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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Chronic low back pain is considered as a high-impact condition that affects the working population of Latin America, with long reaching social and economic repercussions. Its true frequency is unknown due to the absence of well-designed clinical trials that use standardized definitions and criteria. ⋯ Despite the sparse information and the methodological heterogeneity of the studies, pooled results allowed for an indirect estimation of the prevalence of low back pain in the region that was pretty consistent with the published results obtained from other settings. New studies need to be carried out to supplement and overcome the methodological weaknesses of those previously conducted.
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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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Observational Study
Effect of a fixed-dose opioid agonist/antagonist on constipation in patients on long-term opioids for non-malignant pain unable to tolerate laxatives.
Chronic pain affects a large number of patients throughout the world and impacts greatly on their quality of life, including the ability of a patient to sleep, go to work, and socialize. Guidance on the use of opioids in chronic pain patients is available from the British Pain Society; however, patients receiving opioid treatment for their pain often suffer from symptoms associated with opioid-induced bowel dysfunction (OIBD), including constipation. The usual treatment of constipation in these patients is laxatives; however, one study has shown that 54% of patients do not receive the desired results from this approach. Oxycodone/naloxone tablets have been shown to provide analgesia to chronic pain patients, while improving the symptoms of OIBD, as the naloxone component blocks the effects of oxycodone at opioid receptors in the gut. ⋯ The results of this study indicate that patients receiving oxycodone/naloxone tablets achieved statistically and clinically significant improvements in bowel function as well as quality of life after 12 weeks of treatment.
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Comparative Study
Patient perception of pain care in the United States: a 5-year comparative analysis of hospital consumer assessment of health care providers and systems.
The necessity of aggressive pain management in the hospital setting is becoming increasingly evident. It has been shown to improve patient outcomes, and is now an avenue for Medicare to assess reimbursement. In this cohort analysis, we compared the March 2008 to the December 2012 Hospital Consumer Assessment of Health Plans Survey (HCAHPS) reports in order to determine if pain management has improved in the United States after this national standardized survey was created. ⋯ The HCAHPS survey is a national public standardized report used as a way to compare care in the United States. Patient pain perception has improved between the 2008 and 2012 reports. Further studies are needed to evaluate critical care hospitals.