Pain practice : the official journal of World Institute of Pain
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Historical Article
Transdermal opioid patches for pain treatment in ancient Greece.
Pain treatment in ancient Greece, and through the middle ages in Europe, was to a great extent based on the expertise of the Greek physician Galen (c. 129-200 A. D.). Galen makes particular reference to "Olympic Victor's Dark Ointment" (OVDO), which is listed with a number of collyria. ⋯ Olympic Victor's Dark Ointment showed a transdermal transfer of morphine over time comparable to 25% of the most efficient modern transdermal opioid patches, while hardly any morphine was able to penetrate the skin when applied mixed in PBS. We conclude that OVDO is very efficient in its composition and may carry some forgotten abilities in terms of drug delivery, which could be transferred to modern medicine. Indeed, this may lead to a better choice of morphine use and controlled management in individual patient cases, taking both pain relief and anti-inflammatory aspects into account.
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Osteoarthritis is a chronic debilitating condition affecting many adults in the United States. This study was to compare pharmacologic treatments and costs for newly diagnosed and existing osteoarthritis patients to assess unmet medication treatment needs and economic burden. ⋯ Newly diagnosed osteoarthritis patients incurred higher annual costs, but lower pain-related prescription drug costs in the year following diagnosis than patients with existing osteoarthritis.
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Surgical pain in patients with documented opioid-induced delirium can be difficult to treat. We present a case of a patient undergoing laparoscopic hemicolectomy effectively treated with an opioid-free, alpha-2 adrenoreceptor agonist analgesic regimen. ⋯ Nonopioid analgesic regimens are beneficial in patients at risk of postoperative cognitive dysfunction attributable to opioids. Successful postoperative analgesia was achieved in our patient by alternating various routes of administration of alpha-2 adrenoreceptor agonists.
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Comparative Study
Dosing pattern comparison between duloxetine and pregabalin among patients with diabetic peripheral neuropathic pain.
To compare medication dosing patterns of duloxetine and pregabalin among patients with diabetic peripheral neuropathic pain (DPNP). ⋯ The commercially insured patients with DPNP who initiated duloxetine or pregabalin therapy had different dosing patterns. The average daily dose for duloxetine was relatively stable over time, while pregabalin-treated patients had significant dose increase over the 12-month post-index period.
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Inadequately treated acute pain is a global healthcare problem that causes significant patient suffering and disability, risk of chronicity, increased resource utilization, and escalating healthcare costs. Compounding the problem is the lack of adequate instruction in acute pain management available in medical schools worldwide. ⋯ In this article, we review the current status of pain education in educational institutions across the world, focusing on achievements, lacunae, and inadequacies. We appeal to all concerned--pain management specialists, health educators, and policymakers--to consider incorporating education on acute pain and its management at undergraduate medical levels in an integrated manner.