Pain practice : the official journal of World Institute of Pain
-
Chronic noncancer pain represents a major health problem that affects many patients, resulting in suffering, reduced productivity, and substantial health care costs. The patient with chronic noncancer pain is burdened by decreased quality of life, decreased sleep, interference with social relationships, diminished cognitive functions, interference with activities of daily living, decreased productivity, and increased anxiety and depression. A survey examining the burden of pain on health and productivity found decreases of 45% in physical health and 23% in mental health at a cost of $61.2 billion per year in productive work time. ⋯ Chronic pain management guidelines recommend the use of long-acting, extended-release (ER) analgesics because they provide prolonged, more consistent plasma concentrations of drug compared with short-acting agents, thus minimizing fluctuations that could contribute to end-of-dose breakthrough pain. ER analgesics offer more consistent and improved nighttime pain control, less need to awaken at night to take another dose of pain medication, and less clock-watching by patients in chronic noncancer pain. Among the available ER opioids, tramadol ER possesses a unique mechanism of action, making it a viable opioid of first choice for patients suffering from a variety of chronic noncancer pain conditions, such as osteoarthritis, low back pain, and neuropathic pain.
-
Randomized Controlled Trial
Intermittent wound perfusion for postoperative pain relief following upper abdominal surgery: a surgeon's perspective.
Although there are many methods for postoperative pain management, implementation may be limited in some settings due to practical or financial constraints. Simple, inexpensive and easily implemented analgesic methods may improve access to effective pain relief. ⋯ Intermittent wound perfusion with 0.25% bupivacaine is a safe and efficient method to reduce pain scores and opioid requirement in the early postoperative period. Wound perfusion, however, had no beneficial effect on the postoperative respiratory function.
-
Using a large database with information from general practitioners (GP) throughout Germany, we identified all adults (age > or = 18 years) with encounters for painful neuropathic disorders (PNDs) between August 1, 2005 and July 31, 2006 (PND patients). We also constituted an age- and sex-matched comparison group, consisting of randomly selected patients without any GP encounters for PNDs during the same period. Selected characteristics were then compared between PND patients and those in the comparison group over the 1-year study period. ⋯ PND patients averaged 7.3 more GP visits during the year (mean [95% CI] = 9.9 [9.9, 9.9] vs. 2.6 [2.6, 2.7] for comparison group); they also had significantly more specialist referrals and physician-excused absences from work (all P < 0.01). Patients with PNDs under the care of GPs in Germany have comparatively more comorbidities and higher levels of use of healthcare services. The pain-related medications that these patients receive raise concerns that PNDs may not be optimally treated in these settings.
-
Randomized Controlled Trial
Nerve stimulator-guided occipital nerve blockade for postdural puncture headache.
Postdural puncture headache (PDPH) is one of the most common complications of spinal anesthesia, where adequate hydration with bed rest in the horizontal position is the initial recommendation. Epidural blood patch is to date the most effective treatment, but it is an invasive procedure that may result in serious complications. The aim of the current study was to conduct a prospective, randomized, single-blinded comparison between bilateral occipital blockade and conventional expectant therapy in adults suffering from PDPH. ⋯ Visual analog scales were significantly lower in the block group (P < 0.01), and the block group consumed significantly less analgesics in the follow-up period (P < 0.05) compared with control group. Block patients had significantly shorter hospital stays and sick leave periods (P < 0.001). The studied method is superior to expectant conservative therapy in the treatment of patients suffering from PDPH.
-
The burden of painful diabetic peripheral neuropathy (DPN) is a common complication of diabetes. This study expanded on the human burden of painful DPN by quantifying functional and health status impairments among international patients from a randomized, double-blind, placebo-controlled trial of painful DPN. Evaluated outcomes measures included: Brief Pain Inventory-Short Form (mBPI-sf), EuroQOL 5D, Hospital Anxiety and Depression Scale, and Medical Outcomes Study Sleep Scale. ⋯ Patients in all 3 regions reported difficulties with functioning, sleep, and overall health status, which increased with higher pain severity levels. Patients in Asia had substantial impairments; however, they reported less serious problems than the other regions. These data are consistent with painful DPN being a burdensome condition worldwide: people with poorly managed neuropathic pain report a substantial burden of disease.