Chronic pain management

tBackground: Although the effectiveness of low-dose radiotherapy for chronic degenerative and inflam-matory diseases has been documented in previous studies, patient-reported clinical outcomes are rarelyavailable.Objective: This study aimed to determine the effect of low-dose radiotherapy on patients with painfulplantar fasciitis.Method: From 2002 to 2008, 200 patients older than 65 years of age with painful plantar fasciitis weretreated in our hospital. Records from 171 of these patients were available for analysis. All patients weretreated with an identical dose of 3 Gy using identical equipment and techniques. Response was evaluatedwith patient-reported questionnaires and clinical visits.Results: Minimum-term follow-up was 18 months, with mean follow-up at 54 months. Three monthsafter receiving low-dose radiotherapy, 67.3% of patients had no or mild pain, and 57.9% had no or discretemobility restriction. At a mean of 54 months, 61.4% of patients had no or mild pain and 64.9% of patientshad no or discrete mobility restriction; 60.8% of patients reported improved quality of life.Conclusion: Low-dose radiotherapy is effective in most patients with painful plantar fasciitis. Due tominimal side effects and low costs, it represents an excellent treatment option compared to conventionaltherapies or surgery.

Somatosensory rehabilitation is presented by means of its paradigm which is: Look for hypoesthesia, because, by decreasing hypoesthesia neuropathic pain decreases. Occupational therapists are going to observe cutaneous sense disorders if, and only if they know beforehand that they can offer a new treatment to the patients they are taking care of.
Somatosensory rehabilitation and it’s effects are presented: by means of the Mc Gill pain questionnaire which allows the assessment of the patients pain symptoms and by means of the pharmacological treatment indicator: The number needed to treat (NNT). The important and strong correlation (Cov=15.7) between the decrease of hypoesthesia and the decrease of neuropathic pain is demonstrated. The rehabilitation of hyposensitivity based on the neuroplasticity of the somatosensory system is described. The second part of the article tells about the assessment of patients with chronic neuropathic pain: Clinical reasoning of a beginning reeducator, the mapping of the zones of hypoesthesia or when it occurs, that are hypertensive to touch and especially the therapeutic strategy which will be chosen according to the status of the skin. As a conclusion, the ways to learn more about it are enumerated.

Inflammation Mastery / Functional Inflammology, Volume 1 (2014, updated and expanded in 2016). This work is the culmination of several thousand research publications combined with Dr Vasquez's many years of clinical experience and teaching graduate-level students and doctorate-level clinicians worldwide. With radiographs, photos, acronyms, illustrations, flowcharts, and detailed-yet-simplifying explanations, Dr Vasquez makes it easier than ever for clinicians to grasp important concepts in integrative care and functional medicine and then to translate the basic science research and molecular biology into treatment plans that can be explained and used in " the real world " of clinical practice with patients. The associated video tutorials and recorded live conference presentations further help students and clinicians " get it " via Dr Vasquez's effective teaching style which embraces complexity while always emphasizing clinical applicability and psychosocial context. The Inflammation Mastery & Functional Inflammation Mastery & Functional Inflammation Mastery & Functional Inflammation Mastery & Functional Inflammology series of books and videos Inflammology series of books and videos Inflammology series of books and videos Inflammology series of books and videos translates important concepts and nutritional/biomedical science into easy and practical clinical applications for the prevention and treatment of disorders of sustained inflammation, which Dr Vasquez describes as " patterns of metabolic disturbance and inflammatory dysfunction " existing in three sequential and overlapping categories: 1) metabolic inflammation, 2) allergic inflammation, 3) autoimmune inflammation. This book includes access to video presentations which introduce the origin and components of the Functional Inflammology Protocol and FINDSEX ® acronym. Post-publication updates to this information and important social and clinical contextualization are made available in videos and online repositories (access provided in the book), and the e-newsletter available from ICHNFM.ORG. This textbook also provides access, via reprints or hyperlinks, to Dr Vasquez's published articles—an example of which is his recent paradigm-shifting editorial published in the journal Alternative Therapies in Health and Medicine (2014 January). The updated section on pain management allows students and clinicians to understand and apply manual, pharmacologic, nutritional and botanical medicine treatments for musculoskeletal pain, thereby providing better relief for patients and avoiding the hazards of NSAIDs, coxibs, steroids, opioids, immunosuppressants and biologics.

Se presenta se presenta un panorama general de la relación que existe entre la experiencia emocional (vista como una adquisición adaptativa) y el desarrollo y tratamiento de diferentes síndromes crónicos; elaborando, a partir de la revisión de constructos teóricos fundamentales, con especial atención en la presentación de resultados de diferentes estudios en los que bajo una perspectiva emocional-adaptativa, se realizaron intervenciones en pacientes afectados por experiencias traumáticas, dolor crónico muscular o dolor post mastectomía.

También se presenta una reflexión acerca de las implicaciones que semejante enfoque tiene para la comprensión del funcionamiento emocional, el dolor crónico y los procesos de salud-enfermedad, así como sobre las necesidades y perspectivas que este modelo teórico impone a la psicología de la salud en México

A substantial amount of patients, seeking primary health care, suffer from conditions where a clear pathological lesion cannot be found. These conditions, categorized as medically unexplained symptoms, can cause disability with the same severity as those that originate from organic pathology. Nonspecific low back pain is one of the many conditions categorized as medically unexplained symptoms. Many attempts have been made to find the cause of the problem, but there is no common consensus regarding causal factors existing today. Researchers on Medically Unexplained Symptoms (MUS) criticize the foundational ideas of reductionism, dualism and linear cause-effect relationships in health care sciences because it fails to include individual variety and context sensitivity. A new ontological model is needed that can be an alternative to the separation of physiological and psychological processes, and the one-dimensional tendency to solely explain illness/ disease from the micro level. We will explain why the foundational assumptions following the biomedical model do not work well when approaching patients that suffer from MUS. Further we will describe the prevalence, management and suggested pathology of NSCLBP and relate this to stress-physiology and allostatic load. Finally we will present the foundational idea of adaptation and explain how emphasizing the adaptive ability of the individual can embrace both context sensitivity and individual variety, and be a holistic alternative to reductionism.

Originally published as © Vasquez A. Microbial Origins of Fibromyalgia. Naturopathic Doctor News and Reviews 2016 Apr ndnr.com/pain-medicine/microbial-origins-of-fibromyalgia derived from Inflammation Mastery, 4th Edition excerpted as Pain Revolution (full-color) and Brain Inflammation (discounted grayscale printing). Copyright © 2014-present by Dr Alex Vasquez https://www.InflammationMastery.com/fibromyalgia 
See related video archive at https://www.inflammationmastery.com/fibromyalgia-migraine-videos-news

www.spinenpain.com " The neurosignature of pain experience is determined by the synaptic architecture of the neuromatrix " There have been many advances in the understanding & usefulness of an intervention at right time in selective patients producing excellent results. Interventional pain procedures scores over both medicine and surgery, as they do not have side effects like medicines. Surgeries for pain now have limited indications & usually as a last resort. The interventional pain procedures produce immediate pain relief, can be performed with ease by pain physicians without anesthesia as outpatient or daycare and adequate duration of pain relief is obtained and they are suitable for surgically unfit, unwilling & debilitated patients, procedures can be repeated safely if required. With the advancement of technology and science, we have unveiled many aspects of the pain and its treatment. We have to work hard to spread the knowledge of interventional pain techniques. Our goal is to help people suffering from pain, make them productive human being for the society and increase their self esteem so that they can live life as normal individuals.

Vertical Oscillatory pressure (VOP) is a technique of spinal manual therapy in physiotherapy, that has been documented to be the simplest and most versatile for the treatment of candidates indicated for manipulation (Nwuga, 1990). Several studies have shown that VOP has significant effect on pain intensity, mobility of the spine and cardiovascular system in patients with dysfunctions of the spine. However, its effect on the respiratory system during its application is less researched into. This study examined the effect of VOP on pain intensity and some respiratory variables in patients with cervical spondylosis.
Thirty subjects with neck pain were in the experimental group while 30 individuals without neck pain were in the control group. Their ages ranged between 27 and 77 years. Vertical oscillatory pressure was applied on a pre-identified painful vertebra in prone position while taking the respiratory variables (vital capacity and respiratory rate). Severity of pain was assessed using a 10-point standard Borg scale before, during and after VOP. The researcher’s applied force on the spine was monitored by calculating the difference between the body weights during application of VOP and before VOP. The control group’s respiratory variables (vital capacity and respiratory rate) were also monitored before, during and after VOP. However the control groups were asymptomatic of pain hence standard Borg scale was not used for them.
The result showed that vertical oscillatory pressure had no statistical significant effect (P>0.05) on respiratory rate of subjects with neck pain. VOP had statistical significant effect (p< 0.05) on respiratory rate of the control group. There was also statistical significant effect of VOP (P<0.05) on respiratory rate of the experimental when compared to the apparently healthy controls. The result further showed that vertical oscillatory pressure had statistical significant effect (p< 0.05) on vital capacity of subjects with neck pain. VOP had statistical significant effect on vital capacity of the control group. There was no statistical significant effect of VOP (P> 0.05) on vital capacity of the experimental when compared to the apparently healthy controls. Furthermore, the result showed that VOP had statistical significant effect (p< 0.05) on pain intensity of subjects in the experimental group. Furthermore, the result showed there was no statistical significant difference in the force applied (p> 0.05) between the experimental and the apparently healthy controls. Furthermore, the result showed that there were no significant correlation between force applied by the researcher and subjects’ age(r=0.08, p>0.05), body weight(r= 0.16, p>0.05), height(r=-0.10, p>0.05) and body mass index(r=0.19, p>0.05). Furthermore, result of the multiple regression analysis revealed that all the predictor variables (age, height, weight, body mass index) measured in this study accounted for 7.2% of the variability of the applied force. This implies that the remaining 92.8% not accounted for are due to the effects of other factors not included in the equation. The implication of this is that age and anthropometric parameters cannot accurately predict force required during application of VOP without significant errors.
This study concluded that vertical oscillatory pressure relieved neck pain (decreased from moderate pain to very mild pain) with a significant increase in vital capacity and no significant increase in respiratory rate of patients with cervical spondylosis. This implies that vertical oscillatory pressure may be a safe treatment for neck pain in patients with cervical spondylosis. It may also be beneficial in the presence of mildly/moderately decreased vital capacity measurement resulted from phrenic nerve involvement (C3- C5 supplying diaphragm) in patients with cervical spondylosis.

The subject of this article is the "difficult road" of dying (Freemon 1981), known in clinical settings as a trajectory of agitation/anxiety and cognitive impairment that occurs at end-of-life. The "difficult road" can involve seizure activity, neuropsychiatric emergency, myoclonic jerks, hiccups, and other problems associated with CNS-excitement and dysregulation. Palliative Sedation Therapy (PST) has significantly improved outcomes for end-of-life patients, but a group continues to die with symptoms that are refractory to medication. This article suggests that recruitment of the ECS for its neuroprotective effects may be a strategy to minimize the potential for refractory symptoms at the end-of-life. The evidence-base of safety and therapeutic potential associated with the use of cannabinoids for an end-of-life population is discussed.

Vasquez A. Neuroinflammation in fibromyalgia and CRPS is multifactorial. Nature Reviews Rheumatology 2016; March 3: doi:10.1038/nrrheum.2016.25. http://www.nature.com/nrrheum/journal/vaop/ncurrent/full/nrrheum.2016.25.html. Basically what I do in this Correspondence is refute the idea that these "chronic pain" and neuroinflammatory / central sensitization conditions are "idiopathic" and are --rather and importantly-- multifactorial. The distinction is of massive importance, because if we view these conditions as multifactorial we can then begin to dismantle these conditions by addressing the components. Based on my previous work starting in 2004 on migraine (textbook: "Integrative Orthopedics") and 2008 on fibromyalgia (CME monograph: "Musculoskeletal Pain"), I show --working within the constraints of fewer than 500 words-- that these conditions are triggered and perpetuated by 1) dysbiosis, 2) mitochondrial dysfunction, and 3) nutrient deficiencies, especially vitamin D. Logical treatment thereby follows, as already proven safe and effective by respective clinical trials. My current textbooks that cover this information are: Inflammation Mastery, 4th Edition (2016); see hyperlinks: http://www.ichnfm.org/#!blank/an1g3 (please note the discount available via http://www.ichnfm.org/#!store---membership/wq28b)
-- Nondiscount/retail Inflammation Mastery 4th Edition: http://amazon.com/author/alexvasquez
-- Pain Revolution for Migraine and Fibromyalgia: http://www.amazon.com/dp/1522951008
-- Fibromyalgia Solution: http://www.amazon.com/dp/B01AS1ZKPA
-- See also: Migraine and Headache Revolution: http://www.amazon.com/dp/B01AS15XZW
-- See also: Mitochondrial Medicine Arrives to Prime Time in Clinical Care. Altern Ther Health Med 2014 https://www.academia.edu/5636450/
-- See also: Mitochondrial Dysfunction and the Emerging Mitochondrial Medicine. Integrative Medicine 2013 https://www.academia.edu/17119323/
-- See also: Translating Microbiome (Microbiota) and Dysbiosis Research into Clinical Practice: The 20-Year Development of a Structured Approach that Gives Actionable Form to Intellectual Concepts. Int J Hum Nutr Funct Med 2015 https://www.academia.edu/12870819/
-- See also: The clinical importance of vitamin D (cholecalciferol): a paradigm shift with implications for all healthcare providers. Altern Ther Health Med. 2004 https://www.academia.edu/18078062/

Objectives: to evaluate efficacy and safety of superior hypogasteric block (SHB) for treatment of interstitial cystitis/ painful bladder syndrome (IC/PBS) in comparison with bladder hydrodistention (HD).
Materials and Methods: In a prospective study 23 female patients were randomly allocated to receive either SHB versus HD. Patients were evaluated by recording The O’Leary-Sant IC symptom indices (ICSI), IC problem indices (ICPI), pain visual analog scale (VAS),number of day time frequency and nocturia. Pressure flow study was conducted for all patients. Intraoperative and post operative changes and adverse events were recorded. 
Results: Basal ICSI and ICPI scores were comparable between both groups (p = 0.9). There was no statistically significant difference between both groups with respect to urodynamic parameter. Despite recording of better response in SHB in all parameters in comparison with HD group at one-week visit, however, none of them was statistically significant except for pain VAS during first week (p = 0.012). However, all parameters were significantly improved in favor of hydrodistension group at 2-weeks and 4-weeks visit.
Conclusion: Despite effective pain control in cases with IC/PBS after superior hypogasteric block, it lacks durability. Multimodality treatment would be needed for proper control of patients’ symptoms.

The aim of the present study was to comparing the effectiveness of mindfulness based cognitive training MBCT adapted for Iran's culture and cognitive-behavioral training CBT on chronic pain in employees. In this research, using experimental method, 54 employees were selected and randomly assigned into the 2 experimental groups and control 18 per a group), and were assessed in pre-test, post-test and follow up by the West Haven-Yale Multidimensional Pain Inventory (Ira et al, 1995). First experimental group received 8 sessions of MBCT, while second experimental group received 8 sessions of cognitive-behavioral training CBT, each session took 120 minutes. The results of the within and between subjects from analysis of repeated measures revealed that training have a significant effect on reduction in chronic pain (P  0.01).

The aim of the present study was to comparing the effectiveness of mindfulness based cognitive training MBCT adapted for Iran's culture and cognitive-behavioral training CBT on chronic pain in employees. In this research, using experimental method, 54 employees were selected and randomly assigned into the 2 experimental groups and control 18 per a group), and were assessed in pre-test, post-test and follow up by the West Haven-Yale Multidimensional Pain Inventory (Ira et al, 1995). First experimental group received 8 sessions of MBCT, while second experimental group received 8 sessions of cognitive-behavioral training CBT, each session took 120 minutes. The results of the within and between subjects from analysis of repeated measures revealed that training have a significant effect on reduction in chronic pain (P  0.01).

Pain associated with cancer is often difficult to treat, even more so when tumors involve peripheral nerves. Therapy is complex and often requires a multimodal approach that can include medications, radiation, and interventional techniques. These components are utilized with variable success, but are also limited by known complications or adverse effects. We present the case of a 53-year-old woman with a metastatic axillary tumor that involved her brachial plexus. Attempts to control her pain with medication were unsuccessful despite escalation and use of adjunct agents. She was not deemed to be a surgical candidate due to the size and location of the tumor. Radiation was discussed but, obviously, would not work immediately. Our team decided to employ a brachial plexus catheter for continuous nerve block, which provided almost complete relief of pain. Since her pain was deemed to be of peripheral etiology, pulsed radiofrequency ablation of her brachial plexus was used for more long-term pain relief. The patient responded very well with minimal pain issues and no apparent complications. On follow-up, the patient had good relief for almost 2 months. Pulsed radiofrequency is a poorly understood technology that has increasing evidence for certain pain conditions; however, for cancer and peripheral nerves the evidence is slim to none. Our case presents a successful use for pain management of a brachial plexopathy due to a tumor. We propose that pulsed radiofrequency may present a non-neurodestructive pain management technique for tumors involving peripheral nerves, though more data is definitely needed.

The aim of the present study was to comparing the effectiveness of mindfulness based
cognitive training MBCT adapted for Iran's  culture and cognitive-  behavioral training
CBT  on  chronic  pain  in  employees.  In  this  research,  using  experimental  method,  54
employees were selected and randomly assigned into the 2 experimental groups and
control (18 per a group), and were assessed in pre-test, post-test and follow up by the
West Haven-Yale Multidimensional  Pain Inventory (Ira et al,  1995).  First experimental
group  received  8  sessions  of  MBCT,  while  second  experimental  group  received  8
sessions  of  cognitive-behavioral  training  CBT,  each  session  took  120  minutes.  The
results  of  the  within  and  between  subjects  from  analysis  of  repeated  measures
revealed that training have a significant effect on reduce  in chronic pain (P    0.01).
The  post  hoc  test  also  revealed  that  MBCT  was  more  effective  than  CBT  in  chronic
pain (P  0.01).
Key words: Cognitive training, mindfulness, chronic pain, service companies, Iran's culture

What our personal experiences mean are important to us, and influence how we respond to life’s changing circumstances. Due to personal experience, everyone “knows” what pain is. Yet, this knowledge fails us when we try to explain what pain means. What is the meaning of pain?

BACKGROUND AND AIMS: Post Surgical Pain (PSP) treatment represents a significant aspect of management of surgical
patients. Incidence of severe PSP, with significant functional deficit is estimated at 5-10%. Most studies include a limited
number of patients and this is a factor which affects power of results. Aims of our prospective observational study
was to evaluate the incidence and characteristics of acute and chronic PSP in patients undergoing surgery at the university
hospital of second university of naples.
MATERIALS AND METHODS: After Ethics Committee approval and written informed consent, the PSP acute on first day
(at least 6 hours after surgery) through the International Pain Outcomes questionnaire was rated. Subsequently, patients
were followed-up at 6 and 12 months; data collection took place by e-mail or phone and the Brief Pain Inventory and
the DN4 were administered.
RESULTS: We enrolled 235 patients, 219 performed the follow-up to 6months, 195 even that to 12 The incidence of
CPSP at 6 months was of 45.2% for mild pain, 15.9% for moderate pain and of 2.7% for severe pain while the
incidence of CPSP at 12 months was 35.9%, 11.8% and 2.5% respectively for the pain mild, moderate and severe.
Neuropathic pain occurred in 40.3% of patients who CPSP moderate at 12 months compared with 31.9% of the
patients interviewed at 6 months. Incidence and characteristics of PSP varied, often considerably, depending on the type
of surgery, gender, age of the patient and the presence of PSP severe in the 24 hours following surgery.
CONCLUSIONS: The incidence of CPSP 12 months after surgery must be improved in the next future. Preoperative pain
and the percentage of time with severe pain during the first 24 hours after surgery seem to be CPSP predictors.

Incisional pain is particularly troublesome after hysterectomy. A method called transversus abdominis plane block (TAPB) has shown promise in managing postoperative pain. In this study, we evaluated the analgesic efficacy of ultrasound-guided TAPB after hysterectomy at different time points and at each time point separately for 48 hours.