Articles: acute-pain.
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Review Comparative Study
Does sleep differ among patients with common musculoskeletal pain disorders?
Most patients with chronic musculoskeletal pain report poor-quality sleep. The impact of chronic pain on sleep can be described as a vicious circle with mutual deleterious influences between pain and sleep-associated symptoms. ⋯ Furthermore, many other methodologic issues complicate our ability to generalize findings (low external validity) to first-line medicine. Because sleep alterations in common musculoskeletal pain are neither specific nor pathognomonic, the aim is to provide a critical overview of the current understanding of pain and sleep interaction, discussing evidence-based and empiric knowledge that should be considered in further research and clinical applications.
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Abscesses are one of many complications of diverticulitis and can be found intra-abdominally or in the pelvis. ⋯ A deviation from the usual clinical presentation of diverticulitis should prompt the physician to obtain further radiologic evaluation. Computed tomography scanning is recommended, especially when an abscess is suspected.
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Fibromyalgia (FM) is a mysterious pain syndrome with progressive and widespread pain, explicit areas of tender points, stiffness, sleep disturbance, fatigue, and psychological distress without any obvious disease. FM is commonly perceived as a condition of central pain and sensory augmentation. There are documented functional abnormalities in pain and sensory processing in FM. ⋯ Pre-emptive analgesia and pro-active treatment may offer the momentum for acute pain control based on model of central sensitization and pain in FM. This review article on FM appraises the modern practice of multimodal therapy focus on both acute and chronic pain management. Meanwhile, the evolving nonpharmacological approach is summarized and stressed as an essential component of integrated care in FM.
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Expert Rev Clin Pharmacol · Nov 2011
ReviewPharmacokinetic-pharmacodynamic modeling in acute and chronic pain: an overview of the recent literature.
In acute and chronic pain, the objective of pharmacokinetic-pharmacodynamic (PKPD) modeling is the development and application of mathematical models to describe and/or predict the time course of the pharmacokinetics (PK) and pharmacodynamics (PD) of analgesic agents and link PK to PD. Performing population PKPD modeling using nonlinear mixed effects modeling allows, apart from the estimation of fixed effects (the PK and PD model estimates), the quantification of random effects as within- and between-subject variability. Effect-compartment models and mechanism-based biophase distribution models that incorporate drug-association and -dissociation kinetics are applied in PKPD modeling of pain treatment. ⋯ Mixture models do not necessarily need to take PK data into account and allow the objective differentiation of measured responses to analgesics into specific response subgroups, and as such, may play an important role in analyzing Phase I and II analgesia studies. Appropriate application of PKPD modeling leads to the improvement of current therapeutics with respect to dose design and outcome, understanding the interaction of analgesics within complex chronic pain disease processes and may play an important role in drug development. In the current article, novel observations using the aforementioned techniques on opioids, NSAIDs, epidural analgesia, ketamine and GABA-ergic drugs in acute and chronic pain are discussed.
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Trauma, surgery, and burns are three common clinical scenarios that are associated with significant acute pain. This review describes the pathophysiology of acute pain utilizing three preclinical models: surgery, burn, and fracture. ⋯ Peripheral mediators of acute pain can vary depending upon the type of injury. Treatment aimed toward those mediators specific to the injury may improve acute pain management in the future. It will be important to translate these findings into clinical trials in the future.