Pain practice : the official journal of World Institute of Pain
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Observational Study
Prior Authorization in the Treatment of Patients with pDPN and FM.
To determine prior authorization (PA) impact on healthcare utilization, costs, and pharmacologic treatment patterns for painful diabetic peripheral neuropathy (pDPN) and fibromyalgia (FM). ⋯ There was no evidence of statistically significant differences between PA and no PA cohorts in either FM or pDPN populations for total all-cause or disease-related costs.
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Low back pain (LBP) symptoms and signs are nonspecific. If required, diagnostic blocks may find the source of pain, but indicators of suspect diagnosis must be defined to identify anatomical targets. ⋯ Seventy-seven diagnostic suspect indicators of LBP conditions were consensuated. These may facilitate conservative or interventional pain management decision-making.
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Attention deficit hyperactivity disorder (ADHD) is characterized by dysregulation of sensory processing and neurobiology of dopamine. Although cumulative evidence suggests that dopamine is involved in pain processing, pain perception in ADHD subjects and the effect of dopamine agonists such as methylphenidate (MP, Ritalin) on it have rarely been studied. ⋯ These results suggest that adults with ADHD are more sensitive to pain compared with controls and that MP may exert antinociceptive properties in these subjects. Randomized, controlled trials are warranted to verify these findings.
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Observational Study
Clinical Effectiveness of the Obturator Externus Muscle Injection in Chronic Pelvic Pain Patients.
Because of its anatomical location and function, the obturator externus (OE) muscle can be a source of pain; however, this muscle is understudied as a possible target for therapeutic intervention in pain practice. In this retrospective observational study, we evaluated the clinical effectiveness of the OE muscle injection with a local anesthetic in chronic pelvic pain patients with suspected OE muscle problems. ⋯ Fluoroscopy-guided injection of the OE muscle with local anesthetic reduced pain scores and led to a high level of satisfaction at short-term follow-up in patients with suspected OE muscle problem. The results of this study suggest that OE muscle injection may be a valuable therapeutic option for a select group of chronic pelvic pain patients who present with localized tenderness in the OE muscle that is accompanied by groin, anteromedial thigh, or hip pain.
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Genetic factors are known to influence individual differences in pain and sensitivity to analgesics. Different genetic polymorphisms in opioid-metabolizing enzymes that can affect the analgesic response to opioids have been proposed. This study investigates a possible difference in the response to postoperative buprenorphine analgesia related to the presence of different isoforms (cytosine or thymine substitution at nucleotide 802) of UGT2B7 gene. ⋯ The presence of the SNP 802C>T UGT2B7 (UGT2B7*2/*2) is associated with a worse analgesic response to transdermal buprenorphine in the postoperative period of thoracic surgery.