Pain Relief as a Motivation for Cannabis Use Among Young Adult Users With and Without Chronic Pain

This study aims to determine the rate of chronic pain in a community sample of young adult cannabis users, assess the extent to which pain relief is an important motivation for cannabis use, and explore differences in consumption patterns and problem behaviors between users with and without chronic pain. The study design was cross-sectional. Self-selected community-dwelling young adults (ages 18–29 years; n = 143) who regularly use cannabis completed an online survey. Results revealed that approximately 40% of the sample met the criteria for chronic pain, and pain relief was their primary motivation for use. There were no differences between groups with respect to frequency of use or estimated potency of their preferred strains; however, users with chronic pain reported using a wider variety of administration methods and a greater quantity of cannabis with each use. Users with chronic pain also reported more extensive histories of use, with younger age at initiation and longer duration of regular use. Despite riskier consumption patterns, there were no between-group differences in negative consequences owing to use after controlling for gender and educational status. On average, the total sample reported approximately 8 problems in the past 30 days owing to use. These findings suggest that chronic pain is commonly experienced among young adult cannabis users and pain relief is the primary motivation for users with pain. For some users, clinically significant chronic pain and pain-related interference persist despite heavy use. Cannabis users with and without chronic pain report experiencing several negative consequences owing to their use.PerspectiveThis article compares motivations for cannabis use and describes differences in consumption patterns among a community sample of young adult users with and without chronic pain. This information may be useful for providers who assess and treat pain in young adults, particularly in settings that have legalized recreational use.     

Neurosurgical Relief of Chronic Pain

The most favorable candidates for neurosurgical procedures to relieve chronic pain are patients with unresectable malignancies. Percutaneous technics are replacing open procedures and extend the usefulness of neurolytic operations.     

Non-Narcotic Options for Pain Relief with Chronic Neuropathic Conditions

Neuropathic pain is a misunderstood, usually inadequately treated condition. This article discusses the types of pain, mechanisms of pain, diagnosis, and rationale for treating neuropathic pain. The importance of working with patients to achieve their functioning goals is also addressed.     

硬膜外镇痛分娩的产程观察及护理

目的观察和护理硬膜外镇痛分娩。方法选择2003年10月~2004年10月住院分娩产妇,分成自愿接受无痛分娩组36人(实验组)和传统自然分娩组36人(对照组),对疼痛程度、产程、产后出血、新生儿情况等进行比较分析。结果实验组与对照组比较镇痛效果有显著差异(P<0.01)。结论硬膜外镇痛分娩镇痛效果好,促进产程进展,对产后出血及新生儿均无不良影响。     

Medical Marijuana Use for Chronic Pain: Risks and Benefits

ABSTRACT

Reports of three cases in which patients’ pain was previously inadequately treated prior to referral and how it was addressed in a pain clinic are presented. The impact of polypharmacy on medication adherence, fear of opioids among patients and staff, and of stoicism in pain patients is discussed.     

A Randomized, Double-Blind, Placebo-Controlled Study of Preemptively Administered Intravenous Parecoxib: Effect on Anxiety Levels and Procedural Pain During Epidural Catheter Placement for Surgical Operations or for Chronic Pain Therapy

Background: The effect of parecoxib, when used perioperatively or during interventional techniques, is well demonstrated in the literature. Little is known about its effects on anxiety levels before the analgesic technique application. The aim of this prospective, randomized, double‐blind, placebo‐controlled, clinical study is to investigate whether parecoxib, preemptively administrated, has an effect on anxiety levels reported prior to an epidural puncture, and if it influences the reported pain of the interventional technique itself. Material and Methods: The study protocol involved 110 patients, scheduled for epidural catheter placement for chronic pain therapy—Group I, as well as 112 patients scheduled for orthopedic operations under epidural anesthesia—Group II. Patients in each group were randomly allocated into two subgroups in relation to parecoxib/placebo administration before epidural catheter placement: Group Ia, parecoxib 40 mg i.v. (n = 54), Group Ib, placebo (n = 56), Group IIa, parecoxib 40 mg i.v. (n = 57), Group IIb, placebo (n = 55). Patients were given a self‐administered inventory to measure the anxiety level of the presurgical/preprocedural state (State‐Trait Spielberger Anxiety Inventory) and anxiety levels were recorded 1 hour before epidural puncture, 20 minutes postdosing, and 1 hour after epidural catheter placement. Anxiety levels were also measured and recorded using visual analog scale (VAS). One hour after epidural puncture, reported procedural pain was recorded (VAS). One hour and 6 hours postepidural, patients' satisfaction was also recorded, on a 4‐point scale. Results: All four subgroups were similar regarding demographic, operative/procedural data, and coexisting diseases. Preprocedural anxiety levels were significantly decreased with parecoxib administration in comparison with placebo in both groups (P < 0.05). Reported VAS regarding pain from epidural puncture was lower in Groups IA and Ib. Patients' satisfaction was greater with parecoxib in comparison with placebo. Conclusion: The levels of anxiety have been investigated in several medical procedures and early, in the study of pain. The higher the expectation of pain and the anxiety are, the higher the intensity of the pain. Parecoxib seems to exert positive influence on pain and anxiety levels of interventional procedure. Further studies are needed to elucidate the actual mechanisms that are involved.     

Methadone for Pain Relief

Questions from patients about pain conditions and analgesic pharmacotherapy and responses from authors are presented to help educate patients and make them more effective self-advocates. In reply to a question, the authors discuss the use of methadone for pain management, outline how the body processes methadone, list interactions and side effects, and emphasize the importance of taking the medication as prescribed.     

硬膜外麻导管用于婴儿导尿的临床观察

硬膜外麻导管用于婴儿导尿的临床观察ＣａｔｈｅｔｅｒｆｏｒＥｐｉｄｕｒａｌＡｎｅｓｔｈｅｓｉａＵｓｅｄａｓＣａｔｈｅｔｅｒｆｏｒＵｒｉｎｅｉｎＩｎｆａｎｔｓ蒋小剑屈智藩ＪｉａｎｇＸｉａｏｊｉａｎ，ＱｕＺｈｉｆａｎ（Ｐｅｏｐｌｅ’ｓＨｏｓｐｉｔａｌｏｆＹ...     

Ultrasound‐Guided Transversus Abdominis Plane Catheter for Chronic Abdominal Pain

Abstract Background and Objectives: Neural blockade of the thoracolumbar nerves supplying the anterior abdominal wall through transversus abdominis plane (TAP) has been investigated for different applications mainly for the acute pain management following abdominal surgical procedures. The role of this block for chronic pain syndromes is still to be discovered, and its value in chronic abdominal pain needs to be studied. We are presenting new application of the TAP technique for management of chronic abdominal pain syndrome using the continuous infusion. Case report: We present a case of an 18‐year‐old girl who underwent an uneventful laparoscopic cholecystectomy. Postoperatively, patient complained of chronic pain at the site of the surgery. All diagnostic and imaging studies were negative for a surgical or a medical cause. Multiple interventions including epidural blocks, transcutaneous electrical neural stimulation, and celiac plexus blocks had failed to relieve the pain. After discussion with the patient about the diagnostic nature of the procedure and the likelihood of recurrence of pain, TAP block was performed on the right side with significant improvement of pain for about 24 hours. The degree of pain relief experienced by the patient was very dramatic, which encouraged us to proceed with an indwelling TAP catheter to allow for continuous infusion of a local anesthetic. The patient was sent home with the continuous infusion through a TAP catheter for 2 weeks. From the day of catheter insertion and up to 9 months of follow‐up, patient had marked improvement of her pain level as well as her functional status and ability to perform her daily activities, after which our acute pain team stopped following the patient. Conclusion: A successful TAP block confirmed the peripheral (somatic) source of the abdominal pain and provided temporary analgesia after which an indwelling catheter was inserted, which provided prolonged pain relief.     

Epidural Steroid and Clonidine for Chronic Intractable Post‐thoracotomy Pain: A Pilot Study

Background: Chronic post‐thoracotomy pain is relatively common after major thoracic surgery. The primary results of a pilot study using thoracic epidural steroid and clonidine injection to treat chronic intractable post‐thoracotomy pain are presented. Methods: Twenty‐one patients with intractable post‐thoracotomy pain participated in the study. Thirteen patients received thoracic epidural injection of a mixture of 150 μg clonidine and 80 mg of methylprednisolone acetate diluted in 8 mL 0.5% lidocaine. Eight patients continued with comprehensive medical management and served as a control group. A visual analog scale (VAS) for pain was recorded before treatment, 30 minutes after the epidural injection and before discharge, at 3 weeks and 6 months. Pain, sleep disturbances, appetite changes and daily activity, as well as the incidence of complications were recorded. The need for opioid rescue medications was recorded. Results: Twelve of 13 patients in the injection group reported improvement (> 50% reduction of pain) at 3 weeks and 6 months following the injection. Allodynia improved in all injection group patients compared to four of eight in the control group. Sleep disturbance, appetite changes and daily activity were improved in the injection group. The number of patients requiring opioid rescue medications was reduced from 61.5% to 15.3% during the 6‐month duration of study. Injection caused transient hypotension in 46.2% of patients. Mild sedation was noted in 30.7% of patients receiving injection; 15.3% of the patients had localized back pain at the site of injection. Discussion: Our preliminary data suggest possible efficacy of thoracic epidural steroid and clonidine mixture in the treatment of chronic post‐thoracotomy pain. No serious adverse effects were noted in this pilot study. ?     

微量泵控制连续硬膜外麻醉镇痛分娩的临床应用

目的：探讨微量泵控制连续硬膜外麻醉镇痛分娩对分娩的镇痛效果及分娩结局的影响。方法：镇痛分娩组(观察组)80例与传统分娩组(对照组)100例比较其镇痛效果、产程时间、分娩方式、产后2h出血量、新生儿窒息率。结果：两组的产后出血量及新生儿窒息率无显著差异，观察组的产程较对照组短、剖宫产率低于对照组，差异有显著性。结论：微量泵控制连续硬膜外麻醉镇痛分娩是安全有效的，对提高产科质量、降低难产及剖宫产率有积极作用。