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1.
Pain Physician ; 23(4S): S183-204, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32942785

RESUMO

BACKGROUND: The COVID-19 pandemic has worsened the pain and suffering of chronic pain patients due to stoppage of "elective" interventional pain management and office visits across the United States. The reopening of America and restarting of interventional techniques and elective surgical procedures has started. Unfortunately, with resurgence in some states, restrictions are once again being imposed. In addition, even during the Phase II and III of reopening, chronic pain patients and interventional pain physicians have faced difficulties because of the priority selection of elective surgical procedures.Chronic pain patients require high intensity care, specifically during a pandemic such as COVID-19. Consequently, it has become necessary to provide guidance for triaging interventional pain procedures, or related elective surgery restrictions during a pandemic. OBJECTIVES: The aim of these guidelines is to provide education and guidance for physicians, healthcare administrators, the public and patients during the COVID-19 pandemic. Our goal is to restore the opportunity to receive appropriate care for our patients who may benefit from interventional techniques. METHODS: The American Society of Interventional Pain Physicians (ASIPP) has created the COVID-19 Task Force in order to provide guidance for triaging interventional pain procedures or related elective surgery restrictions to provide appropriate access to interventional pain management (IPM) procedures in par with other elective surgical procedures. In developing the guidance, trustworthy standards and appropriate disclosures of conflicts of interest were applied with a section of a panel of experts from various regions, specialties, types of practices (private practice, community hospital and academic institutes) and groups. The literature pertaining to all aspects of COVID-19, specifically related to epidemiology, risk factors, complications, morbidity and mortality, and literature related to risk mitigation and stratification was reviewed. The evidence -- informed with the incorporation of the best available research and practice knowledge was utilized, instead of a simplified evidence-based approach. Consequently, these guidelines are considered evidence-informed with the incorporation of the best available research and practice knowledge. RESULTS: The Task Force defined the medical urgency of a case and developed an IPM acuity scale for elective IPM procedures with 3 tiers. These included urgent, emergency, and elective procedures. Examples of urgent and emergency procedures included new onset or exacerbation of complex regional pain syndrome (CRPS), acute trauma or acute exacerbation of degenerative or neurological disease resulting in impaired mobility and inability to perform activities of daily living. Examples include painful rib fractures affecting oxygenation and post-dural puncture headaches limiting the ability to sit upright, stand and walk. In addition, emergency procedures include procedures to treat any severe or debilitating disease that prevents the patient from carrying out activities of daily living. Elective procedures were considered as any condition that is stable and can be safely managed with alternatives. LIMITATIONS: COVID-19 continues to be an ongoing pandemic. When these recommendations were developed, different stages of reopening based on geographical regulations were in process. The pandemic continues to be dynamic creating every changing evidence-based guidance. Consequently, we provided evidence-informed guidance. CONCLUSION: The COVID-19 pandemic has created unprecedented challenges in IPM creating needless suffering for pain patients. Many IPM procedures cannot be indefinitely postponed without adverse consequences. Chronic pain exacerbations are associated with marked functional declines and risks with alternative treatment modalities. They must be treated with the concern that they deserve. Clinicians must assess patients, local healthcare resources, and weigh the risks and benefits of a procedure against the risks of suffering from disabling pain and exposure to the COVID-19 virus.


Assuntos
Dor Crônica/cirurgia , Infecções por Coronavirus , Manejo da Dor/métodos , Pandemias , Pneumonia Viral , Triagem/métodos , Betacoronavirus , Dor Crônica/classificação , Procedimentos Cirúrgicos Eletivos/classificação , Humanos , Estados Unidos
3.
Rev. esp. anestesiol. reanim ; 67(2): 68-75, feb. 2020. tab, graf
Artigo em Espanhol | IBECS | ID: ibc-197456

RESUMO

OBJETIVO: Conocer los patrones de prescripción de opioides fuertes en dolor crónico no oncológico por parte de médicos de familia. MATERIAL Y MÉTODOS: diseño: estudio descriptivo mediante cuestionario autoadministrado por correo electrónico. EMPLAZAMIENTO: todos los centros de salud de Cataluña. PARTICIPANTES: 3.602 médicos de familia socios de la Sociedad Catalana de Medicina Familiar y Comunitaria. INTERVENCIONES: administración de la encuesta por correo electrónico a los médicos de familia catalanes. MEDICIONES PRINCIPALESs: datos demográficos, número de pacientes que consultan por dolor crónico no oncológico tratados con opioides fuertes, opioides utilizados e indicación, patrones de prescripción, relación con la Unidad del Dolor. RESULTADOS: se obtuvieron 551 respuestas de 3.602 cuestionarios enviados (tasa de respuesta del 15,3%): 480 facultativos (87%) prescriben opioides fuertes para dolor músculo-esquelético; 268 (48,6%) prescriben fentanilo ultrarrápido; 434 (78,7%) disminuyen las dosis de benzodiacepinas al prescribir opioides fuertes. Los efectos adversos más habituales son estreñimiento y náuseas. Las principales dificultades observadas en la prescripción son su manejo (341, 71%) y la resistencia de pacientes y profesionales (87, 18,1%). La valoración de la interrelación con las Unidades de Dolor fue 2+/-1 (escala 1 al 5), siendo los problemas en la comunicación (271, 52,2%) y en la accesibilidad (141, 27,1%) los principales puntos de mejora. CONCLUSIONES: los patrones de prescripción se adecuan mayoritariamente a las guías clínicas en algunos aspectos (disminución de benzodiacepinas o titulación de dosis). Sin embargo, existen áreas de mejora como son el poco uso de laxantes o el uso de opioides ultrarrápidos para indicaciones no autorizadas y sin tratamiento opioide de base. Los médicos de familia demandan formación, perciben resistencias en su prescripción y creen necesario mejorar la relación con las Unidades del Dolor


OBJECTIVE: To identify family doctor prescription patterns for strong opioids for chronic, non-cancer-related pain. MATERIALS AND METHODS: Design A descriptive study based on a self-administered email questionnaire. LOCATION: All primary health care centres in Catalonia. PARTICIPANTS: 3,602 family doctors, all members of the Catalan Society of Family and Community Medicine. INTERVENTIONS: Email survey of Catalan family doctors. MAIN MEASUREMENTS: Demographic data, number of patients treated with potent opioids for chronic non-cancer pain, type of opioid used and indications, prescribing patterns and relationship with the Pain Management Unit. RESULTS: A total of 551 answers were obtained from 3,602 questionnaires sent (response rate of 15.3%), in which 480 physicians (87%) prescribed strong opioids for musculoskeletal pain, 268 (48.6%) prescribed ultra-rapid fentanyl and 434 (78.7%) reduced benzodiazepines dosage when prescribing potent opioids. The most common adverse effects were constipation and nausea. The main problems related with opioid prescription were improper use (341, 71%) and patient and/or practitioner reluctance (87, 18.1%). The assessment of the relationship with Pain Management Units was 2+/-1 (on a 1 to 5 scale), with communication (271, 52.2%) and accessibility (141, 27.1%) being the areas most in need of improvement. CONCLUSIONS: Opioid prescribing patterns generally follow clinical guidelines (e.g. reduction of benzodiazepine use or dose titration). However, there are some areas of improvement, such as sparse use of laxatives or use of ultra-rapid opioids for unapproved indications and in patients with no background opioid therapy. Family doctors perceive patient reluctance to adhere to the prescribed treatment, and call for specific training and better relationships with Pain Management Units


Assuntos
Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Analgésicos não Entorpecentes/administração & dosagem , Dor Crônica/tratamento farmacológico , Médicos de Família , Prescrições de Medicamentos , Analgésicos não Entorpecentes/efeitos adversos , Inquéritos e Questionários , Epidemiologia Descritiva , Dor Musculoesquelética/tratamento farmacológico , Dor Crônica/classificação , Manejo da Dor , Escala Visual Analógica , Espanha
4.
Ann Rheum Dis ; 79(3): 324-331, 2020 03.
Artigo em Inglês | MEDLINE | ID: mdl-31980546

RESUMO

OBJECTIVES: To gain expert-judgement-free insight into the Gestalt of axial spondyloarthritis (axSpA), by investigating its 'latent constructs' and to test how well these latent constructs fit the Assessment of SpondyloArthritis international Society (ASAS) classification criteria. METHODS: Two independent cohorts of patients with early onset chronic back pain (SPondyloArthritis Caught Early (SPACE)) or inflammatory back pain (IBP) (DEvenir des Spondylarthopathies Indifférenciées Récentes (DESIR)) were analysed. Latent class analysis (LCA) was used to estimate the (unobserved) potential classes underlying axSpA. The best LCA model groups patients into clinically meaningful classes with best fit. Each class was labelled based on most prominent features. Percentage fulfilment of ASAS axSpA, peripheral SpA (pSpA) (ignoring IBP) or both classification criteria was calculated. Five-year data from DESIR were used to perform latent transition analysis (LTA) to examine if patients change classes over time. RESULTS: SPACE (n=465) yielded four discernible classes: 'axial' with highest likelihood of abnormal imaging and HLA-B27 positivity; 'IBP+peripheral' with 100% IBP and dominant peripheral symptoms; 'at risk' with positive family history and HLA-B27 and 'no SpA' with low likelihood for each SpA feature. LCA in DESIR (n=576) yielded similar classes, except for the 'no-SpA'. The ASAS axSpA criteria captured almost all (SPACE: 98%; DESIR: 93%) 'axial' patients, but the 'IBP+peripheral' class was only captured well by combining the axSpA and pSpA criteria (SPACE: 78%; DESIR: 89%). Only 4% of 'no SpA' patients fulfilled the axSpA criteria in SPACE. LTA suggested that 5-year transitions across classes were unlikely (11%). CONCLUSION: The Gestalt of axSpA comprises three discernible entities, only appropriately captured by combining the ASAS axSpA and pSpA classification criteria. It is questionable whether some patients with 'axSpA at risk' will ever develop axSpA.


Assuntos
Dor nas Costas/diagnóstico , Dor Crônica/diagnóstico , Medição de Risco/estatística & dados numéricos , Espondilartrite/diagnóstico , Adulto , Dor nas Costas/classificação , Dor Crônica/classificação , Estudos de Coortes , Feminino , Antígeno HLA-B27/sangue , Humanos , Análise de Classes Latentes , Masculino , Reprodutibilidade dos Testes , Medição de Risco/métodos , Espondilartrite/classificação
5.
J Orthop Sports Phys Ther ; 50(4): 189-197, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-31443627

RESUMO

OBJECTIVE: To investigate whether 2 previously published classification approaches, the updated treatment-based classification system and a Pilates subgroup defined by a preliminary clinical prediction rule, could identify patients with chronic low back pain who would benefit more from Pilates exercises compared to an educational booklet. DESIGN: Secondary analysis of a randomized controlled trial. METHODS: Two hundred twenty-two patients received advice and were randomly allocated to a group that received an educational booklet with no additional treatment (n = 74) or a group that received Pilates-based exercise treatment (n = 148) 2 or 3 times a week. At baseline, using a treatment-based classification system, patients were classified as having a good prognosis (positive movement control) or a poor prognosis. Similarly, using the Pilates clinical prediction rule, patients were classified as having a good prognosis (positive) or a poor prognosis (negative). The analysis was conducted using linear regression models to analyze the interaction between subgroup characteristics and treatment effect size, with changes in pain and disability from baseline to 6 weeks after randomization as dependent variables. RESULTS: None of the interaction terms for pain and disability were statistically significant. The treatment effect of Pilates versus an educational booklet was similar in all subgroups. CONCLUSION: The treatment-based classification system and the Pilates clinical prediction rule did not differentiate subgroups of patients with chronic low back pain who were more or less likely to benefit more from Pilates compared to an educational booklet. J Orthop Sports Phys Ther 2020;50(4):189-197. Epub 23 Aug 2019. doi:10.2519/jospt.2019.8839.


Assuntos
Dor Crônica/terapia , Técnicas de Exercício e de Movimento , Terapia por Exercício/métodos , Dor Lombar/terapia , Folhetos , Educação de Pacientes como Assunto/métodos , Adulto , Idoso , Dor Crônica/classificação , Dor Crônica/diagnóstico , Regras de Decisão Clínica , Feminino , Humanos , Dor Lombar/classificação , Dor Lombar/diagnóstico , Masculino , Pessoa de Meia-Idade
6.
Adv Rheumatol ; 59(1): 53, 2019 12 02.
Artigo em Inglês | MEDLINE | ID: mdl-31791421

RESUMO

BACKGROUND: The World Health Organization reports that one of the main incapacitating conditions in older adults is osteomusculoskeletal disorders, and among these is low back pain. There are few instruments translated and transculturally adapted with psychometric properties evaluated for older adults with this health condition in Brazil. The Pain Response to Activity and Positioning (PRAP) questionnaire enables classification of older adults through functional performance. The objective of this study was to perform a cross-cultural adaptation and verify the reliability of the PRAP for older Brazilian people with chronic low back pain. METHODS: A cross-sectional methodological study from the international study "Back Complaints in the Elders". We included individuals aged ≥60 years, with chronic lumbar pain complaints lasting ≥3 months. The transcultural translation and adaptation process followed the criteria proposed by Beaton and Guilhemeim, 1993. Reliability was tested using an unweighted Cohen's Kappa. RESULTS: Thirty-six (36) older adults participated in the study (71.15 ± 7.23 years, 94.4% female). The intra-rater reliability for Low Back Pain (LBP) was between 0.50-1.00 and 0.23-0.84 for lower limbs, while the inter-rater reliability for LBP was between 0.25-0.63 and between 0.18-0.53 for lower limbs. The criteria for low back pain diagnosis showed intra and inter-rater agreement of 0.52 and 0.47, respectively. CONCLUSION: The Brazilian version of the instrument showed adequate reliability and ability to classify older adults in the diagnosis of LBP by reporting the performance of daily activities, and is indicated for use in the context of research and clinical practice. TRIAL REGISTRATION: There is no trial registration. This is a methodological study.


Assuntos
Dor Crônica/diagnóstico , Comparação Transcultural , Inquéritos Epidemiológicos , Dor Lombar/diagnóstico , Traduções , Atividades Cotidianas , Idoso , Brasil , Dor Crônica/classificação , Estudos Transversais , Feminino , Humanos , Dor Lombar/classificação , Masculino , Pessoa de Meia-Idade , Variações Dependentes do Observador , Desempenho Físico Funcional , Reprodutibilidade dos Testes , Autorrelato
7.
Ger Med Sci ; 17: Doc09, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31728134

RESUMO

Objective: The purpose of this study was to find applicable clusters for the development of different treatment pathways in an inpatient multimodal pain-therapy setting based on the multifaceted nature of CLBP. Methods: Based on data of questionnaires (Hospital Anxiety and Depression Scale (HADS), Marburg Questionnaire on Habitual Health Findings (MFHW), quality of life assessment using the Short-Form 12 (SF 12)), a retrospective two-step cluster analysis involving a sample of chronic low back pain (CLBP) patients (N=320) was calculated. Subsequently, the clusters were precisely described and compared on the basis of further data collected during the patients' standard care: pain characteristics, socio-demographic data and the general state of health, psychological variables, therapy intensity, and Diagnosis Related Groups (DRG) data. Results: We found a three-cluster solution: little psychological interference but marginal physical and mental quality of life (Cluster 1); poor well-being, low physical quality of life, and marginal mental quality of life (Cluster 2); and heavy mental strain and marginal physical quality of life (Cluster 3). Conclusions: Similar to previous studies, our results suggest that patients suffering from CLBP differ with regard to the magnitude of mental burden and the presence of physical impairment. These differences ascertain the need for precise targeting of treatment for CLBP. Inpatient pain centers therefore should offer different multimodal therapy pathways and integrate a meaningful triage, taking into account the multifaceted nature of CLBP based on sophisticated knowledge about forms, differences, and relationships among the biopsychosocial components of CLBP.


Assuntos
Dor Crônica/terapia , Dor Lombar/terapia , Adolescente , Adulto , Dor Crônica/classificação , Análise por Conglomerados , Feminino , Humanos , Pacientes Internados , Dor Lombar/classificação , Masculino , Pessoa de Meia-Idade , Determinação de Necessidades de Cuidados de Saúde , Manejo da Dor/métodos , Manejo da Dor/normas , Qualidade de Vida , Estudos Retrospectivos , Inquéritos e Questionários , Adulto Jovem
8.
Afr Health Sci ; 19(2): 1978-1987, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31656480

RESUMO

Introduction: Chronic pain classification in HIV positive patients is essential for diagnosis and treatment. However, this is rarely done despite association with poor outcomes. Methods: A cross-sectional survey of 345 consented patients at a specialized HIV care center in Uganda was conducted. Chronic pain was defined as pain of more than two weeks duration. Data was collected using a socio-demographic questionnaire, the IASP classification of chronic pain; the StEP; Mini Mental Status Examination, Patient Health Questionnaire, Mini International Neuropsychiatric Interview and the World Health Organization quality of life instrument brief version. Chi-square, Fisher's exact, t-test and logistic regression analyses were carried out to determine factors associated with chronic pain. Results: Description of pain aetiology was difficult. Chronic pain was reported in 21.5% of the participants. Non-neuropathic (92.0%) was more common than neuropathic pain (8.0%). Chronic pain was found to be associated with feeling ill [OR=6.57 (3.48 - 12.39)], and worse scores in the quality of life domain for physical health [OR=0.71 (0.60 - 0.83)]. Conclusion: People living with HIV/AIDS commonly have chronic pain that is associated with poor quality of life. More sensitive tools are needed to accurately describe chronic pain in resource limited settings.


Assuntos
Dor Crônica/classificação , Infecções por HIV/complicações , Manejo da Dor/métodos , Adulto , Fármacos Anti-HIV/uso terapêutico , Dor Crônica/epidemiologia , Dor Crônica/etiologia , Comorbidade , Estudos Transversais , Feminino , Infecções por HIV/tratamento farmacológico , Infecções por HIV/psicologia , Humanos , Masculino , Pessoa de Meia-Idade , Neuralgia , Escalas de Graduação Psiquiátrica , Qualidade de Vida , Fatores Socioeconômicos , Inquéritos e Questionários , Uganda/epidemiologia
10.
Medicina (Kaunas) ; 55(5)2019 May 21.
Artigo em Inglês | MEDLINE | ID: mdl-31117297

RESUMO

Chronic pain is a global health concern. This special issue on matters related to chronic pain aims to draw on research and scholarly discourse from an eclectic mix of areas and perspectives. The purpose of this non-systematic topical review is to précis an assortment of contemporary topics related to chronic pain and its management to nurture debate about research, practice and health care policy. The review discusses the phenomenon of pain, the struggle that patients have trying to legitimize their pain to others, the utility of the acute-chronic dichotomy, and the burden of chronic pain on society. The review describes the introduction of chronic primary pain in the World Health Organization's International Classification of Disease, 11th Revision and discusses the importance of biopsychosocial approaches to manage pain, the consequences of overprescribing and shifts in service delivery in primary care settings. The second half of the review explores pain perception as a multisensory perceptual inference discussing how contexts, predictions and expectations contribute to the malleability of somatosensations including pain, and how this knowledge can inform the development of therapies and strategies to alleviate pain. Finally, the review explores chronic pain through an evolutionary lens by comparing modern urban lifestyles with genetic heritage that encodes physiology adapted to live in the Paleolithic era. I speculate that modern urban lifestyles may be painogenic in nature, worsening chronic pain in individuals and burdening society at the population level.


Assuntos
Dor Crônica/classificação , Classificação Internacional de Doenças/tendências , Dor Crônica/tratamento farmacológico , Humanos , Sobremedicalização/prevenção & controle , Organização Mundial da Saúde/organização & administração
11.
Pain Manag Nurs ; 20(5): 418-424, 2019 10.
Artigo em Inglês | MEDLINE | ID: mdl-31101560

RESUMO

BACKGROUND: Enhancing pain patient's ability to function and cope is important, but assessing only intensity ignores those aspects of pain. The Functional Pain Scale (FPS), addresses these dimensions but lacked validation in hospitalized adults with chronic pain. AIMS: This research was conducted to establish the FPS psychometric properties in hospitalized adults. DESIGN: A prospective pilot study examined the reliability and validity of the FPS in two acute care hospitals. SETTINGS: Adult inpatients from medical/surgical units at two hospitals. PARTICIPANTS/SUBJECTS: A convenience sample of 93 subjects from an Academic Medical Center and 51 from a tertiary care hospital who were 21-81 years old and primarily Caucasian. METHODS: Hospitalized adults with chronic pain at two facilities provided pain scores from the FPS, Numeric Rating Scale, Pain, Enjoyment of Life, and General Activities Scale, and Quality of Pain Care Scale. Test-retest reliability and construct validity were evaluated using standard correlation methods. RESULTS: Hospitalized adults aged 21-88 years with chronic pain (N = 144) were evaluated. Data supported test-retest reliability of the FPS (r = .84; p < .001), which had strong, statistically significant correlations with the Numeric Rating Scale at different study sites (r = 0.75 and r = 0.45, respectively), indicating acceptable construct validity. Significant weak correlations between the FPS and other measures of mood and functioning failed to support discriminant validity. CONCLUSIONS: Although statistically significant, the reliability and validity of FPS were not as strong in hospitalized chronic pain patients as reported for older adults in other settings.


Assuntos
Dor Crônica/classificação , Hospitalização , Medição da Dor/normas , Psicometria/normas , Centros Médicos Acadêmicos/organização & administração , Centros Médicos Acadêmicos/estatística & dados numéricos , Adulto , Idoso , Idoso de 80 Anos ou mais , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Medição da Dor/métodos , Psicometria/instrumentação , Psicometria/métodos , Reprodutibilidade dos Testes , Inquéritos e Questionários
12.
J Pain ; 20(4): 369-393, 2019 04.
Artigo em Inglês | MEDLINE | ID: mdl-30527971

RESUMO

Peripheral neuropathic pain is among the most prevalent types of neuropathic pain. No comprehensive peripheral neuropathic pain classification system that incorporates contemporary clinical, diagnostic, biological, and psychological information exists. To address this need, this article covers the taxonomy for 4 focal or segmental peripheral neuropathic pain disorders, as part of the Analgesic, Anesthetic, and Addiction Clinical Trial Translations, Innovations, Opportunities, and Networks (ACTTION) public-private partnership and the American Pain Society (APS) collaborative to develop a standardized, evidence-based taxonomy initiative: the ACTTION-APS Pain Taxonomy (AAPT). The disorders-postherpetic neuralgia, persistent posttraumatic neuropathic pain, complex regional pain disorder, and trigeminal neuralgia-were selected because of their clinical and clinical research relevance. The multidimensional features of the taxonomy are suitable for clinical trials and can also facilitate hypothesis-driven case-control and cohort epidemiologic studies. PERSPECTIVE: The AAPT peripheral neuropathic pain taxonomy subdivides the peripheral neuropathic pain disorders into those that are generalized and symmetric and those that are focal or segmental and asymmetric. In this article, we cover the focal and segmental disorders: postherpetic neuralgia, persistent posttraumatic neuropathic pain, complex regional pain disorder, and trigeminal neuralgia. The taxonomy is evidence-based and multidimensional, with the following dimensions: 1) core diagnostic criteria; 2) common features; 3) common medical and psychiatric comorbidities; 4) neurobiological, psychosocial, and functional consequences; and 5) putative neurobiological and psychosocial mechanisms, risk factors, and protective factors.


Assuntos
Síndromes da Dor Regional Complexa/diagnóstico , Neuralgia/diagnóstico , Sociedades Médicas/normas , Neuralgia do Trigêmeo/diagnóstico , Dor Crônica/classificação , Dor Crônica/diagnóstico , Síndromes da Dor Regional Complexa/classificação , Humanos , Neuralgia/classificação , Neuralgia Pós-Herpética/classificação , Neuralgia Pós-Herpética/diagnóstico , Parcerias Público-Privadas , Neuralgia do Trigêmeo/classificação
13.
Pain ; 160(1): 19-27, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-30586067

RESUMO

Chronic pain is a major source of suffering. It interferes with daily functioning and often is accompanied by distress. Yet, in the International Classification of Diseases, chronic pain diagnoses are not represented systematically. The lack of appropriate codes renders accurate epidemiological investigations difficult and impedes health policy decisions regarding chronic pain such as adequate financing of access to multimodal pain management. In cooperation with the WHO, an IASP Working Group has developed a classification system that is applicable in a wide range of contexts, including pain medicine, primary care, and low-resource environments. Chronic pain is defined as pain that persists or recurs for more than 3 months. In chronic pain syndromes, pain can be the sole or a leading complaint and requires special treatment and care. In conditions such as fibromyalgia or nonspecific low-back pain, chronic pain may be conceived as a disease in its own right; in our proposal, we call this subgroup "chronic primary pain." In 6 other subgroups, pain is secondary to an underlying disease: chronic cancer-related pain, chronic neuropathic pain, chronic secondary visceral pain, chronic posttraumatic and postsurgical pain, chronic secondary headache and orofacial pain, and chronic secondary musculoskeletal pain. These conditions are summarized as "chronic secondary pain" where pain may at least initially be conceived as a symptom. Implementation of these codes in the upcoming 11th edition of International Classification of Diseases will lead to improved classification and diagnostic coding, thereby advancing the recognition of chronic pain as a health condition in its own right.


Assuntos
Dor Crônica/classificação , Dor Crônica/diagnóstico , Classificação Internacional de Doenças , Medição da Dor , Dor Crônica/complicações , Pessoas com Deficiência , Humanos , Cooperação Internacional , Organizações/normas , Medição da Dor/métodos , Medição da Dor/normas
14.
Pain ; 160(1): 28-37, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-30586068

RESUMO

This article describes a proposal for the new diagnosis of chronic primary pain (CPP) in ICD-11. Chronic primary pain is chosen when pain has persisted for more than 3 months and is associated with significant emotional distress and/or functional disability, and the pain is not better accounted for by another condition. As with all pain, the article assumes a biopsychosocial framework for understanding CPP, which means all subtypes of the diagnosis are considered to be multifactorial in nature, with biological, psychological, and social factors contributing to each. Unlike the perspectives found in DSM-5 and ICD-10, the diagnosis of CPP is considered to be appropriate independently of identified biological or psychological contributors, unless another diagnosis would better account for the presenting symptoms. Such other diagnoses are called "chronic secondary pain" where pain may at least initially be conceived as a symptom secondary to an underlying disease. The goal here is to create a classification that is useful in both primary care and specialized pain management settings for the development of individualized management plans, and to assist both clinicians and researchers by providing a more accurate description of each diagnostic category.


Assuntos
Dor Crônica/classificação , Dor Crônica/diagnóstico , Classificação Internacional de Doenças , Manejo da Dor , Humanos
15.
Pain ; 160(1): 53-59, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-30586071

RESUMO

The upcoming 11th revision of the International Statistical Classification of Diseases and Related Health Problems (ICD) of the World Health Organization (WHO) offers a unique opportunity to improve the representation of painful disorders. For this purpose, the International Association for the Study of Pain (IASP) has convened an interdisciplinary task force of pain specialists. Here, we present the case for a reclassification of nervous system lesions or diseases associated with persistent or recurrent pain for ≥3 months. The new classification lists the most common conditions of peripheral neuropathic pain: trigeminal neuralgia, peripheral nerve injury, painful polyneuropathy, postherpetic neuralgia, and painful radiculopathy. Conditions of central neuropathic pain include pain caused by spinal cord or brain injury, poststroke pain, and pain associated with multiple sclerosis. Diseases not explicitly mentioned in the classification are captured in residual categories of ICD-11. Conditions of chronic neuropathic pain are either insufficiently defined or missing in the current version of the ICD, despite their prevalence and clinical importance. We provide the short definitions of diagnostic entities for which we submitted more detailed content models to the WHO. Definitions and content models were established in collaboration with the Classification Committee of the IASP's Neuropathic Pain Special Interest Group (NeuPSIG). Up to 10% of the general population experience neuropathic pain. The majority of these patients do not receive satisfactory relief with existing treatments. A precise classification of chronic neuropathic pain in ICD-11 is necessary to document this public health need and the therapeutic challenges related to chronic neuropathic pain.


Assuntos
Classificação Internacional de Doenças , Neuralgia/classificação , Neuralgia/diagnóstico , Organizações/normas , Dor Crônica/classificação , Dor Crônica/diagnóstico , Humanos , Cooperação Internacional
16.
Pain ; 160(1): 77-82, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-30586074

RESUMO

Chronic musculoskeletal pain is defined as chronic pain arising from musculoskeletal structures such as bones or joints. Although comprising the most prevalent set of chronic pain conditions, it was not represented appropriately in the 10th edition of the International Classification of Diseases (ICD-10), which was organized mainly according to anatomical sites, was strongly focused on musculoskeletal disease or local damage, and did not consider the underlying mechanisms of pain. The new ICD-11 classification introduces the concept of chronic primary and secondary musculoskeletal pain, and integrates the biomedical axis with the psychological and social axes that comprise the complex experience of chronic musculoskeletal pain. Chronic primary musculoskeletal pain is a condition in its own right, not better accounted for by a specific classified disease. Chronic secondary musculoskeletal pain is a symptom that arises from an underlying disease classified elsewhere. Such secondary musculoskeletal pain originates in persistent nociception in musculoskeletal structures from local or systemic etiologies, or it may be related to deep somatic lesions. It can be caused by inflammation, by structural changes, or by biomechanical consequences of diseases of the nervous system. It is intended that this new classification will facilitate access to patient-centered multimodal pain management and promote research through more accurate epidemiological analyses.


Assuntos
Dor Crônica , Classificação Internacional de Doenças , Dor Musculoesquelética , Organizações/normas , Dor Crônica/classificação , Dor Crônica/complicações , Dor Crônica/diagnóstico , Humanos , Cooperação Internacional , Dor Musculoesquelética/classificação , Dor Musculoesquelética/complicações , Dor Musculoesquelética/diagnóstico
17.
Pain ; 160(1): 69-76, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-30586073

RESUMO

Chronic visceral pain is a frequent and disabling condition. Despite high prevalence and impact, chronic visceral pain is not represented in ICD-10 in a systematic manner. Chronic secondary visceral pain is chronic pain secondary to an underlying condition originating from internal organs of the head or neck region or of the thoracic, abdominal, or pelvic regions. It can be caused by persistent inflammation, by vascular mechanisms or by mechanical factors. The pain intensity is not necessarily fully correlated with the disease process, and the chronic visceral pain may persist beyond successful treatment of the underlying cause. This article describes how a new classification of chronic secondary visceral pain is intended to facilitate the diagnostic process and to enable the collection of accurate epidemiological data. Furthermore, it is hoped that the new classification will improve the tailoring of patient-centered pain treatment of chronic secondary visceral pain and stimulate research. Chronic secondary visceral pain should be distinguished from chronic primary visceral pain states that are considered diseases in their own right.


Assuntos
Dor Crônica , Classificação Internacional de Doenças , Organizações/normas , Dor Visceral , Dor Crônica/classificação , Dor Crônica/complicações , Dor Crônica/diagnóstico , Humanos , Cooperação Internacional , Dor Visceral/classificação , Dor Visceral/complicações , Dor Visceral/diagnóstico
18.
Pain ; 160(1): 83-87, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-30586075

RESUMO

The International Classification of Diseases, 11th Revision (ICD-11), proposes, for the first time, a coding system for chronic pain. This system contains 1 code for "chronic primary pain," where chronic pain is the disease, and 6 codes for chronic secondary pain syndromes, where pain developed in the context of another disease. This provides the opportunity for routine, standardised coding of chronic pain throughout all health care systems. In primary care, this will confer many important, novel advantages over current or absent coding systems. Chronic pain will be recognized as a centrally important condition in primary care. The capacity to measure incidence, prevalence, and impact will help in identification of human, financial, and educational needs required to address chronic pain in primary care. Finally, opportunities to match evidence-based treatment pathways to distinct chronic pain subtypes will be enhanced.


Assuntos
Dor Crônica/classificação , Dor Crônica/diagnóstico , Organizações/normas , Atenção Primária à Saúde , Humanos , Cooperação Internacional
19.
Pain ; 160(1): 60-68, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-30586072

RESUMO

This article describes chronic secondary headache and chronic orofacial pain (OFP) disorders with respect to the new International Classification of Diseases (ICD-11). The section refers extensively to the International Classification of Headache Disorders (ICHD-3) of the International Headache Society that is implemented in the chapter on Neurology in ICD-11. The ICHD-3 differentiates between primary (idiopathic) headache disorders, secondary (symptomatic) headache disorders, and OFP disorders including cranial neuralgias. Chronic headache or OFP is defined as headache or OFP that occurs on at least 50% of the days during at least 3 months and lasting at least 2 hours per day. Only chronic secondary headache and chronic secondary OFP disorders are included here; chronic primary headache or OFP disorders are listed under chronic primary pain syndromes that have been described in a companion publication. The subdivisions of chronic secondary OFP of ICHD-3 are complemented by the Diagnostic Criteria for Temporomandibular Disorders and contributions from the International Association for the Study of Pain Special Interest Group on Orofacial and Head Pain and include chronic dental pain. The ICD-11 codes described here are intended to be used in combination with codes for the underlying diseases, to identify patients who require specialized pain management. In addition, these codes shall enhance visibility of these disorders in morbidity statistics and motivate research into their mechanisms.


Assuntos
Dor Crônica , Dor Facial/complicações , Transtornos da Cefaleia/complicações , Classificação Internacional de Doenças , Organizações/normas , Dor Crônica/classificação , Dor Crônica/diagnóstico , Dor Crônica/etiologia , Humanos , Cooperação Internacional
20.
Pain ; 160(1): 88-94, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-30586076

RESUMO

Physical, mental, and social well-being are part of the concept of health according to the World Health Organization, in addition to the absence of disease and infirmity. Therefore, for a full description of a person's health status, the International Classification of Functioning, Disability and Health (ICF) was launched in 2001 to complement the existing International Classification of Diseases (ICD). The 11th version of the ICD (ICD-11) is based on so-called content models, which have 13 main parameters. One of them is functioning properties (FPs) that, according to the WHO, consist of the activities and participation components of the ICF. Recently, chronic pain codes were added to the 11th edition of the ICD, and hence, a specific set of FPs for chronic pain is required as a link to the ICF. In addition, pain is one of the 7 dimensions of the generic set of the ICF, which applies to any person. Thus, assessment and management of pain are also important for the implementation of the ICF in general. This article describes the current consensus proposal by the International Association for the Study of Pain (IASP) and the International Society of Physical and Rehabilitation Medicine (ISPRM) for a specific set of FPs of chronic pain, which will have to be empirically validated in a next step. The combined use of ICD-11 and ICF is expected to improve research reports on chronic pain by a more precise and adequate coding, as well as patient management through better diagnostic classification.


Assuntos
Dor Crônica , Classificação Internacional de Doenças , Organizações/normas , Dor Crônica/classificação , Dor Crônica/diagnóstico , Dor Crônica/fisiopatologia , Humanos , Cooperação Internacional
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