Pain management
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SUMMARY Pregabalin is the only US FDA-approved drug to date for neuropathic pain in spinal cord injured patients. Pregabalin is a novel GABA analog whose primary mechanism of action involves binding at the α2-δ subunit of voltage-sensitive calcium channels. Efficacy is noted within the first several days of administration. ⋯ Dosing can be increased gradually to a recommended maximum of 600 mg per day in divided dosing. Adverse events include somnolence, dizziness and dry mouth, and typically manifest within the first 2 weeks of treatment. Pregabalin is generally safe to use in combination with other pain medications or antidepressants, but safety in pregnant patients has not been established.
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SUMMARY The treatment of chronic pelvic pain in both females and males is a challenge for pain clinicians. Standard therapies are multimodal in nature with use of behavioral, medical and procedural therapeutics. ⋯ This review briefly examines newly employed therapeutic options, while restating currently utilized options. The current state-of-the-art treatment includes focal therapies for identified pathologies and empiric trials of other options for care when precise sources of the chronic pelvic pain are ill defined.
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SUMMARY Neuropathic pain is typically caused by a lesion or dysfunction in the nervous system that results in both negative (i.e., reduced sensitivity) and positive symptoms (i.e., paraesthesia, spontaneous ongoing pain with shooting, electric shock-like sensations and abnormal responses to evoked pain). Intriguingly, chronic pain disorders manifest profound alterations in brain structure and function, and thus, modern nuclear magnetic resonance (NMR) techniques have allowed us to begin to dissect the complexities of how neuropathic pain affects the brain. NMR approaches can be used as an independent measure to improve our understanding of key changes in brain structure, function and chemistry in chronic neuropathic pain. ⋯ Additionally, although at an early stage, NMR methods can also be useful to define clinical metrics to predict chronification of neuropathic pain and responses to drugs. This article provides a review of NMR techniques and their capacity to study spontaneous pain and evoked pain, as well as structural, functional and neurochemical alterations that have repeatedly been associated with chronic neuropathic pain. Finally, the importance for quantifying disease state and treatment efficacy in neuropathic pain using NMR techniques is discussed.
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Colonel Chester 'Trip' Buckenmaier 3rd, MD, speaks to Dominic Chamberlain, Assistant Commissioning Editor: Colonel Buckenmaier is the current Director of the Defense and Veterans Center for Integrative Pain Management (MD, USA) and Fellowship Director of the Acute Pain Medicine and Regional Anesthesia program at Walter Reed National Military Medical Center in Washington DC (USA). He is an Associate Professor in Anesthesiology at the Uniformed Services University of the Health Sciences in Bethesda (MD, USA), and a Diplomat with the American Board of Anesthesiology. He attended Catawba College (NC, USA), on a Reserve Officers' Training Corps (ROTC) scholarship, graduating with a degree in Biology and Chemistry in 1986. ⋯ He performed the first successful continuous peripheral nerve block for pain management in a combat support hospital. In April 2009, he deployed to Camp Bastion (Afghanistan) with the British military and ran the first acute pain service in a theater of war. The Defense and Veterans Center for Integrative Pain Medicine (DVCIPM) is dedicated to improving pain management throughout the continuum of care for service personnel and their families.
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SUMMARY There is good evidence showing that placebo and nocebo responses do not only reflect a psychological reappraisal of an unchanged nociceptive activity. There are several scientific evidences indicating that placebo or nocebo responses trigger changes in the brain that activate descending modulatory mechanisms, affecting the nociceptive signal early in the CNS. ⋯ In this article, we will describe different experimental situations where psychological factors produce physiological changes of the nociceptive signal in the brain, and how these changes are reflected in the spinal cord. Finally, we will discuss the importance of better understanding placebo and nocebo mechanisms in clinical contexts for pain treatment.