Pain medicine : the official journal of the American Academy of Pain Medicine
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To examine the predictive value of physician's prognosis after patient's first visit to a pain specialty clinic. ⋯ Physician's pessimistic evaluation of patient's prognosis after the first visit was longitudinally associated with an increase in depression and in the affective dimension of pain over time, but not with changes in the sensory component of pain. Referring to physician pessimism as a marker for pre-depressed patient may lead to early preventive interventions.
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Comparative Study
Substitution of gabapentin therapy with pregabalin therapy in neuropathic pain due to peripheral neuropathy.
To determine the utility of substitution of pregabalin (PGB) for gabapentin (GBP) therapy in the relief of neuropathic pain (NeP) in patients with peripheral neuropathy (PN). ⋯ Randomized, controlled, blinded head-to-head studies of GBP and PGB have not been published. The results of this open-label assessment of PGB substitution for GBP suggest that PGB may provide additional pain relief and possible improvement in quality of life above that received by GBP use in patients with NeP due to PN.
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Ganglion impar block is an uncommon procedure that has been performed traditional with fluoroscopy. One approach is the trans-sacrococcygeal approach. Sometimes this can be difficult because the sacrococcygeal joint (SCJ) cannot be readily seen on anteroposterior (AP) and lateral fluoroscopy. This technical report describes the feasibility of ultrasound in assisting ganglion impar blocks. ⋯ In cases where the cleft cannot be readily seen on AP and lateral fluoroscopy, we have found ultrasound to be of assistance. Ultrasound does not replace fluoroscopy, because lateral fluoroscopy is still required to establish safe depth, and correct site of injection. However, ultrasound can be helpful when fluoroscopy alone is insufficient.
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Opioid/acetaminophen combination products are widely prescribed for the management of moderate to moderately severe pain. Acetaminophen, when improperly used, can lead to liver damage and even acute liver failure. ⋯ The FDA advisory committee reviewed numerous observational studies and adverse event reporting data. The aims of this article are to: 1) provide a summary and epidemiologic critique of the studies and evidence the FDA advisory committee reviewed; 2) examine the potential consequences, such as poorly managed pain or a shift to treatment with other medications with greater potential toxicity and/or restricted availability, if the FDA follows the advisory committee vote; and 3) outline alternate strategies the FDA should consider for reducing hepatotoxicity associated with opioid/acetaminophen combination products.