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Ceolotto N, Jagadeesan K, Xu L, Standerwick R, Robertson M, Barden R, Barnett J, Kasprzyk-Hordern B. Understanding treatment of pain during SARS-CoV-2 pandemic in a two-year intercity longitudinal study using wastewater-based epidemiology. J Hazard Mater 2024; 471:134121. [PMID: 38636235 DOI: 10.1016/j.jhazmat.2024.134121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Revised: 02/23/2024] [Accepted: 03/23/2024] [Indexed: 04/20/2024]
Abstract
SARS-CoV-2 pandemic had a significant impact on the society, economy, and health of people around the world with consequences that need to be better understood for future pandemic preparedness. This manuscript provides insights into the usage of pharmaceuticals for pain treatment management throughout SARS-CoV-2 pandemic. Four towns and cities with a total population of > 1 million people covering an area of 2000 km2 in South West England were monitored for twenty-four months. Results showed different patterns in pain pharma usage, with small towns having higher population normalised daily loads (PNDLs) than big cities for majority of pain killers studied. This is likely due to demographics of these cities with smaller cities having older population. Per capita consumption of non-steroidal anti-inflammatory drugs (NSAIDs) increased compared to pre-pandemic usage in line with SARS-CoV-2 infections (ibuprofen and acetaminophen), while body pain drugs (diclofenac and naproxen) decreased in line with restrictions and closure of sports facilities. Changes in population normalised daily intake (PNDI) of pain killers were particularly apparent during the 1st and 3rd national lockdown. Comparison of PNDIs with prescriptions highlighted differences related to medication availability (OTC drugs) and patients' nonadherence (prescribed drugs). In addition, several instances of direct disposal events across the catchments were observed which raises an issue of lack of pharma compliance and general understanding of potential environmental impacts from pharma usage.
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Affiliation(s)
- Nicola Ceolotto
- Department of Chemistry, University of Bath, Bath BA2 7AY, UK; Institute for Sustainability, University of Bath, Bath BA2 7AY, UK
| | | | - Like Xu
- Department of Chemistry, University of Bath, Bath BA2 7AY, UK
| | - Richard Standerwick
- Wessex Water, Bath BA2 7WW, UK; Environment Agency, Horizon House, Deanery Road, Bristol, UK
| | | | | | - Julie Barnett
- Department of Psychology, University of Bath, Bath BA2 7AY, UK
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Toor T, Palyo S, Schopmeyer K, Simmons AN, Strigo IA. Exploring the effects of fitbit incentive on treatment outcomes in veterans undergoing intensive pain rehabilitation program. J Patient Rep Outcomes 2024; 8:42. [PMID: 38592366 PMCID: PMC11003939 DOI: 10.1186/s41687-024-00721-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Accepted: 03/29/2024] [Indexed: 04/10/2024] Open
Abstract
OBJECTIVE This study compares clinical pain outcomes between patients in a pain treatment program that received a Fitbit, to patients that did not. We also explored: (1) cognitive, emotional, and psychological factors that may have impacted the decision to opt in to receiving a Fitbit; and (2) whether the choice to receive a Fitbit impacted changes in cognitive, emotional, and psychological factors following treatment. METHODS Among 58 patients in a multidisciplinary pain treatment program at a Veterans Affairs Healthcare System hospital, 31 patients opted to receive a Fitbit as adjunct treatment, while 27 did not. This study utilized patient-reported and practitioner-collected data from the pain treatment program. RESULTS Compared to the non-Fitbit group, the Fitbit group displayed a significant decrease in average pain intensity, however showed no correlation between Fitbit activity and average pain intensity. Additionally, treatment satisfaction was the only predictor of treatment group, when modeling pre- and post-treatment outcomes changes. CONCLUSION The implementation of a Fitbit may lead to improved pain intensity. Initial evidence suggests that opting to receive a Fitbit during a pain treatment program indicates treatment engagement leading to greater treatment satisfaction. Future work is needed to verify and expand upon this potential mechanism.
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Affiliation(s)
- Tiffany Toor
- Department of Veterans Affairs (VA) San Francisco Healthcare System, San Francisco, CA, USA.
| | - Sarah Palyo
- Department of Veterans Affairs (VA) San Francisco Healthcare System, San Francisco, CA, USA
- University of California, San Francisco, CA, USA
| | - Kathryn Schopmeyer
- Department of Veterans Affairs (VA) San Francisco Healthcare System, San Francisco, CA, USA
| | - Alan N Simmons
- Department of Veterans Affairs (VA), San Diego Healthcare System, San Diego, CA, USA
- Emotion and Pain Laboratory, San Francisco Veterans Affairs Health Care Center, 4150 Clement Street, 94121, San Francisco, CA, USA
| | - Irina A Strigo
- Department of Veterans Affairs (VA) San Francisco Healthcare System, San Francisco, CA, USA
- University of California, San Francisco, CA, USA
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da Silva MDV, Piva M, Martelossi-Cebinelli G, Stinglin Rosa Ribas M, Hoffmann Salles Bianchini B, K Heintz O, Casagrande R, Verri WA. Stem cells and pain. World J Stem Cells 2023; 15:1035-1062. [PMID: 38179216 PMCID: PMC10762525 DOI: 10.4252/wjsc.v15.i12.1035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Revised: 11/06/2023] [Accepted: 11/30/2023] [Indexed: 12/26/2023] Open
Abstract
Pain can be defined as an unpleasant sensory and emotional experience caused by either actual or potential tissue damage or even resemble that unpleasant experience. For years, science has sought to find treatment alternatives, with minimal side effects, to relieve pain. However, the currently available pharmacological options on the market show significant adverse events. Therefore, the search for a safer and highly efficient analgesic treatment has become a priority. Stem cells (SCs) are non-specialized cells with a high capacity for replication, self-renewal, and a wide range of differentiation possibilities. In this review, we provide evidence that the immune and neuromodulatory properties of SCs can be a valuable tool in the search for ideal treatment strategies for different types of pain. With the advantage of multiple administration routes and dosages, therapies based on SCs for pain relief have demonstrated meaningful results with few downsides. Nonetheless, there are still more questions than answers when it comes to the mechanisms and pathways of pain targeted by SCs. Thus, this is an evolving field that merits further investigation towards the development of SC-based analgesic therapies, and this review will approach all of these aspects.
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Affiliation(s)
- Matheus Deroco Veloso da Silva
- Department of Pathology, Laboratory of Pain, Inflammation, Neuropathy and Cancer, State University of Londrina, Londrina 86057-970, Paraná, Brazil
| | - Maiara Piva
- Department of Pathology, Laboratory of Pain, Inflammation, Neuropathy and Cancer, State University of Londrina, Londrina 86057-970, Paraná, Brazil
| | - Geovana Martelossi-Cebinelli
- Department of Pathology, Laboratory of Pain, Inflammation, Neuropathy and Cancer, State University of Londrina, Londrina 86057-970, Paraná, Brazil
| | - Mariana Stinglin Rosa Ribas
- Department of Pathology, Laboratory of Pain, Inflammation, Neuropathy and Cancer, State University of Londrina, Londrina 86057-970, Paraná, Brazil
| | - Beatriz Hoffmann Salles Bianchini
- Department of Pathology, Laboratory of Pain, Inflammation, Neuropathy and Cancer, State University of Londrina, Londrina 86057-970, Paraná, Brazil
| | - Olivia K Heintz
- Morningside Graduate School of Biomedical Sciences, University of Massachusetts Chan Medical School, Worcester, MA 01655, United States
| | - Rubia Casagrande
- Department of Pharmaceutical Sciences, Center of Health Science, State University of Londrina, Londrina 86038-440, Paraná, Brazil
| | - Waldiceu A Verri
- Department of Pathology, Laboratory of Pain, Inflammation, Neuropathy and Cancer, Center of Biological Sciences, State University of Londrina, Londrina 86057-970, Paraná, Brazil.
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Freudenberg LS, Baraliakos X, Kampen WU, Vereb M, Fischer M, Toenshoff G, Boddenberg-Pätzold B, Czech N, Klett R. [Pain reduction by radiosynoviorthesis in rheumatism-induced synovitis of the elbow : Results of a retrospective multicenter data analysis]. Z Rheumatol 2023; 82:892-897. [PMID: 35066630 DOI: 10.1007/s00393-022-01158-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/17/2021] [Indexed: 10/19/2022]
Abstract
BACKGROUND Radiosynoviorthesis (RSO) is a nuclear medical local treatment modality for inflammatory joint diseases. It is indicated in patients with rheumatoid arthritis (RA) in joints with persistent synovitis despite adequate pharmacotherapy. Arthritis of the elbow joint occurs in up to 2/3 of patients with RA. Intra-articular radiotherapy using the beta emitter [186Re] rhenium sulfide leads to sclerosis of the inflamed synovial membrane with subsequent pain alleviation. The clinical efficacy in cubital arthritis, however, has so far only been described in small monocentric studies. OBJECTIVE The degree of pain alleviation by RSO was analyzed in patients with rheumatoid cubital arthritis, treated in several nuclear medical practices specialized in RSO. MATERIAL AND METHODS The subjective pain intensity before and after RSO was documented in a total of 107 patients with rheumatic cubital arthritis using a 10-step numeric rating scale (NRS). A difference of ≥ -2 is rated as a significant improvement. Follow-up examinations were done after a mean interval of 14 months after RSO (at least 3 months, maximum 50 months). RESULTS The mean NRS value was 7.3 ± 2.1 before RSO and 2.8 ± 2.2 after RSO. A significant pain alleviation was seen in 78.5% of all patients treated. The subgroup analysis also showed a significant improvement in the pain symptoms in all groups depending on the time interval between the RSO and the control examination. A significant pain progression was not observed. The degree of pain relief was independent of the time of follow-up. CONCLUSION Using RSO for local treatment of rheumatoid cubital arthritis leads to a significant and long-lasting pain relief in more than ¾ of the treated patients.
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Affiliation(s)
- Lutz S Freudenberg
- ZRN Rheinland und ZRN MVZ GmbH, Überseite 88, 41352, Korschenbroich, Deutschland.
- ExzellenznetzRSO e. V., Langgöns, Deutschland, 53428.
| | - Xenofon Baraliakos
- Rheumazentrum Ruhrgebiet Herne, Ruhr-Universität Bochum, Claudiusstr. 45, 44649, Herne, Deutschland
| | - Willm Uwe Kampen
- ExzellenznetzRSO e. V., Langgöns, Deutschland, 53428
- Nuklearmedizin Spitalerhof, Radiologische Allianz, Spitalerstr. 8, 20095, Hamburg, Deutschland
| | - Marika Vereb
- Praxis für Radiologie, Nuklearmedizin und Strahlentherapie, Fr.-Ebert-Str. 50, 34117, Kassel, Deutschland
| | - Manfred Fischer
- ExzellenznetzRSO e. V., Langgöns, Deutschland, 53428
- Praxis für Radiologie, Nuklearmedizin und Strahlentherapie, Fr.-Ebert-Str. 50, 34117, Kassel, Deutschland
| | - Gregor Toenshoff
- ExzellenznetzRSO e. V., Langgöns, Deutschland, 53428
- Radiologie und Nuklearmedizin, Röntgenpraxis Georgstraße, Georgstr. 16, 30159, Hannover, Deutschland
| | - Barbara Boddenberg-Pätzold
- ExzellenznetzRSO e. V., Langgöns, Deutschland, 53428
- Praxis Nuramed Köln-West, Max-Planck-Str. 27A, 50858, Köln, Deutschland
| | - Norbert Czech
- ExzellenznetzRSO e. V., Langgöns, Deutschland, 53428
- Zentrum für Nuklearmedizin und PET/CT Bremen im St. Joseph Stift, Schwachhauser Heerstr. 54, 28209, Bremen, Deutschland
| | - Rigobert Klett
- ExzellenznetzRSO e. V., Langgöns, Deutschland, 53428
- ÜBAG für Nuklearmedizin, Hanau-Frankfurt-Offenbach-Gießen, Paul-Zipp-Str. 171-173, 35398, Gießen, Deutschland
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Bon M, Dardis A, Scarpa M, Sechi A. Relief of nocturnal neuropathic pain with the use of cannabis in a patient with Fabry disease. Mol Genet Metab Rep 2023; 37:101010. [PMID: 38053923 PMCID: PMC10694749 DOI: 10.1016/j.ymgmr.2023.101010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Revised: 09/18/2023] [Accepted: 09/19/2023] [Indexed: 12/07/2023] Open
Abstract
Neuropathic pain is one of the most invalidating symptoms in patients with Fabry disease (FD), affecting their quality of life, it is linked to small fiber neuropathy and it may not respond to available disease specific treatments. We report the case of a 32 years old man with classic FD and severe neuropathic pain who, after the failure of several standard pharmaceutical approaches, was treated with medical cannabis with relief of nocturnal pain and sleep improvement.
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Affiliation(s)
- Martina Bon
- Regional Coordinating Center for Rare Diseases, University Hospital of Udine, Udine, Italy
| | - Andrea Dardis
- Regional Coordinating Center for Rare Diseases, University Hospital of Udine, Udine, Italy
| | - Maurizio Scarpa
- Regional Coordinating Center for Rare Diseases, University Hospital of Udine, Udine, Italy
| | - Annalisa Sechi
- Regional Coordinating Center for Rare Diseases, University Hospital of Udine, Udine, Italy
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Zajacova A, Pereira Filho A, Limani M, Grol-Prokopczyk H, Zimmer Z, Scherbakov D, Fillingim RB, Hayward MD, Gilron I, Macfarlane GJ. Self-Reported Pain Treatment Practices Among U.S. and Canadian Adults: Findings From a Population Survey. Innov Aging 2023; 7:igad103. [PMID: 38094928 PMCID: PMC10714903 DOI: 10.1093/geroni/igad103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Indexed: 02/01/2024] Open
Abstract
Background and Objectives Pain treatments and their efficacy have been studied extensively. Yet surprisingly little is known about the types of treatments, and combinations of treatments, that community-dwelling adults use to manage pain, as well as how treatment types are associated with individual characteristics and national-level context. To fill this gap, we evaluated self-reported pain treatment types among community-dwelling adults in the United States and Canada. We also assessed how treatment types correlate with individuals' pain levels, sociodemographic characteristics, and country of residence, and identified unique clusters of adults in terms of treatment combinations. Research Design and Methods We used the 2020 "Recovery and Resilience" United States-Canada general online survey with 2 041 U.S. and 2 072 Canadian community-dwelling adults. Respondents selected up to 10 pain treatment options including medication, physical therapy, exercise, etc., and an open-ended item was available for self-report of any additional treatments. Data were analyzed using descriptive, regression-based, and latent class analyses. Results Over-the-counter (OTC) medication was reported most frequently (by 55% of respondents, 95% CI 53%-56%), followed by "just living with pain" (41%, 95% CI 40%-43%) and exercise (40%, 95% CI 38%-41%). The modal response (29%) to the open-ended item was cannabis use. Pain was the most salient correlate, predicting a greater frequency of all pain treatments. Country differences were generally small; a notable exception was alcohol use, which was reported twice as often among U.S. versus Canadian adults. Individuals were grouped into 5 distinct clusters: 2 groups relied predominantly on medication (prescription or OTC), another favored exercise and other self-care approaches, one included adults "just living with" pain, and the cluster with the highest pain levels employed all modalities heavily. Discussion and Implications Our findings provide new insights into recent pain treatment strategies among North American adults and identify population subgroups with potentially unmet need for more adaptive and effective pain management.
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Affiliation(s)
- Anna Zajacova
- Department of Sociology, University of Western Ontario, London, Ontario, Canada
| | - Alvaro Pereira Filho
- Department of Political Science, University of Western Ontario, London, Ontario, Canada
| | - Merita Limani
- Department of Sociology, University of Western Ontario, London, Ontario, Canada
| | - Hanna Grol-Prokopczyk
- Department of Sociology, University at Buffalo, State University of New York, Buffalo, New York, USA
| | - Zachary Zimmer
- Department of Family Studies and Gerontology, Global Aging and Community Initiative, Mount Saint Vincent University, Halifax, Nova Scotia, Canada
| | - Dmitry Scherbakov
- Integrative Pain Laboratory, School of Public Health, University of Haifa, Haifa, Israel
| | - Roger B Fillingim
- Department of Community Dentistry and Behavioral Science, University of Florida, Gainesville, Florida, USA
| | - Mark D Hayward
- Department of Sociology, University of Texas at Austin, Austin, Texas, USA
| | - Ian Gilron
- Department of Anesthesiology and Perioperative Medicine, Queens University, Kingston, Ontario, Canada
| | - Gary J Macfarlane
- Department of Epidemiology, Aberdeen Centre for Arthritis and Musculoskeletal Health, University of Aberdeen, Aberdeen, UK
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Slaghmuylder Y, Pype P, Van Hecke A, Lauwerier E. Development of an intervention aimed at the prevention and treatment of chronic pain in breast cancer survivors: An intervention mapping approach. Patient Educ Couns 2023; 108:107618. [PMID: 36586350 DOI: 10.1016/j.pec.2022.107618] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Revised: 12/21/2022] [Accepted: 12/26/2022] [Indexed: 06/17/2023]
Abstract
OBJECTIVE Pain is prevalent among breast cancer survivors and can persist for years, impeding quality of life. Both prevention and pain treatment are important. However, this requires an interdisciplinary approach and complex models of care. We report on the design and implementation of an intervention that follows a step-wise care model, aimed at timely and adequate pain follow-up among breast cancer survivors. METHODS We used intervention mapping to guide our planning process. The intervention was developed in co-design with relevant stakeholders, such as breast cancer survivors and healthcare providers. RESULTS An e-learning training was developed aimed at changing healthcare providers' knowledge, beliefs, and interprofessional behaviour regarding pain follow-up. Second, guides were produced to empower patients in talking about pain and stimulate referral to other disciplines. CONCLUSION To achieve change in pain follow-up, multiple levels should be addressed. Additionally, the implementation and adoption of an intervention opposes challenges. Intervention mapping can serve as a theory-based and data-driven approach for decision-making during planning. PRACTICE IMPLICATIONS This study can inform others about how to prepare for the development and implementation of an intervention. The developed intervention can also be adapted according to the target population and context, and used for other cancer populations.
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Affiliation(s)
- Yaël Slaghmuylder
- InterProfessional Collaboration in Education, Research and Practice (IPC-ERP), Department of Public Health and Primary Care, Ghent University, Ghent, Belgium.
| | - Peter Pype
- InterProfessional Collaboration in Education, Research and Practice (IPC-ERP), Department of Public Health and Primary Care, Ghent University, Ghent, Belgium.
| | - Ann Van Hecke
- University Centre for Nursing and Midwifery, Department of Public Health and Primary Care, Ghent University, Ghent, Belgium.
| | - Emelien Lauwerier
- Department of Public Health and Primary Care, Ghent University, Ghent, Belgium; Department of Experimental-Clinical and Health Psychology, Ghent University, Ghent, Belgium.
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Guenther M, Görlich D, Bernhardt F, Pogatzki-Zahn E, Dasch B, Krueger J, Lenz P. Virtual reality reduces pain in palliative care-A feasibility trial. BMC Palliat Care 2022; 21:169. [PMID: 36195865 PMCID: PMC9533542 DOI: 10.1186/s12904-022-01058-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Accepted: 09/21/2022] [Indexed: 11/20/2022] Open
Abstract
Background Effective symptom control is a stated goal of palliative care (PC) to improve quality of life for terminally ill patients. Virtual reality (VR) provides temporary escapes from pharmacologically resistant pain and allows for experiences and journeys patients may not access in any other way. Enabling wishes through virtual worlds may also offer additional benefits such as controlling psychological and physical symptoms. Aims We investigated the feasibility of a single VR experience as a viable, satisfying, and effective tool for end-of-life pain relief for inpatients presenting palliative needs. Design This is an observational, single-arm and national single-center feasibility trial. Methods A one-time VR experience with a selection of several videos and games was offered to 45 inpatients receiving PC at Muenster University Hospital. Patients with brain tumors, brain metastases, seizures, motion sickness, claustrophobia, vertigo, hearing or visual impairment, or unable to consent were excluded. Primary outcome measured patient reported pain on a visual analogue scale (VAS). We also measured Karnofsky performance status, health-related quality of life (HRQOL) using the EQ-5D-5 L questionnaire, and the Pain Out Questionnaire for postoperative pain. Results We analyzed data from 21 women (52.5%) and 19 men (47.5%) at an average age of 51.9 (SD: 15.81) years. The mean Karnofsky score among the sample was 45.5 (SD: 14.97) and the HRQOL was 41.9 (SD: 23.08). While no serious side effects were reported during the intervention, three patients experienced nausea (7%), two headaches (5%), and three reported dry eyes (7%) afterwards. Significant pain reduction (baseline VAS 2.25 (SD: 0.4399)) was demonstrated during (VAS 0.7 (SD: 0.2983, p < 0.0001)), immediately after (VAS 0.9 (SD: 0.3354, p = 0.0001)) and one hour after the intervention (VAS 1.15 (SD: 0.4163, p = 0.0004)). More than 80% rated the VR experience as very good or good (85%, n = 34) and intended to make use of the device again (82.5%, n = 33). However, two participants (5%) also expressed sadness by becoming aware of old memories and previous opportunities that are gone. Discussion The present pilot study suggests that VR seems to be a feasible and effective tool for pain relief in PC. Its use encompasses the approach of a total pain and symptom therapy and enhances patients’ dignity and autonomy. Future research ought to include if and to what extent VR could reduce the necessity of pharmacological pain relief.
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Affiliation(s)
- Miriam Guenther
- Department of Palliative Care, University Hospital Muenster, Muenster, Germany
| | - Dennis Görlich
- Institute of Biostatistics and Clinical Research, University of Muenster, Muenster, Germany
| | - Florian Bernhardt
- Department of Palliative Care, University Hospital Muenster, Muenster, Germany
| | - Esther Pogatzki-Zahn
- Department of Anesthesiology, Intensive Care and Pain Medicine, University Hospital Muenster, Muenster, Germany
| | - Burkhard Dasch
- Department of Palliative Care, University Hospital Muenster, Muenster, Germany
| | - Janina Krueger
- Specialized Outpatient Palliative Care Service Muenster, Muenster, Germany
| | - Philipp Lenz
- Department of Palliative Care, University Hospital Muenster, Muenster, Germany. .,Department of Palliative Care, University of Muenster, Albert-Schweitzer-Campus 1, Building W 30, D-48149, Muenster, Germany.
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Ren X, Zhang HXB. Uncovering a new route to pain therapy. Cell Calcium 2022; 106:102635. [PMID: 35944383 DOI: 10.1016/j.ceca.2022.102635] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Accepted: 07/21/2022] [Indexed: 11/19/2022]
Abstract
High-voltage-activated calcium channels (HVACCs) are promising targets for developing analgesics given their roles in controlling synaptic transmission, neuronal excitability and neuropeptide release in primary nociceptive neurons. Despite previous efforts in developing HVACCs inhibitors of various drug modalities, it remains undetermined whether targeting HVACCs directly by a gene therapy approach could lead to pain alleviation in vivo. To test this, Sun and colleagues adopted a post-translational ubiquitination-based knockdown method targeting HVACCs in primary sensory neurons. They showed ablation of HVACC currents in a subset of primary sensory neurons, dampened hyperexcitability of sensory neurons after nerve injury and reduced pain behavior with no apparent adverse effects [1]. The results open the possibility of targeting ion channels with ubiquitination-based knockdown as a promising gene therapy candidate for pain treatment in future clinical studies.
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Affiliation(s)
- Xiangyu Ren
- Molecular Neuroscience Laboratory, Salk Institute for Biological Studies, La Jolla, CA 92037, United States of America.
| | - Han-Xiong Bear Zhang
- Department of Neurobiology, Harvard Medical School, Boston, MA 02115, United States of America.
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Geisler A, Zachodnik J, Køppen K, Chakari R, Bech-Azeddine R. Postoperative pain treatment after spinal fusion surgery: a systematic review with meta-analyses and trial sequential analyses. Pain Rep 2022; 7:e1005. [PMID: 35505790 DOI: 10.1097/PR9.0000000000001005] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Revised: 03/09/2022] [Accepted: 03/10/2022] [Indexed: 12/22/2022] Open
Abstract
Supplemental Digital Content is Available in the Text. Patients undergoing spinal surgery are at high risk of acute and persistent postoperative pain. Therefore, adequate pain relief is crucial. This systematic review aimed to provide answers about best-proven postoperative analgesic treatment for patients undergoing lumbar 1- or 2-level fusions for degenerative spine diseases. We performed a search in PubMed, Embase, and The Cochrane Library for randomized controlled trials. The primary outcome was opioid consumption after 24 hours postoperatively. We performed meta-analyses, trial sequential analyses, and Grading of Recommendations assessment to accommodate systematic errors. Forty-four randomized controlled trials were included with 2983 participants. Five subgroups emerged: nonsteroidal anti-inflammatory drugs (NSAIDs), epidural, ketamine, local infiltration analgesia, and intrathecal morphine. The results showed a significant reduction in opioid consumption for treatment with NSAID (P < 0.0008) and epidural (P < 0.0006) (predefined minimal clinical relevance of 10 mg). Concerning secondary outcomes, significant reductions in pain scores were detected after 6 hours at rest (NSAID [P < 0.0001] and intrathecal morphine [P < 0.0001]), 6 hours during mobilization (intrathecal morphine [P = 0.003]), 24 hours at rest (epidural [P < 0.00001] and ketamine [P < 0.00001]), and 24 hours during mobilization (intrathecal morphine [P = 0.03]). The effect of wound infiltration was nonsignificant. The quality of evidence was low to very low for most trials. The results from this systematic review showed that some analgesic interventions have the capability to reduce opioid consumption compared with control groups. However, because of the high risk of bias and low evidence, it was impossible to recommend a “gold standard” for the analgesic treatment after 1- or 2-level spinal fusion surgery.
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Qin W, Yang Y, Zhang L, Yang Q, Li P, Fan B. Impact of Continuing Medical Education for Physicians on the Quality of Cancer Pain Treatment in China. J Pain Symptom Manage 2021; 62:286-292. [PMID: 33346064 DOI: 10.1016/j.jpainsymman.2020.12.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Revised: 11/03/2020] [Accepted: 12/04/2020] [Indexed: 11/26/2022]
Abstract
CONTEXT The management of cancer pain has gained attention in China since the proposal of the three-step analgesic ladder in 1986 and has been further improved after the Chinese Ministry of Health launched the campaign for "Good Pain Management Ward" in 2011. The Beijing Pain Management Center for Quality Control and Improvement was formed with the intent to improve the quality of pain management by various means such as providing continuing medical education (CME) and conducting evaluation in Beijing, the capital of China. OBJECTIVES The objective of this study was to investigate the impact of CME on cancer pain treatment in hospitals in Beijing, China. METHODS The Beijing Pain Management Center for Quality Control and Improvement carried out annual CME on cancer pain treatment for physicians in Beijing in February from 2016 to 2019. The quality of cancer pain treatment in these hospitals was evaluated in August 2015, 2017 and 2019 by using an evaluation instrument containing eight domains. The evaluation results were retrospectively reviewed to assess the impact of CME. RESULTS After annual CME for four successive years, a significant increase in evaluation scores for cancer pain treatment was observed in the participating hospitals. The increased trend varied widely both among the levels of hospitals (secondary and two tiers of tertiary hospitals) and among evaluation domains. These hospitals scored lowest in domains related to opioid tolerance, ongoing care, and risk of nonsteroidal anti-inflammatory drugs in the last evaluation. CONCLUSION CME significantly improved the quality of cancer pain treatment in the participating hospitals. Thus, standard CME courses may be adopted to improve the quality of cancer pain treatment by other regions in China and other countries.
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Affiliation(s)
- Wangjun Qin
- Department of Pharmacy, China-Japan Friendship Hospital, Beijing, China
| | - Yang Yang
- Department of Pain Management, China-Japan Friendship Hospital, Beijing, China
| | - Lei Zhang
- Department of Pharmacy, China-Japan Friendship Hospital, Beijing, China
| | - Qing Yang
- Department of Pain Management, China-Japan Friendship Hospital, Beijing, China
| | - Pengmei Li
- Department of Pharmacy, China-Japan Friendship Hospital, Beijing, China.
| | - Bifa Fan
- Department of Pain Management, China-Japan Friendship Hospital, Beijing, China.
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Rudzki PJ, Jarus-Dziedzic K, Filist M, Gilant E, Buś-Kwaśnik K, Leś A, Sasinowska-Motyl M, Nagraba Ł, Bujalska-Zadrożny M. Evaluation of tramadol human pharmacokinetics and safety after co-administration of magnesium ions in randomized, single- and multiple-dose studies. Pharmacol Rep 2021; 73:604-614. [PMID: 33686610 PMCID: PMC7994227 DOI: 10.1007/s43440-021-00239-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Revised: 02/10/2021] [Accepted: 02/16/2021] [Indexed: 12/03/2022]
Abstract
BACKGROUND Magnesium ions (Mg2+) increase and prolong opioid analgesia in chronic and acute pain. The nature of this synergistic analgesic interaction has not yet been explained. Our aim was to investigate whether Mg2+ alter tramadol pharmacokinetics. Our secondary goal was to assess the safety of the combination. METHODS Tramadol was administered to healthy Caucasian subjects with and without Mg2+ as (1) single 100-mg and (2) multiple 50-mg oral doses. Mg2+ was administered orally at doses of 150 mg and 75 mg per tramadol dosing in a single- and multiple-dose study, respectively. Both studies were randomized, open label, laboratory-blinded, two-period, two-treatment, crossover trials. The plasma concentrations of tramadol and its active metabolite, O-desmethyltramadol, were measured. RESULTS A total of 25 and 26 subjects completed the single- and multiple-dose study, respectively. Both primary and secondary pharmacokinetic parameters were similar. The 90% confidence intervals for Cmax and AUC0-t geometric mean ratios for tramadol were 91.95-102.40% and 93.22-102.76%. The 90% confidence intervals for Cmax,ss and AUC0-τ geometric mean ratios for tramadol were 93.85-103.31% and 99.04-105.27%. The 90% confidence intervals for primary pharmacokinetic parameters were within the acceptance range. ANOVA did not show any statistically significant contribution of the formulation factor (p > 0.05) in either study. Adverse events and clinical safety were similar in the presence and absence of Mg2+. CONCLUSIONS The absence of Mg2+ interaction with tramadol pharmacokinetics and safety suggests that this combination may be used in the clinical practice for the pharmacotherapy of pain.
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Affiliation(s)
- Piotr J Rudzki
- Łukasiewicz Research Network - Pharmaceutical Research Institute, ul. Rydygiera 8, 02-091, Warsaw, Poland
| | | | - Monika Filist
- Łukasiewicz Research Network - Pharmaceutical Research Institute, ul. Rydygiera 8, 02-091, Warsaw, Poland
| | - Edyta Gilant
- Łukasiewicz Research Network - Pharmaceutical Research Institute, ul. Rydygiera 8, 02-091, Warsaw, Poland
| | - Katarzyna Buś-Kwaśnik
- Łukasiewicz Research Network - Pharmaceutical Research Institute, ul. Rydygiera 8, 02-091, Warsaw, Poland
| | - Andrzej Leś
- Łukasiewicz Research Network - Pharmaceutical Research Institute, ul. Rydygiera 8, 02-091, Warsaw, Poland
| | - Małgorzata Sasinowska-Motyl
- Department of Pharmacodynamics, Centre for Preclinical Research and Technology, Medical University of Warsaw, ul. Banacha 1b, 01-793, Warsaw, Poland
| | - Łukasz Nagraba
- Orthopedic and Rehabilitation Department, Medical University of Warsaw, ul. Kondratowicza 8, 03-242, Warsaw, Poland
| | - Magdalena Bujalska-Zadrożny
- Department of Pharmacodynamics, Centre for Preclinical Research and Technology, Medical University of Warsaw, ul. Banacha 1b, 01-793, Warsaw, Poland.
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Malafoglia V, Tenti M, Ilari S, Balzani E, Fanelli A, Muscoli C, Raffaeli W, Bonci A. Opportunities and challenges for nonaddictive interventions in chronic pain. Curr Opin Pharmacol 2021; 57:184-191. [PMID: 33799001 DOI: 10.1016/j.coph.2021.02.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Revised: 02/10/2021] [Accepted: 02/11/2021] [Indexed: 12/06/2022]
Abstract
The worlds of chronic pain and addiction continue to intersect too often in many ways. Chronic pain significantly impairs and disrupts the quality of life of millions of people worldwide. Opioids remain the most prescribed pharmacotherapy offered to patients to alleviate chronic pain. The extensive and often unnecessary prescription of opioids has created a surge in the prevalence of opioid use disorders and opioid overdose-related deaths. In this brief review, we aim to provide a bench-to-bedside overview of promising biomarkers, therapeutic targets, and challenges related to treating patients with chronic pain. We hope this review will inspire new opportunities and insights into the development of novel, nonaddictive treatments for chronic pain that will be available to patients in the near future.
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Affiliation(s)
| | - Michael Tenti
- ISAL Foundation Institute for Research on Pain, Torre Pedrera, Italy
| | - Sara Ilari
- Department of Health Science, Institute of Research for Food Safety & Health (IRC-FSH), University "Magna Graecia" of Catanzaro, Viale Europa, Loc. Germaneto, Catanzaro, Italy
| | - Eleonora Balzani
- Department of Medicine and Surgery, University of Turin, Torino, Italy
| | - Andrea Fanelli
- Anesthesia and Pain Medicine Unit, Department of Emergency and Urgency, Policlinico S.Orsola-Malpighi Hospital, Bologna, Italy
| | - Carolina Muscoli
- Department of Health Science, Institute of Research for Food Safety & Health (IRC-FSH), University "Magna Graecia" of Catanzaro, Viale Europa, Loc. Germaneto, Catanzaro, Italy
| | - William Raffaeli
- ISAL Foundation Institute for Research on Pain, Torre Pedrera, Italy
| | - Antonello Bonci
- ISAL Foundation Institute for Research on Pain, Torre Pedrera, Italy; Global Institute on Addictions, 1501, Biscayne Blvd, Miami, FL, USA.
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14
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Abstract
INTRODUCTION Prevention and treatment of pain in pediatric patients compared with adults is often not only inadequate but also less often implemented the younger the children are. Children 0 to 17 years are a vulnerable population. OBJECTIVES To address the prevention and treatment of acute and chronic pain in children, including pain caused by needles, with recommended analgesic starting doses. METHODS This Clinical Update elaborates on the 2019 IASP Global Year Against Pain in the Vulnerable "Factsheet Pain in Children: Management" and reviews best evidence and practice. RESULTS Multimodal analgesia may include pharmacology (eg, basic analgesics, opioids, and adjuvant analgesia), regional anesthesia, rehabilitation, psychological approaches, spirituality, and integrative modalities, which act synergistically for more effective acute pediatric pain control with fewer side effects than any single analgesic or modality. For chronic pain, an interdisciplinary rehabilitative approach, including physical therapy, psychological treatment, integrative mind-body techniques, and normalizing life, has been shown most effective. For elective needle procedures, such as blood draws, intravenous access, injections, or vaccination, overwhelming evidence now mandates that a bundle of 4 modalities to eliminate or decrease pain should be offered to every child every time: (1) topical anesthesia, eg, lidocaine 4% cream, (2) comfort positioning, eg, skin-to-skin contact for infants, not restraining children, (3) sucrose or breastfeeding for infants, and (4) age-appropriate distraction. A deferral process (Plan B) may include nitrous gas analgesia and sedation. CONCLUSION Failure to implement evidence-based pain prevention and treatment for children in medical facilities is now considered inadmissible and poor standard of care.
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Affiliation(s)
- Stefan J Friedrichsdorf
- Center of Pain Medicine, Palliative Care and Integrative Medicine, University of California at San Francisco (UCSF), Benioff Children's Hospitals in Oakland and San Francisco, Kalifornien, USA.
- Department of Pain Medicine, Palliative Care and Integrative Medicine, Children's Hospitals and Clinics of Minnesota, Minneapolis, MN, USA.
- Department of Pediatrics, University of Minnesota, Minneapolis, MN, USA.
| | - Liesbet Goubert
- Department of Experimental-Clinical and Health Psychology, Ghent University, Gent, Belgien
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Abstract
BACKGROUND The non-opioid analgesic metamizole (dipyrone) is approved for the treatment of severe pain and is often used in the perioperative period. As it can cause agranulocytosis, a severe adverse event, its perioperative administration is controversially discussed. OBJECTIVE Is there enough evidence for a high risk of metamizol-induced agranulocytosis (MIA)? What are the consequences of its perioperative use with respect to the risk profiles of alternative analgesics? MATERIAL AND METHODS Rapid review of the literature on the risk of MIA and adverse effects of non-opioid analgesics. RESULTS The incidence of MIA is estimated to be one case per million inhabitants per year. The risk seems low compared to other drugs associated with a risk of agranulocytosis, such as antithyroid drugs and ticlopidine. The risk profile of metamizole concerning hepatotoxicity, nephrotoxicity, bleeding and cardiovascular adverse effects is favorable compared to other non-opioid analgesics. None of the non-opioid analgesics are licensed to be administered intraoperatively. CONCLUSION The perioperative use of metamizole is possible after a thorough evaluation of the indications as it provides good analgesia with a generally favorable side effect profile and is administered intravenously. The risk of agranulocytosis is small but needs to be mentioned during patient informed consent in order to optimize early recognition. Intraoperative administration aims at reducing the expected severe postoperative pain. A documentation and justification for the evaluation of the indications are recommended.
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Affiliation(s)
- R Sittl
- Interdisziplinäre Schmerzambulanz, Klinik für Anaesthesiologie, Klinikum der Ludwig-Maximilians-Universität München, Pettenkoferstr. 8a, 80336, München, Deutschland
| | - P Bäumler
- Interdisziplinäre Schmerzambulanz, Klinik für Anaesthesiologie, Klinikum der Ludwig-Maximilians-Universität München, Pettenkoferstr. 8a, 80336, München, Deutschland
| | - A-M Stumvoll
- Interdisziplinäre Schmerzambulanz, Klinik für Anaesthesiologie, Klinikum der Ludwig-Maximilians-Universität München, Pettenkoferstr. 8a, 80336, München, Deutschland
| | - D Irnich
- Interdisziplinäre Schmerzambulanz, Klinik für Anaesthesiologie, Klinikum der Ludwig-Maximilians-Universität München, Pettenkoferstr. 8a, 80336, München, Deutschland.
| | - B Zwißler
- Klinik für Anaesthesiologie, Klinikum der Ludwig-Maximilians-Universität München, Marchioninistr. 15, 81377, München, Deutschland
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Abstract
PURPOSE OF REVIEW The goal of this systematic review is to analyze the effectiveness of bisphosphonates (BPs) to treat bone pain in children and adolescents who have diseases with skeletal involvement. RECENT FINDINGS We included 24 studies (2 randomized controlled trials, 3 non-randomized controlled trials, 10 non-randomized open-label uncontrolled studies, 8 retrospective studies, and 1 study with design not specified). The majority of included studies assessed pain from a unidimensional approach, with pain intensity the most frequently evaluated dimension. Only 38% of studies used validated tools; visual analogue scale was the most frequently employed. BPs were used to alleviate bone pain in a wide variety of pediatrics conditions such as osteogenesis imperfecta, secondary osteoporosis, osteonecrosis related to chemotherapy, chronic non-bacterial osteitis, idiopathic juvenile osteoporosis, unresectable benign bone tumor, and cancer-related pain. Twenty of the 24 studies reported a positive effect of BPs for alleviating pain in different pathologies, but 58% of the studies were categorized as having high risk of bias. Intravenous BPs are helpful in alleviating bone pain in children and adolescents. It is advised that our results be interpreted with caution due to the heterogeneity of the doses used, duration of treatments, and types of pathologies included. In addition, this review shows the paucity of high-quality evidence in the available literature and further research is needed. TRIAL REGISTRATION Before the completion of this review, the protocol was registered to PROSPERO (International prospective register of systematic reviews), PROSPERO 2020 ID # CRD42020158316. Available from: https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42020158316.
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Affiliation(s)
| | - Jackeline C Simon
- Motion Analysis Center, Shriners Hospitals for Children, Chicago, IL, USA
- Orthopaedic and Rehabilitation Engineering Center, Marquette University, Milwaukee, WI, USA
| | - Joseph J Krzak
- Motion Analysis Center, Shriners Hospitals for Children, Chicago, IL, USA
- Physical Therapy Program, College of Health Sciences, Midwestern University, Downers Grove, IL, USA
| | - Alissa V Fial
- Research and Instructional Services, Raynor Memorial Libraries, Marquette University, Milwaukee, WI, USA
| | - Karen M Kruger
- Motion Analysis Center, Shriners Hospitals for Children, Chicago, IL, USA
- Orthopaedic and Rehabilitation Engineering Center, Marquette University, Milwaukee, WI, USA
| | - Peter A Smith
- Motion Analysis Center, Shriners Hospitals for Children, Chicago, IL, USA
| | - Gerald F Harris
- Motion Analysis Center, Shriners Hospitals for Children, Chicago, IL, USA
- Orthopaedic and Rehabilitation Engineering Center, Marquette University, Milwaukee, WI, USA
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Abstract
Following arm amputation the region that represented the missing hand in primary somatosensory cortex (S1) becomes deprived of its primary input, resulting in changed boundaries of the S1 body map. This remapping process has been termed 'reorganisation' and has been attributed to multiple mechanisms, including increased expression of previously masked inputs. In a maladaptive plasticity model, such reorganisation has been associated with phantom limb pain (PLP). Brain activity associated with phantom hand movements is also correlated with PLP, suggesting that preserved limb functional representation may serve as a complementary process. Here we review some of the most recent evidence for the potential drivers and consequences of brain (re)organisation following amputation, based on human neuroimaging. We emphasise other perceptual and behavioural factors consequential to arm amputation, such as non-painful phantom sensations, perceived limb ownership, intact hand compensatory behaviour or prosthesis use, which have also been related to both cortical changes and PLP. We also discuss new findings based on interventions designed to alter the brain representation of the phantom limb, including augmented/virtual reality applications and brain computer interfaces. These studies point to a close interaction of sensory changes and alterations in brain regions involved in body representation, pain processing and motor control. Finally, we review recent evidence based on methodological advances such as high field neuroimaging and multivariate techniques that provide new opportunities to interrogate somatosensory representations in the missing hand cortical territory. Collectively, this research highlights the need to consider potential contributions of additional brain mechanisms, beyond S1 remapping, and the dynamic interplay of contextual factors with brain changes for understanding and alleviating PLP.
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Affiliation(s)
- Tamar R Makin
- Institute of Cognitive Neuroscience, University College London, London, United Kingdom; Wellcome Centre for Human Neuroimaging, University College London, London, UK.
| | - Herta Flor
- Institute of Cognitive and Clinical Neuroscience, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany; Department of Psychology, School of Social Sciences, University of Mannheim, Germany; Center for Neuroplasticity and Pain (CNAP), Department of Health Science and Technology, Aalborg University, Aalborg, Denmark
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18
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Blok Z, Ridderikhof ML, Goddijn H, Berendsen M, Hollmann MW. Intravenous acetaminophen does not have an opioid sparing effect in Emergency Department patients with painful conditions. Am J Emerg Med 2020; 39:1-5. [PMID: 32014373 DOI: 10.1016/j.ajem.2020.01.049] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2019] [Revised: 01/16/2020] [Accepted: 01/27/2020] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND Pain in the Emergency Department is common and is frequently treated with opioids. Due to the opioid epidemic, it is clinically helpful to decrease opioid usage. The purpose of this study was to evaluate opioid requirement in Emergency Department patients with painful conditions who receive intravenous acetaminophen. METHODS In this prospective cohort study, patients aged 18 years and older and treated with opioids in the acute phase were included. Patients receiving additional intravenous acetaminophen were compared to patients who did not. Primary outcome was opioid requirement, measured in Morphine Equivalent Units (MEU) during Emergency Department stay. Secondary outcomes were opioid requirement after discharge; decrease in pain scores; occurrence of adverse events and patient satisfaction. RESULTS A total of 116 patients were included of whom 76 received intravenous acetaminophen. Opioid consumption in the acute phase was not significantly different (p=0.53) between patients receiving (10.0 MEU (IQR 7.5; 15.0)) and those not receiving acetaminophen: 10.0 MEU (IQR 7.1; 15.0). After discharge these numbers were 15.0 MEU (IQR 7.5; 30.0) versus 30.0 MEU (IQR 15.0; 43.8), respectively (p=0.059). In both groups median NRS pain scores decreased from 9.0 to 4.0 and >80% of patients were satisfied regarding pain treatment. Nine minor adverse events were recorded, equally divided among the groups. CONCLUSIONS The additional use of intravenous acetaminophen did not decrease opioid requirement in adult patients with acute pain during Emergency Department stay. There was a trend towards decreased opioid requirement during 24 h after discharge.
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Affiliation(s)
- Z Blok
- Department of Emergency Medicine, Amsterdam University Center, location AMC, P.O. Box 22660, 1100 DD Amsterdam, the Netherlands
| | - M L Ridderikhof
- Department of Emergency Medicine, Amsterdam University Center, location AMC, P.O. Box 22660, 1100 DD Amsterdam, the Netherlands.
| | - H Goddijn
- Department of Emergency Medicine, Amsterdam University Center, location AMC, P.O. Box 22660, 1100 DD Amsterdam, the Netherlands
| | - M Berendsen
- Department of Emergency Medicine, Amsterdam University Center, location AMC, P.O. Box 22660, 1100 DD Amsterdam, the Netherlands
| | - M W Hollmann
- Department of Anesthesiology, Amsterdam University Center, location AMC, Amsterdam, the Netherlands
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Fournier E. [Carpal tunnel syndrome: Rare causes and associated forms behind a common and stereotyped affection]. Rev Med Interne 2020; 41:451-458. [PMID: 31980186 DOI: 10.1016/j.revmed.2019.12.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2019] [Accepted: 12/23/2019] [Indexed: 10/25/2022]
Abstract
Carpal tunnel syndrome (CTS) is too common a condition not to daily interact with the practitioner, if only because of its entanglement to other pathologies, causal or chance association. The typical symptomatology, with hand paresthesia and morning pain upon waking, is related to a median nerve injury in the confined space of the carpal tunnel, more often by local inflammation and tenosynovitis of the finger flexors (repetitive activity of the hands). SCC may be secondary to situations (pregnancy) or conditions (edema, hypothyroidism…), which exaggerate the ordinary pathophysiology or cause deposits in the channel (amyloidosis, mucopolysaccharidoses, etc.). Otherwise, SCC is favored by all neuropathies that cause nerve fragility (especially diabetes). It is sometimes the first sign of these various affections of which it can allow early diagnosis. Electroneuromyographic examination (ENMG) is a key examination to confirm the diagnosis (slowing of sensitive and motor conduction of the median nerve through the carpal tunnel, due to local demyelination), to look for a predisposing neuropathy and for signs of seriousness (amplitude reduction of electrophysiological signals) that indicate axonal loss. In SCC forms with only slowed conduction without sign of seriousness, a splint or infiltration treatment may be attempted. If this medical treatment does not bring healing, or if there are signs of seriousness or unbearable pains, a decompression surgery is indicated. Whether it is performed traditionally or endoscopically, it provides fast relief, even immediate.
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Affiliation(s)
- E Fournier
- Département de physiologie, faculté de médecine Pitié-Salpêtrière, Sorbonne université, 91, boulevard de l'Hôpital, 75013 Paris, France.
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20
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Friedrichsdorf SJ, Goubert L. Pediatric pain treatment and prevention for hospitalized children. Pain Rep 2020; 5:e804. [PMID: 32072099 DOI: 10.1097/PR9.0000000000000804] [Citation(s) in RCA: 58] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2019] [Revised: 10/23/2019] [Accepted: 11/13/2019] [Indexed: 12/21/2022] Open
Abstract
Introduction: Prevention and treatment of pain in pediatric patients compared with adults is often not only inadequate but also less often implemented the younger the children are. Children 0 to 17 years are a vulnerable population. Objectives: To address the prevention and treatment of acute and chronic pain in children, including pain caused by needles, with recommended analgesic starting doses. Methods: This Clinical Update elaborates on the 2019 IASP Global Year Against Pain in the Vulnerable “Factsheet Pain in Children: Management” and reviews best evidence and practice. Results: Multimodal analgesia may include pharmacology (eg, basic analgesics, opioids, and adjuvant analgesia), regional anesthesia, rehabilitation, psychological approaches, spirituality, and integrative modalities, which act synergistically for more effective acute pediatric pain control with fewer side effects than any single analgesic or modality. For chronic pain, an interdisciplinary rehabilitative approach, including physical therapy, psychological treatment, integrative mind–body techniques, and normalizing life, has been shown most effective. For elective needle procedures, such as blood draws, intravenous access, injections, or vaccination, overwhelming evidence now mandates that a bundle of 4 modalities to eliminate or decrease pain should be offered to every child every time: (1) topical anesthesia, eg, lidocaine 4% cream, (2) comfort positioning, eg, skin-to-skin contact for infants, not restraining children, (3) sucrose or breastfeeding for infants, and (4) age-appropriate distraction. A deferral process (Plan B) may include nitrous gas analgesia and sedation. Conclusion: Failure to implement evidence-based pain prevention and treatment for children in medical facilities is now considered inadmissible and poor standard of care.
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21
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Fattori V, Zaninelli TH, Rasquel-Oliveira FS, Casagrande R, Verri WA. Specialized pro-resolving lipid mediators: A new class of non-immunosuppressive and non-opioid analgesic drugs. Pharmacol Res 2019; 151:104549. [PMID: 31743775 DOI: 10.1016/j.phrs.2019.104549] [Citation(s) in RCA: 44] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2019] [Revised: 11/04/2019] [Accepted: 11/14/2019] [Indexed: 12/19/2022]
Abstract
We now appreciate that the mechanism of resolution depends on an active and time-dependent biosynthetic shift from pro-inflammatory to pro-resolution mediators, the so-called specialized pro-resolving lipid mediators (SPMs). These SPMs are biosynthesized from the omega-3 fatty acids arachidonic acid (AA), eicosapentaenoic acid (EPA), docosapentaenoic acid (DPA), or docosahexaenoic acid (DHA). Despite effective for a fraction of patients with rheumatic diseases and neuropathic pain, current analgesic therapies such as biological agents, opioids, corticoids, and gabapentinoids cause unwanted side effects, such as immunosuppression, addiction, or induce analgesic tolerance. A growing body of evidence demonstrates that isolated SPMs show efficacy at very low doses and have been successively used as therapeutic drugs to treat pain and infection in experimental models showing no side effects. Moreover, SPMs work as immunoresolvents and some of them present long-lasting analgesic and anti-inflammatory effects (i.e. block pain without immunosuppressive effects). In this review, we focus on how SPMs block pain, infection and neuro-immune interactions and, therefore, emerge as a new class of non-immunosuppressive and non-opioid analgesic drugs.
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Affiliation(s)
- Victor Fattori
- Laboratory of Pain, Inflammation, Neuropathy, and Cancer, Department of Pathology, Center of Biological Sciences, Londrina State University, Londrina, Paraná, Brazil.
| | - Tiago H Zaninelli
- Laboratory of Pain, Inflammation, Neuropathy, and Cancer, Department of Pathology, Center of Biological Sciences, Londrina State University, Londrina, Paraná, Brazil
| | - Fernanda S Rasquel-Oliveira
- Laboratory of Pain, Inflammation, Neuropathy, and Cancer, Department of Pathology, Center of Biological Sciences, Londrina State University, Londrina, Paraná, Brazil
| | - Rubia Casagrande
- Laboratory of Antioxidants and Inflammation, Department of Pharmaceutical Sciences, Center of Health Sciences, Londrina State University, Londrina, Paraná, Brazil
| | - Waldiceu A Verri
- Laboratory of Pain, Inflammation, Neuropathy, and Cancer, Department of Pathology, Center of Biological Sciences, Londrina State University, Londrina, Paraná, Brazil.
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Davidoff AJ, Canavan ME, Feder S, Wang S, Sheinfeld E, Kent EE, Kapo J, Presley CJ. Patterns of pain medication use associated with reported pain interference in older adults with and without cancer. Support Care Cancer 2020; 28:3061-72. [PMID: 31637515 DOI: 10.1007/s00520-019-05074-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2019] [Accepted: 09/06/2019] [Indexed: 10/25/2022]
Abstract
CONTEXT Concerns about the adequacy of pain management among older adults are increasing, particularly with restrictions on opioid prescribing. OBJECTIVES To examine associations between prescription pain medication receipt and patient-reported pain interference in older adults with and without cancer. METHODS Using the 2007-2012 Surveillance Epidemiology and End Results (SEER)-Medicare Health Outcomes Survey (MHOS) database linked to Medicare Part D prescription claims, we selected MHOS respondents (N = 15,624) aged ≥ 66 years, ≤ 5 years of a cancer diagnosis (N = 9105), or without cancer (N = 6519). We measured receipt of opioids, non-steroidal anti-inflammatory drugs, and antiepileptics, and selected antidepressants within 30 days prior to survey. Patient-reported activity limitation due to pain (pain interference) within the past 30 days was summarized as severe, moderate, or mild/none. Logistic regression using predictive margins estimated associations between pain interference, cancer history, and pain medication receipt, adjusting for socio-demographics, chronic conditions, and Part D low-income subsidy. RESULTS Severe or moderate pain interference was reported by 21.3% and 46.1%, respectively. Pain medication was received by 21.5%, with 11.6% receiving opioids. Among adults reporting severe pain interference, opioid prescriptions were filled by 27.0% versus 23.8% (p = 0.040) with and without cancer, respectively. Over half (56%) of adults reporting severe pain in both groups failed to receive any prescription pain medication. CONCLUSIONS Older adults with cancer were more likely to receive prescription pain medications compared with adults without cancer; however, many older adults reporting severe pain interference did not receive medications. Improved assessment and management of pain among older adults with and without cancer is urgently needed.
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Khangura RK, Sharma J, Bali A, Singh N, Jaggi AS. An integrated review on new targets in the treatment of neuropathic pain. Korean J Physiol Pharmacol 2019; 23:1-20. [PMID: 30627005 PMCID: PMC6315088 DOI: 10.4196/kjpp.2019.23.1.1] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/27/2018] [Revised: 09/12/2018] [Accepted: 09/17/2018] [Indexed: 01/01/2023]
Abstract
Neuropathic pain is a complex chronic pain state caused by the dysfunction of somatosensory nervous system, and it affects the millions of people worldwide. At present, there are very few medical treatments available for neuropathic pain management and the intolerable side effects of medications may further worsen the symptoms. Despite the presence of profound knowledge that delineates the pathophysiology and mechanisms leading to neuropathic pain, the unmet clinical needs demand more research in this field that would ultimately assist to ameliorate the pain conditions. Efforts are being made globally to explore and understand the basic molecular mechanisms responsible for somatosensory dysfunction in preclinical pain models. The present review highlights some of the novel molecular targets like D-amino acid oxidase, endoplasmic reticulum stress receptors, sigma receptors, hyperpolarization-activated cyclic nucleotide-gated cation channels, histone deacetylase, Wnt/β-catenin and Wnt/Ryk, ephrins and Eph receptor tyrosine kinase, Cdh-1 and mitochondrial ATPase that are implicated in the induction of neuropathic pain. Studies conducted on the different animal models and observed results have been summarized with an aim to facilitate the efforts made in the drug discovery. The diligent analysis and exploitation of these targets may help in the identification of some promising therapies that can better manage neuropathic pain and improve the health of patients.
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Affiliation(s)
- Ravneet Kaur Khangura
- Department of Pharmaceutical Sciences and Drug Research, Punjabi University, Patiala 147002, India
| | - Jasmine Sharma
- Department of Pharmaceutical Sciences and Drug Research, Punjabi University, Patiala 147002, India
| | - Anjana Bali
- Akal College of Pharmacy and Technical Education, Mastuana Sahib 148002, Sangrur, India
| | - Nirmal Singh
- Department of Pharmaceutical Sciences and Drug Research, Punjabi University, Patiala 147002, India
| | - Amteshwar Singh Jaggi
- Department of Pharmaceutical Sciences and Drug Research, Punjabi University, Patiala 147002, India
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Kleczkowska P, Nowicka K, Bujalska-Zadrozny M, Hermans E. Neurokinin-1 receptor-based bivalent drugs in pain management: The journey to nowhere? Pharmacol Ther 2019; 196:44-58. [PMID: 30468743 DOI: 10.1016/j.pharmthera.2018.11.007] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Hybrid compounds (also known as chimeras, designed multiple ligands, bivalent compounds) are chemical units where two active components, usually possessing affinity and selectivity for distinct molecular targets, are combined as a single chemical entity. The rationale for using a chimeric approach is well documented as such novel drugs are characterized by their enhanced enzymatic stability and biological activity. This allows their use at lower concentrations, increasing their safety profile, particularly when considering undesirable side effects. In the group of synthetic bivalent compounds, drugs combining pharmacophores having affinities toward opioid and neurokinin-1 receptors have been extensively studied as potential analgesic drugs. Indeed, substance P is known as a major endogenous modulator of nociception both in the peripheral and central nervous systems. Hence, synthetic peptide fragments showing either agonism or antagonism at neurokinin 1 receptor were both assigned with analgesic properties. However, even though preclinical studies designated neurokinin-1 receptor antagonists as promising analgesics, early clinical studies revealed a lack of efficacy in human. Nevertheless, their molecular combination with enkephalin/endomorphin fragments has been considered as a valuable approach to design putatively promising ligands for the treatment of pain. This paper is aimed at summarizing a 20-year journey to the development of potent analgesic hybrid compounds involving an opioid pharmacophore and devoid of unwanted side effects. Additionally, the legitimacy of considering neurokinin-1 receptor ligands in the design of chimeric drugs is discussed.
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Hahn Y, Tiernan G, Berecki-Gisolf J. The impact of opioid analgesic prescription uptake on the costs of recovery from injury: Evidence from compensable orthopaedic road trauma patients. Accid Anal Prev 2018; 117:32-39. [PMID: 29631183 DOI: 10.1016/j.aap.2018.03.032] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/24/2017] [Revised: 03/26/2018] [Accepted: 03/31/2018] [Indexed: 06/08/2023]
Abstract
Long-term opioid prescribing after compensable orthopaedic injury may contribute to the 'long right tail' in the cost of recovery. The aim of this study was to estimate the effect of prescription opioid uptake on injury compensation cost, using orthopaedic road traffic injury claims data from Victoria, Australia. We used a maximum likelihood estimation that accounts for potential endogeneity associated with opioid uptake, utilizing information on the doctor's differential propensity to prescribe opioids when treating other compensable injury patients. Our results suggest that opioid recipients incurred significantly greater hospital costs, income compensation payments, and medical and paramedical expenses. Overall, income compensation was the primary driver of the claim cost difference between opioid recipients and non-recipients. The findings imply that there is scope to impose restrictions on long-term opioid usage, and to encourage the use of alternative pain relief medicines.
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Affiliation(s)
- Youjin Hahn
- School of Economics, Yonsei University. Postal address: 50 Yonsei-ro, Seodaemun-gu, Seoul 03722, South Korea.
| | - Gemma Tiernan
- The Cube Group, Postal address: 7/136 Exhibition Street, Melbourne, VIC, 3000, Australia.
| | - Janneke Berecki-Gisolf
- Accident Research Centre, Monash University, Postal address: MUARC, Building 70, 21 Alliance Lane, Monash University, Clayton, VIC, 3800, Australia.
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Bobola MS, Chen L, Ezeokeke CK, Kuznetsova K, Lahti AC, Lou W, Myroniv AN, Schimek NW, Selby ML, Mourad PD. A Review of Recent Advances in Ultrasound, Placed in the Context of Pain Diagnosis and Treatment. Curr Pain Headache Rep 2018; 22:60. [PMID: 29987680 PMCID: PMC6061208 DOI: 10.1007/s11916-018-0711-7] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Ultrasound plays a significant role in the diagnosis and treatment of pain, with significant literature reaching back many years, especially with regard to diagnostic ultrasound and its use for guiding needle-based delivery of drugs. Advances in ultrasound over at least the last decade have opened up new areas of inquiry and potential clinical efficacy in the context of pain diagnosis and treatment. Here we offer an overview of the recent literature associated with ultrasound and pain in order to highlight some promising frontiers at the intersection of these two subjects. We focus first on peripheral application of ultrasound, for which there is a relatively rich, though still young, literature. We then move to central application of ultrasound, for which there is little literature but much promise.
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Affiliation(s)
- Michael S Bobola
- Department of Neurological Surgery, University of Washington, Seattle, WA, USA
| | - Lucas Chen
- Department of Neurological Surgery, University of Washington, Seattle, WA, USA
| | | | - Katy Kuznetsova
- Applied Physics Laboratory, University of Washington, Seattle, WA, USA
| | - Annamarie C Lahti
- Department of Neurological Surgery, University of Washington, Seattle, WA, USA
| | - Weicheng Lou
- Department of Neurological Surgery, University of Washington, Seattle, WA, USA
| | - Aleksey N Myroniv
- Department of Neurological Surgery, University of Washington, Seattle, WA, USA
| | - Nels W Schimek
- Department of Neurological Surgery, University of Washington, Seattle, WA, USA
| | - Madison L Selby
- Department of Neurological Surgery, University of Washington, Seattle, WA, USA
| | - Pierre D Mourad
- Department of Neurological Surgery, University of Washington, Seattle, WA, USA.
- Applied Physics Laboratory, University of Washington, Seattle, WA, USA.
- Division of Engineering and Mathematics, University of Washington, Bothell, WA, USA.
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Kaye AD, Cornett EM, Hart B, Patil S, Pham A, Spalitta M, Mancuso KF. Novel Pharmacological Nonopioid Therapies in Chronic Pain. Curr Pain Headache Rep 2018; 22:31. [PMID: 29616344 DOI: 10.1007/s11916-018-0674-8] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
PURPOSE OF REVIEW Opioid use and abuse has led to a worldwide opioid epidemic. And while opioids are clinically useful when appropriately indicated, they are associated with a wide range of dangerous side effects and whether they are effective at treating or eliminating chronic pain is controversial. There has long been a need for the development of nonopioid alternative treatments for patients that live in pain, and until recently, only a few effective treatments were available. Today, there are a wide range of nonopioid treatments available including NSAIDs, acetaminophen, corticosteroids, nerve blocks, SSRIs, neurostimulators, and anticonvulsants. However, these treatments are still not entirely effective at treating pain, which has sparked a new exploration of novel nonopioid pharmacotherapies. RECENT FINDINGS This manuscript will outline the most recent trends in novel nonopioid pharmacotherapy development including tramadol/dexketoprofen, TrkA inhibitors, tapentadol, opioid agonists, Nektar 181, TRV 130, ßarrestin2, bisphosphonates, antibodies, sodium channel blockers, NMDA antagonists, TRP receptors, transdermal vitamin D, AAK1 kinase inhibition, calcitonin gene-related peptide (CGRP), TRPV4 antagonists, cholecystokinin, delta opioid receptor, neurokinin, and gene therapy. The pharmacotherapies discussed in this manuscript outline promising opioid alternatives which can change the future of chronic pain treatment.
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Wattier JM. [Conventional analgesics and non-pharmacological multidisciplinary therapeutic treatment in endometriosis: CNGOF-HAS Endometriosis Guidelines]. ACTA ACUST UNITED AC 2018; 46:248-255. [PMID: 29510963 DOI: 10.1016/j.gofs.2018.02.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2018] [Indexed: 12/24/2022]
Abstract
A major symptom of endometriosis is pelvic pain with a wide range of intensity, rhythm, type, and expression, without clearly established relationship between pain and the disease. Endometriosis-associated pain has physical, psychological/behavioral and social consequences with a significant impact on patient quality-of-life in relation with the biopsychosocial model of chronic pain. Pain assessment in all of its dimensions, as well as assessing the consequences of pain is therefore a crucial part of therapeutic management. Conventional analgesics are commonly used although studies demonstrating their efficacy in the treatment of endometriosis-related pelvic pain are lacking. Non-steroid anti-inflammatory drugs (NSAIDs), known to be effective in dysmenorrhea unrelated to endometriosis, have not been recently re-assessed in patients with endometriosis. Following rigorous assessment, the characterization of neuropathic components of endometriosis-related pelvic pain may lead to treatment with antiepileptic of antidepressant drugs, although gabapentin and amitriptyline have yet to be specifically assessed in the setting of endometriosis-related pain. Other pharmacologically active compounds have been tested to treat endometriosis-related pain but did not demonstrate efficacy with sufficient level of evidence. Diets, dietary supplements and herbal medicine are often proposed and/or used as adjuncts without any conclusive evidence. Although the effects on endometriosis-related pain are methodologically difficult to assess, physical adjunctive therapies such as acupuncture, transcutaneous neurostimulation, osteopathy/chiropractics, physical therapy and physical activity, the long-term therapeutic relationship they establish may potentiate beneficial effects perceived by patients. However, it remains difficult to demonstrate significant effects of cognitive and/or behavioral interventions on endometriosis-related pain. CONCLUSION The complexity of managing endometriosis-related pain requires a holistic approach with sustained attention to the patient. Treatments, either pharmacologic or non-pharmacologic, including adjuvant therapies, associate a technical expertise to which a human approach must be added in order to bring value to these treatments. Multidisciplinary and/or inter disciplinary approaches are therefore essential to the care of patients suffering from endometriosis.
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Affiliation(s)
- J-M Wattier
- Centre d'étude et traitement de la douleur, hôpital Claude-Huriez, CHRU de Lille, rue Michel-Polonowski, 59000 Lille, France.
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Schüning J, Maier C, Schwarzer A. [ Pain treatment with opioids for non-cancer pain by the family physician]. MMW Fortschr Med 2017; 159:52-61. [PMID: 29086255 DOI: 10.1007/s15006-017-9599-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Affiliation(s)
- Julia Schüning
- Abteilung für Geriatrie/Neurologie, Elisabeth Krankenhaus GmbH, Recklinghausen, Deutschland
| | - Christoph Maier
- Abteilung für Schmerzmedizin, Berufsgenossenschaftliches Universitätsklinikum Bergmannsheil GmbH, Ruhr-Universität Bochum, Bochum, Deutschland
| | - Andreas Schwarzer
- Abteilung für Schmerzmedizin, Berufsgenossenschaftliches Universitätsklinikum Bergmannsheil GmbH, Ruhr-Universität Bochum, Bochum, Deutschland.
- Abt. für Schmerzmedizin, Berufsgenossenschaftliches Universitätsklinikum Bergmannsheil, Ruhr-Universität Bochum, Bürkle-de-la-Camp-Platz 1, D-44789, Bochum, Deutschland.
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Abstract
Treating pain in older adults can be complex because of the age-related physiologic changes, comorbidities, and polypharmacy. Thus, an individualized, multimodal treatment approach is recommended. Treatment plans should include pharmacologic and nonpharmacologic strategies. Several important clinical guidelines and expert panel statements are available to guide health care providers in the best practices for treating pain in older adults. This article provides evidence-based recommendations for pharmacological and non-pharmacological pain management in older adults.
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Affiliation(s)
- Ann L Horgas
- University of Florida, College of Nursing, PO Box 100197-HSC, Gainesville, FL 32610, USA.
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Drewes AM, Bouwense SAW, Campbell CM, Ceyhan GO, Delhaye M, Demir IE, Garg PK, van Goor H, Halloran C, Isaji S, Neoptolemos JP, Olesen SS, Palermo T, Pasricha PJ, Sheel A, Shimosegawa T, Szigethy E, Whitcomb DC, Yadav D. Guidelines for the understanding and management of pain in chronic pancreatitis. Pancreatology 2017; 17:720-731. [PMID: 28734722 DOI: 10.1016/j.pan.2017.07.006] [Citation(s) in RCA: 150] [Impact Index Per Article: 21.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2017] [Revised: 06/26/2017] [Accepted: 07/11/2017] [Indexed: 12/11/2022]
Abstract
Abdominal pain is the foremost complication of chronic pancreatitis (CP). Pain can be related to recurrent or chronic inflammation, local complications or neurogenic mechanisms with corresponding changes in the nervous systems. Both pain intensity and the frequency of pain attacks have been shown to reduce quality of life in patients with CP. Assessment of pain follows the guidelines for other types of chronic pain, where the multidimensional nature of symptom presentation is taken into consideration. Quantitative sensory testing may be used to characterize pain, but is currently used in a research setting in advanced laboratories. For pain relief, current guidelines recommend a simple stepwise escalation of analgesic drugs with increasing potency until pain relief is obtained. Abstinence from alcohol and smoking should be strongly advised. Pancreatic enzyme therapy and antioxidants may be helpful as initial treatment. Endoscopic treatment can be used in patients with evidence of ductal obstruction and may be combined with extracorporeal shock wave lithothripsy. The best candidates are those with distal obstruction of the main pancreatic duct and in early stage of disease. Behavioral interventions should be part of the multidisciplinary approach to chronic pain management particularly when psychological impact is experienced. Surgery should be considered early and after a maximum of five endoscopic interventions. The type of surgery depends on morphological changes of the pancreas. Long-term effects are variable, but high success rates have been reported in open studies and when compared with endoscopic treatment. Finally, neurolytical interventions and neuromodulation can be considered in difficult patients.
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Affiliation(s)
- Asbjørn M Drewes
- Centre for Pancreatic Diseases, Department of Gastroenterology and Hepatology, Aalborg University Hospital, Denmark.
| | - Stefan A W Bouwense
- Department of Surgery, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Claudia M Campbell
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, USA
| | - Güralp O Ceyhan
- Department of Surgery, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | - Myriam Delhaye
- Department of Gastroenterology, Erasme University Hospital, Brussels, Belgium
| | - Ihsan Ekin Demir
- Department of Surgery, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | - Pramod K Garg
- Department of Gastroenterology, All India Institute of Medical Sciences, New Delhi, India
| | - Harry van Goor
- Department of Surgery, Radboud University Medical Center, Nijmegen, The Netherlands
| | | | - Shuiji Isaji
- Department of Surgery, Mie University Graduate School of Medicine, Japan
| | - John P Neoptolemos
- Institute of Translational Medicine, University of Liverpool, United Kingdom
| | - Søren S Olesen
- Centre for Pancreatic Diseases, Department of Gastroenterology and Hepatology, Aalborg University Hospital, Denmark
| | - Tonya Palermo
- Seattle Children's Hospital Research Institute, Washington School of Medicine, USA
| | - Pankaj Jay Pasricha
- Center for Neurogastroenterology, Johns Hopkins University School of Medicine, Baltimore, USA
| | - Andrea Sheel
- Institute of Translational Medicine, University of Liverpool, United Kingdom
| | - Tooru Shimosegawa
- Department of Gastroenterology, Tohoku University Graduate School of Medicine, Japan
| | - Eva Szigethy
- Visceral Inflammation and Pain Center, Division of Gastroenterology, University of Pittsburgh and UPMC, Pittsburgh, PA, USA
| | - David C Whitcomb
- Division of Gastroenterology, Hepatology and Nutrition, University of Pittsburgh and UPMC, Pittsburgh, PA, USA
| | - Dhiraj Yadav
- Division of Gastroenterology, Hepatology and Nutrition, University of Pittsburgh and UPMC, Pittsburgh, PA, USA
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Milani GP, Benini F, Dell'Era L, Silvagni D, Podestà AF, Mancusi RL, Fossali EF. Acute pain management: acetaminophen and ibuprofen are often under-dosed. Eur J Pediatr 2017; 176:979-982. [PMID: 28600631 DOI: 10.1007/s00431-017-2944-6] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2017] [Revised: 05/22/2017] [Accepted: 05/28/2017] [Indexed: 10/19/2022]
Abstract
UNLABELLED Most children with pain are managed by either acetaminophen or ibuprofen. However, no study has so far investigated if children are prescribed adequate doses of acetaminophen or ibuprofen in emergency department. Aim of this retrospective study was to investigate the prevalence of under-dosage of these drugs in children presenting with pain in emergency department. Children initially prescribed with acetaminophen or ibuprofen for pain management were included. The χ 2 automatic interaction detection method was used considering the percentage variation from the minimum of the appropriate dose as dependent variable while prescribed drug, age, gender, body weight, type of hospital (pediatric or general), and availability of internal guidelines on pediatric pain management in the emergency department as independent variables. Data on 1471 children managed for pain were available. Under-dosage was prescribed in 893 subjects (61%), of whom 577 were prescribed acetaminophen and 316 ibuprofen. The use of acetaminophen suppositories, body weight <12 kg or >40 kg, and the use of oral ibuprofen identified clusters of children associated with under-dosage prescription. CONCLUSION Prescription of acetaminophen and ibuprofen was frequently under-dosed. The use of suppositories, lower and higher body weight, and the use of ibuprofen were associated with under-dosage. Under-dosing may reflect prescription of anti-pyretic doses. CLINICAL TRIAL REGISTRATION Agenzia Italiana del Farmaco-Observational Study Register (RSO). Registration code: PIERRE/1 What is Known: • Pain is frequent in children presented to emergency department. • International recommendations on pain management are often not implemented. What is New: • Acetaminophen and ibuprofen were frequently underdosed in children prescribed for pain in the Italian emergency departments. • Under-dosage may be related to the habit of using acetaminophen and ibuprofen in the recommended range for fever treatment.
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Affiliation(s)
- Gregorio P Milani
- Pediatric Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico and Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Milan, Italy. .,Pediatric Emergency Department, Università degli Studi di Milano, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via della Commenda 9, 20122, Milan, Italy.
| | - Franca Benini
- Pediatric Pain and Palliative Care Service, Department of Women's and Children's Health, University Hospital, Padua, Italy
| | - Laura Dell'Era
- Pediatric Emergency Department, Università degli Studi di Milano, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via della Commenda 9, 20122, Milan, Italy
| | | | - Alberto F Podestà
- Dipartimento Materno Infantile, ASST Santi Paolo e Carlo, Ospedale San Carlo Borromeo, Milan, Italy
| | | | - Emilio F Fossali
- Pediatric Emergency Department, Università degli Studi di Milano, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via della Commenda 9, 20122, Milan, Italy
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Abstract
INTRODUCTION Nocebo-induced algesic responses occurring within clinical contexts present a challenge for health care practitioners working in the field of pain medicine. OBJECTIVES Following the recent research on algesic nocebo effects, the scope of this review is to develop ethically acceptable strategies to help avoid, or at least reduce, nocebo responses within clinical settings. METHODS We reviewed relevant clinical studies that depict how patient-practitioner interactions may contribute to the reduction of nocebo responses. RESULTS A strong algesic nocebo effect may adversely impact a patient's condition by causing decreases in both the efficacy and effectiveness of interventions, as well as by promoting treatment nonadherence and discontinuation. These effects may be triggered through multiple channels and can lead to significant alterations in a patient's perception of pain, consequently producing a weakening of the specific positive effects of pharmacological, psychological, or physical pain-management interventions. CONCLUSION To minimize nocebo effects in clinical settings, we identified and discussed five contextual aspects relevant to the treatment of patients with chronic pain: (1) negative patient-clinician communication and interaction during treatment; (2) emotional burden of patients during treatment with analgesic medication; (3) negative information provided via informational leaflets; (4) cued and contextual conditioning nocebo effects; and (5) patient's lack of positive information. Through an understanding of these elements, many preventive and ethically acceptable clinical actions can be taken to improve multidisciplinary pain treatment outcomes.
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Hållstam A, Löfgren M, Benson L, Svensén C, Stålnacke BM. Assessment and treatment at a pain clinic: A one-year follow-up of patients with chronic pain. Scand J Pain 2016; 17:233-242. [PMID: 29229208 DOI: 10.1016/j.sjpain.2016.08.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2016] [Revised: 08/08/2016] [Accepted: 08/15/2016] [Indexed: 10/21/2022]
Abstract
BACKGROUND AND AIMS Pain is one of the most common reasons for patients to seek primary health care. Pain relief is likely to be achieved for patients suffering from acute pain, but for individuals with chronic pain it is more likely that the condition will persist. These patients have the option of being referred to specialised pain clinics. However, the complexity surrounding chronic pain patients is not well studied in these settings. This study aimed to describe patients with chronic pain referred to a pain clinic by using the information submitted during their first visit and one year later and also to identify associations between baseline characteristics and improvements in health-related quality of life in the follow-up. METHODS This was a longitudinal observational study of a sample consisting of 318 patients referred to a pain clinic. One group of patients containing 271 individuals (median age 48, 64% females) was assessed and received conventional pain treatment (CPT group) and a second group of 47 patients (median age 53, 64% females) was assessed by a pain specialist and referred back to their physician with a treatment recommendation (assessment only, AO group). Patient-reported outcome measures in health-related quality of life (EQ-5D), pain intensity (VAS), mental health (HADS), insomnia (ISI), pain-related disability (PDI), kinesiophobia (TSK) and sense of coherence (SOC) were collected at the first visit and one year later. RESULTS At baseline, the CPT group reported a low EQ-5D Index (median (md) 0.157) and EQ VAS (md 40) as well as considerable high, current pain intensity VAS (md 58), HADS anxiety (md 8), ISI (md 17), PDI (md 36) and TSK (md 39). The AO group showed similar problems (no significant differences compared to the CPT group), except for ISI, where the AO group reported less severe problems. At the one-year follow-up, the CPT group had a statistically significant improvement in EQ-5D, VAS, ISI, PDI and TSK. In the AO group no significant changes were observed. In the CPT group there was an association between a high ISI level at baseline and an improved EQ-5D Index in the follow-up. CONCLUSIONS The study describes rarely explored groups of patients with chronic pain at a pain clinic. Severe pain problems were present in both groups at their first visit. A statistically significant improvement could be seen in the group that was conventionally treated while this was not the case among those subjects who were assessed and referred. The results imply, that relatively limited treatment strategies were helpful for the patients' health-related quality of life. Despite these improvements, the patients were not fully recovered, pointing to the chronicity of pain conditions and the need of support for many patients. IMPLICATIONS Increased knowledge about assessment, selection and treatment at pain clinics is important to improve the quality of the work performed at these clinics. Despite limited resources, further efforts should be made to collect comparable, valid data on a regular base from pain clinics in order to develop recommendation models.
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Affiliation(s)
- Andrea Hållstam
- Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, and Unit of Anaesthesiology and Intensive Care, Södersjukhuset, SE-11883 Stockholm, Sweden.
| | - Monika Löfgren
- Department of Clinical Sciences, Karolinska Institutet, and Department of Rehabilitation Medicine, Danderyd Hospital, SE-18288 Stockholm, Sweden.
| | - Lina Benson
- Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, SE-11883 Stockholm, Sweden
| | - Christer Svensén
- Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, and Unit of Anaesthesiology and Intensive Care, Södersjukhuset, SE-11883 Stockholm, Sweden; University of Texas Medical Branch at Galveston, UTMB Health, Department of Anaesthesiology, Galveston, TX, USA.
| | - Britt-Marie Stålnacke
- Department of Clinical Sciences, Karolinska Institutet, and Department of Rehabilitation Medicine, Danderyd Hospital, SE-18288 Stockholm, Sweden; Department of Community Medicine and Rehabilitation, Rehabilitation Medicine, Umeå University, SE-90185 Umeå, Sweden.
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Wireklint Sundström B, Holmberg M, Herlitz J, Karlsson T, Andersson H. Possible effects of a course in cardiovascular nursing on prehospital care of patients experiencing suspected acute coronary syndrome: a cluster randomised controlled trial. BMC Nurs 2016; 15:52. [PMID: 27594805 PMCID: PMC5010668 DOI: 10.1186/s12912-016-0175-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2016] [Accepted: 08/30/2016] [Indexed: 11/25/2022] Open
Abstract
Background Current research suggests that nurses can influence the outcome for patients with acute coronary syndrome (ACS). The aim of this study has been to evaluate whether a course in cardiovascular nursing (CVN) can improve ambulance nurses’ (ANs’) prehospital care of patients experiencing suspected ACS, related to pain intensity. Methods This is a cluster randomised controlled trial that was conducted in the ambulance services. Patients were allocated to one of two groups: in the first group, patients were treated by ANs who had attended the CVN course and in the second group patients were treated by ANs without this qualification. Inclusion criteria were: 1/pain raising suspicion of ACS, and 2/pain score ≥4 on a visual analogue scale (VAS). The primary outcome was the estimated intensity of pain or discomfort according to VAS 15 min after randomisation. Secondary outcomes were estimated intensity of pain or discomfort on admission to hospital and further requirement of pain treatment, as well as symptoms such as paleness and/or cold sweat; nausea and/or vomiting; anxiety, dyspnea, degree of alertness, respiratory depression and aggressiveness. A further secondary outcome measured was survival to 30 days. Lastly, a final diagnosis was made. A total of 38 ANs attended the CVN course. There were 1,747 patients who fulfilled the inclusion criteria. Results The pain score did not differ significantly between the two groups fifteen minutes after randomisation (median value of VAS was 4.0 in both groups). On admission to hospital the pain score was significantly lower for patients treated by an AN who had attended the CVN course (n = 332) compared with those treated by an AN who had not attended the course (n = 1,415) (median 2.5 and 3.0 respectively, p = 0.001). The ANs who had attended the course used higher doses of morphine. Conclusions An educational intervention with a CVN course did not relate significantly to more efficient pain relief in suspected ACS during the first 15 min. However, this intervention was associated with more effective pain relief later on in the prehospital setting. Thus, a CVN course for ANs appears to be associated with reduced pain intensity among patients experiencing suspected ACS. This result needs however to be confirmed in further trials. Trial registration The ClinicalTrials.gov Protocol Registration System (registration number NCT00792181).
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Affiliation(s)
- Birgitta Wireklint Sundström
- PreHospen - Centre for Prehospital Research, University of Borås, Borås, Sweden ; Faculty of Caring Science, Work Life and Social Welfare, University of Borås, Borås, Sweden ; School of Health Sciences, University of Borås, SE-501 90 Borås, Sweden
| | - Mats Holmberg
- PreHospen - Centre for Prehospital Research, University of Borås, Borås, Sweden ; Faculty of Caring Science, Work Life and Social Welfare, University of Borås, Borås, Sweden
| | - Johan Herlitz
- PreHospen - Centre for Prehospital Research, University of Borås, Borås, Sweden ; Faculty of Caring Science, Work Life and Social Welfare, University of Borås, Borås, Sweden
| | - Thomas Karlsson
- Department of Public Health and Community Medicine, Sahlgrenska Academy, Gothenburg, Sweden
| | - Henrik Andersson
- PreHospen - Centre for Prehospital Research, University of Borås, Borås, Sweden ; Faculty of Caring Science, Work Life and Social Welfare, University of Borås, Borås, Sweden
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Franceschi F, Marsiliani D, Alesi A, Mancini MG, Ojetti V, Candelli M, Gabrielli M, D'Aurizio G, Gilardi E, Adducci E, Proietti R, Buccelletti F. A simplified way for the urgent treatment of somatic pain in patients admitted to the emergency room: the SUPER algorithm. Intern Emerg Med 2015; 10:985-92. [PMID: 26341218 DOI: 10.1007/s11739-015-1304-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2015] [Accepted: 08/14/2015] [Indexed: 02/08/2023]
Abstract
Somatic pain is one of the most frequent symptoms reported by patients presenting to the emergency department (ED), but, in spite of this, it is very often underestimated and under-treated. Moreover, pain-killers prescriptions are usually related to the medical examination, leading to a delay in its administration, thus worsening the patient's quality of life. With our study, we want to define and validate a systematic and homogeneous approach to analgesic drugs administration, testing a new therapeutic algorithm in terms of earliness, safety, and efficacy. 442 consecutive patients who accessed our ED for any kind of somatic pain were enrolled, and then randomly divided into two groups: group A follow the normal process of access to pain-control drugs, and group B follow our SUPER algorithm for early administration of drugs to relieve pain directly from triage. We excluded from the study, patients with abdominal pain referred to the surgeon, patients with headache, recent history of trauma, history of drug allergies, and life-threatening conditions or lack of cooperation. Drugs used in the study were those available in our ED, such as paracetamol, paracetamol/codeine, ketorolac-tromethamine, and tramadol-hydrochloride. Pain level, risk factors, indication, and contraindication of each drug were taken into account in our SUPER algorithm for a rapid and safe administration of it. The Verbal Numeric Scale (VNS) and the Visual Analog Scale (VAS) were used to verify the patient's health and perception of it. Only 59 patient from group A (27.1 %) received analgesic therapy (at the time of the medical examination) compared to 181 patients (100 %) of group B (p < 0.001). Group B patients, received analgesic therapy 76 min before group A subjects (p < 0.01), resulting in a significant lower VNS (7.31 ± 1.68 vs 4.75 ± 2.3; p < 0.001), and a superior VAS after discharge (54.43 ± 22.16 vs 61.30 ± 19.13; p < 0.001) compared to group A subjects. No significant differences concerning side effects were observed between group A and group B patients. Early administration of a pain-control therapy directly from triage is safe and effective, and significantly improves patients perceptions of their own health.
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Affiliation(s)
- Francesco Franceschi
- Emergency Department, Catholic University of Sacred Heart, Policlinico "A. Gemelli", Largo A. Gemelli, 8, 00168, Rome, Italy.
| | - Davide Marsiliani
- Emergency Department, Catholic University of Sacred Heart, Policlinico "A. Gemelli", Largo A. Gemelli, 8, 00168, Rome, Italy
| | - Andrea Alesi
- Emergency Department, Catholic University of Sacred Heart, Policlinico "A. Gemelli", Largo A. Gemelli, 8, 00168, Rome, Italy
| | - Maria Grazia Mancini
- Emergency Department, Catholic University of Sacred Heart, Policlinico "A. Gemelli", Largo A. Gemelli, 8, 00168, Rome, Italy
| | - Veronica Ojetti
- Emergency Department, Catholic University of Sacred Heart, Policlinico "A. Gemelli", Largo A. Gemelli, 8, 00168, Rome, Italy
| | - Marcello Candelli
- Emergency Department, Catholic University of Sacred Heart, Policlinico "A. Gemelli", Largo A. Gemelli, 8, 00168, Rome, Italy
| | - Maurizio Gabrielli
- Emergency Department, Catholic University of Sacred Heart, Policlinico "A. Gemelli", Largo A. Gemelli, 8, 00168, Rome, Italy
| | - Gabriella D'Aurizio
- Emergency Department, Catholic University of Sacred Heart, Policlinico "A. Gemelli", Largo A. Gemelli, 8, 00168, Rome, Italy
| | - Emanuele Gilardi
- Emergency Department, Catholic University of Sacred Heart, Policlinico "A. Gemelli", Largo A. Gemelli, 8, 00168, Rome, Italy
| | - Enrica Adducci
- Emergency Department, Catholic University of Sacred Heart, Policlinico "A. Gemelli", Largo A. Gemelli, 8, 00168, Rome, Italy
| | - Rodolfo Proietti
- Emergency Department, Catholic University of Sacred Heart, Policlinico "A. Gemelli", Largo A. Gemelli, 8, 00168, Rome, Italy
| | - Francesco Buccelletti
- Emergency Department, Catholic University of Sacred Heart, Policlinico "A. Gemelli", Largo A. Gemelli, 8, 00168, Rome, Italy
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Tiselius HG, Chaussy CG. Arguments for choosing extracorporeal shockwave lithotripsy for removal of urinary tract stones. Urolithiasis 2015; 43:387-96. [PMID: 26315364 DOI: 10.1007/s00240-015-0818-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2015] [Accepted: 08/14/2015] [Indexed: 12/16/2022]
Abstract
At a time when there is an almost unlimited enthusiasm and preference among urologists for endoscopic stone removal, we have found it essential to meet some of the frequently presented arguments on why extracorporeal shockwave lithotripsy (SWL) should not be used. We have based our considerations in this brief article on our 30-35 years' experience with the non-invasive or least invasive technique that SWL represents. Stone disintegration, requirement of repeated treatment sessions, the concern of residual fragments, complications and economic aspects are some points that are discussed.
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Affiliation(s)
- Hans-Göran Tiselius
- Division of Urology, Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institutet, Stockholm, Sweden.
| | - Christian G Chaussy
- University of Munich, Munich, Germany.
- University of Regensburg, Regensburg, Germany.
- Keck School of Medicine, USC, Los Angeles, USA.
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van Dijk JFM, Vervoort SCJM, van Wijck AJM, Kalkman CJ, Schuurmans MJ. Postoperative patients' perspectives on rating pain: A qualitative study. Int J Nurs Stud 2015; 53:260-9. [PMID: 26337854 DOI: 10.1016/j.ijnurstu.2015.08.007] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2014] [Revised: 07/15/2015] [Accepted: 08/11/2015] [Indexed: 11/25/2022]
Abstract
BACKGROUND In postoperative pain treatment patients are asked to rate their pain experience on a single uni-dimensional pain scale. Such pain scores are also used as indicator to assess the quality of pain treatment. However, patients may differ in how they interpret the Numeric Rating Scale (NRS) score. OBJECTIVES This study examines how patients assign a number to their currently experienced postoperative pain and which considerations influence this process. METHODS A qualitative approach according to grounded theory was used. Twenty-seven patients were interviewed one day after surgery. RESULTS Three main themes emerged that influenced the Numeric Rating Scale scores (0-10) that patients actually reported to professionals: score-related factors, intrapersonal factors, and the anticipated consequences of a given pain score. Anticipated consequences were analgesic administration-which could be desired or undesired-and possible judgements by professionals. We also propose a conceptual model for the relationship between factors that influence the pain rating process. Based on patients' score-related and intrapersonal factors, a preliminary pain score was "internally" set. Before reporting the pain score to the healthcare professional, patients considered the anticipated consequences (i.e., expected judgements by professionals and anticipation of analgesic administration) of current Numeric Rating Scale scores. CONCLUSIONS This study provides insight into the process of how patients translate their current postoperative pain into a numeric rating score. The proposed model may help professionals to understand the factors that influence a given Numeric Rating Scale score and suggest the most appropriate questions for clarification. In this way, patients and professionals may arrive at a shared understanding of the pain score, resulting in a tailored decision regarding the most appropriate treatment of current postoperative pain, particularly the dosing and timing of opioid administration.
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Affiliation(s)
- Jacqueline F M van Dijk
- Pain Clinic, Department of Anesthesiology, University Medical Center Utrecht, The Netherlands.
| | - Sigrid C J M Vervoort
- Department of Internal Medicine & Infectious Diseases, University Medical Center Utrecht, The Netherlands
| | - Albert J M van Wijck
- Pain Clinic, Department of Anesthesiology, University Medical Center Utrecht, The Netherlands
| | - Cor J Kalkman
- Department of Anesthesiology, University Medical Center Utrecht, The Netherlands
| | - Marieke J Schuurmans
- Department of Nursing Science, University Medical Center Utrecht, The Netherlands
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Krokmyrdal KA, Andenæs R. Nurses' competence in pain management in patients with opioid addiction: A cross-sectional survey study. Nurse Educ Today 2015; 35:789-794. [PMID: 25779029 DOI: 10.1016/j.nedt.2015.02.022] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/15/2014] [Revised: 02/17/2015] [Accepted: 02/19/2015] [Indexed: 06/04/2023]
Abstract
BACKGROUND There may be up to 21 million opioid abusers in the world. Drug abuse and associated health-related problems are increasing. Opioid addiction can cause serious bacterial infection, injury and trauma, conditions that can trigger pain. Opioid abusers experience pain differently from non-addicts. There is limited research on nurses' competence to provide pain treatment to patients with opioid addiction. OBJECTIVE To report on a Norwegian pilot study examining nurses' knowledge about pain and competence in treating pain in patients who abuse opioids. DESIGN A descriptive cross-sectional survey design was employed. PARTICIPANTS Nurses at medical (n=64) and orthopaedic (n=34) units at two urban, public Norwegian hospitals. METHODS Data were collected in January 2010 using a self-administered questionnaire. Sample selection was determined by purposive sampling. The response rate was 54%. RESULTS Eighty-eight percent of nurses did not have sufficient knowledge about pain treatment in patients with opioid addiction. Eight-eight percent and seventy-seven percent regarded work-place experience and colleagues as the primary contributors to their knowledge about pain treatment, respectively. Work-place experience contributed most to nurses' competence. Ninety percent, 70% and 84% of nurses responded that education, literature and information technology, respectively, played a minor role in obtaining knowledge about pain management. Sixty-five percent of the respondents had basic skills for evaluating pain, although 54% could not evaluate the degree of pain. Almost 62% of nurses did not trust the pain experience self-reported by patients who were opioid abusers. CONCLUSION Our study shows shortcomings in the nurses' competence to evaluate and treat pain, suggesting that patients with opioid addiction may not receive adequate pain management. Nurses' competence to offer pain treatment to opioid abusers could be characterized as experience-based rather than evidence-based.
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Affiliation(s)
- Kurt A Krokmyrdal
- Faculty of Health Studies, Sogn og Fjordane University College, P. O. Box 523, N-6803 Førde, Norway.
| | - Randi Andenæs
- Faculty of Health Science, Department of Nursing, Oslo and Akershus University College of Applied Sciences, Norway
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Ericsson E, Brattwall M, Lundeberg S. Swedish guidelines for the treatment of pain in tonsil surgery in pediatric patients up to 18 years. Int J Pediatr Otorhinolaryngol 2015; 79:443-50. [PMID: 25677565 DOI: 10.1016/j.ijporl.2015.01.016] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2014] [Revised: 01/11/2015] [Accepted: 01/13/2015] [Indexed: 11/24/2022]
Abstract
BACKGROUND Surgery of the tonsils often causes severe pain lasting for many days as been shown by data from the National Tonsil Surgery Register in Sweden. Tonsillotomy is associated with fewer readmissions due to bleeding, number of days requiring analgesics and health care contacts due to pain compared to tonsillectomy. The register data demonstrate the necessity of better-evidenced based pain treatment guidelines for tonsil-surgery. OBJECTIVES To develop evidenced based pain treatment guidelines for tonsil-surgery in Sweden. METHODS The evidence based guidelines were designed by an updated literature review and from the clinical expertise in the pediatric pain field, which thereafter were reviewed by ENT-doctors and anesthetists from each ENT-clinic in Sweden. RESULTS A multimodal pain treatment approach is advocated, including premedication and administration during anesthesia, with paracetamol (acetaminophen), clonidine and betamethasone. If not given as a premedication the combination can be administered intravenously in the initial phase of anesthesia. At the end of surgery, if no bleeding problems, cox-inhibitors can be given. After discharge from hospital, the recommendations for pain relief are paracetamol combined with cox-inhibitors (ibuprofen, diclofenac) and if needed oral clonidine in favor of opioids. When pain intensity decreases, discontinue the analgesic treatment in the following order: opioid, clonidine, paracetamol and at last ibuprofen. The need for analgesic treatment after tonsillectomy is usually 5-8 days, after tonsillotomy only 3-5 days. Parents are recommended to contact the hospital if the child has difficulties in drinking or eating adequately and/or suffers from pain despite taking the recommended medication regularly. CONCLUSIONS Swedish guidelines for tonsil-surgery provide practical evidence-based pain treatment recommendations.
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Abstract
INTRODUCTION Sacral insufficiency fractures are often overlooked and lead to severe therapy-resistant pain. These fractures can be most sensitively detected with magnetic resonance imaging (MRI). Similar to balloon kyphoplasty, sacroplasty provides fixation of these fractures with cement. OBJECTIVES This study was carried out to investigate whether pain is reduced using this method and whether computed tomography (CT)-guided cement application results in less cement extravasation and fewer complications than C-arm controlled application. MATERIAL AND METHODS In a retrospective multicenter study, 46 patients (41 female, 5 male) with an average age of 75 years were treated by sacroplasty. The procedure was performed with CT-guidance for 25 patients and with C-arm control for 21 patients. Pain was evaluated using a visual analog scale. Patients were followed up for 6 months. RESULTS The average operation time was 35 min and postinterventional hospital stay averaged 4 days. In the CT group pain decreased from an average score of 8.8 ± 0.7 preoperatively to 2.6 ± 0.6 postoperatively (p < 0.001) and in the C-arm group pain decreased from 8.2 ±1.0 to 2.2± 1.4 (p < 0.001). There were no cases of cement extravasation in the CT group (0 out of 25 = 0 %) and 8 asymptomatic cases in the C-arm group (8 out of 21 = 38 %). In addition, there were two injuries to the superior gluteal artery with hematoma in the area of puncture, one requiring operative treatment. There were two mortalities in the CT group from lung disease and stroke during the study but this was unrelated to the operation. CONCLUSION Balloon sacroplasty results in a reliable and significant reduction in pain for sacral insufficiency fractures. The C-arm controlled cement application resulted in more frequent extravasation and complications than CT-guided application.
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Affiliation(s)
- A Prokop
- Unfallchirurgie, Klinikum Sindelfingen, Klinikverbund Südwest, Arthur-Gruber-Str. 70, 71065, Sindelfingen, Deutschland.
| | - R Andresen
- Institut für Diagnostische und Interventionelle Radiologie/Neuroradiologie, Westküstenklinikum, Heide, Deutschland
| | - M Chmielnicki
- Unfallchirurgie, Klinikum Sindelfingen, Klinikverbund Südwest, Arthur-Gruber-Str. 70, 71065, Sindelfingen, Deutschland
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Bouwense SAW, de Vries M, Schreuder LTW, Olesen SS, Frøkjær JB, Drewes AM, van Goor H, Wilder-Smith OHG. Systematic mechanism-orientated approach to chronic pancreatitis pain. World J Gastroenterol 2015; 21:47-59. [PMID: 25574079 PMCID: PMC4284360 DOI: 10.3748/wjg.v21.i1.47] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2014] [Revised: 08/23/2014] [Accepted: 11/19/2014] [Indexed: 02/07/2023] Open
Abstract
Pain in chronic pancreatitis (CP) shows similarities with other visceral pain syndromes (i.e., inflammatory bowel disease and esophagitis), which should thus be managed in a similar fashion. Typical causes of CP pain include increased intrapancreatic pressure, pancreatic inflammation and pancreatic/extrapancreatic complications. Unfortunately, CP pain continues to be a major clinical challenge. It is recognized that ongoing pain may induce altered central pain processing, e.g., central sensitization or pro-nociceptive pain modulation. When this is present conventional pain treatment targeting the nociceptive focus, e.g., opioid analgesia or surgical/endoscopic intervention, often fails even if technically successful. If central nervous system pain processing is altered, specific treatment targeting these changes should be instituted (e.g., gabapentinoids, ketamine or tricyclic antidepressants). Suitable tools are now available to make altered central processing visible, including quantitative sensory testing, electroencephalograpy and (functional) magnetic resonance imaging. These techniques are potentially clinically useful diagnostic tools to analyze central pain processing and thus define optimum management approaches for pain in CP and other visceral pain syndromes. The present review proposes a systematic mechanism-orientated approach to pain management in CP based on a holistic view of the mechanisms involved. Future research should address the circumstances under which central nervous system pain processing changes in CP, and how this is influenced by ongoing nociceptive input and therapies. Thus we hope to predict which patients are at risk for developing chronic pain or not responding to therapy, leading to improved treatment of chronic pain in CP and other visceral pain disorders.
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Noé GK, Schiermeier S, Hatzmann W, Soltész S, Spüntrup C, Anapolski M. Pain medication requirements after sacropexy and combination interventions. JSLS 2014; 18:JSLS-D-14-00036. [PMID: 25392656 PMCID: PMC4208892 DOI: 10.4293/jsls.2014.00036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Laparoscopic surgery is associated with reduced morbidity, and postoperative pain is reduced. The aim of this study was to assess postoperative pain intensity, analgesic requirements, and the influence of cofactors after laparoscopic sacral colpopexy. METHODS The study assessed 287 patients treated with laparoscopic sacropexy for genital prolapse with a Pelvic Organ Prolapse Quantification grade>1. Patients were asked to evaluate their pain postoperatively using a 4-point verbal pain rating scale. In addition, medical records were analyzed regarding the requirement for analgesic medication. RESULTS Patients distinguished between abdominal pain and shoulder pain after laparoscopy. Abdominal pain reached maximum severity on day 1 and showed a good response to nonsteroidal antiphlogistics, whereas shoulder pain was rarely found (6.27%). Of the patients, 38% required no pain treatment or required 1 dose at most. The need for pain medication reached its climax on day 1 and decreased during the 5 following days. Non-opioid analgesics provided a sufficient therapeutic effect. CONCLUSION Laparoscopic sacropexy is associated with a moderate degree of postoperative pain. Non-opioid analgesics should be preferred as first-line therapy. The typical shoulder-tip pain showed only a low prevalence in our study group. From our point of view, the low rate of shoulder-tip pain corresponded with the low intra-abdominal carbon dioxide pressure.
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Abstract
BACKGROUND AND OBJECTIVE Clinical trials have documented the efficacy and good tolerability of tapentadol prolonged released (PR) for severe chronic pain. This study investigated routine long-term administration by pain specialists. METHODS The effectiveness analysis included prospective data collected over a 3 month period (cohort I, n = 1457, mean age 61.2 ± 13 years) and over a 12 month period (cohort II, n = 588, 60.1 ± 13.2 years) regarding previous and concomitant analgesic treatment, tapentadol dosage, pain intensity, sleep and quality of life parameters, and tolerability. RESULTS Most patients (>77%) had suffered from severe chronic pain for ≥2 years with low back pain the main pain diagnosis (82%); 91% had already received analgesic long-term treatment prior to initiation of tapentadol therapy (42% of those received strong opioids). After 3 month tapentadol treatment, cohort I had experienced a mean pain reduction of 2.4 points (from 6.8 ± 1.6 at baseline) and improvements of 2.1 points in quality of sleep (from 5.8 ± 2.5) and quality of life (from 6.5 ± 2; all p ≤ 0.001). The 12 month tapentadol treatment (cohort II) reduced the mean pain intensity by 3.2 points from 6.7 ± 1.6 at baseline (NRS-11; p ≤ 0.001); 57% of the patients experienced clinically relevant pain relief of ≥50%. At end of observation, 92% attained either their intended pain reduction and/or an additional individual treatment target, both predefined at start of tapentadol therapy. This was accompanied by a significant reduction in pain-related impairments in daily activities and an improvement in quality of life (all p ≤ 0.001). Most frequent side-effects were nausea (6.3% of patients) and dizziness (3.8%) for cohort I, and nausea (1.5%) and constipation (1.2%) for cohort II. CONCLUSION Tapentadol PR is effective and well tolerated and can be considered an alternative to classical strong opioids in long-term chronic pain therapy. LIMITATIONS The study lacks a control group; assessment under routine practice conditions, however, reflects daily practice clinical management conditions.
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Deshpande S, Rivera DE, Younger JW, Nandola NN. A control systems engineering approach for adaptive behavioral interventions: illustration with a fibromyalgia intervention. Transl Behav Med 2014; 4:275-89. [PMID: 25264467 DOI: 10.1007/s13142-014-0282-z] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
Abstract
The term adaptive intervention has been used in behavioral medicine to describe operationalized and individually tailored strategies for prevention and treatment of chronic, relapsing disorders. Control systems engineering offers an attractive means for designing and implementing adaptive behavioral interventions that feature intensive measurement and frequent decision-making over time. This is illustrated in this paper for the case of a low-dose naltrexone treatment intervention for fibromyalgia. System identification methods from engineering are used to estimate dynamical models from daily diary reports completed by participants. These dynamical models then form part of a model predictive control algorithm which systematically decides on treatment dosages based on measurements obtained under real-life conditions involving noise, disturbances, and uncertainty. The effectiveness and implications of this approach for behavioral interventions (in general) and pain treatment (in particular) are demonstrated using informative simulations.
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Affiliation(s)
- Sunil Deshpande
- Control Systems Engineering Laboratory, School for Engineering of Matter, Transport, and Energy, Arizona State University, Tempe, AZ 85287 USA
| | - Daniel E Rivera
- Control Systems Engineering Laboratory, School for Engineering of Matter, Transport, and Energy, Arizona State University, Tempe, AZ 85287 USA
| | - Jarred W Younger
- Neuroinflammation, Pain and Fatigue Laboratory, Department of Psychology, University of Alabama at Birmingham, Birmingham, AL 35294 USA
| | - Naresh N Nandola
- Control Systems Engineering Laboratory, School for Engineering of Matter, Transport, and Energy, Arizona State University, Tempe, AZ 85287 USA ; ABB Corporate Research Center, Bangalore, India
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Gispen MEC. A human rights view on access to controlled substances for medical purposes under the international drug control framework. Eur J Pharmacol 2013; 719:16-24. [PMID: 23872413 DOI: 10.1016/j.ejphar.2013.04.062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2013] [Revised: 04/15/2013] [Accepted: 04/26/2013] [Indexed: 11/16/2022]
Abstract
The world is confronted with a major public health deficit caused by poor access to controlled essential medicines under the international drug control framework. This is affecting millions of patients on a daily basis and resulting in numerous human rights violations. The present review contextualises this deficit from a human rights perspective. Drug control efforts are informed by a twofold objective stemming from the double nature of scheduled substances: free access for medical purposes should be ensured, though non-medical use of substances such as opium should be restricted. The international drug control framework is, in theory, based on this twofold notion, however at the level of interpretation, monitoring, and implementation, a one-sided emphasis is demonstrated. By tracing a parallel between the obligations of states under the international drug control framework and those that derive from human rights law, the review shows that the two systems seem incoherent and conflicting in nature and flags the importance of cross-disciplinary research into drug control and human rights.
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Affiliation(s)
- Marie Elske C Gispen
- Netherlands Institute of Human Rights (SIM) and Ethics Institute of Utrecht University, Achter Sint Pieter 200, 3512 HT Utrecht, the Netherlands.
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Wandner LD, Heft MW, Lok BC, Hirsh AT, George SZ, Horgas AL, Atchison JW, Torres CA, Robinson ME. The impact of patients' gender, race, and age on health care professionals' pain management decisions: an online survey using virtual human technology. Int J Nurs Stud 2013; 51:726-33. [PMID: 24128374 DOI: 10.1016/j.ijnurstu.2013.09.011] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2013] [Revised: 09/18/2013] [Accepted: 09/19/2013] [Indexed: 11/25/2022]
Abstract
BACKGROUND Previous literature indicates that biases exist in pain ratings. Healthcare professionals have been found to use patient demographic cues such as sex, race, and age when making decisions about pain treatment. However, there has been little research comparing healthcare professionals' (i.e., physicians and nurses) pain decision policies based on patient demographic cues. METHODS The current study used virtual human technology to examine the impact of patients' sex, race, and age on healthcare professionals' pain ratings. One hundred and ninety-three healthcare professionals (nurses and physicians) participated in this online study. RESULTS Healthcare professionals assessed virtual human patients who were male and African American to be experiencing greater pain intensity and were more willing to administer opioid analgesics to them than to their demographic counterparts. Similarly, nurses were more willing to administer opioids make treatment decisions than physicians. There was also a significant virtual human-sex by healthcare professional interaction for pain assessment and treatment decisions. The sex difference (male>female) was greater for nurses than physicians. CONCLUSIONS Results replicated findings of previous studies using virtual human patients to assess the effect of sex, race, and age in pain decision-making. In addition, healthcare professionals' pain ratings differed depending on healthcare profession. Nurses were more likely to rate pain higher and be more willing to administer opioid analgesics than were physicians. Healthcare professionals rated male and African American virtual human patients as having higher pain in most pain assessment and treatment domains compared to their demographic counterparts. Similarly the virtual human-sex difference ratings were more pronounced for nurses than physicians. Given the large number of patients seen throughout the healthcare professionals' careers, these pain practice biases have important public health implications. This study suggests attention to the influence of patient demographic cues in pain management education is needed.
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Affiliation(s)
- Laura D Wandner
- Department of Clinical and Health Psychology, University of Florida, Gainesville, FL, United States
| | - Marc W Heft
- College of Dentistry, University of Florida, Gainesville, FL, United States
| | - Benjamin C Lok
- Computer and Information Science and Engineering Department, University of Florida, FL, United States
| | - Adam T Hirsh
- Department of Psychology, Indiana University - Purdue University Indianapolis, Indianapolis, IN, United States
| | - Steven Z George
- Department of Physical Therapy, University of Florida, Gainesville, FL, United States
| | - Anne L Horgas
- College of Nursing, University of Florida, Gainesville, FL, United States
| | | | - Calia A Torres
- Department of Clinical and Health Psychology, University of Florida, Gainesville, FL, United States
| | - Michael E Robinson
- Department of Clinical and Health Psychology, University of Florida, Gainesville, FL, United States.
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48
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Tesfaye S, Wilhelm S, Lledo A, Schacht A, Tölle T, Bouhassira D, Cruccu G, Skljarevski V, Freynhagen R. Duloxetine and pregabalin: high-dose monotherapy or their combination? The "COMBO-DN study"--a multinational, randomized, double-blind, parallel-group study in patients with diabetic peripheral neuropathic pain. Pain 2013; 154:2616-2625. [PMID: 23732189 DOI: 10.1016/j.pain.2013.05.043] [Citation(s) in RCA: 173] [Impact Index Per Article: 15.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2012] [Revised: 05/22/2013] [Accepted: 05/23/2013] [Indexed: 02/06/2023]
Abstract
This multicentre, double-blind, parallel-group study in diabetic peripheral neuropathic pain addressed whether, in patients not responding to standard doses of duloxetine or pregabalin, combining both medications is superior to increasing each drug to its maximum recommended dose. For initial 8-week therapy, either 60 mg/day duloxetine (groups 1, 2) or 300 mg/day pregabalin (groups 3, 4) was given. Thereafter, in the 8-week combination/high-dose therapy period, only nonresponders received 120 mg/day duloxetine (group 1), a combination of 60 mg/day duloxetine and 300 mg/day pregabalin (groups 2, 3), or 600 mg/day pregabalin (group 4). Primary outcome (Brief Pain Inventory Modified Short Form [BPI-MSF] 24-hour average pain change after combination/high-dose therapy) was analyzed comparing combination (groups 2, 3 pooled) with high-dose monotherapy (groups 1, 4 pooled). Secondary end points included response rates, BPI-MSF severity items, and comparison of duloxetine and pregabalin in BPI-MSF average pain. Eight hundred four patients were evaluated for initial therapy and 339 for combination/high-dose therapy. There were no significant differences between combination and high-dose monotherapy regarding BPI-MSF average pain (mean change: combination: -2.35; high-dose monotherapy: -2.16; P = 0.370) and most secondary end points, which, however, consistently favoured combination therapy. Fifty-percent response rates were 52.1% for combination and 39.3% for high-dose monotherapy (P = 0.068). In exploratory analyses of the initial 8-week therapy uncorrected for multiple comparisons, 60 mg/day duloxetine was found superior to 300 mg/day pregabalin (P < 0.001). Both drugs and their combination were well tolerated. Although not significantly superior to high-dose monotherapy, combination therapy was considered to be effective, safe, and well tolerated.
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Affiliation(s)
- Solomon Tesfaye
- University of Sheffield, Royal Hallamshire Hospital, Sheffield, UK Regional Medical Affairs, Lilly Deutschland GmbH, Bad Homburg, Germany Unidad de Neurología, Clínica Creu Blanca, Barcelona, Spain Global Statistical Sciences, Lilly Deutschland GmbH, Bad Homburg, Germany Neurologische Klinik und Poliklinik, Klinikum rechts der Isar, Technische Universität, München, Germany INSERM U987 Centre d'Evaluation et de Traitement de la Douleur, Hôpital Ambroise Paré, Boulogne Billancourt, France Sapienza University, Department of Neurology & Psychiatry, Roma, Italy Lilly Research Laboratories, Indianapolis, IN, USA Zentrum für Anästhesiologie, Intensivmedizin, Schmerztherapie & Palliativmedizin, Benedictus Krankenhaus, Tutzing & Klinik für Anästhesiologie, Technische Universität München, Germany
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49
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Marcus NJ. Comprehensiveness, uniformity and standardization in the evaluation of patients with complaints of pain. J Back Musculoskelet Rehabil 1997; 8:89-93. [PMID: 24572750 DOI: 10.3233/bmr-1997-8204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
An increasing number of physicians from a variety of disciplines are specializing in the treatment of patients with pain, and reporting treatment success using disparate interventions. Due to the lack of standardized evaluations of patients with pain, however, it has been impossible to reasonably assess the claims of any facility and even more difficult to compare the types of treatments from a variety of treatment settings. This paper will describe the process of the fomation of the Uniform Outcome Measures Committee of the American Academy of Pain Medicine. The deliberations of the Committee and the status of the development of a data collection system package will be described.
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Affiliation(s)
- N J Marcus
- 130 E. 77th St., New York, NY 10021, USA
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