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21 - Analgesia for the Chronic Pain Patient

from SECTION TWO - ANALGESIA FOR THE EMERGENCY PATIENT

Published online by Cambridge University Press:  03 December 2009

John H. Burton
Affiliation:
Albany Medical College, New York
James Miner
Affiliation:
University of Minnesota
James Miner
Affiliation:
Department of Emergency Medicine, Hennepin Medical Center, 701 Park Avenue South, Minneapolis, MN 55415, Email:miner015@umn.edu
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Summary

SCOPE OF THE PROBLEM

All chronic pain begins as acute pain. The physiologic transition from acute to chronic pain syndromes results from physiologic and psychosocial transitions that are not well defined. Generally speaking, acute pain becomes chronic pain when the physiologic insult that caused the original pain has resolved or reached a static or progressive state.

A large number of emergency department (ED) patients have underlying chronic pain syndromes. It is very common in the U.S. population, with rates as high as 40% noted in one review.

The key step to the prevention of chronic pain may be the adequate treatment of acute pain. Acute pain serves an adaptive purpose in that it stimulates protection of the injured area via recruitment of tissue repair mechanisms as well as physiologic responses such as increased blood pressure and respirations. As the injury heals, these adaptive purposes become maladaptive, as limited movement causes a decreasing range of motion, prolonged stress response causes impaired immune response, hypercoagulable states, and vegetative symptoms (Table 21-1).

It can be difficult to determine at what point pain changes from adaptive to maladaptive, or from acute to chronic. Acute and chronic pain call for different treatment approaches, both in terms of the approach to the patient and to the medications used. The maladaptive components of chronic pain can push patients toward behaviors that can hinder their recovery (lack of abnormal use of painful extremities, inactivity) and impact their mood, social interactions, and lifestyle (Figure 21-1).

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Publisher: Cambridge University Press
Print publication year: 2008

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References

Portenoy, RK, Ugarte, C, Fuller, I, Haas, G.Population-based survey of pain in the United States: Differences among white, African American, and Hispanic subjects. J Pain 2004;5(6):317–328.CrossRefGoogle ScholarPubMed
Verhaak, PF, Kerssens, JJ, Dekker, J, Sorbi, MJ, Bensing, JM. Prevalence of chronic benign pain disorder among adults: A review of the literature. Pain 1998;77(3):231–239.CrossRefGoogle ScholarPubMed
Baker, K.Chronic pain syndromes in the emergency department: Identifying guidelines for management. Emerg Med Australas 2005;17(1):57–64.CrossRefGoogle ScholarPubMed
MacFarlane, BV, Wright, A, O'Callaghan, J, Benson, HA. Chronic neuropathic pain and its control by drugs. Pharmacol Ther 1997;75(1):1–19.CrossRefGoogle ScholarPubMed
Elliott, AM, Smith, BH, Penny, KI, Smith, WC, Chambers, WA.The epidemiology of chronic pain in the community. Lancet 1999;354(9186):1248–1252.CrossRefGoogle Scholar
Puke, MJ, Wiesenfeld-Hallin, Z.The differential effects of morphine and the alpha 2-adrenoceptor agonists clonidine and dexmedetomidine on the prevention and treatment of experimental neuropathic pain. Anesth Analg 1993;77(1):104–109.Google ScholarPubMed
Backonja, M, Beydoun, A, Edwards, KR, et al. Gabapentin for the symptomatic treatment of painful neuropathy in patients with diabetes mellitus: A randomized controlled trial. JAMA 1998;280(21):1831–1836.CrossRefGoogle ScholarPubMed
Watson, CP.Antidepressant drugs as adjuvant analgesics. J Pain Symptom Manage 1994;9(6):392–405.CrossRefGoogle ScholarPubMed
Onghena, P, Houdenhove, B.Antidepressant-induced analgesia in chronic non-malignant pain: A meta-analysis of 39 placebo-controlled studies. Pain 1992;49(2): 205–219.CrossRefGoogle ScholarPubMed
McQuay, H, Carroll, D, Jadad, AR, Wiffen, P, Moore, A.Anticonvulsant drugs for management of pain: A systematic review. BMJ 1995;311(7012):1047–1052.CrossRefGoogle ScholarPubMed
Rowbotham, M, Harden, N, Stacey, B, Bernstein, P, Magnus-Miller, L, for the Gabapentin Postherpetic Neuralgia Study Group. Gabapentin for the treatment of postherpetic neuralgia: A randomized controlled trial. JAMA 1998;280(21):1837–1842.CrossRefGoogle ScholarPubMed
Mao, J, Price, DD, Hayes, RL, Lu, J, Mayer, DJ, Frenk, H. Intrathecal treatment with dextrorphan or ketamine potently reduces pain-related behaviors in a rat model of peripheral mononeuropathy. Brain Res 1993;605(1):164–168.CrossRefGoogle ScholarPubMed
Mao, J, Price, DD, Mayer, DJ. Thermal hyperalgesia in association with the development of morphine tolerance in rats: Roles of excitatory amino acid receptors and protein kinase C. J Neurosci 1994;14(4):2301–2312.CrossRefGoogle ScholarPubMed

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  • Analgesia for the Chronic Pain Patient
    • By James Miner, Department of Emergency Medicine, Hennepin Medical Center, 701 Park Avenue South, Minneapolis, MN 55415, Email:miner015@umn.edu
  • John H. Burton, Albany Medical College, New York, James Miner, University of Minnesota
  • Book: Emergency Sedation and Pain Management
  • Online publication: 03 December 2009
  • Chapter DOI: https://doi.org/10.1017/CBO9780511547225.021
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  • Analgesia for the Chronic Pain Patient
    • By James Miner, Department of Emergency Medicine, Hennepin Medical Center, 701 Park Avenue South, Minneapolis, MN 55415, Email:miner015@umn.edu
  • John H. Burton, Albany Medical College, New York, James Miner, University of Minnesota
  • Book: Emergency Sedation and Pain Management
  • Online publication: 03 December 2009
  • Chapter DOI: https://doi.org/10.1017/CBO9780511547225.021
Available formats
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  • Analgesia for the Chronic Pain Patient
    • By James Miner, Department of Emergency Medicine, Hennepin Medical Center, 701 Park Avenue South, Minneapolis, MN 55415, Email:miner015@umn.edu
  • John H. Burton, Albany Medical College, New York, James Miner, University of Minnesota
  • Book: Emergency Sedation and Pain Management
  • Online publication: 03 December 2009
  • Chapter DOI: https://doi.org/10.1017/CBO9780511547225.021
Available formats
×