Combining Procedural and Behavioral Treatments for Chronic Low Back Pain: A Pilot Feasibility Randomized Controlled Trial.

Individual treatments for chronic low back pain (CLBP) have small magnitude effects. Combining different types of treatments may produce larger effects. This study used a 2×2 factorial randomized controlled trial (RCT) design to combine procedural and behavioral treatments for CLBP.

The Utility of a Novel, Combined Biofeedback-Virtual Reality Device as Add-on Treatment for Chronic Migraine: A Randomized Pilot Study.

Objectives: To determine if the frequent use of a combined biofeedback-virtual reality device improves headache-related outcomes in chronic migraine.

Materials And Methods: In this randomized, controlled pilot study, 50 adults with chronic migraine were randomized to the experimental group (frequent use of a heart rate variability biofeedback-virtual reality device plus standard medical care; n=25) or wait-list control group (standard medical care alone; n=25). The primary outcome was a reduction in mean monthly headache days between groups at 12 weeks.

An Acute Pain Service experience initiating methadone for opioid use disorder in hospitalized patients with acute pain.

Objective: Inform readers of the use of a clinical pathway that includes initiation of methadone in hospitalized patients with acute pain who have untreated opioid use disorder (OUD).

Design: A retrospective chart review with frequency distributions and descriptive statistics calculated to describe demo-graphic and clinical characteristics of the sample.

Setting: Urban academic hospital.

Opioid Guidelines Are a Necessary Response to the Opioid Crisis.

Guidelines for opioid prescribing in noncancer pain have proliferated since the opioid crisis in the United States became widely recognized. The recently published Centers for Disease Control (CDC) guidelines for opioid prescribing have been controversial. Many of these concerns arise from underestimation of the scale of the opioid crisis, as well as misunderstanding what the guidelines actually say.

Challenges to Treatment of Chronic Pain and Addiction During the "Opioid Crisis".

Health care in the USA faces a double challenge, the crisis of chronic pain and the crisis of opioid misuse and overdose. Patients have been prescribed opioids at high doses with unclear indications for long periods of time, putting them at high risk for morbidity and mortality. A significant proportion of these patients have comorbid psychiatric or substance use disorders complicating their pain conditions.

Opioid risk assessment in palliative medicine.

Introduction: Pain management with opioids is a fundamental element of palliative medicine. Since the risks of chronic opioid therapy have emerged, a reassessment of these risks in the setting of palliative care is warranted.

Areas Covered: This article presents information about opioid-related risks including i) sedation, cognitive impairment and falls; ii) constipation; iii) addiction to opioids and associated aberrant behavior; and iv) death due to respiratory depression.

Transcranial magnetic stimulation in the treatment of chronic widespread pain: a randomized controlled study.

Objective: Our objective was to assess transcranial magnetic stimulation (TMS) in the treatment of chronic widespread pain.

Methods: Nineteen participants were randomized into 2 groups: one group receiving active TMS (n = 7) and another group receiving sham stimulation (n = 11) applied to the left dorsolateral prefrontal cortex. During sham stimulation, subjects heard a sound similar to the sound heard by those receiving the active treatment and received an active electrical stimulus to the scalp.

Vascular risk in migraineurs: interaction of endothelial and cortical excitability factors.

Background: Migraine is a common primary headache disorder occurring predominantly in a young, relatively healthy population.

Results: There is a growing literature on associations between migraine, especially migraine with aura, and ischemic stroke as well as other vascular events. Migraine as a risk factor for vascular disease and connections between migraine and endothelial, structural, and genetic risk are reviewed.

Needle echogenicity in ultrasound-guided lumbar spine injections: a cadaveric study.

Background: Echogenicity of regional anesthesia needles has been tested on different preclinical models; however, previous studies were done in an ideal experimental setting utilizing high-frequency insonation and superficially located targets. Because steep-angle deep injections are typically required for spinal and other chronic pain procedures, and low-frequency transducers are used, further feasibility study is warranted.

Objectives: To determine effectiveness of steep-angle deep injections, typically required for spinal and other chronic pain procedures.

What are we treating with chronic opioid therapy?

The recent increase in the number of patients taking opioids chronically for pain has not yielded the expected benefits in reduction of symptoms and improved function. Chronic pain patients typically respond well initially to opioid medications, but regular use is associated with adverse psychological and physical effects. Patients with significant psychiatric comorbidity and substance use issues are more likely to stay on opioids and to receive higher doses.

Extended-release hydrocodone - gift or curse?

Hydrocodone is a semisynthetic opioid, which has been used for decades as a short-acting analgesic combined with acetaminophen (or less commonly ibuprofen). Several long-acting, non-acetaminophen-containing hydrocodone formulations are undergoing trials in the US under the auspices of the US Food and Drug Administration, and may be available shortly. This article reviews some of the advantages (including drug familiarity and lack of acetaminophen toxicity) and potential disadvantages (including altered use patterns and high morphine equivalent dosing) of such a medication formulation.

Management of pain with comorbid substance abuse.

Substance use disorders are a large public health problem in the United States. Over the past decade, there has been a trend of increased prescription drug misuse, morbidity, and mortality related to prescription opioids. For providers who treat pain, this has led to clinical dilemmas as the newly appreciated risks must be balanced with the benefits of treatment, particularly in patients with known substance use disorders.

Opioids in the management of HIV-related pain.

Background: Human Immunodeficiency Virus (HIV) patients have an increased rate of chronic pain, particularly peripheral neuropathy. This disease burden causes considerable disability and negatively affects quality of life. Pain is undertreated and more complex to manage in these patients for a number of reasons, including complex anti-retroviral drug regimens, higher risks of side effects, and higher rates of comorbid psychiatric illness and substance abuse.