Pain medicine : the official journal of the American Academy of Pain Medicine
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Case Reports
Successful treatment of refractory postherpetic neuralgia with topical gallium maltolate: case report.
Postherpetic neuralgia is a common sequela of herpes zoster (shingles), in which chronic pain may last for weeks to years. Currently, available treatments include systemic opioid analgesics, tricyclic antidepressants, corticosteroids, and anticonvulsants, as well as topical capsaicin and lidocaine. These treatments are commonly unsatisfactory, with fewer than half of treated patients experiencing more than a 50% reduction in pain. ⋯ Gallium has significant anti-inflammatory activity, inhibiting the activation and proliferation of pro-inflammatory T cells. Because gallium is chemically similar to zinc, it can interfere with the activity of matrix metalloproteinases (zinc-bearing proteases), which have been implicated in the etiology of neuropathic pain, and it may suppress the secretion of substance P. Gallium may also inhibit viral replication and the inflammatory activity of viral proteins. This case provides rationale to study topical gallium maltolate in patients with refractory peripheral neuropathic pain.
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Letter Case Reports
Methemoglobinemia in the setting of chronic transdermal lidocaine patch use.
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Randomized Controlled Trial
Efficacy of a 0.1% capsaicin hydrogel patch for myofascial neck pain: a double-blinded randomized trial.
The objective of this study was to evaluate the efficacy of a hydrogel patch containing capsaicin 0.1% compared with a placebo hydrogel patch without capsaicin to treat chronic myofascial neck pain. ⋯ Future research may help to discern specific effects of capsaicin, trigger point stimulation by application of the patch, and the placebo effect.
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The primary goal of this investigation was to survey military health care professionals at a Camp Bastion, Afghanistan, regarding their perceptions of care delivered by an anesthesiologist-directed acute pain service (APS) at a British Combat Support Hospital (CSH)-Role 3. ⋯ Overall, the majority of military health care survey responders indicated support for an APS team as part of a CSH care, and confirmed its contributions to improving trauma care.
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Tonsillectomy is one of the most commonly done surgical procedures in children. There are many unreported deaths following tonsillectomy in children due to opioids. Genetic variations in liver microenzyme, CYP2D6, had been associated with some of the deaths. ⋯ Ultrarapid metabolizers and some extensive metabolizers of CYP2D6 relatively produce more active opioid metabolites resulting in life-threatening adverse effects, especially in young children. Young and obese children with history of sleep apnea are at higher risk of developing serious opioid-related respiratory depression. The adverse outcomes can be avoided and the safety of pain management can be improved by CYP2D6 genetic testing before prescribing these opioids or by using alternative analgesics.