Articles: pain-clinics.
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Cannabinoids have been known for their analgesic, anxiolytic, antiemetic and antispastic properties for many centuries. Since an endogenous cannabinoid system has been identified in the past two decades, cannabinoids have also become the focus of interest in western medicine. This review summarizes preclinical and clinical studies on the role of the endocannabinoid system and exogenous cannabinoids in anaesthesia and pain management. ⋯ In general, the results of the very few well-conducted clinical trials often diverge from the highly interesting and promising findings of preclinical studies. Taken together, the most recent preclinical and clinical data suggest that cannabinoids should be applied as low-dose co-analgesics to inhibit neuroplasticity and central sensitization rather than as analgesics in acute pain.
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Clinical Trial
Neuropsychological assessment of chronic non-malignant pain patients treated in a multidisciplinary pain centre.
The aim of the study was to investigate the influence of pain, sedation, pain medications and socio-demographics on cognitive functioning in chronic non-malignant pain patients. Chronic non-malignant pain patients (N=91) treated in a multidisciplinary pain centre were compared with age and sex matched healthy volunteers (N=64). Furthermore four subgroups of patients were examined: Group 1 (N=21) received no pain medications, group 2 (N=19) were in long-term oral opioid treatment, group 3 (N=18) were treated with antidepressants and/or anticonvulsants and group 4 (N=33) were treated with a combination of long-term oral opioids and antidepressants and/or anticonvulsants. ⋯ Treatment with opioids was associated with poorer performance of PASAT. High scores of PVAS and SVAS were associated with poor performance of PASAT and CRT, respectively. MMSE seems to be too insensitive for detecting the milder forms of cognitive impairment found in chronic non-malignant patients.
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Meralgia paresthetica is a clinical syndrome of pain, dysesthesia or both, in the anterolateral thigh. It is associated with an entrapment mononeuropathy of the lateral femoral cutaneous nerve. Diagnosis of meralgia paresthetica is typically made clinically and is based on the characteristic location of pain or dysesthesia, sensory abnormality on exam, and absence of any other neurological abnormality in the leg. The majority of patients with meralgia paresthetica respond well to conservative treatment. ⋯ An implanted spinal cord stimulator may be an ideal treatment for intractable meralgia paresthetica after conservative treatments have failed because it is not destructive and can always be explanted without significant permanent adverse effects.
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Sedation is commonly provided for patients undergoing interventional pain management procedures. Although many pain management interventionalists have trained in anesthesiology, the use of sedatives, analgesics and hypnotics, as well as monitoring techniques, may vary considerably between practices. This review provides an update on recent advances in the pharmacology of drugs commonly used for sedation, anxiolysis and analgesia. ⋯ In addition to providing the right drug for the procedure, patient monitoring must be appropriate for the patient and the clinical circumstances. Undertaking a sedation analgesic course of therapy in support of an interventional procedure will require that patients are monitored appropriately during the course of treatment. Guidelines for monitoring patients during sedation are available.
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Fatigue is frequently found in chronic pain patients (CPPs) and may be etiologically related to the presence of pain. Fishbain et al. have recently demonstrated that chronic low back pain (LBP) and chronic neck pain patients are more fatigued than controls. The purpose of this study was to determine whether chronic LBP- and chronic neck pain-associated fatigue responded to multidisciplinary multimodal treatment not specifically targeted to the treatment of fatigue. ⋯ Multidisciplinary multimodal pain facility treatment improves chronic LBP- and neck pain-associated fatigue. At the present time we cannot predict this improvement with significant accuracy.