The Clinical journal of pain
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Pain is a common symptom in patients with multiple sclerosis (MS) and it is thought to be the result of a mixture of neuropathic and nociceptive pain. Different elements of pain need to be recognized and treated differently, but a clinical tool to classify these components still remains to be defined. ⋯ Original spontaneous descriptors, possibly pathology-specific, emerged in all groups not included in the MGPQ and pointed out the need to use assessment tools based on people experience.
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Opioid-induced constipation persists as a challenge in the management of chronic pain treated with opioid therapy. Multiple opioid antagonists have been applied in attempt to combat the gastrointestinal side effects of opioid analgesia, however their lipid-soluble nature allows passage into the central nervous system and consequent antagonism of centrally mediated analgesia. In contrast, methylnaltrexone offers the advantage of peripheral receptor-specific opioid antagonism due to chemical alterations conferring greater polarity and less lipid solubility. We present use of enteral methylnatrexone to treat severe opioid-induced constipation in a young boy who had failed treatment with the non-specific opioid antagonist, naloxone. This case reports describes the safe transition from enteral naloxone to enteral methylnaltrexone and discusses the potential risk of relative opioid toxicity during the transition. ⋯ Our case report demonstrates safe transition from enteral naloxone to enteral methylnaltrexone in a pediatric patient, avoiding the serious consequences of relative opioid toxicity. This patient experienced significant improvement of opioid-induced constipation and reduction in opioid requirements and it is possible that other patients would benefit as well. The role of enteral methylnaltrexone deserves further investigation.
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Short-lasting unilateral neuralgiform headache with conjunctival injection and tearing (SUNCT) syndrome is a rare type of trigeminal autonomic cephalalgia. SUNCT syndrome is typically idiopathic, and secondary SUNCT syndrome after indirect injury is very rare. We report a case of SUNCT syndrome manifested dramatically after a whiplash injury and treated by greater occipital nerve (GON) block. ⋯ Secondary SUNCT syndrome induced by whiplash injury is rare. Our case showed good outcome of SUNCT syndrome treated by GON.