Trends in use and misuse of opioids in the Netherlands: a retrospective, multi-source database study.

Background: The USA is currently facing a serious opioid misuse epidemic that started with increased prescribing of oxycodone and the inclusion of pain as a fifth vital sign, and eventually resulted in massive overdose mortality. In Europe, including the Netherlands, the medical use of opioids (mainly oxycodone) has also increased since 2009, but an increase in proxies for opioid misuse has not yet been described.

Methods: For this retrospective, multi-source database study, data were requested from several national databases in the Netherlands to evaluate the following time trends: (1) number of people with opioid prescriptions, (2) number of hospital admissions related to opioid intoxication, (3) number of people treated for opioid use disorder, and (4) number of people who died from opioid poisoning.

Pain Exposure Physical Therapy versus conventional treatment in complex regional pain syndrome type 1-a cost-effectiveness analysis alongside a randomized controlled trial.

Objective: To analyze cost-effectiveness of Pain Exposure Physical Therapy compared to conventional treatment alongside a randomized controlled trial (NCT00817128) in patients with complex regional pain syndrome type 1, where no clinical difference was shown between the two groups in an intention-to-treat analysis.

Design: Randomized controlled trial with 9 months follow-up.

Setting: Patients were recruited from hospitals and general practitioners in the region around a university hospital.

Severity of Neuropathy Is Associated With Long-term Spinal Cord Stimulation Outcome in Painful Diabetic Peripheral Neuropathy: Five-Year Follow-up of a Prospective Two-Center Clinical Trial.

Objective: Evidence from prospective studies for long-term treatment efficacy of spinal cord stimulation (SCS) in painful diabetic peripheral neuropathy (PDPN) is not available. We report prospective data on the effect of SCS on pain ratings, treatment success and failure, and complications during a 5-year follow-up in patients with PDPN.

Research Design And Methods: Patients with PDPN ( = 48) were included in this prospective multicenter study.

A Trial-Based Economic Evaluation Comparing Spinal Cord Stimulation With Best Medical Treatment in Painful Diabetic Peripheral Neuropathy.

Unlabelled: The objective was to perform an economic evaluation comparing spinal cord stimulation (SCS) in combination with best medical treatment (BMT) with BMT in painful diabetic peripheral neuropathy patients. Alongside a prospective 2-center randomized controlled trial, involving 36 painful diabetic peripheral neuropathy patients with severe lower limb pain not responding to conventional therapy, an economic evaluation was performed. Incremental cost-effectiveness ratios were based on: 1) societal costs and quality-adjusted life years (QALYs), and 2) direct health care costs and the number of successfully treated patients, respectively, both with a time horizon of 12 months.

Pain exposure physical therapy (PEPT) compared to conventional treatment in complex regional pain syndrome type 1: a randomised controlled trial.

Objective: To compare the effectiveness of pain exposure physical therapy (PEPT) with conventional treatment in patients with complex regional pain syndrome type 1 (CRPS-1) in a randomised controlled trial with a blinded assessor.

Setting: The study was conducted at a level 1 trauma centre in the Netherlands.

Participants: 56 adult patients with CRPS-1 participated.

Are pain-related fears mediators for reducing disability and pain in patients with complex regional pain syndrome type 1? An explorative analysis on pain exposure physical therapy.

Objective: To investigate whether pain-related fears are mediators for reducing disability and pain in patients with Complex Regional Pain Syndrome type 1 when treating with Pain Exposure Physical Therapy.

Design: An explorative secondary analysis of a randomised controlled trial.

Participants: Fifty-six patients with Complex Regional Pain Syndrome type 1.

[Complex regional pain syndrome type 1: negating the myth].

Complex regional pain syndrome type 1 (CRPS-1) was identified in the Netherlands more than 30 years ago, but since then the arguments supporting this diagnosis have become weaker. Incidence has decreased, it is often not possible to make a definite diagnosis, the pathophysiology remains unclear and treatments are extremely diverse. Since the patient group is so heterogeneous, it is often unclear exactly which patients should be included.

[Neuromodulation in severe neuropathic pain].

Pain relief in patients with chronic neuropathic pain can be difficult to accomplish. If pharmacological treatment combined with a form of physical therapy and psychological support does not lead to improvement, nerve blocks and rehabilitation can be considered. Appropriately screened patients with persistent incapacitating pain may respond to neuromodulation.

Spinal cord stimulation and pain relief in painful diabetic peripheral neuropathy: a prospective two-center randomized controlled trial.

Objective: Painful diabetic peripheral neuropathy (PDPN) is a common complication of diabetes mellitus. Unfortunately, pharmacological treatment is often partially effective or accompanied by unacceptable side effects, and new treatments are urgently needed. Small observational studies suggested that spinal cord stimulation (SCS) may have positive effects.

Multimodal and widespread somatosensory abnormalities in persistent shoulder pain in the first 6 months after stroke: an exploratory study.

Objective: To explore the role of multimodal and widespread somatosensory abnormalities in the development of persistent poststroke shoulder pain (pPSSP) in the first 6 months after stroke.

Design: Prospective inception cohort study.

Setting: Stroke units of 2 teaching hospitals.

The effectiveness and cost evaluation of pain exposure physical therapy and conventional therapy in patients with complex regional pain syndrome type 1. Rationale and design of a randomized controlled trial.

Background: Pain Exposure Physical Therapy is a new treatment option for patients with Complex Regional Pain Syndrome type 1. It has been evaluated in retrospective as well as in prospective studies and proven to be safe and possibly effective. This indicates that Pain Exposure Physical Therapy is now ready for clinical evaluation.

The use of laminectomy for the placement of a percutaneous spinal cord stimulation electrode.

Objective: The placement of a percutaneous electrode for trial stimulation to evaluate the effectiveness of spinal cord stimulation can be impossible because of epidural adhesions from previous spinal surgeries. The authors would like to describe a combination of techniques in order to place a percutaneous lead for a test phase.

Materials And Methods: Technical report of an illustrative case where a partial laminectomy was used to assist a percutaneous lead placement.

[Guideline 'Pain management for trauma patients in the chain of emergency care'].

Pain management for trauma patients is a neglected aspect in the chain of emergency care in general practices, ambulance services, mobile trauma teams and in hospital emergency departments. The aim of the guideline 'Pain management for trauma patients in the chain of emergency care' is to provide pain management recommendations for trauma patients in the chain of emergency care and thereby improve the assistance that patients receive. Paracetamol is the treatment of choice, if necessary with additional use of NSAIDs or opioids; NSAIDs can be administered in the absence of contra-indications, but should be avoided in cases where the patient history is unknown; fentanyl and morphine can be given for severe pain during emergency care, esketamine can be considered in patients with severe pain and hypovolemia.

Persistent shoulder pain in the first 6 months after stroke: results of a prospective cohort study.

Objective: To identify factors associated with persistent poststroke shoulder pain (pPSSP) in the first 6 months after stroke.

Design: Prospective inception cohort study.

Setting: Stroke units of 2 teaching hospitals.

Somatosensory symptoms and signs and conditioned pain modulation in chronic post-stroke shoulder pain.

Unlabelled: Persistent shoulder pain is a common complication after stroke. Its etiology and underlying mechanisms are not well understood and treatment is generally unsatisfactory. The objective of this study was to assess the role of central sensitization and disinhibition in chronic stroke patients with chronic PSSP (n = 19), pain-free stroke patients (n = 29), and healthy controls (n = 23).

Classifying post-stroke shoulder pain: can the DN4 be helpful?

The etiology of post-stroke shoulder pain (PSSP) is largely unclear and may involve both nociceptive and neuropathic mechanisms. No gold standard is present for PSSP diagnosis. The neuropathic pain diagnostic questionnaire (DN4), was originally developed to identify neuropathic pain in the clinical context.

Pain exposure physical therapy may be a safe and effective treatment for longstanding complex regional pain syndrome type 1: a case series.

Objective: To determine if treatment of longstanding complex regional pain syndrome type 1, focusing on functional improvement only while neglecting pain, results in clinical improvement of this syndrome.

Design: Prospective description of a case series of 106 patients.

Setting: Outpatient clinic for rehabilitation.

Pain prevalence and pain relief in trauma patients in the Accident & Emergency department.

Background: Acute pain in the A&E department (ED) has been described as a problem, however insight into the problem for trauma patients is lacking.

Objective: This study describes the prevalence of pain, the pain intensity and the effect of conventional pain treatment in trauma patients in the ED.

Methods: In a prospective cohort study of 450 trauma patients, pain was measured on admission and at discharge, using standardized and validated pain instruments.

Use of a tubular retractor system as a minimally invasive technique for epidural plate electrode placement under local anesthesia for spinal cord stimulation: technical note.

Objective: To improve the technique of placement of large plate electrodes for spinal cord stimulation with a minimally invasive approach using the METRx tubular retractor system (Medtronic Sofamor Danek, Minneapolis, MN). This dilating system splits the paravertebral musculature, avoiding the need to strip these muscles from the spine. The technique described makes it possible to perform the procedure (currently, it is most frequently performed using general anesthesia) with local anesthesia and sedation, allowing test stimulation, and with little intraoperative or postoperative discomfort for the patient.

The present role of percutaneous cervical cordotomy for the treatment of cancer pain.

The results obtained by percutaneous cervical cordotomy (PCC) were analysed in 43 terminally ill cancer patients treated in our institution from 1998 to 2001. We wished to determine whether there is still a place for PCC in the actual clinical situation with its wide choice of pain therapies. All patients had severe unilateral pain due to cancer, resistant to opioids and co-analgesics.