Chronic Pain

Achieving safe, effective pain control for inpatients can challenge even experienced clinicians. Components of successful pain control include avoiding pain crises while still steering clear of respiratory depression, being confident with equianalgesic calculations, and transitioning to the outpatient setting.

Phase III study results show patients with chronic non-cancer pain and opioid-induced constipation (OIC) experienced improvements in spontaneous bowel movement frequency and other symptoms of OIC.

A literature review of randomized controlled trials and open-label studies of six months or longer duration finds good evidence that opioid therapy improves pain scores, with weaker evidence for its long-term effect on functional status.

Though the total National Institutes of Health (NIH) budget has stayed flat over the past several years, chronic pain research has enjoyed an expanded slice of the federal funding pie, as dollars committed to that portion of science grew from $279 million in 2008 to $396 million in 2012.

Results from a small study indicate patients with difficult-to-treat diabetic peripheral neuropathy (DPN) may benefit from therapy with tanezumab, a humanized monoclonal antibody against nerve growth factor.

Analysis of claims data finds patients often receive starting doses of Butrans that do not follow published recommendations, with more than one-third of patients receiving initial doses that are too low.

Declaring that the benefits of the original formulation of OxyContin no longer outweigh the risks of misuse and abuse, the FDA announced it would not approve any applications for non-tamper resistant formulations of the drug, a decision that could have far-reaching implications for all makers of opioid medications.

Understanding and addressing these disorders can improve the patient's mental health as well as their chronic pain and other comorbid conditions. Incorporating cognitive behavioral therapy and mindfulness-based cognitive therapy into the management of chronic pain has been shown to improve pain outcomes.

Successful CRPS management should be viewed as a continuum that requires a flexible treatment approach that incorporates pharmacologic and nonpharmacologic components.

Pain is a common side effect of cancer that can be caused by the disease itself, treatment, and other factors. Greater awareness of the causes and types of cancer pain, knowledge of available treatments, and willingness to consult pain specialists are the keys to providing effective cancer pain management.

Pain has been associated with a number of conditions, including addiction, depression, and anxiety. Greater awareness of concurrent comorbid conditions and the options available to treat them produces better outcomes in chronic pain patients.

Pain is a product of the brain and the experiences of pain can be shaped by mood, cognition, anxiety, fear, genetics, and other individual differences. Currently, pain is measured subjectively but an objective measure of pain may improve the diagnosis and management of patients with chronic pain.

New implantable technologies such as spinal cord stimulation and peripheral nerve stimulation have shown great potential to improve the management of patients with chronic pain.

Chronic pain is a difficult condition to diagnose and manage, especially since most diagnostic measures are subjective and treatment varies from patient to patient. A key to diagnosing and treating chronic pain is to have a strong understanding of the different diagnostic tools and treatment options available.

A poster session at the 2013 AAPM annual meeting highlighted research on the role of central sensitization in chronic pain, the use of microwave ablation to treat refractory pain in patients with soft tissue tumors, a possible treatment for opioid-induced hyperalgesia, and the psychosocial effects of opioid treatment in patients with sickle-cell anemia.

Trial design and other factors can conspire to produce false positive or false negative results, which complicates not only the search for more effective pain treatments but also the safe and effective use of pain medications in practice.

The authors of three award-winning posters shared results and insights at the 2013 AAPM Annual Meeting.

While digital medicine and neuromodulation have gathered enough clinical evidence to treat chronic pain, Timothy R. Deer, MD, president and CEO of St. Francis Hospital's Center for Pain Relief, in Charleston, WV, said regenerative therapies like platelet-rich plasma, stem cells and biologics are lagging years behind in the testing realm with a long road to go.

There are several tools and resources available to pain practitioners who want to use their patient data to conduct a clinical trial.

Promising advances in research hint at the day when truly tailored pain management will be possible, allowing us to move past our current model of treatment.

Severe neuropathic pain due to diabetic peripheral neuropathy is associated with negative health impact and increased healthcare utilization, underscoring the need for the development of safe and effective treatments.

Researchers successfully treated a patient with refractory complex regional pain syndrome by inducing a coma with ketamine and dexmedetomidine.

Study results show that intrathecal ziconotide provides significant pain relief for patients with refractory painful myelopathies and neuropathies.

MRI data shows that multiple sclerosis patients with central neuropathic pain often have lesions focused in the center of the mid-thoracic spinal cord.

Sports medicine clinicians from the Hospital for Special Surgery (HSS), in New York City, report that platelet-rich plasma (PRP) injections improve joint pain and function in patients with osteoarthritis, a leading cause of disability that affects more than 47 million people in the United States.

Though original results of the five-year Spine Patient Outcomes Research Trial (SPORT) determined surgically-treated spinal stenosis (SpS) patients showed significant advantage in body pain and physical function after two years than their nonsurgically-treated counterparts, a subgroup analysis published in the Feb. 15 issue of Spine found patients who received epidural steroid injections (ESI) in the SPORT study exhibited a worse outcome through four years' follow-up, regardless of surgical or nonsurgical treatment.

The push to provide better pain care and ensure adequate analgesia for patients living with chronic pain led to liberalized opioid prescription practices that have been accompanied by a massive increase in the abuse, misuse, and diversion of prescription opioids. Efforts to combat this include technological remedies such as "abuse-deterrent" formulations of opioids and educational approaches such as the REMS program approved by the FDA in 2012.

The Canadian government's recent decision to allow the sale of a generic version of the original formulation of OxyContin could have serious consequences for efforts to curb opioid abuse, misuse, and diversion in the US.

Steve Gelfand, MD, secretary of Physicians for Responsible Opioid Prescribing (PROP) responds to recent comments by Drs. Cole and Webster in Pain Management.

Confusion between methadone and other medications with lookalike names can cause life-threatening errors.