Pain medicine : the official journal of the American Academy of Pain Medicine
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Visual impairment apparently is a rare but significant complication following epidural fluid injection and epiduroscopy. We report a review of cases reported in the literature with the aim of gaining an understanding of how the complication occurs as well as how to avoid it. ⋯ Retinal hemorrhage following epidural fluid injections/epiduroscopy apparently is due to an increase in cerebrospinal fluid pressure proportional to the rate and the amount of fluid injected. A sudden increase in epidural pressure is transmitted into the subarachnoid space to the optic nerve sheath, compressing the optic nerve and its vasculature. The vasculature compression ruptures retinal blood vessels.
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Randomized Controlled Trial Multicenter Study
Oxymorphone extended-release tablets relieve moderate to severe pain and improve physical function in osteoarthritis: results of a randomized, double-blind, placebo- and active-controlled phase III trial.
To compare oxymorphone extended release (ER) and placebo on indices of pain, function, and safety in patients with chronic osteoarthritis (OA) pain. ⋯ In this short-term study, oxymorphone ER was superior to placebo for relieving pain and improving function in patients with moderate to severe chronic OA pain, and is an alternative to other sustained-release opioids.
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Randomized Controlled Trial Multicenter Study Comparative Study
A double-blind, randomized multicenter trial comparing duloxetine with placebo in the management of diabetic peripheral neuropathic pain.
Assess efficacy and safety of duloxetine, a selective serotonin and norepinephrine reuptake inhibitor, on the reduction of pain severity, in patients with diabetic peripheral neuropathic pain (DPNP). ⋯ In this clinical trial, duloxetine 60 mg QD and duloxetine 60 mg BID were effective and safe in the management of DPNP.
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The study's primary objective is to define treatment success from the patient perspective across four domains (pain, fatigue, emotional distress, interference with daily activities) using the Patient Centered Outcomes Questionnaire (PCOQ). Secondary objectives include examination of patient expectations for treatment across domains and derivation of patient subgroups based on PCOQ responses. ⋯ Patients might require larger reductions in pain than has previously been reported in the literature as "meaningful" for them to consider treatment successful. Patients did not expect treatment to meet their criterion for success in the interference domain, suggesting patients' success criteria and treatment expectations might differ for some domains. The finding of patient subgroups has implications for treatment matching.
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Clinical Trial
An open-label study of the lidocaine patch 5% in painful idiopathic sensory polyneuropathy.
Painful idiopathic distal sensory polyneuropathy is common, but has been largely ignored as a model for the evaluation of neuropathic pain therapies. We have therefore conducted a safety, tolerability, and effectiveness study of the lidocaine patch 5% in painful idiopathic distal sensory polyneuropathy. ⋯ The lidocaine patch 5% appeared well tolerated and potentially effective in the management of painful idiopathic distal sensory polyneuropathy. Idiopathic distal sensory polyneuropathy is an appropriate patient population for the conduct of clinical trials of neuropathic pain therapies.