Stimulation therapies

Transcutaneous electrical nerve stimulation (TENS) was used in a 4-week, single-blind study that randomized 31 patients with type 2 diabetes and symptoms and signs of peripheral neuropathy, to receive either active electrotherapy or sham therapy 98 . Patients in the active group had a 52 reduction in pain compared with 27 in controls. In another study, 54 patients with diabetes who were using a TENS device were identified, and the patients' symptoms prior to and following electrotherapy were...

Treatment

Only a few evidence-based treatment regimens for CRPS are available so far these are summarized in Box 20.1. In fact, three literature reviews of outcome studies found discouragingly little consistent information regarding the pharmacologic agents and methods for treatment of CRPS 90-93 . Moreover, the methodology is often poor and patient numbers are low. Although CRPS shows a different phenotype in Box 20.1 Interventions supported by evidence Calcium channel-blocking anticonvulsants Physical...

Nerve injury affecting nerves anterior to the pelvis

Pain from the thoracolumbar nerve (posterior branch - pelvic lumbago, lateral branch - lateral pelvic pain, anterior branch - inguinal and testicular pain), e.g. 12th rib syndrome, nerve root irritation due to canal stenosis or disk. Ilio-inguinal and iliohypogastric nerve injury (inguinal canal, suprapubic and scrotal testicular pain), e.g following lumbar spinal surgery, incisions in the iliac abdominal region, Pfannenstiel incisions, inguinal surgery. Genitofemoral nerve injury (scrotal...

Urolithiasis

Irritative effects of stones moving within the urinary system (renal pelvis calices, ureters, bladder, urethra) can lead to severe pain (renal colic) and if sufficiently obstructive to urine flow, can destroy kidney function. It may be recurrent in stone-formers and may be continuous when numerous or large renal pelvic (staghorn) calculi are present. It occurs in 15 of white men and 6 of all women in industrialized countries 48 . Diagnosis is based on history of stone formation and or imaging...

Painful bladder syndrome interstitial cystitis

Painful bladder syndrome (PBS alternatively known as bladder pain syndrome) is a descriptive diagnosis that has been recently advocated for use on an international level as descriptive of a complex of urologic complaints including pain 59 . Thought to be an early form of the disorder interstitial cystitis (IC), there is an expectation that a majority of patients with PBS might have a common etiology. Notably, IC has no agreed etiology, pathophysiology or treatment and nor does the less defined...

A stepwise treatment approach to FMS

A graded treatment approach to functional somatic syndromes is recommended 10 . The American Pain Society (APS) 1 and the German Interdisciplinary Guideline Group 24 both recommend a stepwise treatment approach. Treatment should begin with confirming the diagnosis and patient education. Self-management and patient-centered communication are regarded as key principles of FMS therapy. Both guidelines recommended first, second and third lines of therapy depending on the course of symptoms, the...

Proctalgia fugax

Defined as episodic spasms of pain localized to the rectum and anus occurring at irregular intervals and without an identifiable cause, proctalgia fugax is highly prevalent, occurring in 14-19 of healthy subjects 36 . Episodes are normally brief (seconds to minutes) and infrequent (usually < 6 year). Proctalgia fugax is not the same as chronic proctalgia, which is pain that is more continuous in nature and typically of lower intensity. Spasms of the sigmoid colon, levator ani, and or pelvic...

References

Andren-Sandberg A, Dervenis C, Lowenfels B. Etiologic links between chronic pancreatitis and pancreatic cancer. Scand J Gastroenterol 1997 32 97-103. 2. Kozuch PL, Brandt LJ. Review article diagnosis and management of mesenteric ischaemia with an emphasis on pharmacotherapy. Aliment Pharmacol Ther 2005 21 201-215. 3. Brandt LJ, Boley SJ. AGA technical review on intestinal ischaemia. Gastroenterology 2000 118 954-968. 4. van Deinse WH, Zawacki JK, Phillips D. Treatment of acute mesenteric...

Pathophysiology

The diagnosis of cancer should be considered when evaluating presumably chronic disorders. This topic is the subject of an entire chapter in this text, so only brief mention will be given here, but cancer-related pain is illustrative of all other visceral pains. Neoplasms can arise in all visceral structures and dull constant pain is often an early symptom. Some neoplasms occur more commonly in the presence of recurrent inflammatory processes such as chronic pancreatitis and ulcerative colitis,...

Clinical trial quality and sources of bias

There are a large number of potential sources of bias in clinical trials, and many types of bias result in overestimation of treatment effects. In addition, some clinical trial reports draw conclusions that are not justified by the data. For example, publications describing prospective cohort trials sometimes attribute benefits to the treatment when the absence of a control group makes such conclusions unwarranted. RCTs are the optimal clinical trial design for establishing efficacy, yet all...

Epidemiology of nonspecific neck pain

Epidemiological studies of neck pain are based on questionnaires and surveys, which may overestimate the frequency of the condition. Nevertheless, it is clear that nonspecific neck pain including whiplash places a heavy burden on individuals, employers, and healthcare services. About two-thirds of the population will experience neck pain at some time in their lives 7, 8 , with the condition being most common in middle age, and in women 9 . The reported prevalence of neck pain varies widely...

Static magnetic therapy

The effects of wearing small magnets as therapy for chronic pelvic pain versus placebo were assessed 61 . No difference was seen following 2 weeks' treatment but some significant differences appeared at 4 weeks as assessed by the Pain Disability Index and the Clinical Global Impression Scale but not the McGill Pain Questionnaire. Analyzed in terms of weighted mean differences, the differences were nonsignificant and there was a substantial drop-out rate. The putative mechanism of action of this...

Acknowledgment

Data on therapy included in contribution by the author to the publication Clinical Evidence. 1. Ferrari R, Russell AJ. Epidemiology of whiplash an international dilemma. Ann Rheum Dis 1999 58 1-5. 2. Binder AI. Neck pain syndromes. Clinical Evidence, Issue 18, Dec 2007. BMJ Publishing Group, London. 3. Gore DR, Sepic SB, Gardner GM. Roentgenographic findings of the cervical spine in asymptomatic people. Spine 1986 11 521-524. 4. Boden SD, McCowin PR, Davis DO, Dina TS, Mark AS, Wiesel S...

Epidemiology of chronic pelvic and vulvalperineal pain in women

Population data on pain prevalence in women are available. A US-based telephone survey interviewed respondents aged 18-50 years 21 17,927 households were contacted, 5325 women agreed to participate, and of these 925 reported pelvic pain of at least 6 months' duration, including pain within the past 3 months. Having excluded those pregnant or post-menopausal and those with only cycle-related pain, 773 5263 (14.7 ) were identified as suffering from chronic pelvic pain. A British population survey...

Definition and classification

According to the criteria of the American College of Rheumatology (ACR), fibromyalgia syndrome is defined as chronic (> 3 months) widespread pain (CWP) (including pain on both sides of the body, above and below the waist, and axial pain) and tenderness on manual palpation in at least 11 out of 18 defined tender points 4 . Chronic widespread pain and tender points do not capture the essence of all FMS-associated symptoms 5, 6 . Other key symptoms of FMS are fatigue and nonrestorative sleep....

Diverticular disease

Diverticuli, sacs or pouch openings off the main lumen of the gut, occur most commonly in the colon but can also occur at any other GI tract site. They typically arise at the site of penetrating blood vessels which represent weak sites in the colon wall. Colonic diverticuli are generally pain free but severe abdominal pain and infection may result if their mouth opening to the lumen becomes inflamed and or obstructed. The disorder is then termed diver-ticulitis and is associated with pain,...

Irritable bowel syndrome functional bowel disorders

Irritable bowel syndrome IBS is one of several functional bowel disorders, including noncardiac chest pain, functional dyspepsia, epigastric pain syndrome, postprandial distress syndrome and chronic proctalgia, which represent diagnoses of exclusion that are based on symptomatology 22 . IBS has been demonstrated to be associated with abnormalities of motility and or sensation in different subpopulations. The diagnosis of IBS is given to 40-70 of referrals to gastroenterologists. IBS typically...