Pain medicine : the official journal of the American Academy of Pain Medicine
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Randomized Controlled Trial Multicenter Study
A double-blind, randomized, placebo-controlled comparison of botulinum toxin type a injection sites and doses in the prevention of episodic migraine.
Several randomized, controlled studies have reported benefits of botulinum toxin type A (BoNTA; Allergan Inc., Irvine, CA, USA) over placebo in the treatment of migraine. Some studies reported significant benefits at dosages as low as 16 U, while other studies reported safety, tolerability, and efficacy at dosages up to 260 U. However, the optimal treatment paradigm and patient population have yet to be defined. ⋯ In this exploratory study of episodic migraine patients, low-dose injections of BoNTA into the frontal, temporal, and/or glabellar muscle regions were not more effective than placebo. BoNTA was safe and well tolerated. Future studies may examine higher BoNTA doses, flexible injection sites, multiple treatments, and disallow concomitant prophylactic medications.
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Chronic, neuropathic pain may be secondary to myriad etiologies including diabetic peripheral neuropathy and fibromyalgia. It is a debilitating condition that imposes a significant burden on individuals and society alike. This article will review various instruments designed to assess quality of life (QoL) and key data assessing QoL of patients suffering from these diseases as well as currently available pharmacologic agents for symptomatic management. As basic and clinical science progress over the next few years, along with the introduction of novel pharmacologic agents, we anticipate greater potential for pain intervention and improvement in the quality of life of our patients.
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The occurrence of diabetic peripheral neuropathy (DPN) is linked to poor glycemic control over time. While most people never develop diabetic peripheral neuropathic pain (DPNP) as a consequence of DPN, enough of them do that we must have effective options for the management of this disabling condition. ⋯ One of these medications, duloxetine has been established to significantly improve pain and to address depression by its reuptake inhibition of norepinephrine and serotonin. This article examines the epidemiology of DPNP, its underlying pathogenesis, necessary evaluation methods, and treatment options available with a focus on the role of duloxetine.
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New treatment options for diabetic peripheral neuropathic pain (DPNP) have recently been developed, including two Food and Drug Administration (FDA) approved agents, duloxetine and pregabalin. As clinicians face a broader spectrum of efficacious treatments, side-effect profiles play an increasingly important role in the development of a pain management regimen. In this article we review the safety profile of agents commonly used in the treatment of DPNP.
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Case Reports
Meningitis after percutaneous radiofrequency trigeminal ganglion lesion. Case report and review of literature.
A 79-year-old man with severe trigeminal neuralgia presented to the pain clinic, and was offered a radiofrequency trigeminal ganglion lesion. He had only partial response to the first procedure, so a second was undertaken. The following day he presented with signs of meningitis and the diagnosis was confirmed on lumbar puncture. He was treated with appropriate antibiotics, and recovered well. ⋯ If breach of the oral mucosa has occurred, then antibiotic prophylaxis should be administered.