The Clinical journal of pain
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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.
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Randomized Controlled Trial
A randomized, placebo-controlled trial of acetaminophen extended release for treatment of post-marathon muscle soreness.
To compare the efficacy of acetaminophen extended release (ER) caplets to placebo in treating muscle soreness after a marathon. ⋯ Acetaminophen ER 1300 mg, a nonprescription drug, was an effective treatment for post-race muscle soreness on the day of the marathon. In addition, acetaminophen ER provided benefit for interference with sleep and overall satisfaction with treatment, and was generally well tolerated.
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The objective of the study was to examine patients' experiences of pain in Hospital in the Home (HITH) programs and identify the issues related to providing optimal pain management for acute care patients in the home environment. ⋯ Treatment of pain at home was suboptimal with patients experiencing moderate-to-severe pain and discomfort during the treatment phase of their illness. Lack of appropriate discharge planning strategies meant that patients went home without adequate analgesia and use of nonprescribed pain medication was common. The number of patients transferred home without analgesics indicates a worrying underrecognition of the need for analgesia in this care context and poses a risk to patient safety that is no less significant because patients are at home.
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Multicenter Study Comparative Study
A comparative investigation of observational pain assessment tools for older adults with dementia.
Pain assessment in patients with dementia and severe limitations in ability to communicate can be challenging. The American Geriatrics Society (AGS) encourages the incorporation of 6 behavioral domains (ie, facial expressions, verbalizations/vocalizations, body movements, changes in interpersonal interactions, changes in activity patterns/routines and mental status changes) when conducting pain assessments among seniors with dementia. We investigated 6 observational pain assessment measures (differing with respect to the extent that they cover the AGS-recommended domains) under 2 different pain conditions (ie, influenza vaccination and movement-exacerbated pain) in a sample of long-term care residents with cognitive impairments. Given that a criticism of pain assessment scales is that many of the pain behaviors assessed are highly overlapping with symptoms of delirium, we also investigated the impact of the elimination of delirium-related items. ⋯ Our results provide much needed psychometric information regarding newly developed pain assessments measures for seniors with dementia. The measures differed with respect to ability to differentiate pain-related from non-pain-related states. Moreover, our findings support the utility of comprehensive coverage of the AGS-recommended pain assessment domains.