Current opinion in supportive and palliative care
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Patients receiving chronic opioid treatment who develop paradoxical pain sensations, as well as worsening existing pain, can be diagnosed as suffering from opioid-induced hyperalgesia (OIH). As the worldwide population expands so too does the proportion of patients who experience pain that requires a strong opioid. Recognizing the symptoms of OIH and optimizing the use of morphine in the hospital setting is imperative. This review focuses on clinical data relating to evidence of OIH at the bedside and the novel techniques employed by healthcare providers in order to improve the heightened pain sensations experienced by susceptible patients. ⋯ Looking to the future, improved clinician-patient communication, advanced diagnostic techniques and a refinement of prescribed adjunct pharmacotherapies will offer the most successful multimodal pain management approach to the problem of OIH.
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Curr Opin Support Palliat Care · Jun 2015
ReviewIs ginger beneficial for nausea and vomiting? An update of the literature.
Nausea and vomiting can pose a significant burden to patients in a variety of clinical settings. Previous evidence suggests that ginger may be an effective treatment for these symptoms; however, current evidence has been mixed. This article discusses recent clinical trials that have investigated ginger as a treatment for multiple types of nausea and vomiting. In addition, the potential mechanisms of action of ginger will be discussed. ⋯ The results of studies in this article suggest that ginger is a promising treatment for nausea and vomiting in a variety of clinical settings and possesses a clinically relevant mechanism. However, further studies are required to address the limitations in the current clinical literature before firm recommendations for its use can be made.
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Curr Opin Support Palliat Care · Jun 2015
ReviewClassification of neuropathic pain in cancer patients.
Neuropathic pain can affect up to 40% in patients with cancer, which could be related to the tumour, treatment or comorbid diseases. Effective assessment to diagnose neuropathic pain is crucial in order to choose the right treatment. ⋯ We have combined these recommendations to outline a clinically relevant process to classify neuropathic pain in patients with cancer.
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Conditioned pain modulation (CPM) paradigms have been increasingly used over the past few years to assess endogenous analgesia capacity in healthy individuals and pain patients. The current review concentrates on selected recent literature advancing our understanding and practice of CPM. ⋯ The reviewed literature refines the methodology used for eliciting CPM responses and characterizing their physiological attributes in healthy individuals and pain patients, and exemplifies the materializing concept of individualized pain medicine through targeting impaired mechanisms of pain modulation by designated drugs for optimal pain alleviation.
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Curr Opin Support Palliat Care · Jun 2015
ReviewCould targeting epigenetic processes relieve chronic pain states?
Aberrations in the epigenetic landscape have previously been associated with human diseases such as cancer and schizophrenia, and drugs that target epigenetic processes are currently used as therapeutic agents. This article will review the evidence obtained from animal studies indicating that epigenetic processes might regulate long-term pain states and then discuss the possibility that targeting epigenetic mechanisms might be useful for the management of chronic pain. ⋯ The field of epigenetics and pain is rapidly emerging but further investigation is needed to fully comprehend the contribution of epigenetic processes to chronic pain states. Although therapeutic approaches targeting these mechanisms might seem worthwhile, we cannot assert that currently available global tools such as histone deacetylase inhibitors can be used successfully for the long-term treatment of chronic pain states.