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CHRONIC PAIN SYNDROME

CHRONIC PAIN SYNDROME. Chronic Pain. Chronic Pain define as: Pain persists beyond either the course of an acute disease or reasonable time for an injury to heal Pain is associated with chronic pathological process Pain that recurs at interval of months or year. Chronic Pain Syndrome.

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CHRONIC PAIN SYNDROME

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  1. CHRONIC PAIN SYNDROME

  2. Chronic Pain Chronic Pain define as: • Pain persists beyond either the course of an acute disease or reasonable time for an injury to heal • Pain is associated with chronic pathological process • Pain that recurs at interval of months or year

  3. Chronic Pain Syndrome I Malignant • Cancer pain syndrome II Non-Malignant • Nociceptive • Neuropathic • Psychogenic • Central pain

  4. Nociceptive • Low back pain • Myofacial pain • Visceral pain • Headache and facial pain • Neck and shoulder pain • Neuropathic pain • Sympathetically mediated pain • Post herpetic neuralgia • Trigeminal neuralgia • Phantom pain

  5. Modalities of Pain Management I Pharmacological II Anaesthesiologic III Special technique * Facet Blocks * Acupuncture (Gate control theory) * Cryolysis * Ablative technique * Radio frequency * Physical therapy

  6. Contd... Pharmacological • Analgesic • Paracetamol • NSAID • Opioids • Co-analgesics • Anti-depressant • Anti-convulsant

  7. Contd... Anesthisiologic • Central nerve blocks • Spinal • Epidural • Peripheral nerve blocks • Femoral • ICN • Others • Autonomic Nerve blocks • Stellete ganglion • Lumber Sympathectomy

  8. Contd... Special Technique • Facet block for back pain • Cryolysis for nerve damage • Radio frequency for facet joint / nerve damage • Acupuncture • 361 classical acupuncture points lie along specific pathway or meridians • Ablative neuro-surgical procedure - interrupt sensory pathways to the brain or in the brain and brain stem.

  9. Low Back Pain Most common condition seen in the pain clinic Major causes: • Prolapse inter-vertebral disc • Facet joint degeneration • Sacroiliac joint arthritis • Musculoskeletal disorder • Miscellaneous

  10. Prolapsed Intervertebral Disk

  11. Management of Low Back Pain • Pain alone may not justify decompression surgery like laminectomy or micro-discectomy

  12. Treatment Options Drug therapy vs nerve block procedure • drug therapy NSAID, week opioids & other support therapy • Low morbidity out patient • Epidural steroid • Facet joint steroid injection • Sacroiliac steroid injection

  13. Myofacial Pain Syndrome • Pathogenesis • The likely has a central mechanism, with peripheral clinical manifestations. • Causes • Abnormal stresses on the muscles from sudden stress on shortened muscles, leg-length discrepancies, or skeletal asymmetry • Poor posture, static position for a prolonged period of time Chronic infections and sleep deprivation

  14. Sympathetically Mediated Pain (SMP) Reflex sympathetic dystrophy (RSD) and causalgia RSD A group of condition associated with extremity pain and autonomic dysfunction Causalgia Specific syndrome of burning pain and autonomic dysfunction associated with major nerve trunk injury.

  15. Treatment Options • Drug therapy • Antidepressant • Anti convulsant • Narcotic analgesic • Oral nifedipine • Adrenergic blocking agents • Nerve Block • Chemical sympathectomy • Physical therapy

  16. Post-herpetic neuralgia • Pain in the distribution of a nerve • It follows an acute herpetic attack Incidence: 3-4 per 1000 Clinically: • Burning pain • constant deepache • crawling or scratching pain • stabbing or shooting

  17. Management • Drug therapy (main stay) • Anticonvulsant • Anti depressant • Nerve block • Little role

  18. Trigeminal Neuralgia • Conditions occur more often in • Female • middle aged • Strictly unilateral, however in 2% it may be bilateral • Pain in the face is characterized by sharp, severe (paroxysmal) and brief lasting no more then a few seconds.

  19. Management of Trigeminal Neuralgia • Drug Therapy • Anti-convulsant • Anti depressant • Nerve block • Cryo-analgesia • Radio-frequency

  20. Malignant Pain Syndrome Incidence 70% of cancer patients suffer from pain as a symptoms

  21. Management Strategies • Pharmacological methods • Interventional pain management • neurolytic blocks • Intraspinal drug delivery system

  22. Pharmacologic therapy “Analgesic staircase” Strong opioids +/- adjuvant Weak opioids +/- adjuvant Non-opioids NSAID +/- adjuvant

  23. Invasive Procedures • When pain or side effects persist despite comprehensive trials of pharmacologic therapy I Neurolytic blocks • Coeliac plexus • Hypogastric plexus II Intra-spinal drug delivery • short terms – intrathecal or epidural infusion • long term – implants

  24. CONCLUSION • Control of pain in chronic pain syndrome can be achieved in most patients by the application of a carefully individualized, flexible programme of : • analgesic drugs • Interventional pain management

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