Pain Management
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Notes
The 2012 Treatment Guidelines section will contain the most recent published guidelines.
Pain Management
Daily Treatment Report
Cognitive Therapy-CBT-Psychotherapy
Cognitive behavior therapy, exercise, or both for treating chronic widespread pain. (Arch Intern Med. 2012)
Device Therapy
Drug Side-Effects and Interactions
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
Effects of strength vs aerobic exercise on pain severity in adults with fibromyalgia: A randomized equivalence trial. (Pain. 2012)
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
Pain management for inflammatory arthritis (rheumatoid arthritis, psoriatic arthritis, ankylosing spondylitis and other spondylarthritis) and gastrointestinal or liver comorbidity. (Cochrane Database Syst Rev. 2012)
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 - 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
Drug-Food-Supplement Information
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 - Vitamin and Mineral Supplement Fact Sheets
Nutrition
Other
Other Treatments
Acupuncture in pain management (Continuing Education in Anaesthesia, Critical Care & Pain 2008)
Naprapathic Manual Therapy or Evidence-based Care for Back and Neck Pain: A Randomized, Controlled Trial. (Clinical Journal of Pain 2008)
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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