Pain medicine : the official journal of the American Academy of Pain Medicine
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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.
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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.
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Clinical Trial
Lidocaine 5% patch: an open-label naturalistic chronic pain treatment trial and prediction of response.
There have been a few open-label nonplacebo reports on the successful use of lidocaine 5% patch (L5P) for other types of pain besides postherpetic neuralgia, such as chronic low back pain. With the these reports, we began to utilize L5P routinely for chronic pain patients (CPPs) with various pain diagnoses. The purpose of this report was to describe the results of a retrospective review of this open-label naturalistic L5P chronic pain treatment trial and to attempt to delineate predictors of perceived clinical response. ⋯ A significant percentage of CPPs exposed to an L5P 3-day naturalistic trial perceived clinical improvement. However, this can only be concluded as an initial effect, and whether or not this effect is attributable to L5P cannot be derived from our data as the effect could have been nonspecific. The apparent CPP perceived clinical improvement was not associated with any particular useful clinical indicator. As such, at present, no variable can be recommended for use in selecting CPPs for such a naturalistic L5P clinical treatment trial. However, this study indicates that such a trial can be useful in selecting CPPs who may perceive benefit from L5P.
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The purpose of this study was to investigate the nature of sleep problems in veterans presenting to a pain clinic, factors that predict likelihood of being prescribed a sleep medication, types of medications prescribed, and the relationships between sleep medication use and sleep quality, pain, and depression. ⋯ Results suggest depression may contribute more significantly to sleep problems than pain-related variables in this population. The data suggest the need for controlled, prospective studies of sleep medication to further investigate the impact of sleep medications on sleep components in patients with chronic pain.
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Comment Letter Case Reports
Universal precautions: a matter of mutual trust and responsibility.