Whereas US osteopaths[1] saw Traumatic Brain Injury as underdiagnosed in Chronic Pain patients, Canadian psychiatrists[2] took a contrary view that cognitive symptoms of Post-Concussive Syndrome are nonspecific and occur in a majority of Chronic Pain patients with no history of head injury.
PRACTICE POINT Impaired concentration, memory and attention are common accompaniments of Chronic Pain and do not necessarily imply physical injury to the brain |
Internists[3] and medical students[4] reading vignettes increased their estimates of patients' pain and disability if it was medically explicable or if the reported pain intensity was low.
Both groups decreased their evaluations if there was inadequate medical explanation or the reported pain intensity was high. Internists judged greater pain and disability if the reported patient-doctor relationship was negative.
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PRACTICE POINT Physician judgments of severity of pain and disability are demonstrably biased by:
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For the first time, validated measures of Alexithymia have confirmed[5] that Chronic Pain patients are less able to identify and verbalise their emotions, and suggests that this disability contributes to their psychological vulnerability.
A review[6] of the medical research literature on Chronic Pain and Depression concludes that there is some evidence for Depression-proneness before the onset of the pain, and that the psychological disability largely results from, rather than causes, the Chronic Pain. Citing the difficulties in assessing Depression in sufferers from Chronic Pain, the authors caution against faulty conclusions that Depression antedates the pain.
PRACTICE POINT The "thin skull" profile, which should be established for Chronic Pain clients includes 1.
Alexithymia ("no words for feelings") |
Because narcotics are commonly misused and abused[7], [8] in Chronic Pain, the search continues for better pharmacological approaches.
The classic Antidepressant Amitryptiline has been shown[9] to be an equally effective Chronic Pain-killer in high or low dosage. Recent review[10] of research confirmed efficacy of Prozac-type (SSRI) Antidepressants in some types of Chronic Pain.
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PRACTICE POINT The Chronic Pain-killer efficacy of Antidepressant medications is independent of the presence of Depression |
Epidural Spinal Cord Stimulation by implanted electrodes is effective in a wide range of localised Chronic Pain conditions, even though it has largely been used for Failed Back pain hitherto[11].
More than half a series of 200 implanted patients needed analgesic medication occasionally at most to supplement the Stimulation. The anatomically-restricted extent of the pain relief is being addressed by technical advances[12].
PRACTICE POINT Spinal Cord Stimulation by implanted electrodes is becoming a viable option for localised Chronic Pain |
Copyright © 2008 Electronic Handbook of Legal Medicine