Pain medicine : the official journal of the American Academy of Pain Medicine
-
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.
-
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.
-
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.
-
Prior work suggests that positive affect inhibits pain while negative affect facilitates it. The current study sought to determine whether: 1) affective modulation of pain extends to a patient population; 2) cocaine and alcohol dependence influences the pattern of modulation; and 3) affective modulation of pain is mediated by changes in arm temperature. ⋯ Affect modulates pain perception in patients and does not appear to be mediated by changes in arm temperature. Additionally, pain modulation was not significantly influenced by cocaine or alcohol dependence. These data are encouraging, because they suggest that nonpharmacological methods of pain modulation may be effective in substance-dependent individuals.