Pain medicine : the official journal of the American Academy of Pain Medicine
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1) Investigate psychosocial adaptation to chronic pain in patients with systemic lupus erythematosus; 2) Compare pain adaptation of lupus, chronic low back pain, and temporomandibular disorders patients; and 3) Evaluate the validity of Multidimensional Pain Inventory-based profiles of lupus patients. ⋯ Although many systemic lupus erythematosus patients cope well with their chronic pain, a substantial proportion exhibit pain-related distress, activity interference, or interpersonal difficulties.
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The phenomenon of inflammatory masses at the tips of intrathecal drug administration catheters was the subject of a recent case-compilation report and a number of animal studies. We sought to synthesize current clinical and preclinical data to formulate hypotheses about the etiology of catheter-tip masses. ⋯ The evidence suggests that the long-term administration of opioids, especially morphine, caused the masses that were observed in humans and in two species of animals. A relationship probably exists between mass formation and intrathecal morphine doses or concentration. Other factors remain to be investigated.
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To assess the effectiveness of the lidocaine patch 5% (Lidoderm), a targeted peripheral analgesic, in reducing pain intensity/interference with quality of life (QOL) among patients with postherpetic neuralgia (PHN). ⋯ Based on results of previous randomized, controlled trials and the current study, designed to gauge response in the clinical practice setting, the lidocaine patch 5% should be considered a first-line therapy, alone or in combination with other agents, for PHN due to its efficacy, safety, minimal systemic side effects and drug interactions, and ease of administration. Although the lidocaine patch 5% was equally effective in longstanding PHN, it would appear prudent to begin therapy as early in the course of PHN as possible.
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In a companion article, we synthesized current clinical and preclinical data to formulate hypotheses about the etiology of drug administration catheter-tip inflammatory masses. In this article, we communicate our recommendations for the detection, treatment, mitigation, and prevention of such masses. ⋯ Attentive follow-up and maintenance of an index of suspicion should permit timely diagnosis, minimally invasive treatment, and avoidance of neurological injury from catheter-tip inflammatory masses. Whenever it is feasible, positioning the catheter in the lumbar thecal sac and/or keeping the daily intrathecal opioid dose as low as possible for as long possible may mitigate the seriousness, and perhaps, reduce the incidence of such inflammatory masses.