eMedicine Specialties > Physical Medicine and Rehabilitation > Medical Diseases
Chronic Pain Syndrome: Treatment & Medication
Updated: Jun 29, 2009
- Overview
- Differential Diagnoses & Workup
- Treatment & Medication
- Follow-up
- Multimedia
Treatment
Rehabilitation Program
Physical Therapy
Physical therapy (PT), in association with occupational therapy (OT), has an important role in functional restoration for patients with chronic pain syndrome.4 The goal of a PT program is to increase strength and flexibility gradually beginning with gentle gliding exercises. Patients usually are reluctant to participate in PT because of intense pain.
A self-directed or therapist-directed PT program is important and should be individualized to each patient's needs and goals.
PT techniques include hot or cold applications, positioning, stretching exercises, traction, massage, ultrasound therapy, transcutaneous electrical nerve stimulation (TENS), and manipulations. Heat, massage, and stretching can be used to alleviate excess muscle contraction and pain. Other intervention should be offered to enable greater confidence and comfort when patients do not progress in a reasonable amount of time.
Occupational Therapy
OT is very important for initiating gentle active measurements and preliminary desensitization techniques with patients who have chronic pain, especially regional chronic pain syndrome.
Recreational Therapy
Recreational therapy can help the patient with chronic pain take part in pleasurable activities that help decrease pain. The patient finds enjoyment and socialization in previously lost or new recreational activities. Usually, patients with chronic pain are depressed because of intense pain. Recreational therapists may play an important role in the treatment process as they help enable the patient to become active.
Medical Issues/Complications
Management of chronic pain in patients with multiple problems is complex,5 usually requiring specific treatment, simultaneous psychological treatment, and PT. A good relationship between the physician and patient should be established.
Treatment of chronic pain syndrome must be tailored for each individual patient. The treatment should be aimed at interruption of reinforcement of the pain behavior and modulation of the pain response. The goals of treatment must be realistic and should be focused on restoration of normal function (minimal disability), better quality of life, reduction of use of medication, and prevention of relapse of chronic symptoms.
Surgical Intervention
- Nerve blocks are used for diagnostic, prognostic, and therapeutic procedures.
- Sympathetic blocks are more effective therapeutic tools for chronic pain.
- Sympathetic blocks including stellate ganglion and lumbar sympathetic blocks commonly are used. (See images below and Images 8-10.)
- Spinal cord stimulation commonly is used to treat neuropathic pain refractory to other forms of treatment. Spinal cord stimulation also is used for patients with a failed back syndrome with radicular pain. Careful evaluation is recommended before patient selection.
- Intrathecal morphine pumps, either fully implantable pumps or external pumps, are used to treat chronic pain. This method of treatment should be considered very carefully for pain of nonmalignant origin.
Schematic anatomical representations, sympathetic chain and stellate ganglion.
Stellate block, important anatomical landmarks (surface and cross-sectional views).
Pertinent anatomy for lumbar sympathetic block (cross-sectional view).
Consultations
Consultation with a psychologist, a urologist, a neurologist, an obstetrician-gynecologist, a gastrointestinal specialist, or other appropriate specialists is very important, especially before considering invasive or aggressive management.
- As in other chronic pain, the high incidence of personality pathology, as noted by Monti, may represent an exaggeration of maladaptive personality traits and coping styles as a result of a chronic intense pain.
- A psychological evaluation should be performed to identify the stressor and to obtain information about the distress of the patient. The evaluation should consist of a structural clinical interview and a personality measure (eg, Minnesota Multiphasic Personality Scale, Hopelessness Index).
Other Treatment
- Application of heat and cold: Use of these modalities is encouraged for treatment of chronic pain syndrome. Use of cold in neuropathic pain is controversial.
- TENS: This method of treatment has significant benefit in the treatment of rheumatoid arthritis and osteoarthritis. According to a double-blind study, exercise groups have significant benefit over TENS. Electrodes should be applied over or near the area of pain with the dipole parallel to major nerve trunks. TENS application should be avoided near the carotid sinus, during pregnancy, and in patients with demand-type pacemakers. The most common adverse effect of TENS is skin hypersensitivity.
- Psychophysiologic therapy1
- This type of therapy consists of reassurance, counseling, relaxation therapy, stress management programs, and biofeedback techniques. With these modalities of treatment, the frequency and severity of chronic pain may be reduced.
- Biofeedback may be helpful in some patients when combined with medications. Myofascial and sympathetically mediated pain syndromes have been treated successfully using behavioral techniques. Relaxation training, including autogenic training and progressive muscle relaxation, commonly is used. This approach is as effective as biofeedback.
- Vocational therapy should be recommended and initiated early for all appropriate patients. Each patient is evaluated to determine work history, educational background, vocational skills and abilities, and motivation level to return to work. The patient should get help from a vocational counselor for legal rights and obligations in each state (eg, workman's compensation). Each patient needs to set realistic goals. Vocational therapy can provide work capacities and targeted work hardening so that the patient may return to gainful employment, the ultimate functional restoration.
- Psychological interventions, in conjunction with medical intervention, PT, and OT, increase the effectiveness of the treatment program.1 Family members are involved in the evaluation and treatment processes.
Medication
Pharmacotherapy consists of symptomatic abortive therapy (to stop or reduce the severity of the acute exacerbations) and long-term therapy for chronic pain. Initially, pain may respond to simple OTC analgesics, such as paracetamol, ibuprofen, aspirin, or naproxen. If treatment is unsatisfactory, the addition of other modalities or the use of prescription drugs is recommended. If possible, avoid barbiturate or opiate agonists. Also, discourage long-term and excessive use of all symptomatic analgesics because of the risk of dependence and abuse.
Tizanidine may improve the inhibitory function in the CNS and can provide pain relief. Amitriptyline (Elavil) and nortriptyline (Pamelor) are the tricyclic antidepressants (TCAs) most frequently used to treat chronic pain. The selective serotonin reuptake inhibitors (SSRIs) fluoxetine (Prozac), paroxetine (Paxil), and sertraline (Zoloft) are commonly prescribed by many physicians. Other antidepressants, such as doxepin, desipramine protriptyline, and buspirone, also can be used.
A French study found evidence that botulinum toxin type A (BoNT-A) has direct analgesic effects when administered to patients with chronic neuropathic pain (performing actions that are independent of its effect on muscle tone).6 Consequently, the study's authors suggested that BoNT-A may have "novel indications" in analgesia.
Antidepressants
Increase the synaptic concentration of serotonin and/or norepinephrine in the CNS by inhibiting their reuptake by the presynaptic neuronal membrane.
Amitriptyline (Elavil)
Analgesic for certain chronic and neuropathic pain.
Adult
25-100 mg/d PO hs; not to exceed 150 mg /d
Pediatric
Children: 0.1 mg/kg PO hs; increase, as tolerated, over 2-3 wk to 0.5-2 mg/d hs
Adolescents: 25-50 mg/d PO initially; increase gradually to 100 mg/d in divided doses
Phenobarbital may decrease effects; coadministration with CYP2D6 enzyme system inhibitors (eg, cimetidine, quinidine) may increase amitriptyline levels; amitriptyline inhibits hypotensive effects of guanethidine; may interact with thyroid medications, alcohol, CNS depressants, barbiturates, and disulfiram
Documented hypersensitivity; patients who have taken MAOIs in past 14 d; has history of seizures, cardiac arrhythmias, glaucoma, and urinary retention
Pregnancy
D - Fetal risk shown in humans; use only if benefits outweigh risk to fetus
Precautions
Caution in cardiac conduction disturbances, history of hyperthyroidism, or history of renal or hepatic impairment; avoid using in the elderly
Nortriptyline (Pamelor)
Has demonstrated effectiveness in the treatment of chronic pain. By inhibiting the reuptake of serotonin and/or norepinephrine by the presynaptic neuronal membrane, this drug increases the synaptic concentration of these neurotransmitters in the CNS. Pharmacodynamic effects such as the desensitization of adenyl cyclase and down-regulation of beta-adrenergic receptors and serotonin receptors also appear to play a role in its mechanisms of action.
Adult
25-100 mg PO hs; not to exceed 200 mg/d
Pediatric
Children: 0.1 mg/kg PO hs; increase, as tolerated, up to 0.5-2 mg/d hs
Adolescents: 25-50 mg/d PO; gradually increase to 100 mg/d
Cimetidine may increase nortriptyline levels when used concurrently; nortriptyline may increase prothrombin time in patients stabilized with warfarin
Documented hypersensitivity; narrow-angle glaucoma; patients who have taken MAOIs in past 14 d
Pregnancy
D - Fetal risk shown in humans; use only if benefits outweigh risk to fetus
Precautions
Caution in cardiac conduction disturbances, history of hyperthyroidism, and history of renal or hepatic impairment; due to pronounced effects in cardiovascular system, best to avoid in elderly
Duloxetine (Cymbalta)
Indicated for diabetic peripheral neuropathic pain. Potent inhibitor of neuronal serotonin and norepinephrine reuptake.
Adult
60 mg PO qd; may initiate with lower dose in patient unable to tolerate 60 mg/d
Pediatric
Not established
Metabolized by CYP1A2 and CYP2D6; coadministration with drugs that inhibit CYP1A2 (eg, fluvoxamine, cimetidine, ciprofloxacin, enoxacin) may increase duloxetine blood levels and toxicity; coadministration with drugs that inhibit CYP2D6 (eg, paroxetine, fluoxetine, quinidine) may increase duloxetine blood levels and toxicity; duloxetine moderately inhibits CYP2D6 and may decrease elimination of CYP2D6 substrates (eg, tricyclic antidepressants, phenothiazines [eg, thioridazine], type 1C antiarrhythmics [eg, propafenone, flecainide]); coadministration with MAO inhibitors or triptans serotonin syndrome consisting of serious, sometimes fatal reactions that include hyperthermia, rigidity, myoclonus, autonomic instability, mental status changes including extreme agitation, delirium, and coma (see contraindications)
Documented hypersensitivity; uncontrolled narrow-angle glaucoma; within 14 d of stopping MAO inhibitor use (do not initiate MAO inhibitors within 5 d of stopping duloxetine)
Pregnancy
C - Fetal risk revealed in studies in animals but not established or not studied in humans; may use if benefits outweigh risk to fetus
Precautions
Observe closely for clinical worsening and suicidality when initiating treatment or following dosage change; gradually decrease dose when discontinuing, do not abruptly discontinue; caution with hepatic impairment or end-stage renal disease; recommended not to prescribe to patients with substantial alcohol use or evidence of chronic liver disease; may cause slight blood pressure increase; may activate mania or hypomania; common adverse effects include nausea, dry mouth, constipation, decreased appetite, fatigue, somnolence and increased sweating; may cause serotonin syndrome (ie, changes in mental status [agitation, hallucinations, coma], autonomic instability [tachycardia, labile blood pressure, hyperthermia], neuromuscular abnormalities [hyperreflexia, incoordination], and/or gastrointestinal tract symptoms
Venlafaxine (Effexor)
Inhibit neuronal serotonin and norepinephrine reuptake. In addition, causes beta-receptor down-regulation. May decrease pain in neuropathic pain and help with sleep and other mood disorders (depression or depressive symptoms).
Adult
5 mg PO qd initially; can be increased gradually to 50-150 mg PO bid
Pediatric
Not established
Cimetidine, MAO inhibitors, sertraline, fluoxetine class I-C antiarrhythmics, TCAs, phenothiazine may increase the effects of venlafaxine
Documented hypersensitivity; patients taking MAO inhibitors or who have taken them within 14 days of initiating therapy
Pregnancy
C - Fetal risk revealed in studies in animals but not established or not studied in humans; may use if benefits outweigh risk to fetus
Precautions
Patients on this medication may experience hypertension; fatal reaction may occur if venlafaxine is taken concurrently with an MAO inhibitor; exercise caution in patients with cardiovascular disorders; the sustained release formulation should not be divided, crushed, or placed in water
Fluoxetine (Prozac)
An atypical non-TCA with potent specific 5HT-uptake inhibition and fewer anticholinergic and cardiovascular adverse effects than TCAs. Consider as alternative to TCAs.
Adult
10 mg PO on waking; can be increased q2wk; not to exceed 60 mg/d
Pediatric
Not established
Increases toxicity of diazepam and trazodone by decreasing clearance; also increases toxicity of MAOIs and highly protein-bound drugs; serotonin syndrome (ie, myoclonus, rigidity, confusion, nausea, hyperthermia, autonomic instability, coma, eventual death) occurs with simultaneous use of other serotonergic agents (eg, anorectic agents, tramadol, buspirone, trazodone, clomipramine, nefazodone, tryptophan); discontinue other serotonergic agents at least 2 wk prior to SSRIs
Documented hypersensitivity; pregnancy and breastfeeding; severe renal or hepatic disease
Pregnancy
C - Fetal risk revealed in studies in animals but not established or not studied in humans; may use if benefits outweigh risk to fetus
Precautions
Caution in hepatic impairment and history of seizures; MAOIs should be discontinued at least 14 d before initiating fluoxetine therapy; anxiety, insomnia or drowsiness, tremor, anorexia, anorgasmia, and other sexual dysfunctions have been reported; nausea, flulike symptoms, and agitation that resolve within 1-2 wk also have been noted
Sertraline (Zoloft)
An atypical non-TCA with potent specific 5HT-uptake inhibition and fewer anticholinergic and cardiovascular adverse effects than TCAs. Consider as alternative to TCAs.
Adult
50 mg/d PO initially; increase at weekly intervals after several weeks; not to exceed 200 mg/d
Pediatric
Not established
Serious potentially fatal reactions such as autonomic instability may occur with concurrent use of MAOIs; other antidepressants, phenothiazines, group IC antiarrhythmics, cimetidine, phenytoin, phenobarbital, digoxin, and warfarin
Documented hypersensitivity; pregnancy and breastfeeding; severe renal or hepatic disease
Pregnancy
C - Fetal risk revealed in studies in animals but not established or not studied in humans; may use if benefits outweigh risk to fetus
Precautions
Caution in preexisting seizure disorders, recent myocardial infarction, unstable heart diseases, and hepatic or renal impairment; anxiety, insomnia or drowsiness, tremor, anorexia, anorgasmia, and other sexual dysfunctions have been reported; nausea, flulike symptoms, and agitation that resolve within 1-2 wk also have been noted
Paroxetine (Paxil)
An atypical non-TCA with potent specific 5HT-uptake inhibition and fewer anticholinergic and cardiovascular adverse effects than TCAs. Consider as alternative to TCAs.
Adult
10 mg/d PO initially, then titrate upward; not to exceed 50 mg/d
Pediatric
Not established
Serious potentially fatal reactions such as autonomic instability may occur with concurrent use of MAOIs; other antidepressants, phenothiazines, group IC antiarrhythmics, cimetidine, phenytoin, phenobarbital, digoxin, and warfarin
Documented hypersensitivity; pregnancy and breastfeeding; severe renal or hepatic disease
Pregnancy
C - Fetal risk revealed in studies in animals but not established or not studied in humans; may use if benefits outweigh risk to fetus
Precautions
Anxiety, insomnia or drowsiness, tremor, anorexia, anorgasmia, and other sexual dysfunctions have been reported; nausea, flulike symptoms, and agitation that resolve within 1-2 wk also have been noted
Anticonvulsants
Certain antiepileptic drugs (eg, the GABA analogue gabapentin and pregabalin [Lyrica]) have proven helpful in some cases of neuropathic pain.2 For example, a randomized, double-blind, placebo-controlled study reported that twice-daily doses of gastric-retentive, extended-release gabapentin (gabapentin ER) provided a safe and effective treatment for postherpetic neuralgia; nonplacebo patients in the study received 1800 mg of gabapentin per day.3
Other anticonvulsant agents (eg, clonazepam, topiramate, lamotrigine, zonisamide, tiagabine) also have been tried in chronic pain syndrome.
Gabapentin (Neurontin)
Has anticonvulsant properties and antineuralgic effects; however, exact mechanism of action is unknown. Structurally related to GABA but does not interact with GABA receptors.
Adult
100-1200 mg PO tid
Pediatric
<12 years: Not recommended
>12 years: Administer as in adults
Antacids may significantly reduce bioavailability of gabapentin (administer at least 2 h following antacids); may increase norethindrone levels significantly
Documented hypersensitivity
Pregnancy
C - Safety for use during pregnancy has not been established.
Precautions
Caution in severe renal disease; abrupt withdrawal may precipitate seizures
Pregabalin (Lyrica)
Structural derivative of GABA. Mechanism of action unknown. Binds with high affinity to alpha2 -delta site (a calcium channel subunit). In vitro, reduces calcium-dependent release of several neurotransmitters, possibly by modulating calcium channel function. FDA approved for neuropathic pain associated with diabetic peripheral neuropathy or postherpetic neuralgia and as adjunctive therapy in partial-onset seizures.
Adult
50 mg PO tid initially; if needed, may increase to 100 mg tid within 1 wk
Pediatric
Not established
May cause additive effects on cognitive and gross motor functioning when coadministered with drugs that cause dizziness or somnolence
Documented hypersensitivity
Pregnancy
C - Fetal risk revealed in studies in animals but not established or not studied in humans; may use if benefits outweigh risk to fetus
Precautions
Discontinue gradually (over a minimum of 1 wk) to minimize increased seizure frequency in patients with seizure disorders; may cause insomnia, nausea, headache, or diarrhea with abrupt withdrawal; common adverse effects include dizziness, somnolence, blurred vision, weight gain, and peripheral edema; may elevate creatinine kinase level, decrease platelet count, and increase PR interval; doses >300 mg/d associated with higher rate of adverse effects and treatment discontinuation; decrease dose with renal impairment (ie, CrCl <60 mL/min); angioedema has been reported during postmarketing surveillance
Analgesics
Used commonly for many pain syndromes. Pain control is essential to quality patient care. Analgesics ensure patient comfort, promote pulmonary toilet, and have sedating properties, which are beneficial for patients who have sustained traumatic injuries.
Oxycodone (OxyContin, OxyIR, Roxicodone)
Long-acting opioids may be used in patients with CPS. Start with small dose, and if appropriate, gradually increase.
Adult
10-160 mg PO q12h
Pediatric
<12 years: Not established
>12 years: Administer as in adults
Phenothiazines may antagonize analgesic effects; MAOIs, general anesthesia, CNS depressants, and TCAs may increase toxicity
Documented hypersensitivity; presence of intracranial lesion associated with impaired intracranial pressure (hydromorphone); patients receiving MAOIs or those who have recently used MAOIs; poor respiratory function (eg, COPD, cor pulmonale, emphysema, status asthmaticus, kyphoscoliosis)
Pregnancy
B - Fetal risk not confirmed in studies in humans but has been shown in some studies in animals
D - Fetal risk shown in humans; use only if benefits outweigh risk to fetus
Precautions
Caution in COPD, emphysema, and renal insufficiency
Fentanyl (Duragesic)
Potent narcotic analgesic with much shorter half-life than morphine sulfate. DOC for conscious sedation analgesia. Ideal for analgesic action of short duration during anesthesia and during immediate postoperative period. Excellent choice for pain management and sedation with short duration (30-60 min). Easy to titrate. Easily and quickly reversed by naloxone. When using transdermal dosage form, most patients achieve pain control with 72-h dosing intervals; however, some patients require dosing intervals of 48 h.
Adult
25-100 mcg/h TD system q2-3d
Pediatric
Not established
Phenothiazines may antagonize analgesic effects of opiate agonists; TCAs may potentiate adverse effects of fentanyl when both drugs are used concurrently
Documented hypersensitivity; hypotension or potentially compromised airway that would cause difficulty in establishing rapid airway control
Pregnancy
C - Fetal risk revealed in studies in animals but not established or not studied in humans; may use if benefits outweigh risk to fetus
Precautions
Caution in hypotension, respiratory depression, constipation, nausea, emesis, and urinary retention; idiosyncratic reaction, known as chest wall rigidity syndrome, may require neuromuscular blockade in order to increase ventilation
Acetaminophen (Tylenol, Feverall, Aspirin Free Anacin)
DOC for pain in patients with documented hypersensitivity to aspirin or NSAIDs, with upper GI disease, who are pregnant, or who are taking oral anticoagulants.
Adult
650-1000 mg PO, initially; may repeat after 6h if necessary
Pediatric
<3 years: Not established
3-6 years: 10 mg/kg PO; not to exceed 720 mg/d
6-12 years: 10 mg/kg PO; not to exceed 2.6 g/d
>12 years: Administer as in adults
Rifampin can reduce analgesic effects of acetaminophen; coadministration with barbiturates, carbamazepine, hydantoins, and isoniazid may increase hepatotoxicity
Documented hypersensitivity; known G-6-PD deficiency
Pregnancy
B - Fetal risk not confirmed in studies in humans but has been shown in some studies in animals
Precautions
Hepatotoxicity possible following various dose levels in those with chronic alcoholism; severe or recurrent pain or high or continued fever may indicate a serious illness; APAP is contained in many OTC products, and combined use with these products may result in cumulative APAP doses exceeding recommended maximum dose
Nonsteroidal anti-inflammatory drugs
Have analgesic, anti-inflammatory, and antipyretic activities. Their mechanism of action is not known, but they may inhibit cyclo-oxygenase activity and prostaglandin synthesis. Other mechanisms may exist as well, such as inhibition of leukotriene synthesis, lysosomal enzyme release, lipoxygenase activity, neutrophil aggregation, and various cell membrane functions.
Ibuprofen (Motrin, Advil, Ibuprin)
DOC for patients with mild to moderate pain. Inhibits inflammatory reactions and pain by decreasing prostaglandin synthesis.
Adult
400-800 mg PO q8h; not to exceed 3.2 g/d
Pediatric
<6 months: Not established
6 months to 12 years: 4-10 mg/kg/dose PO tid/qid
>12 years: Administer as in adults
Coadministration with aspirin increases risk of inducing serious NSAID-related side effects; probenecid may increase concentrations and, possibly, toxicity of NSAIDs; may decrease effect of hydralazine, captopril, and beta-blockers; may decrease diuretic effects of furosemide and thiazides; may increase PT when taking anticoagulants (instruct patients to watch for signs of bleeding); may increase risk of methotrexate toxicity; phenytoin levels may be increased when administered concurrently
Documented hypersensitivity; peptic ulcer disease, recent GI bleeding or perforation, renal insufficiency, or high risk of bleeding
Pregnancy
B - Fetal risk not confirmed in studies in humans but has been shown in some studies in animals
D - Fetal risk shown in humans; use only if benefits outweigh risk to fetus
Precautions
Caution in congestive heart failure, hypertension, and decreased renal and hepatic function; caution in coagulation abnormalities or during anticoagulant therapy
Naproxen sodium (Anaprox, Naprelan, Naprosyn, Anaprox)
For relief of mild to moderate pain. Inhibits inflammatory reactions and pain by decreasing activity of cyclo-oxygenase, which results in a decrease of prostaglandin synthesis.
Adult
275 mg PO tid or 550 mg PO bid
Pediatric
<2 years: Not established
>2 years: 2.5 mg/kg/dose PO; not to exceed 10 mg/kg/d
Coadministration with aspirin increases risk of inducing serious NSAID-related side effects; probenecid may increase concentrations and, possibly, toxicity of NSAIDs; may decrease effect of hydralazine, captopril, and beta-blockers; may decrease diuretic effects of furosemide and thiazides; may increase PT when taking anticoagulants (instruct patients to watch for signs of bleeding); may increase risk of methotrexate toxicity; phenytoin levels may be increased when administered concurrently
Documented hypersensitivity; peptic ulcer disease; recent GI bleeding or perforation; renal insufficiency
Pregnancy
B - Fetal risk not confirmed in studies in humans but has been shown in some studies in animals
D - Fetal risk shown in humans; use only if benefits outweigh risk to fetus
Precautions
Acute renal insufficiency, interstitial nephritis, hyperkalemia, hyponatremia, and renal papillary necrosis may occur; patients with preexisting renal disease or compromised renal perfusion risk acute renal failure; leukopenia occurs rarely, is transient, and usually returns to normal during therapy; persistent leukopenia, granulocytopenia, or thrombocytopenia warrants further evaluation and may require discontinuation of drug
More on Chronic Pain Syndrome |
| Overview: Chronic Pain Syndrome |
| Differential Diagnoses & Workup: Chronic Pain Syndrome |
 Treatment & Medication: Chronic Pain Syndrome |
| Follow-up: Chronic Pain Syndrome |
| Multimedia: Chronic Pain Syndrome |
| References |
| Further Reading |
| « Previous Page | Next Page » |
References
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Further Reading
Related eMedicine topics:
Arthritis, Rheumatoid
Chronic Pelvic Pain
Chronic Pelvic Pain Syndrome and Prostatodynia
Corticosteroid Injections of Joints and Soft Tissues
Epidural Steroid Injections
Fibromyalgia [Pediatrics: General Medicine]
Fibromyalgia [Physical Medicine and Rehabilitation]
Fibromyalgia [Rheumatology]
Image-guided Stellate Ganglion Blocks
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Osteoarthritis [Physical Medicine and Rehabilitation]
Osteoarthritis [Rheumatology]
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Paraspinal Injections - Facet Joint and Nerve Root Blocks
Pathophysiology of Chronic Back Pain
Rheumatoid Arthritis [Physical Medicine and Rehabilitation]
Rheumatoid Arthritis [Rheumatology]
Therapeutic Injections for Pain Management
Virtual Reality Biofeedback in Chronic Pain and Psychiatry
Clinical guidelines:
Chronic pelvic pain. In: Guidelines on chronic pelvic pain. European Association of Urology - Medical Specialty Society. 2008 Mar. 55 pages. NGC:006454
Fibromyalgia treatment guideline. University of Texas at Austin School of Nursing, Family Nurse Practitioner Program - Academic Institution. 2005 May. 13 pages. NGC:004350
General treatment of chronic pelvic pain. In: Guidelines on chronic pelvic pain. European Association of Urology - Medical Specialty Society. 2008 Mar. 13 pages. NGC:006520
Management of fibromyalgia syndrome. American Pain Society Fibromyalgia Panel - Independent Expert Panel. 2004 Nov 17. 8 pages. NGC:004057
Prostatitis and chronic pelvic pain syndrome. In: Guidelines on the management of urinary and male genital tract infections. European Association of Urology - Medical Specialty Society. 2008 Mar. 10 pages. NGC:006494
Psychological factors in chronic pelvic pain. In: Guidelines on chronic pelvic pain. European Association of Urology - Medical Specialty Society. 2008 Mar. 8 pages. NGC:006519
Clinical trials:
Botulinum Toxin Type A for the Treatment of Male Chronic Pelvic Pain Syndrome (BTX-URO-01)
Efficacy of TMS in Chronic Idiopathic Pain Disorders
Neurotropin to Treat Chronic Neuropathic Pain
Supporting Effect of Dronabinol on Behavioral Therapy in Fibromyalgia and Chronic Back Pain
Transcranial Magnetic Stimulation for Treating Women With Chronic Widespread Pain
Keywords
chronic pain syndrome, pain management, pain relief, fibromyalgia, chronic pain, muscle pain, arthritis pain, pain medicine, TENS, TENS unit, pain meds, pain treatment, pain therapy, nerve block, pain medications, treatment for pain, chronic pain treatment, chronic pain relief, pain relievers, neuropathic pain, chronic pain management, spinal cord stimulation, nerve stimulation, nerve blocks, chronic regional pain syndrome, transcutaneous electrical nerve stimulation, chronic benign pain syndrome, chronic intractable benign pain syndrome
