Talk:Intractable pain

Concerning this article

I "prod"ed this article, and the deletion template was removed with a justification that I don't believe is correct. This article is not adequately sourced (per WP:MEDRS), and I believe that much of what it says is incorrect. To my understanding, the term "intractable pain" is simply used to mean pain that cannot be alleviated by treatment. I am going to ask for an opinion from user:Anthonyhcole, who has been the primary maintainer of our pain-related articles. Looie496 (talk) 02:47, 3 January 2014 (UTC)

I have no expertise in pain (I've done a little reading in limited areas of the topic) but I have a high level of expertise in Wikipedia content policy, and will look at this article from that perspective:

Critique

Intractable Pain, also known as Intractable Pain Disease or IP, is a severe, constant pain that is not curable by any known means and which causes a bed or house-bound state and early death if not adequately treated, usually with opioids and/or interventional procedures. It is not relieved by ordinary medical, surgical, nursing, or pharmaceutical measures.

The cited source — http://medical-dictionary.thefreedictionary.com/_/dict.aspx?rd=1&word=intractable+pain — says "pain that is not relieved by ordinary medical, surgical, and nursing measures. The pain is often chronic and persistent and can be psychogenic in nature." So the Wikipedia text does not reflect the source. Also, this is not a suitable source for a Wikipedia medical article per Wikipedia:Identifying reliable sources (medicine) (WP:MEDRS).

Unlike the more common chronic pain, it causes adverse biologic affects on the body's cardiovascular, hormone, and neurologic systems. Patients experience changes in testosterone, estrogen, cortisol, thyroid hormones, and/or pituitary hormones. Both men and women require testosterone, however many doctors neglect to test women for low testosterone. Untreated Intractable Pain can cause death.

The cited source —http://intractablepaindisease.com/ — does not conform to WP:MEDRS.

Although Intractable Pain is not curable, there are treatments. The aim of IP treatment is to appreciate the pain caused by the root condition in order to minimize or reverse the neurological, endocrine, and cardiac changes. The specific treatments depend on the cause of the pain, the physician's preference, and the patient's health and preferences. These treatments van be used on their own, but are commonly combined with one another. Not every patient will respond to every treatment, but some more common treatments include: *Surgical repair, such as spinal fusion for scoliosis *Opioid medications *TENS Unit *SCS (Spinal Cord Simulator)- SCS utilize the gate control theory to block painful signals by sending benign electrical signals along the nerve roots. SCS work similar. *Intrathecal Pain Pump- delivers a very small amount of the chosen medication directly to the thecal space (next to the spinal cord, even closer than am epidural)* Epidural, nerve root, and/or trigger point corticosteroid injections. *mu-Opioids- Depending on the specific drug, opioids can be oral, transdermal, IV, intramuscular, subcutaneous, transmucosal, sublingual, intranasal, epidural, or intrathecal. Examples include morphine, hydromorphone, oxymorphone, hydrocodone, oxycodone, codeine, buprenorphine. *methadone- methadone is a mu-opioid, kappa-opioid, and NMDA receptor antagonist. It is especially useful for neuropathic pain, however it is also useful for other types of pain, such as bone pain, and musculoskeletal pain.

The cited source — http://TameThePain.com — does not conform to WP:MEDRS.

Some medications can be used to potentiate the primary treatment, this is most commonly done to boost the efficacy of opioids and minimize the dose of the opioid needed to alleviate the pain. Some of these treatments are also used on their own, examples include: *Muscle Relaxants *Stimulants *Mood Stabilizers (anti-epileptics and antipsychotics), such as gabapentin/Neurontin/Gralise/Horizant, Lyrica/pregabalin, Topamax/topiramate, quetiapine/Seroquel, risperidone/Risperdal, aripiprazole/Abilify, paliperidone/Invega, iloperidone/Fanapt, ziprasidone/Geodon, lamotrigine/Lamictal, Depakene/Stavzor/valproic acid, or Depakote/divalproex acid *SSRI antidepressants, such as fluoxetine/Prozac/Sarafem, fluvoxamine/Luvox, paroxetine/Paxil, sertraline/Zoloft, citalopram/Celexa, or escitalopram/Lexapro *SSNRI antidepressants, such as duloxetine/Cymbalta, venlafaxine/Effexor, desvenlafaxine/Pristiq, or milnacipran/Savella *NSAIDs- Ibuprofen/Advil/Motrin, naproxen/Naprosyn/Aleve, celecoxib/Celebrex, diclofenac/Voltaren/Flector, or ketorlac/Toradol *Physical Therapy

The cited source — http://www.pain-topics.org/pdf/IntractablePainSurvival.pdf — does not conform to WP:MEDRS

There are many painful conditions that can cause intractable pain disease. Not every patient with these conditions will develop intractable pain, but the following conditions ate known to cause Intractable Pain in some patients: *Failed Back Syndrome *Scoliosis, Kyphosis, kyphoscoliosis *Degenerative Disk Disease *Rheumatoid arthritis *CPS (Central Pain Syndrome)

This text cites no source.

Although not recognized during their lifetimes, John F Kennedy and Howard Hughes are both believe to have suffered from Intractable Pain.

The cited sources — http://www.foresttennant.com/pdfs/905-Feature-JFK-Tennant.pdf and http://pain-topics.org/pdf/HowardHughesPseudoaddict.pdf — do not conform to WP:MEDRS.

Comments

If the authors consider rewriting the article, they should first read and understand WP:MEDRS. Our medical content is - or should be - based on recent scholarly reviews written by independent authors published in high impact journals with a reputation for rigorous peer review; professional or scholarly societies' position statements or similar; or graduate-level textbooks published by a prestigious publisher.

I am concerned that some of the ideas contained in this article are not yet mainstream. If this is the case, the authors should also familiarise themselves with our guideline WP:FRINGE which, in a nut shell, states, "To maintain a neutral point of view, an idea that is not broadly supported by scholarship in its field must not be given undue weight in an article about a mainstream idea. More extensive treatment should be reserved for an article about the idea, which must meet the test of notability. Additionally, when the subject of an article is the minority viewpoint itself, the proper contextual relationship between minority and majority viewpoints must be clear."

On the basis of the poor sourcing this article should be deleted immediately. --Anthonyhcole (talk · contribs · email) 13:08, 3 January 2014 (UTC)

Thanks for your detailed comments. I don't think it is necessary to delete the article, since the topic is legitimate, but I would favor redirecting to pain or chronic pain until some properly sourced content can be written. That's what I tried to do yesterday, but my action was reverted. Looie496 (talk) 17:30, 3 January 2014 (UTC)