Pain medicine : the official journal of the American Academy of Pain Medicine
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Randomized Controlled Trial
Efficacy of a metered-dose 8% lidocaine pump spray for patients with post-herpetic neuralgia.
Topical lidocaine patch is effective in the treatment of post-herpetic neuralgia (PHN), but not suited for paroxysmal pain because of the long latency of analgesia. Here, we examined the efficacy of 8% lidocaine pump spray (Xylocaine pump spray, XPS) for PHN. ⋯ In both studies, XPS provided a significant improvement in PHN due to its prompt analgesia, lack of systemic side effects, and convenience of use.
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The number of opioid analgesic prescriptions has increased since 1990. Opioids are being prescribed for longer periods of time for both cancer- and noncancer-associated moderate to severe chronic pain. Concurrent with the increased prescribing of opioids has been an increase in their diversion from prescribed use and their abuse; frequently, this abuse occurs after the opioid analgesic has been physically or chemically manipulated to increase the concentration or bioavailability of the active ingredient. ⋯ However, none of these formulations are currently commercially available in the United States. This paper describes the formulations now under development and their potential clinical utility and impact on society. These emerging opioid formulations designed to reduce the risk of misuse and/or abuse may be useful to physicians in meeting the important goals of maximizing pain relief and minimizing prescription opioid abuse.
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Review
Current risk assessment and management paradigms: snapshots in the life of the pain specialist.
Opioid analgesics can be a safe and effective treatment option for patients with chronic pain, but issues surrounding their use-including side effects, tolerance, and the potential for misuse and diversion-prompt some clinicians to avoid using these agents, and can lead to the continued undertreatment of pain. This article offers practical advice to clinicians who choose to prescribe opioid analgesics. Through a series of case presentations, it illustrates the steps health care providers can take to prepare their practice for opioid prescribing, assess and select patients for opioid treatment, initiate and manage therapy, and address concerns about aberrant behaviors.
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Pain syndromes are prevalent among older individuals and generally increase in incidence as the population ages. Yet, pain often is undertreated in older patients, sometimes due to difficulties in assessing pain intensity and the effectiveness of treatment in the context of age-related cognitive impairment and physiologic changes. As a result, older patients with chronic pain conditions are more likely to experience greater functional limitations and decreased quality of life due to these and other barriers to appropriate care. This article discusses the epidemiology, assessment, and management of pain in older adults, and reviews special issues in the treatment of this population, such as adverse effects due to changes in drug metabolism and drug-drug interactions.
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Review Meta Analysis
Do opioids induce hyperalgesia in humans? An evidence-based structured review.
DESIGN/OBJECTIVES: Consistent rodent evidence indicates that opioid exposure will decrease the rodent's pain threshold (ptr). This is termed opioids-induced hyperalgesia (OIH). Currently, the consistency of the evidence for the occurrence of OIH in humans is unclear. This is a structured evidence-based review for all levels of evidence (all studies and case reports) on OIH in humans in order to determine the consistency of this evidence. ⋯ There is not sufficient evidence to support or refute the existence of OIH in humans except in the case of normal volunteers receiving opioid infusions. Prospective CPP clinical studies measuring ptrs and tolerances pre- and post-opioid placement with CPP non-opioid control groups are required.