Pain medicine : the official journal of the American Academy of Pain Medicine
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Opioids can be a safe and effective option for carefully selected patients with a structured treatment program that includes consistent monitoring. However, the benefits and risks of opioid therapy for patients with chronic pain, and society as a whole, have been sharply debated. A key component of this debate has involved the administration of rapid-onset opioids for the management of breakthrough pain. ⋯ Fentanyl buccal tablet can be an effective and generally safe treatment for breakthrough pain when appropriate patient selection, administration, dosing, and monitoring are applied.
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Randomized Controlled Trial
painACTION-back pain: a self-management website for people with chronic back pain.
To determine whether an interactive self-management Website for people with chronic back pain would significantly improve emotional management, coping, self-efficacy to manage pain, pain levels, and physical functioning compared with standard text-based materials. ⋯ An online self-management program for people with chronic back pain can lead to improvements in stress, coping, and social support, and produce clinically significant differences in pain, depression, anxiety, and global rates of improvement.
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To describe characteristics of older adults who received opioids for chronic non-cancer pain (CP), ascertain types of opioid treatments received, and examine associations between patient characteristics and treatment outcomes. ⋯ Over 50% of older patients with CP tolerated treatment. Treatment was discontinued in 48% of cases, mostly due to side effects and lack of analgesic efficacy. Efforts are needed to establish the long-term safety and efficacy of opioid treatment for CP in diverse older patient populations.
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Case Reports
Intrathecal granuloma formation in a patient receiving long-term spinal infusion of tramadol.
Intrathecal granuloma associated to the tip of subarachnoid catheters implanted in patients receiving long-term spinal infusion is a rare but potentially catastrophic complication. Its development seems to be related to the intrathecal administration of opioid drugs, although not all opioids induce granuloma formation with the same frequency. ⋯ Chronic intrathecal administration of high-dose tramadol could cause an inflammatory mass as it can be caused by similar, off-label infusions of morphine or hydromorphone. Additionally, tramadol stimulates the activity of natural killers and the proliferation of lymphocytes.