Pain management
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Stephen G Waxman speaks to Roshaine Gunawardana, Commissioning Editor: Stephen G Waxman is the Bridget Marie Flaherty Professor of Neurology, Neurobiology and Pharmacology; Director, Center for Neuroscience and Regeneration/Neurorehabilitation Research, Yale University School of Medicine and Veterans Affairs Medical Center, CT, USA.
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SUMMARY ⋯ Pregabalin 300 mg/day as an add-on to transdermal buprenorphine 35 µg/h led to significant pain reduction and a significant reduction of interference with sleep quality in patients with chronic low back pain.
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SUMMARY Fentanyl buccal tablets (FBT) have been designed to treat breakthrough pain (BTP) in patients who are already receiving, and who are tolerant to, opioid therapy for their underlying persistent pain. FBT are a formulation that uses an effervescent drug delivery system to enhance penetration across the buccal mucosa. OraVescent technology provides an effervescent reaction that liberates carbon dioxide in the buccal cavity. ⋯ The safety and tolerability profile is generally typical of that observed with other opioids. The pharmacokinetic properties of FBT allow for a meaningful clinical efficacy, with an onset of action that closely matches the onset of BTP. FBT, as with any other transmucosal preparations of fentanyl, should not be used in patients who are not opioid-tolerant.
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Nanna Finnerup graduated from the Medical School at Aarhus University, Denmark, in 1993, and after an internship worked at the Department of Neurology and Clinical Neurophysiology at the University of Copenhagen, Denmark. Since 1998 she has worked at the Danish Pain Research Center at Aarhus University. ⋯ Dr Finnerup is a Management Committee Member of the Special Interest Group on Neuropathic Pain (NeuPSIG) of the International Association for the Study of Pain and a board member of the Scandinavian Association for the Study of Pain (SASP). She is a member of the Editorial Advisory Board of the Scandinavian Journal of Pain, the Encyclopedia of Pain and Pain Management.
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SUMMARY ⋯ In this observational study in normal clinical practice, transdermal buprenorphine provided effective pain relief and was generally well tolerated by patients with cancer pain. It also improved quality of life for patients and reduced caregiver burden. Considering the high number of study discontinuations (mainly due to nontreatment-related death and lost to follow-up), the results of this study need to be evaluated with caution.