Pain management
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Summary Duloxetine hydrochloride (duloxetine) is used as a nonopioid analgesic for the treatment of certain chronic pain conditions. It is a serotonin and norepinephrine reuptake inhibitor and has been approved in the USA for the management of both diabetic peripheral neuropathic pain and fibromyalgia. ⋯ Effect sizes in studies of each of the aforementioned chronic pain conditions are comparable with other commonly used pain medications. Treatment-emergent adverse events are generally mild to moderate in severity, and tend to occur early and transiently.
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Virtual reality (VR) has been used to manage pain and distress associated with a wide variety of known painful medical procedures. In clinical settings and experimental studies, participants immersed in VR experience reduced levels of pain, general distress/unpleasantness and report a desire to use VR again during painful medical procedures. Investigators hypothesize that VR acts as a nonpharmacologic form of analgesia by exerting an array of emotional affective, emotion-based cognitive and attentional processes on the body's intricate pain modulation system. ⋯ Recently, new applications, including VR, have been developed to augment evidenced-based interventions, such as hypnosis and biofeedback, for the treatment of chronic pain. This article provides a comprehensive review of the literature, exploring clinical and experimental applications of VR for acute and chronic pain management, focusing specifically on current trends and recent developments. In addition, we propose mechanistic theories highlighting VR distraction and neurobiological explanations, and conclude with new directions in VR research, implications and clinical significance.
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Using an electronic pain diary to better understand pain in children and adolescents with arthritis.
Summary ⋯ Real-time data capture approaches can be used enable a better understanding of how pain and other symptoms in youths with juvenile idiopathic arthritis change within and across days, and how best to treat them. Valuable next steps include incorporating the e-Ouch pain diary into an everyday clinical setting to measure patient outcomes.
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SUMMARY Chronic widespread pain (CWP) represents pain involving several regions of the body. Various psychological and social risk factors such as poor general health status, sleep disturbance, fatigue and high psychological distress have been identified for the development of CWP. Numerous chronic pain conditions are comorbid, resulting in the development of CWP in many of these patients. ⋯ It has been proposed that these comorbid pain disorders share common denominators, including exposure to certain environmental events, elevated psychological distress, pain amplification and genetic predisposition. Increased awareness of CWP is important for improved diagnoses and more effective pain management. Patients with CWP can be effectively managed in multidisciplinary pain clinics.