Pain Management

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Pain Management

Daily Treatment Report

Cognitive Therapy-CBT-Psychotherapy

Device Therapy

Drug Side-Effects and Interactions

FDA Renews Warnings on Pain-Relief Patch: Misuse and misprescribing can lead to overdose, death from fentanyl-laden patches “The patches deliver a potent pain killer containing the narcotic fentanyl. They are primarily used by cancer patients who are tolerant to the side effects of narcotic pain medications, according to U.S. Food and Drug Administration officials who issued Friday's warning.”

FDA Warns of Potential Serious Side Effects with Breakthrough Cancer Pain Drug "The Food and Drug Administration is alerting health care professionals and consumers to concerns over the use of Fentora (fentanyl buccal) tablets after recent reports of deaths and other adverse events. Fentora, a potent opioid pain medication, is used only for treatment of breakthrough pain in cancer patients receiving opioid treatment and who have become tolerant to it. Breakthrough pain is intense increases in pain that occur with rapid onset, even when opioid pain-control medication is being used. Patients who take narcotic pain medications daily and around-the-clock develop tolerance and are more resistant to the dangerous side effects of these medications than patients who take narcotic pain medication on a less frequent basis."

Sleep Apnea Often Seen With Chronic Opioid Use "Sleep-disordered breathing is very common in patients who use opioids for chronic pain conditions, according to a report issued online September 6th by the journal Pain Medicine."

Chronic opioid use is a risk factor for the development of central sleep apnea and ataxic breathing. (J Clin Sleep Med. 2007) "CONCLUSIONS: There is a dose-dependent relationship between chronic opioid use and the development of a peculiar pattern of respiration consisting of central sleep apneas and ataxic breathing. Although potentially significant, the clinical relevance of these observations remains to be established."

The tell-tale heart: population-based surveillance reveals an association of rofecoxib and celecoxib with myocardial infarction. (PLoS ONE. 2007) "CONCLUSIONS/SIGNIFICANCE: The strong relationship between prescribing and outcome time series supports a population-level impact of COX-2 inhibitors on MI incidence. Further, mean age at MI appears to have been lowered by use of these medications. Use of a population monitoring approach as an adjunct to pharmacovigilence methods might have helped confirm the suspected association, providing earlier support for the market withdrawal of rofecoxib."

Australia Bans Novartis's Prexige on Liver Worries "Australia's drugs regulator banned the use of Novartis's Prexige because of liver problems in patients using the painkiller, the watchdog said, including two deaths and two liver transplants. … Prexige had initially been seen as a blockbuster seller for Novartis, but analysts' expectations collapsed following the Vioxx withdrawal, and there were doubts whether Prexige would ever win U.S. approval."

Addiction to opioids in chronic pain patients: A literature review (European Journal of Pain 2007)

Risk of congestive heart failure with nonsteroidal antiinflammatory drugs and selective Cyclooxygenase 2 inhibitors: A class effect? (Arthritis Rheum. 2007) "CONCLUSION: In elderly patients with known CHF, indomethacin and rofecoxib are associated with a greater risk of recurrent CHF compared with celecoxib. Alternatives should be considered for patients with CHF who require antiinflammatory drugs."

Long-term Risk of Ischemic Stroke Associated with Rofecoxib. (Cardiovasc Drugs Ther. 2007) "CONCLUSIONS: Based on extended follow-up data, APPROVe is the first trial to report an increase in ischemic stroke risk with rofecoxib compared to placebo. The finding of ischemic strokes after rofecoxib use had been discontinued should be further studied to determine whether patients previously exposed to rofecoxib remain at an increased risk."

NSAID Use and Progression of Chronic Kidney Disease (The American Journal of Medicine 2007) "High cumulative NSAID exposure is associated with an increased risk for rapid CKD progression in the setting of a community-based elderly population. For older adult patients with CKD, these results suggest that nonselective NSAIDs and selective COX-2 inhibitors should be used cautiously and chronic exposure to any NSAID should be avoided."

Painkillers linked to high blood pressure "Men who frequently take over-the-counter pain relievers have higher blood pressure than those who don't, a new study shows."

Risk of cardiovascular events in patients receiving celecoxib: a meta-analysis of randomized clinical trials. (Am J Cardiol. 2007) "In conclusion, these analyses failed to demonstrate an increased CV risk with celecoxib relative to placebo and demonstrated a comparable rate of CV events with celecoxib treatment compared with nonselective NSAIDs."

Drugs

Oral morphine for cancer pain. (Cochrane Database Syst Rev. 2007)

Methadone for cancer pain. (Cochrane Database Syst Rev. 2007)

Antidepressants for neuropathic pain. (Cochrane Database Syst Rev. 2007)

When it comes to opiates, just say NO. (J Clin Invest. 2007)

Medication errors with opioids: results from a national reporting system. (J Opioid Manag. 2007)

[Opioids for chronic pain patients. What are the consequences of following the Nordic recommendations?] (Ugeskr Laeger. 2007)

Buprenorphine--a review of its role in neuropathic pain. (J Opioid Manag. 2007)

Oral morphine for cancer pain. (Cochrane Database Syst Rev. 2007)

Methadone for cancer pain. (Cochrane Database Syst Rev. 2007)

Opioids May Be Useful for Chronic Noncancer Pain Management in Primary Care

Effectiveness of oxycodone, ibuprofen, or the combination in the initial management of orthopedic injury-related pain in children. (Pediatr Emerg Care. 2007)

Survey of intrathecal opioid usage in the UK. (Eur J Anaesthesiol. 2007) "CONCLUSIONS: The use of low-dose lipophilic intrathecal opioids for postoperative analgesia is widespread in the UK. Patients are commonly nursed in low-dependency post-anaesthetic care areas. The low incidence of adverse events reported by the respondents along with the popularity of the technique suggests that low-dose spinal opioid administration is safe."

Intrathecal opioids for intractable pain syndromes. (Acta Neurochir Suppl. 2007) "For more than 20 years intrathecal opioid application with implantable pumps is an option for selected patients with malignant as well as non-malignant pain. In general, most types of pain should be treatable by opioid medication. However, the associated systemic side-effects such as nausea, vomiting, constipation or the risk of suppression of the central nervous system hinder the application of oral or intravenous opioid therapy as a sole, widely applicable treatment. Causes of non-malignant pain that may represent an indication for intrathecal drug-delivery systems include: failed back syndrome, neuropathic pain, axial spinal pain, complex regional pain syndrome, diffuse pain, brachial plexitis, central pain, failed spinal cord stimulation (SCS) therapy, arachnoiditis, poststroke pain, spinal cord injury pain and peripheral neuropathy."

Oxycodone: a pharmacological and clinical review. (Clin Transl Oncol. 2007)

OxyContin maker misled on addiction risks "Purdue learned from focus groups with physicians in 1995 that doctors were worried about the abuse potential of OxyContin. The company then gave false information to its sales representatives that the drug had less potential for addiction and abuse than other painkillers, the U.S. attorney said."

FDA Announces Results of Investigation Into Illegal Promotion of OxyContin by The Purdue Frederick Company, Inc.: Company Misrepresented Prescription Pain Reliever to Health Care Professionals "The U.S. Food and Drug Administration's (FDA) Office of Criminal Investigations (OCI) announced today that The Purdue Frederick Company, Inc. has agreed to pay more than $700 million to resolve criminal charges and civil liabilities in connection with several illegal schemes to promote, market and sell OxyContin, a powerful prescription pain reliever that the company produces. An investigation by OCI uncovered an extensive, long-term conspiracy by The Purdue Frederick Company, Inc. to generate the maximum amount of revenues possible from the sale of OxyContin through various illegal schemes. To further this goal, Purdue trained its sales representatives to make false representations to health care providers about the difficulty of extracting oxycodone, the active ingredient, from the OxyContin tablet; trained its sales force to represent to health care providers that OxyContin did not cause euphoria and was less addictive than immediate-release opiates; and allowed health care providers to entertain the erroneous belief that OxyContin was less addictive than morphine."

Tailoring Chronic Pain Treatment to the Patient: Long-Acting, Short-Acting, and Rapid-Onset Opioids (Medscape Neurology & Neurosurgery. 2007) "Pain is the most common reason individuals seek medical assistance in the United States. … Although acute pain is considered pain of relatively brief or short duration and may be considered biologically useful as a symptom of a disease or injury, chronic pain -- often described as pain beyond the time of normal healing or pain that persists beyond 3 months -- is considered maladaptive and serving no useful biological function. Examples of common chronic pain syndromes include osteoarthritis, low back pain, headache, cancer-related pain, and neuropathic pain."

Opioid and Nonopioid Therapies for the Management of Pain "Because some patients fail to achieve a good outcome with opioid therapy, nonopioid medications and interventions are receiving greater research attention. Opioids are also the subject of new exploration, most of this directed toward separating desired analgesia from unwanted side effects such as euphoria, tolerance, abuse risk, and constipation."

Exercise

Stretching exercises vs manual therapy in treatment of chronic neck pain: a randomized, controlled cross-over trial. (J Rehabil Med. 2007) "CONCLUSION: Both stretching exercise and manual therapy considerably decreased neck pain and disability in women with non-specific neck pain. The difference in effectiveness between the 2 treatments was minor. Low-cost stretching exercises can be recommended in the first instance as an appropriate therapy intervention to relieve pain, at least in the short-term."

General Information

Patient-controlled analgesia: patient and nurse satisfaction with intravenous delivery systems and expected satisfaction with transdermal delivery systems. (Curr Med Res Opin. 2007)

[Cancer pain management : Basic therapy and treatment of breakthrough pain.] (Schmerz. 2007)

Managing the Symptoms of Neuropathic Pain: An Exploration of Patients' Experiences. (J Pain Symptom Manage. 2007) "The most common management strategy was the use of conventional medications, often associated with poor effectiveness and unpleasant side effects. Complementary and alternative medicine was ineffective, but many found resting or retreating helpful. They exhibited a repeated cycle of seeking help to manage the pain, with each unsuccessful attempt followed by new attempts. Some had tried to accept their pain, but there was insufficient psychological, social, emotional, and practical support to allow them to do this successfully."

Principles of Pain Management in the Elderly

Managing Central Pain Syndromes "Central pain is defined as pain associated with lesions of the central nervous system that lead to damage of somatosensory pathways.1 It is considered to be one of the most distressing forms of chronic pain and can be intractable in many patients. Central pain can be nociceptive and/or neuropathic in nature and can be precipitated by trauma, stroke, multiple sclerosis, or compression of cranial nerves."

Challenges in acute post-operative pain management. (Am J Health Syst Pharm. 2007)

Management of chronic spinal pain. (Pain Physician 2007)

Guidelines

NGC - Interventional techniques: evidence-based practice guidelines in the management of chronic spinal pain. (2007)

NGC - Assessment and management of chronic pain. (2007)

Guideline Use Improves Pain Control in Emergency Department "Implementation of the guidelines was associated with greater use of morphine and at higher doses. In addition, use of NSAIDs and acetaminophen increased."

NGC - Acute pain management in older adults. (2006)

Immunotherapy

Internet Sites

Treatment Information

DrugBank (drug structure)

FDA - MedWatch (Drug Alerts)

Drug-Food-Supplement Information

Drug Information Online

Drug Interaction Checker

DrugDigest (drug interactions)

FDA - Drug Interactions: What You Should Know

NIH - Botanical Dietary Supplements: Background Information

NIH - Drug, Supplements, and Herbal Information

NIH - Herbal Supplements: Consider Safety, Too

NIH - Medicines

NIH - Vitamin and Mineral Supplement Fact Sheets

Nutrition

Other

Other Treatments

Acupuncture in pain management (Continuing Education in Anaesthesia, Critical Care & Pain 2007)

Naprapathic Manual Therapy or Evidence-based Care for Back and Neck Pain: A Randomized, Controlled Trial. (Clinical Journal of Pain 2007)

Effectiveness of Massage Therapy for Chronic, Non-malignant Pain: A Review (eCAM 2007)

Peripheral nerve stimulation for the treatment of chronic pain. ( Clin Neurosci. 2007)

Spinal cord stimulation: indications and outcomes (Neurosurgical Focus 2007)

Deep brain stimulation for the treatment of various chronic pain syndromes (Neurosurgical Focus 2007)

Radiotherapy

Supplements-Vitamins-CAM

Acetyl-L-carnitine in neuropathic pain: experimental data. (CNS Drugs. 2007)

Can vitamin C prevent complex regional pain syndrome in patients with wrist fractures? A randomized, controlled, multicenter dose-response study. (J Bone Joint Surg Am. 2007) "CONCLUSIONS: Vitamin C reduces the prevalence of complex regional pain syndrome after wrist fractures. A daily dose of 500 mg for fifty days is recommended. LEVEL OF EVIDENCE: Therapeutic Level I."

The use of CAM and conventional treatment among primary care consulters with chronic musculoskeletal pain. (BMC Fam Pract. 2007) "Glucosamine and fish oil were the most commonly used CAM treatments (38%, 35% respectively). Most CAM treatments were scored on average as being helpful, and users indicated that they intended to use again 87% of the CAM treatments they had already used. CONCLUSION: We provide direct evidence that most primary care consulters with chronic musculoskeletal pain have used CAM in the previous year, usually in combination with conventional treatments. The high prevalence and wide range of users experiences of benefit and harm from CAM strengthen the argument for more research into this type of medicine to quantify benefit and assess safety."

The use of CAM and conventional treatment among primary care consulters with chronic musculoskeletal pain. (BMC Fam Pract. 2007)

Surgery

Transplantation

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