Pain medicine : the official journal of the American Academy of Pain Medicine
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Review Case Reports Historical Article
Pharmacologic management part 2: lesser-studied neuropathic pain diseases.
This second part of a review of the pharmacologic management of neuropathic pain diseases describes the current treatment options for three lesser-studied neuropathic syndromes: Central poststroke pain, spinal cord injury, and complex regional pain syndrome II. Diagnosis can be difficult in patients with these syndromes, because the pain experienced is much greater and of a different type than would normally be expected following a stroke or injury to the spinal cord or a peripheral nerve. ⋯ However, the results of published trials do support the use of anticonvulsants and/or tricyclic antidepressants as first-line pharmacotherapy in these three neuropathic pain syndromes. To maximize treatment outcomes, future research must: Continue to more fully elucidate the relationship between the signs and symptoms of pain and the underlying pathophysiology; Delineate the natural history of central poststroke pain, spinal cord injury, and complex regional pain syndrome; Identify patient-related factors that may indicate an increased risk of developing neuropathic pain following stroke or nerve injury; Investigate emerging treatments that target underlying pain mechanisms.
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Comparative Study
Intrathecal drug delivery for treatment of chronic low back pain: report from the National Outcomes Registry for Low Back Pain.
To obtain data on patient demographics, clinical practices, and long-term outcomes for patients with chronic low back pain treated with implantable drug-delivery systems. ⋯ Current clinical practices related to trialing of drug-delivery systems resulted in the majority of patients successfully trialed. At 12-month follow-ups, implanted patients experienced reductions in numeric back and leg pain ratings, improved Oswestry scores, and high satisfaction with the therapy.
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Pain clinicians are increasingly asked to provide expert commentary in a variety of medico-legal or forensic contexts. The purpose of this study was to discover the frequency and type of medico-legal activity undertaken by pain specialists, their familiarity with current guidelines, and their opinions with respect to a need for formal ethical or practice guidelines. ⋯ Survey data revealed that 72% of pain specialists had engaged in some form of medico-legal work within the past year. Of those who engaged in this work, 96% completed this work as a treating clinician for their patients. While the majority of respondents engaged in activities such as the completion of disability forms, other high frequency activities included depositions and testimony. Differences between physicians and nonphysicians also were noted. Results revealed that the majority of pain specialists supported the development of guidelines for medico-legal practice. It was suggested that pain societies move to develop ethical and/or clinical practice guidelines to address this issue.
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Neuropathic pain arises from a lesion or dysfunction within the nervous system; the specific mechanisms that elicit neuropathic pain symptoms are the subject of ongoing research. It is generally acknowledged that neuropathic pain is extremely difficult to treat, and a major factor impacting outcomes is the presence of comorbidities such as poor sleep, depressed mood, and anxiety. Patients who suffer from chronic pain experience difficulties in initiating and maintaining sleep. ⋯ Nonpharmacologic interventions include relaxation therapy, sleep restriction therapy, and cognitive therapy. Strategies for pharmacologic interventions should attempt to maximize outcomes by employing, where possible, agents that address both the pain and the comorbidities. In this way, functionality may be restored and the patient's quality of life improved.