The Clinical journal of pain
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The control of severe cancer pain may be problematic despite advances in pain management. Patients with severe intractable pain and/or intractable side effects may require aggressive interventional pain management strategies including the administration of medications by the continuous intrathecal route and/or neurosurgical procedures. ⋯ Failure of the intrathecal route may require the additional use of neurosurgical procedures such as cordotomy for pain control. We describe a case of severe cancer pain refractory to conventional intrathecal medications and cordotomy that was successfully managed by the addition of meperidine to the intrathecal regimen.
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Topical morphine has been used on open wounds for pain management, but has a variable duration of action not suitable for palliative dressing changes. The objective of this study is to find an opioid and delivery method that would provide long-lasting pain relief between dressing changes. Methadone powder (100 mg) was mixed in Stomahesive powder (10 g) and sprinkled on the open wound once daily at the time of dressing change. ⋯ Exudative wounds with exposed tissue work best, whereas dry wounds with eschar show less response. Topical methadone powder can be effective for pain relief in open, exudative wounds with little eschar. Further research questions are raised.
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Randomized Controlled Trial Clinical Trial
Differential effects of neuropathic analgesics on wind-up-like pain and somatosensory function in healthy volunteers.
To investigate the effects of gabapentin, carbamazepine, and amitriptyline on temporal summation, simple nociceptive pain, and innocuous touch sensation in healthy volunteers. ⋯ We have shown that gabapentin, carbamazepine, and amitriptyline, three pharmacologically different drugs, have distinct and quantifiable effects on somatosensory pathways in healthy volunteers. These findings provide a link between pharmacology of the study drugs and clinical effectiveness. The effects of gabapentin and carbamazepine on temporal summation pain show that these drugs can block centrally amplified wind-up pain in the absence of a neuropathic disorder.
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Multicenter Study Clinical Trial
Parents' views about infant pain in neonatal intensive care.
The purpose of this study was to describe parents' perceptions and feelings about their infant's pain experience and pain care in the neonatal intensive care unit. ⋯ The findings from this study expand knowledge about how parents understand and respond to the difficult situation in which their newborn infant is subjected to essential but painful procedures. The findings provide direction for research and clinical practice interventions aimed at: 1) helping parents to gain knowledge and correct their misperceptions; 2) engaging parents in meaningful dialog about their concerns and preferences for involvement; and 3) helping parents to develop effective coping strategies to reduce psychologic distress related to their infant's pain.
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Clinical Trial Controlled Clinical Trial
Sex differences in delayed onset muscle pain.
In contrast to the research using typical experimental pain stimuli, there is no consensus that women are more sensitive to delayed onset muscle pain than men. The purpose of this study was to examine sex differences in delayed onset muscle pain with use of a quantified stimulus intensity and multidimensional and valid pain measures. ⋯ The absence of higher muscle pain ratings in women than men in this investigation resembles a review of the delayed onset muscle soreness and pain literature. However, the findings contradict a few other acute muscle pain investigations, in which actual muscle tissue damage was not induced by eccentric contractions. Additional research is required to identify the parameters that influence the detection of sex differences.