Pain medicine : the official journal of the American Academy of Pain Medicine
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The Screener and Opioid Assessment of Pain Patients (SOAPP v.1) has been shown to be a reliable measure of risk potential for substance misuse and to correlate with a history of substance abuse, legal problems, craving, smoking, and mood disorders among chronic pain patients. The aim of this study was to examine differences over time on a number of measures among chronic pain patients who were classified as high or low risk for opioid misuse based on scores on the SOAPP. ⋯ Differences in subjective pain intensity were found between those who are high risk for opioid misuse compared with those at low risk for medication misuse, implying that higher-risk patients may experience more subjective pain. Consequently, these patients may be more challenging to treat.
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Case Reports
Direct placement of a brachial plexus neural catheter for analgesia after traumatic upper limb amputation.
We report a case of traumatic upper limb injury that resulted in above elbow amputation. A multimodal approach was employed to optimize postoperative analgesia; this included continuous peripheral nerve blockade, initiated intraoperatively. ⋯ The pathophysiology of phantom pain is related to our case experience. This report highlights the complex challenge of controlling pain in combat casualties and promotes employment of multimodal analgesic strategies, including advanced regional anesthesia, in the military setting.
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To successfully treat a patient with complex regional pain syndrome, refractory to standard therapy, to enable a rapid and full return to professional duties. ⋯ This case suggests therapeutic benefit from aggressive treatment of both the peripheral and central components of CRPS.
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The number of opioid analgesic prescriptions has increased since 1990. Opioids are being prescribed for longer periods of time for both cancer- and noncancer-associated moderate to severe chronic pain. Concurrent with the increased prescribing of opioids has been an increase in their diversion from prescribed use and their abuse; frequently, this abuse occurs after the opioid analgesic has been physically or chemically manipulated to increase the concentration or bioavailability of the active ingredient. ⋯ However, none of these formulations are currently commercially available in the United States. This paper describes the formulations now under development and their potential clinical utility and impact on society. These emerging opioid formulations designed to reduce the risk of misuse and/or abuse may be useful to physicians in meeting the important goals of maximizing pain relief and minimizing prescription opioid abuse.