Pain physician
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Pain clinicians have always been challenged by the variability of response to pain treatment. Differences in the degree of pain stimulation and pain sensitivity, weight and age differences, prior opioid use and tolerance, as well as the differences in bioavailability of various opioid formulations have been cited as causes for the wide variability in analgesia seen with opioids. Genetics may explain the variability of responses and help to predict more effective (or less dangerous) medication choices and doses. Genetics may also help to predict the response to specific opioids and antidepressants. ⋯ Genetic testing may explain and predict many of the clinical responses seen with opioids and adjuvant medications, and may help the clinician identify those patients at genetic risk of opioid misuse and addiction.
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Randomized Controlled Trial
Efficacy and safety of dexmedetomidine added to caudal bupivacaine in pediatric major abdominal cancer surgery.
Caudal analgesia has been prolonged by the addition of various adjuvants. Dexmedetomidine is a highly selective alpha-2 agonist with sedative and analgesic properties. ⋯ Addition of dexmedetomidine (1 μg/kg) to caudal bupivacaine 0.25% (1 mL/kg) in pediatric major abdominal cancer surgeries achieved significant postoperative pain relief for up to 19 hours, with less use of postoperative analgesics, and prolonged duration of arousable sedation. Hemodynamic changes were statistically significant, yet of no clinical significance.
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The awareness is growing that central sensitization is of prime importance for the assessment and management of chronic pain, but its classification is challenging clinically since no gold standard method of assessment exists. ⋯ Clinicians can use the proposed classification algorithm for differentiating neuropathic, nociceptive, and central sensitization pain.
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Epidural and intrathecal injections of methylprednisolone acetate (MPA) have become the most commonly performed interventional procedures in the United States and worldwide in the last 2 decades. However neuraxial MPA injection has been dogged by controversy regarding the presence of different additives used in commercially prepared glucocorticoids. We previously showed that MPA could be rendered 85% free of polyethylene glycol (PEG) by a simple physical separation of elements in the suspension. ⋯ Results of the present study identified a cytotoxic effect of commercially available MPA with preservatives or with a "clear phase" containing higher concentrations of preservatives on primary isolated rat DRG sensory neurons. This was shown by TUNEL positive assay and by increased caspase-3 expression as one of the final executing steps in apoptotic pathways in DRG neurons. However, our results showed no statistically significant difference between the control cells (saline-treated) and cells treated with MPA with reduced concentrations of preservatives, pointing out that either PEG or myristylgamma-picolinium chloride (MGPC) or their combination have harmful effects on these cells. Reduction of concentrations of preservatives from commercially available MPA suspensions by using the simple method of inverting vials for 2 hours could be considered useful in clinical practice to enhance the safety of this depot steroid when injected neuraxially.