RESUMO
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. While there is much needed research to examine the relationship between opioid misuse and TBI, the present recommendations provide at least some clinical considerations that might serve to prevent further deaths among a high-risk group.
Assuntos
Analgésicos Opioides/normas , Lesões Encefálicas Traumáticas/tratamento farmacológico , Prescrições de Medicamentos/normas , Transtornos Relacionados ao Uso de Opioides/prevenção & controle , Uso Indevido de Medicamentos sob Prescrição/prevenção & controle , Consenso , Humanos , Guias de Prática Clínica como AssuntoRESUMO
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. The study also included cognitive interviews of 20 patients with varying spasticity etiologies to determine if the draft screening tool was understandable and relevant to patients with spasticity. RESULTS: The Delphi panel reached an initial consensus on 21 of 47 items for the screening tool and determined that the tool should have no more than 11 to 15 items and a 1-month recall period for symptom and impact items. After 2 rounds of review, 13 items were selected and modified by the expert panelists. Most patients (n = 16 [80%]) completed the cognitive interview and interpreted the items as intended. CONCLUSIONS: Through the use of a Delphi panel and patient interviews, a 13-item spasticity screening tool was developed that will be practical and easy to use in routine clinical practice.
Assuntos
Avaliação da Deficiência , Espasticidade Muscular/fisiopatologia , Avaliação das Necessidades , Adulto , Idoso , Técnica Delphi , Pessoas com Deficiência , Feminino , Humanos , Entrevistas como Assunto , Masculino , Pessoa de Meia-IdadeRESUMO
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. Further research in the use of botulinum toxin to treat keloidal pain is warranted.
Assuntos
Toxinas Botulínicas Tipo A/uso terapêutico , Queloide/complicações , Fármacos Neuromusculares/uso terapêutico , Dor/tratamento farmacológico , Dor/etiologia , Idoso de 80 Anos ou mais , Feminino , HumanosRESUMO
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. This report describes another treatment option in rare cases of severe dry mouth after administration of BoNTB.
