Pain medicine : the official journal of the American Academy of Pain Medicine
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The primary objective of this study was to identify veterans affairs (VA) primary care clinicians' attitudes regarding chronic pain treatment. A secondary objective was to explore relationships between clinician and practice characteristics and an objective measure of opioid prescribing rates. ⋯ High clinician confidence and interest in treating chronic pain concurrent with low satisfaction with ability to provide optimal treatment suggests a need for more system support. VA primary care clinicians are frequently influenced by fears of contributing to dependence or addiction. The relationships among panel size, job satisfaction, and opioid prescribing rates merit additional investigation.
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Review
A systematic review of opioid conversion ratios used with methadone for the treatment of pain.
Review and analyze the evidence base comprising methadone conversion methods and associated dosing ratios for the treatment of pain. ⋯ There was no evidence to support the superiority of one method of rotation to methadone over another. Patients may be successfully rotated to methadone despite discrepancies between rotation ratios initially used and those associated with stabilization. Further research is needed to identify patient-level factors that may explain the wide variance in successful methadone rotations.
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To describe the natural course of patients with acute neck pain presenting in general practice and to identify prognostic factors for recovery and sick leave. ⋯ Acute neck pain had a good prognosis for the majority of patients, but still a relatively high proportion of patients reported neck pain after 1-year follow-up. The advice given by the GP "to wait and see" was associated with recovery, and "referral" was associated with prolonged sick leave.
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The application of continuous peripheral nerve block (CPNB) has been an important anesthetic tool in the management of combat soldiers wounded from current conflicts. Placing and maintaining CPNBs becomes a challenge in this patient population due to concomitant prophylactic and therapeutic anticoagulation. ⋯ This case highlights the application of simultaneous CPNB techniques in a patient with multiple extremity injuries receiving anticoagulant therapy.
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We investigated potential analgesics for chemotherapy-evoked neuropathic pain using rats treated with paclitaxel. ⋯ The present data and data from the literature review suggest that there are several potential treatments for chemotherapy-evoked neuropathic pain. Nonsteroidal anti-inflammatory drugs have little or no efficacy. Opioids have an effect, but probably only with high doses. At least some antidepressants are analgesic in these conditions. Some, but clearly not all, anticonvulsants and sodium channel blockers have efficacy. Tramadol is a particularly promising candidate. Topiramate, acetyl-L-carnitine, carbamazepine, and venlafaxine may have protective or restorative effects. Clinical trials of these candidates are needed to advance the treatment of chemotherapy-evoked pain.