Pain medicine : the official journal of the American Academy of Pain Medicine
-
Evidence suggests that fibromyalgia (FM) is a centrally mediated pain disorder. Antidepressants, including electroconvulsive therapy, provide some symptomatic relief in FM and other pain disorders. Repetitive transcranial magnetic stimulation (rTMS) is a new antidepressant treatment, which may also be useful in treating chronic pain. ⋯ These preliminary findings suggest a possible role for rTMS in treating FM.
-
A 47-year-old woman who underwent allogenic peripheral blood stem cell transplant developed withdrawal symptoms soon after Fentanyl 25 mcg/h patch was stopped, which has not been reported at this dose. Possible causes, such as the inhibition of CYP3A4 induced by cyclosporine causing elevations of serum fentanyl, are discussed.
-
Comparative Study
Older and younger adults in pain management programs in the United States: differences and similarities.
1) To investigate health status of older (>or=60 years) and younger adults (<60 years) with chronic pain and to separately compare that with existing normative data; and 2) to examine more fully differences in health status between younger and older adults with chronic pain and explore their geographic variation across three multidisciplinary pain programs in the Pacific, Mountain, and New England regions of the United States. ⋯ Older adults with chronic pain differ in a number of important domains from younger adults with chronic pain: overall the former present with greater physical, and less psychosocial impairment.
-
1) To examine recent change in prevalence and Medicare-associated charges for non-invasive/minimally invasive evaluation and treatment of nonspecific low back pain (LBP); and 2) to examine magnetic resonance imaging (MRI) utilization appropriateness in older adults with chronic low back pain (CLBP). ⋯ LBP documentation and diagnostic studies are increasing in Medicare beneficiaries, and evidence suggests that MRIs may often be ordered unnecessarily. Injection procedures appear to account for a significant proportion of LBP-associated costs. More studies are needed to examine the appropriateness with which imaging procedures and non-invasive/minimally invasive treatments are utilized, and their effect on patient outcomes.
-
Two patients experiencing cancer pain with neuropathic components were treated with epidural administration of a mixture of ketamine (1 mg/mL) + morphine (1 mg/mL) + bupivacaine (1 mg/mL) injected daily by epidural port. No serious adverse effect was observed throughout the therapy. The patients were mostly pain-free and have gotten better quality of life during 110- and 48-day follow-up when the therapy was given by epidural route. Low doses of epidural ketamine added to morphine and bupivacaine increase the mean duration of satisfactory analgesia without severe adverse effects and restore quality of life when traditional therapy fails.