The document discusses pharmacological treatments for phantom limb pain (PLP). It finds that while certain drugs can help aspects of PLP, no single treatment eliminates it. Opioids may help severe pain but have risks. Muscle relaxants can ease cramping. Psychological treatments like hypnosis and relaxation are also useful by reducing stress, a common PLP factor. The best approach may integrate pharmacological treatments with psychological ones to safely manage different PLP aspects.
Phantom pain is pain caused by elimination or interruption of sensory nerve impulses by destroying or injuring the sensory nerve fibers after amputation or deafferentation
Phantom pain is pain caused by elimination or interruption of sensory nerve impulses by destroying or injuring the sensory nerve fibers after amputation or deafferentation
Trigger points are commonly seen in patients with myofascial pain which is responsible for localized
pain in the affected muscles as well as referred pain patterns. Correct needle placement in a
myofascial trigger point is vital to prevent complications and improve efficacy of the trigger point
injection to help reduce or relieve myofascial pain
Office based ultrasound-guided injection techniques for musculoskeletal
disorders have been described in the literature with regard to tendon, bursa, cystic, and
joint pathologies. For the interventionalist, utilizing ultrasound yields multiple advantages technically
and practically, including observation of needle placement in real-time, ability to perform
dynamic studies, the possibility of diagnosing musculoskeletal pathologies, avoidance of radiation
exposure, reduced overall cost, and portability of equipment within the office setting.
an overview of muscle pain disorder which regularly create some discomfort for patient to live a normal life as well as to the doctor regarding diagnosis of the problem.
Indian Dental Academy: will be one of the most relevant and exciting training
center with best faculty and flexible training programs for dental
professionals who wish to advance in their dental practice,Offers certified
courses in Dental implants,Orthodontics,Endodontics,Cosmetic Dentistry,
Prosthetic Dentistry, Periodontics and General Dentistry.
Neuropathic Pain
Causes, Mechanisms and Treatment of Neuropathic Pain
Presented At Primed, QE2 Conference Centre, Westminster, London to National Audience of Primary Care Doctors
5th November 2009
This is my current baby. I have always been interested in personal health, and I am currently working on becoming NASM CPT certified (I've passed practice tests, I just need to set aside a few weeks to actually take the real thing). TrP are a topic of health that has always been an interest of mine, and when training people, or looking after my own health, I would like to incorporate clinical Myofascial dysfunction treatment in my and others workouts. I decided to go straight to the golden source, and I have slowly but surely been going over the Travell Trigger Point Manual over the previous few months, painstakingly notating all information I consider to be important. I plan on finishing this project in particular by mid-2018, and hope that I can help others identify any myofascial pain and stay healthy in their own personal lives :)
Option of interventional pain therapy in multimodal treatment of chronic cancer and non-cancer pain
Established role when pharmacotherapy or surgery not suitable
Indications well accepted
Evidence for efficacy moderate to strong
Trigger points are commonly seen in patients with myofascial pain which is responsible for localized
pain in the affected muscles as well as referred pain patterns. Correct needle placement in a
myofascial trigger point is vital to prevent complications and improve efficacy of the trigger point
injection to help reduce or relieve myofascial pain
Office based ultrasound-guided injection techniques for musculoskeletal
disorders have been described in the literature with regard to tendon, bursa, cystic, and
joint pathologies. For the interventionalist, utilizing ultrasound yields multiple advantages technically
and practically, including observation of needle placement in real-time, ability to perform
dynamic studies, the possibility of diagnosing musculoskeletal pathologies, avoidance of radiation
exposure, reduced overall cost, and portability of equipment within the office setting.
an overview of muscle pain disorder which regularly create some discomfort for patient to live a normal life as well as to the doctor regarding diagnosis of the problem.
Indian Dental Academy: will be one of the most relevant and exciting training
center with best faculty and flexible training programs for dental
professionals who wish to advance in their dental practice,Offers certified
courses in Dental implants,Orthodontics,Endodontics,Cosmetic Dentistry,
Prosthetic Dentistry, Periodontics and General Dentistry.
Neuropathic Pain
Causes, Mechanisms and Treatment of Neuropathic Pain
Presented At Primed, QE2 Conference Centre, Westminster, London to National Audience of Primary Care Doctors
5th November 2009
This is my current baby. I have always been interested in personal health, and I am currently working on becoming NASM CPT certified (I've passed practice tests, I just need to set aside a few weeks to actually take the real thing). TrP are a topic of health that has always been an interest of mine, and when training people, or looking after my own health, I would like to incorporate clinical Myofascial dysfunction treatment in my and others workouts. I decided to go straight to the golden source, and I have slowly but surely been going over the Travell Trigger Point Manual over the previous few months, painstakingly notating all information I consider to be important. I plan on finishing this project in particular by mid-2018, and hope that I can help others identify any myofascial pain and stay healthy in their own personal lives :)
Option of interventional pain therapy in multimodal treatment of chronic cancer and non-cancer pain
Established role when pharmacotherapy or surgery not suitable
Indications well accepted
Evidence for efficacy moderate to strong
Simon will explore CSS media queries and other methods for creating incredibly flexible adaptive layouts for varying devices, viewports and orientations.
INTRODUCTION
HISTORY
EPIDEMIOLOGY
DEFINITIONS OF PAIN
BENEFITS OF PAIN
NOCICEPTION
PAIN RECEPTORS
THEORIES OF PAIN
CHARACTERISTICS OF PAIN
PAIN PATHWAY
MECHANISM OF PAIN
PAIN ASSESSMENT
APPLIED ASPECTS
CONCLUSION
REFERENCES
Hendricks, la velle counseling modalities nfjca v3 n1 2014William Kritsonis
William Allan Kritsonis, Editor-in-Chief, NATIONAL FORUM JOURNALS (Founded 1982). Dr. LaVelle Henricks, Texas A&M University-Commerce and colleagues published in national refereed journal.
Dr. William Allan Kritsonis, Distinguished Alumnus, Central Washington University, College of Education and Professional Studies, Ellensburg, Washington; Invited Guest Lecturer, Oxford Round Table, University of Oxford, United Kingdom; Hall of Honor, Prairie View A&M University/Member of the Texas A&M University System.
Austin Pain & Relief is an open access, peer reviewed, scholarly journal dedicated to publish articles covering all areas of Pain & Relief.
The journal aims to promote research communications and provide a forum for doctors, researchers, physicians and healthcare professionals to find most recent advances in all areas of Pain & Relief. Austin Pain & Relief accepts original research articles, reviews, mini reviews, case reports and rapid communication covering all aspects of pain and relief.
Austin Pain & Relief strongly supports the scientific up gradation and fortification in related scientific research community by enhancing access to peer reviewed scientific literary works. Austin Publishing Group also brings universally peer reviewed journals under one roof thereby promoting knowledge sharing, mutual promotion of multidisciplinary science.
What/Where is the true source of PFP?
What theories do we use for diagnosing PFP and how does literature support the theories?
How can we better treat “PFPS” patients through a more thorough evaluation and the developing classifications of PF disorders?
Chronic pain: Role of tricyclic antidepressants, dolsulepinSudhir Kumar
Chronic pain is common. Depression often co-exist with chronic pain. This article looks at the pathophysiology, prevalence of chronic pain and depression. The role of TCA, especially dosulepin and amitriptyline has been discussed.
Anesthesia
What are the risks and complications of anesthesia?
Stages of anesthesia
types of Anesthesia :
General ,local and Regional Anesthesia
Drugs for Anesthesia
ABSTRACT: IASP (International Association for study of pain) defined pain as “an unpleasant, sensory and
emotional experience associated with actual or potential tissue damage or described in terms of such damage”.
Chronic Pain can be more described as a disease rather than a symptom. Antidepressants are the drugs that can elevate
the mood. Recent trials have elucidated that anti- depressants can be of worth in treating chronic pain conditions.
However, the safe use of these drugs depends on upon the clinician or any other health professional and their ability to
choose the right tolerated drug at safe doses. Any psychiatric comorbidity must be treated to avail best results with
anti-depressant therapy.However, most of the trials focus upon only Tri-CyclicAntidepressants and Selective
Serotonin Reuptake Inhibitors. Research into other novel Anti-depressant drugs may lead to best chances of recovery
in patients with chronic pain.
1. 04250065 Psychology of Pain
Mathew Aspey
Psychology of Pain.
Pharmacological
Treatments as a Stand -
Alone Treatment of
Phantom Limb Pain.
Word Count = 993 words.
Pharmacological Treatments as a Stand - Alone Treatment of Phantom Limb Pain.
2. 04250065 Psychology of Pain
What is Phantom Limp Pain?
Phantom limb pain (PLP) is a phenomenon referring to the pain experienced from limb
that has previously been amputated or severed. PLP has a surprisingly high level of
prevalence, as it effects up to 72% of all amputees (Jensen et al, 1984 (1)
). They also found
that pain persisted until 7 years after amputation; Sherman et al (1980) (2)
found that no
more than 15% find total pain relief. Pain can be either episodic or continuous and is often
described as a ‘cramping, crushing or stabbing pain’ in the missing limb (Clement and Taunton,
2001 (3)
). Livingston (1943) (4)
suggested that a common feature is that the reported pain is
felt in definite parts of the phantom limb (e.g. the phantom hand is clenched so it feels
tired and painful).
What Causes Phantom Limb Pain?
A vast body of research has been conducted to determine the causes of this
phenomenon. It is widely accepted that it is a result of damage to the nerve endings in the
residual limb (A)
sending pain signals to the brain making it think that the limb is still there (5).
Sussman (1995) (6)
suggested that it starts in the homunculus (B)
, an area of the sensory
cortex (C)
. When a part of the actual body is lost, the corresponding part of the homunculus
remains, but is unable to handle the loss of information from the missing area. To remedy
this, the brain rewires its circuits so that the neighbouring neurons in the cortex invade the
vacant territory in order to compensate this loss of sensations; this is known as cortical
reorganisation.
Pharmacological Treatments of Phantom Limb Pain.
It is currently unsure whether there exists a stand-alone treatment for PLP. Although
there are many treatments that successfully help with aspects of PLP, there does not
appear to be a single treatment to eliminate phantom pain altogether. It appears as though
the best way to treat PLP is to employ a combination of pharmacological treatments with
psychological treatments.
Initially, measures are taken in an attempt to try and prevent the onset of PLP.
Calcitonin (D)
is a hormone produced by the thyroid gland (E)
to slow the rate at which the
body breaks down bone and is often used to prevent bone deterioration in the treatment of
postmenopausal osteoporosis (F)
. This is often administered intravenously (G)
during the week
following amputation (7)
.
Flor et al (2000) (8)
suggested that pharmacological treatments resulting in vasodilation
(H)
of the residual limb, ease burning PLP but not other features. Cramping phantom pain is
caused by muscle tension in the residual limb; clonazepam may relieve cramping PLP as it
depresses activity in the central nervous system and is used as a treatment of muscle
tension. Baclofen is also a muscle relaxant, often used to treat muscle spasms and
neuropathic (I)
pain syndromes, of which PLP is one. Although these treatments have proven
successful, they do not always eliminate phantom pain for all patients.
3. 04250065 Psychology of Pain
In cases where pain is severe, an opioid (J)
, such as morphine (K)
may be administered in
order to ease the pain. Sawynok (2003) (9)
suggests that Opioids are generally safe
treatments when closely monitored by health professionals. Although proven to be highly
successful in the treatment of severe pain, morphine is not without its dangers. If patients
are over – dosed, side effects such as sweating (in extreme cases causing hypothermia),
salivation and certain lung secretions which may depress lung function to the point of
respiratory arrest (L)
. Morphine is also known for causing both constipation and vomiting.
Research in this area suggests that although pharmacological treatments specialise in
easing certain types of PLP, they are not broad enough to cover all types of pain that are
experienced here. In order to account for this it is often useful to implement the use of
psychological treatments, to be used in conjunction with pharmacological treatments.
Psychological Treatments of Phantom Limb Pain.
Stress has been identified as a common factor in phantom limb pain. Arena et al (1990)
(10)
tested for relationships between situational stress and PLP in 27 male, 71 year old
amputees and found that 74% demonstrated significant stress - pain relationships. This
finding brings light to the possibility that psychological treatments may also be useful in the
alleviation of phantom pain.
There has been research into the effects of hypnosis as a treatment of PLP; Wain
(1986) (11)
suggested that hypnosis allows effective strategies to be implemented in order to
allow patients to gain control over their experienced pain. Although hypnosis has a good
reputation for having no pharmacological side effects, there is a debate about whether or
not all people are susceptible to hypnosis, Horn and Munafo (1997) (12)
suggests that people
react to hypnosis in many different ways, dependent upon their ‘hypnotisability’ which can
either facilitate or inhibit their openness to hypnotic suggestions. This may significantly
decrease its effectiveness. However, hypnosis is also regarded as a recognised relaxation
technique; this provides a basis for the assumption that relaxation may be a feasible
treatment for PLP.
Conclusion.
In conclusion, although there is much research to provide support for the use of
pharmacological treatments to eradicate PLP, most research points to specific drugs as an
appropriate treatment for certain aspects of the pain experienced in a phantom limb. At
present research has produced inconclusive findings for a stand – alone pharmacological
treatment for phantom limb pain. From, this it may be important to suggest a systematic
collaboration of pharmacological treatments such as a strictly monitored course of opioid
treatments to ease pain, with muscle relaxants to ease muscles cramping and a psychological
treatment such as hypnosis to promote relaxation. This collaboration of treatments may
need extensive research before being implemented as most pharmacological treatments
have unique side effects relating to each one, care must be made to ensure that these side
effects do not outweigh the initial pain.
4. 04250065 Psychology of Pain
Additional Resources.
Above is a diagram showing the Homunculus, which is a map of the body, within
the sensory cortex in the brain. Here the areas of the body that detect more
sensory information are represented much larger than areas which detect less
sensory information.
5. 04250065 Psychology of Pain
Glossary of Terms (13)
.
A. Residual Limb: - part of the amputated limb that is left behind (stump).
B. Homunculus (little man): - The nerve map of the human body that exists on
the parietal lobe of the human brain whereby each of its body parts is linked
with its corresponding area of the actual body.
C. Sensory Cortex: - located posterior to the central sulcus in the parietal
lobe receives sensory input from receptors in the body.
D. Calcitonin: - a hormone produced by the thyroid gland (E)
to slow the rate at
which the body breaks down bone.
E. Thyroid Gland: - located around the trachea, the thyroid gland is a gland
that makes and stores hormones which regulate heart rate, blood pressure
and body temperature.
F. Osteoporosis: - a chronic, progressive condition associated with
deterioration of bone tissue resulting in low bone mass.
G. Intravenous: - administration of medication directly into the vein.
H. Vasodilation: - Widening of the interior of the blood vessels as a result of
the relaxation of the muscular wall of the vessels.
I. Neuropathic: - pain which comes from injury to the nerves themselves and
not from injured body parts
J. Opioid: - A synthetic narcotic, resembling the naturally occurring opiates.
K. Morphine: - kills pain at low doses and makes you feel tranquil, increasing
your tolerance to pain. With morphine, the perception of pain is still there,
but the appreciation of the pain decreases
L. Respiratory arrest: - spontaneous respiration dude to damage caused to
the respiratory centre.
References.
• (1) Jensen TS, Krebs B, Nielsen J, Rasmussen P. Non-painful phantom limb
phenomena in amputees: incidence, clinical characteristics and temporal
course. Acta Neurol Scand 1984; 70: 407–14
6. 04250065 Psychology of Pain
• (2) Sherman RA, Sherman CJ, Gall NG (1980) A survey of current
phantom limb pain treatment in the United States. Pain 8:85-99
• (3) Clement, D.B. and Taunton J.E. ()Alleviation of pain with the use of
Farabloc, an electromagnetic shield: A review BC MedicalJournal
Volume 43, Number 10, December 2001, pages 573-577
• (4) Livingston, W.K. (1943) Pain Mechanisms. MacMillan, New York.
• (5) Cleveland Clinic Foundation. Retrieved on 16th
November 2006 from
www.clevelandclinic.org/health/health-info/docs/3600/3692.asp?index=12092&src=news
• (6) Sussman, V. (October 1995). The route of phantom pain. U.S. News &
World Report, 76-78.
• (7) Mayo Foundation for Medical Education and research. Retrieved on
16th
November 2006 from http://www.mayoclinic.com/health/phantom-
pain/DS00444/DSECTION=6
• (8) Flor H, Mühlnickel W, Karl A, Denke C, Grusser S, Kurth R, et al. A
neural substrate for nonpainful phantom limb phenomena. Neuroreport
2000; 11: 1407–11
• (9) Sawynok, J. (2003). Topical and peripherally acting analgesics.
Pharmacological Reviews, 55(1), 1-20.
• (10) Arena, J., Sherman, R., Bruno, G. & Smith J. (1990). The relationship
between situation stress and phantom limb pain: Cross-lagged correlation
data from six month pain logs. Journal of Psychosomatic Research, 34(1),
71-77.
• (11) Wain, H. (1986). Pain control with hypnosis in consultation and liaison
psychiatry. Psychiatric Annuals, 16(2), 106-109.
• Horn, S. & Munafo, M. Pain Theory, Research and Intervention. Open
University Press: Buckingham. 1997
• Medical Terms. Retrieved on 16th
November 2006 from
http://www.medterms.com/script/main/art.asp?articlekey=5965
7. 04250065 Psychology of Pain
• (2) Sherman RA, Sherman CJ, Gall NG (1980) A survey of current
phantom limb pain treatment in the United States. Pain 8:85-99
• (3) Clement, D.B. and Taunton J.E. ()Alleviation of pain with the use of
Farabloc, an electromagnetic shield: A review BC MedicalJournal
Volume 43, Number 10, December 2001, pages 573-577
• (4) Livingston, W.K. (1943) Pain Mechanisms. MacMillan, New York.
• (5) Cleveland Clinic Foundation. Retrieved on 16th
November 2006 from
www.clevelandclinic.org/health/health-info/docs/3600/3692.asp?index=12092&src=news
• (6) Sussman, V. (October 1995). The route of phantom pain. U.S. News &
World Report, 76-78.
• (7) Mayo Foundation for Medical Education and research. Retrieved on
16th
November 2006 from http://www.mayoclinic.com/health/phantom-
pain/DS00444/DSECTION=6
• (8) Flor H, Mühlnickel W, Karl A, Denke C, Grusser S, Kurth R, et al. A
neural substrate for nonpainful phantom limb phenomena. Neuroreport
2000; 11: 1407–11
• (9) Sawynok, J. (2003). Topical and peripherally acting analgesics.
Pharmacological Reviews, 55(1), 1-20.
• (10) Arena, J., Sherman, R., Bruno, G. & Smith J. (1990). The relationship
between situation stress and phantom limb pain: Cross-lagged correlation
data from six month pain logs. Journal of Psychosomatic Research, 34(1),
71-77.
• (11) Wain, H. (1986). Pain control with hypnosis in consultation and liaison
psychiatry. Psychiatric Annuals, 16(2), 106-109.
• Horn, S. & Munafo, M. Pain Theory, Research and Intervention. Open
University Press: Buckingham. 1997
• Medical Terms. Retrieved on 16th
November 2006 from
http://www.medterms.com/script/main/art.asp?articlekey=5965