Journal of pain & palliative care pharmacotherapy
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Human animals have evolved with the primary missions of survival and reproduction and these natural drives may impact behavior whether humans are aware of them or not. The author offers evidence in support of the idea that injury and resulting acute or chronic pain may trigger the unconscious human primate brain to believe there is a threat to survival. This perceived threat may be exacerbated or mitigated by the pain manager, both of which may impact health outcomes in a negative or positive way, respectively. The commentary argues the patient-health care provider relationship is of paramount importance for those with chronic pain and illness and should be nurtured for the best possible outcomes.
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J Pain Palliat Care Pharmacother · Jun 2014
Randomized Controlled TrialChronic postthoracotomy pain and perioperative ketamine infusion.
The objectives of this study were to investigate whether continuous intravenous ketamine during the first 72 hours after thoracotomy could reduce the incidence and intensity of chronic postthoracotomy pain (CPTP) and to define the incidence and risk factors of CPTP. Seventy-eight patients receiving thoracotomy for lung tumor (benign or malignant) were randomly divided into two groups: ketamine group (n = 31) and control groups (n = 47). Patients in the ketamine group received intravenous ketamine 1 mg/kg before incision, followed by 2 μg/kg/minute infusion for 72 hours plus sufentanil patient-controlled intravenous analgesia after thoracotomy. ⋯ Retractor used time (OR = 5.811, P = .002), inadequate acute pain control (NRS ≥ 5) (OR = 5.425, P = .048), and chemotherapy (OR = 3.784, P = .056) were independent risk factors for chronic postthoracotomy pain. The authors conclude that continuous intravenous ketamine (2 μg/kg/min) during the first 72 hours after thoracotomy was not beneficial to prevent chronic postthoracotomy pain. The independent risk factors for chronic postthoracotomy pain were retractor used time, inadequate acute pain control, and chemotherapy.
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J Pain Palliat Care Pharmacother · Jun 2014
Case ReportsSubacute pain after total knee arthroplasty.
Acute pain during and immediately after total knee arthroplasty (TKA) can be well controlled by spinal anesthesia, local infiltration analgesia, and peripheral nerve blocks; this enables early or fast-track rehabilitation. However, about half of patients have clinically significant pain in the following weeks. ⋯ Intensive analgesic and antihyperalgesic treatment during the first few weeks after TKA surgery may reduce the risk of chronic pain after this operation, which is itself intended to remove the patient's chronic osteoarthritis pain. Spinal cord stimulation may be an effective option for patients with mainly neuropathic pain after TKA surgery.
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J Pain Palliat Care Pharmacother · Jun 2014
ReviewDisrupting the downward spiral of chronic pain and opioid addiction with mindfulness-oriented recovery enhancement: a review of clinical outcomes and neurocognitive targets.
Prescription opioid misuse and addiction among chronic pain patients are problems of growing medical and social significance. Chronic pain patients often require intervention to improve their well-being and functioning, and yet, the most commonly available form of pharmacotherapy for chronic pain is centered on opioid analgesics--drugs that have high abuse liability. Consequently, health care and legal systems are often stymied in their attempts to intervene with individuals who suffer from both pain and addiction. ⋯ The purpose of this paper is to describe how the downward spiral of chronic pain and prescription opioid misuse may be targeted by one such intervention, Mindfulness-Oriented Recovery Enhancement (MORE), a new behavioral treatment that integrates elements from mindfulness training, cognitive-behavioral therapy, and positive psychology. The clinical outcomes and neurocognitive mechanisms of this intervention are reviewed with respect to their effects on the risk chain linking chronic pain and prescription opioid misuse. Future directions for clinical and pharmacologic research are discussed.
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J Pain Palliat Care Pharmacother · Jun 2014
Clinical TrialA transit compartment model unmasks OxyContin's reflective pharmacokinetics from urine measurements in humans.
The absorption pattern of orally administered OxyContin (OXC) reflected in urine indicates that its appearance into systemic circulation undergoes transit absorption delays. The authors developed an OXC transit-delay compartment model that identified a new source of oxycodone hydrochloride (OC): the rate of appearance of OC due to OXC tablet dissolution in transit through the gastrointestinal (GI) tract (R(a)(GI)), which is due to disintegration of OXC's AcroContin delivery system. R(a)(GI) is independent of the biphasic dissolution and release of OC from the delivery system. The authors conclude that an OXC transit-delay compartment model can be of value in the interpretation of OXC pharmacokinetics.