American journal of therapeutics
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Complex regional pain syndrome (CRPS) describes a diversity of painful conditions following trauma, coupled with abnormal regulation of blood flow and sweating, trophic changes, and edema of skin. The excruciating pain and diverse autonomic dysfunctions in CRPS are disproportionate to any inciting and recovering event. CRPS type I is formerly identified as "reflex sympathetic dystrophy." CRPS type II is the new term for "causalgia" that always coexists with documented nerve injury. ⋯ It is crucial to have a high sensitivity value combined with a fair specificity in revising diagnostic criteria of CRPS. The validation and consensus for new rationalized diagnostic criteria of CRPS could facilitate further research to enhance clinical outcome including quality of life. These endeavors to minimize suffering from CRPS would certainly be appreciated by many patients and their loved ones.
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Three issues related to the management of acute musculoskeletal pain in the ambulatory care setting deserve more attention than they currently receive: pain assessment, the degree of diagnostic specificity needed to select treatment, and gaps in the care that clinicians need to consider. This article describes several pain assessment instruments and explains why they are appropriate in the acute care setting. ⋯ Therefore, categorizing the pain as mechanical or secondary to underlying causes is sufficient to select and institute treatment. Gaps in care, such as the need for increased patient education, accurate information to dispel misconceptions about therapy, and additional safety and efficacy data about drugs used to treat acute musculoskeletal pain, are also addressed.
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Review
Chronic pain of osteoarthritis: considerations for selecting an extended-release opioid analgesic.
Chronic/persistent pain due to osteoarthritis is one of the most common pain conditions affecting Americans today. Inadequate pain relief or dissatisfaction with current treatments is a source of frustration and suffering for patients with chronic/persistent pain. ⋯ The several extended-release opioid analgesics that have been developed may provide an opportunity for improved patient convenience; however, clinicians must consider adverse event profiles, pharmacokinetics, abuse potential, and controlled substance-scheduling status of extended-release opioid analgesics. The purpose of this review is to highlight the efficacy and safety of extended-release opioid analgesics utilized in the management plan of chronic pain due to osteoarthritis.
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The burden of chronic/persistent pain is substantial for the patient and society as a whole. Although a variety of pharmacologic treatments are available, chronic/persistent pain remains inadequately treated. ⋯ Other limitations to the current pharmacologic treatment options include gastrointestinal effects, cardiovascular effects, and organ toxicity, as well as fear of abuse or addiction. The purpose of this review is to highlight the burden of chronic/persistent pain in today's society and discuss the limitations of short-acting pharmacologic therapies used in the treatment of chronic/persistent pain.
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Review Meta Analysis
Treatment of high-risk older persons with lipid-lowering drug therapy.
Randomized, double-blind, placebo-controlled studies and observational studies have demonstrated that statins reduce mortality and major cardiovascular events in high-risk persons with hypercholesterolemia. The aim of this study was to review the evidence for treating high-risk older persons with lipid-lowering drugs. A MEDLINE search of the English-language literature published from January 1, 1989, to June 2006 was conducted to review all studies in which lipid-lowering drug therapy was administered to high-risk older persons. ⋯ For moderately-high-risk persons, the serum LDL cholesterol should be reduced to <100 mg/dL. When LDL cholesterol-lowering drug therapy is used for high-risk persons or moderately-high-risk persons, the serum LDL cholesterol should be reduced at least 30% to 40%. High-risk older persons should be treated with lipid-lowering drugs according to the NCEP III updated guidelines to reduce cardiovascular morbidity and mortality.