Pain management
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SUMMARY Contemporary clinical assessment of back pain is based on the diagnostic triage paradigm. The most common diagnostic classification is nonspecific back pain, considered to be of nociceptive etiology. A small proportion are diagnosed with radicular pain, of neuropathic origin. ⋯ The consequence of this is that in the clinic, diagnostic triage may erroneously classify patients with nonspecific back pain or radicular pain. A promising alternative is the development of mechanism-based pain phenotyping in patients with back pain. Timely identification of contributory pain mechanisms may enable greater opportunity to select appropriate therapeutic targets and improve patient outcomes.
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Considerable evidence demonstrates substantial ethnic disparities in the prevalence, treatment, progression and outcomes of pain-related conditions. Elucidating the mechanisms underlying these group differences is of crucial importance in reducing and eliminating disparities in the pain experience. ⋯ These diverse factors, and others may all play a role in facilitating elevated levels of pain-related suffering among individuals from ethnic minority backgrounds. Here, we present a brief, nonexhaustive review of the recent literature and potential physiological and sociocultural mechanisms underlying these ethnic group disparities in pain outcomes.
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SUMMARY The capsaicin 8% patch is licensed in Europe for the treatment of peripheral neuropathic pain in nondiabetic adults. In controlled trials it provided pain relief for up to 3 months with a single 30- or 60-min application. In this article, a group of pain specialists from Germany and the UK share their considerable experience of real-world use of the capsaicin 8% patch. ⋯ Response to retreatment also appears to be equal to that of the first treatment, even in patients treated for the fifth time. It was also observed that patients receiving capsaicin 8% patch treatment are often able to reduce their intake of concomitant pain medications. Observations from real-life use of the capsaicin 8% patch will help to maximize its therapeutic potential.
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SUMMARY The fear-avoidance model of chronic pain has stimulated extensive research and the development of a variety of interventions focused on reducing pain-related fear, avoidance behavior and functional disability in individuals with chronic pain. Although there is considerable evidence supporting the model, oversight of potentially important factors and inconsistent findings regarding postulated pathways have led to proposed model revisions. ⋯ Additional evaluation using structural equation modeling may lead to a formulation of the fear-avoidance model that balances parsimony with heuristic value. Clinical implications and areas for future research are discussed.
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SUMMARY The immediate-release formulation of gabapentin (gabapentin three-times daily) is approved for treatment of postherpetic neuralgia (PHN). Although it has a low propensity for drug-drug interactions, it requires multiple daily dosing and is associated with a high frequency of dizziness and somnolence. A once-daily formulation of gabapentin was recently approved for the treatment of PHN. ⋯ Clinical studies have confirmed the efficacy of once-daily, gastroretentive gabapentin in the treatment of PHN. In addition, these studies have suggested that the rate of dizziness and somnolence may be reduced compared with similar studies using gabapentin three-times daily. This article reviews key aspects of the pharmacology, efficacy and safety of once-daily gabapentin in the treatment of PHN.