Pain medicine : the official journal of the American Academy of Pain Medicine
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Case Reports
A report of 3 soldiers returned to full duty after lumbar radiofrequency facet denervation in a theater of war.
To provide the advanced interventional procedure of zygapophysial joint neurotomy to soldiers meeting the diagnostic criteria in a combat environment and thus reduce medical evacuations of soldiers from a theater of war. ⋯ Medical evacuation from Iraq was prevented and all soldiers returned to rigorous combat duties including the wearing of body armour daily. We believe to be the first to report on the use of RF nerve ablation in a war time setting and with this functional outcome.
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Randomized Controlled Trial
The abuse potential of Remoxy(®), an extended-release formulation of oxycodone, compared with immediate- and extended-release oxycodone.
Remoxy(®) is a water-insoluble, highly viscous oral formulation of oxycodone extended release (ER) currently in development. The primary objective was to determine the abuse potential of Remoxy under fed conditions relative to oxycodone ER and immediate release (IR) under fasted conditions and compared with placebo (treatment group X). A secondary objective was to evaluate abuse potential under reversed fed/fasted conditions (treatment group Y). ⋯ The abuse potential of Remoxy when taken whole or chewed was significantly lower than two comparators with known abuse potential, including oxycodone IR and crushed oxycodone ER, under the fed/fasted conditions tested. Remoxy may be associated with a reduced risk potential for abuse.
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The objective of the study was to develop and begin to evaluate a new measure of the centrality of pain in patients' lives. ⋯ The COPS has excellent internal consistency and construct validity. Additional studies are needed to further validate the scale.
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Failed back surgery syndrome (FBSS) is a chronic pain condition that has considerable impact on the patient and health care system. Despite advances in surgical technology, the rates of failed back surgery have not declined. The factors contributing to the development of this entity may occur in the preoperative, intraoperative, and postoperative periods. Due to the severe pain and disability this syndrome may cause, more radical treatments have been utilized. Recent trials have been published that evaluate the efficacy and cost-effectiveness of therapeutic modalities such as spinal cord stimulation for the management of patients with failed back surgery. ⋯ FBSS is a challenging clinical entity with significant impact on the individual and society. To better prevent and manage this condition, knowledge of the factors contributing to its development is necessary. While research on FBSS has increased in recent years, perhaps the best strategy to reduce incidence and morbidity is to focus on prevention. Patients diagnosed with FBSS should be managed in an interdisciplinary environment. More radical treatments for FBSS have now been extensively studied providing clinicians with much needed evidence on their efficacy. Incorporating these results into our current knowledge provides a basis on which to construct an evidence-based guide on how best to manage patients who suffer from FBSS.
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US soldiers injured in Iraq, and civilian burn trauma patients are treated at the US Army Institute of Surgical Research. Burn patients experience extreme pain during wound care, and they typically receive opioid analgesics and anxiolytics for debridement. Virtual Reality (VR) has been applied as an adjunct to opioid analgesics for procedural pain. We describe the first use of ketamine combined with immersive VR to reduce excessive pain during wound care. ⋯ Results from these first two cases suggest that a moderate dose of ketamine combined with immersive virtual reality distraction may be an effective multimodal analgesic regimen for reducing acute procedural pain during severe burn wound cleaning.