Pain medicine : the official journal of the American Academy of Pain Medicine
-
This article reviews the literature on patient-provider interactions among patients with chronic pain conditions with an emphasis on shared medical decision making. ⋯ Treatment of chronic pain is often complex and may be further complicated when patients and health care providers have differing goals and attitudes concerning treatment. Difficulties in engaging in collaborative treatment decision making may result. Efforts to enhance patient-provider communication as well as to systematically examine nonspecific treatment factors are likely to promote effective management of chronic pain.
-
To review major clinical issues related to recognition and diagnosis of breakthrough pain. ⋯ Greater knowledge and awareness of BTP in cancer and nonmalignant conditions will lead to improved recognition and diagnosis of BTP and ultimately to more effective treatment and enhanced quality of life for these patients.
-
Clinical Trial
Assessment of dosing frequency of sustained-release opioid preparations in patients with chronic nonmalignant pain.
Many patients with moderate to severe chronic nonmalignant pain require dosing of long-acting opioids more frequently than recommended by the product's manufacturer. To accurately quantitate opioid dosing in clinical practice, daily dosing was prospectively assessed in pain clinic patients. ⋯ Many patients taking common long-acting opioids for chronic nonmalignant pain require dosing more frequently than recommended by product labeling, and take an additional 3-4 daily doses of rescue opioid, yet they continue to report moderate to severe pain. Newer opioid formulations that can provide sustained analgesia with convenient dosing are needed as well as a better understanding of the many additional factors that may influence opioid use patterns in patients with chronic pain.
-
Meta Analysis
Targeted pharmacotherapy of evoked phenomena in neuropathic pain: a review of the current evidence.
Evoked phenomena in clinical neuropathic pain are viewed as a window into the underlying pathophysiology. They are also potential therapeutic targets. This study sought evidence for the effect on such evoked phenomena of currently used agents. ⋯ There is minimal evidence to guide clinicians in treating evoked pain phenomena in clinical neuropathic pain states. There is little clinical evidence to either support or refute theoretical arguments for efficacy of specific agents in evoked neuropathic pain phenomena. More and larger trials are needed to examine these phenomena. Consensus is required with respect to methods used to elicit these evoked phenomena.
-
Randomized Controlled Trial Clinical Trial
Effect of local administration of transdermal fentanyl on peripheral opioid analgesia.
Transdermal fentanyl is a commonly used analgesic for the treatment of severe chronic pain. Recent investigations have shown the presence of mu-opioid receptors in the skin and opioid analgesic efficacy with alternative routes of administration of narcotics. This placebo-controlled, double-blind prospective study assessed whether transdermal fentanyl administration produces local peripheral opioid analgesia at the site of application. ⋯ These results suggest that the application of transdermal fentanyl patch for a period of 2 h does not produce local peripheral opioid analgesia at the site of patch application.