Pain medicine : the official journal of the American Academy of Pain Medicine
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Ketamine, noncompetitive antagonist of N-methyl-D-aspartate (NMDA) receptors, has been used in the treatment of chronic neuropathic pain for almost 15 years. The aim of the study was to describe and evaluate side effects of this drug in the group of 32 patients with diabetic polyneuropathy and with postherpetic neuralgia. ⋯ Ketamine is evaluated as a nonoptimal, however, available NMDA blocker suitable for clinical use. Studying its effects in clinics can be expected to increase our knowledge necessary for the development of new, effective, and safe "antineuralgic drug."
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The purpose of this study was to document particulate size in commonly used corticosteroid preparations. Inadvertent injection of particulate corticosteroids into a vertebral or foraminal artery can cause brain and spinal cord embolic infarcts and the size of the particles could be directly related to the chance that a clinically significant infarct would occur. One might assume that corticosteroids with particles significantly smaller than red blood cells might be safer. ⋯ Compared with the particulate steroid solutions, dexamethasone sodium phosphate had particles that were significantly smaller than red blood cells, had the least tendency to aggregation, and had the lowest density. These characteristics should significantly reduce the risk of embolic infarcts or prevent them from occurring after intra-arterial injection. Until shown otherwise in clinical studies, interventionalists might consider using dexamethasone or another corticosteroid preparation with similar high solubility and negligible particle size when performing epidural injections.
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Pain is poorly understood on a population level. This study provides updated estimates of the prevalence, location, severity, and impact of pain in a U.S. community and discusses current definitions of "chronic" pain. ⋯ The prevalence of chronic pain is high, often in more than one location, and over 21% of chronic pain sufferers report dissatisfaction with current care.
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Randomized Controlled Trial
A randomized double-blind placebo-controlled study of low-dose intravenous Lorazepam to reduce procedural pain during bone marrow aspiration and biopsy.
To evaluate the efficacy of intravenous lorazepam as premedication for bone marrow aspiration and biopsy (BMAB). ⋯ Intravenous lorazepam was safe in patients undergoing BMAB and was more effective than placebo in enhancing cooperation during BMAB and willingness to undergo another procedure. However, use of lorazepam 1 mg provided no reduction in the pain associated with BMAB. Further studies should focus on providing appropriate analgesia for this potentially painful procedure.
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The primary aim of this pilot investigation was to identify structural brain differences in older adults with chronic low back pain (CLBP) as compared with pain-free individuals. ⋯ Older adults with CLBP have structural brain changes in the middle CC, middle cingulate WM, and the GM of the posterior parietal cortex as well as impaired attention and mental flexibility. Additional investigation is needed to corroborate and extend these findings and more clearly elucidate their relationship to physical function and the risk of disability.