Pain medicine : the official journal of the American Academy of Pain Medicine
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Comparative Study Clinical Trial Controlled Clinical Trial
Acute and chronic pain in geriatrics: clinical characteristics of pain and the influence of cognition.
This study aimed to identify which of the well-known characteristics of chronic pain patients are seen even in older patients with multiple comorbidities and considerable functional impairments and how cognition influences patients' reports of acute and chronic pain. ⋯ Geriatric inpatients with chronic pain differ from acute pain patients in pain description, pain reduction during treatment, use of analgesics, and emotional distress. Cognitive impairment seems to change the ability to localize acute pain. In our study, the perception of pain intensity was independent of cognition. Because of the small sample size, further studies are needed to confirm these findings. Multiprofessional, intense rehabilitation programs for geriatric patients with chronic pain are considered of prime importance.
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Clinical Trial Controlled Clinical Trial
Epidural and intrathecal analgesia is effective in treating refractory cancer pain.
The use of neuraxial (intrathecal and epidural) analgesia has been suggested in treatment guidelines put forth for the treatment of refractory cancer pain. We review the literature and present our algorithm for using neuraxial analgesia. We also present our outcomes using this algorithm over a 28-month period. ⋯ Oral opioid intake after instituting neuraxial analgesia revealed a significant decrease from 588 mg/day oral morphine equivalents to 294 mg/day. At follow-up, self-reported drowsiness and mental clouding (0-10) also significantly decreased from 6.2 +/- 3.0 and 5.4 +/- 3.4 to 3.2 +/- 3.0 and 3.1 +/- 3.0, respectively. This retrospective review shows promising efficacy of neuraxial analgesia in the context of failing medical management.
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Complex Regional Pain Syndrome (CRPS) is a disorder that can be accompanied by severe pain that is often both chronic and resistant to conventional therapy. Harbut and Correll previously reported the successful treatment of a 9-year case of intractable Type I CRPS with an intravenous inpatient infusion of ketamine in an adult female patient. ⋯ This retrospective review suggests that limited subanesthetic inpatient infusions of ketamine may offer a promising therapeutic option in the treatment of appropriately selected patients with intractable CRPS. More study is needed to further establish the safety and efficacy of this novel approach.
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Review Practice Guideline Guideline
Public policy statement on the rights and responsibilities of health care professionals in the use of opioids for the treatment of pain: a consensus document from the American Academy of Pain Medicine, the American Pain Society, and the American Society of Addiction Medicine.
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We present two cases of cancer patients with intractable mechanical and visceral pain that was unrelieved with either comprehensive medical management or intrathecal morphine who received intrathecal bupivacaine. While the continuous administration of a seemingly significant daily dose neither relieved pain nor caused measurable clinical changes, the addition of small, presumably negligible bolus doses on top of the continuous infusion resulted in spectacular pain control, clear thermoanalgesic suspended block, and in one of the patients, significant hypotension. To the best of our knowledge, such an observation has neither been reported before nor can we provide a satisfactory explanation for it. However, we believe it may have significant implications for the treatment of some patients, in particular, cancer patients with mechanical pain that cannot be adequately relieved with morphine whatever the route of administration.