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chronic pain

Traditional Chinese Medicine for Chronic Pain: The Oldest Medicine for Older Adults

Traditional Chinese Medicine for Chronic Pain: The Oldest Medicine for Older Adults

Teaser: 

Mary Xiumei Wu, MD, TCM (China), MSc, Dipl OM, RAc, President, Toronto School of Traditional Chinese Medicine, Toronto, ON.

Traditional Chinese medicine (TCM) is a distinct and comprehensive medical system deeply rooted in Chinese philosophy. It is composed of fundamental theory, unique diagnostic methods, and a variety of treatment modalities primarily including acupuncture, Chinese herbal medicine, tuina massage, and taiji qigong. Traditional Chinese medicine has a wide range of clinical applications encompassing health promotion, disease prevention, and treatment and may be used for pain management either as an alternative or complement to allopathic medicine. An advantage of TCM is that it improves the patient’s general health in addition to controlling pain; therefore, it usually provides long-lasting effects and results in the relief of other accompanying symptoms such as fatigue, poor circulation, anxiety, depression, and insomnia, which are common comorbidities of pain in older adults.
Key words: traditional Chinese medicine (TCM), acupuncture, herbal medicine, tuina massage, taiji qigong, chronic pain.

Pain and Depression in Aging Individuals

Pain and Depression in Aging Individuals

Teaser: 


Lucia Gagliese, PhD, CIHR New Investigator, School of Kinesiology and Health Science, York University; Department of Anesthesia, Behavioural Sciences & Health Research Division, University Health Network; Departments of Anesthesia and Psychiatry, University of Toronto, Toronto, ON.

Depression is highly prevalent among older adults with chronic pain living both in community and institutional settings. It is associated with decreased quality of life, including impairments in physical and social well-being. This article reviews the relationship between pain and depression. The potential mediating role of disability, life interference, and perceived control are described. Routine assessment of both pain and mood, using scales validated for this age group, is advocated. Finally, the importance of integrating pharmacological and psychological interventions for the management of pain and depression in the older adult is highlighted.
Key words: chronic pain, depression, mood disturbance, assessment, management.

Aging and the Neurobiology of Addiction

Aging and the Neurobiology of Addiction

Teaser: 

Paul J. Christo, MD, Assistant Professor; Director, Pain Treatment Center & Multidisciplinary Pain Fellowship, Division of Pain Medicine, Department of Anesthesiology and Critical Care, The Johns Hopkins University School of Medicine, Baltimore, MD, USA.
Greg Hobelmann, MD, Postdoctoral Fellow, Division of Pain Medicine, Department of Anesthesiology and Critical Care, The Johns Hopkins University School of Medicine, Baltimore, MD, USA.
Amit Sharma, MD, Postdoctoral Fellow, Division of Pain Medicine, Department of Anesthesiology and Critical Care, The Johns Hopkins University School of Medicine, Baltimore, MD, USA. *Current Address: Assistant Professor, College of Physicians & Surgeons of Columbia University, New York, NY.

Living with Chronic Pain

Living with Chronic Pain

Teaser: 


Author: Jennifer P. Schneider
Publisher: Healthy Living Books

Reviewed by Jackie Gardner-Nix, MD, Chronic Pain Consultant, Pain Management Program, Sunnybrook and Women’s College Health Sciences Centre; Pain Clinic, St. Michael’s Hospital, Toronto, ON.

You know you’ve been given a good book to review when you wish you had written it! Jennifer Schneider serves up a worthy paperback tome on chronic pain that will be valued by many of those suffering pain or living with a family member with pain. Among its virtues is its accessibility--any reader with at least a grade twelve education should have no problem cracking it. At 304 pages in length, readers are more likely to dip into it for selected topics than read it cover to cover, particularly as chronic pain patients tend to have limited attention span and recall. But for that purpose, it is well worth setting on the bookshelf.

Schneider begins the book with an informative introduction intended for those who live with chronic pain, defining pain and the differences between acute and chronic pain, nociceptive and neuropathic pain, and “breakthrough” pain. She describes pain prevalence in the United States and lists the most common types of pain encountered by physicians: back pain, arthritis, migraines, fibromyalgia, and so on. The NMDA receptors and their role in pain are discussed. Schneider also includes a useful lesson for lay readers in how to interpret evidence-based findings, explaining the different types of clinical studies (double blind, placebo-controlled, etc.).

Chapter 2 addresses finding the right health care professional and assumes the existence of an ideal world where you have a choice! She acknowledges that physicians often undertreat pain due to lack of knowledge and understanding of the condition, and many fear sanctions from governing bodies if they prescribe narcotics.

Subsequent chapters deal with non-opioid medications used for pain and cover all the usual adjuvant medications, including a section on the controversial coxibs and topical agents. One chapter on opioid medications makes it clear that the author is not “opio-phobic”--a welcome fact for many patients who need chronic pain management. However, the reader could potentially misinterpret this chapter as espousing that all pain is responsive to painkillers, as Schneider seems to paint a rosier picture of the role of opioids in chronic pain than perhaps they merit. She cites studies that show efficacy of opioids in various types of pain and tends to ascribe tolerance development (reduced analgesic efficacy over time) as being due to worsening of the underlying condition, a view that is long out of date. Tolerance to analgesic efficacy of opioids is not rare! The studies she quotes do not reflect the true clinical picture of the challenges we face in finding stable doses of opioids that can return patients to the work force or to normal functioning. Similarly, there is no discussion of the extent of the reduction of pain scores by medication interventions and how that translates to improving function. Sleep studies that alert those on chronic opioid therapy to the possibility of sleep apnea are addressed. Nevertheless, Schneider is diligent in discussing side effects of opioids such as constipation, nausea, sexual difficulties, and sedation, and she adequately addresses the issue of driving under medication. Moreover, the proceeding chapter appropriately emphasizes the difference between addiction and physical dependency.

To complete the discussion of conventional therapies for chronic pain, a chapter is dedicated to alternative therapies, including acupuncture, yoga, tai chi, massage, prayer, and cognitive behaviour therapy. The chapter spends little time on meditation but more on hypnosis. Jon Kabat Zinn would not appreciate her interpretation of his mindfulness meditation as a “relaxation technique,” but it is difficult to cover such a wide range of topics and be accurate in describing them all.

One of her particular interests is clearly the influence of personality types on chronic pain, and 61 pages are devoted to describing this--a part of the book many lay readers are likely to go to first. But though she discusses how personality traits affect an individual’s capacity to cope with pain and disability, she fails to connect these traits and the initial development of chronic pain. Moreover, she does not acknowledge the literature dealing with pain-prone personalities or the concept of secondary gain.

Schneider concludes by looking at the indirect and direct costs of chronic pain and describes how family and friends can help the patient. A discussion of current research and new developments rounds out the text.

This book is a good resource for health care professionals and educated readers alike. It would be a worthy reference for health care personnel in locales such as long-term care facilities. Jennifer Schneider has attempted a comprehensive guide on chronic pain, a daunting task considering that many books dealing with clinical issues rapidly become out of date. All in all, this is a timely book that ably sums up where things are, right now, in chronic pain.

NACPAC website offers help for chronic pain sufferers

NACPAC website offers help for chronic pain sufferers

Teaser: 

The North American Chronic Pain Association of Canada (NACPAC) is a "self-help organization dedicated to providing support to people in chronic pain, and to giving them assistance in living their lives to the fullest." NACPAC is a registered Canadian Charity and has its own web-site at http://www3.sympatico.ca/nacpac. The website offers information about chronic pain, support groups in Canada, a directory of Canadian pain clinics and pain specialists, related associations and resource lists, links to other chronic pain information on the web, medical information, reference material, book suggestions and more.

November 8th to14th is Chronic Pain Awareness Week in Canada. NACPAC encourages anyone touched by chronic pain to educate others on the plight of chronic pain sufferers in Canada. If you are unable to access NACPAC via the web, their toll free number is 1-800-616-7246.

Chronic Pain Management: Older People Need Better Access to Opioid Analgesics

Chronic Pain Management: Older People Need Better Access to Opioid Analgesics

Teaser: 

Sherene Chen See is a freelance writer from Toronto, Ontario. We regret that Sherene Chen See's articles are not available on-line.

 

Key Recommendations for the Pharmacological Management of Chronic Pain in the Older Person1

Acetaminophen is the drug of choice for relieving mild to moderate musculoskeletal pain.

Opioid analgesic drugs are effective for relieving moderate to severe pain. Regulatory agencies should review their policies to allow older patients better access to opioid analgesic drugs for pain.

Non-opioid analgesic medications (including atypical pain modulating drugs like tricyclics and anticonvulsants) may be appropriate for some patients with neuropathic pain and other chronic pain syndromes.

Non-steroidal anti-inflammatory drugs (NSAIDs) should be used with caution. In older people NSAIDs have significant side effects and are the most common cause of adverse drug reactions, especially in the frail elderly.

1 The management of chronic pain in older persons: AGS Panel on Chronic Pain in Older Persons. American Geriatrics Society. J Am Geriatr Soc 1998;46(5):635-51.