Pain medicine : the official journal of the American Academy of Pain Medicine
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To identify and characterize methadone-related drug interactions, as well as factors accounting for the variability in manifesting these interactions clinically. ⋯ Drug interactions associated with methadone and their clinical significance are still poorly understood in general. Many tertiary drug information references and review articles report interactions associated with methadone in a general sense, much of which is theoretical and not verified by case reports, much less well-designed clinical trials. The majority of drug interaction reports that do exist were performed in the MMT population, which may differ significantly from chronic pain or cancer pain populations.
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Multicenter Study Clinical Trial
Open-label, multicenter study of combined intrathecal morphine and ziconotide: addition of morphine in patients receiving ziconotide for severe chronic pain.
To assess the safety and efficacy of adding intrathecal morphine to intrathecal ziconotide in patients treated with stable ziconotide doses. ⋯ Intrathecal morphine, combined with stable intrathecal ziconotide doses, reduced pain in patients with previously suboptimal pain relief on ziconotide monotherapy.
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Radiofrequency denervation of the zygapophysial (facet) joint is a frequently performed procedure for chronic low back pain. Several studies have shown considerable efficacy of the procedure, but none of the randomized controlled trials performed to date has used anatomically correct placement of radiofrequency cannula parallel to the target nerve. Three main techniques have been utilized for many years: North American, European, and Australian. Each has conceptual and technical limitations. This review analyzes these techniques and proposes a standardized technique of radiofrequency denervation of lumbar zygapophysial joints. ⋯ We believe that the technique using "tunnel vision" with anatomically appropriate cannula placement and use of a large-bore, curved needle with a 10-mm active tip may improve the results of radiofrequency denervation of lumbar zygapophysial joints. Providing a detailed description of an anatomically accurate technique should be of value to those seeking to perform this procedure in a valid manner.
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This study was conducted to examine the psychometric properties of a Chinese translation of the Pain Catastrophizing Scale (HK-PCS). ⋯ This study has illustrated satisfactory psychometric properties of the HK-PCS. We provide evidence for the validity and reliability of the HK-PCS as an instrument for measuring pain catastrophizing in the Chinese patient with chronic pain.
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Case Reports
An N-of-1 trial as an aid to decision-making prior to implanting a permanent spinal cord stimulator.
Limited evidence supports the efficacy of spinal cord stimulation (SCS). Therefore, it is crucial to assess the usefulness of this invasive procedure before implanting permanent electrodes in each patient. An N-of-1 trial is an experiment in which a single participant undergoes periods of comparative treatments. We illustrate how an N-of-1 trial design may permit clinicians to conduct such an assessment in an individual patient. ⋯ We encourage clinicians to perform an N-of-1 trial in every patient before implanting permanent electrodes for SCS.