Pain medicine : the official journal of the American Academy of Pain Medicine
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Randomized Controlled Trial
Pain Among Community-Dwelling Older Adults with Dementia: Factors Associated with Undertreatment.
To identify factors associated with no analgesic treatment in community-dwelling older adults with mild-to-moderate dementia and moderate-to-severe pain. ⋯ The initiation of analgesic trials is complicated for individuals with dementia and comorbid pain and depressive symptomology. Future research should focus on identifying the most effective assessment and treatment procedures to best direct clinical care for this population.
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To assess the effectiveness of local anesthesia, delivered via elastomeric pump to manage pain in patients undergoing cardiothoracic surgery. ⋯ The use of elastomeric pumps in patients undergoing cardiothoracic surgery for reducing postoperative opioid consumption and pain may not be as beneficial as previously reported.
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Chronic pain is a significant health problem strongly associated with a wide range of physical and mental health problems, including addiction. The widespread prevalence of pain and the increasing rate of opioid prescriptions have led to a focus on how physicians are educated about chronic pain. This critical scoping review describes the current literature in this important area, identifying gaps and suggesting avenues for further research starting from patients' standpoint. ⋯ The findings highlight significant discrepancies between the prevalence of chronic pain in society and the low priority assigned to educating future physicians about the complexities of pain and the social context of those afflicted. This suggests the need for better pain education as well as attention to the "hidden curriculum."
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To investigate the prevalence of chronic pain and opioid management among patients with chronic kidney disease (CKD). ⋯ Based on a systematic review of the current literature, there is fair evidence for the high prevalence of chronic pain among patients with CKD, which is not being effectively managed, probably due to underprescription of analgesics or opioids in the CKD population. Clinicians are in need of additional and well-designed randomized control trials that focus on the indications for opioid therapy, appropriate opioid doses and dosing intervals, outcomes with adequacy of symptom control, and reporting on the incidence of adverse side effects.
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Methylnaltrexone, a peripherally acting µ-opioid receptor antagonist, alleviates opioid-induced constipation. Understanding its long-term safety and efficacy profile in patients with chronic noncancer pain is warranted given the persistence of opioid-induced constipation. ⋯ Change from baseline in mean weekly bowel movement rate, Bowel Movement Straining Scale score, Bristol Stool Scale score, and mean percentage of patients with complete evacuation from baseline to week 48 were significantly improved ( P < 0.001 for all). Long-term subcutaneous methylnaltrexone was well tolerated, with no new safety concerns, and provided consistent opioid-induced constipation relief in patients with chronic noncancer pain.