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1.
Anesth Analg ; 105(6): 1805-15, 2007 Dec.
Article in English | MEDLINE | ID: mdl-18042886

ABSTRACT

Pregabalin is a new synthetic molecule and a structural derivative of the inhibitory neurotransmitter gamma-aminobutyric acid. It is an alpha2-delta (alpha2-delta) ligand that has analgesic, anticonvulsant, anxiolytic, and sleep-modulating activities. Pregabalin binds potently to the alpha2-delta subunit of calcium channels, resulting in a reduction in the release of several neurotransmitters, including glutamate, noradrenaline, serotonin, dopamine, and substance P. In this review, I will discuss the pharmacology of pregabalin and available efficacy studies in pain management. This review will focus on the advances in pregabalin pharmacology since my previous review in 2005.


Subject(s)
Pain/drug therapy , gamma-Aminobutyric Acid/analogs & derivatives , Animals , Disease Management , Humans , Pain/metabolism , Pregabalin , gamma-Aminobutyric Acid/pharmacology , gamma-Aminobutyric Acid/therapeutic use
2.
Curr Top Med Chem ; 7(3): 235-49, 2007.
Article in English | MEDLINE | ID: mdl-17305567

ABSTRACT

COX-2 inhibitors are equally as efficacious as the non-selective NSAIDs for the treatment of postoperative pain, but have the advantages of a better gastrointestinal side-effect profile as well as a lack of antiplatelet effects. There have been recent concerns regarding the cardiovascular side effects of COX-2 inhibitors. Nonetheless, they remain a valuable option for postoperative pain management. The pharmacology of these agents and available studies are reviewed.


Subject(s)
Cyclooxygenase 2 Inhibitors/therapeutic use , Pain, Postoperative/drug therapy , Celecoxib , Cyclooxygenase 2 Inhibitors/pharmacology , Humans , Isoxazoles/pharmacology , Isoxazoles/therapeutic use , Pyrazoles/pharmacology , Pyrazoles/therapeutic use , Sulfonamides/pharmacology , Sulfonamides/therapeutic use , Treatment Outcome
3.
J Pain ; 6(5): 333-7, 2005 May.
Article in English | MEDLINE | ID: mdl-15890635

ABSTRACT

UNLABELLED: Chronic perineal pain is often a difficult condition to manage. Current treatments include pudendal nerve injections and pudendal nerve release surgery. The obturator internus muscle has a close relationship to the pudendal nerve and might be a potential target for therapeutic intervention. PERSPECTIVE: A case is presented of refractory perineal pain that was successfully treated by injecting the obturator internus muscle with botulinum toxin A.


Subject(s)
Botulinum Toxins, Type A/administration & dosage , Musculoskeletal Diseases/drug therapy , Neuromuscular Agents/administration & dosage , Pelvic Pain/drug therapy , Chronic Disease , Female , Humans , Middle Aged , Muscle, Skeletal/innervation , Muscle, Skeletal/physiopathology , Musculoskeletal Diseases/complications , Pelvic Floor/innervation , Pelvic Floor/physiopathology , Pelvic Pain/etiology , Perineum
5.
Anesthesiol Clin North Am ; 23(1): 49-72, 2005 Mar.
Article in English | MEDLINE | ID: mdl-15763411

ABSTRACT

Cyclooxygenase (COX)-2 inhibitors are as efficacious as nonselective nonsteroidal anti-inflammatory drugs for the treatment of postoperative pain but have the advantages of a better gastrointestinal side-effect profile as well as a lack of antiplatelet effects. There have been recent concerns regarding the cardiovascular side effects of COX-2 inhibitors. Nonetheless, they remain a valuable option for postoperative pain management. The pharmacology of these agents and available studies are reviewed.


Subject(s)
Cyclooxygenase Inhibitors/therapeutic use , Pain, Postoperative/drug therapy , Prostaglandin-Endoperoxide Synthases/metabolism , Animals , Contraindications , Cyclooxygenase 2 , Cyclooxygenase 2 Inhibitors , Cyclooxygenase Inhibitors/adverse effects , Drug Interactions , Humans , Membrane Proteins , Prostaglandin-Endoperoxide Synthases/biosynthesis
6.
Pain Pract ; 5(2): 95-102, 2005 Jun.
Article in English | MEDLINE | ID: mdl-17177755

ABSTRACT

Pregabalin is a new analog of the neurotransmitter gamma-aminobutyric acid (GABA). It is an alpha2-delta (alpha2-delta) ligand that has analgesic, anticonvulsant, and anxiolytic activity. Alpha2-delta is an auxiliary protein associated with voltage-gated calcium channels. Pregabalin binds potently to the alpha2-delta subunit resulting in modulation of calcium channels and reduction in the release of several neurotransmitters, including glutamate, norepinephrine, serotonin, dopamine, and substance P. This review discusses the pharmacology of this medication as well as available studies in patients.

7.
Reg Anesth Pain Med ; 29(3): 243-56, 2004.
Article in English | MEDLINE | ID: mdl-15138911

ABSTRACT

In the management of patients with low back pain and radiculopathy, selective nerve root blocks (SNRBs) are now a common procedure for both diagnostic and therapeutic purposes. This article reviews the available studies as well as the relevant anatomy, pathology, technical considerations, and complications.


Subject(s)
Low Back Pain/therapy , Nerve Block/methods , Radiculopathy/therapy , Spinal Nerve Roots , Humans , Low Back Pain/diagnosis , Radiculopathy/diagnosis , Spinal Nerve Roots/anatomy & histology , Spinal Nerve Roots/physiology
8.
J Pain Symptom Manage ; 27(5): 440-59, 2004 May.
Article in English | MEDLINE | ID: mdl-15120773

ABSTRACT

This study constituted the first step in the psychometric development of a self-report screening instrument for risk of opioid medication misuse among chronic pain patients. A 26-item instrument, the Pain Medication Questionnaire (PMQ), was constructed based on suspected behavioral correlates of opioid medication misuse, which heretofore have received limited empirical investigation. The PMQ was administered to 184 patients at an interdisciplinary pain treatment center. Reliability coefficients for the PMQ were found to be of moderate but acceptable strength. Construct and concurrent validity were examined through correlation of PMQ scores to measures of substance abuse, physical and psychological functioning, and physicians' risk assessments. To explore high and low cutoff points for misuse risk, subgroups were formed according to the upper and lower thirds of PMQ scores and compared on validity measures. Higher PMQ scores were associated with history of substance abuse, higher levels of psychosocial distress, and poorer functioning. Future psychometric analyses will consider predictive validity and examine shortened versions of the instrument.


Subject(s)
Narcotics/therapeutic use , Pain/diagnosis , Pain/drug therapy , Psychometrics/methods , Risk Assessment/methods , Substance Abuse Detection/methods , Substance-Related Disorders/diagnosis , Substance-Related Disorders/psychology , Analgesics, Opioid/therapeutic use , Attitude to Health , Chronic Disease , Comorbidity , Female , Health Care Surveys/methods , Humans , Male , Middle Aged , Pain/epidemiology , Pain/psychology , Psychometrics/statistics & numerical data , Reproducibility of Results , Risk Factors , Sensitivity and Specificity , Substance Abuse Detection/statistics & numerical data , Substance-Related Disorders/epidemiology , Substance-Related Disorders/prevention & control , United States/epidemiology
9.
N Engl J Med ; 350(8): 840-2; author reply 840-2, 2004 Feb 19.
Article in English | MEDLINE | ID: mdl-14978838
11.
Anesth Analg ; 97(1): 156-62, table of contents, 2003 Jul.
Article in English | MEDLINE | ID: mdl-12818959

ABSTRACT

UNLABELLED: Although interdisciplinary pain management programs are both therapeutically effective as well as cost-effective, they are currently being underutilized because of managed care policies. We used this prospective comparison trial, with 1-yr follow-up of chronic pain patients, to demonstrate the short- and long-term efficacy of an interdisciplinary pain management program, and evaluate the impact of managed care's physical therapy "carve out" practices on these treatment outcomes. Consecutive chronic pain patients (n = 201) were evaluated, some of whom had their physical therapy "carved out" from this integrated program. Results revealed that successful completion of interdisciplinary pain management was therapeutically effective. Most importantly, physical therapy "carved out" practices had a negative impact on both the short-term and 1-yr follow-up outcome measures. Thus, interdisciplinary pain management is effective in treating the major health problem of chronic pain. However, insurance carrier policies of contracting treatment "carve outs" significantly compromise the efficacy of this evidence-based, best standard of medical care treatment. This raises important medico-legal and ethical issues. IMPLICATIONS: Interdisciplinary pain management is effective and cost-effective in treating the major health problem of chronic pain. The present study demonstrated its efficacy using a prospective, 1-yr posttreatment evaluation methodology. Moreover, physical therapy "carve out" practices by insurance carriers had a negative impact on the outcomes, raising important medico-legal and ethical issues.


Subject(s)
Managed Care Programs/organization & administration , Pain Management , Chronic Disease , Depression/psychology , Disability Evaluation , Follow-Up Studies , Humans , Pain/psychology , Pain Measurement , Patient Dropouts/statistics & numerical data , Physical Therapy Modalities , Prospective Studies , Psychiatric Status Rating Scales , Surveys and Questionnaires , Treatment Outcome
13.
Clin J Pain ; 18(3): 139-43, 2002.
Article in English | MEDLINE | ID: mdl-12048414

ABSTRACT

OBJECTIVE: The objective was to evaluate whether the Multidimensional Pain Inventory (MPI) is effective for predicting response to interdisciplinary treatment in a heterogeneous group of patients with chronic pain. Changes in patients' profiles to a predominantly adaptive coping status after treatment also were assessed. DESIGN: A prospective study was conducted of patients with an array of pain conditions. A standard evaluation battery, including measures of self-reported pain and disability, psychosocial functioning, helpfulness of the program, and medication use, was used for all patients before and after treatment. The MPI status of patients was evaluated and differential response to treatment was assessed. METHODS: Sixty-five consecutive patients with chronic pain were evaluated before and immediately after participation in an interdisciplinary pain treatment program. This heterogeneous pain-condition cohort was also differentiated on the basis of the MPI to evaluate potential differential response to treatment. RESULTS: Results revealed significant improvement among these patients with chronic pain when a comprehensive interdisciplinary pain-management program was administered. This improvement was seen across the variety of outcomes evaluated, including narcotic medication use. Most important, the MPI subgroup classification did not significantly predict the degree of positive treatment outcome; all subgroups improved. CONCLUSIONS: Although there were major differences in psychosocial functioning before treatment, the MPI was not found to significantly predict response to interdisciplinary treatment in a heterogeneous group of patients with chronic pain. Thus, a comprehensive interdisciplinary treatment program may achieve its full effectiveness across a wide array of pain/disability-related outcome variables, regardless of initial MPI profile categorization.


Subject(s)
Pain Management , Pain Measurement/methods , Pain/physiopathology , Adult , Aged , Chronic Disease , Cohort Studies , Female , Forecasting , Humans , Male , Middle Aged , Palliative Care/methods , Patient Care Team , Prospective Studies , Treatment Outcome
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