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A specialist in public policy and bioethics considers the conundrum of gaining insurance coverage for this cost-efficient but expensive paradigm change to prescribing decisions, as well as some of the ethical issues associated with the practice of pharmacogenomic testing.
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Dr. Cuevas-Trisan discusses the emerging role of botulinum toxins as chemical neuromodulators, and their application to the management of chronic intractable pain syndromes.
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Viscosupplementation, or the injection of a synthetic hyaluronic acid into the affected joint, is thought to improve the viscosity of synovial fluid, therely enhancing movement and reducing pain. Dr. Cuevas-Trisan discusses the approach, and FDA approved and non-approved indications.
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Can opioids be rationally prescribed for chronic pain? Dr. Stacey considers some of the components of getting there, including strengths and limitations in the current CDC guidelines, the practice of tapering; elements of patient assessment, red flags to watch for, and the proper role of opioids in...
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Successful treatment of chronic pain means going beyond the pharmacologic options to embrace self-care, psychological and psychosocial factors, functional restoration, and alternative medicine. Dr. Pohl provides an exploration, and outlines some ideas for primary practitioners to engage.
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Spinal manipulative therapy is far from new, but questions remain over effectiveness in comparison to other treatment options, as well as the patients for whom it may be most beneficial. Dr. George reviews the current research, and what remains to be learned.
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Dr. Pergolizzi outlines some of the newer analgesic candidates under investigation, their mechanisms of action, and why trial design for these investigations may not always mimic clinical practice. Also discussed are new targets for analgesic testing.
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Although recent CDC guidelines have focused on opioids for chronic pain management, little attention has gone to the perioperative setting as a potential contributor to the prescription drug crisis. Dr. Bottros gives his perspective on opioids and other alternatives for postoperative pain.
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Brain neuroimaging techniques have heralded a revolution in our understanding of chronic pain. Dr. Harris discusses how these, and proton magnetic resonance spectroscopy are permitting the noninvasive evaluation of brain structure and function as it relates to pain syndromes.
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Despite its widespread use as a treatment modality for pain, the results of controlled trials of acupuncture efficacy have returned mixed results. Dr. Harris reviews the evidence including emerging approaches that may help to determine if analgesia from acupuncture derives from placebo or from...