The Clinical journal of pain
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Randomized Controlled Trial
Involvement of intra-articular corticotropin-releasing hormone in postoperative pain modulation.
Opioid receptors are expressed on peripheral nerve endings and opioid peptides (beta-endorphin, END) are produced in various immune cells of synovial tissue after knee trauma. Because corticotropin-releasing hormone (CRH) acts through its receptors on END-containing immune cells, this randomized controlled trial investigated whether the intra-articular (IA) injection of CRH reduces postoperative pain intensity and supplemental analgesic consumption in patients undergoing arthroscopic knee surgery. ⋯ In conclusion, this first clinical trial provides preliminary evidence for a short but not robust analgesic effect of a single dose of IA CRH in patients undergoing arthroscopic knee surgery. Further clinical studies will have to examine different doses of IA CRH-induced analgesia and to support the involvement of opioid peptides.
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To evaluate the roles of neuronavigation-assisted percutaneous radiofrequency thermocoagulation therapy in patients with primary trigeminal neuralgia (TN). ⋯ Neuronavigation is a very useful tool during percutaneous radiofrequency thermocoagulation therapy in patients with primary TN.
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Increased abuse and diversion of prescription opioids has been a consequence of the increased availability of opioids to address the widespread problem of undertreated pain. Opioid risk management refers to the effort to minimize harms associated with opioid therapy while maintaining appropriate access to therapy. ⋯ This paper reviews the principles of opioid risk management by examining the epidemiology of prescription opioid abuse in the United States; identifying key stakeholders involved in opioid risk management and their responsibilities for managing or monitoring opioid abuse and diversion; and summarizing the mechanisms currently used to monitor and address prescription opioid abuse. Limitations of current approaches, and emerging directions in opioid risk management, are also presented.
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We conducted a systematic review of the literature on the effectiveness and complications of programmable intrathecal opioid and ziconotide drug delivery systems (IDDS) for patients with chronic noncancer pain. ⋯ The studies reviewed found improvement in pain and functioning on average among patients with chronic noncancer pain who received permanent IDDS. However, their methodologic limitations preclude conclusions concerning the effectiveness of this technology long-term and as compared with other treatments. Drug side effects and hardware complications were common. Suggestions are made for methodologic improvements in future studies.
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To assess the health and quality of life associated with chronic pain of predominantly neuropathic origin (POPNO) on health and daily activity in the general population. ⋯ This study confirms the importance of identifying neuropathic pain in the community, and the need for multidimensional management strategies that address all aspects of health.