Neuropsychiatric Management of Persistent Pain

摘要

Persistent or chronic pain is a major cause of disability and distress all over the world. Chronic pain can affect adults, old people and children in every culture. Relief from persistent pain is a major thrust of research into developing newer modalities of treatments. Pain is not just a sensation. It has a psychological component. Brain and mind mechanisms are equally involved in the experience of pain. An effective management strategy should take a holistic view of the experience of chronic pain and a multidisciplinary approach. The present review summarizes the current state of the science of the neuropsychiatric management of persistent pain. Introduction Pain is the most frequent complaint in medical practice. Intractable and persistent pain is common. Back pain disables a large number of people in every part of the world. Pain disorders are diagnosed twice as commonly in women than in men. The peak ages of presentation are in the 40s and 50s, perhaps because the tolerance to pain declines with age. But more recently, due to changing lifestyles and occupations, pain disorders are becoming more prevalent in the younger populations. Pain used to be most common in persons with blue-collared occupations due to increased likelihood of work-related injuries. But in recent times, with the emergence and boom of the information technology industry, job-related repetitive strain injuries (RSIs), leading to persistent pain syndromes are becoming common in this population. First degree relatives of patients with pain disorder have an increased likelihood of pain disorders. This indicates a possible genetic basis for the behavioral mechanisms of the experience of pain. Depressive disorders, anxiety disorders and substance abuse are more common in the families of pain disorder patients than in the general population. Definition of Pain Pain is an unpleasant sensory and emotional experience associated with actual or potential tissue damage or described in terms of such damage.Pain is not just sensation. It is experienced in our consciousness. It has effects on the mind. Mind can be usefully employed to modify the experience. The Experience of Pain