Pain practice : the official journal of World Institute of Pain
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Randomized Controlled Trial
Preoperative vs. postoperative bilateral paravertebral blocks for laparoscopic cholecystectomy: a prospective randomized clinical trial.
The aim of this clinical trial was to determine the potential analgesic effect of preoperative paravertebral blockade in patients undergoing laparoscopic cholecystectomy. ⋯ Bilateral paravertebral blockade performed prior to general anesthesia for laparoscopic cholecystectomy can provide early discharge and better postoperative pain management.
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This meta-analysis compared efficacy (pain response) of drugs that are licensed or commonly used in the treatment of fibromyalgia. A meta-analysis of safety measured via discontinuation because of adverse events was also performed. ⋯ All eight active treatments displayed evidence suggesting improvement over placebo in the treatment of pain in patients suffering from fibromyalgia. Indirect comparison of active treatments found no strong differences.
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Although previous studies suggest that the clinical setting of an interdisciplinary pain treatment program may provide an optimal environment to promote smoking cessation, currently available smoking cessation interventions may be less effective for adults with chronic pain due, in part, to unrecognized clinical factors related to chronic pain. The specific aim of this qualitative study was to solicit information from adult smokers with chronic pain participating in an interdisciplinary pain treatment program regarding their perceptions of how smoking affects pain symptoms, and how these beliefs, cognitions, and emotions may either impede or facilitate smoking cessation. Similar information was solicited from a group of pain specialty physicians. ⋯ Important barriers were identified toward making a quit attempt during pain treatment including quitting smoking while making changes in opioid use, and perceived difficulty managing multiple treatment-related stressors. Several pain-related benefits of smoking cessation were identified by physicians, but important barriers to providing smoking cessation services were recognized including lack of time and knowledge about how to help patients quit smoking. The findings of this study identified several novel and important clinical factors that should be incorporated into a targeted smoking cessation intervention for adults with chronic pain.
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Chronic pain has been recognized as a major worldwide health care problem. Today, medical experts and health agencies agree that chronic pain should be treated with the same priority as the disease that caused it, and patients should receive adequate pain relief. To achieve good analgesia, patient adherence to a prescribed pain treatment is of high importance. ⋯ Signs of tolerance, hyperalgesia, and drug abuse should be monitored as these may occur in some patients. An individualized treatment algorithm with a clear treatment goal and regular treatment reassessment is key for successful treatment. Long-acting opioids offer sustained pain relief over 24 hours with manageable side effects-they simplify treatment thereby supporting treatment adherence.
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Cancer patients with bone metastases are at risk of a variety of skeletal events, including vertebral compression and pathologic fractures. Approximately 30% to 40% of patients with advanced lung cancer will develop bone metastases in the course of their disease, resulting in a significant negative impact on both morbidity and survival. Skeletal complications of bone metastases include pain, pathologic fractures, spinal cord compression, and hypercalcemia. ⋯ Few reports exist about the treatment of sacral metastatic tumors with percutaneous sacroplasty. Further, no previous reports about sacroiliac joint cementation for joint stabilization have been found. In the present case, sacroiliac joint cementation successfully resolved residual pain that remained despite percutaneous sacroplasty treatment of the pathologic sacral fracture.