Talk:Intractable pain

Concerning this article

I "prod"ed this article, and the deletion template was removed with a justification that I don't believe is correct. This article is not adequately sourced (per WP:MEDRS), and I believe that much of what it says is incorrect. To my understanding, the term "intractable pain" is simply used to mean pain that cannot be alleviated by treatment. I am going to ask for an opinion from user:Anthonyhcole, who has been the primary maintainer of our pain-related articles. Looie496 (talk) 02:47, 3 January 2014 (UTC)

I have no expertise in pain (I've done a little reading in limited areas of the topic) but I have a high level of expertise in Wikipedia content policy, and will look at this article from that perspective:

Critique

Intractable Pain, also known as Intractable Pain Disease or IP, is a severe, constant pain that is not curable by any known means and which causes a bed or house-bound state and early death if not adequately treated, usually with opioids and/or interventional procedures. It is not relieved by ordinary medical, surgical, nursing, or pharmaceutical measures.

The cited source — http://medical-dictionary.thefreedictionary.com/_/dict.aspx?rd=1&word=intractable+pain — says "pain that is not relieved by ordinary medical, surgical, and nursing measures. The pain is often chronic and persistent and can be psychogenic in nature." So the Wikipedia text does not reflect the source. Also, this is not a suitable source for a Wikipedia medical article per Wikipedia:Identifying reliable sources (medicine) (WP:MEDRS).

Unlike the more common chronic pain, it causes adverse biologic affects on the body's cardiovascular, hormone, and neurologic systems. Patients experience changes in testosterone, estrogen, cortisol, thyroid hormones, and/or pituitary hormones. Both men and women require testosterone, however many doctors neglect to test women for low testosterone. Untreated Intractable Pain can cause death.

The cited source —http://intractablepaindisease.com/ — does not conform to WP:MEDRS.

Although Intractable Pain is not curable, there are treatments. The aim of IP treatment is to appreciate the pain caused by the root condition in order to minimize or reverse the neurological, endocrine, and cardiac changes. The specific treatments depend on the cause of the pain, the physician's preference, and the patient's health and preferences. These treatments van be used on their own, but are commonly combined with one another. Not every patient will respond to every treatment, but some more common treatments include: *Surgical repair, such as spinal fusion for scoliosis *Opioid medications *TENS Unit *SCS (Spinal Cord Simulator)- SCS utilize the gate control theory to block painful signals by sending benign electrical signals along the nerve roots. SCS work similar. *Intrathecal Pain Pump- delivers a very small amount of the chosen medication directly to the thecal space (next to the spinal cord, even closer than am epidural)* Epidural, nerve root, and/or trigger point corticosteroid injections. *mu-Opioids- Depending on the specific drug, opioids can be oral, transdermal, IV, intramuscular, subcutaneous, transmucosal, sublingual, intranasal, epidural, or intrathecal. Examples include morphine, hydromorphone, oxymorphone, hydrocodone, oxycodone, codeine, buprenorphine. *methadone- methadone is a mu-opioid, kappa-opioid, and NMDA receptor antagonist. It is especially useful for neuropathic pain, however it is also useful for other types of pain, such as bone pain, and musculoskeletal pain.

The cited source — http://TameThePain.com — does not conform to WP:MEDRS.

Some medications can be used to potentiate the primary treatment, this is most commonly done to boost the efficacy of opioids and minimize the dose of the opioid needed to alleviate the pain. Some of these treatments are also used on their own, examples include: *Muscle Relaxants *Stimulants *Mood Stabilizers (anti-epileptics and antipsychotics), such as gabapentin/Neurontin/Gralise/Horizant, Lyrica/pregabalin, Topamax/topiramate, quetiapine/Seroquel, risperidone/Risperdal, aripiprazole/Abilify, paliperidone/Invega, iloperidone/Fanapt, ziprasidone/Geodon, lamotrigine/Lamictal, Depakene/Stavzor/valproic acid, or Depakote/divalproex acid *SSRI antidepressants, such as fluoxetine/Prozac/Sarafem, fluvoxamine/Luvox, paroxetine/Paxil, sertraline/Zoloft, citalopram/Celexa, or escitalopram/Lexapro *SSNRI antidepressants, such as duloxetine/Cymbalta, venlafaxine/Effexor, desvenlafaxine/Pristiq, or milnacipran/Savella *NSAIDs- Ibuprofen/Advil/Motrin, naproxen/Naprosyn/Aleve, celecoxib/Celebrex, diclofenac/Voltaren/Flector, or ketorlac/Toradol *Physical Therapy

The cited source — http://www.pain-topics.org/pdf/IntractablePainSurvival.pdf — does not conform to WP:MEDRS

There are many painful conditions that can cause intractable pain disease. Not every patient with these conditions will develop intractable pain, but the following conditions ate known to cause Intractable Pain in some patients: *Failed Back Syndrome *Scoliosis, Kyphosis, kyphoscoliosis *Degenerative Disk Disease *Rheumatoid arthritis *CPS (Central Pain Syndrome)

This text cites no source.

Although not recognized during their lifetimes, John F Kennedy and Howard Hughes are both believe to have suffered from Intractable Pain.

The cited sources — http://www.foresttennant.com/pdfs/905-Feature-JFK-Tennant.pdf and http://pain-topics.org/pdf/HowardHughesPseudoaddict.pdf — do not conform to WP:MEDRS.

Comments

If the authors consider rewriting the article, they should first read and understand WP:MEDRS. Our medical content is - or should be - based on recent scholarly reviews written by independent authors published in high impact journals with a reputation for rigorous peer review; professional or scholarly societies' position statements or similar; or graduate-level textbooks published by a prestigious publisher.

I am concerned that some of the ideas contained in this article are not yet mainstream. If this is the case, the authors should also familiarise themselves with our guideline WP:FRINGE which, in a nut shell, states, "To maintain a neutral point of view, an idea that is not broadly supported by scholarship in its field must not be given undue weight in an article about a mainstream idea. More extensive treatment should be reserved for an article about the idea, which must meet the test of notability. Additionally, when the subject of an article is the minority viewpoint itself, the proper contextual relationship between minority and majority viewpoints must be clear."

On the basis of the poor sourcing this article should be deleted immediately. --Anthonyhcole (talk · contribs · email) 13:08, 3 January 2014 (UTC)

Thanks for your detailed comments. I don't think it is necessary to delete the article, since the topic is legitimate, but I would favor redirecting to pain or chronic pain until some properly sourced content can be written. That's what I tried to do yesterday, but my action was reverted. Looie496 (talk) 17:30, 3 January 2014 (UTC)

I can't find a suitable target article, so I'm thinking about stubifying this one. I'll list some definitions and other matter here to think with.

Definition

• Chronic pain unrelated to any detectable pathology.[1]
• Cademenos maintains that intractable is something of a medical excuse since it simply refers to forms of pain which cannot be operationally defined or verified.[2]
• Intractable pain has been defined as pain that has been present for over a month and unremitting despite treatment.[3]
• Intractable pain has been defined in controlled substances regulations and generally refers to pain in which the cause cannot be removed or otherwise treated and for which no relief or cure has been found after reasonable efforts.[4]
• Oregon Medical Practice Act: "A pain state in which the cause of the pain cannot be removed or otherwise treated and for which, in the generally accepted course of medical practice, no relief or cure of the cause of the pain has been found after reasonable efforts, including, but not limited to evaluation by the attending physician and one or more physicians specializing in the treatment of the body area, system or organ perceived as source of the intractable pain."[5]
• California Business and Professional Code: A pain state in which "the cause of the pain cannot be removed or otherwise treated and which, in the generally accepted course of medical practice, no relief or cure of the cause of the pain is possible or none has been found after reasonable efforts," including but not limited to evaluation by the attending physician and one or more physicians "specializing in the treatment of the area, system, or organ of the body perceived as the source of the pain."[6]

Intractable pain acts

• In 1989 Texas became the first state to pass an intractable pain act, authorizing physicians to prescribe or administer controlled substances to relieve intractable pain, and several other states followed.[7]
• Iowa and Michigan became the first states, in 2002, to delete the term "intractable pain" from law. More recently, Arizona, California, North Dakota, Oregon, Rhode Island and Texas [removed] the term and definition of "intractable pain"; the resulting laws now govern the treatment of all types of pains.[8]

Nap time. --Anthonyhcole (talk · contribs · email) 08:26, 4 January 2014 (UTC)

This article seems deeply confused, but it should be fixed and expanded. The key thing to recognize here is that intractable pain is apparently a legal concept. That means that you can quote the definition from the law books, and MEDRS does not apply to that definition. The fact that some law books have since removed it is irrelevant - notability is not temporary, and the historical recognition of the importance of treating pain figures into the broader understanding of politics leading to, for example, today's celebrations in Colorado of marijuana legalization. More broadly though, I expect the phenomenon of intractable pain to be a symptom rather than a disease - which is not to say it isn't horrible, nor that there aren't widely effective means to try to deal with it regardless of its true cause, just that it is not something you'd expect to come from just one condition, and so descriptions of the syndrome, the role of testosterone, etc. should be considered carefully in regard to whether that affects every possible way of suffering it or just one particular way. Wnt (talk) 10:23, 5 January 2014 (UTC)

It's not really a legal concept. It gets defined in legal terms because it form a basis for prescribing drugs that would otherwise be prohibited -- that makes it necessary to have a very precise definition. But it is also used in a non-legal way simply to mean severe pain that can't be alleviated. Looie496 (talk) 23:23, 5 January 2014 (UTC)

Intractable pain disease

Tennant has proposed[9] this neologism for a syndrome he describes as

extremely painful conditions, as evidenced by failure of various interventions to control their pain, including surgery, nerve blocks, physical rehabilitation, and weak opioids. Patients describe their pain as constant, debilitating, and potent enough to interfere with sleep and sexual function. Many report suicidal thoughts for the sole purpose of stopping the pain, incessant crying spells, fatigue, depression, social isolation, restriction of mobility, and numerous bed- or couch-bound days.

and

intermittently elevated blood pressure and pulse rate and abnormal concentrations of serum cortisol and other adrenal hormones, indicating the presence of a severe and extended stress state.

but it does not yet appear to have been embraced by the wider scholarly and professional community:

• Google Scholar
• Google Books so I think it would be inappropriate to present it in this encyclopedia article until such time as it has become more mainstream. --Anthonyhcole (talk · contribs · email) 01:50, 5 January 2014 (UTC)

Name changed to Intractable Pain Syndrome

I’m not sure what is supporting the IPD “Disease” name but in 2020 a consensus paper written by Forest Tennant and nearly 20 other health professionals defined the name. "THE INTRACTABLE PAIN SYNDROME: A CALL FOR RECOGNITION AND PREVENTION" [10]. It’s the founding document for Intractable Pain Syndrome Research and Education Project and this paper is the latest version found.

Please take time to read and the name from Forest Tennant’s talks went from Intractable Pain early on to Intractable Pain Syndrome for the last 3 years in his spoken web presentations. Technophant (talk) 20:07, 6 October 2023 (UTC)

The news article that announced the above link is here from Pain News Network. Keep in mind that Dr Tennant is in his 70’s so the pace of his research has slowed and his skill in managing websites is low. He is still doing a weekly webcast and a few weeks ago he mentioned this Wikipedia article while it read Intractable Pain Disease and he acknowledged that this was the name he originally chose and he does regard it as a disease proper and explains why he changed the name to syndrome. I'll sign here and look for the webcast to post here. Technophant (talk) 01:15, 17 January 2024 (UTC)

Lead rewrite

There's currently the line "Both men and women require testosterone, however many doctors neglect to test women for low testosterone." in the lead. I suggest it can be moved elsewhere. Technophant (talk) 09:55, 24 April 2024 (UTC)