science

Intractable pain

Intractable pain is a science topic covered in the lgStudy science library. This page brings together a partial reference excerpt, illustrations, worked examples, real-world applications and a short study plan, so you can understand Intractable pain rather than just read about it. In short: Intractable pain, also called intractable pain syndrome (IPS), is a severe, constant, relentless, and debilitating pain that is not curable by any known means and which causes a house-bound or bed-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.

Key takeaways

Intractable pain belongs to science; place it in that map before memorising details.
Learn the definition first, then one example that makes the definition concrete.
Connect Intractable pain to a quantity you can measure, compute or draw — that is where exam questions come from.
Reproduce the core statement of Intractable pain from memory before moving on to harder problems.

Reference excerpt

Intractable pain, also called intractable pain syndrome (IPS), is a severe, constant, relentless, and debilitating pain that is not curable by any known means and which causes a house-bound or bed-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. Unlike the more common chronic pain, it causes adverse biologic effects 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.

Legal definitions The exact definition of intractable pain varies based on the source and is not generally agreed upon. Several states (California, Colorado, Florida, New Jersey, Texas, Virginia, Minnesota, and Washington) have passed intractable pain laws or guidelines. Texas, under their Intractable Pain Treatment Act, defines intractable pain as a state of pain for which the cause of the pain cannot be removed or otherwise treated and in the generally accepted course of medical practice, relief or cure of the cause of the pain is not possible or has not been found after reasonable efforts. Florida's intractable pain statute defines "intractable pain" as pain for which, in the generally accepted course of medical practice, the cause cannot be removed and otherwise treated.

Treatments 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 can 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 Medical cannabis and/or cannabinoid therapy TENS unit Spinal cord stimulator (SCS) – utilizes the gate control theory to block painful signals by sending benign electrical signals along the nerve roots. 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 an 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, and buprenorphine. methadone – methadone is a mu-opioid, kappa-opioid, and NMDA receptor antagonist. It is used for neuropathic pain, however it is also useful for other types of pain, such as bone pain, and musculoskeletal pain. 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), pregabalin (Lyrica), topiramate (Topamax), quetiapine (Seroquel), risperidone (Risperdal), aripiprazole (Abilify), paliperidone (Invega), iloperidone (Fanapt), ziprasidone (Geodon), lamotrigine (Lamictal), or valproic acid (Depakote). SSRI antidepressants, such as fluoxetine (Prozac/Sarafem), fluvoxamine (Luvox), paroxetine (Paxil), sertraline (Zoloft), citalopram (Celexa), or escitalopram (Lexapro) SNRI 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 ketorolac (Toradol) Physical therapy

Causes 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 are known to cause intractable pain in some patients:

Failed back syndrome Scoliosis, kyphosis, kyphoscoliosis Complex regional pain syndrome (CRPS) Degenerative disk disease Rheumatoid arthritis Central pain syndrome (CPS) Migraine Ehlers–Danlos syndromes

Notable figures Although not recognized during their lifetimes, Elvis Presley, John F Kennedy and Howard Hughes are believed to have suffered from intractable pain.

References

Worked examples

Example 1 — a first encounter with Intractable pain

Start with the simplest possible case. Write down what Intractable pain claims or describes in one sentence, then invent the smallest concrete situation in which that sentence is true. In science, the smallest case is usually a single object, a single equation or a single measurement. Check that every symbol or term in your sentence has a meaning in that case.

Example 2 — changing one variable

Take the situation from Example 1 and change exactly one quantity: double it, halve it, or set it to zero. Predict what should happen to Intractable pain before you calculate. Comparing your prediction with the result is the fastest way to find out whether you understand the idea or only the words.

Example 3 — an exam-style question

Typical questions about Intractable pain ask you to (a) state it precisely, (b) apply it to given data, and (c) explain a limitation. Practise writing all three answers in under five minutes; the third part is what separates a full-mark answer from an average one.

Applications of Intractable pain

In research: Intractable pain appears in science research whenever the underlying quantities have to be modelled precisely. Papers usually cite it as a starting assumption and then explore where it breaks down.
In technology and industry: Engineering practice reuses Intractable pain in design rules, simulations and safety margins. Knowing the idea lets you read a specification sheet and understand why the numbers look the way they do.
In the classroom: Intractable pain is common in secondary-school and first-year university syllabi. It links to neighbouring topics Pain, so understanding it makes those chapters shorter.
In everyday life: Look for Intractable pain outside the textbook — in sport, cooking, traffic, electronics or the sky above you. An example you found yourself is remembered far longer than one you were given.

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How to study Intractable pain in 20 minutes

Read the reference excerpt below once, without taking notes.
Close the page and write down what Intractable pain means in your own words.
Compare your version with the excerpt and mark what you missed.
Work through the three examples above with pen and paper.
Explain Intractable pain out loud to somebody else — or to Teacher Smith in the lgStudy chat.

Frequently asked questions

What is Intractable pain in simple terms?

Why does Intractable pain matter?

Because it connects several science ideas at once: it gives you a definition you can apply, a quantity you can calculate, and a way to check whether a result is plausible.

How should I study Intractable pain?

Read the excerpt, restate it from memory, then work through the examples and applications listed on this page. The five-step study plan above takes about twenty minutes.

What does this page cover?

It gives you a compact reference excerpt plus original lgStudy explanations, examples, applications and study material on Intractable pain.