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Helping you to make the most of your time on the Internet. The mission of Pain Treatment Topics is to serve as a noncommercial resource for healthcare professionals & their patients, providing open access to clinical news, information, research, and education for a better understanding of evidence-based pain-management practices. Visit the Site Overview for an explanation of the various tabs and sections.
Guest author, Dmitry M. Arbuck, MD, observes that the application of opioid antagonists, such as naltrexone, in chronic pain management relies on neurobiological differences between acute versus chronic pain generation and perception, and on underlying physiological and psychological mechanisms. Dr. Arbuck describes specific applications of naltrexone for chronic pain, including previously unpublished dosing regimens. Learn more here>
A recent meta-analysis of clinical studies examining yoga as an adjunct for pain management reports significant benefits for the relief of chronic pain and associated disability. However, a closer look reveals that available research is largely inadequate and potential harms of yoga need more cautious consideration. Read details>
> Chronic Pain Prolongs Postsurgical Pain > Could High-Dose Opioids Conquer Chronic Pain? > Fibromyalgia Linked to Deficient Vitamin D > Chiropractic or Exercise Tops Meds for Neck Pain > Harms of Epidural Steroid Injections Examined > What’s Really Driving Opioid-Related Death Rates?
See Table of Contents for ALL UPDATES> Stay Updated on UPDATES, Register for e-Notifications>
Latest Continuing Education Postings
From: PAINClinician.com; Charles E. Argoff, MD, et al.; 2011. Two-part CME program presents techniques for the multi-dimensional assessment of chronic pain and examines options for multimodal treatment. Case studies focus on drug treatments as well as nonpharmacologic therapies that address biopsychosocial issues contributing to pain severity and functional issues. See details>
From: PAINClinician.com; Jeffrey Gudin, MD, et al.; 2011. This 2-part CME activity reviews mechanisms of pain, as well as the pathophysiology of spinal pain. A case study explores evidence for the appropriate treatment of chronic neuropathic pain, including pharmacotherapy options. See details>
Opioid Rx & Safety
Management of Opioid Tolerability and By: Dmitry Arbuck, MD, et al. in Journal of Medicine, 2010. This important review discusses how adverse effects (AEs) of opioids may be classed as inhibitory or excitatory, or both. AEs can be treatment limiting, but a number of counter strategies are presented, including: opioid rotation and/or alternate analgesics, the selective use of opioid antagonists, and adjunctive therapies to better manage AEs. See details> Pharmacology of Opioids in the Treatment of Reviews opioid agonists, agonist-antagonists, partial agonists, and antagonists, with discussions of their potency, variations in receptor site binding affinities, and concentration at the receptor site. Information on 14 specific opioids is presented. See details>
New Book on Pharmacologic Pain Management
Pain Assessment and Pharmacologic Management by Chris Pasero and Margo McCaffery is meticulously researched and presents best practices and evidence-based guidelines for effectively managing pain with the latest medications and drug regimens. It is an essential resource and reference for all healthcare providers who treat pain of any type in adults of all ages. See more details and ordering info>
NEW Pain Treatment GUIDELINES/REPORTS
Adult Cancer Pain NCCN guideline includes algorithms for assessment, follow-up, and decisions related to referral for interventional therapies. Prescribing and titration tables for opioids and non-opioid dosing are included. Details here> ASPMN Guidelines on Monitoring for Opioid-Induced Sedation and Respiratory Depression Recommendations focus on assessment and monitoring practices, as well as interventions aimed at reducing the impact of adverse events. Details here>
NEW in Pain Disorders
Pain Management in Patients with Cancer: Focus on Opioid Analgesics Reviews opioid drugs as monotherapy or with adjuvant analgesics. See details> The Management of Cancer Pain The authors review barriers to cancer pain relief, including patient evaluation considerations. See details here>
NEW Resources for Patients
Spotlight on Fibromyalgia Articles and resources on fibromyalgia,including the need for an accurate diagnosis. See details> Shingles/PHN (Postherpetic Neuralgia) Resources discuss all aspects of shingles and its complication, postherpetic neuralgia. See listings>
Clinical Concepts: Current Comments
Paper examines the problems and suggests prescribing precautions. Access here>
Pain Disorders Section: Shingles/PHN
Shingles, or acute herpes zoster infection, is a common complication of reactivated varicella zoster virus (chicken pox). In turn, this may foster development of the chronic pain syndrome, postherpetic neuralgia (PHN). Ddocuments in this section explore all aspects of shingles/PHN, including diagnosis and treatment strategies. See listings>
Help for Safely Using Opioid Pain Relievers
Pain & Disability Assessment Tools to Note
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This page was last updated 1/21/12 |
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Improving pain practice requires better research. However, healthcare professionals, and certainly patients, usually have had little specific training in evaluating research. This UPDATES series on “Making Sense of Pain Research” helps to close the education gap, teaching readers how to understand and interpret the often mysterious and complex language of research to assess its quality and validity. 
Extensive, REMS-compliant, educational activity for patients and their caregivers focusing on the proper and safe use of opioid pain relievers. Pprovides an understanding of opioids and their risks. Vital instruction is provided on recognizing opioid problems and on being prepared for what to do during an emergency. 
Our listing of Pain & Disability Assessment Tools is one of the most frequently visited features. We continually work to make this the most comprehensive offering available anywhere.
The U.S. Food and Drug Administration is warning practitioners and patients about a potential mix-up between opioid analgesics from Endo Pharmaceuticals and common over-the-counter pain relievers like Excedrin and Bufferin made at a Novartis manufacturing plant. Tablets from one product may have carried over into packaging of another product. It also is expected that there may be temporary shortages of the involved analgesics. Some of the OTC products are being recalled [
The Transmucosal Immediate Release Fentanyl (TIRF) Risk Evaluation and Mitigation Strategy (REMS) is an FDA-required program beginning in March 2012. It is designed to ensure informed risk-benefit decisions before initiating treatment, and during treatment, to ensure appropriate use of all TIRF medications. TIRF REMS ACCESS is a shared program requiring a one-time enrollment by prescribers, patients, pharmacies, and distributors. 
This year’s initiative from the International Association for the Study of Pain (IASP) draws attention to one of the most common, painful, and disabling conditions that affect people throughout their lives: the headache. There are many useful, free resources at the IASP website and will be available during the year. 
Pain Treatment Topics provides non-commercial information and education on the causes and effective management of pain. To do this, we rely on support in the form of annual educational grants and, through these, we are able to provide all offerings absolutely free and without restriction to site visitors. Learn how your organization can participate in helping to support this website. 
