الفهرس 
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Abstract
- 80 - SUMMARY
The relief of chronic pain is a subject which has
been recently receiving an increasing attention. This
has been evidenced by the increasing number of pain re-
lief clinics established in the last few years.
Drug therapy using the non-narcotic, narcotic and
adjuvant analgesics plays a major role in the management
of chronic pain. Analgesics, being easy to administer, from the first line of defense in treating pain. How-ever, they are not without serious shortcomings, includ-ing unsatisfactory duration of pain relief,unaccentable side effects and, with the narcotic analgesics, the development of tolerance and physical dependence.
Interruption of pain pathways at the peripheral nerve endings include TENS, Cryoanalgesia, radiofreque-ncy denervation and intravenous regional sympathetic block. At the spinal cord level, interruption can be achieved by barbotage and intrathecal cold saline, neurolytic nerve blocks, intrathecal and epidural nar-cotics, dorsal column stimulation, and neurosurgical destructive procedures e.g. cordotomy and rhizotomy.
The substantia gelatinosa and dorsal horns of the spinal cord contain opiate receptors, and application of a law narcotic dose to the spinal cord may produce profound segmental pain relief free from other sensory,
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motor, or nympathetie changer!. The use of ouberachnoid
or epidural narcotics may therefore be the procedure of choice in some patients with malignant disease and in-tractable abdominal, pelvic, or lower extremity pain.
Interruption of pain pathways at higher centers
include ablation of the pituitary, brain stimulation and neurosurgical destructive procedures.
Acupuncture has been used extensively for the
treatment of various pain states including musculoske-letal pain; neuralgia; headache and visceral pain.
All patients with chronic pain syndrome should be referred to physical therapy, at least for evaluation. The role of a physical therapist in the pain center is to prevent disability, restore function, promote heal-ing, and train the chronic pain patient to cope with
permanent disability.
Anaesthetists and others, whose skills are directed mainly towards the physical aspects of the complaint, have come to realise that management is incomplete without attention to the psychological factors.