Journal of pain research
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Journal of pain research · Jan 2020
Modified Pectoral Nerve Block versus Serratus Block for Analgesia Following Modified Radical Mastectomy: A Randomized Controlled Trial.
Modified pectoral nerves (PECSII) and serratus blocks have been recently used for analgesia in breast surgery, but evidence comparing their analgesic benefits is limited. This prospective randomized, controlled study aims to examine the analgesic efficacy and safety profile of ultrasound-guided PECSII versus serratus blocks in patients undergoing modified radical mastectomy (MRM) for breast cancer. ⋯ NCT02946294.
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Journal of pain research · Jan 2019
ReviewPharmacological rationale for tapentadol therapy: a review of new evidence.
Chronic pain could be considered as a neurological disorder. Therefore, appropriate selection of the therapy, which should consider the pathophysiological mechanisms of pain, can result in a successful analgesic outcome. Tapentadol is an analgesic drug which acts both as a μ-opioid receptor (MOR) agonist and as a noradrenaline reuptake inhibitor (NRI), thereby generating a synergistic action in terms of analgesic efficacy, but not for the burden of adverse effects. ⋯ This molecule holds the potential to address at least some of the current limitations of analgesic therapy due to its unique mechanism of action and has shown to be safe and effective in the treatment of chronic pain of cancer and noncancer etiologies including nociceptive, neuropathic and mixed pain. In particular, the MOR component of tapentadol activity predominantly allows for analgesia in nociceptive pain; on the other hand, the NRI component contributes, now in a predominant manner, for analgesic efficacy in cases of neuropathic pain states. This paper will discuss recent pieces of evidence on the pathophysiology of pain, the background on tapentadol and then present some new studies on how the unique mechanism of action of tapentadol provides a key role in its analgesic efficacy in a number of pain states and with a favorable safety profile.
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Journal of pain research · Jan 2019
ReviewTapentadol in the treatment of osteoarthritis: pharmacological rationale and clinical evidence.
Osteoarthritis (OA) is the most prevalent joint disease in older people worldwide. Pain owing to OA is considered one of the most frequent causes of chronic pain; however, current pharmacological approaches have some limitations in terms of efficacy and safety. ⋯ Tapentadol is an analgesic molecule, which combines two synergistic mechanisms of action, MOR, and norepinephrine reuptake inhibition. This narrative review will briefly discuss the mechanisms contributing to the onset and maintenance of pain in OA patients; clinical data on the use of tapentadol in this setting will then be presented and commented.
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Journal of pain research · Jan 2021
Real-World Cost-Effectiveness Analysis of Spinal Cord Stimulation vs Conventional Therapy in the Management of Failed Back Surgery Syndrome.
Failed back surgery syndrome (FBSS) causes disability and lowers health-related quality of life (HRQoL) for patients. Many patients become refractory to conventional medical management (CMM) and spinal cord stimulation (SCS) is advised. However, comparative cost-effectiveness research of both clinical approaches still lacks further evidence. This probabilistic cost-effectiveness analysis compares CMM versus SCS plus CMM in FBSS patients for a 5-year period in Spain. ⋯ SCS is a cost-effective treatment for FBSS compared to CMM alone based on real-world evidence.
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Journal of pain research · Jan 2020
Sensing Evoked Compound Action Potentials from the Spinal Cord: Novel Preclinical and Clinical Considerations for the Pain Management Researcher and Clinician.
Spinal cord stimulation (SCS) is a drug-free treatment for chronic neuropathic pain. Recent SCS technology can record evoked compound action potentials (ECAPs) in the spinal cord during therapy and utilize features of the sensed ECAP to optimize the SCS. The purpose of this work is to characterize the relevant parameters that govern the integrity and morphology of acquired ECAPs, and the implications for pain management clinicians and researchers working with ECAPs. ⋯ Together, this information can allow the ECAP to be readily distinguished from the stimulation artifact, although movement may continue to be a confounder; caution is inculcated for ECAP signal processing techniques that rely on the stability of the artifact to avoid clinically misleading results. The promise of closed-loop, ECAP-servoed neuromodulation relies on accurate and proper sensing of the ECAP, while clearly elucidating the clinically relevant trade-offs and design choices made to enable these novel features.