Current pain and headache reports
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Opioid analgesics are effective for treating many pain conditions. Opioid analgesic tolerance is a pharmacologic phenomenon that could affect the clinical use of opioid analgesics. ⋯ Thus, exposure to opioids could lead to two seemingly unrelated cellular processes (ie, the development of opioid tolerance and opioid-induced pain sensitivity). Their converging effects may be part of the mechanisms leading to the reduced opioid analgesic efficacy in chronic opioid therapy.
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Curr Pain Headache Rep · Feb 2006
ReviewRational multidrug therapy in the treatment of neuropathic pain.
Multidrug therapy (MDT) has been widely accepted and used as a standard of practice in most areas of medical practice, including neuropathic pain. Because neuropathic pain is a new field of medical science and practice, standards for its treatment including MDT are still evolving. In this article, we present rationale and principals for the MDT of neuropathic pain based on our best understandings of the underlying mechanisms of the disease processes and the actions of drugs, the goal being to maximize benefits and minimize adverse effects. MDT for neuropathic pain is based on a comprehensive clinical neuropathic pain assessment and ongoing monitoring of the drug therapy's efficacy and adverse effects, administering one drug at the time.
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Celiac plexus block has long been used to provide analgesia for upper abdominal pain. In particular, neurolytic celiac plexus block has been advocated for pancreatic cancer pain. ⋯ In addition, neurolytic celiac plexus block may prolong survival, but the data supporting this remain controversial. The optimal technique for accomplishing neurolytic celiac plexus block remains undetermined.
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Intrathecal analgesic infusion therapy through an implantable pump system is a sophisticated medical therapy for those who suffer from chronic, severe pain who are unresponsive to traditional medical therapy. This article describes the patient selection and monitoring process and reviews available intrathecal medications and combinations.