Talk:Pain management
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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?
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- So done. Please contribute. Polacrilex
[edit] 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)
[edit] 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)
