Talk:Pain management

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2005 comment

Given that the management of pain is a separate discipline, with a variety of disparate opinions, would it not make sense for "pain management" to be a separate article?

Certainly! JFW | T@lk 01:48, 5 Jun 2005 (UTC)

So done. Please contribute. Polacrilex

From local anesthesia

Text removed from local anesthesia which IMO might be better placed here, please review. Kosebamse 08:44, 25 February 2006 (UTC)

Generally, a certain risk of local tissue damage is involved when using local anesthetics often and regularly during a longer period at a specific location of your body. For example, the chronic use of topical eye anesthetics in chronic eye pain would almost certainly and relatively quickly lead to serious eye damage (corneal damage). Before using local anesthetics, chronic local pain should not only carefully be assessed with medical specialists for the local problem (for example an ophtalmologist, dermatologist, dentist or a neurologist/specialist for peripheral nerve blocks), but also by specialists for centrally active pain medication.

• Medical specialists (ophtalmologists, dermatologists, dentists or neurologists for peripheral nerve blocks) for the local problem can assess how big the risk of chronically using local anesthetics at that particular location is.
• In most cases of chronic pain, it is not the peripheral nervous system but the central nervous system that is not able to cope with the pain impulses coming from the location in the peripheral nervous system where the damage that causes the pain is actually located. Therefore, medical specialists for the central nervous system (usually a neurologist or pain specialist) can assess if and what kind of centrally acting medication can or should be taken. Very often, it is less harmful and risky to use centrally active substances (especially when they are only taken in low doses) against chronic pain in the peripheral nerve system than chronically using local anesthetics at a particular location of the body. Relatively risk free, especially when taken in small doses, and at the same time often effective against chronic peripheral pain are antidepressants of the SSRI class and the stronger tricyclic antidepressants like for example amitriptyline. Furthermore, modern anticonvulsants like pregabalin or gabapentin are relatively risk free and at the same time relatively effective against chronic pain, at least when taken in very low or low doses. One of the strongest and more risky options in the reduction of peripheral pain are anticonvulsants like carbamazepine. On the other hand, some other classes of centrally acting substances like for example opioids (they are unfortunately still often used in the treatment of chronic pain, including local pain in the peripheral nerve system) are extremely harmful and should be avoided in the treatment of chronic pain at all costs.

End of moved text.

I tend to think the above is much better suited to this section than Local Anesthesia, where it was before. I still have problems with the last sentence of it however! What medical basis is there for On the other hand, some other classes of centrally acting substances like for example opioids (they are unfortunately still often used in the treatment of chronic pain, including local pain in the peripheral nerve system) are extremely harmful and should be avoided in the treatment of chronic pain at all costs, when proper use of opioids have virtually no adverse affects other than dependence and tolerance? Yes, abuse leads to addiction, and abuse includes use with alcohol and other drugs, but that is not the topic of this article - see Drug Addiction for that.

IMHO the entire 'all fruit of the poppy is evil and should be discouraged' stance is politics, and not medicine, and has no place in Wikipedia outside of articles on The War on Drugs.

To make things even clearer, I've been taking opioids for Chronic Pain for over 10 years now. I have to take some care to avoid constipation (so I eat fruit and get exercise), and I don't drink alcohol. In this time I've had no medical conditions develop as a result of my daily intake of pain killers. Nor have I taken to crime and thuggery to get more, as I take the dose recomended by a Pain Specialist, and no more. Yes, I take a higher dose of a stronger drug now than I did 10 years ago. I also still have a marriage and a family, and I haven't been tempted to take drastic action to stop my pain (i.e. suicide) since I've been taking opioids. Rther than just huddling on my bed whimpering I can now be involved in life and my family. None of my Doctors (my GP and my Pain Specialist, my Neurologist and my Orthopaedic Surgeon) have mentioned any adverse effects or risks due to use of opioids other than constipation and dependence if I stay within their guidelines. So what are these extremely harmful effects?

Ignorance by people who believe all the negative misinformation over the years. Opioids certainly have their place, and other alternatives should be tried before relying on them, but for some cases, they can make life bearable as you noted. Even some doctors and nurses are ignorant of recent research that show that tolerance does not equal addiction. MeekMark 22:11, 13 May 2006 (UTC)

BTW, my problem is due to neuralgia of the brachial plexus and supraspinatal nerve, complicated by the legacy of septic arthritis, which is certainly a peripheral nervous system problem. Nothing I've tried over many many years comes even close to the efficacy of opioids for day-to-day management of my pain. Johnpf 07:45, 13 May 2006 (UTC)

Merge Pain medicine into Pain management

The References and External Links are the only things in Pain medicine that are not in Pain management. Therefore, merge the former into the latter. Pan Dan 21:18, 12 September 2006 (UTC)

See also section

I removed two links from the See Also. Re EMFT, I don't think we should list therapies, as that would just be a huge list. Any specific recommendation from WP:MEDRS should go in the body, supported by sources. The other see also was to Coccydynia, which is a medical term for a type of pain. I see a justification for linking Coccydynia to this article, but not the other way around - there are many medical terms for different kinds of pain, and many things that cause pain, and they should not all be listed. Verbal chat 18:15, 7 June 2009 (UTC)

"Wikipedia is not a paper encyclopedia; there is no practical limit to the number of topics it can cover, or the total amount of content, other than verifiability and the other points presented on this page.". The subject matter, EMFT and electrotherapy, discusses the pain management. In particular the ET article as demonstrated in my recent inter-wiki link here to this article "Pain management". When I first looked at it, I too did not see a reason for linking Coccydynia to this article. It after all a type of pain. However, if the (or an) article does have a section on managing the pain from a condition, I see no reason why we can't link to it. It would be appropriate, ie.: "Cancer = morphine." However the link towards the condition is not as obvious as the modality. Hence I agree with Verbal. I'm not going to go out of my way, anyways to make a list of conditions. There are many medical terms for different conditions. ie. Cancer, cuts, etc., which have different kinds of pain. However, per WP:Paper, if someone wants to make a list on the conditions, I'm not going to stop them. I will however ask that after 5 or 10 conditions that we create a content fork. Similarly, for the modalities, ie. EMFT, tylenol, etc., I think we should a different list. Hence:

== See also ==

===Modalities===

====Medication====

====Devices====

====Other====

===Conditions===

This is my suggestion for implementing the see also. --CyclePat (talk) 18:34, 7 June 2009 (UTC)

I disagree, and not paper is not a good argument. The see also section should only contain links that would appear in a comprehensive article on the subject, and these wouldn't. Links shouldn't go both ways. Verbal chat 18:39, 7 June 2009 (UTC)

There's no real arguing here regarding conditions. I agree with your suggestion and would prefer not to see the conditions listed here in "Pain management". However, if a condition exists which is notable, ie Cancer#Symptom_control, then this article, "Pain management", should talk about it. However, this might be overburdening (considering the amount of medical conditions that exist). Also, if an article is already well referenced why should we repeat everything in here at "Pain management"? It seems out of place to go into such details here at "Pain management". Hence, a "see also" section feels a bit more relevant and less controversial. In fact, in your first comment you specifically indicated "Any specific recommendation from WP:MEDRS should go in the body." I agree. I also agree with Wp:See also which states

"A reasonable number of relevant links that would be in the body of a hypothetical "perfect article" are suitable to add to the "See also" appendix of a less developed one. Links already included in the body of the text are generally not repeated in "See also"; however, whether a link belongs in the "See also" section is ultimately a matter of editorial judgment and common sense. A "perfect" article then might not require a "See also" section at all, though some links may not naturally fit into the body of text and others may not be included due to size constraints. Links that would be included if the article were not kept relatively short for other reasons may thus be appropriate, though should be used in moderation, as always. These may be useful for readers looking to read as much about a topic as possible, including subjects only peripherally related to the one in question."

But sometimes, That point is conceded. However, I still strongly believe we can and, if someone wants to they could should add it. In fact, despite our personal preference, we should add it. Please feel free to take out the condition, but also please note my logic which dissents upon our "personal preference". As for EMFT that is a modality and should remain. --CyclePat (talk) 18:59, 7 June 2009 (UTC)

Nul edit proposal

Proposal: Add content regarding electrotherapy. See page 100 here. --CyclePat (talk) 20:41, 8 June 2009 (UTC)

Oppose for the reason given above. We're not going to link to every pain killer, therapy, etc, from this and every other article involving pain. I think you should take your proposal to the medicine wikiproject to get their opinion of it (please drop a note here). Also, please don't make null edits to draw attention here - people can watchlist talkpages. Thanks, Verbal chat 20:51, 8 June 2009 (UTC)

New Intro'

In light of the following I have changed the introductory sentence. I'm no expert, so please improve (with references) if possible.

Chronic pain management: the essentials By Paul A. J. Hardy. "Pain management " is concerned with the reduction of suffering and enhanced quality of life rather than a reduction in the pain complaint. Pain management is central to the treatment of chronic, that is long duration, pain. P. 10.

Approaches to pain management: an essential guide for clinical leaders By Joint Commission Resources. The goal of pain management is to relieve the physical and psychosocial symptoms associated with pain while maintaining the patient's level of function. Pain is intimately linked to overall quality of life. P. 129.

Pain management: an interdisciplinary approach By Chris J. Main, Chris C. Spanswick. Pain management is a growing area of interest for many health care professionals. It is a truly interdisciplinary concept, involving a team comprising medical practitioners, clinical psychologists, physiotherapists, occupational therapists, and nurse practitioners. (Back page)

Anthony (talk) 10:28, 16 November 2009 (UTC)

Temporary free access to IASP journal Pain

I just saw this. "For a limited time, this title is open to the public in a free trial period." Anthony (talk) 02:17, 7 May 2010 (UTC)

Low level laser therapy (LLLT)

I have amended the expression in this contribution but have not read the cited sources. Anthony (talk) 14:25, 8 September 2010 (UTC)

What's needed

• Gene therapy isn't mentioned in the article, but according to this there's at least one clinical trial that shows some promise. I leave it to the regular editors of this article to decide if it should be mentioned or if it's too early.Sjö (talk) 11:26, 12 April 2011 (UTC)
• An explanation of the WHO analgesic ladder would be useful. --Anthonyhcole (talk) 03:39, 7 August 2011 (UTC)

Caffiene

The article doesn't mention caffeine. See "Caffeine as an analgesic adjuvant for acute pain in adults" Vernon White ^{. . . Talk} 07:26, 13 April 2012 (UTC)

Every possible drug solution is far outside of the scope of this article. Just as every technological solution is as well. We'd end up with an article that would be as long as a book!Wzrd1 (talk) 00:48, 15 August 2012 (UTC)

Under-treatment: this whole section, including the title could be less biased (see talk)

(moved discussion to Talk:Undertreatment of pain Blue Rasberry (talk) 14:57, 29 July 2016 (UTC))

Interventional Pain Management

I would appreciate some input about the possibility of expanding this article to include some of the latest breakthroughs in interventional pain management. Atsme☯ talk 00:16, 7 April 2014 (UTC)

Please just go ahead and do what you will. This article contains a brief summary of interventions, per Wikipedia:Summary style. If you intend adding more detail about a topic already covered, it may be more appropriate to add it to the main article, Interventional pain management. But just do what you think is appropriate and I'm sure others will chime in with suggestions if they think they're warranted. --Anthonyhcole (talk · contribs · email) 09:08, 7 April 2014 (UTC)

Forked content about treatment

There is a list of many treatments in this article. I do not think it would be worthwhile to develop the text of those treatments here, when already, those treatments are better described in their own articles. Much of the content here is original writing a a duplicated effort with those other articles.

Ideally, content in the subsections here could be brief and direct readers to the fuller other article. Personally, I like to take information out of the leads of the main article when I am making subsections. I was looking through what is here - I am not even sure that all pain management strategies are well covered. If a single authoritative source gave an overview of the treatments, then it might be useful to list them and cite that source. The list would be useful to a reader, and also provide an internal check that everything is covered. Blue Rasberry (talk) 16:25, 26 May 2016 (UTC)

Moved section on undertreatment to own article

I moved all the content here that was in the "undertreatment" section to undertreatment of pain. See more information at Talk:Undertreatment of pain. Blue Rasberry (talk) 14:17, 29 July 2016 (UTC)

spam for my employer - added external link

There was no external links section here. I created one with a link to a publication by my employer.

• Pain Management Guide

Here are some pros and cons for this source -

pros

• layman language and patient perspective
• relevant content
• produced in partnership with medical specialty organizations
• nonprofit
• no ads, except for the publication itself
• all free to read

cons

• I work for this org, see WP:COI
• there are ads to subscribe to the publication in some places
• content is United States-centric

If any of this gives anyone pause, please remove the link immediately. Blue Rasberry (talk) 21:03, 29 July 2016 (UTC)

I removed the link per comment at Talk:Analgesic#Spam_for_my_employer. Here it is again.

• Pain Management Guide

This is now a request for any reviewer to consider adding this to the external links section of this article and the article Analgesic, if it is relevant. I would not have expected anyone to say, "lots of ads" The publication advertises itself. This link has no ads to any other product or organization than itself, and there is no commercial sponsorship in this publication.

Here are some other potential external links which I think have the similar intent of being consumer health guides. Any of these might be shared also or instead of the one I proposed.

• Pain Management Health Center from WebMD
• Resource Guide to Chronic Pain Treatment from the American Chronic Pain Association
• Treatment Guidelines on Pain from the WHO
• PAINedu.org Pocket Manual from the Inflexxion Health Series
• NINDS Chronic Pain Information Page from the NIH

I did some searches and at first look, these all seem to be popular recommendations by search engines. What does anyone think of these? Blue Rasberry (talk) 16:39, 1 August 2016 (UTC)

This article is labeled start-level and high-importance. (I think it could use a review, since at a glance it looks C-level.) As such, I'd expect some external links covering areas not yet addressed in this article or perhaps having alternative presentations. In the long term, I'm not sure what external links would meet WP:ELNO#1. --Ronz (talk) 02:09, 2 August 2016 (UTC)

By "alternative presentations" I mean different media, less technical, etc. --Ronz (talk) 21:29, 2 August 2016 (UTC)

I added the WHO Treatment Guidelines on Pain because it didn't look like a consumer guide. That is, it discusses the topic of the article, approaches to pain management, rather than "Here's what you can do if you have a headache." Analgesic already has quite a lot of information; I'm not sure the link would add much. BlackcurrantTea (talk) 05:25, 25 February 2017 (UTC)

Merger proposal

I propose that Algology (medicine) be merged into Pain management. I think that the content in the Algology article can easily be explained in the context of pain management, and the Pain management article is of a reasonable size that the merging of Algology will not cause any problems as far as article size or undue weight is concerned. Kwekubo (talk) 17:45, 14 October 2018 (UTC)

• Support. I think it would be an uncontroversial merge.CV9933 (talk) 19:14, 14 October 2018 (UTC)
•  Done Jytdog (talk) 23:06, 1 November 2018 (UTC)

Proposing to delete the sentence : "However, no studies have compared hypnosis to a convincing placebo, so the pain reduction may be due to patient expectation (the "placebo effect")"

Because of this basically where placebos where used in recent RCT: https://www.sciencedirect.com/science/article/abs/pii/S0149763418304913Walidou47 (talk) 12:23, 21 April 2020 (UTC)