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Rehabilitation of Patients in PainDepartment of Neurology, Long Island Jewish Medical Center, New Hyde Park, NY, U.S.A. The rehabilitation of patients in pain requires accurate physical and psychological diagnoses, the establishment of realistic goals, and the selection of therapies appropriate to those diagnoses and goals. The distinction between nociceptive and non-nociceptive syndromes guides the selection of therapeutic interventions. Nonsteroidal anti-inflammatory drugs are characterized by a peripheral site of action, gastrointestinal toxicity, and a ceiling effect. With the use of a loading dose and an appropriate duration of trial, they provide relief for mild to moderate nociceptive pain. The opioid analgesics act centrally, have no ceiling effect, and, if side effects are managed properly, provide relief for moderate to severe pain. Opioids, widely accepted for the treatment of pain due to cancer, also have a role in selected patients with non-cancer pain. Adjuvant medications, particularly the tricyclic antidepressants, are analgesic in certain cases of neuropathic pain and in other chronic pain states. Anesthesiological procedures can be used for regional blockade, sympathetic blockade, or for delivery of drugs more directly to the central nervous system. Physical and psychological techniques are difficult to analyze in a rigorously double-blind fashion, but anecdotal reports and common sense approaches favor their inclusion in an overall pain regimen.
Key Words: Pain • Nociceptive • Opioid • Nonsteroidal • Adjuvant.
Neurorehabilitation and Neural Repair, Vol. 5, No. 3,
153-160 (1991) |
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