Pain medicine : the official journal of the American Academy of Pain Medicine
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Randomized Controlled Trial
Low-dose sublingual ketamine does not modulate experimentally induced mechanical hyperalgesia in healthy subjects.
Musculoskeletal pain has been associated with N-methyl-d-aspartate (NMDA) receptor-mediated mechanisms. This randomized controlled trial (RCT) investigated the effect of the NMDA receptor antagonist ketamine (25 mg sublingually) on modulating experimental muscle pain. ⋯ In comparison with placebo, a single low-dose sublingual pharmacological intervention targeting the processes of sensitization via antagonism of NMDA receptors did not modulate the effects of acute experimentally induced mechanical hyperalgesia, suggesting a higher dose or repeat doses may be required.
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There are many external influences in today's market force that impair the relationship between the pain medicine specialist and the patient, and ultimately prevent optimal quality of care. This article explores the ethical challenges facing the pain medicine specialist in today's increasingly "business" environment and will offer solutions for maintaining the professionalism of pain medicine. ⋯ Solutions offered include collegial associations, social responsibility, legislative initiatives, pain education, interdisciplinary evaluation and treatment, improved relationships with third-party payers, reduced racial disparities, and ethics education. Ethics is the "roadmap" that enables the pain medicine specialist to navigate the increasingly murky waters of practicing pain management today by maintaining the professionalism necessary to combat today's "business" pressures.
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Multicenter Study
Pain relief and tolerability balance of immediate release tapentadol or oxycodone treatment for patients with moderate to severe osteoarthritis or low back pain.
Opioid treatment effectiveness may be best compared using definitions of treatment response, which combine measures assessing pain reduction and the occurrence of adverse events (AEs). This analysis of data from two phase III clinical trials was conducted to examine the pain relief and tolerability (PRT) balance of immediate release (IR) tapentadol and oxycodone in patients with moderate to severe osteoarthritis (OA) or low back pain. ⋯ Pain reduction and tolerability are both important attributes of an effective analgesic treatment. Based on data from two trials, tapentadol IR produced an improved PRT balance compared with oxycodone IR.
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The objective of this study was to determine if there is consistent evidence for smoking to be considered a red flag for development of opioid dependence during opioid exposure in patients with pain and chronic pain patients (CPPs). ⋯ There is limited consistent indirect evidence that smoking status in patients with pain and CPPs is associated with alcohol-drug and opioid dependence. Smoking status could be a red flag for opioid-dependence development on opioid exposure.
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Clinical Trial
Palmitoylethanolamide in the treatment of chronic pain caused by different etiopathogenesis.
To assess the efficacy and safety of palmitoylethanolamide (PEA), an endogenous fatty acid amide belonging to the N-acylethanolamines family, in reducing pain severity in patients with pain associated to different pathological conditions. ⋯ In this study, PEA was effective and safe in the management of chronic pain in different pathological conditions.