Journal of Back and Musculoskeletal Rehabilitation - Volume 9, issue 3
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Journal of Back and Musculoskeletal Rehabilitation is a journal whose main focus is to present relevant information about the interdisciplinary approach to musculoskeletal rehabilitation for clinicians who treat patients with back and musculoskeletal pain complaints. It will provide readers with both 1) a general fund of knowledge on the assessment and management of specific problems and 2) new information considered to be state-of-the-art in the field. The intended audience is multidisciplinary as well as multi-specialty.
In each issue clinicians can find information which they can use in their patient setting the very next day. Manuscripts are provided from a range of health care providers including those in physical medicine, orthopedic surgery, rheumatology, neurosurgery, physical therapy, radiology, osteopathy, chiropractic and nursing on topics ranging from chronic pain to sports medicine. Diagnostic decision trees and treatment algorithms are encouraged in each manuscript. Controversial topics are discussed in commentaries and rebuttals. Associated areas such as medical-legal, worker's compensation and practice guidelines are included.
The journal publishes original research papers, review articles, programme descriptions and cast studies. Letters to the editors, commentaries, and editorials are also welcomed. Manuscripts are peer reviewed. Constructive critiques are given to each author. Suggestions for thematic issues and proposed manuscripts are welcomed.
Abstract: Pain due to terminal illness such as AIDS and cancer-related pain should be managed according to the guidelines set forth by the World Health Organization. These guidelines suggest a pharmacologic tailoring approach to the level and intensity of the patient's pain. These guidelines obey the KISS principal (keep it simple) suggesting the use of less potent analgesic agents before utilizing more potent agents. Likewise, the treatment of non-malignant pain should be based on the same KISS principal utilizing least costly and least invasive therapies either in series or in parallel until the patient's pain is well managed. Interventional strategies and…certainly implantable technologies for pain control have a place as ‘tools’ for the management of cancer, AIDS, and non-malignant-related pain syndromes. Since these therapies are costly and invasive, they should be used only after the failure of more conservative, less invasive and less costly therapies. This paper outlines a rational place for the use of implantable modalities for the treatment of cancer, AIDS and non-malignant pain.
Abstract: Many patients with pain also suffer from depression. The exact relationship between these two problems is unclear but it appears that, in many patients, the depression may not simply be secondary to the pain. When these problems coexist, successful management requires the proper assessment and treatment of both. This paper discusses depressive disorders associated with pain and their treatment, with special focus on medication management.
Abstract: Neuropathic pain is common and may be resistant to usual doses of analgesic medications. However, an improved understanding of the pathophysiology of neuropathic pain and a growing number of adjuvant medications that are useful for the treatment of neuropathic pain provide renewed hope for clinicians and their patients. It is useful to classify adjuvant analgesic drugs into two broad categories. Membrane stabilizing agents, which include the anticonvulsants, antiarrhythmics and probably corticosteroids, may act by blocking sodium channels on damaged neural membranes. Medications that enhance dorsal horn inhibition, which include the antidepressants and some anticonvulsants, may augment biogenic amine or GABAergic…mechanisms in the dorsal horn of the spinal cord. Current evidence regarding efficacy generally does not support the use of one agent over another and selection of a particular agent may depend in part on the expected side effects or experience with a given drug. For maximum analgesic effect, more than one agent may be necessary and to improve therapy and minimize side effects, medications generally should be started at lower doses and titrated slowly to effect. Although labor-intensive, this strategy may improve compliance and optimize patient care.