Pain medicine : the official journal of the American Academy of Pain Medicine
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Comparative Study
The effects of transdermal fentanyl on driving, cognitive performance, and balance in patients with chronic nonmalignant pain conditions.
To evaluate driving performance, cognition, and balance in patients with chronic nonmalignant pain before and after the addition of transdermal fentanyl to their treatments. ⋯ The addition of transdermal fentanyl to a treatment regimen containing no opiates or small amounts of opiates for patients with chronic nonmalignant pain did not negatively affect their driving performances, reaction times, cognition, or balance. Future studies in this area are needed to guide treatment decisions.
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Previous literature suggests that increases in the medical use of opioids over the early 1990s did not contribute to increased morbidity secondary to opioid abuse. Our objective was to evaluate the period 1997-2001 to analyze trends in medical use and medical abuse of three classes of opioid analgesics that are commonly used in sustained-release formulations: fentanyl, morphine, and oxycodone. ⋯ Using this method of analysis, the rates of drug abuse, and resultant morbidity secondary to the use of opioid analgesics, remain low in spite of the increase in medical use of these substances.
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Review Case Reports
Pharmacologic management part 1: better-studied neuropathic pain diseases.
Neuropathic pain impacts millions of people in the United States and around the world. Patients experience one of many symptoms, such as pain, paresthesia, dysesthesia, hyperalgesia, and allodynia, for many years because of unavailable or inadequate treatment. One of the major challenges in treating patients with neuropathic pain syndromes is a lack of consensus concerning the appropriate first-line treatment options for conditions associated with neuropathic pain, including postherpetic neuralgia, diabetic peripheral neuropathy, and trigeminal neuralgia. ⋯ Clinicians who must make decisions regarding the care of individual patients may find some guidance from the number of randomized trials with a positive outcome for each agent. Using quality-of-life study outcomes, treatment strategies must encompass the impact of therapeutic agents on the comorbid conditions of sleep disturbance and mood and anxiety disorders associated with neuropathic pain. Looking to the future, emerging therapies, such as pregabalin and newer N-methyl-D-aspartate-receptor blockers, may provide physicians and patients with new treatment options for more effective relief of pain.
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Comparative Study
Intrathecal drug delivery for treatment of chronic low back pain: report from the National Outcomes Registry for Low Back Pain.
To obtain data on patient demographics, clinical practices, and long-term outcomes for patients with chronic low back pain treated with implantable drug-delivery systems. ⋯ Current clinical practices related to trialing of drug-delivery systems resulted in the majority of patients successfully trialed. At 12-month follow-ups, implanted patients experienced reductions in numeric back and leg pain ratings, improved Oswestry scores, and high satisfaction with the therapy.