Chronic Pain Management: Therapy, Drugs and Needles

Abstract

In 1931, the French medical missionary Dr Albert Schweitzer wrote, "Pain is a more terrible lord of mankind than even death itself". Seventy years on, chronic pain sufferers cannot agree more with this statement, while clamouring for help from family physicians and specialists, and even 'therapists' who promise to offer pain relief using unconventional methods or bizarre potions. Some persons would even contemplate suicide in order to avoid suffering pain for the rest of their lives.Chronic pain is a complex condition in both pathological and neurobiological terms. The causes are diverse, and may even be unknown in some instances. Why does a patient with fi bromyalgia exhibit so much pain? Why does one who had an anatomically successful discectomy continue to have intractable radicular (i.e. sensory nerve root) symptoms? Why does a depressed patient show more pain than another patient with the same condition? In medical school we learnt that pain is a symptom and, instinctively, we search relentlessly for an underlying problem so that we can solve it.Often, a prolonged and expensive search for a cause and a cure stands in the way of managing chronic pain. Chronic pain has long been viewed by many doctors as less important clinically than other chronic diseases like hypertension, diabetes mellitus, heart disease, and stroke, because "nobody dies from chronic pain". However, some studies have shown central neuroplastic changes in patients with chronic pain, much like the changes that occur with learning and memory. 1 Health authorities and healthcare workers should therefore view chronic pain as a disease rather than a symptom. Moreover, there is evidence that supraspinal mechanisms may be involved in neuropathic pain conditions such as complex regional pain syndrome (CRPS). 2 Data from studies in the USA showed that chronic pain affects about 50 million Americans every year. Other studies have also shown that chronic pain affects about 19% of the general population in Europe, 29% in Canada and 17% to 20% in Australia. [3][4][5] Closer to home, a survey found a 10.8% prevalence of chronic pain in Hong Kong. 6 In this issue, Yeo and Tay 7 provide local data on the prevalence of chronic pain in Singapore.

Prevención y tratamiento de náuseas y vómitos postoperatorios

“…Al estimularse estos receptores, ejecutan la señal al centro del vómito, originando el estímulo eferente, el que se transmite por las vías eferentes vegetativas (pares craneales V, VII, IX, X y XII) y somáticas (nervios frénicos, intercostales y abdominogenitales), para finalmente producir el reflejo del vómito. 5,6 Los receptores D2 se encuentran también a nivel gástrico y al parecer intervienen en la inhibición de la motilidad gástrica, retardando el vaciamiento gástrico.…”

“…El área postrema no posee barrera hematoencefálica efectiva, por lo que recibe estímulos presentes en la sangre o el líquido cefalorraquídeo y luego los transmite a la ZQG. 5,6 Propios de la intervención quirúrgica Las cirugías con mayor incidencia de NVPO según Apfel son la colecistectomía laparoscópica y las histerectomías 9 . Sin embargo, existe controversia si es que constituye un factor de riesgo independiente.…”

Activation of G protein‐coupled receptor 39 alleviates neuropathic pain and chronic inflammation

“…[ 3 ] At present, the commonly used treatment drugs include antidepressants, anticonvulsants, opioid analgesics, local anesthetics, and nonsteroidal anti‐inflammatory drugs, most of which exert transient effects by blocking nerve signal transmission, accompanied by adverse reactions such as nausea, drowsiness, dizziness, analgesic tolerance, and addiction after opioid treatment. [ 4,5 ] Therefore, the treatment of NP is still a thorny problem worldwide. It is of great significance to further explore the potential molecular mechanism and novel therapeutic targets of NP.…”