The Clinical journal of pain
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Opioid therapy for chronic pain has been popularized over the past few decades, and a concern has arisen that the analgesic efficacy of opioids is not always maintained over prolonged courses of treatment despite dose escalation and stable pain. Considering the potentially serious adverse effects of opioids, the idea that pain relief could diminish over time may have a significant impact on the decision to embark on this therapy, especially in vulnerable individuals. ⋯ The theoretical basis for loss of analgesic efficacy over time is then examined. Mechanisms for loss of analgesic efficacy proposed are pharmacologic tolerance, opioid-induced hyperalgesia, subtle and intermittent withdrawal, and a number of psychologic factors including loss of the placebo component.
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Comparative Study
Comparable analgesic efficacy of transdermal buprenorphine in patients over and under 65 years of age.
To compare the efficacy and tolerability of transdermal buprenorphine in elderly patients and 2 younger populations, all requiring analgesic treatment for moderate-to-severe chronic pain. ⋯ This investigation showed that the treatment of chronic pain with transdermal buprenorphine in elderly patients above the age of 65 years is at least as effective, tolerable, and safe as in patients studied in 2 age-groups below that age.
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To provide a better empirical understanding of the dimensionality of neuropathic and non-neuropathic pain quality. ⋯ The findings support the hypothesis that pain qualities cluster into distinct groups. If replicated in additional samples, the pain quality domains identified may provide clinicians and researchers with a useful way to summarize data from pain quality measures, and may also provide meaningful end points that would allow for treatment differentiation between various pharmacologic entities.