Pain medicine : the official journal of the American Academy of Pain Medicine
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Prescription opioid abuse is a major public health problem in the United States. Physicians who prescribe opioid analgesics are sometimes confronted with patients who request early refills, claiming that they have been "shorted" by their pharmacy. While a substantial differential diagnosis exists for apparent opioid overuse, the underfilling of opioid prescriptions at the level of retail pharmacies has not yet been systematically investigated. ⋯ There was no evidence supporting patients' claims of significant opioid analgesic underfilling by retail pharmacies. Patients who repeatedly report medication shortages should be evaluated for opioid use disorders.
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To develop and evaluate a clinical decision support system (CDSS) named Assessment and Treatment in Healthcare: Evidenced-Based Automation (ATHENA)-Opioid Therapy, which encourages safe and effective use of opioid therapy for chronic, noncancer pain. ⋯ Usability testing optimized the CDSS to better address barriers such as lack of provider education, confusion in dosing calculations and titration schedules, access to relevant patient information, provider discontinuity, documentation, and access to validated assessment tools. It also highlighted barriers to good clinical practice that are difficult to address with CDSS technology in its current conceptualization. For example, clinicians indicated that constraints on time and competing priorities in primary care, discomfort in patient-provider communications, and lack of evidence to guide opioid prescribing decisions impeded their ability to provide effective, guideline-adherent pain management. Iterative testing was essential for designing a highly usable and acceptable CDSS; however, identified barriers may limit the impact of the ATHENA-Opioid Therapy system and other CDSS on clinical practices and outcomes unless CDSS are paired with parallel initiatives to address these issues.
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Chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) is of significant interest in urology and unfortunately, the therapy modalities recommended are not fully effective. Therefore, we undertook a pilot study to determine whether acupuncture improves the pain, voiding symptoms, and quality of life in men with category IIIB CP/CPPS. ⋯ The results of this study suggest that acupuncture appears to be a safe and potentially effective treatment in improving the symptoms and quality of life of men clinically diagnosed with CP/CPPS.
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Randomized Controlled Trial
Effects of intravenous prostaglandin E1 on pain and body temperature in patients with post-herpetic neuralgia.
Bathing, heating, or sympathetic blockade often alleviates pain due to post-herpetic neuralgia (PHN), suggesting that blood flow may affect PHN pain. Here, we examined the effect of prostaglandin E1 (PGE), which improves blood circulation, on pain and body temperature in patients with PHN. ⋯ Intravenous infusion of PGE produces analgesia associated with elevation of skin temperature in patients with PHN.