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Duloxetine in the management of diabetic peripheral neuropathic pain  [cached]
Ormseth MJ,Scholz BA,Boomershine CS
Patient Preference and Adherence , 2011,
Abstract: Michelle J Ormseth, Beth A Sholz, Chad S BoomershineDivision of Rheumatology and Immunology, Vanderbilt University, Nashville, TN, USAAbstract: Diabetic neuropathy affects up to 70% of diabetics, and diabetic peripheral neuropathic pain (DPNP) is the most common and debilitating of the diabetic neuropathies. DPNP significantly reduces quality of life and increases management costs in affected patients. Despite the impact of DPNP, management is poor with one-quarter of patients receiving no treatment and many treated with medications having little or no efficacy in managing DPNP. Duloxetine is one of two drugs approved by the United States Food and Drug Administration for DPNP management. Duloxetine is a serotonin and norepinephrine reuptake inhibitor (SNRI) proven safe, effective, and cost-saving in reducing DPNP symptoms at a dose of 60 mg/day. Duloxetine doses greater than 60 mg/day for DPNP management are not recommended since they are no more efficacious and associated with more side effects; addition of pregabalin or gabapentin for these patients may be beneficial. Side effects of duloxetine are generally mild and typical for the SNRI class including nausea, dizziness, somnolence, fatigue, sweating, dry mouth, constipation, and diarrhea. Given its other indications, duloxetine is a particularly good choice for DPNP treatment in patients with coexisting depression, anxiety, fibromyalgia, or chronic musculoskeletal pain. Duloxetine treatment had no clinically significant effect on glycemic control and did not increase the risk of cardiovascular events in diabetes patients. However, duloxetine use should be avoided in patients with hepatic disease or severe renal impairment. Given its safety, efficacy, and tolerability, duloxetine is an excellent choice for DPNP treatment in many patients.Keywords: duloxetine, diabetic peripheral neuropathic pain, review, treatment
Duloxetine in the management of diabetic peripheral neuropathic pain
Ormseth MJ, Scholz BA, Boomershine CS
Patient Preference and Adherence , 2011, DOI: http://dx.doi.org/10.2147/PPA.S16358
Abstract: loxetine in the management of diabetic peripheral neuropathic pain Review (6341) Total Article Views Authors: Ormseth MJ, Scholz BA, Boomershine CS Published Date July 2011 Volume 2011:5 Pages 343 - 356 DOI: http://dx.doi.org/10.2147/PPA.S16358 Michelle J Ormseth, Beth A Sholz, Chad S Boomershine Division of Rheumatology and Immunology, Vanderbilt University, Nashville, TN, USA Abstract: Diabetic neuropathy affects up to 70% of diabetics, and diabetic peripheral neuropathic pain (DPNP) is the most common and debilitating of the diabetic neuropathies. DPNP significantly reduces quality of life and increases management costs in affected patients. Despite the impact of DPNP, management is poor with one-quarter of patients receiving no treatment and many treated with medications having little or no efficacy in managing DPNP. Duloxetine is one of two drugs approved by the United States Food and Drug Administration for DPNP management. Duloxetine is a serotonin and norepinephrine reuptake inhibitor (SNRI) proven safe, effective, and cost-saving in reducing DPNP symptoms at a dose of 60 mg/day. Duloxetine doses greater than 60 mg/day for DPNP management are not recommended since they are no more efficacious and associated with more side effects; addition of pregabalin or gabapentin for these patients may be beneficial. Side effects of duloxetine are generally mild and typical for the SNRI class including nausea, dizziness, somnolence, fatigue, sweating, dry mouth, constipation, and diarrhea. Given its other indications, duloxetine is a particularly good choice for DPNP treatment in patients with coexisting depression, anxiety, fibromyalgia, or chronic musculoskeletal pain. Duloxetine treatment had no clinically significant effect on glycemic control and did not increase the risk of cardiovascular events in diabetes patients. However, duloxetine use should be avoided in patients with hepatic disease or severe renal impairment. Given its safety, efficacy, and tolerability, duloxetine is an excellent choice for DPNP treatment in many patients.
Efficacy and Safety of Duloxetine in Patients with Chronic Low Back Pain Who Used versus Did Not Use Concomitant Nonsteroidal Anti-Inflammatory Drugs or Acetaminophen: A Post Hoc Pooled Analysis of 2 Randomized, Placebo-Controlled Trials  [PDF]
Vladimir Skljarevski,Peng Liu,Shuyu Zhang,Jonna Ahl,James M. Martinez
Pain Research and Treatment , 2012, DOI: 10.1155/2012/296710
Abstract: This subgroup analysis assessed the efficacy of duloxetine in patients with chronic low back pain (CLBP) who did or did not use concomitant nonsteroidal anti-inflammatory drugs (NSAIDs) or acetaminophen (APAP). Data were pooled from two 13-week randomized trials in patients with CLBP who were stratified according to NSAID/APAP use at baseline: duloxetine NSAID/APAP user ( ), placebo NSAID/APAP user ( ), duloxetine NSAID/APAP nonuser ( ), and placebo NSAID/APAP nonuser ( ). NSAID/APAP users were those patients who took NSAID/APAP for at least 14 days per month during 3 months prior to study entry. An analysis of covariance model that included therapy, study, baseline NSAID/APAP use (yes/no), and therapy-by-NSAID/APAP subgroup interaction was used to assess the efficacy. The treatment-by-NSAID/APAP use interaction was not statistically significant ( ) suggesting no substantial evidence of differential efficacy for duloxetine over placebo on pain reduction or improvement in physical function between concomitant NSAID/APAP users and non-users. 1. Introduction Low back pain has a lifetime prevalence rate of 80% in the United States and is one of the primary causes of disability in individuals younger than 45 years of age [1, 2]. Low back pain usually resolves spontaneously within a few days or weeks, but for some individuals, this pain becomes chronic [1]. Commonly prescribed medications for chronic low back pain (CLBP) include nonsteroidal anti-inflammatory drugs (NSAIDs), opioids, muscle relaxants, anticonvulsants, and tricyclic antidepressants (TCAs) [3]. Over-the-counter medications that are frequently used include acetaminophen (APAP), aspirin, and certain NSAIDs [4]. However, there is no clinical evidence to support the efficacy of any of these agents in CLBP [4, 5]. Furthermore, a number of these treatments pose safety risks that include sedation, respiratory depression and addiction (opioids), gastrointestinal bleeding and ulcers, and cardiovascular events (NSAIDs) [6]. In addition, antidepressants with serotonin reuptake inhibition properties may increase the risk of bleeding events [7, 8], either when taken alone or in combination with other drugs that affect coagulation, such as NSAIDs [9]. Duloxetine hydrochloride (hereafter referred to as duloxetine) is a potent serotonin and norepinephrine reuptake inhibitor (SNRI) that has been approved by the United States Food and Drug Administration for the management of diabetic peripheral neuropathic pain, fibromyalgia, and chronic musculoskeletal pain (as established in studies in CLBP and chronic pain
Duloxetine in the treatment of chronic pain due to fibromyalgia and diabetic neuropathy  [cached]
Alan Wright,Kyle E Luedtke,Chad VanDenBerg
Journal of Pain Research , 2010,
Abstract: Alan Wright, Kyle E Luedtke, Chad VanDenBergCenter for Clinical Research, Mercer University, Atlanta, Georgia, USAAbstract: Duloxetine is a serotonin-norepinephrine reuptake inhibitor approved by the US Food and Drug Administration for the treatment of fibromyalgia and painful diabetic neuropathy at doses of 60 mg daily. Duloxetine has been shown to significantly improve the symptoms of chronic pain associated with these disorders, as measured by the Fibromyalgia Impact Questionnaire, Brief Pain Inventory scores, the Clinical Global Impressions Scale, and other various outcome measures in several placebo-controlled, randomized, double-blind, multicenter studies. Symptom improvement generally began within the first few weeks, and continued for the duration of the study. In addition, the efficacy of duloxetine was found to be due to direct effects on pain symptoms rather than secondary to improvements in depression or anxiety. Adverse events including nausea, constipation, dry mouth, and insomnia, were mild and transient and occurred at relatively low rates. In conclusion, duloxetine, a selective inhibitor for the serotonin and norepinephrine transporters, is efficacious in the treatment of chronic pain associated with fibromyalgia or diabetic neuropathy, and has a predictable tolerability profile, with adverse events generally being mild to moderate.Keywords: duloxetine, chronic pain, neuropathic pain, fibromyalgia, efficacy, safety
Management of Acute Musculoskeletal Pain: A Review
JM Muthuuri
East African Orthopaedic Journal , 2012,
Abstract: Objectives: Acute musculoskeletal insult (injury and surgery) is very common. It is also one of the commonest sources of acute pain. Unfortunately, this pain is also commonly undertreated. This is because of various factors that include poor understanding of the subject, fear of pharmacologic agents, there uses and limitations. Untreated acute pain evolves to chronic pain which is more difficult to treat; and the result is the younger population of workers loose valuable time and the elderly become more morbid and incapacitated. The purpose of this paper is to discuss the broad principles of multimodal and multi-agent approach to acute pain management for better patient care. Data Source: The material source is from various published articles in books and journals. Data Selection/Extraction: This is a review article on general principles. No specific data is given to compare a method or an agent with another. Conclusions: Control of acute musculoskeletal pain, whethertraumatic or postoperative is more likely to be achieved by use of modern protocols that apply existing basic techniques. Staff education and regular assessment of pain using formal scoring systems is critical. Multimodal approach should result into improved quality of care. Parenteral opioids administered by intramuscular injection or by patient-controlled analgesia devices are the recommended approach. Addition of perioperative use of non-steroidal anti-inflammatory drugs enhances pain control. Use of continuous spinal techniques is a useful alternative in selected patients. Combinations of techniques are the most effective with potential benefits in terms of overall patient outcome.
Role of calcitonin in management of musculoskeletal pain  [cached]
Lars Arendt-Nielsen,Hans Christian Hoeck,Morten A Karsdal,Claus Christiansen
Rheumatology Reports , 2009, DOI: 10.4081/rr.2009.e12
Abstract: Calcitonin was discovered more than 40 years ago and the scientific community continues to debate the primary and secondary pharmacological actions of calcitonin. Presently calcitonin is accepted by agencies only for treatment of osteoporosis, but many studies have indicated an effect on pain in many different experimental settings both pre-clinically and clinically. The effects of calcitonin on clinical pain conditions have received increasing attention in the past decades, although a consensus on mode of action and potential indications still has to be reached. Several key advances in the pain field may enable a deeper understanding of the putative analgesic effects of calcitonin. Most studies have focused on the effect of calcitonin on musculoskeletal pain problems. Ample lines of independent evidence suggest that calcitonin exerts putative analgesic effects. Well-designed clinical trials, particularly in the field of musculoskeletal pain, are needed to validate fragmented evidence of analgesic actions. This in combination with advanced mechanism-based pain assessment tools can provide new insight into the role of calcitonin, alone or in combination with other compounds, in management of pain.
Duloxetine in the treatment of chronic pain due to fibromyalgia and diabetic neuropathy
Alan Wright, Kyle E Luedtke, Chad VanDenBerg
Journal of Pain Research , 2011, DOI: http://dx.doi.org/10.2147/JPR.S12866
Abstract: loxetine in the treatment of chronic pain due to fibromyalgia and diabetic neuropathy Review (6456) Total Article Views Authors: Alan Wright, Kyle E Luedtke, Chad VanDenBerg Published Date December 2010 Volume 2011:4 Pages 1 - 10 DOI: http://dx.doi.org/10.2147/JPR.S12866 Alan Wright, Kyle E Luedtke, Chad VanDenBerg Center for Clinical Research, Mercer University, Atlanta, Georgia, USA Abstract: Duloxetine is a serotonin-norepinephrine reuptake inhibitor approved by the US Food and Drug Administration for the treatment of fibromyalgia and painful diabetic neuropathy at doses of 60 mg daily. Duloxetine has been shown to significantly improve the symptoms of chronic pain associated with these disorders, as measured by the Fibromyalgia Impact Questionnaire, Brief Pain Inventory scores, the Clinical Global Impressions Scale, and other various outcome measures in several placebo-controlled, randomized, double-blind, multicenter studies. Symptom improvement generally began within the first few weeks, and continued for the duration of the study. In addition, the efficacy of duloxetine was found to be due to direct effects on pain symptoms rather than secondary to improvements in depression or anxiety. Adverse events including nausea, constipation, dry mouth, and insomnia, were mild and transient and occurred at relatively low rates. In conclusion, duloxetine, a selective inhibitor for the serotonin and norepinephrine transporters, is efficacious in the treatment of chronic pain associated with fibromyalgia or diabetic neuropathy, and has a predictable tolerability profile, with adverse events generally being mild to moderate.
Chronic musculoskeletal pain predicted hospitalisation due to serious medical conditions in a 10 year follow up study
Hans Lindgren, Stefan Bergman
BMC Musculoskeletal Disorders , 2010, DOI: 10.1186/1471-2474-11-127
Abstract: A ten-year follow up of a cohort from the general adult population in two health care districts with mixed urban and rural population in the south of Sweden, that in 1995 participated in a survey on health and musculoskeletal pain experience. Information on hospitalisation for each subject was taken from the regional health care register. Multiple logistic regression analyses were used to study the associations between chronic musculoskeletal pain and different medical conditions as causes of hospitalisation.A report of CRP (OR = 1.6; p < 0.001) or CWP ( OR = 2.1; p < 0.001) predicted at least one episode of inpatient care over a ten year period, with an increased risk in almost all diagnostic subgroups, including cerebrovascular diseases, ischemic heart diseases, and infectious diseases. There was however no increased risk of hospitalisation due to neoplasms.The presence of especially CWP was associated with hospital inpatient care due to several serious medical disorders. This may imply a general vulnerability to different medical conditions that has to be addressed in the assessment and management of subjects with chronic musculoskeletal pain.Chronic musculoskeletal pain is common in the general population with a prevalence of 35-50% [1-3].This includes various painful local or regional musculoskeletal disorders, but also subjects with chronic widespread pain (CWP). CWP, with a prevalence of 11% [2-4], may reflect a musculoskeletal or other underlying organic disease, but this is reported only in a small proportion of subjects. Despite the possible lack of pathological findings, chronic musculoskeletal pain and especially CWP is known to have a great impact on self-reported health and also to be a common cause for visits in primary care [5-7]. CWP has been reported to be associated with increased cancer mortality [8], due to both a higher incidence of cancer and a reduced cancer survival [9], but this was not confirmed in a more recent report from a large populat
Effect of electroacupuncture on opioid consumption in patients with chronic musculoskeletal pain: protocol of a randomised controlled trial
Xue Charlie CL,Helme Robert D,Gibson Stephen,Hogg Malcolm
Trials , 2012, DOI: 10.1186/1745-6215-13-169
Abstract: Background Chronic musculoskeletal pain is common and has been increasingly managed by opioid medications, of which the long-term efficacy is unknown. Furthermore, there is evidence that long-term use of opioids is associated with reduced pain control, declining physical function and quality of life, and could hinder the goals of integrated pain management. Electroacupuncture (EA) has been shown to be effective in reducing postoperative opioid consumption. Limited evidence suggests that acupuncture could assist patients with chronic pain to reduce their requirements for opioids. The proposed research aims to assess if EA is an effective adjunct therapy to standard pain and medication management in reducing opioids use by patients with chronic musculoskeletal pain. Methods In this multicentre, randomised, sham-acupuncture controlled, three-arm clinical trial, 316 patients regularly taking opioids for pain control and meeting the defined selection criteria will be recruited from pain management centres and clinics of primary care providers in Victoria, Australia. After a four-week run-in period, the participants are randomly assigned to one of three treatment groups to receive EA, sham EA or no-EA with a ratio of 2:1:1. All participants receive routine pain medication management delivered and supervised by the trial medical doctors. Twelve sessions of semi-structured EA or sham EA treatment are delivered over 10 weeks. Upon completion of the acupuncture treatment period, there is a 12-week follow-up. In total, participants are involved in the trial for 26 weeks. Outcome measures of opioid and non-opioid medication consumption, pain scores and opioid-related adverse events are documented throughout the study. Quality of life, depression, function, and attitude to pain medications are also assessed. Discussion This randomised controlled trial will determine whether EA is of significant clinical value in assisting the management of debilitating chronic pain by reducing opioids consumption and their associated adverse events, as well as improving the quality of life for those with chronic pain. Such an outcome will provide the rationale for including EA into multidisciplinary programmes for effective management of chronic musculoskeletal pain. Trial registration Australian New Zealand Clinical Trial Registry (ACTRN12609000676213) http://www.anzctr.org.au/trial_view.aspx?ID=308008
Pain management in chronic pancreatitis  [cached]
Cathia Gachago, Peter V Draganov
World Journal of Gastroenterology , 2008,
Abstract: Abdominal pain is a major clinical problem in patients with chronic pancreatitis. The cause of pain is usually multifactorial with a complex interplay of factors contributing to a varying degree to the pain in an individual patient and, therefore, a rigid standardized approach for pain control tends to lead to suboptimal results. Pain management usually proceeds in a stepwise approach beginning with general lifestyle recommendations. Low fat diet, alcohol and smoking cessation are encouraged. Analgesics alone are needed in almost all patients. Maneuvers aimed at suppression of pancreatic secretion are routinely tried. Patients with ongoing symptoms may be candidates for more invasive options such as endoscopic therapy, and resective or drainage surgery. The role of pain modifying agents (antidepressants, gabapentin, pregabalin), celiac plexus block, antioxidants, octreotide and total pancreatectomy with islet cell auto transplantation remains to be determined.
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