Pain medicine : the official journal of the American Academy of Pain Medicine
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The present study aimed to assess neuropathic symptoms, their stability over time and relationship to pain intensity, pain distribution, and emotional distress in patients with musculoskeletal disorders. ⋯ Our study demonstrates that neuropathic symptoms are prominent features of chronic musculoskeletal pain and are stable over time. These symptoms were closely related to emotional distress and to the diagnosis of fibromyalgia. The results lend support to the theory that neuropathic symptoms represent an underlying sensitization.
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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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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.
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Randomized Controlled Trial
Intravenous magnesium for complex regional pain syndrome type 1 (CRPS 1) patients: a pilot study.
To explore the feasibility of intravenous magnesium administration as a potential candidate intervention for a large size trial in Complex Regional Pain Syndrome Type 1 (CRPS 1). ⋯ Intravenous magnesium significantly improved pain, impairment and quality of life and was well tolerated. The results of this pilot study are encouraging and suggest that magnesium IV as a treatment in CRPS 1 should be further explored in a large size formal trial design.
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Randomized Controlled Trial
A pilot study investigating the effects of fast left prefrontal rTMS on chronic neuropathic pain.
Stimulating the human cortex using transcranial magnetic stimulation (TMS) temporarily reduces clinical and experimental pain; however, it is unclear which cortical targets are the most effective. The motor cortex has been a popular target for managing neuropathic pain, while the prefrontal cortex has been investigated for an array of nociceptive pain conditions. It is unclear whether the motor cortex is the only effective cortical target for managing neuropathic pain, and no published studies to date have investigated the effects of prefrontal stimulation on neuropathic pain. ⋯ The prefrontal cortex may be an important TMS cortical target for managing certain types of pain, including certain neuropathic pain syndromes.