Pharmacological management of fibromyalgia

Fibromyalgia (FM) is a valid and common disorder of chronic widespread musculo-skeletal pain.http://www.medicalchronicle.co.zahb201

Disturbed sleep and quality of life in female Fibromyalgia patients

Fibromyalgia is a musculoskeletal disorder that mainly affects women. One of the main symptoms of this disorder is poor sleep quality. The aim of this study is to determine how sleep quality and quality of life are related to female fibromyalgia patients versus healthy controls.This paper was initially delivered at the Annual Congress of the Biological Sciences Division of the South African Academy for Science and Art, ARC-Plant Protection Research Institute, Roodeplaat, Pretoria, South Africa on 01 October 2010.http://www.satnt.ac.zaam2014ay201

South African guideline for the use of chronic opioid therapy for chronic non-cancer pain

Chronic pain may have a significant impact on health-related quality of life and can be difficult to manage. In carefully selected patients, and as part of a comprehensive pain management strategy, opioid analgesia may help to achieve long-term pain control with a manageable side-effect profile and a low risk of serious adverse effects. However, appropriate evaluation, including biopsychosocial screening and risk screening is essential before initiating an opioid and during continued therapy. This guideline aims to assist practitioners in screening and selecting appropriate patients with chronic non-cancer pain to initiate, monitor and continue pain management with opioid therapy.The development of this guideline was supported by an unrestricted grant from Mundipharma who did not participate in the development or writing of the guideline. Dr M Raff has received honoraria for consultancies and non-restricted research grants from Mundipharma, Pfizer, Janssen Pharmaceutica, AstraZeneca, MSD, Eli Lilly, Aspen and Abbott Laboratories. Drs J Crosier and S Eppel have received honoraria from Mundipharma. Prof. H Meyer has received honoraria for consultancies and non-restricted research grants from Janssen Pharmaceutica, Eli Lilly, MSD and Mundipharma. Dr B Sarembock has received honoraria for consultancies and non-restricted research grants from MSD, AstraZeneca, Pfizer and Mundipharma. Dr D Webb has received professional fees for services to Abbott Laboratories, Adcock Ingram, Alcon Laboratories, AstraZeneca, Eli Lilly, Janssen Pharmaceutica, Mundipharma, Novartis, and Reckitt Beckiser Pharmaceuticals.http://www.samj.org.zaam201

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

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 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.www.safpj.co.zaam201

Hydrotherapy and its effects on chronic pain intensity, physical functionality and quality of life in the elderly

Chronic pain is often associated with impaired muscle strength and limited physical activity and performance, resulting in impaired physical functioning. This study aimed to determine whether voluntary participation in a structured 6-week hydrotherapy exercise programme would improve pain management, functionality and quality of life in an elderly population (n = 22; 77.7 ± 6.6 y)suffering from chronic pain and living in nursing homes in Tshwane. The experimental group (n= 13) attended hydrotherapy classes twice a week for six weeks, while the control group (n = 9)did not. Questionnaires were completed (Chronic Pain Grade, Functional Status Index, and the SF 36), and functional testing performed, in both groups at weeks 0, 3 and 6. The experimental group reported reduced pain intensity at week 3 (p = 0.051); reduced pain-induced disability at week 6 (p = 0.080); reduced assisted help required for activities of daily living (ADL) at week 3 (p = 0.040); reduced difficulty on performing ADL at week 3 (p = 0.012) and reduced pain experienced with ADL at week 3 (p = 0.007) and week 6 (p = 0.014). Improvements in upper body strength and agility were demonstrated. Improvements in sub-scales for quality of life were demonstrated at weeks 3 and 6. The control group showed no statistically significant changes in the above parameters. In conclusion, participation in structured hydrotherapy classes has been shown in this small study to be a beneficial intervention strategy for managing chronic pain in the elderly.http://www.ajol.info/journal_index.php?jid=153&ab=ajpherd2017-12-31am201

The impact of chronic pain on the quality of life of patients attending primary healthcare clinics

OBJECTIVES: The objective was to study the nature and magnitude of the impact of pain on the quality of life of patients with chronic pain. DESIGN: This was a descriptive, cross-sectional quantitative study. SETTING AND SUBJECTS: One thousand and sixty-six adult patients were screened between October and December 2010 in four primary healthcare clinics in south-west Tshwane. OUTCOME MEASURES: Patients reporting persistent pain for six months or longer were considered to be chronic pain patients (437, 41%), and were interviewed with regard to the impact of chronic pain on their quality of life using the Wisconsin Brief Pain Questionnaire. RESULTS: Four hundred and nineteen patients (95.9%, 95% confidence interval (CI): 93.6-97.6) of chronic pain patients reported that chronic pain impacted on their quality of life and functioning. Sixty-eight per cent of patients (95% CI: 63.3- 72.4) reported being severely adversely affected by chronic pain. Pain had a severe impact on sleep quality in 39.2% patients, walking ability (37.4%), routine housework (33.8%), mood (20.1%), interpersonal relationships (15.3%) and enjoyment of life (16.3%). The more intense the experience of severe pain was, the greater the impact of chronic pain on everyday life (p-value < 0.001). Equally, patients with better pain relief enjoyed a better quality of life (p-value < 0.001). CONCLUSION: A substantial proportion of patients attending primary healthcare clinics experience chronic pain which impacts on their lives in multiple and significant ways.http://www.sajaa.co.za/index.php/sajaaam201

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.http://www.safpj.co.za/index.php/safpjhttp://www.tandfonline.com/oemdam2017Family Medicin

Neuropathic pain - current concepts

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 patient’s history and findings on clinical examination, such as hyperalgesia and other sensory findings in an area correlating with the patient’s 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

Pain management in primary care - current concepts

René Descartes (1596-1650) may be considered the first scientist in pain physiology. In his famous book De Homine (published posthumously in 1662) he described the transmission of pain signals via the nerves and spinal cord, terminating in the brain ventricles and “pineal organ”. The pain processing (nociception) system was conceptualised as a “hard-wired” pain pathway which reproduces a pain sensation in direct proportion to the extent and severity of the painful (noxious) insult – this outdated concept has been reinforced over years (and even today!) by many text books and healthcare professionals

Fibromyalgia syndrome : current concepts

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