Need For Pain Medication Research Articles

Exploring U.S. consumers’ knowledge, attitudes and practices towards over-the-counter medications

Pain is a common reason for self-medication with over-the-counter (OTC) analgesics. However, this self-treating population has remained largely uncharacterized. This cross-sectional observational study investigated individuals who self-medicate their pain with OTC analgesics to elucidate their pain characteristics and medication use. In addition, presence of and risk factors for concerns about pain medication were examined. The clinical profile of the participants (n = 1,889) was worse than expected with long-standing pain complaints (median pain duration of 9 years), pain located at multiple body sites (median of 4, and 13% with ≥10 painful body areas), about one-third suffering from daily pain and about 40% experiencing substantial pain-related disability. Head (58.6% of sample), low back (43.6%), and neck (30.7%) were the most common pain locations. About 73% had a physician diagnosis, mainly migraine and osteoarthritis. Paracetamol (used by 68.6% of patients) and nonsteroidal anti-inflammatory drugs (46.8%) were the most frequently used pain medications. About 40% of our sample showed substantial concern about the perceived need for pain medication and the perceived potential for harmful effects (eg, fear for addiction). These findings highlight the importance for health professionals to systematically probe pain patients about their self-medication practices and explore attitudes about pain medication.Perspective: This study found that the clinical picture of people who self-medicate their pain with OTC analgesics looked worse than expected. We also identified substantial concerns about pain medication. Therefore, we recommend that health professionals systematically probe pain patients about their self-medication practices and explore concerns about pain medication.

Oxygen equimolar mixture of nitrous oxide during post-operative physiotherapy in patients with cerebral palsy: A randomised double-blind placebo-controlled study

The administration of an equimolar mixture of nitrous oxide-oxygen (N 2 O) is recommended during painful procedures. However, the evaluation of its use during physiotherapy after surgery has not been reported, although pain may hamper physiotherapy efficiency. This study investigated whether the use of N 2 O improves the efficacy of post-operative physiotherapy after multilevel surgery in patients with cerebral palsy. It was a randomised 1:1, double-blind, placebo-controlled study. Sixty-four patients were enrolled. All patients had post-operative physiotherapy starting the day after surgery. Patients received either N 2 O or placebo gas during the rehabilitation sessions. All patients had post-operative pain management protocol, including pain medication as needed for acute pain. The primary objective was to reach angles of knee flexion of 110° combined with hip extension of 10°, with the patient lying prone, within 6 or less physiotherapy sessions. Secondary evaluation criteria were the number of sessions required to reach the targeted angles, the session-related pain intensity, and the analgesics consumption for managing post-operative pain. Targeted angles were achieved more often in the N 2 O group (23/32, 72%, vs. Placebo: 13/32, 41%; P = 0.01). Patients treated with N 2 O tended to require less often level III analgesic agents for managing post-operative pain, compared to those receiving placebo: 18/32 (58%) vs. 24/32 (75%). The administration of N 2 O during post-operative physiotherapy can help to achieve more quickly an improved range of motion, and, although not significant in our study, to alleviate the need for pain medication. Further studies evaluating the administration of N 2 O in various settings are warranted.

The inherent role of the multidisciplinary palliative care team on pain management: A critical review

Cancer pain and palliative care (PC) are recognized as significant international health issues. Treatment of pain and rehabilitation programs in PC are challenging. Rehabilitation is the process that helps a person to reach physical, psychologic, social and educational potential with physiologic, anatomic impairment, desires and life ambitions. Rehabilitation improves patients physical function, independence and pain management to improve quality of life and patients’ dignity. Update on the role of rehabilitation in PC by detailed view of rehabilitation treatment methods and their evidence for application into PC conditions. Databases of Cochrane Library, Google Scholar and Pubmed were search from January 2005–December 2016. There is few evidence that rehabilitation can impact function and pain management in PC. However, experience suggests that physical modalities should be applied early to minimize the generalized deconditioning and aid in the pain management, decreasing the need for pain medications. Physical modalities can be applied by health care providers. Passive, active, and active-assisted motion exercises and gentle strengthening exercises can aid in the maintenance of strength and joint range of motion. The prescription of assistive devices, and the teaching of compensatory techniques for mobility can aid in ambulation. There is also evidence that immune function may be improved by moderate exercise. A rehabilitation team has the ability to integrate physical aspects of treatment in a biopsychosocial model of pain into a comprehensive rehabilitation program for cancer patients. More research should focus on the role of rehabilitation and defining appropriate interventions.

Video-Assisted Mini-Open Sublay (VAMOS): A Simple Hybrid Approach for Lateral Incisional Hernias.

PurposeThe purpose is to present a new hybrid approach of lateral incisional hernia repair associated with reduced operative trauma and anatomically optimal mesh placement.MethodsVideo-Assisted Mini-Open Sublay (VAMOS) consists of a laparoscopic atraumatic dissection of the hernia sac, diaphanoscopy, laparoscopically-assisted closure of the fascial gap and mesh placement in sublay position through a minimized skin incision. Feasibility of this concept was assessed in a cohort of 7 consecutive patients.ResultsVAMOS approach was feasible in all 7 patients. Median hernia size was 8 cm, the median skin incision width was 7.7 cm. Median operative time was 86 min. In all patients a sufficient mesh overlap on all sides of the fascial gap was ensured. On short-term follow-up no procedure related complications were recorded, seroma formation occurred in 2 patients. Pain medication was necessary for median 4.9 days. There was no need for pain medication on day 14, whatsoever.ConclusionInitial VAMOS results show that the technique is simple, time-saving and safe. It provides a substantial reduction in postoperative pain compared to an open approach. Through implantation in the intermuscular sublay position and minor access-related trauma, it is possible to achieve a biomechanically optimal mesh position, to lay the foundations for adequate remodelling of the abdominal wall, and to prevent recurrence as well as local complications. All in all, VAMOS appears to have several advantages over current surgical strategies.

A randomized double-blind placebo-controlled trial on the effect of local analgesia on postoperative gluteal pain in patients undergoing sacrospinous ligament colpopexy

The incidence of temporary gluteal pain after sacrospinous ligament colpopexy ranges from 6.1% to 15.3%. Gluteal pain may occur as a result of injury to S3 to S5 nerve roots that course over the mid-portion of the coccygeus-sacrospinous ligament complex at the time of suspension suture placement. There are no data on the use of injections to prevent postoperative pain from nerve entrapment at the time of suture placement. The purpose of this study was to determine whether intraoperative local analgesia that is administered at the level of the sacrospinous ligament can lessen the gluteal pain felt by patients postoperatively after sacrospinous ligament colpopexy. In a randomized double-blind placebo-controlled trial, women with vaginal apex prolapse who were undergoing surgical treatment with sacrospinous ligament colpopexy underwent intraoperative injection with either 0.25% bupivacaine or normal saline solution. Subjects completed visual analog pain scales (0-10) and the Activities Assessment Scale and recorded the use of pain medications over a 6-week period. The primary outcome was postoperative gluteal pain. A sample size of 50 subjects (25 in each arm) was planned to test the hypothesis that local analgesia administration will lessen postoperative pain compared with placebo. Between April 2014 and March 2016, 51 women were enrolled in the study, and 46 women underwent sacrospinous ligament colpopexy. On postoperative day 1, 90.2% of all subjects (n=41) reported gluteal pain. At weeks 1 and 2, 63.8% (n=29) and 44.1% (n=20) women reported pain; at weeks 4 and 6, 33.3% (n=15) and 26.9% (n=12) women continued to have some pain. On day 1, the mean score for gluteal pain was 3.7±2.9. By week 1, the score was 1.8±2.6; by week 6, the mean score was 0.1±0.3. There were no differences in pain scores for patients who had undergone injection with 0.25% bupivacaine and those who were injected with normal saline solution. Patients in the placebo group used significantly more nonsteroidal antiinflammatory drugs than the treatment group: adjusted odds ratio, 1.25; 95% confidence interval, 1.04-1.35; P=.01). By 6 weeks, 87.5% of patients had returned to their baseline "light" activity level. There was no difference in time to return to baseline between the groups. Intraoperative administration of local analgesia does not reduce patients' perceptions of postoperative gluteal pain after sacrospinous ligament colpopexy; however, it may reduce the need for pain medication after surgery.

3:20 PM Abstract No. 45 Thoracic cryoablation for palliation of tumors in chest wall and pleura

To evaluate safety and efficacy of percutaneous cryoablation for palliation of primary and secondary tumors to chest wall and pleura. An IRB approved, retrospective analysis identified 30 patients (19 men, 11 women; mean age 61 ± 11.8 years; range 34-81) at an academic tertiary medical center who underwent a total of 34 thoracic cryoablation procedures between March 2012 and September 2017 using CT-guidance. Imaging studies and medical record were reviewed to extract tumor location and histology. Procedural details including device, probe number and type, treatment protocol, intraprocedural anesthesia and complications were collected. Pre- and posttreatment pain level and change in pain medication was also collected, in addition to duration of reported pain relief. Cases were selected with input from a multidisciplinary tumor board. Tumors ranged from 1 to 11 cm in size and included mesothelioma, and metastases from osteosarcoma, breast cancer, non–small cell lung cancer, renal cell carcinoma, adenoid cystic carcinoma, thymoma, hepatocellular carcinoma, colon adenocarcinoma, and medullary thyroid carcinoma. Clinical and imaging follow-up was available for an average of 13 months (range, 1-57 mos). A dual-freeze protocol and 2-6 cryoprobes were used, depending on the size and number of targeted lesions. All cases were performed under general anesthesia and intercostal nerve block was performed with 0.5% bupivacaine at the end of the procedure. One patient received peri-procedural antimicrobial coverage given the presence of a chest wall implant. There were no immediate complications. Pain scores and need for pain medication decreased in all cases. Duration of treatment response was variable. Cryoablation for palliation of tumors in chest wall and pleura is safe and effective. Our presentation details how to prevent intraprocedural complications and to maximize patient benefit.

Microendoscopic discectomy for lumbar disc herniations.

Introduction:Lumbar disc herniation is one of the main causes of discogenic low back pain and reported to affect 60%–80% of people during their lifetime. The two main surgical modalities for intervertebral disc surgery are standard open discectomy and minimally invasive discectomy which include percutaneous endoscopic lumbar discectomy and microendoscopic discectomy (MED). We report our experience with the same technique of MED to evaluate the efficacy of MED for lumbar disc pathology.Aims and Objectives:The aims and objectives were to study the efficacy, advantages, and associated limitations and complications of MED in lumbar disc herniations.Materials and Methods:This study was carried out on 300 patients who had single-level herniated disc. The procedure was done by Microscopic Endoscopic Tubular Retraction System. Preoperative assessment of Visual Analog Scale (VAS) and modified Suezawa and Schreiber (MSS) clinical scoring system was documented 1 day prior to surgery. Postoperative results were determined to be excellent, good, fair, or poor according to MacNab criteria and also evaluated by MSS clinical scoring system on postoperative day 7 and after 6 months.Results:A total of 187 patients were males and 113 patients were females and a majority of patients were in the age group of 31–40 years. A total of 192 patients had disc herniations at L4–L5 level. The mean operative time was 82 min and the mean hospital stay was 5.3 days. Eighteen cases (6%) developed postoperative complications including discitis, dysesthesia, recurrent prolapsed intervertebral disc, residual disc, dural tear, and nerve root injury. Mean preoperative VAS score was 8.7 and the mean postoperative VAS scores at postoperative day 7 and at 6 months were 2.25 and 1.12, respectively. The mean preoperative MSS score was 3.27 and the MSS scores at postoperative day 7 and at 6 months were 7.42 and 8.2, respectively. The overall successful outcome of the endoscopic discectomy after 6-month follow-up on the basis of VAS improvement percentage was 87.6%, MSS scoring percentage was 91.6%, and MacNab scoring percentage was 92.67%.Conclusion:MED is a safe and effective technique. It offers decreased blood loss, shorter operative time, shorter in-hospital stay, decreased need for pain medication, decreased rate of infection, and a shorter return to work time. Limitations of this technique include a learning curve which is related to surgery time, complications, conversion to open procedures, and recurrent disc herniation.

Ultra-mini PСNL versus RIRS in treatment of patients with nephrolithiasis

A comparative analysis of the two methods of contact lithotripsy was held in 41 patients with nephrolithiasis. Ultra-mini percutaneous nephrolithotripsy (Ultra-mini PСNL) was performed in the І group (19 patients) using sheath with outer diameter of 11Fr. Retrograde intrarenal surgery (RIRS) in the ІІ (22 patients). We can regard ultra-mini PСNL as safe, mini-invasive, effective procedure in management of renal calculi up to 2 cm in diameter. RIRS is the procedure of choice in patients with a JJ-stent previously installed due to obstruction because predilation of the ureter facilitates advancement of the ureteral access sheath. There was no significant difference in stone free rate between the groups, but ultra-mini PСNL is associated with shorter hospital stay, lower cost, shorter fluoroscopy time, greater postoperative hemoglobin drop. RIRS is accompanied by greater incidence of JJ-stent placement, less need for pain medication in postoperative period.

Mindfulness as a protective factor against depressive symptoms in people with fibromyalgia

Background: Depressive symptoms complicate pain management for people with FM, with adverse consequences such as a greater need for pain medications and limited pain coping strategies. Determining risks and protective factors associated with depressive symptoms in persons with FM could inform the development and implementation of mental health interventions.Aims: To formulate and test a behavioral activation model of depression with mindfulness as a protective factor for people with FM.Methods: We conducted an online cross-sectional survey with 117 adults with FM from community and clinic networks. Path analysis was used to assess the relationships of pain intensity, perceived stress, activity interference, pain catastrophizing and mindfulness with depressive symptoms.Results: Mindfulness has a negative direct association with depressive symptoms and a negative indirect association with depressive symptoms through perceived stress, activity interference and pain catastrophizing. Perceived stress, activity interference and pain catastrophizing had direct associations with depressive symptoms. Finally, perceived stress, activity interference and pain catastrophizing had indirect associations with depressive symptoms through pain intensity.Conclusions: Mindfulness seems to play an important role as a protective factor against the negative effects of stress and depression among people with FM and should be included in mental health interventions for chronic pain.

Patients’ Preferences Related to Treatments for Endometriosis-Related Pain: Results of a Discrete Choice Experiment in the UK

To generate evidence on patient preferences concerning medication attributes among UK patients with endometriosis-related pain. An online discrete choice experiment among endometriosis patients diagnosed 0.5-10 years ago and without confounding pain conditions. Attributes and levels were defined from literature search, expert and patient interviews. The design included 12 choice sets, each consisting of two alternative fictitious treatments and a No treatment option. A pilot study was conducted and a subset did a cognitive-debriefing interview. A D-efficient design was used for the full study. Analyses included a conditional logit model with interactions. The attributes following qualitative research were: mode of administration, ability to conceive, worst level of (i) pelvic pain, (ii) period pain, (iii) pain during intercourse, need for pain medication (days/month), fracture risk and out-of-pocket costs. Following pilot analysis (n=30) and patient interviews (n=10), minor wording and format changes were made. The full study included 200 participants. Participants’ average age was 32.5 (19-42), 58.5% used hormonal contraceptives, 71% wanted (more) children, and 45% were dissatisfied with current pain treatment; 78% of patients always took pain treatment during their periods, 79% reported a period pain-level of 7-10. Of pain types, period pain had the most influence; patients’ WTP was £36.39 for a period pain-level of 4-6. “Ability to conceive” was valued at £20.51/month and participants preferred options without fracture risk (£13.51/month). Both of these are limitations with current treatments. Treatment at a lower cost was preferred, as were oral tablets over vaginal rings and weekly injections. The most important pain type was period pain, perhaps influenced by the fact that 75% of participants experienced severe period pain. Overall lack of preference for vaginal rings should be interpreted with caution as interviews highlighted patients’ lack of awareness of this device. A treatment allowing patients to conceive was appreciated.

Equimolar mixture of nitroux oxyde and oxygen during post-operative physiotherapy in patients with cerebral palsy: A randomized, double-blind, placebo-controlled study.

The administration of an equimolar mixture of nitrous oxide and oxygen (N2O) is recommended during painful procedures. However, the evaluation of its use during physiotherapy after surgery has not been reported, although pain may hamper physiotherapy efficiency. This study investigated whether the use of N2O improves the efficacy of post-operative physiotherapy after multilevel surgery in patients with cerebral palsy. It was a randomized 1:1, double-blind, placebo-controlled study. All patients had post-operative physiotherapy starting the day after surgery. Patients received either N2O or placebo gas during the rehabilitation sessions. All patients had post-operative pain management protocol, including pain medication as needed for acute pain. The primary objective was to reach angles of knee flexion of 110° combined with hip extension of 10°, with the patient lying prone, within six or less physiotherapy sessions. Secondary evaluation criteria were the number of sessions required to reach the targeted angles, the session-related pain intensity and the analgesics consumption for managing post-operative pain. Sixty-four patients were enrolled. Targeted angles were achieved more often in the N2O group (23 of 32, 72%, vs. Placebo: 13/ of 32, 41%; p=0.01). The administration of N2O during post-operative physiotherapy can help to achieve more quickly an improved range of motion, and, although not significant in our study, to alleviate the need for pain medication. Further studies evaluating the administration of N2O in various settings are warranted. During this randomized placebo-controlled double-blind study, children receiving nitrous oxide and oxygen (N2O) achieved more often the targeted range of motion during physiotherapy sessions after multilevel surgery. Compared to placebo, nitrous oxide and oxygen (N2O) enabled a better management of acute pain related to physiotherapy procedures.

The Influence of Anesthesia On Perioperative Outcome in Children - Institutional and Individual Factors

The perioperative care of children is challenging for health care providers. Since anesthetists cannot affect the nature of the disease and have hardly an impact on the decision for surgery we summarized in this review individual and institutional factors for improving perioperative outcome by anesthetists. Individual factors include the level of education and the professional experience of the anesthetist as well as an anesthetic management that is focused on the maintenance of an adequate cerebral perfusion. Besides individual factors this review emphasizes the importance of institutional factors as measures to reduce anxiety and insecurity of the parents which result in less distress and coping of the children in the postanesthesia care unit as well as less need for pain medication, less emergence delirium and less sleep disorders. A behaviorally oriented preoperative preparation of parents and children also affects the postoperative course of the pediatric patients positively as well as institutional concepts for the reduction of perioperative medication errors and adverse drug events. We believe that perspectively pediatric surgery will be increasingly performed in high volume hospitals which are able to guarantee beneficial institutional structures as well as a high educational level and high professional experience of the employed anesthetists.

Nerve Growth Factor Antagonists: Is the Future of Monoclonal Antibodies Becoming Clearer?

Although there is an unmet need for pain medications that are both effective and safe, virtually no novel analgesics have been approved over the past two decades. In view of both experimental and clinical evidence of a major role for nerve growth factor (NGF) in the generation and maintenance of a wide range of pain states, the clinical development of humanised anti-nerve growth factor monoclonal antibodies (anti-NGF mAbs) aroused particular interest. However, the US Food and Drug Administration (FDA) placed a clinical hold on anti-NGF mAb clinical studies in late 2010, first because of reports of serious joint-related adverse events, and afterwards because of sympathetic nervous system safety concerns. The development programmes of tanezumab and fasinumab resumed after the FDA lifted its hold in March 2015, whereas other anti-NGF mAbs were dropped by their sponsors. This article provides an updated review on the analgesic efficacy and safety of anti-NGF agents based on data from fully published studies and public information from websites, and discusses the possible future role of these agents in managing chronic pain. The efficacy of anti-NGF mAbs was highly variable depending on the chronic pain condition studied. The most consistent and convincing results were obtained in patients with symptomatic osteoarthritis of the knee and/or hip. Conversely, studies in non-specific lower back pain and peripheral neuropathic pain generated mixed results. Finally, there was no conclusive evidence of the effectiveness of anti-NGF mAbs in cancer pain and urological chronic pelvic pain syndromes. Treatment-emergent adverse events were similar across anti-NGF mAbs, thus being suggestive of 'class-specific effects'. Although most patients tolerated anti-NGF agents well, neurosensory symptoms occurred frequently, and some patients developed new or worsened peripheral neuropathies. However, the most problematic safety issue was rapidly destructive arthropathies, leading to joint replacement surgery. To date, the aetiologies of joint-related side effects and their pathophysiology have not been clearly elucidated. However, some risk factors have been identified, such as higher doses of anti-NGF mAbs and longer drug exposure, concurrent nonsteroidal anti-inflammatory drug use and pre-existing subchondral insufficiency fractures. Taken together, the present data suggest that low-dose anti-NGF mABs may exhibit a favourable risk-benefit ratio in selected patients with certain chronic pain conditions, especially symptomatic osteoarthritis.

The Effect of Magnesium Sulfate on Renal Colic Pain Relief; a Randomized Clinical Trial.

Renal colic can be managed by preventing the contraction movements of ureter muscles. By reducing acetylcholine in the nerve terminals, magnesium sulfate could be effective in this regard. The aim of this study is to investigate the effect of magnesium sulfate on acute renal colic pain relief. The present study was a double-blind clinical trial in which the patients suffering from acute renal colic were randomly divided into 2 groups of who either received standard protocol (intravenous infusion of 0.1 mg/Kg morphine sulfate, 30 mg of Ketorolac, and 100 ml normal saline as placebo/15 minutes) or standard protocol plus 15 mg/Kg of intravenous magnesium sulfate 50%/100 ml normal saline/15 minutes. Severity of patients' pain was measured by visual analogue scale (VAS) at baseline, and 30 and 60 minutes after infusion. The collected data were analyzed using STATA statistical software. 100 cases were randomly allocated to intervention or control group. The two groups were similar in baseline pain score and demographic characteristics. At 30 and 60 minutes, mean pain score was less in the intervention group compared to the control group. Moreover, the difference between the two groups was statistically significant regarding the additional amount of morphine, suggesting that the intervention group needed less additional morphine than the control group. The results of this study showed that Magnesium sulfate can be used as an adjunct drug in treatment of patients suffering from renal colic. It not only alleviates the pain in the patients, but also diminishes the need for pain medications.

Endoscopic Posterior Cervical Foraminotomy in Bony Stenosis – A Review of the Literature

Background: Posterior cervical foraminotomy is a feasible treatment option for cervical radiculopathy. In this article, we want to give a short review on the advantages, indications and limitations of this treatment procedure. Methods: A Medline search for endoscopic posterior cervical foraminotomy was done and 13 articles were compared regarding the surgical technique, patient outcome, complications, intraoperative blood loss, surgical time, hospital stay and postoperative need for pain medication. Results: Compared to patients treated by an open approach, patients treated by endoscopic posterior cervical foraminotomy show equal clinical results, but lower complication rates and less intraoperative blood loss, reduced surgical time, hospital stay and postoperative need for pain medication. Conclusion: This review shows that posterior endoscopic decompression is a successful option in the treatment of bony cervical foraminal stenosis.

In vitro and in vivo assessment of the abuse potential of PF614, a novel BIO-MD™ prodrug of oxycodone.

The need for pain medication which will not lead to abuse is well recognized. Ensysce has designed prodrug analogs of the commonly used pain medications including hydromorphone, oxycodone (OC), hydrocodone, and morphine that limit their use to oral delivery, two of which are in clinical development. This study was undertaken to demonstrate that PF614, an extended-release prodrug of OC, allows the release of OC as designed when delivered orally, yet it resists ex vivo extraction with household chemicals and is pharmacologically inactive when administered by nonoral routes (nasal and parenteral), thereby substantially reducing its intravenous (IV) and intranasal abuse potential. In vitro and in vivo methods were used to determine release of OC from PF614 and to show potential µ-opioid receptor activity. Plasma and cerebral spinal fluid levels of OC were evaluated following in vivo IV administration of PF614 in rats. In vitro extraction of OC from PF614 was explored using enzymes, common solvents, and household chemicals at room temperature and elevated temperature over time to determine release of OC from the prodrug. PF614 was stable with in vitro exposure to human plasma, saliva, and liver microsomes or culinary enzyme preparations. PF614 was stable (≥90 percent remaining as intact prodrug) under all room temperature conditions evaluated for 24 hours. At 80°C for 1 hour, no OC was released. Incubation at 80°C for 24 hours in vinegar or vodka produced a conversion to OC of 6 percent. Incubation with trypsin at 37°C converted PF614 approximately stoichiometric to OC with half-life of 4 hours. PF614's penetration of the central nervous system was 83-fold lower than OC and it had a 6.5-fold reduced potency as a µ-opioid agonist. Finally, oral PF614 delivers OC into plasma with an extended-release profile in dogs (reduced Cmax; delayed Tmax). The Bio-Activated Molecular Delivery prodrug design limits the use of PF614 to the intended oral route of delivery with reduced potential for IV or nasal abuse, as it cannot be activated intravenously or nasally to provide an active opioid. Unlike existing opioid formulations, the extended-release profile of PF614 cannot be accelerated by chewing or ex vivo extraction to pharmacologically active substances.

Predictors of Response to Radioligand Therapy of Metastatic Castrate-Resistant Prostate Cancer with 177Lu-PSMA-617.

RLT was performed in 40 hormone-refractory patients with distant metastases and progressive disease (mean age, 71.4 y). 68Ga-PSMA-11 PET/CT was performed in all patients 1-2 wk before RLT. All patients were treated with a mean of 6 GBq. The SUVmax of tumor lesions was determined using region-of-interest analysis. Complete blood counts, renal and liver function assessments, previous therapies, pain medication, and SUVs were included in the analysis. PSA was assessed 2 mo after RLT. In the univariate analysis, younger age, higher levels of γ-glutamyl transferase, lower pretherapeutic hemoglobin, a higher Gleason score, a higher number of platelets, higher C-reactive protein, regular need for pain medication, and higher lactate dehydrogenase had a negative impact on the therapeutic response; however, the multivariate analysis revealed that the most significant independent factors were the number of platelets and regular need for pain medication. The response was independent of the amount of PSMA uptake as well as previous therapies and other measured factors. A PSA decline of more than 50% was observed significantly more in patients without a regular need for analgesics.

Self-Administered Lidocaine Gel for Intrauterine Device Insertion in Nulliparous Women: A Randomized Controlled Trial.

To evaluate self-administration of vaginal lidocaine gel to decrease pain with intrauterine device (IUD) insertion in nulliparous women. In this randomized, double-blind, placebo-controlled trial, women self-administered 2% lidocaine or placebo vaginal gel 5 minutes before IUD insertion. The primary outcome was change in pain from baseline to IUD insertion on a 100-mm visual analog scale. We also assessed pain after speculum insertion, tenaculum placement, uterine sounding, and 5 minutes after IUD insertion. Secondary outcomes included patient acceptability, ease of IUD insertion, and need for pain medication for up to 7 days. From July 2012 to May 2013, 59 women were randomized; 30 received lidocaine gel and 29 placebo. Baseline demographics, including age, race, and body mass index, were similar. There was no difference in median change in pain during IUD insertion in women receiving lidocaine (61 mm [interquartile range 53-71]) compared with placebo (69 mm [interquartile range 63-80], P=.06). Women receiving lidocaine experienced less pain with tenaculum placement (32 mm [interquartile range 18-54]) compared with placebo (56 mm [interquartile range 26-75], P=.02). Most (76%) women were satisfied with their IUD insertion experience and 86% would probably or definitely recommend an IUD to a friend. Thirty-four percent of women required pain medication for at least 3 days after IUD insertion. For nulliparous women, self-administered vaginal lidocaine gel does not reduce pain with IUD insertion, but does decrease pain with tenaculum placement. ClinicalTrials.gov, http://clinicaltrials.gov, NCT01534520.

Culture-broker and medical decoder: contributions of caregivers in American Indian cancer trajectories.

Caregivers play a special role in the management and control of cancer-related pain. For American Indians with cancer, caregivers can contribute to patient education, medication compliance, and can facilitate communication between the patient and the provider and the patient and the family. To identify the role(s) of caregivers of American Indian cancer survivors. As a part of a large randomized intervention designed to improve barriers to cancer symptom management, 13 focus groups were held among American Indian cancer survivors and their caregivers at Southwest reservations and urban sites. Focus groups, audiotaped and transcribed, used constant comparative methods in the analysis of caregiver dialogues. Caregivers are patient educators and provider culture-brokers and their communication strategies use a combination of cultural and conventional strategies in their care of American Indian cancer patients. Cultural communication styles include "talk stories" (storytelling), group (talking circles), and dialogue to manage cancer pain, educate the patient and community, and to protect the patient from stigma, reduce barriers to care, and provide support to patients and families. Active discussion with providers "re-packaged" the patient's reporting/responses to specific clinical measures (pain measure scores) and identified the need for pain medication and compliance-related issues. Findings are not generalizable to the American Indian population outside of the sites and focus groups from which data were collected. Caregivers are "cultural brokers" who inform providers of the cultural nuances associated with American Indian patient care. However, caregivers voiced that cultural restriction for not discussing illness openly was a sanction and an important barrier.

Mimic activity of differentiated pain intensities : Correlation of characteristics of Facial Action Coding System and electromyography

The monitoring of facial expressions to assess pain intensity provides away to determine the need for pain medication in patients who are not able to do so verbally. In this study two methods for facial expression analysis - Facial Action Coding System (FACS) and electromyography (EMG) of the zygomaticus muscle and corrugator supercilii - were compared to verify the possibility of using EMG for pain monitoring. Eighty-seven subjects received painful heat stimuli via athermode on the right forearm in two identical experimental sequences - with and without EMG recording. With FACS, pain threshold and pain tolerance could be distinguished reliably. Multiple regression analyses indicated that some facial expressions had apredictive value. Correlations between FACS and pain intensity and EMG and pain intensity were high, indicating acloser relationship for EMG and increasing pain intensity. For EMG and FACS, alow correlation was observed, whereas EMG correlates much better with pain intensity. Results show that the facial expression analysis based on FACS represents acredible method to detect pain. Because of the expenditure of time and personal costs, FACS cannot be used properly until automatic systems work accurately. The use of EMG seems to be helpful in the meantime to enable continuous pain monitoring for patients with acute post-operative pain.