Pain management
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SUMMARY An extended-release, multivesicular liposome-encapsulated form of the local anesthetic bupivacaine, DepoFoam(®) bupivacaine (proposed proprietary name EXPAREL™), is in development for use as part of a multimodal regimen for the treatment of postsurgical pain. Placebo- and active-controlled clinical trials in patients who have undergone either orthopedic or soft-tissue procedures indicate that a single local administration into the surgical site results in analgesic activity for up to 3-4 days and decreases the use of opioid rescue medication. The safety profile of DepoFoam bupivacaine appears to be similar to that of bupivacaine HCl, and adverse events are dose-related.
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SUMMARY Spinal cord stimulation (SCS) as treatment for chronic neuropathic pain has developed into an important therapeutic strategy. However, several studies indicate that as many as 30-50% of patients do not respond sufficiently to technically well-functioning SCS. Experimental studies have revealed some of the possible neuronal systems and transmitters involved in SCS. ⋯ Relevant data exist for intrathecal baclofen as an adjuvant to SCS, but trials with clonidine and adenosine have also been performed. Available basic studies indicate that other substances might also prove useful in future trials. The present data thus only announce the beginning of 'drug-enhanced spinal stimulation'.
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SUMMARY Chronic pain, especially headache and recurrent abdominal pain, affects a sizable number of children and adolescents. In this selective overview, the need and rationale for psychological approaches to the treatment of chronic pediatric pain will be explored, and current developments and open questions will be addressed. Thus far, research has mostly focused on the efficacy of various psychological interventions such as relaxation, biofeedback and cognitive-behavioral interventions, specifically for headaches and recurrent abdominal pain. ⋯ On the other hand, much research has been devoted to self-help treatment formats such as internet-based intervention programs. Rather surprisingly, the role of parents in the treatment of chronic pediatric pain is far from being understood, which may be best accounted for by the fact that psychological interventions were mostly adapted from treatment programs in adults rather than being specifically developed for children and adolescents. Conclusions for clinical practice and research are outlined.
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Pain is a topic that affects every one of us - either directly or via a person close to us. Since the beginning of May, the issue of pain and its impact to society has become a new topic on the agenda of the EU institutions in Brussels. On the 3rd and 4th May 2011 a very unique symposium on the 'Societal Impact of Pain' (SIP 2011) took place in the European parliament, bringing together more than 300 European healthcare stakeholders from over 30 countries. ⋯ Due to the urgency of this matter with pain affecting a significant number of the European population the scientific program of the symposium was endorsed by more than 85 national and international organizations and institutions that support pain care in Europe. Therefore, it provided a multistakeholder platform for healthcare professionals and specialists, as well as representatives of health authorities, pain advocacy groups, politicians, regulators and budget holders for discussion and to share examples of best practice in pain care. The pharmaceutical company Grünenthal GmbH was responsible for organization, logistics and support.
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SUMMARY Trigeminal neuropathic pains have presented diagnostic and therapeutic challenges to providers. In addition, knowledge of pathophysiology, current classification systems, taxonomy and phenotyping of these conditions are incomplete. While trigeminal neuralgia is the most identifiable and studied, other conditions are being recognized and require distinct management approaches. ⋯ Trigeminal neuropathic pain is managed medically based on the guidelines for other neuropathic pain conditions. Burning mouth syndrome is also treated with a number of neuropathic medications, both topical and systemic. In all these conditions, patients need to be thoroughly educated about their condition, involved in its management, and be provided with supportive and adjunctive treatment resources.