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Burdensome problems of chronic musculoskeletal pain and future prospects.

Ushida T - J Orthop Sci (2015)

Bottom Line: However, these drugs are commonly associated with problems such as adverse effects, drug dependency and drug abuse, and they must be used with care.Besides, exercise therapy has been found to be effective in treating many different types of chronic pain.The therapeutic strategy is based on a cognitive-behavioral approach, and patients are taught about methods for restoring physical function and coping with pain, mostly with drugs and exercise therapy, so that any pain present does not impair function and the patient can reintegrate into society.

View Article: PubMed Central - PubMed

Affiliation: Multidisciplinary Pain Center, Aichi Medical University, Nagakute, Japan. ushidat-koc@umin.ac.jp.

ABSTRACT
According to a recent survey, about 15 % of the Japanese population suffers from moderate-severe chronic musculoskeletal pain persisting for at least 6 months. Social factors and related psychological factors (including depression) thus appear to greatly affect chronic musculoskeletal pain. This suggests the need for measures that take these factors into account. Treatment for musculoskeletal pain at present is generally based on a biomedical model that has been used for many years in this field, and modern medical imaging technologies have been a high priority to support this model and treatment strategy. Under the concept of the biomedical model, nonsteroidal antiinflammatory drugs, channel blockers and opioid analgesics are generally used as pharmacotherapy to alleviate chronic pain. However, these drugs are commonly associated with problems such as adverse effects, drug dependency and drug abuse, and they must be used with care. Surgery may also be effective in treating certain diseases, but studies have shown that many patients suffer residual chronic pain even after such treatment. Besides, exercise therapy has been found to be effective in treating many different types of chronic pain. Lately, various countries have been launching interdisciplinary pain centers that use a multidisciplinary approach to treat chronic musculoskeletal pain. Treatment in these centers is provided by a team of specialists in anesthesiology, psychiatry and orthopedics as well as the relevant paramedical professionals. The therapeutic strategy is based on a cognitive-behavioral approach, and patients are taught about methods for restoring physical function and coping with pain, mostly with drugs and exercise therapy, so that any pain present does not impair function and the patient can reintegrate into society.

No MeSH data available.


Related in: MedlinePlus

The number needed to treat (NNT) with analgesic drugs for neuropathic pain. Numbers needed to treat (NNT) values for various drug classes in all central and peripheral neuropathic pain conditions. BTX-A botulinum toxin type A; TCAs tricyclic antidepressants; SNRIs serotonin noradrenaline reuptake inhibitors; SSRIs selective serotonin reuptake inhibitor. The figure illustrates the change from 2005 values in light gray to 2010 values in dark gray. The circle sizes indicate the relative number of patients who received active treatment drugs in trials for which dichotomous data were available. [From Finnerup et al. Pain 150(3) pp 573–581]
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Fig6: The number needed to treat (NNT) with analgesic drugs for neuropathic pain. Numbers needed to treat (NNT) values for various drug classes in all central and peripheral neuropathic pain conditions. BTX-A botulinum toxin type A; TCAs tricyclic antidepressants; SNRIs serotonin noradrenaline reuptake inhibitors; SSRIs selective serotonin reuptake inhibitor. The figure illustrates the change from 2005 values in light gray to 2010 values in dark gray. The circle sizes indicate the relative number of patients who received active treatment drugs in trials for which dichotomous data were available. [From Finnerup et al. Pain 150(3) pp 573–581]

Mentions: As analgesic medications (such as anxiolytics, antidepressants and anticonvulsants) have recently come into common use for treating pain (particularly neuropathic pain) in the field of orthopedics, we must consider the adverse effect of these medications since many orthopedic providers are not familiar with these drugs. In Japan, benzodiazepines are frequently used as anxiolytics over the long term, but the Food and Drug Administration (FDA) in the USA does not recommend these agents for long-term use because of the development of resistance to the effects, the risk of drug dependency and the occurrence of withdrawal symptoms when taking the patient off these drugs. Anticonvulsants suppress the transmission of pain signals by blocking neural excitation and neurotransmitter release. However, they may also trigger numerous side effects, such as drowsiness and dizziness, because of their actions in ion channels (sodium channels, calcium channels, etc.) distributed throughout the nervous system. It is particularly important to note that elderly patients or patients with spinal cord disorders who may have reduced functioning in the nervous system may be at a higher risk of falls than usual and should take extra care when using these drugs. Opioids have also come into use for treating musculoskeletal pain. In addition to the unique side effects of opioids such as nausea, opioids have been noted for associations with drug resistance and dependency as well as social problems such as drug abuse in other countries. Medical providers must become well versed in the use of these drugs and only prescribe them to patients who are indicated while closely monitoring the dosage. While the appropriate use of pharmacotherapies can benefit patients, drug effects are often limited and the number needed to treat (NNT; the number of patients who must be treated for 1 patient to achieve high efficacy against their pain, i.e., reducing pain by half) in the treatment of neuropathic pain ranges from about 3 to 10 (Fig. 6) [11].Fig. 6


Burdensome problems of chronic musculoskeletal pain and future prospects.

Ushida T - J Orthop Sci (2015)

The number needed to treat (NNT) with analgesic drugs for neuropathic pain. Numbers needed to treat (NNT) values for various drug classes in all central and peripheral neuropathic pain conditions. BTX-A botulinum toxin type A; TCAs tricyclic antidepressants; SNRIs serotonin noradrenaline reuptake inhibitors; SSRIs selective serotonin reuptake inhibitor. The figure illustrates the change from 2005 values in light gray to 2010 values in dark gray. The circle sizes indicate the relative number of patients who received active treatment drugs in trials for which dichotomous data were available. [From Finnerup et al. Pain 150(3) pp 573–581]
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC4664610&req=5

Fig6: The number needed to treat (NNT) with analgesic drugs for neuropathic pain. Numbers needed to treat (NNT) values for various drug classes in all central and peripheral neuropathic pain conditions. BTX-A botulinum toxin type A; TCAs tricyclic antidepressants; SNRIs serotonin noradrenaline reuptake inhibitors; SSRIs selective serotonin reuptake inhibitor. The figure illustrates the change from 2005 values in light gray to 2010 values in dark gray. The circle sizes indicate the relative number of patients who received active treatment drugs in trials for which dichotomous data were available. [From Finnerup et al. Pain 150(3) pp 573–581]
Mentions: As analgesic medications (such as anxiolytics, antidepressants and anticonvulsants) have recently come into common use for treating pain (particularly neuropathic pain) in the field of orthopedics, we must consider the adverse effect of these medications since many orthopedic providers are not familiar with these drugs. In Japan, benzodiazepines are frequently used as anxiolytics over the long term, but the Food and Drug Administration (FDA) in the USA does not recommend these agents for long-term use because of the development of resistance to the effects, the risk of drug dependency and the occurrence of withdrawal symptoms when taking the patient off these drugs. Anticonvulsants suppress the transmission of pain signals by blocking neural excitation and neurotransmitter release. However, they may also trigger numerous side effects, such as drowsiness and dizziness, because of their actions in ion channels (sodium channels, calcium channels, etc.) distributed throughout the nervous system. It is particularly important to note that elderly patients or patients with spinal cord disorders who may have reduced functioning in the nervous system may be at a higher risk of falls than usual and should take extra care when using these drugs. Opioids have also come into use for treating musculoskeletal pain. In addition to the unique side effects of opioids such as nausea, opioids have been noted for associations with drug resistance and dependency as well as social problems such as drug abuse in other countries. Medical providers must become well versed in the use of these drugs and only prescribe them to patients who are indicated while closely monitoring the dosage. While the appropriate use of pharmacotherapies can benefit patients, drug effects are often limited and the number needed to treat (NNT; the number of patients who must be treated for 1 patient to achieve high efficacy against their pain, i.e., reducing pain by half) in the treatment of neuropathic pain ranges from about 3 to 10 (Fig. 6) [11].Fig. 6

Bottom Line: However, these drugs are commonly associated with problems such as adverse effects, drug dependency and drug abuse, and they must be used with care.Besides, exercise therapy has been found to be effective in treating many different types of chronic pain.The therapeutic strategy is based on a cognitive-behavioral approach, and patients are taught about methods for restoring physical function and coping with pain, mostly with drugs and exercise therapy, so that any pain present does not impair function and the patient can reintegrate into society.

View Article: PubMed Central - PubMed

Affiliation: Multidisciplinary Pain Center, Aichi Medical University, Nagakute, Japan. ushidat-koc@umin.ac.jp.

ABSTRACT
According to a recent survey, about 15 % of the Japanese population suffers from moderate-severe chronic musculoskeletal pain persisting for at least 6 months. Social factors and related psychological factors (including depression) thus appear to greatly affect chronic musculoskeletal pain. This suggests the need for measures that take these factors into account. Treatment for musculoskeletal pain at present is generally based on a biomedical model that has been used for many years in this field, and modern medical imaging technologies have been a high priority to support this model and treatment strategy. Under the concept of the biomedical model, nonsteroidal antiinflammatory drugs, channel blockers and opioid analgesics are generally used as pharmacotherapy to alleviate chronic pain. However, these drugs are commonly associated with problems such as adverse effects, drug dependency and drug abuse, and they must be used with care. Surgery may also be effective in treating certain diseases, but studies have shown that many patients suffer residual chronic pain even after such treatment. Besides, exercise therapy has been found to be effective in treating many different types of chronic pain. Lately, various countries have been launching interdisciplinary pain centers that use a multidisciplinary approach to treat chronic musculoskeletal pain. Treatment in these centers is provided by a team of specialists in anesthesiology, psychiatry and orthopedics as well as the relevant paramedical professionals. The therapeutic strategy is based on a cognitive-behavioral approach, and patients are taught about methods for restoring physical function and coping with pain, mostly with drugs and exercise therapy, so that any pain present does not impair function and the patient can reintegrate into society.

No MeSH data available.


Related in: MedlinePlus