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ABSTRACTQuestions from patients about pain conditions and analgesic pharmacotherapy and responses from authors are presented to help educate patients and make them more effective self-advocates. In reply to a question, lumbar spinal stenosis, commonly a multifactorial disease that can have profound functional consequences, is considered, along with a discussion of physical and pharmacologic treatments and quality of life.

ABSTRACTQuestions from patients about pain conditions and analgesic pharmacotherapy and responses from authors are presented to help educate patients and make them more effective self-advocates. Trigger point pathophysiology in myofascial pain syndrome, which involves muscle stiffness, tenderness, and pain that radiates to other areas of the body, is considered. The causes of trigger points and several theories about how they develop are reviewed, and treatment approaches, including stretching, physical therapy, dry needling, and injections, are offered.

Questions from patients about pain conditions and analgesic pharmacotherapy and responses from authors are presented to help educate patients and make them more effective self-advocates. In response to a question about advance directives for a patient experiencing chronic pain, the authors discuss the importance of having legal documents in place.

ABSTRACTQuestions from patients about analgesic pharmacotherapy and responses from the authors are presented to help educate patients and make them more effective self-advocates. The topic addressed in this issue is prolotherapy and a discussion and its history, types, indications, side effects and treatments.

Combination spinal analgesic chemotherapy: a systematic review.

BackgroundAdults with intellectual disability experience more pain than adults without and, despite a higher number of medications being prescribed, may be less likely to receive medication for pain. We conducted a systematic review of existing literature on medication for pain and painful conditions in adults with intellectual disability to explore if there is any association with polypharmacy, multimorbidity or demographic characteristics.MethodsThis systematic review followed PRISMA guidelines. Medline, Embase, PubMed, PsycINFO, Web of Science, CINAHL, Cochrane Library and Scopus were searched from January 2000 to 21st October 2024. We included original, peer-reviewed observational, qualitative or mixed-method studies published in English with data on medication for pain or painful conditions in adults with intellectual disability. Two independent reviewers performed study selection, data extraction, and quality assessment; disagreements were resolved by a third reviewer. Adapted Newcastle–Ottawa Scale or the Critical Appraisal Skills Programme for qualitative studies was used for quality assessment of included studies and findings were reported via narrative synthesis. PROSPERO registration: CRD42023415051.ResultsTwenty-seven of 26,170 articles met the eligibility criteria. Adults with intellectual disability were more likely to have simple analgesic medication than non-steroidal anti-inflammatory drugs, opioids or adjuvant pain medications than the general population. Psychotropic medications were more commonly prescribed in adults with intellectual disability than medication for pain or painful conditions. Adults with intellectual disability and caregivers reported under-recognition and most likely under-treatment of pain.ConclusionsAdults with intellectual disability may receive less pharmacological management of pain with analgesics and medication for painful conditions despite the high prevalence of polypharmacy, suggesting pain is under-treated. Better assessment and pharmacological treatment of pain and painful conditions is a key future research priority to address this health inequality and improve quality of life for this vulnerable group of people.

Case Scenario: Self-extraction of Intrathecal Pump Medication with a Concomitant Intrathecal Granulomatous Mass

ABSTRACTQueries from European physicians about analgesic pharmacotherapy and responses from the author are presented. Topics addressed in this issue pertain to opioids, drug interactions, and driving; and transdermal buprenorphine interactions and impact on respiratory function.This feature is adapted from paineurope 2012; Issue 1, ©Haymarket Medical Publications Ltd., and is presented with permission. paineurope is provided as a service to pain management by Mundipharma International, Ltd., and is distributed free of charge to health care professionals in Europe. Archival issues can be accessed via the Web site: http://www.paineurope.com, at which European health professionals can register online to receive copies of the quarterly publication.

ABSTRACTQuestions from patients about analgesic pharmacotherapy and responses from the authors are presented to help educate patient sand make them more effective self-advocates. The topics addressed in this issue are the signs, symptoms, and treatment of irritable bowel syndrome (IBS). A discussion of pain management and complementary therapies is included.

Inter-individual divergence in thresholds for detecting opioid effects: Within-subject human laboratory evidence of a testable behavioral phenotype.

The book Clinical Management of the Elderly Patient in Pain is an out of the ordinary read. It is edited by Dr Gary McCleane and Dr Howard Smith, both practicing pain clinicians who also contributed a number of the chapters. Other contributing authors are from the United States, United Kingdom and Canada, and represent a variety of fields including anesthesia, geriatrics, psychiatry and physiatry. The book has three introductory chapters on older adult demographics and pain, aging and pain, and pharmacological changes in elders. The main section of the book consists of 12 chapters on different classes of analgesics administered through a variety of routes and preparations, followed by chapters on physical therapy, psychosocial issues and uses of psychotropics. The book finishes with a chapter listing suggested medications for common painful conditions in older adults. There is an appendix of drug interactions as well as a glossary and index. The preface notes that this is not a typical book on pain management and states that it will consider “treatment that may be conventional, but also that which may appear more contentious”. The preface notes how it can be difficult to balance pain relief with side effects and advocates “considering the patient as a whole”. To the editors, this means considering not only treating the pain but also the harms that can come from analgesic side effects, polypharmacy and drug interactions. The audience of the book is the generalist “busy clinician” faced with “all the problems of satisfactorily managing pain in the elderly”. Each chapter has something for those interested in novel therapies for chronic pain. For example, I learned that menthol has analgesic properties mediated through the delta opioid receptor. I also learned about novel uses of topical nitrates for chronic pain. There are detailed descriptions of the evidence behind topical therapies, which in reducing systemic side effects, are certainly of benefit in older adults. The material is presented with enough prescribing information and supporting evidence to make one comfortable with trying these medications on patients. The editors remain true to the preface in considering the effects of the analgesics and their side effects but this information is not organized in any consistent fashion throughout the book. As indicated in the preface, only a short part of the book is dedicated to discussion of opioids. Some statements in the relevant chapter do stand out and merit mention. There is a statement that the development of analgesic tolerance is quite common in opioids but there is no evidence provided, contrary to most of the book. However, there is evidence that opioid tolerance is quite low (1). As well, a study is quoted as noting the increased risk of nonspine fractures in older women taking opioids (2). This same study shows an even higher risk of nonspine fractures for older women taking antidepressants, a drug class that is recommended throughout the book. The chapter author does say that his overall opinion – that opioids should used only in a limited fashion in chronic pain in elders – is based on his past experience. The evidence for the use of opioids is increasing (3,4); with systematic reviews showing a number needed to treat of 2.5 (5) and studies showing sustained improvement and no significant increase in adverse effects even in frail older adults (6). Increasingly, it is becoming apparent that there may be better opioid choices in frail elders and in renal failure (7,8). One of the best chapters is on psychosocial issues and provides useful and practical help to clinicians. The chapter on use of psychotropics also provides practical information as well as the principle of treating both the symptom and the person. There are other titles of related interest in the Haworth Series on Clinical Pain and Symptom Palliation that likely go into much greater detail on psychological and spiritual issues and nonpharmacological management of pain that would likely provide much greater depth in these areas. One of the major challenges in managing pain in older adults is the issue of pain management in those with cognitive impairment. Unfortunately, the only significant mention of cognitive impairment is with respect to side effects from medication as opposed to the difficulties of assessing and titrating analgesics in those with severe dementia who cannot contribute any meaningful history. The demographics of older adults, their need for improved pain management and the pharmacokinetic alterations in this population are key points that everyone needs to understand to manage pain in this population. However, these points are repeated in a number of chapters as if these were all written separately and not edited as a whole. The writing style is variable and at times faulty, which can distract from the useful content. A more detailed index would help clinicians to retrieve useful medication suggestions during a busy office. The preface noted that this book is intended to act as an interface between the specialist pain practitioner and busy generalist clinician trying to manage older adults in pain. However, many generalist clinicians are still needing to build the basic principles of pain management into their practice and need simpler, more directive tips about pain assessment and reevaluation, diagnosis, and considerations around treatment of underlying pathology to manage an older adult in pain. Clinical Management of the Elderly Patient in Pain is a detailed resource for those who are interested in the evidence that supports the use of new and emerging medications and routes of administration. I believe this book would be of interest to the generalist physician who has a special interest and experience in pain management and is able to read the whole text and bookmark the excellent suggestions for therapies that might be better tolerated in older adults.

BackgroundNo official published figures are available regarding the annual use of NSAIDs in Albania. Nonsteroidal anti-inflammatory drugs are used primarily to manage different pain conditions, less commonly they are used...

Purpose: Phenyramidol was first described pharmacologically in 1959 and is used in the treatment of painful musculoskeletal diseases.In this review, a collective evaluation of in silico, in vitro, in vivo, and clinical studies of Phenyramidol, whose analgesic and myorelaxant efficacy was initially defined, was performed.Our aim was to elucidate the clinical effects, safety, and tolerability profile of Phenyramidol.Method: Literature was retrieved by a PubMed search, using different combinations of pertinent keywords (e.g., phenyramidol, spasm, pain, musculoskeletal disorders), without any limitations in terms of the publication date and language.Papers that assessed the therapeutic efficacy and tolerability of phenyramidol were selected for inclusion according to their relevance for the topic, as judged by the authors. Results:In studies, it has been reported that Phenyramidol exhibits an effective and safe analgesic, myorelaxant and anti-inflammatory activity with equivalent analgesic potency to Codeine and Meperidine.It has been shown that with the use of oral or intramuscular Phenyramidol is an effective and safe treatment option that provides up to 94% improvement in painful musculoskeletal disorders and is tolerable in 96.8% of patients.No addictive effects or serious adverse effects on the cardiovascular system have been observed due to oral, parenteral, or concomitant oral and parenteral use of Phenyramidol.It has been reported in studies that oral phenyramidol does not cause any toxicity, does not have an addictive effect, and does not have any significant side effects on the gastrointestinal system even at daily dosages of up to 3200 mg.No serious side effects or mutagenic effects were observed in patients with the use of phenyramidol, and the incidence of side effects was reported to be similar to that of placebo.It has been observed that phenyramidol has strong anti-inflammatory efficacy in silico, in vitro, and in vivo studies, and in addition to having statistically significant higher analgesic efficacy than thiocolchicoside and acetylsalicylic acid, phenyramidol provides anti-inflammatory efficacy equivalent to Ibuprofen and Dexamethasone through balanced cyclooxygenase enzyme inhibition. Conclusion:Phenyramidol, which contains three pharmacological efficacies that are statistically significant potent analgesic, myorelaxant and anti-inflammatory in studies, is an effective and safe treatment option that provides up to 94% improvement in painful musculoskeletal disorders and is tolerable in 96.8% of patients.Phenyramidol, with its analgesic, myorelaxant and anti-inflammatory effects, is a treatment option that can be used as the first choice in the symptomatic treatment of painful musculoskeletal diseases.

Faculty Opinions recommendation of Is ethnicity associated with morphine's side effects in children? Morphine pharmacokinetics, analgesic response, and side effects in children having tonsillectomy.

In recent years, interest in the relationship between gut microbiota and disease states has grown considerably. Indeed, several strategies have been employed to modify the microbiome through the administration of different diets, by the administration of antibiotics or probiotics, or even by transplantation of feces. In the present manuscript, we focus specifically on the potential application of probiotics, which seem to be a safe strategy, in the management of digestive, pain, and emotional disorders. We present evidence from animal models and human studies, notwithstanding that translation to clinic still deserves further investigation. The microbiome influences gut functions as well as neurological activity by a variety of mechanisms, which are also discussed. The design and performance of larger trials is urgently needed to verify whether these new strategies might be useful not only for the treatment of disorders affecting the gastrointestinal tract but also in the management of emotional and pain disorders not directly related to the gut.