The Clinical journal of pain
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Hospitalized patients often experience adverse events of the gastrointestinal tract due to analgesic treatment. The objectives of this study were to estimate use of medications for treatment of nausea, vomiting, or constipation (NVC medications) after initiation of analgesic treatment, and to compare differences in length of stay and treatment costs between patients who received NVC medications and those who did not. ⋯ Use of an analgesic with improved gastrointestinal tolerability may potentially reduce use of NVC medications and hospital resources.
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Spinal cord stimulation (SCS) is the most commonly used implantable neurostimulation modality for management of pain syndromes. We present a patient with history of right facial pain successfully treated for refractory angina with SCS and had coincident near resolution of facial pain. ⋯ SCS is one of the most promising treatment options for refractory angina. Numerous randomized, controlled trials have demonstrated efficacy in increasing exercise duration and time to angina, decreasing number of angina attacks, sublingual nitrate consumption, and number of ischemic episodes. Reductions in pain, sympathetic tone, and myocardial oxygen demand as well as improvement in coronary microcirculatory blood flow have all been proposed as beneficial outcomes of stimulation. AFP is a poorly understood condition, often without etiology, and most commonly treated symptomatically. The resolution of our patient's AFP is secondary to unclear mechanism(s). We propose SCS may have altered central processing or spinal trigeminal nucleus fibers; additionally, the pain may have been sympathetically mediated and altered by SCS.
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Increased sensitivity to pressure is commonly associated with painful musculoskeletal conditions, including whiplash-associated disorders (WADs). Pressure pain thresholds (PPTs) close to the site of presumed tissue damage are thought to represent the degree of peripheral nociceptive sensitization. PPTs over healthy tissue, away from the site of injury, are a marker of central nervous system hyperexcitability. There is uncertainty, however, as to what extent does the sensitization of the nociceptive system, whether peripheral or central, contribute to the ongoing, habitual pain experienced by people with WAD. ⋯ The competing explanations for these findings are that either PPTs provide a poor marker of peripheral and central sensitivity or that these processes are only weakly related to the day-to-day pain experienced by patients with WAD. The latter explanation is supported by the confounding effect of psychological factors on pain score.