Pain practice : the official journal of World Institute of Pain
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Acute postoperative pain remains a major problem, with both undertreatment and overtreatment leading to serious consequences, including increased risk of persistent postoperative pain, impaired rehabilitation, increased length of stay and/or hospital readmission, and adverse events related to excessive analgesic use, such as oversedation. New analgesic medications and techniques have been introduced that target the preoperative, intraoperative, and postoperative periods to better manage acute postoperative pain, with improvements in analgesic efficacy and safety over more traditional pain management approaches. This review provides an overview of these new analgesic medications and techniques. Specific topics that are discussed include the use of preoperative nonsteroidal anti-inflammatory drugs, anxiolytics, and anticonvulsants; intraoperative approaches such as neuraxial analgesia, continuous local anesthetic wound infusion, transversus abdominis plane block, extended-release epidural morphine, intravenous acetaminophen, and intravenous ketamine; and postoperative use of intravenous ibuprofen, new opioids (eg, tapentadol) or opioid formulations (morphine-oxycodone), and patient-controlled analgesia. ⋯ New, targeted, analgesic medications and techniques may provide a safer and more effective approach to the management of acute postoperative pain than traditional approaches such as postoperative oral analgesics.
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The aim of our study was translation and assessment of validity and reliability of the Persian version of DN4 questionnaire. The goal was to fill the gap caused by the absence of a validated instrument in Persian to facilitate discrimination of neuropathic pain. In this study, the adaptation and validation of the questionnaire was carried out in 4 steps, including translation, retranslation, semantic, and literal assessments, and a pilot study for practicability and potential perception difficulties of the final Persian version on 45 patient samples. ⋯ Inter-rater agreement and test-retest reliability were significant intraclass coefficient (ICC = 0.957 and ICC = 0.918, respectively). The Persian version of DN4 questionnaire is a reliable, valid, feasible, and easily administered tool for precise discrimination neuropathic pain from NNP in Farsi. The characteristics of this test can assist practitioner to diagnose neuropathic pain accurately for both clinical and research purposes.
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Iliopsoas impingement is an under recognized cause of failed total hip arthroplasty. We report 2 cases of iliopsoas impingement resolution diagnosed with the aid of imaging techniques and fluoroscopically guided injection.
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Evaluate prevalence and risk-adjusted healthcare costs of diagnosed opioid abuse in the national Veterans Health Administration (VHA). Costs were compared between patients with and without diagnosed opioid abuse. ⋯ Diagnosed opioid abuse prevalence is almost 7-fold higher in the veteran's administration population than in commercial health plans and translates to a significant economic burden. Appropriate interventions should be considered to prevent and reduce opioid abuse.
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Observational Study
Impact of a Pregabalin Step Therapy Policy Among Medicare Advantage Beneficiaries.
Managed healthcare organizations often utilize formulary management strategies such as prior authorization and step therapy to guide appropriate medication use and to control medication expenditures. The objective of this study was to examine clinical and economic outcomes associated with implementation of a pregabalin step therapy (ST) policy among Medicare Advantage Prescription Drug (MAPD) members. ⋯ After controlling for differences in age and comorbidity burden between the groups, implementation of a pregabalin ST restriction was associated with increased disease-related pharmacy costs and decreased total medical costs; however, there was no net difference in total healthcare cost or total pharmacy cost.