Pain medicine : the official journal of the American Academy of Pain Medicine
-
Review
Consensus Recommendations on Initiating Prescription Therapies for Opioid-Induced Constipation.
Aims of this consensus panel were to determine (1) an optimal symptom-based method for assessing opioid-induced constipation in clinical practice and (2) a threshold of symptom severity to prompt consideration of prescription therapy. ⋯ The BFI is a simple assessment tool with a validated threshold of clinically significant constipation. Prescription treatments for opioid-induced constipation should be considered for patients who have a BFI score of ≥30 points and an inadequate response to first-line interventions.
-
Comparative Study
Shortening the Screener and Opioid Assessment for Patients with Pain-Revised (SOAPP-R): A Proof-of-Principle Study for Customized Computer-Based Testing.
The Screener and Opioid Assessment for Patients with Pain-Revised (SOAPP-R) is a 24-item self-report instrument that was developed to aid providers in predicting aberrant medication-related behaviors among chronic pain patients. Although the SOAPP-R has garnered widespread use, certain patients may be dissuaded from taking it because of its length. Administrative barriers associated with lengthy questionnaires further limit its utility. ⋯ Curtailment and stochastic curtailment have potential to improve the SOAPP-R's efficiency in computer-based administrations.
-
Patients who present for steroid injections are not routinely screened for potential hypothalamic-pituitary-adrenal (HPA) axis suppression from previous steroid exposure. Patients often receive various steroid therapies that are not reported by the patient or recorded in available medical records. Yet, HPA axis suppression has been reported with a single intra-articular injection. ⋯ Our results suggest that patients receive steroids from many sources and may be at risk for HPA axis suppression. Further testing is necessary to determine if these patients indeed have biochemical evidence of adrenal suppression. Utilization of a screening questionnaire might help identify patients who should be considered for HPA axis testing prior to steroid injections.
-
In recent years, there has been increased attention to pain management after surgery in the hospital setting along with financial enticement from the US government. The aim of this study is to evaluate the current efficacy of postoperative pain management. ⋯ The incidence of severe-to-extreme pain in patients before and after discharge following inpatient surgery is 12-13%, and this is a reduction from 10 years ago.
-
Persistent pain is associated with dysfunction of the autonomic nervous system, in particular a loss of vagal inhibitory control, that can be indexed by decreased vagally mediated heart rate variability (vmHRV). Effective treatment (e.g., analgesic self-medication) may lead to a restoration of vmHRV. The objective of this article was to further explore the relationship of pain and vagal control and to investigate the effect of analgesic self-medication on the association of vmHRV and pain. ⋯ In line with previous research, vmHRV is inversely associated with pain interference. Analgesic intake mediates the association of vmHRV and pain. Effective analgesic self-medication may lead to a restoration in vmHRV. These results further support the vagus nerve as an objective indication of pain severity and treatment efficacy in patients with persistent pain.