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Pain management in severe chronic pain

Shannon Kelly, Keith Quirolo, Anne Marsh, Lynne Neumayr, Alicia Garcia, Brian Custer
BACKGROUND: Chronic red blood cell (RBC) transfusion therapy (CTT) is an integral component of the management of severe sickle cell disease (SCD) and can prevent complications, such as stroke. RBC units can be administered via simple transfusion or exchange transfusion, and erythrocytapheresis (automated RBC exchange transfusion [aRBX]), is increasingly used for CTT. Comparisons of simple and aRBX transfusions are limited, and the current scope of aRBX use is not known. STUDY DESIGN AND METHODS: We administered a survey to define current transfusion practices for CTT and performed a review of the erythrocytapheresis literature...
October 19, 2016: Transfusion
Hamid Reza Bahrami, Shokouhsadat Hamedi, Roshanak Salari, Mohammadreza Noras
Irritable Bowel Syndrome (IBS) is a chronic digestive disorder, which is characterized by abdominal pain, bloating, diarrhea and constipation periods. The etiology is unknown. Based on the different mechanisms in the etiology, treatment focuses on controlling symptoms. Due to the longtime of syndrome, inadequacy of current treatments, financial burden for patients and pharmacologic effects, several patients have turned to the use of complementary and alternative medicine (CAM). Complementary and alternative treatments for IBS include hypnosis, acupuncture, cognitive behavior therapy, yoga, and herbal medicine...
August 2016: Electronic Physician
So Young Joo, Yoon Soo Cho, Sung-Rae Cho, Dohern Kym, Cheong Hoon Seo
PURPOSE: Pain Scrambler therapy is a patient-specific electrocutaneous nerve stimulation device. Burn pruritus is a common form of chronic and disabling neuropathic pain that is often difficult to treat effectively. Pruritus is mediated by histamines, which are effector molecules stored in mast cells and released locally during injury or inflammation. Burn pruritus may be accompanied by peripheral neuropathic pain, which may result from injury to sensory nerves that hampers conductance of neuronal messages along the large A and small C afferent fibers to the spinal cord...
October 15, 2016: Burns: Journal of the International Society for Burn Injuries
Sonja U Kubik, Paul R Martin
OBJECTIVE: The purpose of this study was to evaluate the psychometric properties of the newly developed Headache Triggers Sensitivity and Avoidance Questionnaire (HTSAQ) designed to measure variables relating to the Trigger Avoidance Model of Headaches. BACKGROUND: The Trigger Avoidance Model of Headaches proposes that one pathway to developing a primary headache disorder is through the avoidance of headache triggers, resulting in an increase in trigger potency through sensitization...
October 18, 2016: Headache
Pranav Gupta, Virendra Singh, Sujata Sethi, Arun Kumar
AIM: To compare the efficacy of combined local anesthetic injection with 0.5 % bupivacaine and levosulpiride versus local anesthetic injection alone on outcome measures including levels of pain intensity and depression in the management of myofascial pain syndrome in orofacial region. PATIENTS AND METHODS: This was a prospective, randomized, controlled and open-label comparative clinical study. Seventy-four patients diagnosed to have myofascial pain syndrome and fulfilling the inclusion criteria were enrolled for the study...
September 2016: Journal of Maxillofacial and Oral Surgery
K Ye, X Lu, W Li, M Yin, X Liu, J Qin, G Liu, M Jiang
OBJECTIVE: To evaluate the technical aspects and short-term clinical results of stent placement for chronic occlusion of a filter-bearing inferior vena cava (IVC) in patients with severe post-thrombotic syndrome (PTS). METHODS: A retrospective analysis of 24 patients with severe PTS associated with occlusion of a filter-bearing IVC treated by stent placement was conducted at a single institution from January 2010 to December 2014. Patient-reported quality of life and limb Villalta scores were evaluated before and after treatment by questionnaire and clinical examination, respectively...
October 14, 2016: European Journal of Vascular and Endovascular Surgery
Gareth T Jones, Elizabeth A Jones, Marcus J Beasley, Gary J Macfarlane
The generalisability of randomised controlled trials will be compromised if markers of treatment outcome also affect trial recruitment. In a large trial of chronic widespread pain (CWP), we aimed to determine the extent to which randomised participants represented eligible patients, and whether factors predicting randomisation also influenced trial outcome. Adults from eight UK general practices were surveyed to determine eligibility for a trial of two interventions (exercise, and cognitive behavioural therapy (CBT))...
September 29, 2016: Pain
Anne M Boonstra, Roy E Stewart, Albère J A Köke, René F A Oosterwijk, Jeannette L Swaan, Karlein M G Schreurs, Henrica R Schiphorst Preuper
Objectives: The 0-10 Numeric Rating Scale (NRS) is often used in pain management. The aims of our study were to determine the cut-off points for mild, moderate, and severe pain in terms of pain-related interference with functioning in patients with chronic musculoskeletal pain, to measure the variability of the optimal cut-off points, and to determine the influence of patients' catastrophizing and their sex on these cut-off points. Methods: 2854 patients were included. Pain was assessed by the NRS, functioning by the Pain Disability Index (PDI) and catastrophizing by the Pain Catastrophizing Scale (PCS)...
2016: Frontiers in Psychology
Jennifer Greene Naples, Walid F Gellad, Joseph T Hanlon
When possible, chronic noncancer pain (CNCP) in older adults should be managed by nonpharmacologic modalities in conjunction with nonopioid analgesics. If moderate-to-severe pain persists despite these approaches, however, nonparenteral opioids may be considered as adjunctive therapy. This article reviews the epidemiology of opioid use and their effectiveness for CNCP in older adults and summarizes important age-related changes in opioid pharmacokinetics and pharmacodynamics that increase the risks of adverse effects in the elderly...
November 2016: Clinics in Geriatric Medicine
Zachary A Marcum, Nakia A Duncan, Una E Makris
Pharmacologic management of chronic pain in older adults is one component of the multimodal, interdisciplinary management of this complex condition. In this article, we summarize several of the key barriers to effective pharmacologic management in older adults and review the existing (albeit limited) evidence for its effectiveness and safety, especially in a medically complex population with multimorbidity. This review covers topical formulations, acetaminophen, oral nonsteroidal antiinflammatory drugs, and adjuvant therapies...
November 2016: Clinics in Geriatric Medicine
Dae Wook Lee, Chang Hun Lim, Jae Young Han, Woong Mo Kim
Chronic pelvic pain in women is a very annoying condition that is responsible for substantial suffering and medical expense. But dealing with this pain can be tough, because there are numerous possible causes for the pelvic pain such as urologic, gynecologic, gastrointestinal, neurologic, or musculoskeletal problems. Of these, musculoskeletal problem may be a primary cause of chronic pelvic pain in patients with a preceding trauma to the low back, pelvis, or lower extremities. Here, we report the case of a 54-year-old female patient with severe chronic pelvic pain after a transcutaneous electrical nerve stimulation (TENS) accident that was successfully managed with image-guided trigger point injections on several pelvic stabilizing muscles...
October 2016: Korean Journal of Pain
Yaron Haviv, Avraham Zini, Yoni Etzioni, Valeri Klitinich, Alex Dobriyan, Yair Sharav, Rafael Benoliel, Galit Almoznino
OBJECTIVE: To identify patient and pain characteristics associated with negative impacts on daily life among patients with chronic orofacial pain (COFP). STUDY DESIGN: Medical records of 200 COFP patients were analyzed. RESULTS: Diagnostic categories included temporomandibular disorders (85; 42.7%), headaches (47; 23.6%), neuropathic pain (37; 18.5%), trigeminal neuralgia (16; 8.0%), and painful posttraumatic trigeminal neuropathy (PTTN) (14; 7...
August 27, 2016: Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology
Mesut Mutluoglu, Gunalp Uzun, Michael Bennett, Peter Germonpré, David Smart, Daniel Mathieu
Diabetic foot ulcers (DFUs) are one of the most common indications for hyperbaric oxygen treatment (HBOT). The role of HBOT in DFUs is often debated. Recent evidence based guidelines, while recommending its use, urge further studies to identify the patient subgroups most likely to benefit from HBOT. A recent study in Diabetes Care aimed to assess the efficacy of HBOT in reducing the need for major amputation and improving wound healing in patients with chronic DFUs. In this study, patients with Wagner grade 2-4 diabetic foot lesions were randomly assigned to have HBOT (30 sessions/90 min/244 kPa) or sham treatment (30 sessions/90 min/air/125 kPa)...
September 2016: Diving and Hyperbaric Medicine: the Journal of the South Pacific Underwater Medicine Society
Sohita Dhillon
Hydrocodone bitartrate extended-release (Hysingla(®) ER; referred to hereafter as hydrocodone ER) was the first single-entity hydrocodone formulation recognized by the US FDA as having abuse-deterrent properties. It is indicated for the management of pain severe enough to require daily, around-the-clock, long-term opioid treatment and for which alternative treatment options are inadequate. Once-daily oral hydrocodone ER provides consistent plasma hydrocodone concentrations and sustained analgesia over the 24-h dosing interval...
November 2016: Clinical Drug Investigation
Kehua Zhou, Peng Jia
Depression slows wound healing in patients with chronic wounds. The prevalence of depressive symptoms differs in the literature and the current understandings of factors related to depression in patients with wounds have been limited. To investigate the prevalence of depressive symptoms and the associated factors in patients with wounds, we performed this retrospective study in which depressive symptoms were evaluated with the Patient Health Questionnaire 9-item (PHQ-9). Valid PHQ-9 scores were collected from 222 patients (112 males and 110 females; age: 64...
September 26, 2016: Wound Repair and Regeneration
Adil E Bharucha, Tae Hee Lee
Although pelvic pain is a symptom of several structural anorectal and pelvic disorders (eg, anal fissure, endometriosis, and pelvic inflammatory disease), this comprehensive review will focus on the 3 most common nonstructural, or functional, disorders associated with pelvic pain: functional anorectal pain (ie, levator ani syndrome, unspecified anorectal pain, and proctalgia fugax), interstitial cystitis/bladder pain syndrome, and chronic prostatitis/chronic pelvic pain syndrome. The first 2 conditions occur in both sexes, while the latter occurs only in men...
October 2016: Mayo Clinic Proceedings
Miguel Manzur, Sukgu M Han, Joie Dunn, Ramsey S Elsayed, Fernando Fleischman, Yolee Casagrande, Fred A Weaver
OBJECTIVE: The objective of this study was to describe the outcomes of patients with acute aortic syndrome (AAS) during and after transfer to a regional aortic center by a rapid transport system. METHODS: Review of patients with AAS who were transferred by a rapid transport system to a regional aortic center was performed. Data regarding demographics, diagnosis, comorbidities, transportation, and hospital course were acquired. Severity of existing comorbidities was determined by the Society for Vascular Surgery Comorbidity Severity Score (SVSCSS)...
October 1, 2016: Journal of Vascular Surgery
Benjamin D Elder, Timothy F Witham
Low back pain is highly prevalent, affecting a vast majority of the adult population at some point in their lifetime. Thorough history and physical examination is critically important in evaluating these patients and screening for potentially serious conditions. Imaging should be guided by the history and physical examination, particularly when there is concern for serious conditions and/or a focal neurological deficit present. Adequate treatment of patients with low back pain often requires a multidisciplinary approach, involving several medical specialties...
October 2016: Seminars in Neurology
Cornelius Kürten, Mladen Tzvetkov, Volker Ellenrieder, Harald Schwörer
History and clinical findings | We report about a 79 year old non-diabetic patient who was admitted to the emergency room with severe hypoglycemia (blood glucose level: 36 mg / dl and Glasgow Coma Scale Score: 3). After the infusion of G40 % her blood glucose level stabilised. The patient reported to have taken 50 mg of Tramadol during the night to treat her headache. Investigations and diagnosis | No other differential diagnosis for hypoglycemia (i.e. diabetes, insulinoma, severe liver or kidney disease) could be established...
September 2016: Deutsche Medizinische Wochenschrift
Wei-Wei Chen, Xia Zhang, Wen-Juan Huang
Pain and anxiety are the most common neurological responses to many harmful or noxious stimuli and their management clinically is often challenging. Many of the frequently used morphine-based drugs, non-steroid anti-inflammatory drugs and acetaminophen, while efficient for treating pain, lead to patients suffering from several unwanted side effects. Melatonin, produced from the pineal body is a hormone of darkness, is involved in the control of circadian rhythms, and exerts a number of pharmacological effects...
October 2016: Experimental and Therapeutic Medicine
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