Articles: neuropathic-pain.
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Comparative Study
A retrospective study of open thoracotomies versus thoracoscopic surgeries for persistent postthoracotomy pain.
Persistent thoracotomy pain syndrome (PTPS) is a recognized complication and is considered to be less after video-assisted thoracoscopic surgery (VATS) compared with open thoracic surgery (OTS). The primary objective was to compare the incidence of PTPS at 6 months. Secondary objectives were to compare the incidence of neuropathic pain between VATS and OTS and to report perioperative factors associated with the development of PTPS. ⋯ Our study indicates that PTPS is significantly more common and has a higher chance of being neuropathic with OTS. Despite being relatively less traumatic, VATS still carries a significant potential for PTPS. A diagnosis of cancer and history of previous pain are highly predictive of its development.
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External noninvasive peripheral nerve stimulation (EN-PNS) is a neuromodulation technique in which a low-frequency electrical stimulation is applied via a ball-shaped electrode that is placed directly onto the skin. ⋯ Patients reported EN-PNS to provide ongoing benefit at long-term follow-up. Further prospective investigations are justified.
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This study aimed to characterize the prevalence of various pain qualities in older adults with chronic nonmalignant pain and determine the association of pain quality to other pain characteristics namely: severity, interference, distribution, and pain-associated conditions. In the population-based MOBILIZE Boston Study, 560 participants aged ≥70 years reported chronic pain in the baseline assessment, which included a home interview and clinic exam. Pain quality was assessed using a modified version of the McGill Pain Questionnaire (MPQ) consisting of 20 descriptors from which 3 categories were derived: cognitive/affective, sensory, and neuropathic. ⋯ Findings from this study indicate that older adults have multiple pain-associated conditions that likely reflect multiple physiological mechanisms for pain. Linking pain qualities with other associated pain characteristics serve to develop a multidimensional approach to geriatric pain assessment. Future research is needed to investigate the physiological mechanisms responsible for the variability in pain qualities endorsed by older adults.
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Curr Pain Headache Rep · Dec 2016
ReviewMultiple Sclerosis-Related Pain Syndromes: An Imaging Update.
Pain in multiple sclerosis (MS) is a common manifestation, made up of complex phenomenon involving intricate neurophysiological processing at central levels of the pain pathway. Our understanding of the clinical and neurophysiological mechanisms of central/neuropathic pain related to MS continues to improve with improved imaging techniques but remains a challenging area of research. ⋯ This article will discuss the updated criteria of MS neuropathic pain and critically review some of the latest research into imaging correlations of MS pain syndromes. And discuss how advanced MRI imaging techniques (such as functional magnetic resonance imaging [fMRI], 3D imaging, fluid attenuated inversion recovery [FLAIR*], and diffusion tensor imaging [DTI]) have detailed neuropathic pain with a focus on migraines and trigeminal neuralgias and will highlight some of the ongoing limitations, variabilities, and deficiencies.
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Palliative care clinicians are increasingly involved in the care of elderly patients suffering from chronic malignant and nonmalignant illnesses, of which neuropathic pain is a prevalent problem. As a person becomes more frail, pain medications such as opioid analgesics and adjuvant pain medications can result in unwanted effects such as sedation, confusion, and increased risk of falls. ⋯ Methadone is an opioid analgesic that is effective in the treatment of neuropathic pain, is excreted by the bowels, is highly lipophilic, and can be administered through the oral, buccal, or sublingual routes. We present three cases highlighting the use of low-dose adjuvant methadone to manage complex neuropathic pain in the frail elderly.