New Considerations in Chronic Musculoskeletal Pain Management: Psychoneuroendocrine Contributions

Chronic musculoskeletal pain has a lifetime prevalence of up to 80% and is 1 of the primary reasons patients visit health care providers. Classic approaches to chronic pain do little to differentiate it from acute injury-related pain, either in physiology or treatment. The neurology of chronic pain...

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Bibliographic Details
Published inIntegrative medicine (Encinitas, Calif.) Vol. 10; no. 1; p. 25
Main Author Oberg, Erica
Format Journal Article
LanguageEnglish
Published Mendota Heights InnoVision Health Media, Inc 01.02.2011
Subjects
Back pain
Behavior
Brain
Cognition & reasoning
Lifestyles
Neurochemistry
Pain management
Social interaction
Stress
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Summary:Chronic musculoskeletal pain has a lifetime prevalence of up to 80% and is 1 of the primary reasons patients visit health care providers. Classic approaches to chronic pain do little to differentiate it from acute injury-related pain, either in physiology or treatment. The neurology of chronic pain is, in fact, different. It is characterized by central sensitization, changes in the neural pathways involved in nociception in the prefrontal cortex, chronic activation of the hypothalamic-pituitary-adrenal (HPA) axis, and changes in emotional and cognitive patterns. Furthermore, psychosocial and lifestyle factors play a role in predisposing or mediating chronic pain. This review describes these phenomena and presents a novel paradigm by which integrative clinicians might approach chronic pain. If psychoneuroendocrine factors are diagnosed as contributing factors in a patient with chronic pain, treatment approaches should include extensive use of mind-body techniques, cognitive behavioral therapy and other psychotherapy approaches, lifestyle change and health behavior counseling. Although not part of this review, the use of micronutrient and botanical medicines that address HPA dysfunction and affective symptoms may also have an appropriate role. [PUBLICATION ABSTRACT]
ISSN:1546-993X
1945-7081