December 2011

A look at cancer pain statistics, including the percent of patients with cancer who report experiencing pain, the number of oncologists who refer patients to pain specialists, hospitalization rates for patients with breakthrough cancer pain, and medical costs for cancer patients with breakthrough pain.

The best setting for the treatment of painful diabetic neuropathy is primary care, where diabetes and its associated chronic pain can be managed as a single entity. The American Diabetes Association defines diabetic peripheral neuropathy (DPN) as "the presence of symptoms and/or signs of peripheral nerve dysfunction in patients with diabetes after exclusion of other causes." Approximately 16% of diabetic patients will experience painful diabetic neuropathy (PDN).

Norris describes the recent history and current activities of the Montana Pain Initiative, a "grassroots, interdisciplinary organization dedicated to improving the quality of life of Montanans with pain by removing barriers to effective pain assessment and management through research, education, and advocacy."

Gillian Hawker, MD, MSc, FRCPC, a practicing rheumatologist and clinical researcher, discusses the importance of standardized pain assessment in patients with arthritis, reviews clinically useful pain measures, and offers advice to clinicians on evaluating chronic arthritis pain. Dr. Hawker recently authored a chapter, "Measures of Adult Pain", that was included in a special issue of Arthritis Care & Research, a journal of the American College of Rheumatology.

Indicated in patients who are already receiving, and are tolerant to, opioid analgesics for their underlying persistent cancer pain. Two new, fast-acting forms of fentanyl were approved by the FDA this year for the management of breakthrough cancer pain. Abstral, a transmucosal tablet, was approved in January and Lazanda, a nasal spray, was approved in June.

The most successful opioid treatment programs and the most successful patients in those programs use evidence-based dosing of methadone. Many studies over the last 40 years show patients do better on adequate doses of methadone. They have better outcomes when they're on enough methadone to block physical withdrawal signs and symptoms than when they're on insufficient doses.

Several studies indicate there may be an increased risk of falls and fractures associated with the use of narcotic analgesics in elderly patients.

Can chemical safeguards, built directly into prescription analgesics such as Oxecta, Exalgo, and others, help curb the epidemic of addiction and abuse that killed 14,800 Americans in 2008 alone and subjects the entire pain management community to cumbersome government oversight?

Studies show good efficacy and tolerability for this novel medication in the treatment of low back pain. With an estimated lifetime prevalence of 70-85%, low back pain is one of the most common causes of chronic pain in the US. However, despite the widespread prevalence of this painful condition, effective treatment remains elusive for many patients, causing a great deal of frustration not only for them but also for their treating clinicians.

There was a wealth of important fibromyalgia treatment-related research presented at major pain conferences in 2011.

Publisher's note, December 2011.