Chronic pain as a symptom or a disease the IASP Classification of Chronic Pain for the International Classification of Diseases

Abstract


Chronic pain is a major source of suffering. It interferes with daily functioning and often is accompanied by distress. Yet, in the International Classification of Diseases, chronic pain diagnoses are not represented systematically. The lack of appropriate codes renders accurate epidemiological investigations difficult and impedes health policy decisions regarding chronic pain such as adequate financing of access to multimodal pain management. In cooperation with the WHO, an IASP Working Group has developed a classification system that is applicable in a wide range of contexts, including pain medicine, primary care, and low-resource environments. Chronic pain is defined as pain that persists or recurs for more than 3 months. In chronic pain syndromes, pain can be the sole or a leading complaint and requires special treatment and care. In conditions such as fibromyalgia or nonspecific low-back pain, chronic pain may be conceived as a disease in its own right; in our proposal, we call this subgroup “chronic primary pain.” In 6 other subgroups, pain is secondary to an underlying disease: chronic cancer-related pain, chronic neuropathic pain, chronic secondary visceral pain, chronic posttraumatic and postsurgical pain, chronic secondary headache and orofacial pain, and chronic secondary musculoskeletal pain. These conditions are summarized as “chronic secondary pain” where pain may at least initially be conceived as a symptom. Implementation of these codes in the upcoming 11th edition of International Classification of Diseaseswill lead to improved classification and diagnostic coding, thereby advancing the recognition of chronic pain as a health condition in its own right.

Treede, Rolf-Detlefa; Rief, Winfriedb; Barke, Antoniab; Aziz, Qasimc; Bennett, Michael I.d; Benoliel, Rafaele; Cohen, Miltonf; Evers, Stefang; Finnerup, Nanna B.h,i; First, Michael B.j; Giamberardino, Maria Adelek; Kaasa, Steinl,m,n; Korwisi, Beatriceb; Kosek, Evao; Lavand'homme, Patriciap; Nicholas, Michaelq; Perrot, Serger; Scholz, Joachims; Schug, Stephant,u; Smith, Blair H.v; Svensson, Peterw,x; Vlaeyen, Johan W.S.y,z,aa; Wang, Shuu-Jiunbb,cc

PAIN: January 2019 - Volume 160 - Issue 1 - p 19–27doi: 10.1097/j.pain.0000000000001384

Pregnancy Research on Osteopathic Manipulation Optimizing Treatment Effects: The PROMOTE Study A Randomized Controlled Trial

Kendi L. HENSEL, DO, PhD, Steve BUCHANAN, DO, FACOOG (Dist), Mayra RODRIGUEZ, MPH, des Anges CRUSER, PhD

Abstract

Objective—To evaluate the efficacy of Osteopathic Manipulative Treatment (OMT) to reduce low back pain and improve functioning during the third trimester in pregnancy and improve selected outcomes of labor and delivery.

Study Design—PROMOTE was a randomized, placebo-controlled trial of 400 women in their third trimester. Women were randomized to usual care only (UCO), usual care plus OMT (OMT), or usual care plus placebo ultrasound treatment (PUT). The study included seven treatments over nine weeks. The OMT protocol included specific techniques administered by board-certified OMT specialists. Outcomes were assessed using self-report measures for pain and back-related functioning, and medical records for delivery outcomes.

Results—There were 136 women in the OMT group, 131 in PUT, and 133 in UCO. Characteristics at baseline were similar across groups. Findings indicate significant treatment effects for pain and back related functioning (P<.001 for both), with outcomes for the OMT group. Similar to that of the PUT, but both groups were significantly improved compared to UCO. For secondary outcome of meconium- stained amniotic fluid there were no differences between the groups.

Conclusion—OMT was effective for mitigating pain and functional deterioration compared to the UCO group; however OMT did not differ significantly from PUT. This may be attributed to PUT being a more active treatment than intended. There was no higher likelihood of conversion to high risk status based on treatment group. Therefore, OMT is a safe, effective adjunctive modality to improve pain and functioning during their third trimester.

Published in final edited form as:
Am J Obstet Gynecol. 2015 January ; 212(1): 108.e1–108.e9. doi:10.1016/j.ajog.2014.07.043.

Medo da dor e lesão

A Osteopatia é muito mais do que manipular articulações ou músculos. Na verdade está tudo, ou quase tudo no sistema nervoso central. Afinal tudo em nós está em permanente movimento e comunicação. Só 20% do nosso input/ output é nociceptivo e motor. O resto é proprioceptividade, memória, emoções, intimamente ligados ao SN autónomo e glândulas. Cabe ao Osteopata contemporâneo entender esta complexidade de informações aplicando a simplicidade do toque com a intenção de um novo "reset" no paciente cujo sintoma é a "dor".

Aqui fica um link de um trabalho cada vez mais multidisciplinar e transversal às áreas que atuam na dor e movimento.

-Fearing Pain and Injury-

https://www.facebook.com/Aspetar/videos/581839102316175/?t=1

Gleno-umeral (ombro)...

Aula de Biomecânica da cintura escapular.  A conversar com um aluno sobre centros de rotação da articulação gleno-umeral e braços de momento dos músculos da coifa, nos movimentos rotacionais internos/ externos e depressão/ elevação do úmero. 

O meu modelo de doença na pessoa