Pain medicine : the official journal of the American Academy of Pain Medicine
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Comparative Study
Continuous intrathecal infusion of hydromorphone: safety in the sheep model and clinical implications.
To determine the safety of hydromorphone delivered by continuous intrathecal infusion via implanted delivery systems in sheep. ⋯ Hydromorphone was not associated with inflammatory mass formation in the sheep model. Further studies are necessary to determine whether hydromorphone is a safer alternative to morphine for continuous intrathecal infusion for the treatment of chronic pain.
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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.
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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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Chronic pain improves with electroconvulsive therapy (ECT), yet few case reports account for treatment of comorbid major depression, a significant confounder of the analgesia of ECT. This study reports on the analgesia of ECT, controlling for treatment of depression. ⋯ ECT has analgesic properties independent of its improvement of depression in patients with chronic pain and major depression. Improvements in depression were similar, while there was a significantly greater improvement in pain with ECT. The lower post-ECT treatment pain scores suggest a specific analgesic effect of ECT.