Pain practice : the official journal of World Institute of Pain
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Randomized Controlled Trial
Analgesic effectiveness of dipyrone (metamizol) for postoperative pain after herniorrhaphy: a randomized, double-blind, dose-response study.
The efficacy of non-narcotic analgesics is mostly supported by randomized, placebo-controlled trials with no comparison with ordinary practice. Additionally, systematic reviews of these placebo-controlled trials have failed to determine clinically meaningful dose-response effect. ⋯ This trial shows a dose-response effect of 40 mg/kg over 15 mg/kg of intravenous dipyrone based on better movement-induced pain control, lower morphine consumption and fewer opioid-related side effects.
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We report the successful use of low-dose ketamine infusion for treating a severe episode of painful myoclonus in the lower extremities, associated with opioid-induced hyperalgesia (OIH), in a patient who was receiving long-term, high dose intrathecal hydromorphone therapy. A low-dose ketamine infusion immediately relieved the painful myoclonus. It also enabled a reduction in the intrathecal opioid dosage leading to a resolution of the acute symptoms attributed to OIH.
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Editorial Comment
Chronic pelvic pain: is it time for an algorithmic approach?