October 2011

Lonnie Zeltzer, MD, director of the Pediatric Pain Program at Mattel Children's Hospital at UCLA, and Professor of Pediatrics, Anesthesiology, Psychiatry and Biobehavioral Sciences at the David Geffen School of Medicine at UCLA, discusses barriers to effective pain care in children, explains why primary care physicians and family physicians need additional training in pediatric pain care, and talks about why applying the biopsychosocial model of care equips clinicians to deal with the complexities of pain.

In addition to offering sessions that covered more traditional topics in pain management, including presentations on the evaluation and treatment of back pain, assessing sleep disturbance in fibromyalgia, and identifying changes in the neuromuscular system in osteoarthritis, this year's ACR/ARHP Annual Meeting also offered several additional sessions that addressed more off-the-beaten-path topics.

A look at back pain statistics, including the lifetime prevalence of low back, the rank of back pain among the causes of disability in US adults, the estimated number of work days lost annually to "lumbar injuries", and other numbers and figures.

Clinicians who treat patients with postherpetic neuralgia (PHN) can select from a wide range of agents that have been shown to have some clinical efficacy, including topical analgesics such as the lidocaine patch.

Low back pain is one of the most frequently reported reasons for why patients visit their doctor, with lifetime prevalence as high as 60-80%. However, despite the availability of a wide range of treatment modalities and several published guidelines, outcomes for patients with low back pain are often unsatisfactory.

Studies have shown that primary care physicians as a group need more training and education to better prepare them to accurately diagnose and treat migraine, which remains one of the most misunderstood forms of headache, despite its heavy burden on patients in the US.

Although several large trials have shown limited or negligible efficacy for glucosamine and chondroitin in the management of pain associated with osteoarthritis of the hip and knee, other smaller trials have demonstrated some potential benefits. This conflicting evidence, in conjunction with recommendations by several organizations supporting the use of these supplements, has contributed to their widespread use and popularity among patients.

Several recent studies have looked at whether opioid medications are an effective option for treating chronic pain associated with fibromyalgia. Although chronic opioid therapy (COT) can be effective for many forms of chronic noncancer pain, there is little evidence that supports its use in the treatment of fibromyalgia.

Despite pain being one of the symptoms most frequently reported by patients with cancer, studies show that cancer pain remains undertreated in the US, despite efforts to raise awareness of the widespread prevalence of pain in cancer patients, and of the need to prioritize effective assessment and treatment.