Pain practice : the official journal of World Institute of Pain
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Randomized Controlled Trial
Tramadol added to bupivacaine does not prolong analgesia of continuous psoas compartment block.
The primary aim of our study was to evaluate the quality and duration of analgesia when tramadol was added to 0.25% bupivacaine for continuous psoas compartment block (CPCB) using visual analog pain scores. Thirty patients were prospectively randomized into two equal groups (n = 15). ⋯ Success with catheter placement adjacent to the lumbar plexus was 100%, and none of the patients developed any catheter-related complications. In conclusion, tramadol does not provide a clinically significant analgesic action as an adjunct to 0.25% bupivacaine for CPCB.
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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.
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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.
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To examine the use of pregabalin in patients with painful neuropathic disorders under the care of general practitioners (GPs) in the U.K. ⋯ In the U.K., many patients prescribed pregabalin by their GPs may have been refractory to other pain-related medications. Use of these medications declined following initiation of pregabalin therapy.