Number Of Pain Medications Research Articles

Whole-Body Cryostimulation in Fibromyalgia

<h3>Research Objectives</h3> to determine whether the addition of Whole-Body Cryostimulation (WBC) to a rehabilitation program is able to induce a greater reduction of pain, depressive symptoms, disease impact and improvement in function and sleep quality in female patients with fibromyalgia (FM) as compared to matched controls undergoing only a rehabilitation program. <h3>Design</h3> Randomized controlled trial. <h3>Setting</h3> Participants were recruited consecutively from the in-patients of the Rehabilitation Unit in our hospital. <h3>Participants</h3> We selected 45 patients with: i) age between 18 and 65 years; ii) FM diagnosed by a rheumatologist according to American College of Rheumatology criteria; iii) FM diagnosed for more than one year. 25 patients were randomly allocated to the WBC group and 20 patients to the control group. <h3>Interventions</h3> Daily 45-min physiotherapy and 45-min standard supervised adapted physical activity sessions for an average length of hospital stay of 26 days. Patients allocated to the WBC group received additional ten 2-minute WBC sessions at a temperature of -110°. <h3>Main Outcome Measures</h3> Pain severity (VAS 0-10); Disease impact (Fibromyalgia Impact Questionnaire); Depressive symptomatology(BDI-II25); Sleep quality (VAS 0-10); 6-min walking test (meters) were measured before (T0) and after the completion of the rehabilitation program (T1). <h3>Results</h3> No significant differences between groups at T0 in terms of age, BMI, pain duration, number of pain medications, and scores on questionnaires were observed. Both groups reported positive changes in all outcomes at T1. The between-group comparison showed a statistically larger magnitude of changes in the WBC group at T1, specifically, in pain severity, disease impact, sleep quality, and depressive symptoms. Statistically significant improvements in 6MWT were observed at T1 in both groups. The between-group comparison at T1 did not show significant differences, but longer distances walked were evident in the WBC group. <h3>Conclusions</h3> Our preliminary results suggest that WBC could represent an effective add-on treatment for improving pain, disease impact, sleep quality, and depressive symptoms in FM patients. Larger studies are needed to confirm our results. <h3>Author(s) Disclosures</h3> Nothing to disclose.

Does liposomal bupivacaine reduce hospital length of stay for multilevel lumbar decompressions? A retrospective matched cohort study

Objectives: Adequate post-operative pain control improves patient outcomes, leading to fewer analgesia-related complications and shorter length of hospital stay (LOS). Liposomal bupivacaine (LB) is a long-acting injectable anesthetic. This study evaluates the impact of local LB use on pain control outcomes (LOS, visual analog scale [VAS], narcotic usage, readmission, and complications) after multilevel spinal decompression surgery compared to matched cohorts without local LB. Methods: A single-center retrospective cohort study matched by age, gender, body mass index (BMI), medical comorbidities, and previous use of opioids was done at our institute. Subjects were divided into two groups; one who had LB at the end of spine surgery and one without LB. Patients’ demographics, number of operating levels, and outcomes parameters (LOS and VAS), number of pain medications used preoperatively, through the hospitalization and at discharge, complication rate, and readmission rate were collected. Results: Eighty-six patients with spinal stenosis were included; 45 (52.3%) in the LB group and 41 (47.7%) in the non-LB group. The average age was 67.8 ± 10.5. Both groups were comparable in terms of BMI and medical comorbidities. There was no diffidence in pain killers consumption between the two groups, throughout hospitalization and at the discharge. Strong statistically significant difference with VAS score favoring LB use (P &lt; 0.001). LOS was 15 h less in the LB group (32.4 ± 36.6 vs. 47.5 ± 39.1) (P = 0.069). The complication rate was 10.6%, with no difference between both groups (P = 0.49). Both groups had no readmissions or the emergency department visits for pain complaints. After excluding patients with complications, LOS was significantly shorter in the LB group (P = 0.029). In subgroup analysis for the LB group to look for the impact of the learning curve, the VAS score was less, and LOS was shorter in the second half of the included patients. However, the difference did not reach statistical significance. Conclusion: LB, as local infiltration at the end of a multilevel lumbar decompression, is an effective tool to decrease post-operative pain and shorten hospital stay, especially in patient with no post-operative complications.

“Back Rx, a personalized mobile phone application for discogenic chronic low back pain: a prospective pilot study”

BackgroundIntervertebral disc pathology is the most common identifiable cause of chronic lower back pain (CLBP). There are limited conservative alternatives to treat discogenic axial CLBP. Back Rx is a mobile application (app) developed to treat patients with this condition, following the Back Rx exercise program, assisted by a virtual coach.MethodsPatients 18 to 65 years of age, with axial CLBP (more than 3 months), and evidence of lumbar disc pathology by magnetic resonance imaging (MRI) were enrolled to the study. Patients’ symptomatology was prospectively evaluated at baseline and after 3 months of using the Back Rx app. The main outcome of the study was back pain evaluated using the visual analog scale (VAS) for pain. Secondary outcomes were the patient's functionality, the weekly pain medication intake, the patients’ adherence to the app, and the patients´ satisfaction rate.ResultsSeventy-five patients with CLBP were enrolled in the study. All patients had a statistically significant improvement from baseline to final follow-up in the average VAS scores, and the functionality evaluations. Average VAS scores decreased from 5.17 ± 2.1 at baseline to 3.8 ± 2.6 at final follow-up (P = 0.016). Patients showed a significant decrease in the number of pain medications taken during a week (P = 0.001). Overall compliance with the app was 52%, and 65% of the patients rated the overall experience as good or excellent.ConclusionThe Back Rx app decreased pain and increased function in patients with discogenic axial CLBP compared to their baseline status. Further measures are needed to increase patients' compliance with the app and the Back Rx program.Trial registrationRetrospectively registered in 2/2/2017 NCT03040310 (ClinicalTrials.gov).

P.129 Radiofrequency rhizotomy for trigeminal neuralgia under general anaesthetic with intraoperative neuromonitoring

Background: Radiofrequency rhizotomy is an efficacious technique for treatment of trigeminal neuralgia that is classically performed with the patient awake. Previous studies have investigated methods for both anatomic and neurophysiologic optimization for nerve targeting. Methods: We performed a retrospective review of prospectively collected data on patients undergoing radiofrequency rhizotomy under a general anesthetic. Electrodes are placed in the temporalis, masseter and one of mylohyoid or anterior belly of digastric muscles. We then localize of the correct subdivision of the trigeminal nerve. The division of the trigeminal nerve with pain shows a muscle response, which is not present in normal subdivisions. Results: A total of 23 radiofrequency rhizotomies were performed under general anesthetic. Abnormal conduction reflexes were present in all cases, and dissipated after lesioning. Pre-operative BNI pain scores were 4.1 ± 0.3, which dropped to 1.8 ± 1.9 post-op (p=0.003). Number of pain medications (2.9 ± 0.6 v. 1.3 ± 1.3, p=0.007) and number of patients with opioid usage (78.7% v. 21.7%, p=0.007) both decreased after rhizotomy. Conclusions: Using a novel conduction pathway, we have successfully been able to monitor radiofrequency rhizotomy in patients operated on under a general anesthetic, with promising preliminary results. Further work is needed to better evaluate this intervention.

Factors Associated With Oral Mucositis Severity in Children Who Have Received Chemotherapy.

Oral mucositis (OM) is a major complication for pediatric oncology patients undergoing cancer therapy. This paper aimed to report on the relationship between OM severity and various patient factors as well as to compare 2 scales used to assess OM severity. The severity of 68 separate episodes of OM in 47 pediatric oncology patients who had received chemotherapy was regularly assessed using the Children's International Mucositis Evaluation Scale (ChIMES) and World Health Organization (WHO) scale. The mean time from the start of the patients' chemotherapy block to the onset of OM was 8.4 days (±4.0), the median duration of OM was 7.0 days (4.0, 10.5) and median admission duration was 7.0 days (4.5, 13.5). There was a significant relationship between the severity of OM and the duration of symptoms ( P <0.001), patient's admission length ( P <0.001) and low neutrophil count. With decreasing neutrophil count, the severity of OM and number of pain medications used increased. Neutrophil count recovery coincided with resolution of OM. No significant relationship was found between OM severity and the child's cancer diagnosis. The 2 scales used to measure OM severity showed substantial agreement.

CLINICAL EFFECT OF ENDODONTIC DEBRIDEMENT FOR ACUTE APICAL INFLAMMATION

Background: Accurate diagnosis and effective management of acute toothache is one of the important aspects of dental care. In the past, with acute periapical inflamation, 19.4% - 71.2% of the surveyed clinical endodontists would open the space between appointments, however recent literature suggests that this method is prone to complications. Currently, there is a tendency not to open for drainage but to proceed with immediate endodontic treatment. Objectives: To compare the results of endodontic treatment of acute periodontitis by immediate endodontic debridement and open tooth methods. Materials and methods: Interventional prospective study on patients with teeth diagnosed with acute periapical inflammation. Patients were randomly divided into 2 groups: group I for immediate root canal treatment and group II for open tooth. Patients recorded pain levels and the number of pain medications used 5 days after the first treatment session. Treatment results are considered successful when the patient has no pain or mild pain after surgery, failure when the pain is moderate or severe after surgery. Comparison of mean time to completion of treatment between the 2 study groups. Results: In group I, values of pain were recorded lower than in group II during days 3 to 5 after treatment. The immediate root canal treatment group had a higher success rate of 77.8% compared to the open tooth group of 62.9%, with pain levels ranging from no pain to mild pain. The maximum number of pain medication used in group I was 5.44 ± 0.50, in group II was 5.54 ± 0.50. Then gradually decreased in the next 4 days. However, there was no significant difference between the 2 groups in the level of pain medications use. The number of treatment times of group I was mainly 2 and 3 times: accounting for 35.1% and 48.6%, less than group 2, mainly over 3 appointments, accounting for 77.8%. Conclusions: Patients improved pain symptoms after 5 days in both study groups. The immediate root canal treatment group had a higher success rate than the open tooth group. Key words: acute periapical imflamation, endodontic debridement, endodontic pain.

Neuropathic Pain in Hand Osteoarthritis: A Cross-Sectional Study.

Symptomatic hand osteoarthritis (OA) is a severely debilitating condition. Neuropathic pain (NP) has been shown to be a factor affecting pain severity, hand function, psychological wellbeing, body schema, and the number of pain medications in people with OA of other joints. The aim of this study was to assess the prevalence of NP in symptomatic hand OA and assess its association with pain, hand function, measures of psychological wellbeing, sleep, body schema disturbances, and number of pain medications. Participants with symptomatic hand OA diagnosed through the American College of Rheumatology criteria, were recruited and completed a series of online questionnaires. These included the Douleur Neuropathique 4 interview (DN4-interview), Short Form Brief Pain Inventory (SF-BPI), Neglect-like Symptoms questionnaire, Functional Index of Hand Osteoarthritis (FIHOA), Centre for Epidemiologic Studies Depression Scale (CES-D), Pain Catastrophising Scale (PCS), and the Pittsburgh Sleep Quality Index (PSQI). Logistic regression with age, body mass index, and sex as covariates were utilised to assess differences between participants with and without NP as identified through the DN4-interview. Correlation analysis assessed the relationship between pain intensity, body schema alterations, and number of pain medications. A total of 121 participants were included in the present study. Forty-two percent of participants presented with NP. Participants with NP reported higher levels of worst pain (OR: 10.2 95% CI: 2.2 to 48.5; p = 0.007). Worst pain intensity correlated with the number of pain medications (rho = 0.2; p = 0.04), and neglect-like symptoms (rho = 0.4; p < 0.0001). No difference between phenotypes was shown for catastrophising, function, depression, neglect-like symptoms, pain interference, or sleep. A large proportion of people with symptomatic hand OA present with NP. This phenotype is characterised by greater levels of pain intensity. Pain intensity is associated with number of pain relief medications and body schema alteration. Psychological factors, hand function, and sleep do not appear to be affected by the presence of NP.

Pain-coping types among older community-dwelling care receivers with chronic pain

Objectives There is a lack of knowledge on coping with pain and sub-group specific pain-coping profiles among older home care receivers with chronic pain. To describe pain-coping strategies, identify subgroups based on cognitive and behavioral pain-coping strategies and pain-related psychological impairment and to compare these groups with regard to socio-demographic, medical, pharmacological and psychological characteristics. Method Data of 212 care receivers were examined using the German pain-coping questionnaire (FESV) to determine how they cope with pain. Subgroups were identified using hierarchic agglomerative cluster analysis, using Ward’s algorithm and squared Euclidean distance, and characterized using socio-demographic, medical, pharmacological and psychological parameters. Multinomial logistic regression was used to identify variables associated with the subgroups. Results Older care receivers apply cognitive and behavioral strategies to manage pain. Three subgroups were identified: Cluster 1 (25.9%) with good coping competences and little psychological impairment, Cluster 2 (40.1%) with poor coping competences and high psychological impairment, and Cluster 3 (34%) with good coping competences and high psychological impairment. Significant differences between the clusters were observed for age, pain intensity, pain-related interference, daily activities, depression and resilience. Logistic regression demonstrated that belonging to Cluster 2 was associated with the number of pain-reducing medications, depression and resilience. Belonging to Cluster 3 was significantly linked to daily activities, the number of pain medications, depression and the level of care required. Conclusion Differentiating between pain-coping profiles in the group of older care receivers with chronic pain necessitates target group-specific pain-oriented psychotherapeutic interventions, which can result in improved pain management.

Cyclodestructive procedures for refractory glaucoma.

Cyclodestructive procedures for refractory glaucoma.

Reduction of post-operative pain after tonsillectomy by a local mucosal flap – a prospective, randomized, controlled clinical trial on 100 adult patients

Background: Tonsillectomy is one of the most frequent operations in otorhinolaryngology being associated with intense post-operative pain and an impairment of swallowing and speech.Aims: To determine whether wound sealing with a local mucosal flap can improve patient rehabilitation.Materials and methods: The study was designed as a prospective, randomized, monocentric, controlled clinical trial including 100 patients. Patients were operated on using either conventional extracapsular tonsillectomy (n = 50) or a modified technique with a local mucosal flap prepared from the posterior surface of the tonsil (n = 50). Number of requested pain medications, local oedema, patient-reported pain level, post-operative haemorrhage, impairment of speech, swallowing and general condition were assessed. The study was registered at the German Clinical Trials Register.Results: The mucosal flap technique significantly reduced post-operative pain [2.94 (intervention group) vs. 4.61 (control group) in an numerical analogue scale, p < .001] and the number of pain medications [6 (intervention group) vs. 1 (control group), p < .001].Conclusions: Wound sealing with a local mucosal flap can reduce post-operative pain in tonsillectomy patients and is recommended whenever anatomically feasible.Significance: This new tonsillectomy technique can help to reduce post-operative pain and thereby improve the patients’ post-operative rehabilitation.

Management of Chronic Neck and/or Low Back Pain With a Multimodal Nonpharmacological Pain Relief Kit

**Background:** Chronic neck and back pain lasting over 3 months is a significant source of disability. Recent recommendations for treating chronic pain indicate nonpharmacological interventions be initially prescribed. Topical menthol, elastic therapeutic tape, thermal therapy, and exercise have been found to be effective in reducing musculoskeletal pain. The pain relief kit described here includes these nonpharmacological interventions for patients to self-select their pain management. **Purpose:** The purpose of this 3-week study was to determine the effect of a multimodal, nonpharmacological pain relief kit on pain, functioning, and pain medication consumption in individuals experiencing chronic neck and/or low back pain. **Study Design:** This is a repeated measures single observational cohort study. **Methods:** Study participants included 25 volunteers with moderate intensity (>3/10) chronic neck and/or low back pain. Subjects completed baseline data collection and then received a pain relief kit. This kit included a brochure, product samples, and a description of how to use the four nonpharmacological interventions, includ- ing topical menthol, kinesiology tape, thermal therapy, and 3 stretching and 3 strengthening exercises to be performed using elastic resistance. Data were collected at 3 points—before giving the kit (baseline) and at 1 week (T1) and 3 weeks (T2) after giving the kit—using the Modified Patient Specific Functional Scale (MPSFS), Medical Outcomes Survey (MOS)-36, and by assessing their ability to complete 4 functional tasks and pain intensity while completing the tasks. Furthermore, all participants used a daily log to enter the rating of their pain, document the interventions used from the kit, and the number of pain medications they consumed. **Results:** There was a significant (P < .05) improvement between baseline to T2 in MPSFS and the MOS Physical Functioning and Energy/Fatigue scale. Also, between baseline to T2, the subjects reported improvement in performing 2 functional tasks and significantly less pain while completing all of the functional tasks. Finally, over the duration of the study, subjects reported significantly less daily pain, fewer days of pain per week, and less pain medication consumed per day. **Conclusion:** The use of nonpharmacological interventions provided in the pain relief kit allow chronic neck and low back pain patients to effectively self-manage their pain, improve their ability to perform functional tasks, and reduce their pain medication consumption.

Analyzing Analgesic Medications in Community-Dwelling Older Adults.

Analyzing medication data for research purposes is complex, and methods are rarely described in the literature. Our objective was to describe methods of quantifying opioid and nonopioid analgesics and to compare the utility of five different analgesic coding methods when analyzing relationships between pain, analgesic use, and clinical outcomes. In this study, we used physical function as the outcome variable for its clinical relevance and its relationship to pain in older adults. Secondary analyses of baseline cross-sectional data from the Advanced Cognitive Training Interventions for Vital Elders (ACTIVE) study. Community settings in six regions of the United States. A total of 2,802 community-residing adults older than age 65 years. A medication audit was conducted. Analgesics were coded as any pain medication, counts (total analgesics, number of opioids and nonopioids), equianalgesics (oral morphine equivalents, oral acetaminophen equivalents), and dose categories. Adjuvant medications used to treat pain (e.g., tricyclic antidepressants and anticonvulsants) and low-dose aspirin typically used for cardiovascular conditions were excluded from these analyses. To examine the utility of these various approaches, a series of hierarchical regression models were conducted with pain and analgesics as predictors and physical functioning as the dependent variable. Eighty-one point nine percent of participants reported experiencing recent pain, but 26% reported analgesic use. Nonopioids were the most common drug class used. Models revealed that pain was significantly associated with worse physical function (β = -0.45, P = 0.001), after controlling for demographic and analgesic variables. Two basic drug coding methods (e.g., any pain medication, number of pain medications) were equivalent in their explanatory power (β = -0.12, P = 0.001) and were slightly stronger predictors of function than the more complex coding procedures. Analgesic medications are important variables to consider in community-based studies of older adults. We illustrate several methods of quantifying analgesic medications for research purposes. In this community-based sample, we found no advantage of complex equianalgesic coding methods over simple counts in predicting physical functioning. The results may differ depending on the research question or clinical outcome studied. Thus, methods of analyzing analgesic drug data warrant further research.

Identifying Treatment Effect Modifiers in the STarT Back Trial: A Secondary Analysis.

This analysis provides preliminary exploratory findings about the characteristics of patients who might least likely benefit from targeted treatment using prognostic stratified care for LBP.

Occupational History For Adults With Sickle Cell Disease Compared With Healthy Siblings

IntroductionSickle cell disease (SCD) has a negative impact on academic and job functioning. Recurrent acute vaso-occlusive crises and organ dysfunction related to SCD can limit employment options and interfere with job retention. Potential associates of unemployment and poor job performance in adults with SCD include health-related (pain frequency and intensity, health-care utilization) and psychosocial (support system, coping mechanism). Moreover, poor academic achievement may increase the rates of unemployment in this patient group. The goal of this study is to compare patients' rates of unemployment and disability with those of their unaffected siblings. Patients and MethodsTwenty adult SCD patients (16 hemoglobin SS and 4 hemoglobin SC ; age: median = 29, range 20-56 years; sex: 8 males, 12 females) completed questionnaires relating to occupational experiences. Questionnaires were administered during routine clinic visits. Questions on the questionnaires relate to demographics, chronic pain scale, health-care utilization, use of hydroxyurea, employment status, length of employment, annual income, job satisfaction and use of tobacco, alcohol, or illicit drugs. These questionnaires also included questions relating to patients unaffected siblings who are within 5 years of age difference. We also performed paper and electronic chart review to obtain each patient's health related data including number of days in the hospital for acute illnesses and for routine clinic appointments in the previous year, number of pain medications, other chronic medical conditions and SCD-related laboratory and tests results. Fourteen out of twenty patients (70%) were on hydroxyurea therapy and 14/20 (70%) had 3 or more hospitalizations in the previous one year. Patients on chronic transfusion therapy and those with other disabling conditions unrelated to SCD were excluded. ResultsFour out of twenty SCD patients (20%) are currently employed as compared to 15/20 (75%) of their healthy siblings (p < .001, all tests reported are Fisher's Exact Test). Two of the SCD patients have been employed for more than 2 years as compared to 11 of their siblings (p = .006). Fourteen of SCD patients are on disability, while this is true for only one of the siblings (p < .001). Four of the twenty SCD patients are college graduates compared with 6 of the 20 unaffected siblings (p = .36). It is interesting to note that 12 out of 14 (86%) SCD patients who are currently on disability have previously had a job. Five of the fourteen (36%) SCD patients on disability reported that they missed more than 3 days per week of work due to their SCD. Of the unemployed patients, fourteen out of 16 (88%) wished they had a job. ConclusionsThis study highlights the negative impact of sickle cell disease on adult patients' employment rates and job retention. Even though 16/20 (80%) of the SCD patients have previously had a job, only 20% are currently employed. Extension of this study will focus on development of specific interventions that may improve accommodation of SCD patients by encouraging collaboration between patients, families, medical providers, and employers. We believe that this is necessary in order to provide the most favorable environment for these patients to have better job functioning and it will also result in less economic burden on the society. Disclosures:No relevant conflicts of interest to declare.

Postoperative Headache Following Acoustic Neuroma Resection: Occipital Nerve Injuries Are Associated With a Treatable Occipital Neuralgia

To demonstrate that occipital nerve injury is associated with chronic postoperative headache in patients who have undergone acoustic neuroma excision and to determine whether occipital nerve excision is an effective treatment for these headaches. Few previous reports have discussed the role of occipital nerve injury in the pathogenesis of the postoperative headache noted to commonly occur following the retrosigmoid approach to acoustic neuroma resection. No studies have supported a direct etiologic link between the two. The authors report on a series of acoustic neuroma patients with postoperative headache presenting as occipital neuralgia who were found to have occipital nerve injuries and were treated for chronic headache by excision of the injured nerves. Records were reviewed to identify patients who had undergone surgical excision of the greater and lesser occipital nerves for refractory chronic postoperative headache following acoustic neuroma resection. Primary outcomes examined were change in migraine headache index, change in number of pain medications used, continued use of narcotics, patient satisfaction, and change in quality of life. Follow-up was in clinic and via telephone interview. Seven patients underwent excision of the greater and lesser occipital nerves. All met diagnostic criteria for occipital neuralgia and failed conservative management. Six of 7 patients experienced pain reduction of greater than 80% on the migraine index. Average pain medication use decreased from 6 to 2 per patient; 3 of 5 patients achieved independence from narcotics. Six patients experienced 80% or greater improvement in quality of life at an average follow-up of 32 months. There was one treatment failure. Occipital nerve neuroma or nerve entrapment was identified during surgery in all cases where treatment was successful but not in the treatment failure. In contradistinction to previous reports, we have identified a subset of patients in whom the syndrome of postoperative headache appears directly related to the presence of occipital nerve injuries. In patients with postoperative headache meeting diagnostic criteria for occipital neuralgia, occipital nerve excision appears to provide relief of the headache syndrome and meaningful improvement in quality of life. Further studies are needed to confirm these results and to determine whether occipital nerve injury may present as headache types other than occipital neuralgia. These findings suggest that patients presenting with chronic postoperative headache should be screened for the presence of surgically treatable occipital nerve injuries.

Pain medications in Palestinian households: Safety and wastage analysis

Background and Objective: Inappropriate use and storage of pain medications may cause unnecessary wastage and potential harm. The objective of this study was to investigate the extent of storage, wastage and potential harm of pain medications stored in households in Nablus district, Palestine. Methodology: This is a cross sectional, anonymous, questionnaire-based study. The drug product inventory in the surveyed households was investigated and family members were interviewed. Data were coded, entered and analyzed using statistical package for social sciences software (SPSS 16). Results: A total of 415 households in Nablus district, Palestine were surveyed. The total number of medications in the surveyed households was 5505; the mean ± SD was 13.3 ± 7.8. The total number of pain medications stored was 1103, constituting 20% of the stored medications. The average number of pain medications was 2.7 ± 1.8 per household. Pain medication storage was not associated with most of the tested demographic variables. More than one third (39.7%) of pain medications were stored in relatively unsafe places around the house within the reach of children. The percentages of unused pain medications, expired, and those with no clear expiration date were 20%, 14.9% and 12.9% respectively. Estimated pain medication wastage in the 415 households and in the whole Nablus district was 4,000 USD and 384,000 USD respectively. The most common pain medications encountered in households were: acetaminophen (42%), ibuprofen (24%) and diclofenac (18%). Conclusion: Pain medications were frequently encountered in Palestinian households, and relatively large percentage was being wasted. Keeping a limited stock of pain medication may avoid overuse of more expensive health services and might thus be cost-saving as well.

The Challenge of Prescription Drug Misuse: A Review and Commentary

This article presents an analysis of the patterns of illicit use of prescription pain relievers, of the likely structure of the illicit market, and of the complexity of pain management. It suggests that a federal enforcement policy focused on physicians is unlikely to reduce the overall use of illicit drugs, but that it is likely to have an adverse impact on the ethical structure of medical care and to compromise the effectiveness of pain treatment. Pain medications, such as OxyContin, Vicodin, and Methadone, have received increased government and media attention over the last 2 or 3 years, as the growth of their application in the treatment of patients with acute and chronic pain has been accompanied by an increase in reported drug abuse and dependence, adverse medical events, and pharmacy robberies. In response, the federal government announced a new initiative to control prescription drug abuse.1 Various proposed measures, including heightened scrutiny of physicians' practices, increased prosecution of physicians, increased restrictions on a number of pain medications, drug monitoring programs to catch “doctor shoppers,” and encouragement of more rigorous patient screening, will, it is claimed, limit the diversion of prescription medications from medical channels. In its 2002 review of OxyContin diversion, the Drug Enforcement Administration (DEA) stated “Illegal acts by physicians and pharmacists are the primary sources of diverted pharmaceuticals available on the illicit market.”2 The DEA report goes on to identify other sources of diversion, including doctor shopping, robberies, burglaries, thefts, illicit internet distribution, drug gang distribution, and foreign diversion. In view of the multiplicity of sources and the lack of quantitative information regarding the contribution of each source to the illicit market, it is not clear on what basis the DEA claimed that physicians and pharmacists are the primary sources. However, the recently proposed measures to control …

USE OF ANALGESIC DRUGS IN INDIVIDUALS WITH SPINAL CORD INJURY

This study set out to elucidate which factors are associated with or predictive for the use of analgesic drugs in patients with spinal cord injury and pain. A cross-sectional descriptive study with a partly prospective cohort. One hundred and twenty-three patients with a spinal cord injury matched for gender, age, level of lesion and completeness of injury. Questionnaires consisting of ratings in the areas of pain intensities, pain unpleasantness, life satisfaction, anxiety and depression, and questions about consumption of analgesic drugs were posted to the 123 patients. Of the 101 patients (82.1%) who returned the questionnaire, 90 (46 women and 44 men) still suffered from pain and were thus included in the study. Statistical analysis showed that although the number of pain medications used per person had increased in the last 3 years, the ratings of pain were unaffected. Logistic regression analyses also revealed that the use of pain-relieving medication was associated with higher ratings on the affective component of pain, lower ratings of leisure activities and the presence of stabbing/cutting pain. The affective component of pain is the main predictor for the use of analgesics in patients with a spinal cord injury. Complementary strategies, including a multidisciplinary approach, for relieving the unpleasantness of pain need to be explored further.

EVALUATION OF BOTULINUM TOXIN TYPE B (MYOBLOC) FOR MYOFASCIAL PAIN: RESULTS OF A PRELIMINARY PATIENT SURVEY

Botulinum toxin type B (Myobloc; BoNT-B) is indicated for the treatment of cervical dystonia. The toxin prevents acetylcholine release presynaptically at the neuromuscular junction, producing a dose-dependent degree of paralysis in injected muscles. This effect has been found to alleviate symptoms, including pain associated with cervical dystonia, and suggests that BoNT-B may be useful for the treatment of other painful conditions. We treated six patients (2 male; 4 female) with myofascial pain syndrome with BoNT-B injections (total dose 5000–10,000 U), and report of the results of a follow-up telephone survey conducted 4 to 16 weeks post-injection. The four female patients had pain in the neck/shoulders and were injected in that region. The two male patients were injected in the lower back muscles. The survey included questions about the severity of pain pre- and post-injection (0–10 numeric rating scale), range of motion (ROM), need for use of pain medications, and change in functioning. The severity of pain pre-injection averaged about 7/10. All patients had a very positive response to treatment. Following BoNT-B injection, pain severity decreased an average of −3.1/10. 5/6 patients had improvements in ROM, and 4/6 patients reported a decrease in number of pain medications needed. There were improvements in the ability to perform certain basic tasks (eg, brushing teeth) as well as other activities (eg, running). Overall, BoNT-B was well-tolerated. Some patients experienced flu-like symptoms that subsided after about 1 week. All patients indicated that treatment was very helpful and would be interested in receiving a re-injection. Our preliminary findings support further investigation of BoNT-B in the treatment of myofascial pain. Support of Elan Pharmaceuticals is gratefully acknowledged.

Association of osteoporotic vertebral compression fractures with impaired functional status

purpose: To determine if vertebral compression fractures in elderly women were associated with impairments in physical, functional, and psychosocial performance. subjects and methods: Ten white women with confirmed vertebral compression fractures were age- and race-matched with 10 control subjects without fractures in a case-control design. All subjects invited to participate in this study were patients of the Geriatrics Division of the Department of Medicine at Duke University Medical Center. All study participants lived either in the community or in the independent-living sections of local retirement communities in and around Durham, NC. Subjects with fractures (mean age = 81.9 years, SD = 5.9 years) had two or more vertebral compression fractures in their medical records, whereas control subjects (mean age = 79.6 years, SD = 6.5 years) had no history of vertebral fractures. Spinal radiographs of all women confirmed group assignment Physical, functional, and psychosocial performances were evaluated. Physical performance was assessed by measurements of maximal trunk extension torque and thoracic and lumbar spinal motion in the sagittal plane, functional reach, mobility skills, 10-ft timed walk, and 6-minute walk test. Thoracic and lumbar spinal configurations were also determined. Functional performance was assessed using the Functional Status Index. Psychosocial performance was assessed with the following scales: Hopkms Symptom Checklist 90 Revised, Rosenberg Self-Esteem Scale, West Haven-Yale Pain Inventory, Beck Depression Inventory, and single-item health-belief questions. results: Control subjects were not significantly different from patients with fractures in age, weight, number of current illnesses, number of prescribed medications, number of pain medications, ratings of lumbar spine degenerative disc disease, or lumbar spine facet joint arthritis. Activity levels and exercise participation were similar in both groups. Control subjects had no vertebral fractures, whereas fracture subjects had 4.2 ± 2.6 fractures (range: 2 to 10). Thoracic kyphosis was increased and lumbar lordosis was reduced in fracture subjects. Fracture subjects had reduced maximal trunk extension torque, thoracic and lumbar spine sagittal plane motion, functional reach, mobility skills, and 6-minute walk test. The Functional Status Index showed reduced levels of functional performance in fracture subjects compared with controls with increased levels of assistance, pain with activity, and difficulty in activities. Psychosocial performance was limited in fracture subjects with increased psychiatric symptoms, increased pain, and greater perception of problems caused by health. conclusion: Vertebral compression fractures are associated with significant performance impairments in physical, functional, and psychosocial domains in older women.