Pain medicine : the official journal of the American Academy of Pain Medicine
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New treatment options for diabetic peripheral neuropathic pain (DPNP) have recently been developed, including two Food and Drug Administration (FDA) approved agents, duloxetine and pregabalin. As clinicians face a broader spectrum of efficacious treatments, side-effect profiles play an increasingly important role in the development of a pain management regimen. In this article we review the safety profile of agents commonly used in the treatment of DPNP.
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Our case will demonstrate a safe and practical alternative location for an implantable drug delivery system (IDDS) pump. Traditionally, these pumps have been placed subcutaneously in the lower abdomen. We will describe the technique used for under the breast placement. ⋯ The retromammary location for the IDDS pump is a safe and aesthetically pleasing option for some patients. This location is a useful alternative for female cachectic patients, or patients with abdominal ostomies.
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Randomized Controlled Trial Multicenter Study
Duloxetine for the management of diabetic peripheral neuropathic pain: evaluation of functional outcomes.
To assess the effectiveness of duloxetine, compared with placebo, on patient-reported health outcomes over a 12-week period, in the management of diabetic peripheral neuropathic pain (DPNP). ⋯ Acute treatment with duloxetine was associated with significant improvement in functional outcomes in persons with DPNP.
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In several high profile prosecutions of physicians for prescribing opioids, prosecutors claimed that the doctors should have known the individuals were feigning pain solely to obtain the prescriptions. This study was to determine how readily physicians can tell that patients lie. ⋯ Deception is difficult to detect. In the current legal climate surrounding prescribing opioids, accepting patients' reports of pain at face value can have significant legal consequences for the doctor. While doctors must make every reasonable effort to confirm the diagnosis and need for opioid therapy, allowance must be made for the fact that conscientious doctors can be deceived.