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Pain management after photorefractive keratectomy.

PURPOSE OF REVIEW: To review current concepts regarding the mechanisms of postoperative pain after photorefractive keratectomy (PRK) and rev … ue to their less significant side effect profile. The use of systemic opiate agents is reserved for breakthrough pain.

Preoperative pain sensitivity predicts postoperative pain severity and analgesics requirement in lumbar fusion surgery - a prospective observational study.

BACKGROUND CONTENT: The goal of postoperative pain management is to facilitate the patient's return to normal activity and decrease the detrimental effects of acute postsurgical pain. In order to provide more tailored and successful pain treatment, it is necessary to identify individuals who are at a high risk of experiencing severe postoperative pain. The most precise way to assess pain sensitivity is by determining the pressure pain threshold and heat pain threshold by objective methods using a digital algometer and neurotouch respectively. PURPOSE: The primary aim of the study is to assess

Mild hyperthermia by MR-guided focused ultrasound in an ex vivo model of osteolytic bone tumour: optimization of the spatio-temporal control of the delivered temperature.

BACKGROUND: Magnetic resonance guided focused ultrasound was suggested for the induction of deep localized hyperthermia adjuvant to radiation- or chemotherapy. In this study we are aiming to validate an experimental model for the induction of uniform temperature elevation in osteolytic bone tumours, using the natural acoustic window provided by the cortical breakthrough. MATERIALS AND METHODS: Experiments were conducted on ex vivo lamb shank by mimicking osteolytic bone tumours. The cortical breakthrough was exploited to induce hyperthermia inside the medullar cavity by delivering acoustic en

Mechanisms of neuropathic pain.

Neuropathic pain refers to pain that originates from pathology of the nervous system. Diabetes, infection (herpes zoster), nerve compression, nerve trauma, "channelopathies," and autoimmune disease are examples of diseases that may cause neuropathic pain. The development of both animal models and newer pharmacological strategies has led to an explosion of interest in the underlying mechanisms. Neuropathic pain reflects both peripheral and central sensitization mechanisms. Abnormal signals arise not only from injured axons but also from the intact nociceptors that share the innervation territor

[A case report of chronic intestinal pseudo-obstruction with autoimmune autonomic ganglionopathy suspected from seropositive results for anti-ganglionic acetylcholine receptor antibody].

A 37-year-old woman who had previously been diagnosed with idiopathic chronic intestinal pseudo-obstruction (CIPO) at another hospital was admitted to our institution with severe abdominal pain. She had a history of several abdominal surgeries to treat ileus at the previous hospital, and contrast-enhanced computed tomography on admission revealed subileus without any apparent causes of obstruction. Total parenteral nutrition, a gastrointestinal prokinetic agent, and opiates reduced persistent pain;however, breakthrough pain continued. A neurologist at our hospital suggested autoimmune autonomi…

Postoperative epidural analgesia for patients undergoing pectus excavatum corrective surgery: a 10-year retrospective analysis.

INTRODUCTION: Managing postoperative pain in patients undergoing minimally invasive pectus excavatum repair (Nuss procedure) is challenging … treatments for nausea and pruritus, pain scores according to epidural site insertion, occurrence of breakthrough pain, and presence of severe pain throughout their hospital stay. Secondary outcomes were analyzed using linear or logistic regression adjusted for pain scores at baseline. The criterion for statistical significance was set a priori at alpha =0.05. RESU …

Neuronal regulation of cancer: Mechanisms, functional consequences and therapeutic opportunities.

Recent breakthroughs highlight a previously underappreciated role of the nervous system in tumor biology, drawing attention to the emerging interdisciplinary field of tumor neuroscience. Foundational discoveries have elucidated complex bidirectional interactions between neurons and cancer cells, redefining the tumor microenvironment as a dynamic neurobiological niche. A major recent breakthrough is the discovery that tumor cells can form direct synaptic or pseudo-synaptic contacts with neurons, extending the concept of synaptic communication beyond the nervous system. In this Review, we summar

Advantages of Ciprofol with Special Consideration of Pediatric Anesthesia.

The search for an ideal anesthetic has always been a major goal in anesthesiology. In recent years, the introduction of ciprofol has marked a major breakthrough in the pharmacological field, following the introduction of dexmedetomidine. Ciprofol has similar characteristics to propofol but with greater hemodynamic stability. Furthermore, it overcomes one of the most common discomforts associated with propofol: pain at the injection site. These characteristics make it a suitable hypnotic for pediatric use. Although studies on children are still limited, the literature on adults is now substanti

Current management of cancer pain in Italy: Expert opinion paper.

IntroductionChronic pain and breakthrough cancer pain (BTcP) have a high prevalence in all cancer types and cancer stages, combined with a significant physical, psychological, and economic burden. Despite efforts to improve appropriate management of cancer pain, a poor assessment and guilty undertreatment are still reported in many countries. The purpose of this expert opinion paper is to contribute to reduce and clarify these issues with a multidisciplinary perspective in order to share virtuous paths of care.MethodsCommon questions about cancer pain assessment and treatment were submitted to

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… Breakthrough pain: definition, prevalence and characteristics. Pain. 1990;41:273–81. 10.1016/0304-3959(90)90004-W. Portenoy RK, Hagen NA. Breakthrough pain: definition, prevalence and characteristics. Pain. 1990;41:273–81. doi: 10.1016/0304-3959(90)90004-W. … Considerations in selecting rapid-onset opioids for the management of breakthrough pain. J Pain Res. 2013;6:189–200. 10.2147/JPR.S40745. Smith H. Considerations in selecting rapid-onset opioids for the management of breakthrough pain. J Pain Res. 2013;6:189–200. doi: 10.2147/JPR.S40745. …

Case reports: sudden worsening of cluster headache: A signal of aneurysmal thrombosis and enlargement.

We report a 55-year-old man presenting with symptoms of cluster headache, including throbbing pain behind the left eye, tearing, and rhinorrhea. Magnetic resonance imaging and magnetic resonance angiography revealed no abnormalities. Two days of intravenous dihydroergotamine resolved his pain. His headaches were somewhat relieved with a treatment regimen of 100 mg of imipramine each night, 40 mg of propranolol twice a day, 250 mg of divalproex three times a day, and dihydroergotamine nasal spray for breakthrough headaches. Two months later, the severity of his pain increased dramatically. Repe

[Pain Management in Palliative Care].

A consistent pain management together with treatment of dyspnoea belongs to the main issues in symptom control in particular in palliative t … imply as possible, according to a fix drug schedule and individually adjusted to the needed dosage. Breakthrough pain has to be treated with rapidly efficacious, non-retarded analgetics. The typical adverse reaction profile for opiates like constipation and initial nausea should be considered prophylactically by applying concurrent medication with adjuvants. Co-ana …

Long-term assessment of symptomatology and satisfaction of an extended oral contraceptive regimen.

OBJECTIVE: The study was conducted to assess hormone withdrawal symptoms, patient acceptance and occurrence and management of bleeding with an extended oral contraceptive (OC) regimen. METHODS: Subjects were placed on an OC containing 3 mg drosperinone (DRSP) and 30 microg ethinyl estradiol (EE), in the standard 21/7 fashion for two cycles, before converting to an extended pattern of OC for women who indicated they had menstrually related symptoms such as headaches, cramping and mood swings (52 weeks with phone-call follow-up 6 months later). Daily assessments of bleeding, headache, pelvic pa

An Individualized, Interdisciplinary Approach to the Perioperative Care of Patients on Buprenorphine.

PURPOSE OF THE REVIEW: This review provides an overview of the pharmacodynamics and pharmacokinetics of buprenorphine followed by a review of the published research on the perioperative use of buprenorphine for acute postoperative pain, and analgesia management in patients already on buprenorphine. RECENT FINDINGS: Current evidence comparing buprenorphine with full opioid agonists is heterogeneous, showing either modest superiority or comparable analgesic efficacy, with a reduced incidence of certain adverse effects such as respiratory depression. Despite concerns that its high receptor affin

Peripheral Mechanism of Cancer-Induced Bone Pain.

Cancer-induced bone pain (CIBP) is a type of ongoing or breakthrough pain caused by a primary bone tumor or bone metastasis. CIBP constitutes a specific pain state with distinct characteristics; however, it shares similarities with inflammatory and neuropathic pain. At present, although various therapies have been developed for this condition, complete relief from CIBP in patients with cancer is yet to be achieved. Hence, it is urgent to study the mechanism underlying CIBP to develop efficient analgesic drugs. Herein, we focused on the peripheral mechanism associated with the initiation of CIB…

Concept for postoperative analgesia after pedicled TRAM flaps: continuous wound instillation with 0.2% ropivacaine via multilumen catheters. A report of two cases.

Pedicled TRAM flap surgery is a complex procedure characterised by an extensive wound site. We present two patients with efficient postopera … at rest and on coughing were low on the first postoperative day, and later zero. No medication for breakthrough pain was required throughout the recovery period, and the patients experienced no adverse events linked to the analgesia scene. Patient satisfaction was excellent, and quality of recovery score was superior.

Alternatives to oral opioids for cancer pain.

Although the optimal route of administration of opioids is by mouth, some patients may require alternative routes during the course of their … fentanyl (Actiq) provides a rapid onset of pain relief and is appropriate for treating episodes of breakthrough pain.

Postoperative oxycodone toxicity in a patient with chronic pain and end-stage renal disease.

We present this case to review the metabolism of oxycodone and the effects of end-stage renal disease on the elimination of oxycodone and its metabolites. A 42-year-old female with end-stage renal disease who was dependent on hemodialysis presented for left hamstring posterior capsule release. She had been receiving methadone for 2 years for chronic leg pain. On postoperative day 1, the patient's medication was changed from IV hydromorphone to oral oxycodone to treat breakthrough pain. By the next day, the patient was unarousable with notable respiratory depression. She did not fully recover a…

Ketamine versus hydromorphone patient-controlled analgesia for acute pain in trauma patients.

BACKGROUND: It is unknown whether ketamine administered via patient-controlled analgesia (PCA) provides adequate analgesia while reducing op … who were receiving PCA, were randomized to ketamine or hydromorphone PCA plus opioid analgesics for breakthrough pain. RESULTS: Twenty subjects were randomized. There was no difference in median daily breakthrough opioid use (10 [0.63-19.38] mg versus 10 [4.38-22.5] mg, P = 0.55). Subjects in the ketamine group had lower median cumulative opioid use on therapy day …

Efficacy and Safety of Sinopharm Vaccine for SARS-CoV-2 and breakthrough infections in Iranian Patients with Hemoglobinopathies: A Preliminary Report.

BACKGROUND: The ongoing COVID-19 pandemic, caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has led to high morbidity and mortality worldwide. Vaccination against SARS-CoV-2 is a leading strategy to change the course of the COVID-19 pandemic. AIMS OF THE STUDY: Our aim was to investigate the efficacy and side effects of the Sinopharm vaccine in patients with hemoglobinopathies in Iran and the frequency of breakthrough infection after a full course of vaccination. METHODS: A multicenter cross-sectional study of 434 patients with hemoglobinopathies (303 β-thalassemia maj

Fear of pain in children and adolescents with neuropathic pain and complex regional pain syndrome.

A significant proportion of children and adolescents with chronic pain endorse elevated pain-related fear. Pain-related fear is associated with high levels of disability, depressive symptoms, and school impairment. Because of faulty nerve signaling, individuals with neuropathic pain and complex regional pain syndrome may be more prone to develop pain-related fear as they avoid use of and neglect the affected body area(s), resulting in exacerbated symptoms, muscle atrophy, maintenance of pain signaling, and ongoing pain-related disability. Not surprisingly, effective treatments for elevated pai