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Neuropathic Pain With Damaged Pain-Processing Areas of the BrainDamage to pain-processing areas in the brain also can result in neuropathic pain that is “referred”—that is, felt elsewhere. In this example, an injury to the thalamus (inset) causes pain in a shoulder.
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f4-ascp-04-2-4: Neuropathic Pain With Damaged Pain-Processing Areas of the BrainDamage to pain-processing areas in the brain also can result in neuropathic pain that is “referred”—that is, felt elsewhere. In this example, an injury to the thalamus (inset) causes pain in a shoulder.

Mentions: Still other types of neuropathic pain have central or regional origins. Injury to certain parts of the central nervous system—such as the thalamus, a prominent pain-processing center in the brain, due to a stroke (Jensen and Lenz, 1995) or the dorsal horn, a pain-processing center of the spinal cord, due to herpes zoster or shingles—may cause pain in body areas whose neural signals travel through the injured area (Figure 4). Aberrant central neural processing of nonpain signals due to abnormal neurotransmitter activity is now thought likely to be responsible for fibromyalgia syndrome, which presents with diffuse, generalized, or multifocal pain (Mease, 2005). Persistent arousal of a localized region of the sympathetic nervous system may contribute to a complex regional pain syndrome, a neuropathic pain of complex etiology (Burton, Bruehl, and Harden, 2005).

Challenges in Using Opioids to Treat Pain in Persons With Substance Use Disorders

Savage SR, Kirsh KL, Passik SD - Addict Sci Clin Pract (2008)

Bottom Line: Pain and substance abuse co-occur frequently, and each can make the other more difficult to treat.This article discusses the neurobiology and clinical presentation of pain and its synergies with substance use disorders, presents methodical approaches to the evaluation and treatment of pain that co-occurs with substance use disorders, and provides practical guidelines for the use of opioids to treat pain in individuals with histories of addiction.The authors consider that every pain complaint deserves careful investigation and every patient in pain has a right to effective treatment.

Affiliation: Dartmouth Medical School, Hanover, New Hampshire 03755, USA. seddon.r.savage@dartmouth.edu

ABSTRACT
Pain and substance abuse co-occur frequently, and each can make the other more difficult to treat. A knowledge of pain and its interrelationships with addiction enhances the addiction specialist's efficacy with many patients, both in the substance abuse setting and in collaboration with pain specialists. This article discusses the neurobiology and clinical presentation of pain and its synergies with substance use disorders, presents methodical approaches to the evaluation and treatment of pain that co-occurs with substance use disorders, and provides practical guidelines for the use of opioids to treat pain in individuals with histories of addiction. The authors consider that every pain complaint deserves careful investigation and every patient in pain has a right to effective treatment.

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