Hp Meyer

Neuropathic pain in AIDS patients prior to antiretroviral therapy

OBJECTIVE To measure the prevalence, severity and morbidity of neuropathic pain in AIDS patients, prior to the initiation of antiretroviral (ARV) therapy. DESIGN A prospective, cross-sectional and descriptive-analytical study. SETTING The Kalafong Hospital HIV Clinic in Pretoria. SUBJECTS All patients with confirmed AIDS who were referred to the Kalafong HIV clinic to be initiated on ARV therapy during the period August 2006 to March 2007. OUTCOME MEASURES Data were collected regarding the presence and severity of neuropathic pain in each subject. Pain of predominantly neuropathic origin (POPNO) was identified using the Neuropathic Pain Diagnostic Questionnaire (DN4). Numerical rating scales (NRS), adapted from the Brief Pain Inventory, were used to measure pain severity and pain-related interference with six aspects of daily living. RESULTS Of the 354 patients studied, 20.9% (95% confidence interval (CI) 16.8-25.2%) had POPNO. This pain was significantly more frequent in patients who were male, had lower CD4+ counts or higher viral load levels, and those on TB treatment. Eighty per cent of patients with POPNO experienced significant pain (worst pain severity > or =5 out of 10 on a NRS). Pain-related interference was highest for enjoyment of life, mood and ability to work. There was a significant positive correlation between severity of pain and pain-related interference for all domains of daily living evaluated. CONCLUSIONS POPNO results in significant suffering and impaired functioning in patients with AIDS. It is therefore imperative that clinicians assess patients with AIDS for the presence and severity of neuropathic pain and manage it, using the most recent evidence-based guidelines.

Pain management in primary care - current perspectives

Abstract According to a 1998 World Health Organization Survey of 26 000 primary care patients on five continents, 22% reported persistent pain over the past year. Part of the problem lies with some health-care providers who have failed to keep up with the advances in pain medicine and continue to follow the biomedical approach, which regards a specific pathway as the only source of pain. In this model, all pain is regarded as a warning signal of tissue injury, and if conservative treatment fails, some surgical technique will be able to correct the problem. The modern paradigm of pain management has moved from this biomedical to the broader biopsychosocial approach, where pain mechanisms now integrate input from sensory, emotional and cognitive systems.

Prevalence of chronic pain in patients attending primary healthcare facilities in south-west Tshwane

Abstract Objectives: Despite the significant biopsychosocial impact of chronic pain on the health and quality of life of an individual, as well as on healthcare utilisation, no published data are available on the prevalence of chronic pain in the South African primary healthcare context. The aim of this study was to investigate the prevalence and intensity of chronic pain in patients attending primary healthcare facilities in south-west Tshwane. Design and setting: A prospective, cross-sectional study was carried out in four primary healthcare clinics, situated in south-west Tshwane. Subjects: The study was conducted on 1 066 adult patients, aged 18 years or older, over a nine-week period between October and December 2010. Outcome measures: The prevalence and intensity of chronic pain was determined. Results: Chronic pain prevalence was 41%. The confidence interval (CI) was 37.2–45.6. Chronic pain was most frequently experienced as lower back pain [prevalence 30.83% (CI: 19.56–42.09)] and joint pains [prevalence 23.48% (CI: 7.58–39.38)]. Chronic pain was significantly more prevalent with advancing age (p-value = 0.0014), in women than in men (p-value = 0.019), and in widowed and divorced patients, than in married and single patients (p-value = 0.0062). Patients with chronic pain reported their pain intensity over the previous month as maximum pain intensity (mean: 7.69 ± 0.99), minimum pain intensity (mean 2.54 ± 0.89), and average pain intensity (mean 4.57 ± 0.62). Conclusion: Chronic pain was highly prevalent in patients who attended primary healthcare facilities in south-west Tshwane. The intensity of pain was high in a significant proportion of patients.

Neuropathic pain - Current concepts

Abstract Neuropathic pain (NP) represents a common and diverse group of disorders with peripheral and/or central nervous system damage or dysfunction. Many patients report intractable and severe pain that is resistant to simple analgesics. The diagnosis of NP is primarily based on clinical evaluation rather than diagnostic tests. Distinct pain qualities in the patients history and findings on clinical examination, such as hyperalgesia and other sensory findings in an area correlating with the patients pain pattern are important in diagnosis. Various screening tools may assist in the diagnosis of NP. A number of pathophysiological mechanisms have been identified in NP, including sodium- and calcium-channel upregulation and spinal cord hyperexcitability (central sensitisation). Appropriate management includes evaluation of the functional impact of NP, patient education and reassurance. A multi-model biopsychosocial approach that includes various nonpharmacological modalities is recommended. Appropriate pharmacological management is based on evidence-based recommendations that provide guidance for selecting first-, second- and third-line medications, alone or in combination. It is hoped that future treatment advances will improve the care of patients who live with NP.

Fibromyalgia syndrome : current concepts

Abstract Fibromyalgia (FM) is a recognised chronic pain syndrome that is diagnosed without any special investigations. This syndrome constitutes widespread pain in a specific distribution, for a specific period of time, as well as tenderness over at least 11 out of 18 clearly defined tender points. This syndrome is a common cause of other conditions commonly encountered in general practice and this article provides a practical and clinical approach to diagnosis and treatment.

Screening for Adult ADHD in Patients with Fibromyalgia Syndrome

Objective Fibromyalgia syndrome (FMS) is a common chronic pain disorder associated with altered activity of neurotransmitters involved in pain sensitivity such as dopamine, serotonin, and noradrenaline. FMS may significantly impact an individuals functioning due to the presence of chronic pain, fatigue, and cognitive impairment. Dyscognition may be more disabling than the chronic pain but is mostly under-recognized. This study aimed to assess the potential co-occurrence of FMS and adult attention deficit hyperactivity disorder (ADHD), a chronic neurodevelopmental disorder also associated with impaired cognition and dopaminergic function. Methods In a cross-sectional observational study, 123 previously confirmed FMS patients were screened for adult ADHD using the World Health Organization Adult ADHD Self Report scale v1.1. The Revised Fibromyalgia Impact Questionnaire (FIQ-R) was used to assess the impact of FMS. Cognitive assessment was based on self-report in accordance with the 2011 modified American College of Rheumatology criteria and the FIQ-R, respectively. Results Of the 123 participants, 44.72% (N = 55) screened positive for adult ADHD. Participants with both FMS and a positive adult ADHD screening test scored higher on the FIQ-R score (64.74, SD = 17.66, vs 54.10, SD = 17.10). Self-reported cognitive impairment was rated higher in the combined group (odds ratio = 10.61, 95% confidence interval; 3.77-29.86, P < 0.01). Conclusions These results indicate that the co-occurrence of adult ADHD in FMS may be highly prevalent and may also significantly impact the morbidity of FMS. Patients with FMS should be assessed for the presence of adult ADHD.

Assessment of patients with chronic pain

Pain has always been the most common reason why patients seek medical attention. A World Health Organization survey of ± 26 000 primary care patients on five continents demonstrated a prevalence of persistent pain (lasting longer than three months) in 22% of participants, mostly associated with marked reduction in several indicators of well-being (e.g. interference with activities and psychological functioning).

Active myofascial trigger points in head and neck muscles of patients with chronic tension-type headache in two primary health care units in Tshwane

Background: The management of patients presenting with chronic tension-type headache (CTTH) can be challenging for primary health care practitioners. As with most chronic pain disorders, a multimodal management approach is frequently required. It has been postulated that myofascial pain syndrome (MPS) and its hallmark myofascial trigger points (MTrPs) found in specific muscle tissues may play a role in the chronic pain experienced by patients with CTTH. Little is known about the prevalence of MTrPs in patients with CTTH, in primary health care settings on the African continent. This study therefore aimed to investigate the prevalence of active MTrP’s in specific head and neck muscles/muscle groups in patients with CTTH. Methods: A prospective, cross-sectional and descriptive study was done in two primary health care facilities situated in Tshwane, South Africa. The sample included 97 adult patients with CTTH. Five head and neck muscles/muscle groups were examined bilaterally for active MTrPs. Outcome measures were the prevalence and distribution of active MTrPs in these patients. Results: Active MTrPs were found in 95.9% of the patients, the majority (74.2%) having four or more active MTrPs. The temporalis muscles and suboccipital muscle group exhibited the highest number of active MTrPs (prevalence 87.6% and 80.4% respectively). Conclusion: Our study suggests a strong association between MPS and CTTH in patients, presenting in the primary health care setting. This indicates the importance of a musculoskeletal assessment of neck and pericranial muscles in patients with CTTH. This can assist in determining the most appropriate treatment strategy in these patients.