Articles: pain-management-methods.
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To assess efficacy and safety of pharmacological pain treatment in patients with inflammatory arthritis (IA) and gastrointestinal (GI) or liver comorbidities. ⋯ Very little evidence regarding safety and efficacy of pain treatment in patients with IA and GI or hepatic comorbidities was found. In patients with a history of GI events, extrapolating from other studies, NSAID should be used cautiously since there is evidence that these patients are at a higher risk of developing adverse events.
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Anasthesiol Intensivmed Notfallmed Schmerzther · Sep 2012
Review[Pathophysiology and epidemiology of pain in thoracic surgery].
Acute and chronic pain are significant problems after thoracic surgery with a multifactorial pathogenesis. On the one hand iatrogenic procedures as surgical access and complexity of treatment procedures, and on the other hand constitutional factors as psychosocial comorbidities affect individual pain threshold and the development of a Postthoracic Pain Syndrome (PTPS). ⋯ The characterization of pathophysiological pathways wants to point out treatment options. In conclusion there is a need for well organized, multimodal pain therapy concepts to minimize the risk of perioperative and chronic pain.
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In patients with dementia, undertreatment of pain, irrespective of its aetiology, is widely recognized; the risk for undertreatment increases with the severity of dementia. We argue, however, that central neuropathic pain is by far the most undertreated type of pain in patients with dementia. Central pain is a type of neuropathic pain that is known to occur in stroke patients and is caused by white matter lesions. ⋯ Antidepressants and antiepileptic drugs appear to have a positive effect on central neuropathic pain. In the review, advantages and disadvantages of amitriptyline, carbamazepine, lamotrigine, gabapentin and pregabalin are discussed; a negative effect of these drugs on liver and kidney functions, as well as on cognitive functions in patients who already suffer from cognitive impairment is highlighted. Next to pharmacotherapy, non-pharmacological treatment strategies such as transcutaneous electrical nerve stimulation may be effective as long as afferent pathways transmitting the electrical stimulus are still intact.
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Review
The efficacy and safety of muscle relaxants in inflammatory arthritis: a Cochrane systematic review.
To determine the efficacy and safety of muscle relaxants in pain management in patients with inflammatory arthritis (IA). ⋯ Based upon the currently available evidence in patients with IA, benzodiazepines (diazepam and triazolam) do not appear to be beneficial in improving pain over 24 hours or 1 week. The non-benzodiazepine agent zopiclone also did not significantly reduce pain over 2 weeks. However, even short-term muscle relaxant use (24 hours to 2 weeks) is associated with significant adverse events, predominantly drowsiness and dizziness.
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Review
Proposed physician payment schedule for 2013: guarded prognosis for interventional pain management.
As happens every year, on July 1, 2012, the Centers for Medicare and Medicaid Services issued a proposed policy and payment rate for services furnished under the Medicare physician fee schedule for 2013. The proposed rule would provide certified registered nurse anesthetists to practice independent interventional pain management. Other issues, though no less important, include a 27% sustainable growth rate formula cut in reimbursement, along with a 2% sequester, which could lead to a potential cut of 29%. ⋯ Since then, Congress has intervened on multiple occasions to prevent additional cuts from being imposed. In this manuscript, we will describe important proposed changes to the physician fee schedule. Additionally, the impact of multiple changes on interventional pain management will be briefly described.