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I Tried Medical Marijuana For My Chronic Pain
I Tried Medical Marijuana For My Chronic Pain
Published: 2017/06/01
Channel: BuzzFeedBlue
How I Deal with Chronic Pain
How I Deal with Chronic Pain
Published: 2017/10/01
Channel: Simon and Martina
What is Chronic Pain
What is Chronic Pain
Published: 2014/07/19
Channel: Blazin Guns
Elliot Krane: The mystery of chronic pain
Elliot Krane: The mystery of chronic pain
Published: 2011/05/19
Channel: TED
Living with Chronic Pain: My Story + Top  Tips
Living with Chronic Pain: My Story + Top Tips
Published: 2015/12/27
Channel: LittleMissCrista
Living with Chronic Pain | Flare-Up Day Vlog
Living with Chronic Pain | Flare-Up Day Vlog
Published: 2017/01/21
Channel: LittleMissCrista
Things People With Chronic Pain Want You to Learn
Things People With Chronic Pain Want You to Learn
Published: 2016/09/02
Channel: The Mighty
Women Try Crystal Healing For Chronic Pain
Women Try Crystal Healing For Chronic Pain
Published: 2017/10/17
Channel: Boldly
Feed This To Your Brain and Say Goodbye to Chronic Pain -  Dr. Alan Mandell, D.C.
Feed This To Your Brain and Say Goodbye to Chronic Pain - Dr. Alan Mandell, D.C.
Published: 2017/07/25
Channel: motivationaldoc
The Feds Are Sticking It To Chronic Pain Patients
The Feds Are Sticking It To Chronic Pain Patients
Published: 2017/03/08
Channel: Secular Talk
Living with Chronic Pain
Living with Chronic Pain
Published: 2016/05/18
Channel: Nanalew
Why I Can’t Take Narcotics For My Chronic Pain πŸ’Š (8/16/17)
Why I Can’t Take Narcotics For My Chronic Pain πŸ’Š (8/16/17)
Published: 2017/08/17
Channel: Chronically Jaquie
A Good Day Vs. A Bad Day With Chronic Pain
A Good Day Vs. A Bad Day With Chronic Pain
Published: 2017/08/18
Channel: The Mighty
Understanding Pain in less than five minutes
Understanding Pain in less than five minutes
Published: 2014/10/02
Channel: Brainman
Signs You Grew Up With Chronic Pain
Signs You Grew Up With Chronic Pain
Published: 2017/06/21
Channel: The Mighty
Chronic Pain: The Invisible Disease
Chronic Pain: The Invisible Disease
Published: 2015/05/05
Channel: Jackie Hong
My herniated disc and chronic pain
My herniated disc and chronic pain
Published: 2016/05/22
Channel: Claire Simmonds
[CHRONIC PAIN] A day in the life of someone wih chronic pain
[CHRONIC PAIN] A day in the life of someone wih chronic pain
Published: 2016/08/17
Channel: Penny Shipway
Chronic Pain Sufferer Says She Can
Chronic Pain Sufferer Says She Can't Get Pain Medication Amid Opioid Production Cuts
Published: 2016/11/03
Channel: CBS Los Angeles
Chronic Pain - Is it All in Their Head? - Daniel J. Clauw M.D.
Chronic Pain - Is it All in Their Head? - Daniel J. Clauw M.D.
Published: 2013/12/05
Channel: University of Michigan
Lady Gaga Shows What It
Lady Gaga Shows What It's Like to Live With Chronic Pain in New Documentary -- Watch!
Published: 2017/09/19
Channel: Entertainment Tonight
What Chronic Pain Feels Like
What Chronic Pain Feels Like
Published: 2016/11/15
Channel: The Mighty
Chronic Pain - Tame the Beast
Chronic Pain - Tame the Beast
Published: 2017/07/24
Channel: Lukas Escobar - Fisioterapeuta
Depression and Chronic Pain
Depression and Chronic Pain
Published: 2017/03/13
Channel: Kati Morton
Pain Matters- Exploring Chronic Pain in America
Pain Matters- Exploring Chronic Pain in America
Published: 2015/08/20
Channel: tabrezrock007
Living with Chronic Pain and EDS
Living with Chronic Pain and EDS
Published: 2015/02/04
Channel: Simon and Martina
DEALING WITH CHRONIC PAIN | VLOGMAS
DEALING WITH CHRONIC PAIN | VLOGMAS
Published: 2015/12/16
Channel: Channon Rose Vlogs
The Simple Solution to End Chronic Pain
The Simple Solution to End Chronic Pain
Published: 2017/11/02
Channel: Live Sonima
Sleep Without Chronic Pain - Sleep Hypnosis Session - By Thomas Hall
Sleep Without Chronic Pain - Sleep Hypnosis Session - By Thomas Hall
Published: 2016/04/09
Channel: Thomas Hall
Chronic Pain: Shedding the Second Dark Age | Erik Vance | TEDxJacksonHole
Chronic Pain: Shedding the Second Dark Age | Erik Vance | TEDxJacksonHole
Published: 2017/09/26
Channel: TEDx Talks
How to Explain Chronic Pain to ER doctors
How to Explain Chronic Pain to ER doctors
Published: 2016/11/07
Channel: Chronic Christy
Jordan Peterson - Advice for People With Chronic Pain
Jordan Peterson - Advice for People With Chronic Pain
Published: 2017/08/28
Channel: ManOfAllCreation
Service Dog Helps With Chronic Pain 🐾 (6/14/17)
Service Dog Helps With Chronic Pain 🐾 (6/14/17)
Published: 2017/06/15
Channel: Chronically Jaquie
Living With Chronic Pain | Natural Pain Management
Living With Chronic Pain | Natural Pain Management
Published: 2017/06/26
Channel: Corina Nielsen
Healing Chronic Pain Using Mind-Body Principles
Healing Chronic Pain Using Mind-Body Principles
Published: 2017/02/26
Channel: Eric Robins
Chronic Pain Management: Is Medical Marijuana an Effective Relief Alternative?
Chronic Pain Management: Is Medical Marijuana an Effective Relief Alternative?
Published: 2017/11/10
Channel: Cannabis Lifestyle Network
MORNING YOGA FOR CHRONIC PAIN & STIFF JOINTS
MORNING YOGA FOR CHRONIC PAIN & STIFF JOINTS
Published: 2017/11/14
Channel: Sleepy Santosha
Isochronic music to help ease chronic pain, headaches, or sleep. Natural
Isochronic music to help ease chronic pain, headaches, or sleep. Natural
Published: 2014/02/14
Channel: Jason Stephenson - Sleep Meditation Music
How to Manage Chronic Pain
How to Manage Chronic Pain
Published: 2016/04/22
Channel: ThePatriotNurse
Chronic Pain Relief: 14 All-Natural Painkillers
Chronic Pain Relief: 14 All-Natural Painkillers
Published: 2017/02/24
Channel: Dr. Josh Axe
Chronic pain sufferers reveal other side of prescription epidemic
Chronic pain sufferers reveal other side of prescription epidemic
Published: 2017/04/06
Channel: ABC15 Arizona
Lorimer Moseley
Lorimer Moseley 'Body in mind - the role of the brain in chronic pain' at Mind & Its Potential 2011
Published: 2012/04/16
Channel: Happy & Well
DELIVERANCE PRAYER: Chronic Pain, Fibromyalgia, Arthritis, Infirmity, Migraine, by Brother Carlos
DELIVERANCE PRAYER: Chronic Pain, Fibromyalgia, Arthritis, Infirmity, Migraine, by Brother Carlos
Published: 2017/11/19
Channel: Spiritual Warfare Prayer Carlos Oliveira
Using Suboxone for Chronic Pain Management When Addiction Is A Factor
Using Suboxone for Chronic Pain Management When Addiction Is A Factor
Published: 2015/07/22
Channel: DrStephen Grinstead
How to deal with chronic pain | Ajahn Brahm | 04-07-2014
How to deal with chronic pain | Ajahn Brahm | 04-07-2014
Published: 2014/07/06
Channel: Buddhist Society of Western Australia
The truth about living with chronic pain..
The truth about living with chronic pain..
Published: 2016/07/25
Channel: FindYour Happiness
Chronic Pain Syndromes
Chronic Pain Syndromes
Published: 2011/06/23
Channel: University of California Television (UCTV)
My Scoliosis & Chronic Pain Story
My Scoliosis & Chronic Pain Story
Published: 2016/12/03
Channel: ThePhillippis
What Legitimate Chronic Pain Patients Go Through in the ER
What Legitimate Chronic Pain Patients Go Through in the ER
Published: 2014/10/17
Channel: Christina Nunn
Guided Meditation for Chronic Pain
Guided Meditation for Chronic Pain
Published: 2017/11/19
Channel: Various Artists - Topic
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WIKIPEDIA ARTICLE

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Chronic pain
Classification and external resources
ICD-10 R52.1-R52.2
ICD-9-CM 338.2
eMedicine article/310834
MeSH D059350

Chronic pain is pain that lasts a long time. In medicine, the distinction between acute and chronic pain is sometimes determined by an arbitrary interval of time since onset; the two most commonly used markers being 3 months and 6 months since onset,[1] though some theorists and researchers have placed the transition from acute to chronic pain at 12 months.[2] Others apply acute to pain that lasts less than 30 days, chronic to pain of more than six months duration, and subacute to pain that lasts from one to six months.[3] A popular alternative definition of chronic pain, involving no arbitrarily fixed duration, is "pain that extends beyond the expected period of healing".[1] Epidemiological studies have found that 10.1% to 55.2% of people in various countries have chronic pain.[4]

Chronic pain may originate in the body, or in the brain or spinal cord. It is often difficult to treat. Various nonopioid medicines are recommended initially, depending on whether the pain originates from tissue damage or is neuropathic.[5][6] Psychological treatments including cognitive behavioral therapy and acceptance and commitment therapy may be effective for improving quality of life in those with chronic pain. Some people with chronic pain may benefit from opioid treatment while others are harmed.[7][8] A trial of opioids is only recommended in those with non cancer pain who have no history of either mental illness or substance use disorder and should be stopped if not effective.[9]

Severe chronic pain is associated with increased 10 year mortality, particularly from heart disease and respiratory disease. People with chronic pain tend to have higher rates of depression, anxiety, and sleep disturbances; these are correlations and it is often not clear which factor causes another. Chronic pain may contribute to decreased physical activity due to fear of exacerbating pain, often resulting in weight gain. Pain intensity, pain control, and resiliency to pain are influenced by different levels and types of social support that a person with chronic pain receives.

Classification[edit]

The International Association for the study of pain defines chronic pain as pain with no biological value, that persists past normal tissue healing. The DSM-5 recognizes one chronic pain disorder, somatic symptom disorders, a reduction from the three previously recognized pain disorders. The criteria include it lasting for greater than six month.[10]

The suggested ICD-11 chronic pain classification suggests 7 categories for chronic pain.[11]

  1. Chronic primary pain: defined by 3 months of persistent pain in one or more anatomical regions that is unexplainable by another pain condition.
  2. Chronic cancer pain: defined as cancer or treatment related visceral, musculoskeletal, or bony pain.
  3. Chronic posttraumatic pain: pain lasting 3 months post trauma or surgery, excluding infectious or preexisting conditions.
  4. Chronic neuropathic pain: pain caused by damage to the somatosensory nervous system damage.
  5. Chronic headache and orofacial pain: pain that originates in the head or face, and occurs for 50% or more days over a 3 months period.
  6. Chronic visceral pain: pain originating in an internal organ.
  7. Chronic musculoskeletal pain: pain originating in the bones, muscles, joints or connective tissue.

Chronic pain may be divided into "nociceptive" (caused by inflamed or damaged tissue activating specialised pain sensors called nociceptors), and "neuropathic" (caused by damage to or malfunction of the nervous system).[12]

Nociceptive pain may be divided into "superficial" and "deep", and deep pain into "deep somatic" and "visceral". Superficial pain is initiated by activation of nociceptors in the skin or superficial tissues. Deep somatic pain is initiated by stimulation of nociceptors in ligaments, tendons, bones, blood vessels, fasciae and muscles, and is dull, aching, poorly-localized pain. Visceral pain originates in the viscera (organs). Visceral pain may be well-localized, but often it is extremely difficult to locate, and several visceral regions produce "referred" pain when damaged or inflamed, where the sensation is located in an area distant from the site of pathology or injury.[13]

Neuropathic pain[14] is divided into "peripheral" (originating in the peripheral nervous system) and "central" (originating in the brain or spinal cord).[15] Peripheral neuropathic pain is often described as "burning", "tingling", "electrical", "stabbing", or "pins and needles".[16]

Pathophysiology[edit]

Under persistent activation nociceptive transmission to the dorsal horn may induce a pain wind-up phenomenon. This induces pathological changes that lower the threshold for pain signals to be transmitted. In addition it may generate nonnociceptive nerve fibers to respond to pain signals. Nonnociceptive nerve fibers may also be able to generate and transmit pain signals. The type of nerve fibers that are believed to propagate the pain signals are the C-fibers, since they have a slow conductivity and give rise to a painful sensation that persists over a long time.[17] In chronic pain this process is difficult to reverse or eradicate once established.[18] In some cases, chronic pain can be caused by genetic factors which interfere with neuronal differentiation, leading to a permanent reduction in the threshold for pain.[19]

Chronic pain of different etiologies has been characterized as a disease affecting brain structure and function. Magnetic resonance imaging studies have shown abnormal anatomical[20] and functional connectivity, even during rest[21][22] involving areas related to the processing of pain. Also, persistent pain has been shown to cause grey matter loss, reversible once the pain has resolved.[23][24]

These structural changes can be explained by the phenomenon known as neuroplasticity. In the case of chronic pain, the somatotopic representation of the body is inappropriately reorganized following peripheral and central sensitization. This maladaptive change results in the experience of allodynia or hyperalgesia. Brain activity in individuals with chronic pain, measured via electroencephalogram (EEG), has been demonstrated to be altered, suggesting pain-induced neuroplastic changes. More specifically, the relative beta activity (compared to the rest of the brain) is increased, the relative alpha activity is decreased, and the theta activity both absolutely and relatively is diminished.[25]

Dopaminergic dysfunction has been hypothesized to act as a shared mechanism between chronic pain, insomnia and major depressive disorder. Increased tonic dopamine activity and a compensatory decrease in phasic dopamine activity, which is important in inhibiting pain. This is supported by the implication of COMT in fibromyalgia and temporomandibular joint syndrome.[26] Astrocytes, microglia, and Satellite glial cells have been found to be dysfunctional in chronic pain. Increased activity of microglia, alterations of microglial networks as well as increased production of chemokines and cytokines by microglia are proposed to act to potentiate pain. Astrocytes have been observed to lose their ability to regulate the excitability of neurons, increasing spontaneous neural activity in pain circuits.[27]

Management[edit]

Pain management is the branch of medicine employing an interdisciplinary approach to the relief of pain and improvement in the quality of life of those living with pain.[28] The typical pain management team includes medical practitioners (particularly anesthesiologists), clinical psychologists, physiotherapists, occupational therapists, physician assistants, and nurse practitioners.[29] Acute pain usually resolves with the efforts of one practitioner; however, the management of chronic pain frequently requires the coordinated efforts of the treatment team.[30][31][32] Complete and sustained remission of many types of chronic pain is rare, though some can be done to improve quality of life.[33]

Nonopioids[edit]

Initially recommended efforts are non opioid based therapies.[9]

Various nonopioid medicines are used, depending on whether the pain originates from tissue damage or is neuropathic. Limited evidence suggests that chronic pain from tissue inflammation or damage (as in rheumatoid arthritis and cancer pain) is best treated with opioids, while for neuropathic pain (pain caused by a damaged or dysfunctional nervous system) other drugs may be more effective,[5][6][34][35] such as tricyclic antidepressants,[36] serotonin-norepinephrine reuptake inhibitors,[37] and anticonvulsants.[37] Because of weak evidence, the best approach is not clear when treating many types of pain, and doctors must rely on their own clinical experience.[36] Doctors often cannot predict who will use opioids just for pain management and who will go on to develop addiction, and cannot always distinguish between those who are and those who are not seeking opioids due primarily to an existing addiction. Withholding, interrupting or withdrawing opioid treatment in people who benefit from it can cause harm.[7]

Interventional pain management may be appropriate, including techniques such as trigger point injections, neurolytic blocks, and radiotherapy. While there is no high quality evidence to support ultrasound, it has been found to have a small effect on improving function in non-specific chronic low back pain.[38]

Psychological treatments, including cognitive behavioral therapy[39][40] and acceptance and commitment therapy[41][42] have been shown effective for improving quality of life and reducing pain interference in those with chronic pain.

While exercise has been offered as a method to lessen chronic pain and there is some evidence of benefit, this evidence is tentative.[43] Side effects from exercise are few in this population.[43]

Opioids[edit]

In those who have not benefited from other measures and have no history of either mental illness or substance use disorder treatment with opioids may be tried.[9] If significant benefit does not occur it is recommended that they be stopped.[9] In those on opioids, stopping or decreasing their use may improve outcomes including pain.[44]

Some people with chronic pain benefit from opioid treatment and others do not; some are harmed by the treatment.[7] Possible harms include reduced sex hormone production, hypogonadism, infertility, impaired immune system, falls and fractures in older adults, neonatal abstinence syndrome, heart problems, sleep-disordered breathing, opioid-induced hyperalgesia, physical dependence, addiction, and overdose.[45]

Alternative medicine[edit]

Hypnosis, including self-hypnosis, has tentative evidence.[46] Evidence does not support hypnosis for chronic pain due to a spinal cord injury.[47] Preliminary studies have found medical marijuana to be beneficial in treating neuropathic pain, but not other kinds of long term pain.[48] Further research is needed.[49]

Tai Chi has been shown to improve pain, stiffness, and quality of life in chronic conditions such as osteoarthritis, low back pain, and osteoporosis.[50][51] Acupuncture has also been found to be an effective and safe treatment in reducing pain and improving quality of life for chronic pelvic pain syndrome specifically.[52]

Transcranial magnetic stimulation for reduction of chronic pain is not currently supported by high quality evidence, and the demonstrated effects are small and short-term.[53]

Epidemiology[edit]

A systematic literature review of chronic pain found that the prevalence of chronic pain varied in various countries from 10.1% to 55.2% of the population, affected women at a higher rate than men, and that chronic pain consumes a large amount of healthcare resources around the globe.[4]

A large-scale telephone survey of 15 European countries and Israel, 19% of respondents over 18 years of age had suffered pain for more than 6 months, including the last month, and more than twice in the last week, with pain intensity of 5 or more for the last episode, on a scale of 1 (no pain) to 10 (worst imaginable). 4839 of these respondents with chronic pain were interviewed in depth. Sixty six percent scored their pain intensity at moderate (5–7), and 34% at severe (8–10); 46% had constant pain, 56% intermittent; 49% had suffered pain for 2–15 years; and 21% had been diagnosed with depression due to the pain. Sixty one percent were unable or less able to work outside the home, 19% had lost a job, and 13% had changed jobs due to their pain. Forty percent had inadequate pain management and less than 2% were seeing a pain management specialist.[54]

In the United States, the prevalence of chronic pain has been estimated to be approximately 35%, with approximately 50 million Americans experiencing partial or total disability as a consequence.[55] According to the Institute of Medicine, there are about 116 million Americans living with chronic pain, which suggests that approximately half of American adults have some chronic pain condition.[56][57] The Mayday Fund estimate of 70 million Americans with chronic pain is slightly more conservative.[58] In an internet study, the prevalence of chronic pain in the United States was calculated to be 30.7% of the population: 34.3% for women and 26.7% for men.[59]

Outcomes[edit]

Chronic pain is associated with higher rates of depression and anxiety.[60] Sleep disturbance, and insomnia due to medication and illness symptoms are often experienced by those with chronic pain.[61] Chronic pain may contribute to decreased physical activity due to fear of exacerbating pain, often resulting in weight gain.[60] Such co-morbidities can be difficult to treat due to the high potential of medication interactions, especially when the conditions are treated by different doctors.

Severe chronic pain is associated with increased 10 year mortality, particularly from heart disease and respiratory disease.[62] Several mechanisms have been proposed for the increased mortality, e.g. abnormal endocrine stress response.[63] Additionally, chronic stress seems to affect cardiovascular risk by acceleration of the atherosclerotic process. However, further research is needed to clarify the relationship between severe chronic pain, stress and cardiovascular health.[62]

Psychology[edit]

Personality[edit]

Two of the most frequent personality profiles found in people with chronic pain by the Minnesota Multiphasic Personality Inventory (MMPI) are the conversion V and the neurotic triad. The conversion V personality, so called because the higher scores on MMPI scales 1 and 3, relative to scale 2, form a "V" shape on the graph, expresses exaggerated concern over body feelings, develops bodily symptoms in response to stress, and often fails to recognize their own emotional state, including depression. The neurotic triad personality, scoring high on scales 1, 2 and 3, also expresses exaggerated concern over body feelings and develops bodily symptoms in response to stress, but is demanding and complaining.[64]

Some investigators have argued that it is this neuroticism that causes acute pain to turn chronic, but clinical evidence points the other way, to chronic pain causing neuroticism. When long term pain is relieved by therapeutic intervention, scores on the neurotic triad and anxiety fall, often to normal levels.[65][66][67][68] Self-esteem, often low in people with chronic pain, also shows striking improvement once pain has resolved.[68]

It has been suggested that catastrophizing may play a role in the experience of pain. Pain catastrophizing is the tendency to describe a pain experience in more exaggerated terms than the average person, to think a great deal more about the pain when it occurs, or to feel more helpless about the experience.[69] People who score highly on measures of catastrophization are likely to rate a pain experience as more intense than those who score low on such measures. It is often reasoned that the tendency to catastrophize causes the person to experience the pain as more intense. One suggestion is that catastrophizing influences pain perception through altering attention and anticipation, and heightening emotional responses to pain.[70] However, at least some aspects of catastrophization may be the product of an intense pain experience, rather than its cause. That is, the more intense the pain feels to the person, the more likely they are to have thoughts about it that fit the definition of catastrophization.[71]

Social support[edit]

Social support has important consequences for individuals with chronic pain. In particular, pain intensity, pain control, and resiliency to pain has been implicated as outcomes influenced by different levels and types of social support. Much of this research has focused on emotional, instrumental, tangible and informational social support. People with persistent pain conditions tend to rely on their social support as a coping mechanism and therefore have better outcomes when they are a part of larger more supportive social networks. Across a majority of studies investigated, there was a direct significant association between social activities or social support and pain. Higher levels of pain were associated with a decrease in social activities, lower levels of social support, and reduced social functioning.[72][73]

Effect on cognition[edit]

Chronic pain's impact on cognition is an under-researched area, but several tentative conclusions have been published. Most people with chronic pain complain of cognitive impairment, such as forgetfulness, difficulty with attention, and difficulty completing tasks. Objective testing has found that people in chronic pain tend to experience impairment in attention, memory, mental flexibility, verbal ability, speed of response in a cognitive task, and speed in executing structured tasks.[74]

See also[edit]

References[edit]

  1. ^ a b Turk, D.C.; Okifuji, A. (2001). "Pain terms and taxonomies". In Loeser, D.; Butler, S. H.; Chapman, J.J.; Turk, D. C. Bonica's Management of Pain (3rd ed.). Lippincott Williams & Wilkins. pp. 18–25. ISBN 0-683-30462-3. 
  2. ^ Main, C.J.; Spanswick, C.C. (2001). Pain management: an interdisciplinary approach. Elsevier. p. 93. ISBN 0-443-05683-8. 
  3. ^ Thienhaus, O.; Cole, B.E. (2002). "Classification of pain". In Weiner, R.S. Pain management: A practical guide for clinicians (6 ed.). American Academy of Pain Management. ISBN 0-8493-0926-3. 
  4. ^ a b Harstall C, Ospina M. How Prevalent Is Chronic Pain? June 2003 volume XI issue2 Pain Clinical Updates, International Association for the Study of Pain. pages=1–4 [1]
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  21. ^ Baliki MN, Geha PY, Apkarian AV, Chialvo DR (2008). "Beyond feeling: chronic pain hurts the brain, disrupting the default-mode network dynamics". J Neurosci. 28 (6): 1398–1403. doi:10.1523/JNEUROSCI.4123-07.2008. PMID 18256259. 
  22. ^ Tagliazucchi E, Balenzuela P, Fraiman D, Chialvo DR (2010). "Brain resting state is disrupted in chronic back pain patients". Neurosci Lett. 485 (1): 26–31. doi:10.1016/j.neulet.2010.08.053. PMC 2954131β€―Freely accessible. PMID 20800649. 
  23. ^ May A (2009). "Chronic pain may change the structure of the brain". Pain. 137 (1): 7–15. doi:10.1016/j.pain.2008.02.034. PMID 18410991. 
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