THERAPIES INVOLVING TOUCH FOR PAIN IN CHILDREN

BRIEF People Pain a public event open to pain sufferers, their families, their caregivers and the general pub- lic. This event features the stories of people living with pain as told in their own words and will put a face to the serious nature of pain. Untreated or undertreated pain is our nation’s leading public health problem and the only way to move forward is to heighten the public’s awareness about the impact pain has on those who suffer, their families and our health care leaders. The presentation covers three basic areas that pain sufferers experience on their journey through pain. As Thomas Jefferson said, “The art of life is the art of avoiding pain; and he is the best pilot, who steers clearest of the rocks and shoals with which it is beset.” This leads to the premise of the presentation as follows: This talk describe the clinical presentations and the known pain syndromes. Myofascial is pain of muscular origin that is characterized by a variety of referred pain syndromes. These pain syndromes present as headaches, facial pain, shoulder pain, low back pain, viscerosomatic pain syndromes and nerve entrapment syndromes. Myofascial pain is characterized by a trigger point that is a small region of intense pain on a taut muscular band within the larger muscle. There is a characteristic electromyographic abnormality of high frequency, low amplitude end-plate potential activity called end-plate noise. There is also a biochemical abnormality associated with the active trigger zone that includes a lowered pH to the range of 4-5, elevated CGRP, substance P, bradykinin, and elevated cytokines IL1, IL6 and TNF alpha. Treatment of myofascial pain syndromes involves the inactivation of the trigger point. This can be accomplished by manual techniques (trigger point compression and muscle lengthening) and by needling (“dry” needling or injection of local anesthetic). Injection of botulinum toxin can inactivate the trigger point and provide prolonged relief from myofascial pain syndromes. Effective treatment must include the identification and correction or treatment of structural and mechanical predisposing factors, such as forward head posture and hypermobility or joint laxity. Metabolic, hormonal and nutritional predisposing factors like vitamin D deficiency, iron deficiency and hypothyroidism must also be addressed. Treatment can be effective in the acute state as shown in the treatment of acute myogenic (muscle tension) headache, and in the chronic state as demonstrated in the treatment of chronic whiplash syndrome. er knowledge and experience as well as fear that techniques will cause distress in children (Kemper, 2000). However, the few existing studies suggest that manual therapies may be associated with a reduced pain response in infant, child and adolescent populations, and merit further investigation. Pain is the most common disabling sign and system in any system of medicine. There are many modalites, types and sites of pain throughout our lifetime. major concern of all health care practitioners is to relieve the pain while at the same time to treat the underlying cause and conditions. Western medicine many excellent ways of approach to pain management, mainly pharmaceutical products involving narcotics, anti-inflammatory agents and so on. Moreover, Western medicine also provides pain killing injections of drugs through the muscles and veins, sometimes in conjunc- tion with surgical procedures. Sometimes some deleterious side-effects will occur. The ancient and modern traditional Chinese medicine (TCM) approach is a more holistic, naturalistic approach comprising an array of diagnostics and therapeutics encompassing herbology, nutrition/dietetics, acupuncture and related techniques, massage/manipulation as well as various physical, mental and spiritual exercises such as Qi Gong and Tai Chi Chuan. Our integrative approach provides the best of the Western medicine, TCM and other complementary approaches to help heal the pain and enhance the quality of life of our dear patients. BRIEF DESCRIPTION: The talk will discuss the evidence available on botulinium toxin in myofascial pain syndrome and the pharma-economic implications of this therapy. Learning Objectives: 1. Understand contraindications lidocaine. intravenous lidocaine and pre- 3. Understand the barriers to the use of Intravenous local anesthetics have been used for treating chronic pain for over sixty years. There has been a recent upsurge in interest in using intra- venous lidocaine in clinics across Canada. Advantages include excellent pain relief, opioid sparing effect and effectiveness in treating otherwise difficult to treat conditions, such as fibromyalgia and myofascial pain syn- drome. Disadvantages include the need for parenteral administration and the necessity for frequent repeat administrations. This workshop will describe the experience of over 15,000 administrations since 1996 including techniques and monitoring requirements. The results of using a newer technique of 48 h administration via an elastomeric pump will also be described. This technique, currently being examined, may permit long term pain relief and less frequent administration. pared with 3.1 for antidepressants, and 4.2 for anticonvulsants. Opioids are among the most effective treatments for pain. This talk will examine some of the barriers that prevent effective treatment of CDH with opioids. In 25 min or less, I will discuss ways we may improve outcomes using opioids in CDH. individuals and clinical signs and symptoms. 2. Understand the prevalence of internal derangement in adolescent orthodontic population. A sample of 194 male and female adolescents were imaged, making use of magnetic resonance imaging for the temporomandibular joints. MRI determined internal derangement was categorized and the prevalence of internal derangement was determined. Clinical signs and symptoms were recorded to determine whether these clinical factors could aid in predict- ing the status of jaw joint function. Learning Objectives: in human thalamus microneurography, with in Learning Objectives: cytokines neuropathic pain. inhibi- tion could lead to the development of new analgesic tools in hurting humans. The development and testing of new analgesia targets from animal models requires an understanding of the mechanistic processes involved in the pain syndrome being modelled. Are these mechanisms faithfully conserved across different species? This talk will explore the how valid animal and human models for various pain conditions are essential to the develop- ment of new analgesic drugs by the pharmaceutical industry. Learning Objectives: 1. Participants will gain a better understanding of the rationale for developing animal models. 2. Participants will learn about how three different animal models of chronic pain have been studied to learn more about the human condition. Several animal models of chronic pain have brought us closer to understanding basic mechanisms of the respective types of pain, and this has in turn facilitated the development of therapeutic interventions to treat these pains. Yet, despite our optimism in terms of the impact of animal modelling for chronic pain, a sad fact is that there has not been a new class of drugs that has come on the market for chronic pain during the past two decades. This may be for a number of different reasons, but two issues will be discussed in this presentation. One issue is the relevance of animal testing to predicting effectiveness of a new chemical entity to the human questions will be raised concerning some widely used nociceptive tests and whether they relate to chronic pain in humans. The second is the types of chronic pain where animal modelling has not achieved. Some types of chronic pain will described as a start- ing point for discussion on the specific parameters that need to be included in a particular model. There will also be a call to the medical community to define what it is they want modelled, as in many cases the criticism that a model does not relate to the human condition can be countered by the challenge to come up with a uniform human condition to model. Learning Objectives: 1. Participants will gain an understanding of the multidimensional aspects of pain assessment in children and adults with arthritis. 2. Participants will learn about traditional and more innovative approaches to assessing pain in patients with arthritis. It is well recognized that pain is an inherently subjective and a multidimensional phenomenon. Dimensions of the pain experience include: sen- sory (pain intensity, location, quality), affective (pain unpleasantness) and cognitive aspects (pain’s interference with everyday life). Although these dimensions of pain have long been explicitly acknowledged, everyday clinical practice and research on pain have placed greater emphasis on the sen- sory (pain intensity) than on the affective or cognitive dimensions. This presentation will provide an overview of traditional and some more inno- vative approaches (real-time data capture using electronic pain diaries) to assess the multidimensional aspects of pain in children and adults with arthritis. Finally, selected methodological issues associated with these measurement approaches will be discussed. Alberta Learning Objectives: Understand research that supports best in of chronic methods. often psychological treatment of chronic There is a growing body of research that has explored effective psychological treatments for individuals with chronic pain. This session will review what has been learned from these studies. A practical framework based on this research will be presented for a cognitive-behavioural pain management program that can be used in individual and group settings. Practical suggestions will also be provided for primary care providers including family physicians and other health care professionals. BRIEF DESCRIPTION: This presentation will fo