Volume 11, Issue #9

November/December 2011

In This Issue:

The prevalence of chronic pain and the presence of a sleep disorder depend on a number of factors, including the type of pain, the age of the patient, gender, and the existence of comorbid conditions such as depression.
Sleep is a vital physiologic process, and notable reductions in sleep can have negative physiologic, cognitive, and emotional effects. Article covers treating chronic pain-related insomnia.
Educate, Then Let Patient Choose C. Norman Shealy, MD, PhD Fair Grove, MO As with all medical problems, I list the best options I see and then let the patient choose. Here are some of the measures typically discussed:
Along with anxiety and depression, attention deficit hyperactivity disorder (ADHD) is a common comorbidity among patients with chronic pain. Review from a pain specialist of handling this pain comorbidity.
Dry needling (DN) is a unique treatment option for chronic low back pain. DN is a procedure in which filiform needles—needles commonly used in acupuncture—are used to deactivate myofascial trigger points (MTrPs).
chronic pain is associated with high rates of mental health disorders. The comorbid relationship between Chronic pain and these disorders has been identified in patients with chronic low back pain (LBP), chronic work-related musculoskeletal pain disability, chronic arthritis, headache/migraine, temporomandibular joint disorder (TMD), upper extremity disorders such as carpal tunnel syndrome, fibromyalgia, and a heterogeneous chronic pain group.
It has been estimated that 25% of the general population has TMD—a group of pathologies that affect the masticatory muscles (myogenous) and/or the temporomandibular joint (TMJ) (arthrogenous). Disability related to this disorder also has been found to have a major influence on socioeconomic factors and is associated with decreased employment.
Highlights from PAINWeek 2011, as reported by Practical Pain Management.
This educational review summarizes the different classes of medications commonly used in the treatment of low back pain, discussing the mechanism of action, efficacy, complications, contraindications, and current clinical research for each class or group of medications.
Many pain management practitioners realize there is a critical connection between pain and sleep. But how best to treat these pain patients?
A 66-year-old man with long-standing history of chronic neuralgia of the right occipital nerve presents with constant, daily pain of variable intensity associated with photophobia, phonophobia, and frequent nausea. Case Challenge from Practical Pain Management.
Pain after TKA is reported to be a problem in an estimated 20% of cases. It is described as a surgical risk and is often accepted as an unfortunate outcome of the procedure. However, careful physical examination of the diagnostic evaluation can reveal soft tissue pathologies that can be successfully managed.
The editor of Practical Pain Management discuses dealing with chronic pain patients who also suffer from insomnia, a common pain co-morbidity.
Read this call to all pain practitioners to seek new knowledge in chronic pain through research. Why is it so necessary?
Question: What do you do with the patient who tests positive for marijuana on a urine test? Dr. Jennifer Schneider answers this Ask the Expert question.
Tips on prescribing opioids to chronic pain patients: a pain management specialist tells pain practitioners which three opioids to never prescribe in combination.
Letters to the Editor from the November/December 2011 issue of Practical Pain Management.