5 novembre 2022

Legal Definition of Chronic Pain

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Despite the amount of data currently available, which takes into account the pathological nature of pain, there is still no full recognition of pain as a disease. One of the biggest obstacles in this regard is the lack of a definitive etiological description of chronic pain that supports a view of pain as a disease rather than a syndrome; In fact, most chronic pain is defined on the basis of its pathological manifestation. The nosological enterprise is therefore thwarted by the absence of an etiological description to summarize various conditions, characterized mainly by the presence of persistent pain. The pain can be acute, i.e. new, subacute, lasting a few weeks or months, and chronic if it lasts more than 3 months. Treatment of acute and chronic pain in obstetrics includes drug, acupuncture-related, surgical and neural blocking therapy. The types of acute and chronic pain in obstetrics are presented in Table 1. Acute pain in obstetrics usually refers to acute abdominal and visceral pain, as well as pain relief in the peripartum (1, 2, 5). In hospitals, acute pain departments are mainly headed by anesthesiologists interested in algology, and their services are specifically used in obstetric anesthesia due to the specific characteristics of the antepartum, peripartum and postpartum periods, whether it is a pregnancy by spontaneous delivery or surgically assisted. Nowadays, regional anesthesia with epidural analgesia during childbirth is very popular, as well as inhaled nitric oxide, the order of intravenous opioid petantine or remifentanil, acupuncture analgesedation and ordering homeopathic preparations.

In Western countries where midwives perform normal deliveries, i.e. the majority of births (up to 70%-80%), the most common types of acute peripartum analgesia are inhaled nitric oxide and intravenous ordering of opioids, acupuncture and homeopathy. These methods have been used for decades with excellent adherence, safe for both mother and child (1-7). These structural changes can be explained by neuroplasticity. In chronic pain, the somatotopic representation of the body is inappropriately reorganized after peripheral and central sensitization. This can cause allodynia or hyperalgesia. In people with chronic pain, EEGs showed impaired brain activity, suggesting pain-induced neuroplastic changes. Specifically, relative beta activity (relative to the rest of the brain) was increased, relative alpha activity decreased, and theta activity decreased. [29] The 21st century surgical technique, which is classified as a minimally invasive procedure with corresponding analgesia, pain categorization and subsequent loads for pain disorders, should be viewed in this light.

However, current claims still require forensic expertise for postoperative pain. Therefore, forensic experts should consider the clause on ordered treatment in the immediate postoperative period and pain treatment performed (1, 2, 5, 10, 11). Complications of medical treatments for chronic pain may include: Two of the most common personality profiles found in people with chronic pain through the Minnesota Multiphasic Personality Inventory (MMPI) are V conversion and neurotic triad. Conversion personality V expresses exaggerated preoccupation with bodily feelings, develops physical symptoms in response to stress, and often fails to recognize one`s own emotional state, including depression. The neurotic triad personality also expresses exaggerated preoccupation about bodily feelings and develops physical symptoms in response to stress, but is demanding and complains. [93] Various other non-opioid medications may be used depending on whether the pain is due to tissue damage or neuropathic (pain caused by a damaged or dysfunctional nervous system). There is little evidence that cancer pain or chronic pain caused by tissue damage resulting from a condition (e.g., rheumatoid arthritis) is better treated with opioids. For neuropathic pain, other medications may be more effective than opioids,[6][7][40][41] such as tricyclic antidepressants[42], serotonin-norepinephrine reuptake inhibitors,[43] and anticonvulsants. [43] Some atypical antipsychotics, such as olanzapine, may also be effective, but the evidence supporting this is at a very early stage. [44] For women with chronic pain, hormonal medications such as oral contraceptives (« the pill ») may be helpful. [45] If there is no evidence of a single best fit, doctors may need to look for a treatment that works for the person. [42] It is difficult for doctors to predict who will use opioids only to treat pain and who will become addictive.

It`s also difficult for doctors to know which patients are asking about opioids because they are living with opioid addiction. Withholding, withdrawing or withdrawing opioid treatment in people who receive opioid therapy can cause harm. [8] Health care providers treat chronic pain in different ways. The approach depends on many factors, including: Implementing dietary changes, considered biological alternative medicines, has been shown to help improve chronic pain symptoms over time. [61] Adding supplements to the diet is a common dietary change when trying to relieve chronic pain, with some of the most studied supplements being: acetyl-L-carnitine, alpha-lipoic acid, and vitamin E.[61][62][63][64] Vitamin E is perhaps the best studied of the three, with strong evidence that it helps reduce neurotoxicity in cancer patients. Multiple sclerosis and cardiovascular disease. [64] Once the acute pain is gone, you can continue to live as usual. In Canada, it is estimated that about 1 in 5 Canadians have been living with chronic pain and half of these people have been living with chronic pain for 10 years or more.

[89] Chronic pain is also more common in Canada and more pronounced among women and Indigenous communities in Canada. [89] Severe chronic pain is associated with an increased risk of death over a ten-year period, particularly from heart disease and respiratory disease. [91] Several mechanisms have been proposed for this increase, such as an abnormal stress response in the body`s endocrine system. [92] In addition, chronic stress appears to affect heart and lung (cardiovascular) health risks by increasing the rate at which plaque can build up on artery walls (atherosclerosis). However, more research is needed to clarify the link between severe chronic pain, stress, and cardiovascular health. [91] Psychological treatments, including cognitive behavioural therapy[47][48] and acceptance and attachment therapy[49][50] can be helpful in improving quality of life and reducing pain disorders. Short treatment approaches based on mindfulness have been used, but they are not yet recommended as first-line treatment. [51] The effectiveness of mindfulness-based pain management (MBPM) has been proven by a number of studies. [52] [53] [54] Kinesio tape has not been shown to be effective in treating chronic non-specific back pain. [80] Be sure to discuss these four lifestyle pillars with your doctor to determine how each applies to your type of chronic pain and how you can incorporate changes into your daily routine.

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