The Clinical journal of pain
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Physicians frequently express dissatisfaction about caring for patients with chronic pain and frequently report that inadequate training and concern about addiction are impediments to prescribing opioids. Elderly patients with chronic pain may be at increased risk of experiencing uncontrolled pain and this patient population is increasingly being cared for by geriatricians rather than internists. We sought to determine if there is a differential impact on internists and geriatricians of the factors that adversely affect attitudes toward opioid prescribing. ⋯ Factors shown to have an adverse affect on opioid prescribing disproportionately impact on the attitudes of internists compared with geriatricians. Further research is needed to determine if there is also a differential impact on how internists care for their elderly patients with chronic pain.
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Clinical Trial
Intrathecal treatment in cancer patients unresponsive to multiple trials of systemic opioids.
The aim of this study was to evaluate the clinical response to a combination of intrathecal morphine and levobupivacaine in advanced cancer patients who were highly opioid-tolerant, being previously treated with multiple opioid trials unsuccessfully. Initial intrathecal morphine dose was calculated from the previous opioid consumption using a morphine oral-intrathecal ratio of 100:1. Then, doses of both drugs were modified during the treatment according to the clinical needs and balanced with adverse effects. ⋯ Early complications included mild bleeding in 2 patients, without consequences, headache in 4 patients, bladder catheterization in 6 patients, reoperation for bleeding or changes of catheter position in 4 patients, unrelated death in 1 patient, and stroke in another 1. Late complications included local infection in 2 patients, and discontinuation of intrathecal therapy due to spinal compression. In patients who had received multiple trial of opioids and routes of administration, the intrathecal treatment started with an oral-intrathecal morphine conversion ratio of 100:1, and local anesthetics at the most convenient clinical doses provided a long-term improvement of analgesia, with a decrease in adverse effects and opioid consumption until death.
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To present different aspects and advantages of the laparoscopic approach to the pelvic nerves aimed at treating intractable pelvic neuralgia. ⋯ Laparoscopic approach to the pelvic nerves opens new possibilities for the diagnosis and treatment of pelvic neuralgia, and offers new curative surgical techniques.
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Randomized Controlled Trial Clinical Trial
Effect of eutectic mixture of local anesthetics (EMLA) for pain relief during suprapubic aspiration in young infants: a randomized, controlled trial.
The purpose of this study was to determine whether a eutectic mixture of local anesthetics (EMLA) cream reduce the pain experienced by newborns and young infants undergoing suprapubic aspiration (SPA). ⋯ Newborns and infants undergoing SPA experience pain during the procedure. Application of EMLA cream 1 hour before SPA is effective in reducing the pain associated with SPA. In situations in which an SPA is not emergent, strong consideration should be given to the use of EMLA.