Yvonne D’Arcy

Rethinking chronic pain in a primary care setting

ABSTRACT Chronic pain substantially impacts patient function and quality of life and is a burden to society at large in terms of increased health care utilization and loss of productivity. As a result, there is an increasing recognition of chronic pain as a public health crisis. However, there remains wide variability in clinical practices related to the prevention, assessment, and treatment of chronic pain. Certain fundamental aspects of chronic pain are often neglected including the contribution of the psychological, social, and contextual factors associated with chronic pain. Also commonly overlooked is the importance of understanding the likely neurobiological mechanism(s) of the presenting pain and how they can guide treatment selection. Finally, physicians may not recognize the value of using electronic medical records to systematically capture data on pain and its impact on mood, function, and sleep. Such data can be used to monitor onset and maintenance of treatments effects at the patient level and evaluate costs at the systems level. In this review we explain how these factors play a critical role in the development of a coordinated, evidence-based treatment approach tailored to meet specific needs of the patient. We also discuss some practical approaches and techniques that can be implemented by clinicians in order to enhance the assessment and management of individuals with chronic pain in primary care settings.

Normalizing fibromyalgia as a chronic illness

ABSTRACT Fibromyalgia (FM) is a complex chronic disease that affects 3–10% of the general adult population and is principally characterized by widespread pain, and is often associated with disrupted sleep, fatigue, and comorbidities, among other symptoms. There are many gaps in our knowledge of FM, such that, compared with other chronic illnesses including diabetes, rheumatoid arthritis, and asthma, it is far behind in terms of provider understanding and therapeutic approaches. The experience that healthcare professionals (HCPs) historically gained in developing approaches to manage and treat patients with these chronic illnesses may help show how they can address similar problems in patients with FM. In this review, we examine some of the issues around the management and treatment of FM, and discuss how HCPs can implement appropriate strategies for the benefit of patients with FM. These issues include understanding that FM is a legitimate condition, the benefits of prompt diagnosis, use of non-drug and pharmacotherapies, patient and HCP education, watchful waiting, and assessing patients by FM domain so as not to focus exclusively on one symptom to the detriment of others. Developing successful approaches is of particular importance for HCPs in the primary care setting who are in the ideal position to provide long-term care for patients with FM. In this way, FM may be normalized as a chronic illness to the benefit of both patients and HCPs.

Eliminación del dolor ¿Conoce usted las nuevas técnicas?

EL DOLOR ES LA CAUSA más frecuente de que las personas soliciten asistencia médica. Sin embargo, a pesar de la amplia gama de analgésicos, dispositivos tecnológicos y directrices de expertos existentes hoy día, en muchos pacientes no es posible aliviar el dolor. En este artículo se exponen los avances más recientes en el control del dolor, explicando la forma de utilización de estos recursos en el contexto de las directrices estadonidenses relativas al control de los cuadros de dolor agudo, crónico y neuropático. Vamos a comenzar con una revisión breve de estos tres tipos de dolor. Para conocer más detalles relativos a la valoración del dolor, véase el cuadro anexo Valoración apropiada del dolor.

Neuropathic pain: a narrative review of etiology, assessment, diagnosis, and treatment for primary care providers

Abstract Background: Neuropathic pain (NeP) is a distinct type of chronic pain that is a direct result of damage to the nervous system itself. Studies have shown that training on the topic of chronic pain in medical schools is lacking and many practitioners are not confident in their ability to effectively manage patients with such pain. Aims: The purpose of this narrative review is to provide a brief high-level overview of NeP for primary healthcare providers that includes a discussion of mechanisms, prevalence, burden, assessment, and treatment. The information provided here should help primary care providers better understand this type of chronic pain.

Pregabalin for the treatment of neuropathic pain: a narrative review for primary care providers

Abstract Background: Neuropathic pain (NeP) is a distinct type of pain caused by damage to the nervous system itself. This often severe and chronic type of pain requires specific treatments that target the underlying pain pathophysiology. Aim: The purpose of the current narrative review is to provide an overview of pregabalin (Lyrica1) for the treatment of NeP including its effects on pain, pain-related sleep interference, and other health-related outcomes, timing of therapeutic effect, safety and tolerability, and dosing. The information provided here will help primary care providers develop more effective NeP treatment strategies.