Clinical therapeutics
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Clinical therapeutics · Nov 2013
ReviewMedication pain management in the elderly: unique and underutilized analgesic treatment options.
By 2030, the US population of adults aged ≥65 years will increase by >80%, and these adults will account for nearly 20% of the US population. In this population, the decline of multiple physiologic processes and diseases collectively influence treatment options. Physiologic changes, drug-drug interactions resulting from polypharmacy, and drug-disease interactions combine to make elderly patients more sensitive to the adverse events (AEs) associated with medications, all of which must be considered in drug selection. ⋯ It is incumbent that providers consider these options as part of an analgesic armamentarium in an effort to maximize therapeutic benefit and minimize risks in the increasing elderly patient population.
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Clinical therapeutics · Nov 2013
Pain as the fifth vital sign: exposing the vital need for pain education.
The push to evaluate pain in patients as exemplified by the fifth vital sign has exposed serious deficits in practitioner education and training in pain assessment and management because patient report of pain level has become commonplace in clinical practice. The rapid increase in prescription opioid medications suggests that practitioners are trying to address their patients' pain by prescribing opioids. ⋯ In clinical practice, the fifth vital sign has proven to be more complex to assess, evaluate, and manage than originally anticipated. Expanding pain education and training is critical to remedying some of the issues the routine report of pain by patients has uncovered.
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Clinical therapeutics · Nov 2013
Randomized Controlled Trial Comparative StudyReducing the pain of microemulsion propofol injections: a double-blind, randomized study of three methods of tourniquet and lidocaine.
Although the new formulation of lipid-free microemulsion propofol (MP) has some advantages over the lipid emulsion, it reportedly produces more injection pain than lipid-based propofol. Intravenous lidocaine with application of a rubber tourniquet before administration of propofol is considered to be the best method for reducing injection pain; however, this technique is not perfect. ⋯ UMIN000010725.
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Clinical therapeutics · Nov 2013
ReviewGuanfacine extended release: a novel treatment for attention-deficit/hyperactivity disorder in children and adolescents.
Guanfacine extended release (GXR) has reported efficacy for the treatment of attention-deficit/hyperactivity disorder (ADHD) as monotherapy and adjunctive therapy to psychostimulant medications. ⋯ Current evidence indicates that GXR is an effective treatment option for children and adolescents with ADHD. AEs are typically mild to moderate, although severe AEs and discontinuations due to AEs have been observed.
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Clinical therapeutics · Nov 2013
Randomized Controlled TrialEfficacy of periosteal stimulation for chronic pain associated with advanced knee osteoarthritis: a randomized, controlled clinical trial.
Because of morbidity associated with painful knee osteoarthritis (OA) and commonly prescribed analgesics, patients often pursue complementary and alternative modalities (eg, acupuncture). Clinical trials have demonstrated modest therapeutic efficacy of traditional Chinese acupuncture for knee OA pain, and patients with advanced disease have largely been excluded. We have previously demonstrated preliminary short-term tolerability and efficacy of periosteal stimulation therapy (PST) (ie, electrical stimulation of the periosteum facilitated by acupuncture needles) for older adults with advanced knee OA. ⋯ PST plus PST boosters in patients age >50 with advanced knee OA were well-tolerated and modestly reduced pain. ClinicalTrials.gov identifier: NCT00865046.