Pain practice : the official journal of World Institute of Pain
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Neuropathic pain is a considerable burden that affects activities of daily living. The management of neuropathic pain can be challenging because of multiple etiologies and complex manifestations. Ziconotide is a nonopioid intrathecal (IT) analgesic option for patients with neuropathic pain refractory to conventional treatments. ⋯ Common AEs associated with ziconotide include nausea and/or vomiting, dizziness, confusion, urinary retention, and somnolence. Evidence from DBPC trials, open-label studies, case series, and case studies suggests that ziconotide, as either monotherapy or in combination with other IT drugs, is a potential therapeutic option for patients with refractory neuropathic pain. Additional studies are needed to establish the long-term efficacy and safety of ziconotide for neuropathic pain.
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Randomized Controlled Trial Clinical Trial
Effect of rectal diclofenac in reducing postoperative pain and rescue analgesia requirement after cardiac surgery.
Adequate analgesic medication is mandatory after coronary artery bypass grafting (CABG) surgery. The aim of this study was to assess the analgesic efficacy, side effects, and need for rescue analgesia after CABG surgery comparing diclofenac and placebo rectal suppository. ⋯ Rectal diclofenac suppository with tramadol provides adequate pain relief after cardiac surgery, and also reduces tramadol consumption and side effects commonly associated with tramadol.
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Administering drugs into the intrathecal space is becoming more popular in the treatment of patients with intractable pain or intolerable side effects of systemic analgesic treatments. Although morphine and ziconotide are the only intrathecal analgesics currently approved by regulatory authorities in the U. S. (Food and Drug Administration) and Europe (national-level approval by individual countries for morphine and European Agency for the Evaluation of Medicinal Products approval for ziconotide), a wide variety of opioid and non-opioid drugs are being used in this way. ⋯ The most recent polyanalgesic consensus recommendations were published in 2007. In this review, we shall examine these recommendations, which are tailored toward those practicing intrathecal analgesia in the U. S., and discuss how they should be implemented in Europe, where the healthcare systems and regulations of the medical authorities are different.
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To characterize comorbidities, pain-related pharmacotherapy, and healthcare resource use among patients with fibromyalgia (FM) newly prescribed pregabalin or gabapentin in clinical practice. ⋯ Results suggest a high comorbidity and medication use burden in FM patients in this study. Further evaluation is warranted to clarify differences in resource utilization/costs observed with these two anticonvulsants.
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Spinal epidural abscess is a collection of suppurative material that forms between the dura mater and the ligamentum flavum. If not recognized early and treated correctly, it can lead to life-threatening sepsis. Here we report the case of a female patient, 51 years of age, with difficulty walking and bilateral leg pain after having had degenerative discogenic pain for many years. ⋯ To prevent serious morbidity and mortality, early diagnosis is essential. Patients with localized back pain who are at risk for developing such epidural spinal abscesses should receive a magnetic resonance imaging scan with contrast enhancement without delay. The existence of predisposing factors such as intramuscular injections should be considered in the assessment of suspected spinal epidural abscess.