Kuo Y-W, Yen M, Fetzer S, Lee J-D: Reducing the pain of nasogastric tube intubation with nebulized and atomized lidocaine: a systematic review and meta-analysis. J. Pain Symptom Manage. 40(4), 613–620 (2010).
Inserting nasogastric tubes can be painful for patients and so this review aimed to identify the effectiveness of inhaled lidocaine 4 or 10% in reducing pain associated with this procedure. Five randomized controlled trials that allocated intervention or saline control to 212 patients were included in the analysis. The pooled odds ratio was 0.423 (95% CI: 0.204–0.880), suggesting that intervention significantly reduces pain by approximately 57% compared with control groups. However, there was no mention of adverse effects associated with using lidocaine, and no recommendations could be made regarding optimal dose or delivery.
Capewell C, Gregory W, Closs SJ, Bennett MI: Feasibility study of DVD-based educational intervention for cancer pain. Pall. Med. 24(6), 616–622 (2010).
Patient attitudes and knowledge regarding cancer pain and strong opioid analgesia can sometimes be a barrier to good pain control. Educational interventions that address these barriers are effective in oncology outpatients but have not been evaluated in patients with more advanced disease. This feasibility study evaluated a brief DVD-based educational intervention for cancer pain in palliative care patients over a 4-week period. Participants were shown the DVD at baseline (V1) and at 1 week (V2). Outcomes were assessed using the Brief Pain Inventory (BPI) and Patient Pain Questionnaire (PPQ), which assess knowledge and attitudes. A total of 15 patients were recruited and found the DVD acceptable and convenient. During the study period, total BPI and PPQ scores improved significantly by 9.6% (p = 0.02) and 17% (p = 0.04), respectively. Although only an observational study, this intervention appears feasible and potentially effective; a multicenter clinical trial is now needed to evaluate this intervention further.
Murtagh FE, Addington-Hall J, Edmonds P et al.: Symptoms in the month before death for stage 5 chronic kidney disease patients managed without dialysis. J. Pain Symptom Manage. 40(3), 342–352 (2010).
This prospective study examined symptoms in the last month of life in patients dying from chronic kidney disease. Data from 49 patients were available and showed that overall symptom burden was similar to that found in patients with advanced cancer. Interestingly, pain was prevalent in 73% and rated ‘quite a lot‘ or ‘very distressing‘ in 41% of the whole sample, contrary to traditional medical teaching that suggests renal failure is not painful. Etiology of pain varied but bone and joint pains, muscle cramps and soreness, headaches and chest pain were commonly cited. The authors conclude that better symptom monitoring and management is needed for this population.
Moayeri N, van Geffen GJ, Bruhn J et al.: Correlation among ultrasound, cross-sectional anatomy, and histology of the sciatic nerve. Reg. Anesth. Pain Med. 35, 442–449 (2010).
A correlation of short-axis ultrasound images of the sciatic nerve with histologic and cadaveric anatomic cross-sections. Anatomic and histologic specimens were matched with ultrasound images from two healthy volunteers. Comparisons were made at the gluteal, subgluteal, midfemoral and popliteal regions to better understand how ultrasonographic images correlate with sciatic nerve anatomy at different levels.
Taenzer AH, Clark C, Kovarik D: Experience with 724 epidurograms for epidural catheter placement in pediatric anesthesia. Reg. Anesth. Pain Med. 35, 432–435 (2010).
Retrospective review of databases at two academic medical centers examining epidurography results of epidural catheters placed preoperatively in pediatric patients. Of 724 epidurograms, 45.8% were caudal, 9.6% were lumbar and 32.3% were thoracic catheters. Only 12 (1.6%) revealed placement in undesirable locations (intrathecal, intravenous or intraperitoneal). The study did not evaluate anatomically correct catheter placement within the epidural space.
Hashimoto T, Iwasaki T, Takahashi Y et al.: Comparison of bupivacaine, ropivacaine, and levobupivacaine in an equal dose and concentration for sympathetic block in dogs. Reg. Anesth. Pain Med. 35, 409–411 (2010).
Cervicothoracic sympathetic block was performed in 24 dogs. Eight received 1 ml of 0.25% bupivacaine, eight received 1 ml of 0.25% ropivacaine and eight received 1 ml of 0.25% levobupivacaine. Left brachial artery blood flow increased 218% above baseline lasting 100 min in bupivacaine subjects, 254% above baseline lasting 100 min in ropivacaine subjects, and 183% above baseline lasting 80 min in levobupivacaine subjects. Brachial artery blood flow increases were significantly greater with ropivacaine than with bupivacaine or levobupivacaine. Levobupivacaine may be the least potent among the three for sympathetic block at equal concentrations.
Smith CC, Booker T, Schaufele MK et al.: Interlaminar versus transforaminal epidural steroid injections for the treatment of symptomatic lumbar spinal stenosis. Pain Med. 11, 1511–1515 (2010).
A retrospective case–control study of 19 patients who each received interlaminar or transforaminal fluoroscopically guided epidural steroid injection. These were performed for radicular and neurogenic claudication symptoms due to lumbar spinal stenosis. Both groups received statistically significant improvement in visual analog scale scores from pre- to post-injection and at 4–6 week follow-up. There was no statistically significant difference between the two groups in postinjection visual analog scale scores or number of repeat injections.
Green CR, Hart-Johnson T: Cancer pain: an age-based analysis. Pain Med. 11, 1525–1536 (2010).
A longitudinal study was conducted among 96 respondents with pain related to breast, prostate, colorectal, lung or multiple myeloma cancer. Surveys were completed at initial assessment and at 3 and 6 months. Patients were analyzed based on age less than 40 years, between 41 and 59 years, and greater than 60 years. No significant differences in severity of pain were appreciated based on age. Younger patients tended to experience more pain flares. The oldest group showed better emotional functioning at baseline but worse physical functioning at 6 months. Younger groups tended to function worse cognitively at 6 months. The youngest group reported increasing depressive symptoms over time more than the other age groups.
Mercadante S, Tirelli W, David F et al.: Morphine versus oxycodone in pancreatic cancer pain: a randomized controlled study. Clin. J. Pain 26, 794–797 (2010).
Experimental clinical studies have suggested that oxycodone may be superior to morphine in the treatment of visceral pain due to its putative activity on peripheral k-receptors. In this randomized controlled parallel study the two drugs provided similar analgesia with no significant difference in adverse effects. Although only 46 patients were randomized, the study could not confirm the hypothesis that oxycodone is superior to morphine in this type of visceral pain.
Haukka E, Leino-Arjas P, Ojajärvi A, Takala EP, Viikari-Juntura E, Riihimäki H: Mental stress and psychosocial factors at work in relation to multiple-site musculoskeletal pain: a longitudinal study of kitchen workers. Eur. J. Pain DOI: 10.1016/j.ejpain.2010.09.005 (2010) (Epub ahead of print).
This 2-year longitudinal study examines the connection between mental stress and psychological factors at work with multiple-site musculoskeletal pain in female kitchen workers. The study found that several psychosocial factors (e.g., mental stress) predicted multiple-site musculoskeletal pain but also that development of this pain type predicted several psychosocial factors.
Chapman CR, Lipschitz DL, Angst MS et al.: Opioid pharmacotherapy for chronic noncancer pain in the United States: a research guideline for developing an evidence base. J. Pain 11, 807–829 (2010).
This is the report of a large interdisciplinary panel of research and clinical experts who were asked to review the use of opioids for the treatment of chronic noncancer pain and to formulate guidelines for future research. Opioid prescribing has increased dramatically in the USA in the absence of reliable data on treatment outcomes and side effects. Population studies have clearly shown an increase in diversion of prescription opioids in the same epoch. The need for a better database upon which to base clinical decisions is emphasized.
Eldabe S, Kumar K, Buchser E, Taylor R: An analysis of the components of pain, function, and health-related quality of life in patients with failed back surgery syndrome treated with spinal cord stimulation or conventional medical management. Neuromodulation 13, 201–209 (2010).
A careful assessment based upon the PROCESS trial demonstrating significant functional improvement with spinal cord stimulation at 6 and 24 months for patients with failed back surgery syndrome. However, 40% of spinal cord stimulation patients had persisting functional and quality of life impairments. The study was funded by Medtronic, and the control group consisted of patients who had already failed the conventional management that was compared with spinal cord stimulation. Nonetheless, this study has functional and health-related quality of life data that are not commonly found in failed back surgery syndrome outcomes studies.
Financial & competing interests disclosure
N Finnerup has received honoraria and research support from Grünenthal. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.
No writing assistance was utilized in the production of this manuscript.