Pain medicine : the official journal of the American Academy of Pain Medicine
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The goals of this study were to define the endpoints of pain research that are important to patients with chronic pain and to identify clinical and demographic variables that are associated with patients' choices of endpoints. ⋯ These data suggest that empirical research can provide data to guide the choice of endpoints in clinical studies of pain interventions.
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The role of physician variability in pain management is unknown. ⋯ Lower expectations for relief and less satisfaction in its management may contribute to the undertreatment of chronic pain. Perceptions of regulatory scrutiny may contribute to suboptimal pain management. These preliminary data highlight physician variability in pain decision making while providing insights into educational needs.
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A U.S. Food and Drug Administration ruling required clinical trials to evaluate the safety and efficacy of deep brain stimulation devices, thereby limiting treatment to the investigational setting. ⋯ Deep brain stimulation has not been shown to produce effective long-term pain relief. Future studies of motor cortex stimulation and similar therapies will require appropriate control groups and accepted methods of data collection and analysis to support claims that predictable and reliable analgesic effects are produced in humans.
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Mexilitine is an anti-arrhythmic agent used to treat neuropathic pain. The drug has a low side-effect profile with gastritis as the predominant complaint. The following two cases suggest that mexilitine can potentially cause persistent ophthalmic changes and should be used with caution in chronic pain patients with preexisting ocular disease.
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Two patients suffering from systemic sclerosis (SSc) were treated with the 25 micro/hr transdermal fentanyl patch for pain from either deltoid muscle tendinitis of the left arm or from ischemia of the left-hand thumb. When the medication was changed to either oral morphine or oral methadone, the effects did not correspond to the drug conversion table. These findings suggest that patients with SSc and other systemic skin diseases may be at risk for limited absorption of transdermal fentanyl. In contrast, no restriction of the absorption of transdermal testosterone was observed.