Pain physician
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Diabetic peripheral neuropathy (DPN) is a most common devitalizing complication of diabetes mellitus, which is primarily characterized by sensory loss, paresthesia, prickling, pain, or allodynia. ⋯ Nortriptyline reported the advantage relative to other drugs in achieving 30% and 50% pain reduction from the baseline. Gabapentin reported a significance of 50% pain reduction relative to placebo.
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Review Meta Analysis
Corticosteroids: Review of the History, the Effectiveness, and Adverse Effects in the Treatment of Joint Pain.
Corticosteroids have been used for the past 70 years in the treatment of various musculoskeletal conditions. This includes its use for joint pain such as rheumatoid arthritis and osteoarthritis. ⋯ The current evidence would suggest that the use of corticosteroids provides moderate evidence for short-term pain reduction and improvement in function. There are multiple potential adverse effects, such as toxic damage to articular cartilage, as well as numerous systemic side effects, including a reduction in immune function and an increased risk of infection, of which physicians need to be aware.
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Chronic low back pain (CLBP) incurs huge costs owing to increased healthcare expenditure, disability, insurance, and work absenteeism. Opioid analgesics are commonly used for the management of CLBP. ⋯ Oxymorphone has an advantage over other opioids to reduce pain by 30% and 50% in patients with CLBP.
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Meta Analysis
Mind-Body Interventions for Depressive Symptoms in Chronic Pain: A Systematic Review of Meta-Analyses.
Psychological comorbidities in chronic pain (CP) are common and contribute to adverse health outcomes and poor quality of life. Evidence-based guidance for the management of depressive symptoms in CP is limited, particularly for mind-body interventions. ⋯ Mind-body interventions show consistent small to moderate effects in reducing depressive symptoms in CP. The literature in this area demonstrates understudy and oversynthesis. There is a need for more clinical trials focusing on people with axial pain, people with comorbid major depressive disorder, and with depression as the primary outcome of interest. Full SR registered on PROSPERO: CRD42019131871.
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Epidural injections have been extensively used since their description in 1901, and steroids since their first utilization in 1952. Multiple randomized controlled trials and systematic reviews have reached discordant conclusions regarding the effectiveness of sodium chloride solution and steroids in managing spinal pain. True placebo-controlled trials with the injection of an inactive substance to unrelated structures have been nonexistent. Consequently, the discussions continue to escalate, seemingly without proper discourse. In this review, we sought to assess the true placebo nature of saline and the effectiveness of steroids. ⋯ The findings of this systematic review and meta-analysis show that epidurally administered sodium chloride solution and sodium chloride solution with steroids may be effective in managing low back and lower extremity pain. Consequently, the findings of this review provide information that epidurally administered sodium chloride solution is not a true placebo.