Federal Regulations For Prescribing A Scheduled Controlled Substance

It is essential that prescribing clinicians understand the federal regulations that address administering, prescribing, and dispensing scheduled controlled substances whether they treat patients in a medical office, a hospital, a long-term care facility, or a hospice setting. This knowledge is necessary not only to reduce diversion and misuse of controlled substances, but also to protect the clinician's ability to provide care while following state and federal regulations in prescribing a...

Introduction

A biopsychosocial understanding of chronic abdominal pain requires integrating the biological processes affecting the pain, both peripheral and central, with knowledge of the contributing psychosocial factors (1). In effect, it is the brain-gut modulation of both enteroceptive (i.e., gut related) and extrinsic (i.e., environmental and stress related) influences on sensation that are unique to the individual. Although nociceptive signals increase with heightened motor reactivity and visceral...

Heat Allodynia and Hyperalgesia in Fibromyalgia Patients

There are pain conditions that, unlike CRPS described above, are characterized by diffuse pains and hyperalgesia over large areas of body. The ability to use the same patients as their own control in establishing hyperalgesia and allodynia is therefore more challenging in these patient populations. An alternative approach is to compare their ratings of experimental heat stimuli to groups of age- and sex-matched control subjects. For example, heat hyperalgesia has been shown to be a prevalent...

Gonadal Hormone Modulation Of Visceral Pain

The preponderance of evidence suggests that females are more sensitive to pain than males and several chronic pain syndromes including IBS, fibromyalgia, and temporomandibular disorders are more prevalent in women than in men 197-199 . Furthermore, nociceptive thresholds are lowest and pain responses highest during periods of elevated estrogen 199-204 , strongly suggesting that sex hormones modulate pain sensation. Several labs have demonstrated that gonadal hormones modulate behavioral...

Viscerosomatic Inhibition

Patients with IBS or other disorders with visceral hypersensitivity report referred somatic hypersensitivity in the dermatomes where referred pain is perceived. However, outside the area of referred pain, as long as there is not a codiagnosis of another ailment such as fibro-myalgia, patients report normal or hyposensitivity to noxious electric and mechanical somatic stimuli 4,126-131 . In contrast, thermal stimulation is more painful in IBS patients compared to controls, although this...

Visceral Pain Is Referred to Somatic Structures

The initial perception of pain from the viscera is described as diffuse pain along the midline of the trunk 3,2 . It is poorly localized relative to the originating tissue. This likely results from the divergent central projection of visceral afferent fibers synapsing with scores of dorsal horn neurons in many segments. As the pain intensifies, it is more clearly referred to somatic tissue. It is perceived as originating from the area of the body that is innervated by somatic primary afferent...

Opioids

Opioids constitute a major class of analgesic to treat visceral pain. Experimentally, within the types of pain discussed in this chapter, studies have focused on two sites of action for opioids, the periphery and the spinal cord. Systemic administration of m or k opioid receptor agonists attenuates responses to noxious stimulation of the colon, bladder, and uterine-cervix. Administration of naloxone methiodide, which does not cross the blood-brain barrier, indicates separate sites of action for...