Neurologic pain management is now recognized as a subspecialty of neurology. The ideal management of a chronic pain patient is by a multidisciplinary approach, including disciplines such as internal medicine, neurology, anesthesia, nursing, psychology, pharmacy, rehabilitation medicine, physical therapy, etc. Studies of the molecular basis of pain have provided receptors as targets for analgesic drugs. Gene therapy may be used in the near future as a method of delivery of therapeutic proteins with analgesic effect to the site of action and, thus, avoiding some of the undesirable effects of drugs. Viral vectors, expressing proenkephalin can transduce neurons of the dorsal root ganglion, leading to release of enkephalin from nerve terminals in dorsal horn, and produce analgesic effect.
In this clinical summary, Dr. K K Jain focuses on the evaluation of chronic pain as a symptom and includes discussion of the mechanism, differential diagnosis, diagnostic workup, and general management.
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