Pain medicine : the official journal of the American Academy of Pain Medicine
-
Pain can persist long after the resolution of herpes zoster, but little is known regarding its health care costs. The objective of this study was to determine the health care expenditures associated with persisting pain following herpes zoster by comparing expenditures for patients with postherpetic neuralgia or subacute herpetic neuralgia with a control group without these conditions. ⋯ The substantial health care costs associated with persisting pain in herpes zoster have important public health implications given evidence that the incidence of herpes zoster is increasing and that the population is aging in the United States. The results provide a basis for evaluating the cost-effectiveness of existing treatments and emerging prevention strategies.
-
Case Reports
MMTP patients with chronic pain switching to pain management clinics. A problem or an acceptable practice?
Among the many patients served by methadone maintenance treatment programs (MMTPs) is a small population with severe, refractory pain that may be effectively managed using long-term opioid therapy. Pain specialists have begun to treat these patients, and in some cases, methadone has been selected as the opioid analgesic administered for pain management. ⋯ We present four patients who illustrate different outcomes associated with one challenging scenario, specifically the expressed desire on the part of the patient to withdraw from the MMTP because the opioid has become available for pain. Research is needed to evaluate the phenomenology of pain and addiction in this population and the outcomes associated with varied therapeutic strategies.
-
Age-related patterns in postoperative pain are unclear with reports of no age differences and less pain with age. The objective of this study was to identify correlates of pain and intravenous patient-controlled analgesia (i.v. PCA) morphine use in younger and older patients. ⋯ The correlates of postoperative pain and morphine use may differ with age, and the same factor may have different effects across age groups. Research is needed into the mechanisms of these age-specific profiles.
-
Cutaneous application of menthol in healthy subjects induces cold allodynia via sensitization of cold-sensitive nociceptors. We investigated the effects of menthol on preexisting cold allodynia in patients to test whether the allodynia was exacerbated. ⋯ These results suggest that, unlike in controls, menthol is not more hyperalgesic, but may be analgesic in some patients with peripheral and central neuropathic pain.
-
To assess the safety and efficacy of adding intrathecal ziconotide to intrathecal morphine in patients being treated with a stable intrathecal morphine dose. ⋯ Ziconotide, combined with stable intrathecal morphine, may reduce pain and decrease systemic opioid use in patients with pain inadequately controlled by intrathecal morphine alone.