Pain medicine : the official journal of the American Academy of Pain Medicine
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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.
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Case Reports
Successful use of gabapentin in acute pain management following burn injury: a case series.
Pain after burn injury has multiple qualities, including neuropathic and hyperalgesic elements. This element of the burn patients' pain experience is frequently difficult to manage and contributes significantly to their suffering. The onset may be either immediate or delayed. ⋯ Conclusions. This case series introduces the use of gabapentin as a potentially important therapy in the management of neuropathic pain following burn injury. Further research is required to define the use of gabapentin in this specific setting.
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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.
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To identify and characterize methadone-related drug interactions, as well as factors accounting for the variability in manifesting these interactions clinically. ⋯ Drug interactions associated with methadone and their clinical significance are still poorly understood in general. Many tertiary drug information references and review articles report interactions associated with methadone in a general sense, much of which is theoretical and not verified by case reports, much less well-designed clinical trials. The majority of drug interaction reports that do exist were performed in the MMT population, which may differ significantly from chronic pain or cancer pain populations.
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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.