Articles: chronic.
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The management of atrial fibrillation has seen marked changes in recent years. This is the result of better knowledge of the pathophysiology and risks factors for atrial fibrillation, better stratification for thromboembolic and bleeding risks, changing practices in anticoagulation management, and the development of new antiarrhythmic drugs. This article focuses on these new issues, with particular attention to their relevance in the perioperative period. ⋯ Better knowledge of the pathophysiology of atrial fibrillation and improved awareness of the risks associated with this frequent arrhythmia are continuing to improve the management of patients with chronic atrial fibrillation and new-onset atrial fibrillation in the perioperative period. As with most complex disease processes, treatment decisions must be individualized for each patient and clinical context.
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The results of a survey conducted by the pan-European Opioids and Pain European Network of Minds (OPENMinds) Primary Care Group (OMPC) on pain assessment, opioid therapy, and educational needs are presented.
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J Pain Palliat Care Pharmacother · Jun 2014
ReviewDisrupting the downward spiral of chronic pain and opioid addiction with mindfulness-oriented recovery enhancement: a review of clinical outcomes and neurocognitive targets.
Prescription opioid misuse and addiction among chronic pain patients are problems of growing medical and social significance. Chronic pain patients often require intervention to improve their well-being and functioning, and yet, the most commonly available form of pharmacotherapy for chronic pain is centered on opioid analgesics--drugs that have high abuse liability. Consequently, health care and legal systems are often stymied in their attempts to intervene with individuals who suffer from both pain and addiction. ⋯ The purpose of this paper is to describe how the downward spiral of chronic pain and prescription opioid misuse may be targeted by one such intervention, Mindfulness-Oriented Recovery Enhancement (MORE), a new behavioral treatment that integrates elements from mindfulness training, cognitive-behavioral therapy, and positive psychology. The clinical outcomes and neurocognitive mechanisms of this intervention are reviewed with respect to their effects on the risk chain linking chronic pain and prescription opioid misuse. Future directions for clinical and pharmacologic research are discussed.
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Comparative Study Observational Study
Comparison of Gastroesophageal Reflux Disease Questionnaire (GerdQ) and Multi-channel Intraluminal Impedance-pH Monitoring in Identifying Patients with Chronic Cough Responsive to Anti-reflux Therapy.
Empirical therapy has been recommended as an initial clinical approach for treating gastroesophageal reflux-induced chronic cough (GERC). This study compared the predictive accuracy of the Gastroesophageal Reflux Disease Questionnaire (GerdQ) with the accuracy of multichannel intraluminal impedance pH monitoring (MII-pH) for GERC. ⋯ The GerdQ can be used for predicting acid GERC but not nonacid GERC and is inferior to MII-pH.
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J Pain Palliat Care Pharmacother · Jun 2014
Randomized Controlled TrialChronic postthoracotomy pain and perioperative ketamine infusion.
The objectives of this study were to investigate whether continuous intravenous ketamine during the first 72 hours after thoracotomy could reduce the incidence and intensity of chronic postthoracotomy pain (CPTP) and to define the incidence and risk factors of CPTP. Seventy-eight patients receiving thoracotomy for lung tumor (benign or malignant) were randomly divided into two groups: ketamine group (n = 31) and control groups (n = 47). Patients in the ketamine group received intravenous ketamine 1 mg/kg before incision, followed by 2 μg/kg/minute infusion for 72 hours plus sufentanil patient-controlled intravenous analgesia after thoracotomy. ⋯ Retractor used time (OR = 5.811, P = .002), inadequate acute pain control (NRS ≥ 5) (OR = 5.425, P = .048), and chemotherapy (OR = 3.784, P = .056) were independent risk factors for chronic postthoracotomy pain. The authors conclude that continuous intravenous ketamine (2 μg/kg/min) during the first 72 hours after thoracotomy was not beneficial to prevent chronic postthoracotomy pain. The independent risk factors for chronic postthoracotomy pain were retractor used time, inadequate acute pain control, and chemotherapy.