The Clinical journal of pain
-
To present a case of severe disabling postherpetic itching (PHI) and discuss possible mechanisms and management. ⋯ The mechanism of postherpetic neuralgia and PHI are not well understood and no single best treatment for postherpetic neuralgia and PHI is known. Clinical experience suggested that neuropathic itch may be more resistant to treatment than neuropathic pain. This immunocompromized patient with a severe disabling PHI responded to antihistaminic and anticonvulsant treatment.
-
Multicenter Study Comparative Study Clinical Trial
The restore rechargeable, implantable neurostimulator: handling and clinical results of a multicenter study.
Spinal cord stimulation is an effective therapy for chronic, neuropathic pain refractory to medication. Use of a rechargeable neurostimulation system (Restore, Medtronic Inc) could provide greater longevity in the treatment of complex pain. However, patients' ability to successfully recharge a neurostimulation system has not yet been demonstrated. ⋯ Twelve-month experience indicates that the rechargeable neurostimulation system (Restore) was easy to use, with 100% of patients able to recharge successfully. Patient and physician satisfaction was high, with significant improvements in pain, quality of life, and functional status. Complications were comparable to prior experience with this therapy.
-
Optimal treatment for patients with chronic pain remains elusive. A growing international consensus advocates evidence-based practice with assessment of clinical outcomes to improve the process and outcome of care. Clinical decision making about treatment options for an individual patient should include the patient's clinical presentation, available evidence, and patient preferences. ⋯ Outcome measurement has come a long way and core domains to be measured have been established. Establishing normative data is a next main goal. Important methodologic and practical challenges remain to formulate evidence that can be applied to the individual patient with chronic pain.
-
Controlled Clinical Trial
Experimental pain sensitivity in women with temporomandibular disorders and pain-free controls: the relationship to orofacial muscular contraction and cardiovascular responses.
Chronic pain may result both from a generalized hypersensitivity to acute pain, suggestive of central sensitization processes, and dysfunction of the endogenous pain regulatory system. One purpose of this study was to compare experimental pain sensitivity at several anatomic sites in temporomandibular disorder (TMD) patients and pain-free controls during baseline and after standardized mechanical load of the orofacial region. A second purpose was to compare the pain-modulating effects of cardiovascular responses in TMD patients and pain-free controls. ⋯ Significant increases in generalized pain sensitivity occurred in the TMD group, but not in the control group, after isometric contraction of the orofacial muscles, suggestive of a central sensitization process in TMD. Moreover, only in the TMD group there were significant associations between cardiovascular responsesand pain sensitivity, challenging previous assumptions of this relationship occurring mainly in pain-free individuals.
-
Intolerable side effects contribute to poor outcomes among patients managed with opioids, and negotiating these side effects remains an important clinical challenge. Evidence-based approaches to minimizing the side-effect burden from opioids compiled from the literature, and including clinical practice recommendations, focus on (1) reducing the doses of systemic opioids, (2) managing the adverse symptoms of opioids, (3) integrating opioid rotation, and (4) changing the route of administration. ⋯ In addition, specific patient populations, opioid metabolites, and clearance issues are considered. In particular, novel medications and better alternatives to preexisting treatments for specific opioid side effects, such as peripheral opioid antagonists, may ameliorate the management of patients taking long-term opioid therapies.