The Medical clinics of North America
-
Since the first use of intrathecal (IT) drug infusion systems in the early 1980s, these delivery systems have undergone numerous revisions making them more tolerable, easier to program, and longer lasting. Concurrent with technological advances, the indications for IT pump placement have also been continuously evolving, to the point where the most common indication is now noncancer pain. This article provides an evidence-based review of the indications, efficacy, and complications of IT drug therapy for the most commonly administered spinal analgesics.
-
Opioids have been successfully used for the management of acute and cancer-related pain. Concerns regarding side effects, tolerance, dependence, addiction, and hyperalgesia have limited the use of opioids for the management of chronic nonmalignant pain. This article will review updated information from both clinical and preclinical studies regarding opioid-induced hyperalgesia, tolerance, and dependence. The implications of these issues in clinical opioid therapy also will be discussed.
-
Vertebral compression fractures occur more frequently than hip and ankle fractures combined. These fragility fractures frequently result in both acute and chronic pain, but more importantly are a source of increased morbidity and possibly mortality. ⋯ The history, technique, and results of vertebroplasty and kyphoplasty are reviewed. Both methods allow for the introduction of bone cement into the fracture site with clinical results indicating substantial pain relief in approximately 90% of patients.
-
Opioids are extensively used in the management of all types of pain and their use is underpinned by extensive trial evidence and an abundance of practical experience. We are still amassing insight into how they achieve their pain-relieving effects, however, and this understanding becomes more complex as time progresses and shows that opioids are medications with complex and diverse central and peripheral nervous system effects. Despite the 200 years that have passed since the chemical isolation of morphine, every year brings new understanding of the mode of action, propensity to cause side effects, and appropriate clinical use of opioids. This article concentrates on this "new" evidence as disclosed by recent publications.
-
Painful conditions of the musculoskeletal system, including myofascial pain syndrome, constitute some of the most important chronic problems encountered in a clinical practice. A myofascial trigger points is a hyperirritable spot, usually within a taut band of skeletal muscle, which is painful on compression and can give rise to characteristic referred pain, motor dysfunction, and autonomic phenomena. ⋯ Invasive treatments for myofascial trigger points include injections with local anesthetics, corticosteroids, or botulism toxin or dry needling. The etiology, pathophysiology, and treatment of myofascial trigger points are addressed in this article.