Dispatches From the Forefront of Pain Control

For some patients with rheumatologic disorders, pain relief is simply not going to happen when you prescribe treatments that attack peripheral damage or inflammation, says Daniel Clauw, MD. In a podcast describing a session on pain research that he chaired at the recent American College of Rheumatology meeting, Dr. Clauw tells about insights from the world's top researchers into pain mechanisms, and how these should lead to more appropriate use of pain medications, fewer side effects, and better relief for patients.

Dr. Clauw is a Professor of Anesthesiology, Medicine (Rheumatology), and Psychiatry at the University of Michigan Health System and director of its Chronic Pain and Fatigue Research Center.

QUESTIONS AND KEY QUOTES:

•   Could you tell us what the main focus of the session was?

•   Can you tell us a little more about what you mean by "modern techniques"?

"There really has been an explosion of knowledge in the pain field in the last 10 to 15 years regarding the genetics of pain [and] how we can use techniques such as ... structural or functional neuroimaging to phenotype pain better."

•    Are there new methods of measuring pain that physicians really should know about and use in daily clinical practice?

"There are patient reported outcomes that can give insights into underlying mechanism or mechanisms of pain that a patient might have."

"Within any chronic pain state ... there will be a subset of individuals that have ... centralized their pain ... so that they have far more pain than one would expect, just based on the degree of damage or inflammation they have in their peripheral tissues... Rheumatologists can think of this in two ways ... "

•    Is there much debate in the field about which of these assessment measures is best?

•    What are the implications for treatment of this new model of pain?

"People with a higher gain setting or volume-control setting with regard to their pain sensitivity are more likely to experience pain regardless of how much ongoing nociceptive input they have."

"Especially if people have centralized their pain, they're less likely to respond to classes of drugs like opioids, they're less likely to respond to injections or surgical procedures, and they may also be less likely to respond to DMARDs, because these are by and large attacking peripheral inflammation [and] damage rather than turning down the volume control."

FOR YOUR REFERENCE:

PainDETECT Scale
Virtual Medical Centre

Wolfe, Frederick. Fibromyalgianess.
Arthritis & Rheumatism 2009;61:715-716
Full text:  http://onlinelibrary.wiley.com/doi/10.1002/ art.24553/pdf

The "fibromyalgianess" Symptom Intensity Scale is reprinted in full at:
Wilke WS, New developments in the diagnosis of fibromyalgia syndrome: Say goodbye to tender points?
Cleveland Clinic Journal of Medicine 2009;76:345-352
Full text:  http://www.ccjm.org/content/76/6/345.full.pdf

American Pain Society
www.ampainsoc.org

International Association for the Study of Pain
www.iasp-pain.org