Osteoarthritis pain has a significant neuropathic component: an exploratory in vivo patient model.

Osteoarthritis is the most common form of arthritis and includes manifestations of both nociceptive and neuropathic mechanisms. Intravenous lignocaine, a sodium channel blocker and neuronal membrane stabiliser, has been shown in controlled trials to be effective in neuropathic pain; however, the outcome of intravenous lignocaine in osteoarthritis patients has not been assessed yet. The existence of a neuropathic component to the pain of osteoarthritis was investigated by examining possible benefits upon sensory aspects of pain in osteoarthritis patients receiving intravenous lignocaine therapy.

A narrative review of the impact of disbelief in chronic pain.

Although the experience of being believed is frequently alluded to in chronic pain literature, few studies have specifically explored this phenomenon and even fewer reviews have been offered. This narrative review sought to explore the wider social context in which individuals with chronic pain may experience disbelief toward their pain. Articles were obtained through a search of eight databases and a hand search of the references of full-text papers.

Randomised, double-blind controlled trial by dose reduction of implanted intrathecal morphine delivery in chronic non-cancer pain.

Objective: This study aimed to investigate the efficacy of intrathecal morphine in the long term by hypothesising that a reduction of the intrathecal opioid dose following long-term administration would increase the level of pain intensity.

Design: Randomised, double-blind, controlled, parallel group trial.

Setting: Department of Pain Management, Russells Hall Hospital, Dudley, UK.

Hypogonadism and low bone mineral density in patients on long-term intrathecal opioid delivery therapy.

Objectives: This study aimed to investigate the hypothalamic-pituitary-gonadal axis in a sample of male patients undertaking intrathecal opioid delivery for the management of chronic non-malignant pain and the presence of osteopaenia and/or osteoporosis in those diagnosed with hypogonadism.

Design: Observational study using health data routinely collected for non-research purposes.

Setting: Department of Pain Management, Russells Hall Hospital, Dudley, UK.

Prevalence and influence of diagnostic criteria in the assessment of hypogonadism in intrathecal opioid therapy patients.

Background: Hypogonadism is frequently diagnosed based on total testosterone (TT) levels alone. However, 99% of testosterone is bound to the sex hormone-binding globulin (SHBG) with only 1% free testosterone. Alternative assessment methods consist of assay of free testosterone (FT) or bioavailable testosterone (BT) by equilibrium dialysis, calculation of FT and BT through the Vermeulen equations, and calculation of the free androgen index (FAI).

A predictive model for intrathecal opioid dose escalation for chronic non-cancer pain.

Background: Tolerance is defined as a phenomenon in which exposure to a drug results in a decrease of an effect or the requirement of a higher dose to maintain an effect. The fear of a patient developing opioid tolerance contributes regularly to the stigmatization and withholding of intrathecal opioid therapy for chronic pain of non-cancer origin.

Objectives: The aim of this study was to describe the intrathecal opioid dose escalation throughout the years in chronic non-cancer pain patients.

Intrathecal granuloma formation as result of opioid delivery: systematic literature review of case reports and analysis against a control group.

Objective: To investigate the existence of an association between formation of catheter tip intrathecal inflammatory masses with opioid dose and/or concentration.

Methods: A systematic review of catheter tip granulomas case reports and comparison with a control group was carried out. A boolean search was conducted in the electronic databases MEDLINE and EMBASE.

Long-term intrathecal drug administration for chronic nonmalignant pain.

Background: Chronic pain of nonmalignant origin requires effective long-term treatments, as for many patients pain management will be necessary throughout the rest of their lives. Intrathecal drug delivery systems (IDDS) have become a recognized therapy for the management of severe and otherwise intractable chronic pain. However, it is still not clear whether this treatment can be effective for periods up to 10 years or longer, given the paucity of long-term follow-up.

Randomized double-blind sham-controlled crossover study of short-term effect of percutaneous electrical nerve stimulation in neuropathic pain.

Background: Percutaneous electrical nerve stimulation (PENS) is an electrical neuromodulation technique that has shown its therapeutic potential in various chronic pain conditions over the past few years, but well-blinded controlled studies are lacking.

Patients And Methods: A randomized double-blind sham-controlled crossover trial on 31 patients with chronic pain with surface hyperalgesia to investigate the efficacy of PENS.

Results: For the active PENS therapies, the median numerical rating scale (NRS) for pain changed from 7.

Intrathecal inflammatory masses: is the yearly opioid dose increase an early indicator?

Objectives:   The objective of this study is to investigate the association between intrathecal drug, flow rate, drug concentration, and drug dose with the formation of intrathecal inflammatory masses.

Methods:   A retrospective longitudinal study of 56 consecutive patients receiving long-term intrathecal analgesic administration was undertaken through screening of medical records. Data regarding drug flow rate, dose per day, and concentration of drugs administered were recorded for morphine, diamorphine, bupivicaine, clonidine and baclofen and averages computed.

Multiple lead spinal cord stimulation for chronic mechanical low back pain: a comparative study with intrathecal opioid drug delivery.

The objective of this paper is to assess the outcome of implanted multiple thoracolumbar lead spinal cord stimulation (SCS) in mechanical back pain without prior spinal surgery. These results are compared with intrathecal opioid drug delivery (ITDD). An anonymous third party patient questionnaire study of pain relief, function and psychosocial quality of life measures (recorded on 11-point numerical rating scales) for 12 patients with SCS and 13 with ITDD was used.

Stability and Analgesic Efficacy of Di-acetyl Morphine (Diamorphine) Compared with Morphine in Implanted Intrathecal Pumps In Vivo.

The objective of this study was to investigate di-acetyl morphine as an alternative opioid analgesic for use in implanted intrathecal drug delivery systems because of its greater solubility through evaluation of its stability in vivo and analgesic efficacy in the period between pump refills. Contents of intrathecal drug delivery system reservoirs (SynchroMed, Medtronic, Inc., Minneapolis, MN) that had been filled with di-acetyl morphine dissolved in saline (21), bupivacaine (9), or in both bupivacaine and clonidine (19) were sampled in vivo between 1 and 125 days after refill.