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3 results

  • Chapter 35 - Chronic Abdominal Pain

  • from Part VI - Misc
  • Edited by Omar Viswanath, Creighton University, Omaha, Ivan Urits, Southcoast Brain & Spine Center, Wareham
  • Book:
    Cambridge Handbook of Pain Medicine
    Published online:
    01 December 2023
    Print publication:
    14 December 2023, pp 288-294

  • Summary

    Chronic abdominal pain (CAP) is a constant or recurrent pain that lasts for more than three months. Abdominal pain is the most common GI symptom, and it is a leading cause for inpatient and outpatient visits. International prevalence is between 22% and 25%, with more women reporting abdominal pain than men (24% versus 17%). Many diseases can cause CAP. Treatments include celiac plexus neurolysis, celiac plexus blocking agent, various pharmacologic treatment, spinal cord stimulation, and lifestyle modifications.

  • Chapter 31 - Multiple Sclerosis Pain

  • from Part VI - Misc
  • Edited by Omar Viswanath, Creighton University, Omaha, Ivan Urits, Southcoast Brain & Spine Center, Wareham
  • Book:
    Cambridge Handbook of Pain Medicine
    Published online:
    01 December 2023
    Print publication:
    14 December 2023, pp 248-252

  • Summary

    Multiple sclerosis (MS) is an autoimmune disorder of the central nervous system, causing inflammation with oligodendrocyte death and myelin sheath destruction. Classical symptoms of MS are fatigue, paresthesia, motor deficits, cognitive dysfunction, visual disturbances (due to optic neuritis), spasticity, depression, gait disturbance, and pain. To make a formal diagnosis of MS, the 2017 McDonald criteria is used. Pain in MS can present itself as headache, extremity pain, back pain, neuropathic pain, or more specifically, trigeminal neuralgia. Pain in MS can be severe and chronic enough to cause disability and decreased quality of life. The prevalence of neuropathic pain in MS can be as high as 86% and it can manifest itself as back pain, headache, trigeminal neuralgia, or extremity pain. When present, it is associated with MS, which tends to be more severe, with a higher degree of disability. Early treatment of these pains leads to better outcomes of MS itself. Conventional methods to treat pain in these patients produce only a 50% reduction in symptomatology. Some unconventional treatment modalities that have benefited patients are antidepressants, anticonvulsants, cannabinoids, low-dose naltrexone, and spinal stimulation.

  • Consistency of symptom clusters among advanced cancer patients seen at an outpatient supportive care clinic in a tertiary cancer center

  • Sriram Yennurajalingam, Jung Hye Kwon, Diana L. Urbauer, David Hui, Cielito C Reyes-Gibby, Eduardo Bruera
  • Journal:
    Palliative & Supportive Care / Volume 11 / Issue 6 / December 2013
    Published online by Cambridge University Press:
    07 February 2013, pp. 473-480
  • Objective:

    Advanced cancer patients often develop severe physical and psychological symptom clusters (SCs), but limited data exist on their consistency or severity after an outpatient interdisciplinary team consultation led by palliative care specialists. The primary aim of the study was to determine the consistency and severity of SCs in advanced cancer patients in this setting.

    Method:

    A total of 1373 patients with advanced cancer who were referred to The University of Texas MD Anderson Cancer Center's Outpatient Supportive Care Center between January 2003 and October 2008 with a complete Edmonton Symptom Assessment Scale (ESAS; 0–10 scale) occurred at initial and first follow-up visit were reviewed (median 14 days, range 1–4 weeks). We used a Wilcoxon signed-rank test to determine whether symptoms changed over time, and a principal components factor analysis with varimax rotation to determine SCs at baseline and at first follow-up. The number of factors calculated was determined based upon the number of eigenvalues.

    Results:

    The patients' ratings of the following symptoms (mean, SD) at the initial and follow-up visits, respectively, were: fatigue 6.2 (2.3) and 5.7 (2.5, p < 0.0001), pain 5.4 (2.9) and 4.6 (3, p < 0.0001), nausea 2.2 (2.8) and 2.0 (2.6, p < 0.0001), depression 3.0 (2.9) and 2.5 (2.7, p < 0.0001), anxiety 3.4 (3.0) and 2.8 (2.8, p < 0.0001), drowsiness 4.8 (3.1) and 4.4 (3.1, p < 0.0001), dyspnea 3.0 (2.9) and 2.7 (2.8), p < 0.0001), loss of appetite 4.2 (2.7) and 3.9 (2.7, p < 0.0001), sleep disturbances 4.2 (2.6) and 3.8 (2.6, P < 0.0001), and well-being 4.3 (2.5) and 3.9 (2.3, p < 0.0001). Cluster composition differentiated into physical (fatigue, pain, nausea, drowsiness, dyspnea, and loss of appetite) and psychological (anxiety and depression) components at the initial visit, and these two SCs were consistent upon follow-up.

    Significance of results:

    We conclude that SCs remain constant between baseline and near-term follow-up but that the severity of those symptoms lessened during that interval. This knowledge may allow palliative care teams to provide more targeted and higher-quality care, but further studies are needed.