Pain medicine : the official journal of the American Academy of Pain Medicine
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To evaluate the diagnostic usefulness of repeating sacroiliac joint (SIJ) provocative tests post-block. ⋯ Multiple positive pre-block SIJ provocative tests have diagnostic utility however post-block normalization of SIJ provocative tests does not.
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Randomized Controlled Trial
Subcutaneous injection of botulinum toxin a is beneficial in postherpetic neuralgia.
To assess the benefits of subcutaneous injection of botulinum toxin A (BTX-A) for the treatment of postherpetic neuralgia (PHN). ⋯ Subcutaneous administration of BTX-A significantly decreased pain in PHN and reduced opioid use compared with lidocaine and placebo at day 7 and 3 months post-treatment. It also increased subjects' sleep times.
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Randomized Controlled Trial
Safety of multiple-dose intravenous acetaminophen in adult inpatients.
Intravenous (IV) acetaminophen provides rapid and effective analgesia in the postoperative and inpatient settings. The utility and efficacy of acetaminophen is well established; however, due to chronic excessive dosing of over-the-counter acetaminophen products and prescription opioid combination products resulting in the potential for hepatic toxicity, concerns remain about acetaminophen safety. In order to evaluate the safety of IV acetaminophen 1,000mg q6h or 650mg q4h with repeated dosing for 5 days, a randomized, open-label study assessed the safety and tolerability of repeated doses used to treat acute pain or fever in 213 adult inpatients was conducted. ⋯ Consistent with the tolerability and safety results, both treatment groups (1,000mg q6h and 650mg q4h) demonstrated statistically significantly better ratings for the Subject Global Evaluations for the level of satisfaction with side effects related to study treatments as compared with the control group. The findings from this trial support the use of IV acetaminophen as a safe therapy in adult patients.
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Intense acute pain afflicts millions of patients each year. Despite the recently increased focus on the importance of pain control, management of acute pain has remained suboptimal. ⋯ There exists a significant need for effective, well-tolerated analgesic therapies to limit the negative consequences of undermanaged acute pain. The use of multimodal therapy has demonstrated increasing promise and is supported by current practice guidelines.
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Despite the fact that chronic pain and addiction often coexist, few pain training programs offer significant experiential and didactic training in drug abuse and addiction. Similarly, addiction medicine programs often offer little training in pain management. What follows is a review of the intersection between these two specialties from the perspective of clinicians that practice both. ⋯ It is possible to successfully manage patients with coexisting chronic pain and addictive disorders. Addiction medicine and pain management training programs should offer didactic and experiential training in both subspecialties.