MARCH 1, 2016
Clinical practice guidelines for the management of neuropathic pain: A systematic review
Deng Y, et al. – This study aimed to assess the quality of these CPGs. The authors conclude that greater efforts are needed not only to improve the quality of development and presentation of the CPGs, but also to provide more efficacy evidence for the management of patients with NP. BMC Anesthesiology, 03/01/2016
Imamura M, et al. Paraspinous lidocaine injection therapy is not associated with a higher risk of adverse effects compared with conventional treatment and sham injection. Its effects on hyperalgesia might correlate with changes in central sensitization. The Journal of Pain, 03/01/2016
Manworren MC,et al. Knowledge of the effectiveness of multimodal analgesic treatments to manage children's postoperative pain during hospital stays is limited. Our retrospective chart review of a convenience sample of 200 pediatric surgical patients' pain experiences during the first 24 hours after laparoscopic appendectomy demonstrates the benefits of a multimodal analgesic approach. AORN J. 2016 Mar;103(3):317.e1-317
FEBRUARY 15, 2016
Vadivelu N, et al. Options for perioperative pain management in neurosurgery
Moderate-to-severe pain following neurosurgery is common but often does not get attention and is therefore underdiagnosed and undertreated. Compounding this problem is the traditional belief that neurosurgical pain is inconsequential and even dangerous to treat. Concerns about problematic effects associated with opioid analgesics such as nausea, vomiting, oversedation, and increased intracranial pressure secondary to elevated carbon dioxide tension from respiratory depression have often led to suboptimal postoperative analgesic strategies in caring for neurosurgical patients. Journal of Pain Research
Ting S, et al. The pharmacogenomics of pain management: prospects for personalized medicine.
Pain is a common symptom that can be complex to treat. Analgesic medications are the mainstay treatment, but there is wide interindividual variability in analgesic response and adverse effects. Pharmacogenomics is the study of inherited genetic traits that result in these individual responses to drugs. This narrative review will attempt to cover the current understanding of the pharmacogenomics of pain, examining common genes affecting metabolism of analgesic medications, their distribution throughout the body, and end organ effects. Journal of Pain Research
Rizzardo A, et al. Low-back pain at the emergency department: still not being managed?
Low-back pain (LBP) affects about 40% of people at some point in their lives. In the presence of “red flags”, further tests must be done to rule out underlying problems; however, biomedical imaging is currently overused. LBP involves large in-hospital and out-of-hospital economic costs, and it is also the most common musculoskeletal disorder seen in emergency departments (EDs). Therapeutics and Clinical Risk Management 2016:12 183–187
Topical 5% lidocaine medicated plasters represent a well-established first-line option for the treatment of peripheral localized neuropathic pain (LNP). This review provides an updated overview of the clinical evidence (randomized, controlled, and open-label clinical studies, real-life daily clinical practice, and case series). The 5% lidocaine medicated plaster effectively provides pain relief in postherpetic neuralgia, and data from a large open-label controlled study indicate that the 5% lidocaine medicated plaster is as effective as systemic pregabalin in postherpetic neuralgia and painful diabetic polyneuropathy but with an improved tolerability profile. Journal of Pain Research 2016:9 67–79
Acute soft tissue injuries are common and costly. The best drug treatment for such injuries is not certain, although non-steroidal anti-inflammatory drugs (NSAIDs) are often recommended.
Sedation is increasingly used to facilitate procedures on children in emergency departments (ED). This overview of systematic reviews (SR) examines the safety and efficacy of sedative agents commonly used for procedural sedation in children in the ED or similar settings.
Aims of the review were to establish the prevalence of acute pain for adults in hospital, to identify the amount of severe or unacceptable pain reported and to examine the prevalence of acute pain within medical units.
This meta-analysis of trials was conducted to evaluate the analgesic and side effects of ketamine-propofol combination (ketofol) in comparison to propofol in procedural sedation and analgesia (PSA).
FEBRUARY 11, 2016
Dexmedetomidine (Dex) has sedative, analgesic, and anesthetic-sparing effects. This meta-analysis examines demonstrated intraoperative and postoperative effects of intraoperative Dex administration during pediatric surgery.Pain Ther. 2016 Feb 10.
Although morphine is used frequently to treat pain in the intensive care unit, its pharmacokinetics has not been adequately quantified in critically ill patients. We evaluated the glucuronidation and elimination clearance of morphine in intensive care patients compared with healthy volunteers based on the morphine and morphine-3-glucuronide (M3G) concentrations. Anesth Analg. 2015 Nov;121(5):1261-73.
Ohlsson A, Shah PS.Paracetamol (acetaminophen) for prevention or treatment of pain in newborns.
Newborn infants have the ability to experience pain. Newborns treated in neonatal intensive care units are exposed to numerous painful procedures. Healthy newborns are exposed to pain if the birth process consists of assisted vaginal birth by vacuum extraction or by forceps and during blood sampling for newborn screening tests. Cochrane Database Syst Rev. 2015 Jun 25;6
The most common complaint of patients attending the emergency department (ED) is pain, caused by different diseases. Yet the treatment of pain at the ED is suboptimal, and oligoanalgesia remains common. The objective of this study is to determine whether the administration of analgesia at the ED increases by implementation of revised guidelines in pain management. Int J Emerg Med. 2016 Dec;9(1):4. Epub 2016 Feb 10.
FEBRUARY 2, 2016
The use of intravenous acetaminophen for acute pain in the emergency department
Sin B, et al. – Acetaminophen is a mainstay for pain management worldwide. The intravenous (IV) formulation has been widely used in Europe for more than 20 years in adults and children. In the United States, IV acetaminophen (APAP) obtained full approval from the Food and Drug Administration (FDA) in 2010. There is emerging literature to suggest the use of IV APAP for pain reduction in the Emergency Department (ED). This evidence–based review examines the evidence pertaining to the use of IV APAP for acute pain control in the ED. Fourteen randomized controlled trials with various methodological flaws provided limited evidence to support the use of IV APAP as the primary analgesic for acute pain control in patients who presents to the ED. Academic Emergency Medicine, 02/02/2016
Risk for opioid misuse among emergency department cancer patients
ReyesGibby CC, et al. –One of the most challenging areas of emergency medicine practice is the management and treatment of severe and persistent pain, including cancer–related pain. Emergency departments (EDs) in the United States frequently provide care for patients with cancer and an increasing concern is the potential for opioid misuse in this patient group. The authors determined the risk for opioid misuse among ED cancer patients with pain and assessed demographic and clinical factors associated with increased misuse risk. The Texas state prescription monitoring program was also queried for evidence of multiple opioid prescriptions for comparing low– and high–risk groups. The risk of opioid misuse among cancer patients is substantial. Screening for opioid misuse in the ED is feasible. Academic Emergency Medicine, 02/02/2016
Despriee AW, et al. -The authors aimed to investigate the effect of 30% sucrose compared with a placebo (water) as pain relief and comfort during immunisation of 15–month–old children in health care centres. This trial revealed that 30% sucrose orally has a calming and pain–relieving effect on 15–month–old infants during immunisation. Journal of Clinical Nursing, 02/02/16
Identification and management of chronic pain in primary care: A review
Mills S, et al.-Chronic pain is a common, complex, and challenging condition, where understanding the biological, social, physical and psychological contexts is vital to successful outcomes in primary care. Primary care management should be holistic and evidence–based (where possible) and incorporates both pharmacological and non–pharmacological approaches, including psychology, self–management, physiotherapy, peripheral nervous system stimulation, complementary therapies and comprehensive pain–management programmes. These may either be based wholly in primary care or supported by appropriate specialist referral. Current Psychiatry Reports, 02/02/2016
JANUARY 28, 2016
MPR. One Year Later: The Impact of Hydrocodone Combination Product Rescheduling.
Hydrocodone combination analgesic prescriptions have dropped by 22% since the U.S. Drug Enforcement Administration (DEA) reclassified the products from schedule III to schedule II of the Controlled Substances Act. Matching the drop in prescriptions, the number of dispensed hydrocodone combination product tablets also declined by 16%.
An examination of the prevalence of acute pain for hospitalised adult patients: a systematic review.
Aims of the review were to establish the prevalence of acute pain for adults in hospital, to identify the amount of severe or unacceptable pain reported and to examine the prevalence of acute pain within medical units. Gregory J, et al J Clin Nurs. 2016.
JANUARY 27, 2016
Nadia Awad. Trick of the Trade: Diphenhydramine for Local Anesthesia.
Diphenhydramine (DPH) has been utilized as a local anesthetic for several decades. The earliest documentation of the evaluation of antihistamines in this capacity dates back to the 1940s, and with DPH specifically, its use as a local anesthetic in minor skin surgery was first described in 1956.
JANUARY 26, 2016
Lesueur P. Ketamine vs. Morphine for Acute Pain in the ED.
A healthy 38yo male presents with anterior left shoulder dislocation. No known history of opioid use, pain scale 8/10 and he appeared uncomfortable. When discussing pain management, the Attending suggests we begin with morphine and use ketamine as an adjunct.
JANUARY 23, 2016
Italian national guidelines on pain management were published in 2010, but there is little information on how effective pain management is in paediatric emergency care, with other countries reporting poor levels. Using headache as an indicator, we described pain assessment in Italian emergency departments and identified predictors of algometric scale use. Benini F, et al. Acta Paediatr. 2016
JANUARY 20, 2016
At subdissociative doses of 0.1 - 0.5 mg/kg, ketamine provides effective analgesia when used alone or as an adjunct to opioid analgesics without causing cardiovascular or respiratory compromise. Ketamine is a beneficial analgesic agent in the emergency department (ED), particularly in patients with opioid-resistant pain or polytrauma patients who are hemodynamically unstable.
To describe opioid use before and after intensive care unit (ICU) admission and to identify factors associated with chronic opioid use upto 4 years after ICU discharge. Yaffe PB, et al. J Intensive Care Med. 2015.
Preventing chronic postoperative pain.
Chronic postoperative pain is common. Nerve injury and inflammation promote chronic pain, the risk of which is influenced by patient factors, including psychological characteristics. Interventional trials to prevent chronic postoperative pain have been underpowered with inadequate patient follow-up. Ketamine may reduce chronic postoperative pain, although the optimum treatment duration and dose for different operations have yet to be identified. Reddi D, Anaesthesia. 2016.
Preventive analgesia has been proposed as a potential strategy to reduce postoperative pain. However, there is currently no review that focuses on acetaminophen for preventive analgesia. Doleman B, et al. Reg Anesth Pain Med. 2015 Nov-Dec.
To determine whether ketamine added to morphine or hydromorphone patient-controlled analgesia (PCA) provides clinically relevant reductions in postoperative pain, opioid requirements, and adverse events when compared with morphine or hydromorphone PCA in adults undergoing surgery. Wang L, et al. Can J Anaesth. 2015
Although opioids in general and remifentanil in particular have been shown to induce hyperalgesia, data regarding fentanyl are scarce. Thus, the authors investigated the effect of fentanyl dosing on pain perception and central sensitization in healthy volunteers using established pain models. Mauermann E, et al. Anesthesiology. 2016.
Patient compliance and satisfaction with analgesics prescribed after Emergency Department (ED) care for acute pain are poorly understood, largely because of the lack of direct patient follow-up with the ED provider. Our objective was to compare patient satisfaction with three analgesia regimens prescribed for post-ED care-a nasally administered nonsteroidal anti-inflammatory drug (NSAID), an opioid, or combination therapy-by collecting granular follow-up on analgesic use, pain scores, side effects, work activity levels, and overall satisfaction directly from patients. Pollack CV Jr, et al. Acad Emerg Med. 2016
The rapid uptake of nurse practitioner (NP) services in Australia has outpaced evaluation of this service model. A randomized controlled trial was conducted to compare the effectiveness of NP service versus standard medical care in the emergency department (ED) of a major referral hospital in Australia. Jennings N, et al. Acad Emerg Med. 2015
JANUARY 19, 2016
Radial artery blood gas sampling: a randomized controlled trial of lidocaine local anesthesia.
Radial artery puncture is a common procedure and yet the role of local anesthesia for reducing the pain of this procedure continues to be debated. Clinical practice is variable and there is potential for substantial financial savings. This is the first randomized trial to investigate the effectiveness of subcutaneously injected lidocaine anesthesia on the perceived pain of radial artery puncture and the financial impact. Wade RG, et al. J Evid Based Med. 2015
JANUARY 18, 2016
Published data from 1998 revealed that most patients treated for migraine in an emergency department received opioids. Over the intervening years, a large body of evidence has emerged demonstrating the efficacy and safety of non-opioid alternatives. Expert opinion during these years has cautioned against use of opioids for migraine. Our objectives were to compare current frequency of use of various medications for acute migraine in US emergency departments with use of these same medications in 1998 and to identify factors independently associated with opioid use. Cephalalgia. 2015 Apr;35(4):301-9.
Committee Recommends FDA Approval of Opioid Addiction Implant.
The Psychopharmacologic Drugs Advisory Committee has recommended that the Food and Drug Administration approve an implant for treating opioid addiction.The committee voted 12 to 5 in favor of approving probuphine, the first long-acting, subdermal buprenorphine implant to treat addiction to opioids. Buprenorphine is currently only available either as a dissolvable film that is placed under the tongue, or a pill, which allows some addicts to sell their supplies to get money for drugs. Clinical Pain Advisor,1/18/16.
Transversus abdominal plane (TAP) block is a known and useful technique, widely used for postoperative pain management of abdominal wall incisions. During the past years, and following the expansion of ultrasound guided techniques, its use has even gained more adepts. It is usually used as an adjuvant technique, primarily in order to control postoperative pain and reduce opioids consumption. Varela N, et al. Rev Esp Anestesiol Reanim. 2016.
JANUARY 15, 2016
N May. Myths in Emergency Medicine: Antiemetics of No Benefit for Patients Receiving Opioids.
JANUARY 14, 2016
Balbin et al. Intravenous fluids for migraine: A post-hoc analysis of clinical trial data.
1.2 million patients present to US emergency departments (ED) annually with migraine headache. Intravenous fluid (IVF) hydration is used to treat acute migraine commonly. We were unable to identify published data to support or refute this practice. The goal of this analysis was to determine if administration of IVF is associated with improved short-term (one hour) or sustained (24 hour) migraine outcomes.
JANUARY 13, 2016
Currently the only FDA-approved treatment for CM prevention is onabotulinumtoxinA. Two double-blind studies have demonstrated the efficacy of topiramate for CM prevention, but it is not FDA-approved for this indication.
The subject of this publication has been focused on local considerations for facilitating regional best practice, including identifying and uniformly adopting the most relevant international guidelines on opioid use (OU) in chronic pain management.
The intranasal formulation of zolmitriptan, a selective serotonin 5-HT1B/1D agonist, was recently approved by the US Food and Drug Administration for the treatment of acute migraine in pediatric patients 12 years of age or older. This article summarizes the efficacy and tolerability of zolmitriptan (Zomig(®)) nasal spray (NS) in acute migraine in this patient group.
No clinical trials are currently available that demonstrate the effects of marijuana on patients with migraine headache; however, the potential effects of cannabinoids on serotonin in the central nervous system indicate that marijuana may be a therapeutic alternative. Thus, the objective of this study was to describe the effects of medical marijuana on the monthly frequency of migraine headache.
A multicentre, cluster-randomised, controlled, intervention trial in nine EDs. Patients with moderate pain (pain score of ≥4) were eligible for inclusion. The intervention was a range of educational activities to encourage staff to provide 'adequate analgesia'. It was introduced into five early intervention EDs between the 0 and 6 months time points and at four late intervention EDs between 3 and 6 months. At 0, 3 and 6 months, data were collected on demographics, pain scores, analgesia provided and pain management satisfaction 48 h post-discharge (6 point scale).
We compared the efficacy of intravenous (IV) paracetamol versus dipyrone via patient-controlled analgesia (PCA) for postoperative pain relief in children.
Initial management of acute occupational low back pain (AOLBP) commonly occurs in the emergency department (ED), where opioid prescribing can vary from the clinical guidelines that recommend limited use.
JANUARY 5, 2016
Prior studies have identified provider and system characteristics that impede pain management in children, but no studies have investigated the effect of changing these characteristics on prehospital opioid analgesia. Our objectives were to determine: 1) the frequency of opioid analgesia and pain score documentation among prehospital pediatric patients after system wide changes to improve pain treatment, and 2) if older age, longer transport times, the presence of vascular access and pain score documentation were associated with increased prehospital administration of opioid analgesia in children.
Clinical trials have not yet compared the efficacy of capsaicin 8% patch with current standard therapy in peripheral neuropathic pain (PNP).
This meta-analysis of trials was conducted to evaluate the analgesic and side effects of ketamine-propofol combination (ketofol) in comparison to propofol in procedural sedation and analgesia (PSA).
JANUARY 4, 2016
Emergency Department pain management is an often overlooked aspect of acute care and is of paramount importance. Patients are often forced to wait extended periods of time without pain assessment or being offered analgesia for their painful condition. This has been associated with poor psychological and physiological consequences both for the health system and the patient. This is suggestive of a lack of clarity around best practice standards for time to analgesia and pain score documentation in the ED.
Painful procedures are common in the ED setting and beyond. Although these procedures are often essential to patient management, they can also be distressing for children, parents, and health providers. As such, it is imperative that effective pain and anxiety-minimizing strategies be used consistently in all settings where painful procedures take place for children.