Chronic Pain

Chronic pain is a pain that lasts> for 3 months or recurs, persisting> 1 month after healing of acute tissue damage or accompanies a nonhealing lesion. Causes include chronic diseases (eg., Cancer, arthritis, diabetes), injury (eg. As herniated disc, torn ligaments) and many primary pain disorders (eg. As neuropathic pain, fibromyalgia, chronic headache). There are various drugs and psychological treatment method used.

Chronic pain is a pain that lasts> for 3 months or recurs, persisting> 1 month after healing of acute tissue damage or accompanies a nonhealing lesion. Causes include chronic diseases (eg., Cancer, arthritis, diabetes), injury (eg. As herniated disc, torn ligaments) and many primary pain disorders (eg. As neuropathic pain, fibromyalgia, chronic headache). There are various drugs and psychological treatment method used.

(Fibromyalgia) Chronic pain is a pain that lasts> for 3 months or recurs, persisting> 1 month after healing of acute tissue damage or accompanies a nonhealing lesion. Causes include chronic diseases (eg., Cancer, arthritis, diabetes), injury (eg. As herniated disc, torn ligaments) and many primary pain disorders (eg. As neuropathic pain, fibromyalgia, chronic headache). There are various drugs and psychological treatment method used. Unresolved, protracted diseases (eg. As cancer, rheumatoid arthritis, herniated disc) that produce constant nociceptive stimuli can be responsible on its own for a chronic pain. Alternatively injuries can even if they are only slightly, to the cerebral cortex-cause permanent changes (sensitization) in the nervous system of peripheral receptors that can produce persistent pain, despite persistent nociceptive stimuli are lacking. By raising awareness complaints may be due to an almost healed disorder that would otherwise be considered easy or trivial, instead, be perceived as a very strong pain. Psychological factors may also enhance a ongoing pain. Therefore, a chronic pain usually appears dysproportional to identifiable physical processes. In some cases (. For example, chronic back pain after injury) of the primary cause of pain is obvious; in other (eg. B. chronic headache, atypical facial pain, chronic abdominal pain) the trigger is vague, or it remains entirely unclear. In most patients, physical processes are indisputably involved in the maintenance of chronic pain and sometimes (z. B. in Malignomschmerzen) the main factor. However, psychological factors often also play even in these patients, a role. Patients who have to prove continuously that they are sick to get medical help or insurance or sick leave, may unconsciously reinforce their perception of pain, especially when litigation is involved. This reaction formation differs from a simulation (, disability benefits z. B. incapacity) is in the conscious exaggeration of symptoms for a secondary gain. Several factors in the patient’s environment (eg. As family members, friends) can reinforce behaviors that maintain chronic pain. Chronic pain can lead to heightened psychological problems (eg., Depression). It is often difficult to distinguish psychological cause and effect. Symptoms and complaints Chronic pain often leads to vegetative signs (eg. As fatigue, sleep disturbances, decreased appetite, loss of taste for food, weight loss, decreased libido, constipation) that develop slowly. Constant, nichtremittierender pain can cause depression and anxiety and affect nearly all activities. Patients may be inactive, withdraw socially and deal excessively with their physical health. Psychological and social disabilities can be severe and cause a de facto loss of function. Some patients, especially those in which no clear-cut cause exists, have a history of failed medical and surgical treatments, multiple diagnostic tests (and repeat examinations), they have received many drugs (sometimes with development of abuse or dependence) have and inadequate recourse against the health system. Diagnostic investigation of physical cause and symptom changes after a physical cause should be self-been looking for when a dominant psychological component of pain is likely. Physical processes associated with the pain should be properly investigated and characterized. However, after a full diagnosis was performed to repeat these tests with no new findings does not make sense. The best approach is often to terminate the investigation and to put focus on pain relief and restoration of function. The impact of pain on the lives of the patient should be evaluated; the examination by an occupational therapist (occupational therapists) may be necessary. A formal psychiatric examination should be considered when a comorbidity with psychiatric disorder (z. B. Major depression) is suspected as a cause or consequence. Treatment often multimodal therapy (eg. As painkillers, physical methods, psychological treatments) Specific causes should be treated. The early and aggressive treatment of acute pain is always desirable and can prevent the sensitization and the remodeling or limit them and thus prevent the development of a chronic pain syndrome. Arzneimittel or physical methods can be used. Psychological therapies, v. a. Behavioral therapy, are usually helpful. Many patients with a marked functional disability or lack of response to an adequate trial of pain management by their doctor to the multidisciplinary approach that is in pain clinics available benefit. Many patients prefer to be treated their pain at home, although a drug rehabilitation center can offer more advanced types of pain management. The pain control may be jeopardized by certain practices in facilities such. As there are restrictions on visiting hours, the use of television sets and radios (valuable distraction supply) and the use of heating pads (for fear of heat damage). Pharmacotherapy analgesics include NSAIDs, opioids, and co-analgesics (eg, antidepressants, Antikonvulsiva- treatment of pain. Adjuvant analgesics and pharmacotherapy in neuropathic pain). One or more drugs may be appropriate. Co-analgesics are used for neuropathic pain most often. For persistent moderate to severe pain that cause functional limitations, should be considered to clarify the following points opioids: What is the conventional treatment practice? Are other treatments useful? If the patient has an exceptionally high risk of adverse effects of an opioid? Whether the patient is at risk for misuse, abuse or diversion (deviant behaving in drug consumption). When prescribing opioids for chronic pain, physicians should adhere to several steps: information and advice on misuse: Topics should include the risks associated with the combination of opioids with alcohol and anxiolytics, self-adjustment of the dosage and the need for safe storage of drugs. Patients should also be informed about the proper disposal of unused medications; they should be instructed not to share opioids and contact their doctor if they experience sedation. Patients should be evaluated for the risk of misuse, diversion and abuse. These risk factors include previous alcohol or drug abuse, a family history of alcohol or drug abuse and a history of severe psychiatric disorder. The presence of risk factors is not always a contraindication for opioid use. However, patients should, if they have risk factors that are forwarded to a pain management specialist or the doctor should take special precautions to discourage misuse, diversion and abuse; These measures include the prescription of only small amounts (requiring frequent visits to fill), not a substitute for allegedly lost medication and a drug urine screening to confirm that the prescribed opioids taken itself and not be passed on to others. If possible, consent should be obtained, to clarify the objectives, expectations and risks of treatment and the possible use of alternative treatments without opioids. Regular new review of the degree of pain relief, functional improvement and side effects, and look for signs of misuse, diversion or misuse When the pain subsides, patients usually need help in reducing opioid use. If, in addition to the pain of depression, antidepressants should be used. In individual cases, trigger point injections, joint or Spinalinjektionen, nerve blocks or epidural infusion therapies suitable methods can sein.Physikalische Many patients benefit from physiotherapy or occupational therapy. Spray and stretch techniques can relieve myofascial trigger point pain. Some patients need a brace. A spinal cord stimulation may be suitable sein.Psychologische treatments behavioral therapies can improve the level of functioning of a patient without a reduction of pain. Patients should record their daily activities in a diary to identify areas that could be amenable to change. The clinician should give specific recommendations for a gradual increase in physical activities and social participation. The recommended activities should be expanded gradually over time. If possible, the pain should not be allowed to prevent regaining the ability to function. If it is possible to increase the activity in this way, patients report less and less pain. Various cognitive techniques of pain control (eg. As relaxation training, distraction techniques, hypnosis, biofeedback) can be useful. Patients can learn to achieve a distraction of guided imagery (self-hypnosis, the peace and well-being evokes-z. B. by the patient imagines, to lie on the beach or in a hammock). Other cognitive-behavioral techniques (eg. As self-hypnosis) make a training by a specialist is required. The behavior of family members or work colleagues that pain behavior reinforced (z. B. persistent questions about the health of the patient or the insistence that the patient does not do housework) should be prevented if possible. The doctor should avoid to reinforce pain behavior, discourage inappropriate behavior, praise progress of the patient and offer a pain treatment, while the emphasis is on regaining a normal functioning level. Important points nociceptive stimuli, sensitization of the nervous system and psychological factors can contribute to chronic pain. The distinction between the psychological causes and effects of chronic pain can be difficult. It should be looking for a physical cause, even if psychological factors are prominent and always the effect of pain on the patient’s life are valued. Treatment of poorly controlled pain with multimodal therapy (eg appropriate physical, mental, behavoristische and interventional therapies;. Pharmaceuticals).

Health Life Media Team

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