Pain medicine : the official journal of the American Academy of Pain Medicine
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Gastrointestinal (GI) side effects such as nausea and vomiting are common following opioid analgesia and represent a significant cause of patient discomfort and treatment dissatisfaction. This review examines the mechanisms that produce these side effects, their impact on treatment outcomes in chronic pain patients, and counteractive strategies. ⋯ Nausea and vomiting side effects limit the analgesic efficiency of current opioid therapies. There is a clear need for the development of improved opioid-based analgesics that mitigate these intolerable effects.
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The objectives of this medicolegal case report were the following: 1) present details of a chronic pain patient (CPP) on chronic opioid analgesic therapy (COAT), who diverted her opioids and was terminated from treatment, and subsequently committed suicide; 2) present both the plaintiff's and defendant's (the COAT prescriber) expert witnesses' opinions as to the allegation of medical abandonment of this patient and other allegations; and 3) based on these opinions, to develop some recommendations as to how pain physicians can minimize their medicolegal risk when termination of the physician-patient relationship is warranted. ⋯ To avoid and protect themselves against potential abandonment allegations when termination of the physician-patient relationship is warranted, physicians are advised to consider following the outlined procedures.
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Fibromyalgia is a chronic pain disorder that is characterized by diffuse musculoskeletal pain and sensitivity to mechanical stimulation. In this pilot clinical trial, we tested the effectiveness of low-dose naltrexone in treating the symptoms of fibromyalgia. ⋯ We conclude that low-dose naltrexone may be an effective, highly tolerable, and inexpensive treatment for fibromyalgia.
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Randomized Controlled Trial Multicenter Study Comparative Study
N-of-1 randomized trials to assess the efficacy of gabapentin for chronic neuropathic pain.
The objective of this study was to compare the efficacy of gabapentin with placebo for neuropathic pain at the individual and population levels. ⋯ The response rate and mean reduction in symptoms with gabapentin were small. Gabapentin prescribing posttrial was significantly influenced by the trial results.