Category Archives: Chronic Pain

Pharmacological Treatment of Pain

While medications are often prescribed for all types of chronic pain, research has consistently shown that several classes have proven efficacy for the treatment of neuropathic pain. Ideally, pharmacotherapy of pain would be specifically selected on the basis of considerations of etiology (e.g., ischemic, neuropathic), pathophysiology (e.g., demyelination, central pain), and anatomy (e.g., C fibers,… Read More »

Selected Chronic Pain Conditions

Postherpetic Neuralgia Postherpetic neuralgia is defined as pain persisting or recurring at the site of shingles at least 3 months after the onset of the acute varicella zoster viral rash. Postherpetic neuralgia occurs in about 10% of patients with acute herpes zoster. More than half of patients over 65 years of age with shingles develop… Read More »

Multiple Sclerosis and Pain

Multiple sclerosis () is a progressive disease. It is characterized by initial destruction of myelin and eventually axons and cell bodies. It can affect any part of the central nervous system (CNS). It is well established that multiple sclerosis is a painful condition. There are varying reports of the incidence of pain such as: •… Read More »

Back Pain — Injections

There are several targets for intervention techniques in the treatment of back pain. There are many nerve pathways implicated in the experience of back pain, and as many enthusiasts for one particular technique as there are uncontrolled reports of efficacy. The treatment of back pain has, however, to be seen in the light of other… Read More »

Back Pain — Medical Management

Low back pain currently accounts for more than half of all musculoskeletal disability; whilst work loss due to back pain in the UK is approximately 52 million days per year. Disability due to low back pain has reached epidemic proportions although there is no evidence for an increase in pathology. The cost of treating back… Read More »

Depression and Pain

Pain and depression may occur concomitantly. Chronic pain may exacerbate depression. Chronic pain may be exacerbated by depression. The relative contribution and effect of each illness can be difficult to determine. Patients may not appreciate being questioned about symptoms of depression when they are consulting about symptoms of pain, but it is valuable to obtain… Read More »

Sympathetic Nervous System and Pain

Peripheral nociceptor activity causes an increase in efferent sympathetic discharge, but under normal circumstances, sympathetic activity has no impact on the discharge of nociceptive neurons. Although there is some debate as to the usefulness of such a distinction, when nociceptors appear to be under the influence of the sympathetic nervous system, pain is described as… Read More »

Post-Amputation Pain

Pain following limb amputation can be of many causes and is said to be an amalgam of post-operative pain, stump pain of nociceptive or neuropathic cause, phantom pain, and other pains related to disability. Careful consideration should be given to cause so treatment can be properly directed. An amputee is said to be ‘established’ one… Read More »

Neuropathic Pain — an Overview

Clinical description The traditional neuroanatomical model of the sensory system for pain fails to explain a variety of pain syndromes that are associated with damage to the sensory nerve, or the pathways through dorsal horn to cortex. Likewise, the gate control model of pain, useful as it is for explaining the modulating effect of large… Read More »

Neuralgia — Trigeminal and Glossopharyngeal

There are now recognized a number of neurovascular compression syndromes of which trigeminal neuralgia () is the best understood. Since this is the one most relevant to a pain practice it is discussed in more detail; of the other conditions glossopharyngeal neuralgia is worth mentioning. Trigeminal neuralgia This is an unusual example of a neuropathic… Read More »