Expert review of neurotherapeutics
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Chronic noncancer pain is highly prevalent with associated negative effects on function and quality of life of the individuals involved. Opioids have been shown to decrease pain and improve function in some patients with chronic noncancer pain, but they are not always effective and are associated with multiple complications, including drug misuse, abuse and diversion. ⋯ Ideally, in modern medicine, clinical decisions are made based on information derived from high quality evidence. Since no such evidence exists for chronic opioid therapy in chronic noncancer pain, this review describes various aspects of opioid therapy in chronic noncancer pain, including adherence monitoring, along with a ten-step process outlining the principles of effective and safe opioid use.
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Breakthrough pain is defined as transitory flares of pain. Breakthrough pain is caused by cancer, cancer complications, treatment or comorbidities. The usual onset to maximum breakthrough pain intensity time is 3 min and duration is 30 min; therefore, the assessment for response needs to be at short intervals. ⋯ Other routes of administration that have a rapid onset to analgesia include intranasal hydrophilic and lipophilic opioids, inhaled opioids delivered by special delivery devices and parenteral morphine. In a small series of patients experiencing severe flares of pain with spinal opioids unrelieved by parenteral opioids, sublingual ketamine and bolus doses of intrathecal local anesthetics have been effective. Nonpharmacological approaches to managing activity-related pain include radiation therapy, surgical correction of impending fractures, kyphoplasty and radioisotopes.
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This annual 5-day Continued Medical Education event featured the latest in new treatment strategies and techniques for orthopedists, neurosurgeons, physiatrists, primary care providers and other professionals involved in treating patients with spinal disorders. This year's program content focused on: minimally invasive surgery, motion-preservation surgery, nonoperative spine care, value (quality/cost) and maintenance of certification self-assessment examination.
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The most common posterior fossa tumors in children are medulloblastoma, astrocytoma and ependymoma. Atypical rhabdoid teratoid tumors and brain stem gliomas are relatively rare. As the posterior fossa is a limited space, the tumors presenting in this region cause symptoms early on and require prompt treatment to avoid potential morbidity and mortality. ⋯ Adjuvant therapy is required in the majority of cases. Recent advances in the field of radiation biology and pharmacology have improved dose and delivery techniques of chemoradiation therapy. In the current era, advances in translational research and molecular genetics have assumed a major role in the pursuit of achieving a 'cure' for these potentially malignant tumors.
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Placebos are typically defined as physiologically inactive substances that elicit a therapeutic response. The antipode of the placebo effect is the nocebo effect, or the negative effects of placebo, where unpleasant symptoms (e.g., adverse events) emerge after the administration of placebo. Placebo analgesia is one of the most striking examples of the cognitive modulation of pain perception. ⋯ We first review the mechanisms of the placebo effect. We then focus on the importance of placebo in the acute treatment of migraine. We follow by discussing the importance of placebo on the preventive treatment of migraine and our perspectives for the 5 years to come regarding the study of the placebos.