Opioid Dose Reduction in a VA Health Care System--Implementation of a Primary Care Population-Level Initiative.

Objective: To describe processes and outcomes of a health system quality improvement initiative designed to reduce opioid-related harms.

Design: The initiative was a primary care population-level intervention to reduce high-dose opioid prescribing, which was locally defined as >200 morphine-equivalent mg (MED) daily. We describe the implementation process and report prescribing rates and primary care provider (PCP) attitudes and beliefs before and after implementation.

Does pain interfere with antidepressant depression treatment response and remission in patients with depression and pain? An evidence-based structured review.

Objective: The objective of this evidence-based structured review was to determine if there is consistent evidence that pain interferes with achieving antidepressant treatment response/remission of depression in patients with depression and pain.

Methods: After exclusion criteria were applied, of 2,801 studies/reports, 17 studies addressed this question. They were sorted into the four hypotheses outlined herein after.

Driving Ability in Patients with Severe Chronic Low Back or Osteoarthritis Knee Pain on Stable Treatment with Tapentadol Prolonged Release: A Multicenter, Open-label, Phase 3b Trial.

Introduction: Strong centrally acting analgesics, including tapentadol prolonged release (PR), have demonstrated efficacy for the management of non-malignant, chronic pain. Maintaining patient independence, including the ability to drive safely, is a key goal of long-term analgesic therapy. This multicenter, open-label, phase 3b trial evaluated the effects of tapentadol PR on driving ability.

Cross-cultural adaptation, evaluation and validation of the Spouse Response Inventory: a study protocol.

Introduction: Since the response of spouses has been proven to be an important reinforcement of pain behaviour and disability it has been addressed in research and therapy. Fordyce suggested pain behaviour and well behaviour be considered in explaining suffering in chronic pain patients. Among existing instruments concerning spouse's responses the aspect of well behaviour has not been examined so far.

NSAIDs or opioids, damned if you do, damned if you don't?: evidence-based selections to optimize therapeutic goals and minimize harms.

Objective: Available evidence to help guide efficacious nonsteroidal anti-inflammatory drug and opioid analgesic prescribing will be reviewed.

Design: Review.

Conclusions: The available evidence can guide but cannot provide any prescriber with absolute knowledge regarding outcome for these frequently prescribed and potentially dangerous agents.

Safety and efficacy outcomes of long-term treatment up to 4 years with 5% lidocaine medicated plaster in patients with post-herpetic neuralgia.

Objective: Prospective evaluation of the long-term efficacy and safety of the 5% lidocaine medicated plaster in patients with post-herpetic neuralgia (PHN).

Research Design And Methods: Patients with persisting pain for ≥3 months after acute herpes zoster and a baseline pain intensity of at least 4 on an 11-point numerical rating scale (NRS 0-10) were treated with 5% lidocaine medicated plasters for up to 5 years and monitored in regular intervals. Efficacy parameters are presented for the first 4 years and include patients' recall of pain relief (6-point verbal rating scale (VRS), clinical global impression of change (CGIC), patients' global impression of change PGIC), and the global evaluations of study medication.

Ask The Experts: Critical issues in cancer pain management.

Rainer Sabatowski qualified as anesthesiologist in 1995 and as pain specialist in 2003. He was head of a pain clinic at the University of Cologne, Germany, from 2002 to 2007. Since 2007 he has been head of the Comprehensive Pain Center at the University Hospital "Carl Gustav Carus" at the Technical University Dresden (Germany).

Topical nonsteroidal anti-inflammatory drugs for management of osteoarthritis in long-term care patients.

Osteoarthritis is common in patients ≥65 years of age. Although nonsteroidal anti-inflammatory drugs (NSAIDs) are often prescribed for osteoarthritis pain, they pose age-related cardiovascular, renal, and gastrointestinal risks. Two topical NSAIDs, diclofenac sodium 1% gel (DSG) and diclofenac sodium 1.

Influence from genetic variability on opioid use for cancer pain: a European genetic association study of 2294 cancer pain patients.

Cancer pain patients need variable opioid doses. Preclinical and clinical studies suggest that opioid efficacy is related to genetic variability. However, the studies have small samples, findings are not replicated, and several candidate genes have not been studied.

Pregabalin in treatment-refractory fibromyalgia.

Context: Fibromyalgia is a chronic musculoskeletal pain disorder. The pain can be intractable and may not respond to commonly-used treatments, such as tricyclic antidepressants and opioids.

Objectives: To evaluate pregabalin response in the subset of patients with fibromyalgia whose pain had been judged refractory to other treatments.

Pregabalin for postherpetic neuralgia: placebo-controlled trial of fixed and flexible dosing regimens on allodynia and time to onset of pain relief.

Unlabelled: Time to onset of pain relief and improvement in allodynia in 269 patients with postherpetic neuralgia was examined in a 4-week randomized trial comparing flexibly dosed pregabalin (150-600 mg/d), fixed-dose pregabalin (300 mg/d), and placebo. For each patient with clinically meaningful pain reduction (>or=30%) at end point, onset of pain relief was defined as the first study day on which a patient reported >or=1-point reduction in pain relative to baseline. Average dose achieved was 396 mg/d in the flexible-dose group compared with 295 mg/d in the fixed-dose group.

Pregabalin in the treatment of refractory neuropathic pain: results of a 15-month open-label trial.

Objective: Neuropathic pain associated with postherpetic neuralgia (PHN) and painful diabetic peripheral neuropathy (DPN) can be intractable and may not respond to commonly used treatments, such as tricyclic antidepressants (TCAs) and opioids. This long-term, open-label study was a preliminary evaluation of pregabalin for patients whose pain had been judged refractory to other treatments for neuropathic pain.

Design: Patients had previously participated in double-blind, placebo-controlled, randomized trials of pregabalin in DPN and PHN.

Interventions for low back pain: what does the evidence tell us.

Although interventional therapy for chronic spinal pain continues to be popular among patients and providers, the scientific evidence supporting these techniques has lagged behind their presence in the market. This article collates both classic and more recent experimental results involved in the interventional assessment and treatment of chronic spinal pain, and presents key findings for physicians. Although much of the body of evidence is either unsupportive or inconclusive, there are some definitive findings involving each technique that can help shape rational practice.

Oscillocusis: an unusual auditory aura in migraine.

We report a 14-year-old girl with a migraine aura characterized by the sense that ambient sounds were fluctuating in intensity, as if emanating from a radio while the volume control was being altered. These auditory oscillations lasted 5 to 10 minutes and were followed by a typical migraine headache. By analogy with oscillopsia, we term this unique form of migraine aura "oscillocusis.

Back school programs. The pain patient.

After headache, low back pain is the most common cause of intractable pain. It is a condition experienced by 50-80% of the world's population, ranking first among all health problems in frequency of occurrence. This chapter focuses on the treatment of chronic low back pain and describes the pain program at the University of Miami Comprehensive Pain and Rehabilitation Center.