The Clinical journal of pain
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Angiotensin-converting enzyme inhibitors (ACEIs) increase potent proinflammatory and pain mediators in local tissues. Consistent with these observations, animal and human studies demonstrate that ACEIs have hyperalgesic and proinflammatory properties. However, there is no information in literature whether or not the use of ACEIs is associated with increased postoperative pain. Specifically, we tested the primary hypothesis that use of ACEIs is independently associated with increased opioid requirements and pain scores during the initial 72 hours after surgery. ⋯ The adjusted difference in mean 72-hour postoperative using a time-weighted average pain score was estimated at +0.17 [-0.40, +0.74] units on the verbal response scale. This was not statistically significant (P=0.50). Opioid use was estimated by the percent difference in mean 72-hour total postoperative intravenous morphine equivalent dose at -8.1% [-46%, +56%], which was not statistically significant (P=0.72). In conclusion, after controlling for all available factors, we found no significant difference that postoperative pain-as defined by either pain scores or opioid requirements-differed between patients taking ACEIs and patients not taking ACEIs.
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To provide an evidence-based overview of the effectiveness of interventions for 4 nontraumatic painful disorders sharing the anatomic region of the elbow: cubital tunnel syndrome, radial tunnel syndrome, elbow instability, and olecranon bursitis. ⋯ In this review no, or at best, limited evidence was found for the effectiveness of nonsurgical and surgical interventions to treat painful cubital tunnel syndrome, radial tunnel syndrome, elbow instability, or olecranon bursitis. Well-designed and well-conducted RCTs are clearly needed in this field.
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Randomized Controlled Trial
The Primary Practice Physician Program for Chronic Pain (© 4PCP): Outcomes of a Primary Physician-Pain Specialist Collaboration for Community-based Training and Support.
One in 3 patients sees a primary care physician (PCP) for chronic pain yet most PCPs receive no training in this field. We evaluated the impact of 4PCP (© Primary Practice Physician Program for Chronic Pain) comprising of a specialist-PCP training collaboration integrated with clinical support. ⋯ This pilot study demonstrates successful interdisciplinary chronic pain management by PCPs with durability of training effect, improved patient outcomes, visit efficiency, and job satisfaction. 4PCP provides a promising framework to propel the national concept of PCP-specialist collaboration for chronic pain management.
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Preterm infants undergo frequent painful procedures in the neonatal intensive care unit. Electroencephalography (EEG) changes in reaction to invasive procedures have been reported in preterm and full-term neonates. Frontal EEG asymmetry as an index of emotion during tactile stimulation shows inconsistent findings in full-term infants, and has not been examined in the context of pain in preterm infants. Our aim was to examine whether heel lance for blood collection induces changes in right-left frontal asymmetry, suggesting negative emotional response, in preterm neonates at different gestational age (GA) at birth and different duration of stay in the neonatal intensive care unit. ⋯ There are technical challenges in recording EEG during procedures, as pain induces motor movements. More research is needed to determine the most sensitive approach to measure EEG signals within the context of pain in infancy.