Recommendations for Prescribing Opioids for People With Traumatic Brain Injury.

Our objective was to make recommendations intended to reduce the rate of opioid misuse and overdose for a particularly high-risk group of people with traumatic brain injury (TBI). A consensus process conducted with TBI researchers and expert practitioners developed practical recommendations to inform prescribing of opioids for people with TBI. After determining key general principles for prescribing opioids for people with TBI, 6 TBI-specific recommendations were developed, 1 for acute pain in the agitated patient with TBI, 3 recommendations to be considered before prescribing an opioid, and 2 for follow-up and use by mental health and substance use disorder providers.

A Screening Tool to Identify Spasticity in Need of Treatment.

Objective: To develop a clinically useful patient-reported screening tool for health care providers to identify patients with spasticity in need of treatment regardless of etiology.

Design: Eleven spasticity experts participated in a modified Delphi panel and reviewed and revised 2 iterations of a screening tool designed to identify spasticity symptoms and impact on daily function and sleep. Spasticity expert panelists evaluated items pooled from existing questionnaires to gain consensus on the screening tool content.

Treatment of a painful keloid with botulinum toxin type A.

Keloids are associated with small-fiber neuropathy and typically present with itching, pain, and allodynia. The following is a case presentation in which painful neuropathic symptoms from a keloid were treated successfully with botulinum toxin type A. To our knowledge, this is the first such case report in the literature.

Pilocarpine for the treatment of refractory dry mouth (xerostomia) associated with botulinum toxin type B.

A woman with spastic hemiparesis from a stroke was injected with botulinum toxin type B (BoNTB) at a dose of 10,000 U. Although this had the desired effect of a reduction in her spasticity, she also developed severe dry mouth, which became refractory to local remedies such as moist towels, lip balms, and throat lozenges. She was then given pilocarpine (a muscarinic agonist) at a dose of 5 mg, three times a day, to which she responded well.