Parecoxib: a shift in pain management?

Parecoxib (Dynastat) is a parenteral cyclooxygenase-2 inhibitor available in Europe. Clinical trials have reported a benefit in reducing pain following oral, orthopedic, gynecologic and cardiac surgeries. The overall efficacy was dose-related and similar to ketorolac (Toradol). Several trials reported an opioid-sparing effect with parecoxib. No trials have reported significantly fewer opioid-related gastrointestinal side effects (e.g., nausea, vomiting, constipation and intestinal ileus) when opioids were administered with parecoxib versus placebo. Gastroduodenal ulcers, gastric ulcers and duodenal ulcers or erosions were less common with parecoxib than ketorolac. Parecoxib does not affect platelet aggregation, interfere with the antiplatelet affect of aspirin, affect prothrombin and partial thromboplastin time or platelet counts when administered with heparin.

Treatment of non-alcoholic fatty liver disease

Non-alcoholic fatty liver disease, defined as the presence of macrovascular steatosis in the presence of less than 20 gm of alcohol ingestion per day, is the most common liver disease in the USA. It is most commonly associated with insulin resistance/type 2 diabetes mellitus and obesity. It is manifested by steatosis, steatohepatitis, cirrhosis, and, rarely, hepatocellular carcinoma.Hepatic steatosis results from an imbalance between the uptake of fat and its oxidation and export. Insulin resistance, predisposing to lipolysis of peripheral fat with mobilization to and uptake of fatty acids by the liver, is the most consistent underlying pathogenic factor. It is not known why some patients progress to cirrhosis; however, the induction of CYP 2E1 with generation of reactive oxygen species appears to be important.Treatment is directed at weight loss plus pharmacologic therapy targeted toward insulin resistance or dyslipidemia. Bariatric surgery has proved effective. While no pharmacologic therapy has been approved, emerging data on thiazolidinediones have demonstrated improvement in both liver enzymes and histology. There are fewer, but promising data, with statins which have been shown to be hepatoprotective in other liver diseases. The initial enthusiasm for ursodeoxycholic acid has not been supported by histologic studies.

Topical lidocaine patch therapy for myofascial pain

An open label study of topical lidocaine 5% patches was conducted for myofascial pain management based on the hypothesis that electrical dysfunction is a component of myofascial pain and therefore sodium channel blockade may be useful in managing myofascial pain. The efficacy of topical lidocaine patch therapy for myofascial pain impact of the therapy on associated quality of life were investigated in the one-month trial. Principal outcome measures were Brief Pain Inventory- Short Form for pain intensity and quality of life score changes. Twenty-seven patients with moderate-severe myofascial pain were enrolled. Eighteen had low back pain. Two patients reported complete pain relief and 3 reported a lot of relief. Mean improvements for average pain intensity (7, 14, and 28 days), general activity (7 and 28 days), mood and sleep (7, 14, and 28 days), walking (14 and 28 days), and ability to work, relationships, and enjoyment of life (28 days) were significant (P < 0.05). These results suggest lidocaine patches may be useful in the management of myofascial pain.

Myofascial pain response to topical lidocaine patch therapy: case report

This is a case from a preliminary open trial to assess the efficacy of topically applied lidocaine patches as an alternative to trigger point injections for myofascial pain. We describe one case in this report that had a dramatic response to the lidocaine patch. Her pain relief increased, pain intensity decreased, and functional capacity increased. Her pain intensity and relief was measured by the Brief Pain Inventory-Short Form (BPI-SF). A quality of life measure was also included in the BPI-SF. While this was a dramatic response to this patient, it is only one case from an open-trial. The response to other patients has varied. The true clinical utility cannot be obtained from this one report, but only after the data have been analyzed from this initial trial. If the data are promising, a randomized, double-blind, crossover trial is planned.