“Real-life” treatment of chronic pain: Targets and goals

Ablin, Jacob N.; Buskila, Dan

doi:10.1016/j.berh.2015.04.020

Cited by 8 publications

(8 citation statements)

References 54 publications

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“…Treating acute, inflammatory or local pain is usually attainable and with a good prognosis. However, chronic and centralised pain remains challenging and only partially successful, which, in part, is related to the clinical difficulty to establish differential diagnostic, and recognising the coexistence and interaction of distinct types of pain in the same patient . In addition, the neurobiology of chronic pain may be so much more complex than the current therapeutics efficiently can manage.…”

Section: Implications For Managementmentioning

confidence: 99%

“…In addition, the neurobiology of chronic pain may be so much more complex than the current therapeutics efficiently can manage. In such cases, to successfully and realistically manage pain, non‐pharmacological as well as pharmacological modalities aimed at centralised pain must be garnished .…”

Section: Implications For Managementmentioning

confidence: 99%

“…In cases of centralised pain, an efficient treatment should aim to deconstruct complex cases, identifying potential pain (nociceptive) generators, and targeting them with pharmacological and non‐pharmacological modalities . While strategies targeting the mechanisms related to the centralised pain are essential for a rationale treatment plan, a systematic workup for peripheral and nociceptive sources of pain would be adopted . It has been previously demonstrated that primary headaches negatively influenced the efficacy of TMD therapy .…”

Section: Implications For Managementmentioning

confidence: 99%

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Headaches and myofascial temporomandibular disorders: overlapping entities, separate managements?

Conti

Costa

Gonçalves

et al. 2016

J of Oral Rehabilitation

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There are relevant clinical overlaps between some of the painful temporomandibular disorders (TMD) and headache conditions that may hamper the diagnostic process and treatment. A non-systematic search for studies on the relationship between TMD and headaches was carried out in the following databases: PubMed, Cochrane Library and Embase. Important pain mechanisms contributing to the close association and complex relationship between TMD and headache disorders are as follows: processes of peripheral and central sensitisation which take place in similar anatomical areas, the possible impairment of the descending modulatory pain pathways and the processes of referred pain. In addition, the clinical examination does not always provide distinguishing information to differentiate between headaches and TMD. So, considering the pathophysiology and the clinical presentation of some types of headache and myofascial TMD, such overlap can be considered not only a matter of comorbid relationship, but rather a question of disorders where the distinction lines are sometimes hard to identify. These concerns are certainly reflected in the current classification systems of both TMD and headache where the clinical consequences of diagnosis such as headache attributed to or associated with TMD are uncertain. There are several similarities in terms of therapeutic strategies used to manage myofascial TMD and headaches. Considering all these possible levels of interaction, we reinforce the recommendation for multidisciplinary approaches, by a team of oro-facial pain specialists and a neurologist (headache specialist), to attain the most precise differential diagnosis and initiate the best and most efficient treatment.

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Section: Implications For Managementmentioning

confidence: 99%

Section: Implications For Managementmentioning

confidence: 99%

Section: Implications For Managementmentioning

confidence: 99%

See 1 more Smart Citation

Headaches and myofascial temporomandibular disorders: overlapping entities, separate managements?

Conti

Costa

Gonçalves

et al. 2016

J of Oral Rehabilitation

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“…Centrally acting agents such as TCAs, pregabalin, duloxetine and milnacipran have been recommended as first-line treatment options by these guidelines [101][102][103] . However, a huge shift has taken place towards a person/patient centered management of pain, with the recognition that individual patients within a specific diagnostic category may present a combination of various types of pain with markedly different nociceptive and neural contributions [94,104] . The patient may not necessarily fit neatly into traditional categories such as FMS or OA, as different types of pain that require different treatment approaches may coexist in a given individual.…”

Section: Research Highlightmentioning

confidence: 99%

“…I still believe that this distinction seems to be not useful from the viewpoint of clinical practice, as it will not facilitate the selection of appropriate interventions and/or discourage the selection of inappropriate ones. As discussed above, an effective treatment in an individual patient might be much guided by dominant underlying mechanisms responsible for pain rather than the level of pain or specific diagnosis the patient is suffering [94,104,145] . Optimal personalized care may require pharmacological and non-pharmacological strategies aiming at treating centralized pain in an individual even if a formal diagnosis of fibromyalgia has not been made and even in the presence of an inflammatory or structural disease such as RA, OA or CLBP.…”

Section: Research Highlightmentioning

confidence: 99%

Fibromyalgia or Chronic Widespread Pain: Does It Matter?

2016

Itch Pain

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The question whether Fibromyalgia syndrome (FMS) is a distinct clinical entity in the context of chronic widespread pain (CWP) have remained challenging after decades of research and several diagnostic criteria that have attempted to clarify FMS. A recent study has raised more challenges on the issue, proposing that diagnosis of FMS in patients representing with CWP is not informative or helpful for clinical practice and such a differentiation will provide little or no significance regarding the choice of effective and safe therapies. This proposal will be further discussed here by reviewing the recent advances in the field of pain medicine. These advances have collectively provided compelling evidence that all individuals with chronic pain, even those classically categorized as originating from peripheral/nociceptive origins have common central contributions to their pain and associated comorbidities. The recent understanding of the pain mechanisms has also provided important implications on classification and management of pain. Centrally acting agents have been recommended as first-line treatment options for FMS and potential use of these agents has been expanded to other chronic pain disorders. After having reviewed the recent advances in the pain field, distinction between CWP and FMS still seems not to be useful in clinical practice, as effective treatment in an individual patient might be much guided by dominant underlying mechanisms rather than specific diagnosis the patient is suffering. The conditions representing with CWP in the absence of definitive objective confirmation may then be classified under one heading such as "CWP", "chronic pain syndrome" or "central pain", when considering their similar pattern of clinical presentation, commonality of central sensitization to their pathophysiology and their similar response to centrally acting analgesics. Future research should be directed toward classification of CWP based on the validated measurements of different aspects of pain. Such a classification may help clinicians identify the patients who will preferentially respond to peripheral or centrally acting analgesics and may therefore assist in advancing a more individualized and pain mechanism focused treatment in the clinical setting.

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