Pain medicine : the official journal of the American Academy of Pain Medicine
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Randomized Controlled Trial
Beneficial effect of amantadine on postoperative pain reduction and consumption of morphine in patients subjected to elective spine surgery.
To analyze the effect of coadministration of morphine and amantadine on postoperative pain reduction and morphine consumption in patients after elective spine surgery. ⋯ Pre- and postoperative administration of amantadine significantly reduced fentanyl use during operation, as well as reduced the postoperative pain and decreased morphine consumption in young patients undergoing orthopedic surgery.
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The aim of this study was to retrospectively review the chart of cancer patients switched to methadone for unfavorable response to the previous opioid. ⋯ Switching to methadone from different opioids, using an initial fixed ratio followed by a flexible dosing, according to the clinical need, is highly effective and safe when performed in an acute pain relief and palliative care unit. Further studies should assess this approach in other settings.
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Randomized Controlled Trial
Management of neuropathic pain with methylprednisolone at the site of nerve injury.
Peripheral nerve blocks with methylprednisolone may provide effective pain therapy by decreasing ectopic neuronal discharge and the release of local inflammatory mediators at the site of nerve injury. In this study, we aimed to compare the efficacy of lidocaine alone with a combination of depo-methylprednisolone plus lidocaine in the management of neuropathic pain due to peripheral nerve damage. ⋯ Our results suggest that peripheral nerve block with 80 mg depo-methylprednisolone plus 0.5% lidocaine provides effective management in the treatment of neuropathic pain due to peripheral nerve damage.
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Although effective alone, opioids are often used in combination with other drugs for relief of moderate to severe pain. Guidelines for acute perioperative pain recommend the use of multimodal therapy for pain management, although combinations of opioids are not specifically recommended. Mu opioid drugs include morphine, heroin, fentanyl, methadone, and morphine 6β-glucuronide (M6G). ⋯ These differences among the drugs raise the question of whether combinations might result in better pain relief with fewer side effects. This concept has already been demonstrated between two mu opioids in preclinical studies and clinical trials on other combinations are ongoing. This article reviews the current state of knowledge about mu opioid receptor pharmacology, summarizes preclinical evidence for synergy from opioid combinations, and highlights the complex nature of the mu opioid receptor pharmacology.
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Randomized Controlled Trial
Addressing both depression and pain in late life: the methodology of the ADAPT study.
To describe the methodology of the first NIH-funded clinical trial for seniors with comorbid depression and chronic low back pain. ⋯ The results of this trial will inform the care of these complex patients and further understanding of comorbid pain and depression in late life.