Pain practice : the official journal of World Institute of Pain
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Cancer pain is prevalent, undertreated, and feared by patients with cancer. In April 2013, a panel of pain experts convened in Singapore to address the treatment of cancer pain. They discussed the various types of cancer pain, including breakthrough pain, which is sometimes clinically confused with analgesic gaps. ⋯ Specific pain therapy guidelines for those populations are reviewed. Patients with cancer with a history of or active substance abuse disorder deserve pain control but may require close medical supervision. While much "treatment inertia" exists in cancer pain control, cancer pain can be safely and effectively managed and should be carried out to alleviate suffering and improve outcomes.
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Comparative Study Clinical Trial
Ultrasound-guided Pararadicular Injection in the Lumbar Spine: A Comparative Study of the Paramedian Sagittal and Paramedian Sagittal Oblique Approaches.
Ultrasound-guided nerve root blocks and transforaminal injections are well established, and several procedural feasibility studies have been reported. However, the contrast dispersion pattern during ultrasound-guided pararadicular injection has not been reported. We hypothesized that the paramedian sagittal oblique approach provides a superior intraforaminal contrast-spread pattern compared to the paramedian sagittal approach during ultrasound-guided pararadicular injections in the lumbar spine. ⋯ The paramedian sagittal oblique approach delivered a superior intraforaminal contrast-spread pattern and significantly greater pain relief than the paramedian sagittal approach during ultrasound-guided pararadicular injections in the lumbar spine.
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Patients with sickle-cell disease (SCD) can experience recurrent vaso-occlusive episodes (VOEs), which are associated with severe pain. While opioids are the mainstay of analgesic therapy, in some patients with SCD, increasing opioid use is associated with continued and increasing pain. Dexmedetomidine, an α2 -adrenoreceptor agonist with sedative and analgesic properties, has been increasingly used in the perioperative and intensive care settings and has been shown to reduce opioid requirement and to facilitate opioid weaning. ⋯ Dexmedetomidine infusions that lasted for 3 to 6 days were associated with marked reduction in daily oral morphine-equivalent intake and decreases in pain scores (numeric rating scale). There were no hemodynamic changes that required treatment with vasoactive or anticholinergic agents. These preliminary findings of possible beneficial effects of dexmedetomidine in decreasing opioid requirements support the hypothesis that dexmedetomidine may have a role as a possible analgesic adjuvant to mitigate VOE-associated pain in patients with SCD.
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Observational Study
Acute Back Pain Following Surgery under Spinal Anesthesia.
The purpose of this study was to determine the factors having a role in the occurrence of acute back pain following spinal anesthesia. ⋯ Contrary to the common belief, it is demonstrated in this study that number of lumbar punctures, method of approach and position of the spinal anesthesia, age, sex, surgical position, and the type of the surgery did not correlate with occurrence of acute back pain following spinal anesthesia.
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The Pain Self-Efficacy Questionnaire (PSEQ) is a patient self-reported measurement instrument that evaluates pain self-efficacy beliefs in patients with chronic pain. The measurement properties of the PSEQ have been tested in its original and translated versions, showing satisfactory results for validity and reliability. The aims of this study were 2 fold as follows: (1) to translate the PSEQ into Italian through a process of cross-cultural adaptation, (2) to test the measurement properties of the Italian PSEQ (PSEQ-I). ⋯ The PSEQ-I displayed a high construct validity by meeting more than 75% of a priori hypotheses on correlations with measurement instruments assessing pain intensity, disability, anxiety, depression, pain catastrophizing, fear of movement, and coping strategies. Additionally, the PSEQ-I differentiated patients taking pain medication or not. The results of this study suggest that the PSEQ-I can be used as a valid and reliable tool in Italian patients with CLBP.