Pain medicine : the official journal of the American Academy of Pain Medicine
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To determine the risk: benefit of paracetamol combined with caffeine in the short-term management of acute pain conditions. ⋯ Paracetamol/caffeine (1,000 mg/130 mg) is effective and safe for use in acute management of pain. The hepatotoxicity of overdoses of paracetamol results from its oxidative metabolism, caffeine does not produce any increase in oxidative metabolism of therapeutic concentrations of paracetamol.
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Randomized Controlled Trial
Gabapentin does not reduce preoperative anxiety when given prior to total hip arthroplasty.
Gabapentin is an anti-epileptic drug which is also used for the treatment of postoperative pain and a variety of psychiatric diseases including chronic anxiety disorders. We tested the hypothesis that compared with a placebo control, gabapentin would reduce preoperative anxiety in patients undergoing total hip arthroplasty. ⋯ Administration of gabapentin 600 mg prior to surgery does not reduce preoperative anxiety.
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Case Reports
Analgesic effect of subanesthetic intravenous ketamine in refractory neuropathic pain: a case report.
A 59-year-old male patient with progressive neuropathic pain secondary to chronic idiopathic axonal polyneuropathy responded poorly to conventional therapies including gabapentin, tricyclic antidepressants, serotonin-norepinephrine reuptake inhibitors and opioids. Following continuous intravenous administration of low dose ketamine, an N-methyl-D-aspartic acid receptor antagonist, 20 mg/h for 5 days, almost complete pain relief was obtained without significant side effects. ⋯ This supports the growing body of evidence that ketamine may be useful in the management of refractory chronic neuropathic pain. We discuss chronic idiopathic axonal polyneuropathy, neuropathic pain mechanisms, and the use of ketamine in this report.
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Comparative Study
The pain provocation technique for adolescents with chronic pain: preliminary evidence for its effectiveness.
This study aims to investigate the effectiveness of the "pain provocation technique" (PPT)--a focused treatment strategy incorporating interoceptive exposure (i.e., imagining increases in pain intensity), bilateral stimulation (tactile stimulation), and implementation of pain-related coping to decrease pain intensity--for adolescents suffering from chronic pain. ⋯ Results are discussed in terms of the importance of focused treatment strategies such as interoceptive exposure for adolescents suffering from disabling chronic pain. Future studies are warranted to carefully investigate the effectiveness and possible process of change during the PPT such as sensory, cognitive, emotional, and memory aspects.
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Intrathecal sufentanil is a minimally utilized opioid for patients with intractable pain refractory to traditional intrathecal medications. We present an 86-year-old female with a history of multiple spine surgeries who eventually progressed to having chronic, intractable, and diffuse low back pain. After failing medical management, she underwent a successful intrathecal trial of opioid therapy and was subsequently treated with an implantable drug delivery system (IDDS) or intrathecal pump. ⋯ Due to increasing opioid requirements and gradually escalating pain, a computed tomography myelogram was performed to explore neuraxial etiologies of her symptoms. This investigation revealed the presence of a catheter tip-associated inflammatory mass (granuloma). All patients receiving intrathecal medications, including sufentanil, must be considered for the possibility of catheter-associated granuloma, particularly with symptoms of altered neurological function and/or increasing medication requirements associated with worsening pain.