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Persistent chronic pain

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https://www.readbyqxmd.com/read/28226332/responsible-safe-and-effective-prescription-of-opioids-for-chronic-non-cancer-pain-american-society-of-interventional-pain-physicians-asipp-guidelines
#1
Laxmaiah Manchikanti, Adam M Kaye, Nebojsa Nick Knezevic, Heath McAnally, Konstantin Slavin, Andrea M Trescot, Susan Blank, Vidyasagar Pampati, Salahadin Abdi, Jay S Grider, Alan D Kaye, Kavita N Manchikanti, Harold Cordner, Christopher G Gharibo, Michael E Harned, Sheri L Albers, Sairam Atluri, Steve M Aydin, Sanjay Bakshi, Robert L Barkin, Ramsin M Benyamin, Mark V Boswell, Ricardo M Buenaventura, Aaron K Calodney, David L Cedeno, Sukdeb Datta, Timothy R Deer, Bert Fellows, Vincent Galan, Vahid Grami, Hans Hansen, Standiford Helm Ii, Rafael Justiz, Dhanalakshmi Koyyalagunta, Yogesh Malla, Annu Navani, Kent H Nouri, Ramarao Pasupuleti, Nalini Sehgal, Sanford M Silverman, Thomas T Simopoulos, Vijay Singh, Daneshvari R Solanki, Peter S Staats, Ricardo Vallejo, Bradley W Wargo, Arthur Watanabe, Joshua A Hirsch
BACKGROUND: Opioid use, abuse, and adverse consequences, including death, have escalated at an alarming rate since the 1990s. In an attempt to control opioid abuse, numerous regulations and guidelines for responsible opioid prescribing have been developed by various organizations. However, the US opioid epidemic is continuing and drug dose deaths tripled during 1999 to 2015. Recent data show a continuing increase in deaths due to natural and semisynthetic opioids, a decline in methadone deaths, and an explosive increase in the rates of deaths involving other opioids, specifically heroin and illicit synthetic fentanyl...
February 2017: Pain Physician
https://www.readbyqxmd.com/read/28224474/pain-severity-and-pharmacologic-pain-management-among-community-living-older-adults-the-mobilize-boston-study
#2
Ampicha Nawai, Suzanne G Leveille, Robert H Shmerling, Guusje van der Leeuw, Jonathan F Bean
BACKGROUND: Concerns about polypharmacy and medication side effects contribute to undertreatment of geriatric pain. This study examines use and effects of pharmacologic treatment for persistent pain in older adults. METHODS: The MOBILIZE Boston Study included 765 adults aged ≥70 years, living in the Boston area, recruited from 2005 to 2008. We studied 599 participants who reported chronic pain at baseline. Pain severity, measured using the Brief Pain Inventory (BPI) severity subscale, was grouped as very mild (BPI <2), mild (BPI 2-3...
February 21, 2017: Aging Clinical and Experimental Research
https://www.readbyqxmd.com/read/28224075/endoscopic-trochanteric-bursectomy-and-iliotibial-band-release-for-persistent-trochanteric-bursitis
#3
Justin J Mitchell, Jorge Chahla, Alexander R Vap, Travis J Menge, Eduardo Soares, Jonathan M Frank, Chase S Dean, Marc J Philippon
Lateral hip pain associated with trochanteric bursitis is a common orthopedic condition, and can be debilitating in chronic or recalcitrant situations. Conservative management is the most common initial treatment and often results in resolution of symptoms and improved patient outcomes. These modalities include rest, activity modification, physical therapy, anti-inflammatory medication, or corticosteroid injections. However, there is a subset of patients in which symptoms persist despite exhaustive conservative modalities...
October 2016: Arthroscopy Techniques
https://www.readbyqxmd.com/read/28223844/neuronal-plasticity-of-trigeminal-ganglia-in-mice-following-nerve-injury
#4
Randi Lynds, Chuang Lyu, Gong-Wei Lyu, Xie-Qi Shi, Annika Rosén, Kamal Mustafa, Tie-Jun Sten Shi
BACKGROUND: Nerve injury may induce neuropathic pain. In studying the mechanisms of orofacial neuropathic pain, attention has been paid to the plastic changes that occur in the trigeminal ganglia (TGs) and nucleus in response to an injury of the trigeminal nerve branches. Previous studies have explored the impact of sciatic nerve injury on dorsal root ganglia (DRGs) and it has shown dramatic changes in the expression of multiple biomarkers. In large, the changes in biomarker expression in TGs after trigeminal nerve injury are similar to that in DRGs after sciatic nerve injury...
2017: Journal of Pain Research
https://www.readbyqxmd.com/read/28217424/joint-mobilization-in-the-management-of-persistent-insertional-achilles-tendinopathy-a-case-report
#5
Dhinu J Jayaseelan, Andrew A Post, John J Mischke, Josiah D Sault
BACKGROUND & PURPOSE: Insertional Achilles tendinopathy (IAT) can be a challenging condition to manage conservatively. Eccentric exercise is commonly used in the management of chronic tendinopathy; however, it may not be as helpful for insertional tendon problems as compared to mid-portion dysfunction. While current evidence describing the physical therapy management of IAT is developing, gaps still exist in descriptions of best practice. The purpose of this case report is to describe the management of a patient with persistent IAT utilizing impairment-based joint mobilization, self-mobilization, and exercise...
February 2017: International Journal of Sports Physical Therapy
https://www.readbyqxmd.com/read/28215611/effectiveness-of-prolotherapy-in-the-treatment-of-chronic-rotator-cuff-lesions
#6
Mehmet Murat Seven, Omer Ersen, Serkan Akpancar, Huseyin Ozkan, Selim Turkkan, Yavuz Yıldız, Kenan Koca
BACKGROUND: Rotator cuff lesions are one of the major causes of shoulder pain and dysfunction. Numerous non-surgical treatment modalities have been described for chronic rotator cuff lesions, but the debate continues over the optimal procedure. The aim of this report is to present the results of prolotherapy in the treatment of chronic refractory rotator cuff lesions. HYPOTHESIS: Dextrose prolotherapy will reduce pain and improve shoulder function and patient satisfaction...
February 16, 2017: Orthopaedics & Traumatology, Surgery & Research: OTSR
https://www.readbyqxmd.com/read/28213817/breakthrough-cancer-pain-and-rational-drug-use
#7
Juan Manuel Núñez Olarte
Recent data indicate that there are large disparities in the use of opioid analgesics to control breakthrough cancer pain (BTcP) in Europe and worldwide. While it is clear that affordability is a key factor, it is certainly not the only one, and other factors, such as cultural differences and overall awareness, are undoubtedly responsible. More work remains to be done to overcome barriers in the use of these medications when warranted. When prescribing a medication for BTcP, it must be considered that its time profile is different from chronic persistent pain...
February 18, 2017: Supportive Care in Cancer: Official Journal of the Multinational Association of Supportive Care in Cancer
https://www.readbyqxmd.com/read/28212666/classical-hodgkin-lymphoma-masquerading-as-chronic-recurrent-multifocal-osteomyelitis-a-case-report
#8
Michael Pham, Steven Ressler, Allison Rosenthal, Katalin Kelemen
BACKGROUND: Hodgkin lymphoma is a hematologic malignancy usually confined to lymphatic structures and commonly associated with constitutional symptoms. Bony involvement and musculoskeletal symptoms are uncommon and typically seen in advanced disease. In this case, we report an unusual presentation of classical Hodgkin lymphoma and highlight diagnostic challenges leading to the misdiagnosis and treatment as chronic recurrent multifocal osteomyelitis. CASE PRESENTATION: A 38-year-old white man presented with lower extremity musculoskeletal pain...
February 18, 2017: Journal of Medical Case Reports
https://www.readbyqxmd.com/read/28212183/cxcl12-cxcr4-signaling-contributes-to-the-pathogenesis-of-opioid-tolerance-a-translational-study
#9
Chih-Peng Lin, Kai-Hsiang Kang, Huang-Ju Tu, Ming-Yueh Wu, Tzu-Hung Lin, Houng-Chi Liou, Wei-Zen Sun, Wen-Mei Fu
BACKGROUND: Long-term opioid therapy for chronic pain may lead to analgesic tolerance, especially when administered intrathecally, thus preventing adequate pain relief. Discovering drug targets to treat opioid tolerance using a mechanism-based approach targeting opioid-induced neuroinflammation provides new therapeutic opportunities. In this study, we provide translational evidence that CXCL12/CXCR4 signaling contributes to the pathogenesis of opioid tolerance. METHODS: The CXCL12 levels in the cerebrospinal fluid of opioid-tolerant patients were compared with those of opioid-naive subjects...
March 2017: Anesthesia and Analgesia
https://www.readbyqxmd.com/read/28207662/expression-of-mirna-124a-in-cd4-cells-reflects-response-to-a-multidisciplinary-treatment-program-in-patients-with-chronic-low-back-pain
#10
Benjamin Luchting, Jens Heyn, Ludwig Christian Hinske, Shahnaz Christina Azad
STUDY DESIGN: A prospective evaluation of microRNA (miRNA) expression in patients with chronic low back pain (CLBP). OBJECTIVE: The aim of this study was to evaluate whether pain- and T cell-related miRNAs are differentially expressed in CLBP when compared with healthy volunteers and whether these miRNAs may distinguish between responders and nonresponders to a multidisciplinary treatment program. SUMMARY OF BACKGROUND DATA: CLBP is a common health problem worldwide...
February 15, 2017: Spine
https://www.readbyqxmd.com/read/28201840/clinical-response-to-dorsal-duct-drainage-via-the-minor-papilla-in-refractory-obstructing-chronic-calcific-pancreatitis
#11
Chang-Il Kwon, Mark A Gromski, Stuart Sherman, Ihab I El Hajj, Jeffrey J Easler, James Watkins, Lee McHenry, Glen A Lehman, Evan L Fogel
Background and study aims Complete stone removal from the main pancreatic duct might not be achieved in all patients with obstructive chronic calcific pancreatitis. We report our results for endoscopic dorsal pancreatic duct (DPD) bypass of obstructing stones in the ventral pancreatic duct (VPD). Patients and methods 16 patients with obstructive chronic calcific pancreatitis were treated with a DPD bypass. Clinical success was defined as significant pain relief and no hospital admissions for pain management during the ongoing treatment period...
February 15, 2017: Endoscopy
https://www.readbyqxmd.com/read/28197545/active-nerve-regeneration-with-failed-target-reinnervation-drives-persistent-neuropathic-pain
#12
Wenrui Xie, Judith A Strong, Jun-Ming Zhang
Peripheral nerves can regenerate and, when injured, may cause neuropathic pain. We propose that the active regeneration process plays a pivotal role in the maintenance of neuropathic pain. In one commonly used rodent neuropathic pain model, pronounced pain behaviors follow ligation and cutting of the L5 spinal nerve. We found that the injured nerve regenerates into the sciatic nerve and functionally reinnervates target tissues: the regenerated nerve conducts electrical signals, mechanical responses, and tracers between the leg/hindpaw and axotomized sensory ganglion...
January 2017: ENeuro
https://www.readbyqxmd.com/read/28197544/plasticity-in-brainstem-mechanisms-of-pain-modulation-by-nicotinic-acetylcholine-receptors-in-the-rat
#13
Francis J Jareczek, Stephanie R White, Donna L Hammond
Individuals with chronic pain may be driven to smoke more because the analgesic efficacy of nicotine diminishes. To determine whether persistent pain diminishes the actions of a nicotinic acetylcholine receptor (nAChR) agonist in pain modulatory pathways, we examined the effects of epibatidine in the rostral ventromedial medulla (RVM) of rats with and without inflammatory injury induced by intraplantar injection of complete Freund's adjuvant (CFA). In uninjured rats, epibatidine produced a dose-dependent antinociception that was completely blocked by dihydro-β-erythroidine (DHβE; α4β2 antagonist) and partially blocked by methyllycaconitine (MLA; α7 antagonist)...
January 2017: ENeuro
https://www.readbyqxmd.com/read/28194709/high-survivorship-and-little-osteoarthritis-at-10-year-followup-in-scfe-patients-treated-with-a-modified-dunn-procedure
#14
Kai Ziebarth, Milan Milosevic, Till D Lerch, Simon D Steppacher, Theddy Slongo, Klaus A Siebenrock
BACKGROUND: The modified Dunn procedure has the potential to restore the anatomy in hips with slipped capital femoral epiphyses (SCFE) while protecting the blood supply to the femoral head and minimizing secondary impingement deformities. However, there is controversy about the risks associated with the procedure and mid- to long-term data on clinical outcomes, reoperations, and complications are sparse. QUESTIONS/PURPOSES: Among patients treated with a modified Dunn procedure for SCFE, we report on (1) hip pain and function as measured by the Merle d'Aubigné and Postel score, Drehmann sign, anterior impingement test, limp, and ROM; (2) the cumulative survivorship at minimum 10-year followup with endpoints of osteoarthritis (OA) progression (at least one Tönnis grade), subsequent THA, or a Merle d'Aubigné and Postel score < 15; (3) radiographic anatomy of the proximal femur measured by slip angle, α angle, Klein line, and sphericity index; and (4) the risk of subsequent surgery and complications...
February 13, 2017: Clinical Orthopaedics and related Research
https://www.readbyqxmd.com/read/28185925/modest-amounts-of-voluntary-exercise-reduce-pain-and-stress-related-outcomes-in-a-rat-model-of-persistent-hind-limb-inflammation
#15
M H Pitcher, F Tarum, I Z Rauf, L A Low, M C Bushnell
: Aerobic exercise improves outcomes in a variety of chronic health conditions, yet the support for exercise-induced effects on chronic pain in humans is mixed. While many rodent studies have examined the effects of exercise on persistent hypersensitivity, the vast majority employed forced exercise paradigms that are known to be highly stressful. Since stress can also produce analgesic effects, we studied how voluntary exercise, known to reduce stress in healthy subjects, alters hypersensitivity, stress and swelling in a rat model of persistent hind paw inflammation...
February 6, 2017: Journal of Pain: Official Journal of the American Pain Society
https://www.readbyqxmd.com/read/28185371/do-depression-and-anxiety-profiles-over-time-predict-persistent-post-surgical-pain-a-study-in-cardiac-surgery-patients
#16
M Gabrielle Pagé, J Watt-Watson, M Choinière
BACKGROUND: Rates of depression and anxiety in cardiac surgery patients are higher than in the general population. The development of persistent post-surgical pain (PPSP) in this population is also concerning. The objectives of this study were to (1) identify anxiety and depression trajectories of cardiac surgery patients over a 2-year period; (2) examine demographic and clinical characteristics associated with trajectory memberships and (3) determine if anxiety and/or depression trajectories predict PPSP...
February 10, 2017: European Journal of Pain: EJP
https://www.readbyqxmd.com/read/28183561/audit-of-postoperative-pain-management-after-open-thoracotomy-and-the-incidence-of-chronic-postthoracotomy-pain-in-more-than-500-patients-at-a-tertiary-center
#17
G Niraj, A Kelkar, Vipul Kaushik, Yee Tang, Danny Fleet, Frances Tait, Theresa Mcmillan, Sridhar Rathinam
STUDY OBJECTIVE: To evaluate the quality of postoperative pain relief during the first 3 days after surgery and to evaluate with the incidence of persistent pain at 6 months after surgery. DESIGN: Retrospective single-center audit. SETTING: University hospital. PATIENTS: Five hundred four patients who underwent thoracotomy. INTERVENTIONS: Review of patient records, questionnaire, and telephone review...
February 2017: Journal of Clinical Anesthesia
https://www.readbyqxmd.com/read/28183230/arthroscopic-assisted-tendon-reconstruction-for-triangular-fibrocartilage-complex-irreparable-tears
#18
R Luchetti, A Atzei
We report our 11-year experience of performing arthroscopically assisted triangular fibrocartilage complex reconstruction in the treatment of chronic distal radio-ulnar joint instability resulting from irreparable triangular fibrocartilage complex injuries. Eleven patients were treated. Three skin incisions were made in order to create radial and ulna tunnels for passage of the tendon graft, which is used to reconstruct the dorsal and palmar radio-ulnar ligaments, under fluoroscopic and arthroscopic guidance...
February 1, 2017: Journal of Hand Surgery, European Volume
https://www.readbyqxmd.com/read/28176921/increased-local-expressions-of-cx3cl1-and-ccl2-are-related-to-clinical-severity-in-lumbar-disk-herniation-patients-with-sciatic-pain
#19
Zhen-Yu Peng, Rui Chen, Zuo-Zhong Fang, Bin Chen, Zhi-Hua Wang, Xi-Yang Wang
BACKGROUND: Chemokines have been identified to be involved in the modulation of pain through both peripheral and central mechanisms. However, the role of chemokines in lumbar disk herniation (LDH) with sciatic pain remains unknown. OBJECTIVE: The current study was performed to explore the expression of two most commonly studied chemokines CX3CL1 and CCL2 and assess their associations with clinical severity in LDH patients with sciatic pain. METHODS: The soft tissues around nerve root (STANR), annulus fibrosus (AF), and nucleus pulposus (NP) biopsies were obtained from 36 LDH patients with chronic sciatic pain and 10 scoliosis patients (painless controls)...
2017: Journal of Pain Research
https://www.readbyqxmd.com/read/28176463/severe-chronic-norovirus-diarrheal-disease-in-transplant-recipients-clinical-features-of-an-under-recognized-syndrome
#20
Robin K Avery, Bonnie E Lonze, Edward S Kraus, Kieren A Marr, Robert A Montgomery
BACKGROUND: Norovirus (NV) infection has been reported as a cause of severe chronic diarrhea in transplant recipients, but this entity remains under-recognized in clinical practice, leading to diagnostic delays. Transplant clinicians should become familiar with this syndrome in order to facilitate early detection and management. METHODS: Demographic, clinical, and outcomes variables were summarized from a series of transplant recipients with positive stool NV reverse transcription polymerase chain reaction (RT-PCR) assays at Johns Hopkins in 2013-2014...
February 7, 2017: Transplant Infectious Disease: An Official Journal of the Transplantation Society
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