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Journal Cover British Journal of Pain
  [14 followers]  Follow
   Hybrid Journal Hybrid journal (It can contain Open Access articles)
   ISSN (Print) 2049-4637 - ISSN (Online) 2049-4645
   Published by Sage Publications Homepage  [853 journals]
  • Personalised medicine and medicines optimisation
    • Authors: Knaggs; R.
      Pages: 167 - 167
      PubDate: 2016-10-25T04:29:10-07:00
      DOI: 10.1177/2049463716671224
      Issue No: Vol. 10, No. 4 (2016)
  • Independent validation of the Pain Management Plan in a multi-disciplinary
           pain team setting
    • Authors: Quinlan, J; Hughes, R, Laird, D.
      Pages: 168 - 176
      Abstract: Context/background:The Pain Management Plan (PP) is a brief cognitive behavioural therapy (CBT) self-management programme for people living with persistent pain that can be individually facilitated or provided in a group setting. Evidence of PP efficacy has been reported previously by the pain centres involved in its development.Objectives:To provide a fully independent evaluation of the PP and compare these with the findings reported by Cole et al.Methods:The PP programme was delivered by the County Durham Pain Team (Co. Durham PT) as outlined in training sessions led by Cole et al. Pre- and post-quantitative/patient experience measures were repeated with reliable and clinical significant change determined and compared to the original evaluation.Results:Of the 69 participants who completed the programme, 33% achieved reliable change and 20% clinical significant change using the Pain Self-Efficacy Questionnaire (PSEQ). Across the Brief Pain Inventory (BPI) interference domains between 11% and 22% of participants achieved clinical significant change. There were high levels of positive patient feedback with 25% of participants scoring 100% satisfaction. The mean participant satisfaction across the population was 88%.Conclusion:The results from this evaluation validate those reported by Cole et al. It demonstrates clinically significant improvement in pain and health functioning and high patient appreciation results. Both evaluations emphasise the potential of this programme as an early intervention delivered within a stratified care pain pathway. This approach could optimise the use of finite resources and improve wider access to pain management.
      PubDate: 2016-10-25T04:29:10-07:00
      DOI: 10.1177/2049463716657366
      Issue No: Vol. 10, No. 4 (2016)
  • Creating a better picture of chronic pain: improving pain pictogram
           designs through systematic evaluation of user responses
    • Authors: Stones, C; Knapp, P, Closs, S. J.
      Pages: 177 - 185
      Abstract: This article discusses the challenges of visually representing pain qualities in pictogram design. An existing set of 12 pictograms designed for people with literacy problems was evaluated to understand more about misunderstandings of pictogram interpretation. Two sets of university students from different disciplines were asked to interpret the pictograms, and a novel classification system was developed to categorise answer types, as ‘location’, ‘affective’, temporal’ or ‘literal’. Several design recommendations are made as a result that will help improve the design of pain pictograms as a whole as well as guide designers of related pictogram work. We demonstrate how, through the robust classification of incorrect responses, it is possible to extract useful comprehension error patterns to inform future design.
      PubDate: 2016-10-25T04:29:10-07:00
      DOI: 10.1177/2049463716657365
      Issue No: Vol. 10, No. 4 (2016)
  • A feasibility study to determine the benefits of upper extremity virtual
           rehabilitation therapy for coping with chronic pain post-cancer surgery
    • Authors: House, G; Burdea, G, Grampurohit, N, Polistico, K, Roll, D, Damiani, F, Hundal, J, Demesmin, D.
      Pages: 186 - 197
      Abstract: Background:Persistent pain in shoulder and arm following post-surgical breast cancer treatment can lead to cognitive and physical deficits. Depression is also common in breast cancer survivors. Virtual reality therapy with integrative cognitive and physical rehabilitation has not been clinically trialed for this population. The novel BrightArm Duo technology improved cognition and upper extremity (UE) function for other diagnoses and has great potential to benefit individuals coping with post-surgical breast cancer pain.Objectives:The aim of this study was to explore the feasibility of BrightArm Duo therapy for coping with post-surgical chronic pain and associated disability in breast cancer survivors with depression.Methods:BrightArm Duo is a robotic rehabilitation table modulating gravity loading on supported forearms. It tracks arm position and grasping strength while patients play three-dimensional (3D) custom integrative rehabilitation games. Community-dwelling women (N = 6) with post-surgical breast cancer pain in the upper arm trained on the system twice a week for 8 weeks. Training difficulty increased progressively in game complexity, table tilt and session length (20–50 minutes). Standardized assessments were performed before and after therapy for pain, cognition, emotion, UE function and activities of daily living.Results:Subjects averaged upwards of 1300 arm repetitions and 850 hand grasps per session. Pain intensity showed a 20% downward trend (p = 0.1) that was corroborated by therapist observations and participant feedback. A total of 10 out of 11 cognitive metrics improved post-training (p = 0.01) with a significant 8.3-point reduction in depression severity (p = 0.04). A total of 17 of 18 range of motion metrics increased (p < 0.01), with five affected-side shoulder improvements above the Minimal Clinically Important Difference (8°). In all, 13 out of 15 strength and function metrics improved (p = 0.02) with lateral deltoid strength increasing 7.4 N on the affected side (p = 0.05).Conclusion:This pilot study demonstrated feasibility of using the BrightArm Duo Rehabilitation System to treat cancer survivors coping with upper body chronic pain. Outcomes indicate improvement in cognition, shoulder range, strength, function and depression.
      PubDate: 2016-10-25T04:29:10-07:00
      DOI: 10.1177/2049463716664370
      Issue No: Vol. 10, No. 4 (2016)
  • Comparison of fentanyl iontophoretic transdermal system and routine care
           with morphine intravenous patient-controlled analgesia in the management
           of early postoperative mobilisation: results from a randomised study
    • Authors: Langford, R. M; Chang, K.-Y, Ding, L, Abraham, J.
      Pages: 198 - 208
      Abstract: Introduction:Fentanyl iontophoretic transdermal system (ITS) (IONSYS®, The Medicines Company, Parsippany, NJ, USA) and morphine intravenous (IV) patient-controlled analgesia (PCA) have demonstrated equivalent pain control in several published studies. The primary objective of the current study was to compare fentanyl ITS with morphine IV PCA with regard to the patient’s ability to mobilise with acute postoperative pain.Methods:In this multicentre, open-label, randomised, active-controlled, prospective phase IV study, postoperative patients initially received IV morphine and were titrated to pain score
      PubDate: 2016-10-25T04:29:10-07:00
      DOI: 10.1177/2049463716668905
      Issue No: Vol. 10, No. 4 (2016)
  • Effect of adding intrathecal morphine to a multimodal analgesic regimen
           for postoperative pain management after laparoscopic bariatric surgery: a
           prospective, double-blind, randomized controlled trial
    • Authors: El Sherif, F. A; Othman, A. H, Abd El-Rahman, A. M, Taha, O.
      Pages: 209 - 216
      Abstract: Background:Pain control after bariatric surgery is a major challenge. Our objective was to study the efficacy and safety of intrathecal (IT) morphine 0.3 mg added to bupivacaine 0.5% for postoperative pain after laparoscopic bariatric surgery.Methods:After local ethics committee approval, 100 morbidly obese patients scheduled for laparoscopic bariatric surgery were enrolled in this study. Patients were randomly assigned into two groups: Group I received IT 0.3 mg morphine (0.3 mL) added to 1.2 mL of bupivacaine 0.5%; Group II received IT 0.3 mL saline added to 1.2 mL of bupivacaine 0.5%, immediately before induction of general anaesthesia. For both groups, 60 mg ketorolac and 1000 mg paracetamol were infused 30 minutes before the end of surgery. After wound closure, 20 mL bupivacaine 0.25% was infiltrated at wound edges.Results:Visual Analogue Scale (VAS) score was significantly lower in group I immediately, 30 minutes and 1 hour postoperatively. Time to first ambulation, return of intestinal sounds and hospital stay were shorter in group I than group II (p < 0.05); total morphine consumption was significantly lower in group I than group II (p < 0.05). Sedation score was significantly higher in group I immediately postoperatively, while at 30 minutes, 1, 2 and 6 hours postoperatively sedation scores were significantly higher in group II. Itching was significantly higher in group I.Conclusion:The addition of IT morphine to a multimodal analgesic regimen after laparoscopic bariatric surgery was an effective and safe method that markedly reduced postoperative pain, systemic opioid consumption and length of hospital stay.
      PubDate: 2016-10-25T04:29:10-07:00
      DOI: 10.1177/2049463716668904
      Issue No: Vol. 10, No. 4 (2016)
  • Is tapentadol different from classical opioids? A review of the
    • Authors: Langford, R. M; Knaggs, R, Farquhar-Smith, P, Dickenson, A. H.
      Pages: 217 - 221
      Abstract: Tapentadol is a single molecule able to deliver analgesia by two distinct mechanisms, a feature which differentiates it from many other analgesics. Pre-clinical data demonstrate two mechanisms of action: mu-opioid receptor agonist activity and noradrenaline re-uptake inhibition. From these, one may predict that tapentadol would be applicable across a broad spectrum of pain from nociceptive to neuropathic. The evidence in animal models suggests that norepinephrine re-uptake inhibition (NRI) is a key mechanism and may even predominate over opioid actions in chronic (and especially neuropathic) pain states, reinforcing that tapentadol is different to classical opioids and may, therefore, be an a priori choice for the treatment of neuropathic and mixed pain. The clinical studies and subsequent practice experience and surveillance support the concept of opioid and non-opioid mechanisms of action. The reduced incidence of some of the typical opioid-induced side effects, compared to equianalgesic doses of classical opioids, supports the hypothesis that tapentadol analgesia is only partially mediated by opioid agonist mechanisms. Both the pre-clinical and clinical profiles appear to be differentiated from those of classical opioids.
      PubDate: 2016-10-25T04:29:10-07:00
      DOI: 10.1177/2049463716657363
      Issue No: Vol. 10, No. 4 (2016)
  • A service improvement project to review prescribing information provided
           by general practitioners for new referrals to a UK National Health Service
           hospital pain clinic: potential implications of CYP2D6 enzyme inhibition
    • Authors: Radford, H; Fitzgerald, P, Martin, S, Johnson, M. I.
      Pages: 222 - 231
      Abstract: Introduction:Chronic pain is often managed using co-prescription of analgesics and adjuvants, with concomitant medication prescribed for comorbidities. Patients may have suboptimal response to some analgesics or be at risk of drug interactions or adverse drug reactions (ADRs) due to polypharmacy affecting CYP2D6 enzyme activity. The aim of the service improvement project was to determine the proportion of patients referred to a specialist pain service in the UK National Health Service (NHS) by general practitioners (GPs) who may be at risk of suboptimal analgesic response or ADRs due to CYP2D6 inhibition through polypharmacy. This was achieved by reviewing clinical prescribing information provided by GPs at time of referral. It was hoped that the findings could be used to aid clinical and prescribing decisions without conducting CYP2D6 genotyping or phenotyping.Methods:A review of letters from 250 patients referred to an NHS hospital pain service from GPs over a 3-month period was undertaken. Information about current and concomitant medications was analysed to identify the potential for CYP2D6 inhibition and adverse events.Results:Letters failed to provide information about current pain medication for 20 (8%) patients or non-pain concomitant medication for 54 (21.6%) patients. Of 176 patients, 52 (29.5%) patients with information about non-pain concomitant medication had been prescribed at least one known CYP2D6 inhibitor. A total of 35 (19.9%) patients were identified as being at risk of an adverse drug reaction and 33 (18.75%) patients at risk of suboptimal analgesic response due to co-administration of CYP2D6 inhibitors.Conclusion:The review revealed the need for improved detail in GP referral letters used to transfer care to UK NHS hospital pain clinics. There is a need to consider an individual’s CYP2D6 phenotype when prescribing analgesic prodrugs to manage persistent pain. Caution is needed when patients are co-prescribed codeine or tramadol with selective serotonin reuptake inhibitors (SSRIs).
      PubDate: 2016-10-25T04:29:10-07:00
      DOI: 10.1177/2049463716657364
      Issue No: Vol. 10, No. 4 (2016)
  • Ultrasound-guided alcohol neurolysis of lateral femoral cutaneous nerve
           for intractable meralgia paresthetica: a case series
    • Authors: Ahmed, A; Arora, D, Kochhar, A. K.
      Pages: 232 - 237
      Abstract: Meralgia paresthetica is a rare sensory entrapment neuropathy which leads to burning, tingling and numbness in the antero-lateral aspect of thigh. Mostly it runs a benign course, and responds to conservative measures. We present a case series of six patients with intractable meralgia paresthetica with severe pain over antero-lateral thigh along the distribution of lateral cutaneous nerve of thigh which was further confirmed by nerve conduction study. These patients did not respond to the oral anti-neuropathic medications. The two successive diagnostic lateral femoral cutaneous nerve block not only had confirmed the diagnosis but also provided pain relief for a few days. Then the ultrasound-guided lateral femoral cutaneous nerve neurolysis was done using 50% alcohol. In all the patients, there were more than 50% decrease in pain intensity and improvement in quality of life after the procedure, and the relief and improvement were maintained for up to 12 weeks. This case series shows ultrasound-guided lateral femoral cutaneous nerve neurolysis is a safe and effective treatment for intractable meralgia paresthetica and also provides prolonged pain relief and is a good option in avoiding the surgery.Summary pointsThe literature on neurolysis is rare, with only few case reports. This is the first case series on this topic, and it will greatly improve the evidence that ultrasound-guided neurolysis can also be used for intractable meralgia paresthetica patients who do not respond to conservative measures before proceeding to surgery.
      PubDate: 2016-10-25T04:29:10-07:00
      DOI: 10.1177/2049463716668811
      Issue No: Vol. 10, No. 4 (2016)
School of Mathematical and Computer Sciences
Heriot-Watt University
Edinburgh, EH14 4AS, UK
Tel: +00 44 (0)131 4513762
Fax: +00 44 (0)131 4513327
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