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General
Review
Last Updated:
February 22, 2008
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Assessment
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Complimentary Interventions
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Complex Regional Pain Syndrome
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Common
anesthetic drug found effective in treating severe CRPS pain |
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Reflex sympathetic dystrophy/complex regional pain syndrome clinical
practice guidelines - third edition |
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Neurotropin Research Study |
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RSD
Research from Reflex Sympathetic Dystrophy Syndrome Association |
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RSD
Treatment from Reflex Sympathetic Dystrophy Syndrome Association |
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Clinical Guidelines from
Reflex Sympathetic Dystrophy Syndrome Association |
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Spinal cord stimulation in complex regional pain syndrome: cervical and
lumbar devices are comparably effective |
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Clinical practice guideline (second edition) for the diagnosis,
treatment, and management of reflex sympathetic dystrophy/complex
regional pain syndrome (RSD/CRPS)
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Case Series: IV Regional Anesthesia with Ketorolac and Lidocaine: Is
It Effective for the Management of Complex Regional Pain Syndrome 1 in
Children and Adolescents? |
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Complex regional pain syndrome - diagnostic, mechanisms, CNS involvement
and therapy |
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Complex regional pain syndrome and lyme borreliosis: two different
diseases?
 | Complex regional pain syndrome (CRPS) is a frequent
complication appearing as pain of unexplained pathogenesis. Its
association with Lyme borreliosis (LB) is fairly rare. In the
presented clinical case,...the patient fulfilled the criteria for both
diagnoses, i.e. CRPS and LB. The subsequent antibiotic therapy
resulted in a complete remission of both clinical entities. |
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| Neurostimulation Found More Effective and Less
Expensive Than Standard Treatment Protocol for Chronic Reflex
Sympathetic Dystrophy
| An important financial assessment of
neurostimulation was recently published in the journal, Neurology by
Marius A. Kemler, MD Ph.D and Carina A. Furnée, Ph.D . (Neurology
2002;59:1203-1209). Available by order from the
Chronic Pain Resource
Center. |
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| New Studies Available on the Cost-Effectiveness of
Neurostimulation and Intrathecal Drug Delivery
| Two recent journal articles by Krishna Kumar, M.B.,
M.S. FRCS(C), F.A.C.S. compare the cost-effectiveness of both
neurostimulation and intrathecal drug delivery vs. conventional pain
therapies in patients with failed back syndrome. Neurostimulation and
intrathecal drug delivery were found to be cost-effective in the
long-term, despite initial costs of the implantable devices. The
neurostimulation article is available to order through "journal
reprints" section of the web site (Neurosurgery; 51:106-116, 2002).
Available by order from the
Chronic Pain Resource
Center. |
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Fibromyalgia
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Headache
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Antiepileptic Drug Keppra (Levetiracetam) Reduces Migraine Pain in
Children |
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Topiramate in the prophylactic treatment of migraine in children |
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Butterbur for Migraine Prevention |
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Headstrong: A Pilot Study of a CD-ROM Intervention for Recurrent
Pediatric Headache |
| The efficacy and
safety of venlafaxine in the prophylaxis of migraine |
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Surgery Can Reduces Migraine Symptoms |
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Topiramate in migraine prophylaxis: a randomised double-blind versus
placebo study |
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American Academy of Neurology Issues Guidelines for Pediatric Migraine |
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Surgical treatment of migraines reduces sick days and increases employee
productivity |
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Anticonvulsants in migraine |
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Flunarizine in prophylaxis of childhood migraine. A double-blind,
placebo-controlled, crossover study |
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Prophylactic migraine therapy: emerging treatment options |
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Electroacupuncture for Tension-type Headache on Distal Acupoints Only: A
Randomized, Controlled, Crossover Trial |
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Patients Who Responded Poorly to Excedrin-Migraine May Get Significant
Pain Relief With Relpax (Eletriptan) |
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Acupuncture in Addition to Standard Care Confers Clinical Benefit to
Patients with Chronic Headache |
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Strict bed rest following lumbar puncture in children and adolescents is
of no benefit
| Another medical myth is on its way out |
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Topiramate for migraine prevention: a randomized controlled trial |
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Efficacy of topiramate in migraine aura prophylaxis: preliminary results
of 12 patients |
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Botulinum toxin and other new approaches to migraine therapy |
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Brain imaging and prophylactic therapy in children with migraine:
recommendations versus reality
| Conclusions: Imaging is more frequently obtained
and prophylactic therapy less frequently implemented by the referring
physician than would be indicated by published recommendations. |
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Divalproex Sodium Decreases Headaches by Half |
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Triptans May Be Ineffective in Migraine With Cutaneous Allodynia CME
(you will need to login at Medscape) |
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Review of Recent Advances in Acute Migraine Treatment and Prevention |
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Pathogenesis of the migraine attack |
| Frovatriptan |
| Eye-Strain Headache |
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The Usefulness
of Children's Drawings in the Diagnosis of Headache (pdf) |
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Antiepileptic Drugs for Migraine Prophylaxis (pdf) |
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Frequent Headache: A Far Too Common Problem (pdf) |
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Migraine, Tension-Type Headaches, and Their Combination Effects on
Health Outcomes, Quality of Life, and Productivity (pdf) |
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Once-Daily, Extended-Release Divalproex Sodium for Migraine Headache
Prophylaxis: A Study of Safety and Efficacy (pdf) |
| GABA
Receptors Appear to Modulate Nociceptive Transmission in the
Trigeminocervical Complex (pdf) |
| Botox
Effective in Headache Pain Relief |
| Prophylactic
treatment of migraine with angiotensin converting enzyme inhibitor
(lisinopril): randomized, placebo controlled, crossover study
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Add this
option to your list of effective migraine prevention strategies. |
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Efficacy
and Safety of Acetaminophen in the Treatment of Migraine
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Acute Treatment Strategies for Migraine |
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Local Control Measures
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Narcotics
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Pharmacologic Treatment of Opioid-Induced Sedation in Chronic Pain |
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Tramadol Exposures Reported to Statewide Poison Control System |
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The effects of a small-dose naloxone infusion on opioid-induced side
effects and analgesia in children and adolescents treated with
intravenous patient-controlled analgesia |
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Treatment of noncancer pain with oral transmucosal fentanyl citrate (OTFC)
(from Pain.com) |
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Two Formulations
of Extended-Release Oral Morphine Reach Similar Plasma Levels |
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Peripheral opioids in inflammatory pain |
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Enteral administration of naloxone for treatment of opioid-associated
intragastric feeding intolerance |
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Continuous Subcutaneous Infusion of Opiates at End-of-Life |
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The bioavailability of morphine applied topically to cutaneous ulcers |
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Incidence of constipation associated with long-acting opioid therapy: a
comparative study |
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Developmental pharmacokinetics of morphine and its metabolites in
neonates, infants and young children |
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Addition of ultralow dose naloxone to postoperative morphine PCA:
unchanged analgesia and opioid requirement but decreased incidence of
opioid side effects |
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New Formulation Of Actiq (Oral Transmucosal Fentanyl Citrate) Approved
By FDA |
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New Perspectives on the Pharmacology of Opioids and Their Use in Chronic
Pain (CME Available) |
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Optimizing Analgesic Response When Pain is Uncontrolled by Oral Opioids
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This article is from
Cancer Pain Release, where you can find many other similar review
articles |
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Opioids in cancer pain: common dosing errors |
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The importance of
opioid tolerance: a therapeutic paradox J.Amer Coll Surg.
Feb. 2003. Vol. 196, No.2:321-4. |
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Characteristics and adequacy of intravenous morphine infusions in
children in a paediatric oncology setting |
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Oral tramadol for the treatment of pain of 7-30 days' duration in
children
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This open-label, multicenter
trial was designed to determine the safety profile and analgesic
efficacy of tramadol for the treatment of painful conditions lasting
7-30 days in 7-16-yr-old children. We found that tramadol 1-2 mg/kg per
os every 4-6 h (maximal dose = 8 mg x kg(-1). d(-1), not to exceed 400
mg/d) is a safe and effective analgesic in this patient population. |
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Clinical pharmacology of opioids for pain
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Inturrisi CE. Clin J Pain
2002 Jul-Aug;18(4 Suppl):S3-13
Department of Pharmacology, Weill Medical College of Cornell
University, Pain and Palliative Care Service, Memorial Sloan-Kettering
Cancer Center, New York, New York 10021, USA |
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Effects of intermediate- and long-term use of opioids on cognition in
patients with chronic pain
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"Relatively few differences have been found when
cognitive performance in these patients is compared with their
performance before taking opioids, or with the performance of a
comparable pain population not taking opioids. Major unresolved
questions remain regarding such important issues as effects of
different types of opioids, dose effects, interactions with other
medications, and subject variables." |
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FDA Approves Once-Daily Avinza (Extended Release Morphine) For Chronic,
Moderate-To-Severe Pain |
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EPERC Fast Fact and Concept
#75: Methadone for Pain |
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Einstein Researchers Report on Safer Narcotic Painkillers That Prevent
Dependency, Withdrawal Problems |
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PRN Range for Analgesic Orders |
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Sufentanil:
an overview of its use for acute pain management |
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Strategies to manage the adverse effects of oral morphine: an
evidence-based report |
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Intravenous Methadone in the Management of Chronic Cancer Pain |
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Pioneering Durogesic (Transdermal Fentanyl) Skin Patch:
A Clear Choice In
Chronic Pain Which Is Difficult To Treat
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May 27, 2002 -- The UK's
first skin patch to offer strong pain relief (DurogesicTM - transdermal
fentanyl) - has received approval from UK regulators allowing its use
for the first time to treat chronic (ongoing or continued) intractable
pain such as arthritis and back pain. |
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Reducing Morphine
Tolerance (pdf) |
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An
Individual Opinion on the Use of Demerol for Rigors |
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Nasal
Diamorphine Preferred For Children With Limb Fractures
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Seems like
a great idea: 0.1 mg/kg diamorphine intranasally relieves severe
fracture pain faster that an IM injection without the need for a
needle. This study was performed in Great Britain. Hopefully the
product will become available in the United States. This is a
review of the article in the British Med Journal, with a
link to the full text version. |
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The
Neurotoxicity of Opioids
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This is a
brief case presentation demonstrating some of the common side effects
of opioid analgesics and their management. |
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Methadone in
the Treatment of Chronic Non-Malignant Pain-a 2-Year Review
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We are
re-learning the benefits of methadone. Consider this medication in
the treatment of post-herpetic neuralgia. This
is a review of the article in Pain Medicine and a link to its
abstract. |
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Neonatal
Issues
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The reliability and validity of the COMFORT scale as a
postoperative pain instrument in
0 to 3-year-old infants |
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Morphine Does Not Provide Adequate Analgesia for Acute Procedural
Pain
Among Preterm Neonates |
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Childhood Pain May Play Part In Chronic Adult Issues |
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Oral hypertonic glucose spray: a practical alternative for
analgesia in the newborn |
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Sedatives for opiate withdrawal in newborn infants |
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Specific Newborn Individualized Developmental Care and Assessment
Program
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Movements
are associated with acute pain in preterm infants in the neonatal
intensive care unit |
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NPAS - Neonatal
Pain, Agitation, and Sedation Scale
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The
N-PASS is a valid and reliable clinical pain/agitation and
sedation tool for neonates. Nurses find the N-PASS easy and quick
to use clinically, facilitating documentation and management of
pain and sedation. |
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Parental concern and distress about infant pain
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Conclusions: Parents have unmet information needs about infant
pain and wish greater involvement in their infant’s pain care.
Parent concerns about infant pain may contribute to parental
stress. |
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Prevention and management of pain and stress in the neonate
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Consensus
Statement on Neonatal Pain |
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Neonatal
Pain: The Evolution of an Idea |
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Randomized
trial of analgesic effects of sucrose, glucose, and pacifiers in
term neonates
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Both
sucrose solution and the sucking reflex act to relieve pain in
newborns. |
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EMLA
Cream for Circumcision |
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Effect
of neonatal circumcision on pain responses during vaccination in
boys |
| Bladder
Retention of Urine as a Result of Continuous Intravenous Infusion of
Fentanyl: 2 Case Reports |
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A Pictorial and Video Guide to Circumcision Without Pain
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This is a superbly presented, thorough discussion
of the topic. You may need to login on
Medscape
and search for ID #: 453637 |
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Their suggestion: "Using a multimodal approach to
pain prevention during a newborn circumcision might lead to the
following approach. The infant is premedicated with a 10- to
15-mg/kg dose of acetaminophen by mouth at least 30 minutes before
the procedure. He is placed on a padded circumcision chair with
his legs restrained in a comfortable, semiflexed position. His
arms are secured with a swaddled blanket technique and placed in a
flexed position with his hands placed near his face to allow for
self-comforting measures. He is under a radiant warmer so his
temperature is consistent and comfortable. His eyes are shielded
from any bright light. A pacifier along with some 25% sucrose
water is provided. His penis and groin are prepped with a warmed
anti-septic solution, and 0.5% or 1% lidocaine is administered
slowly in an SQRB (Fig 9). The circumcision is performed with a
Mogen clamp. When the circumcision is complete, the infant is
given to his parents, who will comfort and cuddle him, and he
receives additional oral doses of acetaminophen every 6 to 8
hours, for 24 hours." |
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Oral Glucose
is Better than EMLA |
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Age- and therapy-related effects on morphine requirements and
plasma concentrations of morphine and its metabolites in
postoperative infants |
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Repeated neonatal pain influences maternal behavior, but not
stress responsiveness in rat offspring
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These results suggest that repeated pain during the
first 2 weeks of life in the rat does not lead to significant
changes in stress responsiveness in 2-week-old pups, but we
suggest that changes in mother-pup interaction (increased
grooming) might act as a buffer on the cumulative effect of pain
on stress responsiveness. |
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Crying of a newborn child: alarm signal or protocommunication?
Percept Mot Skills 2002 Dec;95:752-4 |
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In praise of the epidural space for analgesia in neonates
Paediatr Anaesth 2002 Nov;12(9):836-7 |
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Effect of postpartum anxiety on the colostral milk
beta-endorphin concentrations of breastfeeding mothers
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These data indicate that the labour pain and the
vaginal delivery process play a central role in increasing
colostral opioid availability for the breastfed neonate;
peripartal maternal anxiety is a negative psychobiological
determinant in opioid galactopoiesis, and possibly in the
postnatal development of several related biological functions of
growing infants. |
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Major Surgery Within the First 3 Months of Life and Subsequent
Biobehavioral Pain Responses to Immunization at Later Age: A Case
Comparison Study
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Conclusions. Major surgery in combination with preemptive
analgesia within the first months of life does not alter pain
response to subsequent pain exposure in childhood. Greater
exposure to early hospitalization influences the pain responses
after prolonged time. These responses, however, diminish after a
prolonged period of nonexposure. |
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Prevention and management of pain and stress in the neonate -
National Guideline Review |
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Prevention and management of pain and stress in the neonate
- AAP Policy (pdf) |
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Consensus
Statement on Neonatal Pain - International Evidence-Based
Group for Neonatal Pain (pdf) |
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Low-dose Morphine Does
Not Cause Neurological Injury in Preterm Infants (pdf) |
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Breastfeeding Is Analgesic in Healthy Newborns (pdf) |
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Neonatal
Pain: The Evolution of an Idea |
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Randomized
trial of analgesic effects of sucrose, glucose, and pacifiers in
term neonates
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Both
sucrose solution and the sucking reflex act to relieve pain in
newborns. |
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EMLA
Cream for Circumcision |
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Effect
of neonatal circumcision on pain responses during vaccination in
boys |
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Neonatal
Pain Management (an early review) |
| Bladder
Retention of Urine as a Result of Continuous Intravenous Infusion of
Fentanyl: 2 Case Reports |
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Neuropathic Pain
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New Agents
and Techniques
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NMDA Receptor
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Other Pain Syndromes
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Pain Physiology
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Sleep and pain
| Conclusion: There is a reciprocal relationship
between sleep quality and pain. The recognition of disturbed or
unrefreshing sleep influences the management of painful medical
disorders. |
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Study Links Chronic Pain to Signals in the Brain
| For centuries, doctors have tried to find effective
ways to treat chronic pain, a devastating neurological disorder that
affects almost 90 million Americans. A new study shows that two
proteins in the brain trigger the neuronal changes that amplify and
sustain this type of pain. The finding may lead to new ways of
treating chronic pain. |
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Pain FAQs |
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Pain Physiology
(pdf) |
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Procedural Pain Prevention
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Psychosocial Factors
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