Pain medicine : the official journal of the American Academy of Pain Medicine
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Randomized Controlled Trial Multicenter Study
A double-blind, randomized, placebo-controlled comparison of botulinum toxin type a injection sites and doses in the prevention of episodic migraine.
Several randomized, controlled studies have reported benefits of botulinum toxin type A (BoNTA; Allergan Inc., Irvine, CA, USA) over placebo in the treatment of migraine. Some studies reported significant benefits at dosages as low as 16 U, while other studies reported safety, tolerability, and efficacy at dosages up to 260 U. However, the optimal treatment paradigm and patient population have yet to be defined. ⋯ In this exploratory study of episodic migraine patients, low-dose injections of BoNTA into the frontal, temporal, and/or glabellar muscle regions were not more effective than placebo. BoNTA was safe and well tolerated. Future studies may examine higher BoNTA doses, flexible injection sites, multiple treatments, and disallow concomitant prophylactic medications.
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Randomized Controlled Trial Multicenter Study
An open-label 52-week clinical extension comparing duloxetine with routine care in patients with diabetic peripheral neuropathic pain.
To assess the safety of duloxetine at a fixed-dose of 60 mg twice daily (BID) for up to 52 weeks, and compare duloxetine with routine care in the management of patients with diabetic peripheral neuropathic pain (DPNP). ⋯ The results of this study provide support for the use of duloxetine in the long-term management of DPNP.
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Chronic, neuropathic pain may be secondary to myriad etiologies including diabetic peripheral neuropathy and fibromyalgia. It is a debilitating condition that imposes a significant burden on individuals and society alike. This article will review various instruments designed to assess quality of life (QoL) and key data assessing QoL of patients suffering from these diseases as well as currently available pharmacologic agents for symptomatic management. As basic and clinical science progress over the next few years, along with the introduction of novel pharmacologic agents, we anticipate greater potential for pain intervention and improvement in the quality of life of our patients.
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Review Meta Analysis
Epidemiology, public health burden, and treatment of diabetic peripheral neuropathic pain: a review.
The literature examining the epidemiology, quality of life burden, cost, and treatment of diabetic peripheral neuropathy pain (DPNP) in U.S. adults was reviewed. ⋯ This review of DPNP identifies gaps in the literature and highlights the need for further study. The establishment of a consistent definition and diagnostic code for DPNP would improve ability to collect data and understand the impact of DPNP on patients and the health care system. Well-designed, prospective studies are needed to better define the epidemiology and public health burden of DPNP.
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Randomized Controlled Trial Multicenter Study
Use of the Synera patch for local anesthesia before vascular access procedures: a randomized, double-blind, placebo-controlled study.
This randomized, double-blind, placebo-controlled, paired study compared the Synera patch, a drug delivery device comprised of an eutectic mixture of lidocaine (70 mg) and tetracaine (70 mg) whose onset is accelerated by a controlled heating device, with placebo. The objective of the study was to evaluate the efficacy of Synera in inducing local anesthesia before a vascular access procedure. ⋯ A 20-minute application of Synera consistently provided clinically useful anesthesia for vascular access procedures, and appears to be well suited for topical dermal anesthesia due to its reduced time required to produce adequate anesthesia and high subject and investigator acceptance.