, 26 are known to pose a greater risk. There are also specific surgical techniques that increase the risk 26, 27 . All of these factors appear to be associated with heightened surgical trauma and particularly with intraoperative nerve injury. Nerve injury is likely a...

Topical Tricyclic Antidepressants and Ketamine

There are preliminary data regarding the effectiveness of topically applied antidepressants for pain. Two randomized controlled trials demonstrated topical doxepin 3-5 is analgesic in a mixed group of patients with neuropathic pain 73, 74 . In a 3 week randomized placebo controlled trial, the concentration of amitriptyline 2 ketamine 1 was not better than placebo 75 however a higher concentration of amitriptyline 4 ketamine 2 was significantly better than placebo in post herpetic neuralgia 76 .

Cannabinoids

The potent anti- nociceptive and antihyperalgesic effects of cannabinoid agonists in animal models of acute and chronic pain, the presence of cannabinoid receptors in pain- processing areas of the brain, spinal cord and periphery and evidence supporting endogenous modulation of pain systems by cannabinoids, provide support that cannabinoids exhibit significant potential as analgesics. Fifteen of eighteen randomized controlled trials examining cannabinoids in the treatment of pain have...