Pain physician
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Review
Monitoring opioid adherence in chronic pain patients: assessment of risk of substance misuse.
Use of opioids for chronic non-cancer pain (CNCP) has increased in recent years because this pain had been undertreated. There was also a simultaneous increase in misuse and abuse of opioids. Deaths due to such abuse and misuse also have risen as seen in the many reports published every day in local papers as well as in the medical literature. So, it is imperative that patients who are prescribed these medications be monitored for adherence so misuse and abuse can be curtailed and opioids are available to those who genuinely need them for chronic pain control. There are various screening tools available to monitor such adherence, and there is an abundance of literature about it in addiction and psychiatric medicine. There is, though, a paucity of such literature as applied to pain medicine. ⋯ We found 52 publications, of which 22 met the criteria to be included in this manuscript. We found only one study that was prospective, and compared the various screening tools that are available to monitor opioid adherence. In the majority of the studies the number treated was small. There was not a single screening tool that can be applied universally to all patients who are on opioid therapy for chronic non-cancer pain.
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Review
A systematic review of observational studies on the effectiveness of opioid therapy for cancer pain.
The prevalence of cancer-related pain and residual pain in cancer survivors is high. Opioids serve as the gold standard for treating moderate to severe cancer pain. The evaluation of the effectiveness of opioids in chronic non-cancer pain has shown a lack of effectiveness, or rather weak evidence for some of the drugs. In contrast, in cancer pain, opioids are expected to be very effective. Due to the nature of the disease, there is evidence of a paucity of randomized trials investigating opioid effectiveness in cancer pain on a long-term basis. Consequently, the effectiveness of opioids in managing cancer-related pain warrants further evidence-based review beyond randomized trials, including observational studies and case reports. ⋯ This systematic review of observational studies indicates Level II-3 evidence for effectiveness of opioids in cancer pain therapy, with 1C/strong recommendation based on observational studies, which could change based on future evidence.
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The pudendal nerve may be strained either between the sacrospinous and sacrotuberous ligaments at the ischial spine level or within Alcock's canal. Alcock's neuralgia is a rare, painful condition caused by compression of the pudendal nerve within Alcock's canal (pudendal canal) which is an aponeurotic tunnel that cannot be stretched. Patients usually present with intense, unilateral pain involving anatomic areas along the pudendal nerve's root, genital, anal, and pelvic regions causing mobility impairment. ⋯ There are 2 types of potential complications that are associated with percutaneous steroid infiltrations: intra-operative (associated with needle placement) and post-operative (infection, bleeding and those associated with the injectate administration). In all cases that steroids were administered within therapeutic doses, no complications were noted. In conclusion, CT-guided percutaneous infiltration with a mixture of long-acting corticosteroid and local anesthetic seems to be a safe and efficient method for the treatment of Alcock's neuralgia.
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A major concern of physicians treating pain patients with chronic opioid therapy and similar drugs is determining whether the patients are also using illicit drugs. This is commonly determined by urine drug testing (UDT). However, there are few studies on whether or not monitoring patients by this technique decreases illicit drug use. ⋯ Continued UDT might decrease illicit drug use among pain patients.