Pain practice : the official journal of World Institute of Pain
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Comparative Study
Opioid utilization and health-care costs among patients with diabetic peripheral neuropathic pain treated with duloxetine vs. other therapies.
This retrospective cohort study assessed subsequent opioid utilization and health-care costs among patients with diabetic peripheral neuropathic pain (DPNP) who initiated duloxetine vs. other standard of care (SOC) treatments. ⋯ DPNP patients who initiated duloxetine therapy were less likely to have subsequent opioid use and had lower health-care costs than SOC patients.
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Complex regional pain syndrome (CRPS), formerly known as reflex sympathetic dystrophy is a pain syndrome with an unclear pathophysiology and unpredictable clinical course. The disease is often therapy resistant, the natural course not always favorable. The diagnosis of CRPS is based on signs and symptoms derived from medical history and physical examination. ⋯ For patients suffering from CRPS refractory to conventional treatment and sympathetic blocks, plexus brachialis block or continuous epidural infusion analgesia coupled with exercise therapy may be tried (2 C+). Spinal cord stimulation is recommended if other treatments fail to improve pain and dysfunction (2 B+). Alternatively peripheral nerve stimulation can be considered, preferentially in study conditions (2 C+).
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Herpes zoster infection is caused by a reactivation of the latent varicella zoster virus that causes chicken pox. It appears predominantly in older adults whose immunity for the virus has waned. The natural course of the disease is usually favorable, and the symptoms disappear spontaneously within a few weeks. ⋯ Antiepileptic drugs and tricyclic antidepressants are the first choice. Interventional treatments, such as epidural injections of corticosteroids and local anesthetic drugs, have an effect on the acute pain but are of limited use in preventing post-herpetic neuralgia. When conservative treatment fails in providing satisfactory relief of post-herpetic neuralgia, a sympathetic block may be considered (2 C+); if this treatment provides unsatisfactory results, spinal cord stimulation may be considered, in a study context (2 C+).
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Ex vivo photographic temperature mapping of bipolar radiofrequency (RF) lesions in animal tissue is performed over a wide range of electrode tip spacings, tip lengths, tip diameters, tip temperatures, and lesion times. In vivo temperature measurements collected during clinical treatment of sacroiliac joint (SIJ) pain corroborate those collected ex vivo. Generation of a "strip lesion" connecting two separated bipolar electrode tips is demonstrated ex vivo for tip spacings as large as 20 mm. ⋯ The size of conventional bipolar lesions can exceed the size of lesions produced both by conventional monopolar RF (12 mm × 7 mm × 7 mm ellipsoidal) and by cooled monopolar RF as used in spinal pain management (10 mm × 10 mm × 10 mm spherical). SIJ pain is treated by placing 5 to 7 straight RF cannulae perpendicular to the dorsal sacrum and producing 4 to 6 overlapping bipolar RF lesions between the dorsal sacral foramina and the ipsilateral SIJ. This bipolar "palisade" (a defensive fence) creates a continuous lesion spanning the region through which multiple sacral lateral branch nerves travel along irregular, branching paths to reach the SIJ.
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Randomized Controlled Trial Multicenter Study
A multicenter, randomized, double-blind, placebo-controlled trial of intravenous ibuprofen (i.v.-ibuprofen) in the management of postoperative pain following abdominal hysterectomy.
Ibuprofen and other nonsteroidal anti-inflammatory drugs are widely used to block pain and inflammation in a variety of settings. Contrarily, opioid analgesia does not block the inflammatory component of pain and the use of these agents can be accompanied by serious side effects. We conducted a multicenter, randomized, double-blind, placebo-controlled trial to evaluate the safety and efficacy of intravenous ibuprofen (i.v.-ibuprofen) as a postoperative analgesic. ⋯ This study demonstrated that i.v.-ibuprofen is an effective analgesic medication that is safe and well tolerated when administered as an 800 mg dose every 6 hours in patients undergoing total abdominal hysterectomy surgery.