Pain management
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This article reviews Nevro Corporation's (CA, USA) Senza System high-frequency spinal cord stimulator (HF10 SCS). HF10 therapy has been shown to be noninferior to traditional low-frequency spinal cord stimulation (SCS), and in some studies, has been shown to have long-term effects that are superior compared with traditional low-frequency SCS in treating both back and leg pain. ⋯ HF10 SCS is based on spinal anatomic mapping and does not require intraoperative paresthesia mapping for placement, thereby improving procedural experience for patients and reducing operating room time. HF10 SCS has altered the nature of SCS therapy in a manner that treats more individuals with chronic, refractory leg and back pain than in the past, and is widely used in the USA, Europe and Australia.
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Phantom limb pain (PLP) is a clinically relevant consequence of limb amputation and its treatment is still challenging. Mirror therapy, in other words, observing and engaging in the intact limb's mirrored movements, offers a promising, mechanism-based treatment for PLP. ⋯ In this paper, based on recent studies in the field, we compare both approaches and discuss their unique advantages and disadvantages. We argue for the necessity of a tailored treatment for PLP that is personalized to the patients' characteristics, preferences and psychological needs.
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With the opioid epidemic reaching new heights in the USA, it has become critical to find suitable alternatives to opioids. Cannabis, an antinociceptive, is a strong contender to help patients reduce their opioid usage. ⋯ This review explores the studies that compare cannabis-opioid interactions and presents some challenges of cannabis research and usage. The practical clinical pharmacology of cannabis as an analgesic, including the route of administration, safety and pharmacokinetics, are discussed to address the concerns, as well as possible solutions, of cannabis as a pain reliever.
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This article reviews the complexities of the opioid epidemic, considering recent research involving the current state of the opioid epidemic; chronic pain and its role in the crisis; the properties of opioids and how they interact with human neurobiology; the effectiveness and risks of opioids as a treatment for chronic pain; opioid addiction and dependence; and pharmacological and psychological interventions for opioid addiction, opioid dependence, and chronic pain management. Opioid abuse can be reduced with the availability and access to treatment facilities for opioid detoxification; using interdisciplinary treatment models for chronic pain, opioid addiction and dependence; conducting more research in the areas of opioid addiction and opioid dependence; and shifting to an increase in nonpharmacological, less invasive treatments for pain.
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Opioid misuse leading to dependence is a major health issue. Recent studies explored valid alternatives to treat pain in postsurgical settings. ⋯ Results showed a reduction of postoperative pain, opioid consumption and cue-induced craving following cortical stimulation. Despite the limited number of studies, this review shows preliminary encouraging evidence regarding the analgesic role of tDCS. However, future studies are needed to further investigate the application of tDCS in postsurgical settings.