The Clinical journal of pain
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According to international guidelines, nonsteroidal anti-inflammatory drugs (NSAIDs) and opioids are the cornerstone drugs for cancer pain. In clinical practice, severe cancer pain often requires 3 step analgesics and alternative routes of administration, thus NSAIDs are usually abandoned. Our aim was to evaluate feasibility, safety, and efficacy of ketoprofen combined with opioids in long-term continuous subcutaneous infusion (CSI) for cancer pain in a prospective observational open-label pilot study. ⋯ Ketoprofen CSI in combination with opioids is a feasible, safe, and effective approach to cancer pain.
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Discogenic pain in the thoracic region is a challenging condition characterized by refractoriness to conservative treatments. Unlike lumbar discogenic pain there is a lack of effective surgical options. Reported here is the treatment of thoracic discogenic pain in 3 patients using a new minimally invasive procedure named intradiscal biacuplasty. ⋯ Cooled, bipolar radiofrequency may be an effective and readily available treatment for thoracic discogenic pain if future comparison studies show benefits of such procedure.
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Randomized Controlled Trial Clinical Trial
Acute pressure block of the sciatic nerve relieves clinical pain but not cold pressor pain.
Acute pressure applied to the sciatic nerve has been recently reported to offer immediate short-term pain relief in patients with various diseases. This study examined the analgesic effect of this novel method on cold pressor pain compared with clinical pain. ⋯ Our study indicated that cold pressor pain and clinical pain responded differently to acute pressure blockade of the sciatic nerve. Our findings indicate that caution should be exercised when attempting to extrapolate cold pressor pain findings to clinical pain.
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Multicenter Study
Negative mood mediates the effect of poor sleep on pain among chronic pain patients.
Sleep disturbances and increased negative mood are common among chronic pain patients. Research suggests that sleep disruption can contribute to increased pain; however, the role of negative mood in this relationship is unclear. The present study investigated the relationship among sleep disturbance, negative mood, and pain within a large sample of chronic pain patients. It was hypothesized that negative mood would mediate the relationship between sleep and pain. ⋯ These findings suggest that addressing negative mood directly, or by addressing sleep disturbances in chronic pain patients, may have a beneficial impact on patients' pain. As sleep disturbance may be causing negative mood, treating the sleep disturbance may also be beneficial among chronic pain patients. Negative mood may perpetuate the impact of sleep disturbances on pain, possibly through increased arousal or disruptions in diurnal patterns.
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Clinical Trial
The use of opioids for breakthrough pain in acute palliative care unit by using doses proportional to opioid basal regimen.
To determine the efficacy and safety of different opioids used in doses proportional to the basal opioid regimen for the management of breakthrough pain (BP). ⋯ This survey suggests that doses of opioids for BP proportional to the basal opioid regimen, are very effective and safe in clinical practice, regardless the opioid and modality used.