Articles: chronic.
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Chronic pain is a challenge for modern medicine. New methods and drugs have been proposed to control pain. Intrathecal administration is a feasible and safe option, but still requires further investigations. This study aimed at reviewing available and well established drugs as well as new promising alternatives for the daily practice. ⋯ Several advances were achieved in controlling pain with intrathecal administration of the above-mentioned drugs. Certainly some will be used, thus enriching therapeutic armamentarium, and others will be temporarily or permanently abandoned. However, several clinical and experimental studies will still be needed for knew knowledge to be incorporated and safely used by professionals dealing with chronic pain.
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Four percent to 5% of the general population suffers from chronic daily or near daily headache. A majority of them are chronic migraine (transformed migraine), and the rest are chronic tension-type headaches. Prophylactic treatments of migraine and chronic tension-type headache are far from satisfactory because of lack of good efficacy, intolerable side effects, development of tachyphylaxis over long-term use, and drug interactions. ⋯ Botulinum toxin type A is well tolerated and totally free of many long-term side effects, which are seen with other prophylactic agents. The clinician may be well advised to consider botulinum toxin type A in the most refractory forms of chronic headaches including chronic migraine and chronic tension-type headache. Appropriate injection techniques, selection of injection sites, and appropriate doses are necessary for success.
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Rofecoxib was the first specific inhibitor of cyclooxygenase-2 (COX-2) approved for the treatment of acute pain. It has been shown to provide analgesia that is significantly better than placebo and has an onset of action and efficacy similar to that of traditional nonselective nonsteroidal anti-inflammatory drugs (NSAIDs), such as naproxen and ibuprofen. In addition, the analgesic efficacy of rofecoxib has been demonstrated to be superior to that of the opioid combination of codeine 60 mg/acetaminophen 600 mg in an acute dental pain model. ⋯ Rofecoxib is a safe and highly effective alternative to previously available NSAIDs and should be considered for the treatment of acute pain conditions in adult patients, especially those at risk for developing gastrointestinal complications. It is preferred in the perioperative setting because of its analgesic efficacy and lack of platelet effects. Because of its more favorable gastrointestinal toxicity profile compared with nonselective NSAIDs, rofecoxib is safer in patients, especially older patients, for whom chronic anti-inflammatory or analgesic therapy is indicated.
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The National All Schedules Prescription Electronic Reporting Act, or NASPER, is a bill proposed by the American Society of Interventional Pain Physicians to provide and improve patient access with quality care, and protect patients and physicians from deleterious effects of controlled substance misuse, abuse and trafficking. Controlled prescription drugs, including narcotic analgesics, anxiolytics, anti-depressants, stimulants, and sedative-hypnotics play a significant and legitimate role in interventional pain management practices in managing chronic pain and related disorders. Based on the 1997 household survey on drug abuse it is estimated that 76.9 million Americans had used an illicit drug at least once in their life. ⋯ The most commonly abused drugs include oxycodone, hydrocodone, hydromorphone, morphine, codeine, clonazepam, alprazolam, lorazepam, diazepam and carisoprodol. The diversion of prescription controlled substances to illicit channels is a public health and safety issue. This review describes the role of controlled substances in chronic pain management, prevalence and economic impact of controlled substance abuse, prescription accountability, effectiveness of prescription monitoring programs, and rationale for national controlled substance electronic reporting system.
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Clinical outcome data was analyzed for 67 patients with contained disc herniation who underwent percutaneous disc decompression procedure using Coblation(R) technology, also referred to as Nucleoplasty after failing to respond to conservative management. Patients presented with clinical symptoms of discogenic low back pain and/or leg pain and were not considered candidates for open surgery. Follow-up data was collected up to 12 months. ⋯ Average pre-procedure pain level for all patients was reported as 6.8 while average pain level was 4.1 at the 12 month follow-up period. Statistically significant improvement was observed in 62%, 59%, and 60% of patients in sitting, standing, and walking ability at 12 months, respectively. The results of this analysis indicated that PDD using Coblation technology, also referred to as Nucleoplasty, is an effective procedure for patients presenting with discogenic back and/or leg pain who have failed conservative therapies and are not considered candidates for open surgical interventions.