The Clinical journal of pain
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Comparative Study
Comparable analgesic efficacy of transdermal buprenorphine in patients over and under 65 years of age.
To compare the efficacy and tolerability of transdermal buprenorphine in elderly patients and 2 younger populations, all requiring analgesic treatment for moderate-to-severe chronic pain. ⋯ This investigation showed that the treatment of chronic pain with transdermal buprenorphine in elderly patients above the age of 65 years is at least as effective, tolerable, and safe as in patients studied in 2 age-groups below that age.
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This paper describes characteristics of opioid use episodes for noncancer pain and defines thresholds for de facto long-term opioid therapy. ⋯ Long-term opioid therapy was characterized by the diversity in medications prescribed, dosage levels, and frequency of use. The proposed threshold for long-term opioid therapy provides a checkpoint for physicians to review whether an explicit decision to sustain opioid therapy has been reached, and to ensure that a documented treatment plan and provisions for monitoring medication use and patient outcomes are in place.
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Prescription opioid misuse is a growing problem in the United States. There are limited data to illuminate the nature of this issue. The Internet seems to be a novel approach in surveying populations of opioid users. An Internet-based survey of nonmedical opioid users visiting informational drug websites was used to measure rates of nonmedical use and characterize users. ⋯ This project demonstrates the feasibility of conducting product-specific, online surveys with rapid recruitment of participants from websites. This approach differentiates rates of nonmedical use of specific prescription opioids and provides other insights into individuals who nonmedically use opioids.
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Deep cross-friction pressure with a finger or an elbow in the proximal gluteal region causes a sciaticlike pain along the side of the thigh and the leg as a clinical presence of referred pain (RP) in patients with nonspecific low back pain (LBP). This study investigated the reliability and discriminative ability of experimentally provoked RP as a result of deep cross-friction with the aid of a Fischer algometer. The new clinical examination method measures the provoked RP threshold resulting in an outcome, expressed in kg/cm2. ⋯ This clinical study support the reliability and discriminative ability of a new method of experimentally provoked RP, using deep cross-friction pressure with the aid of a Fischer algometer in patients with LBP. The experimentally "provoked referred pain threshold" (PPT-RP) values lower than 6 kg/cm correspond clinically with the presence of a referred muscle pain area in the thigh and/or the leg. Further studies of a similar kind are nevertheless needed to confirm those conclusions and to assess the responsiveness of the provoked RP measurements in different treatment follow-up periods.
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The International Association for the Study of Pain defines allodynia as pain due to a stimulus that does not normally provoke pain and hyperalgesia as an increased response to a stimulus, which is normally painful. However, does "normally painful" mean "any stimulation of nociceptors" or "the subjective pain response?" We argue that "normally painful" should not mean "any stimulation of nociceptors," as Von Frey monofilaments may evoke a pricking sensation--which implies the involvement of nociceptors--without necessarily leading to a subjective pain perception. In this paper, we propose that the diagnosis of either allodynia or hyperalgesia should be based on the patient's report, that is, painful versus not painful, rather than on the (sub) type of afferent fiber involved.