Pain practice : the official journal of World Institute of Pain
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Comparative Study Clinical Trial
An open-label comparison of nabilone and gabapentin as adjuvant therapy or monotherapy in the management of neuropathic pain in patients with peripheral neuropathy.
Neuropathic pain (NeP) is prevalent in patients with peripheral neuropathy (PN), regardless of etiology. We sought to compare the efficacy of the cannabinoid nabilone as either monotherapy or adjuvant therapy with a first-line medication for NeP, gabapentin, in a patient population with PN-NeP. Patients diagnosed with PN-NeP were permitted to initiate monotherapy (nabilone or gabapentin) or add one of these two medications (adjuvant therapy) to their existing NeP treatment regimen in a non-randomized open-label nature. ⋯ Sleep adequacy and the sleep problems index within the MOSSS improved in nabilone monotherapy patients in particular. The benefits of monotherapy or adjuvant therapy with nabilone appear comparable to gabapentin for management of NeP. We advocate for head-to-head randomized, double-blind studies for current therapies for NeP in order to determine potential advantages beneficial in this patient population.
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The management of bicipital tendonitis can be challenging to the clinician. Traditionally, blind injections near the bicipital groove have been performed by clinicians with risk of bicipital tendon rupture or atrophy. Because of the inaccuracy and risk associated with blind bicipital tendon steroid injections, we sought to ascertain whether a fluoroscopically guided steroid injection into the region of the origin of the long head of the bicipital tendon (supraglenoid tubercle) was efficacious. ⋯ A fluoroscopically guided block injected into the supraglenoid tubercle may be effective in the management of bicipital tendonitis.
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The study aims to examine predictors associated with duloxetine adherence and its association with healthcare costs among fibromyalgia patients. ⋯ Fibromyalgia patients with higher duloxetine ADD were more likely to adhere to the therapy. High duloxetine adherence was associated with lower (Commercial) or similar (Medicare supplemental) healthcare costs.
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One indirect line of evidence for opioid-induced hyperalgesia (OIH) in humans is decreased pain thresholds (PTREs) and tolerances (PTOLs) in opioid addicts on opioids. There are a number of such studies in opioid maintained addicts, but no such studies in chronic pain patients (CPPs) with current opioid addiction. The objective of this study was to determine if this group demonstrates hyperalgesia. ⋯ This study contributes to the human OIH literature. However, because of the potential confounders in this study, the issue of OIH in humans remains unresolved.