Pain medicine : the official journal of the American Academy of Pain Medicine
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Review Meta Analysis
Time to take stock: a meta-analysis and systematic review of analgesic treatment disparities for pain in the United States.
The recent Institute of Medicine Report assessing the state of pain care in the United States acknowledged the lack of consistent data to describe the nature and magnitude of unrelieved pain and identify subpopulations with disproportionate burdens. ⋯ Our study quantifies the magnitude of analgesic treatment disparities in subgroups of minorities. The size of the difference was sufficiently large to raise not only normative but quality and safety concerns. The treatment gap does not appear to be closing with time or existing policy initiatives. A concerted strategy is needed to reduce pain care disparities within the larger quality of care initiatives.
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Randomized Controlled Trial Multicenter Study Comparative Study
Efficacy and safety of dextromethorphan/quinidine at two dosage levels for diabetic neuropathic pain: a double-blind, placebo-controlled, multicenter study.
To evaluate dextromethorphan coadministered with quinidine as treatment of diabetic peripheral neuropathic pain. ⋯ Throughout a 13-week trial, DMQ was effective, with an acceptable safety profile, for treatment of DPN pain. Other fixed-dose combinations of DMQ should be studied to improve overall tolerability while maintaining significant efficacy.
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Comparative Study
The impact of sexual or physical abuse history on pain-related outcomes among blacks and whites with chronic pain: gender influence.
Physical and sexual abuses commonly co-occur with chronic pain. We hypothesized that: 1) abuse history questions would form distinct factors that relate differently to pain perceptions and pain outcomes; 2) abuse history consequences on physical and mental health differ by gender; and 3) different abuse types and age of occurrence (childhood vs adolescent/adulthood) predict different negative outcomes. ⋯ Our study confirms physical and mental health, and pain-related outcomes are affected by abuse history for men and women. These results support screening all patients for abuse to improve the survivor's overall health and well-being.
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Case Reports
Sternal kyphoplasty for metastatic lung cancer: image-guided palliative care, utilizing fluoroscopy and sonography.
Skeletal metastases can cause severe pain and functional impairment, secondary to direct invasion or osteolysis. Direct palliation of these metastases can reduce the burden of pain. Surgical excision or radiotherapy has been used to target these tumors. ⋯ Ultrasound imaging was used with fluoroscopy. Reproducibility, by other providers, is imperative with any emerging technique; this will facilitate wider patient access and device innovation. Hopefully, future multicenter trials will validate the efficacy and safety of this technique.
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Comparative Study
An in vivo canine study to assess granulomatous responses in the MedStream Programmable Infusion System (TM) and the SynchroMed II Infusion System®.
A rare, but consistently reported complication of intrathecal (IT) delivery of opioids via programmable implantable infusion pumps is aseptic granuloma formation around the tip of the IT catheter. In the current study, the incidence and severity of IT granuloma formation was assessed for the MedStream Programmable Infusion and SynchroMed II Infusion pumps when delivering saline, baclofen, or morphine at varying concentrations and daily doses. ⋯ In this in vivo canine model of IT drug delivery, catheter tip granuloma formation was associated with higher concentrations and daily doses of morphine infusion while none were seen with baclofen or saline, and was not associated with catheter type. For both pumps, granulomas were only produced in the presence of morphine infusion. These results suggest that the MedStream Programmable Infusion System has a granuloma safety profile at least equivalent to that of the SynchroMed II pump.