Pain medicine : the official journal of the American Academy of Pain Medicine
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Randomized Controlled Trial Clinical Trial
Effect of local administration of transdermal fentanyl on peripheral opioid analgesia.
Transdermal fentanyl is a commonly used analgesic for the treatment of severe chronic pain. Recent investigations have shown the presence of mu-opioid receptors in the skin and opioid analgesic efficacy with alternative routes of administration of narcotics. This placebo-controlled, double-blind prospective study assessed whether transdermal fentanyl administration produces local peripheral opioid analgesia at the site of application. ⋯ These results suggest that the application of transdermal fentanyl patch for a period of 2 h does not produce local peripheral opioid analgesia at the site of patch application.
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To review major clinical issues related to recognition and diagnosis of breakthrough pain. ⋯ Greater knowledge and awareness of BTP in cancer and nonmalignant conditions will lead to improved recognition and diagnosis of BTP and ultimately to more effective treatment and enhanced quality of life for these patients.
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This article reviews the literature on patient-provider interactions among patients with chronic pain conditions with an emphasis on shared medical decision making. ⋯ Treatment of chronic pain is often complex and may be further complicated when patients and health care providers have differing goals and attitudes concerning treatment. Difficulties in engaging in collaborative treatment decision making may result. Efforts to enhance patient-provider communication as well as to systematically examine nonspecific treatment factors are likely to promote effective management of chronic pain.
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Clinical Trial
Assessment of dosing frequency of sustained-release opioid preparations in patients with chronic nonmalignant pain.
Many patients with moderate to severe chronic nonmalignant pain require dosing of long-acting opioids more frequently than recommended by the product's manufacturer. To accurately quantitate opioid dosing in clinical practice, daily dosing was prospectively assessed in pain clinic patients. ⋯ Many patients taking common long-acting opioids for chronic nonmalignant pain require dosing more frequently than recommended by product labeling, and take an additional 3-4 daily doses of rescue opioid, yet they continue to report moderate to severe pain. Newer opioid formulations that can provide sustained analgesia with convenient dosing are needed as well as a better understanding of the many additional factors that may influence opioid use patterns in patients with chronic pain.
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Clinical Trial
Effectiveness of prostaglandin E1 for the treatment of patients with neuropathic pain following herpes zoster.
Postherpetic neuralgia (PHN) is one of the most painful neuropathic conditions, the mechanism of which remains unclear. There is no universally accepted treatment. The pain in PHN is often relieved by bathing, heating, or sympathetic blockade, suggesting a circulation-dependent property of the pain. Therefore, we examined the effectiveness of prostaglandin E(1) (PGE(1)), which has an analgesic effect via improvement of peripheral blood circulation, for patients with PHN. ⋯ The results of the present study indicate that oral PGE(1) following the intravenous administration produces prompt and continuous analgesia in patients with PHN. Moreover, the intravenous treatment using PGE(1) appears useful for predicting the analgesic effect of PGE(1) in the patients.