Chronic pain disorder following physical injury

An observational study of buprenorphine treatment of the prescription opioid dependent pain patient

BACKGROUND AND OBJECTIVES

In some countries, particularly the United States and Canada, there has been a growing problem of opioid dependence associated with the treatment of chronic pain. Controversy exists regarding the efficacy and safety of opioid therapy, particularly in high doses for extended periods of time. This study reports on the outcome of chronic pain patients treated with buprenorphine in an outpatient psychiatric consultation clinic.

METHODS

Forty three consecutive outpatient clinic chronic pain patients with a DSM-IV diagnosis of opioid dependence and treated with buprenorphine during a 3-year period were monitored for follow-up periods of up to 5 years. All subjects were dependent on drugs prescribed for pain and were divided into two groups: those who had a history of abuse of alcohol or drugs and those who did not Historical, physical, demographic, and outcome data were collected.

RESULTS

The majority of patients were male, not working, and between the ages of 45-60. Follow-up revealed that treatment with buprenorphine was effective. Most patients had improved pain with treatment of the opioid dependence. There were no differences between those with or without a history of substance abuse.

DISCUSSION AND CONCLUSIONS

Patients often improved with much less preoccupation with pain, expressing great satisfaction with buprenorphine treatment.

SCIENTIFIC SIGNIFICANCE

Buprenorphine is an effective tool when treating the opioid-dependent chronic pain patient.

Pain and substance-related pain-reduction behaviors among opioid dependent individuals seeking methadone maintenance treatment

We surveyed 293 opioid dependent individuals seeking methadone maintenance treatment about their pain experiences and their substance-related pain reduction behaviors. Among the 213 respondents reporting recent pain of at least moderate typical pain intensity, two-thirds had a lifetime history of chronic pain. In comparison to those without a lifetime history of chronic pain, those with a lifetime history were older, reported higher pain frequency, were more likely to endorse accident or surgery and less likely to endorse "don't know" as the genesis of their recent pain, and endorsed comparable levels of substance-related pain reduction behaviors. These findings may have implications for resource and program planning in MMT programs.

Psychiatric issues in chronic pain

Chronic pain requires comprehensive care. While interdisciplinary approaches are recommended, the role of psychiatrists is often misunderstood. Psychiatrists should be involved with the care of patients with chronic pain as early as possible to maximize outcome. Psychiatrists offer an expertise that specifically addresses important deficiencies in the care of patients with chronic pain: 1) the lack of a detailed formulation, 2) the lumping of all psychopathology, and 3) the failure to effectively use psychopharmacologic treatments. This review provides a framework for formulating the diagnoses and treatments of patients with chronic pain.

Somatization disorder, a cause of difficult pain: a case report

Presented is a case report of a 55-year-old man with a suspected diagnosis of pancreatic malignancy who was referred for pain management to the pain and palliative care clinic. A diagnosis of pain originating from a malignancy was later ruled out. The patient was referred for psychiatric evaluation, where his pain symptoms were confirmed to be somatoform in origin. This case highlights the importance of ruling out somatization as the cause of symptoms in difficult pain patients.

The psychology of pain

Emotional and evaluative issues are very important in the evaluation and treatment of pain. Treating the physical pain alone can leave these issues unresolved, and possibly exacerbate them through reinforcement. Understanding the impact of fear, expectations, and attention can help physicians deal more effectively with acute pain. Psychological issues are particularly prominent in chronic pain. Though acute care physicians may not be treating these psychological conditions, they can help by referring patients to the appropriate psychological or multidisciplinary setting.

Parental rearing style, premorbid personality, mental health, and quality of life in chronic regional pain: A causal analysis

The aim of the current study was to establish the causal model among parental bonding, personality characteristics, mental health, quality of life, and chronic regional pain (CRP). Thirty CRP patients and 56 mental illness patients were compared using the Visual Analogue Scale (VAS), Chinese Health Questionnaire (CHQ), Eysenck Personality Questionnaire (EPQ), World Health Organization Quality of Life-Brief-Tawain Version (WHOQOL-BREF-TW), and Parental Bonding Instrument (PBI). There were significant differences in mental health, personality characteristics, and quality of life between the CRP and mental illness groups. Structural equation modeling showed that parental bonding could directly affect personality characteristics, and, hence, directly impact disease and quality of life. CRP is different from mental illness in many dimensions. In this study, CRP appeared to be caused by actual physical dysfunction rather than mental dysfunction.

Pain management in the opioid-dependent patient

The opioid-dependent patient presents great challenges for pain management. These challenges are not limited to potential addictive behaviors. In contrast to the profound pain relieving effects of acute opioid intake, chronic opioid intake can promote a counterintuitive state of enhanced pain sensitivity. Multiple biologic mechanisms inducing opioid tolerance and hyperalgesia have recently been elucidated. The potential hyperalgesic state accompanying opioid dependence complicates pain management somewhat for acute pain and cancer pain, but it especially does so for chronic pain. Guidelines for treatment of opioid dependence in the pain patient are proposed. Treatment oriented toward the long term requires limit setting and psychologic support that go beyond simple medication management.