Treat the Patient, Not the Label: A Pain Neuroscience Update

When dealing with chronic pain, it is often not possible for clinicians to provide adequate answers to their patients about what might be wrong, and why they continue to have their pain. This has led to greater use of diagnostic “labels” for conditions such as fibromyalgia, chronic fatigue syndrome, irritable bowel syndrome, chronic Lyme disease, and many others. Assigning such “labels” to patients with chronic pain has far-reaching consequences for all stakeholders. The aim of this clinical commentary is to highlight some of the common threads among 4 particular conditions common to women—fibromyalgia, chronic fatigue syndrome, irritable bowel syndrome, and chronic Lyme disease—when it comes to the underlying neurobiology and its consequences for the patient and treating clinicians. By taking a “big picture” view of pain as a multiple system output activated in response to threat, we discuss how the various output systems activated can lead to clusters of symptoms that may predispose patients to one or other of these 4 diagnostic conditions. There is now emerging evidence that during the biological response to threat, one output system may be more affected than the others and dominate the clinical picture, hence manifesting as a particular diagnostic condition. We propose that ultimately, these conditions essentially mean the same thing, that the patient has chronic pain, and we advocate for treatment of the patient, not the co...
Source: Journal of Women’s Health Physical Therapy - Category: Physiotherapy Tags: Clinical Commentary Source Type: research

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Authors: Shim JG, Ryu KH, Kim PO, Cho EA, Ahn JH, Yeon JE, Lee SH, Kang DY Abstract Background: Video-assisted thoracoscopic surgery (VATS) is a commonly performed minimally invasive procedure that has led to lower levels of pain, as well as procedure-related mortality and morbidity. However, VATS requires analgesia that blocks both visceral and somatic nerve fibers for more effective pain control. This randomized controlled trial evaluated the effect of erector spinae plane block (ESPB) in the postoperative analgesia management of patients undergoing VATS. Methods: We performed a prospective, randomized, singl...
Source: Journal of Thoracic Disease - Category: Respiratory Medicine Tags: J Thorac Dis Source Type: research
Authors: Xu Y, Li XK, Zhou H, Cong ZZ, Wu WJ, Qiang Y, Shen Y Abstract Background: Paravertebral block (PVB) conducted by epidural catheter is a prevalent pain management for patients undergoing video-assisted thoracoscopic surgery (VATS) lobectomy. The aim of this study was to assess the efficacy and safety of paravertebral block with a modified PVB (MPVB) catheter under surgeon's direct vision after video-assisted thoracoscopic lobectomy. Methods: Three hundred fifty-six patients undergoing VATS lobectomy were retrospectively reviewed and divided into two groups consecutively according to the catheter applied...
Source: Journal of Thoracic Disease - Category: Respiratory Medicine Tags: J Thorac Dis Source Type: research
Conclusions: The "Firefly" app based sensing technology offers the potential to significantly lower the barrier of entry to OSA screening, as no hardware (other than the user's personal smartphone) is required. Additionally, multi-night analysis is possible in the home environment, without requiring the wearing of a portable PSG or other home sleep test (HST). PMID: 32944361 [PubMed]
Source: Journal of Thoracic Disease - Category: Respiratory Medicine Tags: J Thorac Dis Source Type: research
Authors: Aiolfi A, Micheletto G, Guerrazzi G, Bonitta G, Campanelli G, Bona D Abstract Treatment of Boerhaave's syndrome is controversial. Formal thoracotomy and laparotomy were considered the gold standard treatment in the past. However, these approaches are associated with significant surgical trauma, stress, and postoperative pain. Recently published studies reported the application of minimally invasive surgery in the setting of such esophageal emergency. However, the application of minimally invasive surgery in the setting of Boerhaave's syndrome is debated and evidence is puzzled. The aim of this study was to...
Source: Journal of Thoracic Disease - Category: Respiratory Medicine Tags: J Thorac Dis Source Type: research
Fight Aging! publishes news and commentary relevant to the goal of ending all age-related disease, to be achieved by bringing the mechanisms of aging under the control of modern medicine. This weekly newsletter is sent to thousands of interested subscribers. To subscribe or unsubscribe from the newsletter, please visit: https://www.fightaging.org/newsletter/ Longevity Industry Consulting Services Reason, the founder of Fight Aging! and Repair Biotechnologies, offers strategic consulting services to investors, entrepreneurs, and others interested in the longevity industry and its complexities. To find out m...
Source: Fight Aging! - Category: Research Authors: Tags: Newsletters Source Type: blogs
Authors: Gonul S, Bakbak B Abstract Bilateral acute iris transillumination (BAIT) is a relatively new clinical entity characterized by bilateral acute loss of iris pigment epithelium, iris transillumination, pigment dispersion in the anterior chamber, and sphincter paralysis. BAIT has been easily confused with other types of anterior uveitis because of pigment dispersion in the anterior chamber and some symptoms including pain, photophobia, and red eye, which is similar to those in the other types of anterior uveitis. However, inflammatory findings in these patients are not as marked as in those with other types of...
Source: Ocular Immunology and Inflammation - Category: Allergy & Immunology Tags: Ocul Immunol Inflamm Source Type: research
CONCLUSIONS: Although most participants were satisfied with the colonoscopy experience, the study has highlighted areas for improvement. Important factors for colonoscopy experience were gender, randomization group, and type of hospital and therefore crucial to bear in mind when designing screening programs. PMID: 32946700 [PubMed - as supplied by publisher]
Source: Scandinavian Journal of Gastroenterology - Category: Gastroenterology Tags: Scand J Gastroenterol Source Type: research
Authors: Pettersson N, Kragsbjerg F, Hamrin A, Bergman S, Forsblad-d'Elia H, Karling P Abstract BACKGROUNDS/AIMS: Musculoskeletal symptoms are common in patients with ulcerative colitis (UC), but no study has compared the prevalence of chronic pain to controls from a general population. METHODS: Patients with UC (n = 1164) and controls (n = 3867) were sent questionnaires comprising demography, history of pain, pain localization and UC patients' Patient-Simple Clinical Colitis Activity Index. Chronic regional pain (ChRP) and chronic widespread pain (ChWP) were defined as having pain f...
Source: Scandinavian Journal of Gastroenterology - Category: Gastroenterology Tags: Scand J Gastroenterol Source Type: research
Authors: Lam KK, Leung MKM, Irwin MG Abstract Pain relief is an important component of modern obstetric care and can be produced by neuraxial, systemic, or inhalational analgesia or various physical techniques. We review the most recent evidence on the efficacy and safety of these techniques. Over the past decade, the availability of safer local anaesthetics, ultra-short acting opioids, combined spinal-epidural needles, patient-controlled analgesic devices, and ultrasound have revolutionised obstetric regional analgesia. Recent meta-analyses have supported epidural analgesia as the most efficacious technique, as it...
Source: Hong Kong Medical Journal - Category: General Medicine Tags: Hong Kong Med J Source Type: research
Condition:   Postoperative Pain Interventions:   Procedure: lower abdominal surgery;   Other: Erector spinae plane block;   Other: Transversus abdominis plane block Sponsor:   National Cancer Institute, Egypt Recruiting
Source: ClinicalTrials.gov - Category: Research Source Type: clinical trials
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