Assessment and Treatment of Psychosocial Comorbidities in Patients With Neuropathic Pain

Abstract

[3][4][5] In some studies, investigators reported that more than 40% of patients with implanted devices for pain control experience adverse events 6 ; up to 67.7% of patients treated with lumbar surgery for back pain reported that their pain was worse after surgery, 7 and at least moderate adverse effects have been reported to occur in 30% to 61% of all patients who undergo spinal manipulations. 8 These findings do not argue against the use of such treatments but serve as reminders of limitations and possible harmful effects. The mean duration of pain in patients who seek treatment at chronic pain treatment facilities is approximately 7 years. 9 Consequently, all domains of their lives may have been compromised for a substantial amount of time. It is hardly surprising that levels of emotional distress for patients with persistent pain are high. Estimates suggest that at least 1 current psychiatric diagnosis is present in 59% of patients with chronic back pain treated at pain facilities and at least 1 lifetime psychiatric diagnosis is present in 77% of these patients. 10 In contrast, community estimates are 15% for at least 1 current psychiatric diagnosis and 29% to 38% Chronic neuropathic pain is a prevalent problem that eludes cure and adequate treatment. The persistence of intense and aversive symptoms, inadequacy of available treatments, and impact of such pain on all aspects of functioning underscore the important role of several psychosocial factors in causing, maintaining, and amplifying the perception of pain severity, coping adequacy, adaptation, impaired physical function, and emotional distress responses. Moreover, these factors have an influential role in response to treatment recommendations. In this article, we (1) review the prevalence and nature of emotional distress, (2) describe and propose methods for screening and comprehensive psychosocial assessment, and (3) review evidence supporting the potential complementary role of psychosocial treatments of patients with chronic pain. The cognitive-behavioral perspective and treatment approach are emphasized because the greatest amount of evidence supports their benefits. Published results of psychological treatments are modest; however, the same indictment can be placed on currently available pharmacological, medical, and interventional treatments for patients with chronic pain. We note the limited research on the effectiveness of psychological treatment specifically applied to patients with chronic neuropathic pain but suggest that it is reasonable to extrapolate from successful trials in other types of chronic pain. Furthermore, psychological approaches should not be viewed as alternatives but rather should be integrated as part of a comprehensive approach to the treatment of patients with chronic neuropathic pain. Mayo Clin © 2010 Mayo Foundation for Medical Education and ResearchC hronic neuropathic pain is a prevalent problem that eludes successful treatment. Despite increasing knowledge of the neurophysiologic factors underlying neuropathic pa...

Clinical practice guidelines for management of neuropathic pain: Expert panel recommendations for South Africa

“…87 Transcutaneous electrical nerve stimulation (TENS) is widely used for NeuP and nociceptive pain, and while it lacks robust efficacy data, 88 it is recommended by EFNS Task Force 89 as a preliminary or as an adjunct to analgesic therapy as it is inexpensive, non-invasive, safe, and can be self-administered. A review of non-pharmacological treatment approaches by Guastella et al, 90 indicate TENS in focal neuropathic pain when upstream stimulation is possible for a superficial sensitive nerve trunk.…”

Psychobehavioral and psychosocial aspects of neuropathic pain patients

“…No treatment described to date is successful in totally eliminating pain 3 , and it is not desirable that this happens; as a consequence, it is necessary that most people adapt to the presence of chronic pain and learn self-management in face of such persistent stimulus and its consequences. However, this seems to be the most complicated part of such patients' management.…”

“…Psychological management is based on getting relief through active patients' participation, encouraging them to adopt healthcare practices, in addition to fostering active participation in psychosocial sphere. The old dilemma of whether psychobehavioral problems would be cause or reaction is still to be defined 3 . Suffering and not sensation may lead to helplessness and hopelessness, two feelings which easily induce depression.…”

“…Recommending that psychological approaches should not be considered alternatives, but rather be integrated as part of a comprehensive approach to treat patients with chronic neuropathic pain and psychological comorbidities, Turk at al. 3 state that some diagnostic dilemmas are created; "(...) such patients require the consideration of additional treatment to optimize results. Regardless of being cause or effect, psychiatric comorbidities and psychosocial problems may exacerbate and negatively affect neuropathic pain intensity, disease progression, patients' adaptation and responses to treatment.…”

“…Regardless of being cause or effect, psychiatric comorbidities and psychosocial problems may exacerbate and negatively affect neuropathic pain intensity, disease progression, patients' adaptation and responses to treatment. So, it is proposed that the success of the treatment of most chronic neuropathic pain patients should adopt an integrated multimodal approach with tailored prescription, rather than pharmacological therapies 3 . So, it is necessary to understand the meaning of symptoms in the context in which they occur and to have major tolerance with complaints expression so that they are useful for general treatment purposes.…”