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Chronic pain

Pain that has lasted longer than three to six months, though some theorists and researchers have placed the transition from acute to chronic pain at 12 months.

Others apply acute to pain that lasts less than 30 days, chronic to pain of more than six months duration, and subacute to pain that lasts from one to six months.

A popular alternative definition of chronic pain, involving no arbitrarily fixed duration, is “pain that extends beyond the expected period of healing”.

Chronic pain remains a serious public health problem. A survey estimates that almost one in five (19%) adults in Europe suffer from chronic pain with almost two-thirds of chronic pain patients reporting inadequate pain control at times 1).


Around 20% of patients undergoing surgery for lumbar radiculopathy develop chronic pain after surgery, leading to high socio-economic burden. Current perioperative interventions, including education and rehabilitation, are not always effective in preventing prolonged or chronic postoperative pain and disability.

Goudman et al.,proposed a shift in educational intervention from a biomedical towards a biopsychosocial approach for people scheduled for lumbar surgery. Pain neuroscience education (PNE) is such a biopsychosocial approach which aims at decreasing the threat value of pain by reconceptualizing pain and increasing the patient's knowledge about pain.

In a a paper they provides a clinical perspective for the provision of perioperative PNE, specifically developed for patients undergoing surgery for lumbar radiculopathy. Besides the general goals of PNE, perioperative PNE aims to prepare the patient for post-surgical pain and how to cope with it 2).

Treatment

see Chronic pain treatment.

Case reports

Lawson McLean et al. from the Division of Functional and Restorative Neurosurgery, Department of Neurosurgery, Jena University Hospital, present the case of a chronic pain patient treated surgically for degenerative cervical myelopathy secondary to cervical spinal stenosis. Following this surgery, the patient experienced an intractable postoperative pain syndrome that had anatomical borders, an intensity and a character that was different to the background chronic pain from which they suffered.

They successfully implanted a cervical spinal cord stimulation (SCS) lead in the period following their stenosis surgery, which had good therapeutic effect on the postoperative-onset pain. To the best of the knowledge, this is the first description of SCS having a strong positive effect on an acute exacerbation of neuropathic pain. At follow-up 12 months later, assessment of the patient's pain diary revealed a modal pain intensity of NRS 3/10 over the preceding three months. The Brief Pain Inventory (Short Form) scores at this point in time were 10/40 in the pain severity domain and 18/70 in the interference with function domain, demonstrating the long-term effectiveness of this SCS strategy. While SCS has hitherto been untested as a therapy for acute-onset pain, this report demonstrates its utility as a salvage treatment in select cases of uncontrollable postoperative pain 3).

1)
Breivik H, Eisenberg E, O'Brien T. Openminds. The individual and societal burden of chronic pain in Europe: the case for strategic prioritisation and action to improve knowledge and availability of appropriate care. BMC Public Health. 2013;13:1229.
2)
Goudman L, Huysmans E, Ickmans K, Nijs J, Moens M, Putman K, Buyl R, Louw A, Logghe T, Coppieters I. A Modern Pain Neuroscience Approach in Patients Undergoing Surgery for Lumbar Radiculopathy: A Clinical Perspective. Phys Ther. 2019 Mar 28. pii: pzz053. doi: 10.1093/ptj/pzz053. [Epub ahead of print] PubMed PMID: 30921465.
3)
Lawson McLean A, Kalff R, Reichart R. Spinal Cord Stimulation for Acute Pain Following Surgery for Cervical Myelopathy: A Novel Treatment Strategy. Pain Pract. 2018 Oct 27. doi: 10.1111/papr.12742. [Epub ahead of print] PubMed PMID: 30369016.
chronic_pain.txt · Last modified: 2019/03/29 18:07 by administrador