scholarly journals The Use of Conditioning Open-Label Placebo in Opioid Dose Reduction: A Case Report and Literature Review

2021 ◽  
Vol 2 ◽  
Author(s):  
Maria A. Estudillo-Guerra ◽  
Ines Mesia-Toledo ◽  
Jeffrey C. Schneider ◽  
Leon Morales-Quezada
Keyword(s):  
Case Report ◽  
Pain Management ◽  
Side Effects ◽  
Literature Review ◽  
Behavioral Intervention ◽  
Pain Control ◽  
Inpatient Rehabilitation ◽  
Trial Participation ◽  
Open Label ◽  
Cord Injury

Introduction: Adequate pain management for inpatients in rehabilitation units is essential for achieving therapeutic goals. Opioid treatments are commonly prescribed, but these are associated with numerous adverse effects, including the risk of addiction and decreased quality of life. Conditioning an open-label placebo is a promising approach to extend the analgesic effect of the opioid while reducing its overall dosage.Objectives: To describe a patient's experience in using conditioning open-label placebo (COLP) as a pharmaco-behavioral intervention to decrease opioid intake and its side effects after inpatient rehabilitation discharge, and to perform a literature review about the use of open-label placebo in pain.Methods: This case study has been extracted from a clinical trial initiated in 2018. A 61-year-old male was recruited at a tertiary rehabilitation hospital after suffering a traumatic sport-related injury and orthopedic surgery. Pain management included prescription of non-steroidal anti-inflammatory drugs (NSAIDs) and short-acting oxycodone. After trial participation, the patient requested off-label COLP treatment to help him decrease outpatient opioid utilization.Results: After COLP treatment, the patient could discontinue oxycodone intake (a reduction from 15 morphine equivalents/day) after rehabilitation discharge. Moreover, opioid side effects decreased from 46 to 9 points on the numerical opioid side-effects scale. A literature review identified five clinical trials using “honest” open-label placebo (OLP) or COLP as an experimental intervention for pain control. From these studies, two were in the area of chronic lower back pain, one in post spine surgery, one in irritable bowel syndrome, and another in spinal cord injury and polytrauma. Four studies reported positive outcomes related to pain control, while one study showed no significant differences in pain management between treatment-as-usual and the COLP group.Conclusion: The case report illustrates how a pharmaco-behavioral intervention can facilitate downward opioid titration safely after inpatient rehabilitation. It initiates a discussion about new approaches for opioid management using conditioning and the patient's expectation of pain relief.

Craniotomy

2019 ◽  
pp. 221-245
Author(s):  
Roxana Grasu ◽  
Sally Raty
Keyword(s):  
Risk Factors ◽  
Pain Management ◽  
Side Effects ◽  
Respiratory Depression ◽  
Pain Control ◽  
Sensory Nerves ◽  
Current Evidence ◽  
Multimodal Approach ◽  
Perivascular Nerves ◽  
Persistent Headache

This chapter discusses postcraniotomy headache (PCH), a common yet frequently underdiagnosed and undertreated occurrence, with up to 30% of patients experiencing persistent headache after surgery. The chapter identifies risk factors for the development of acute and persistent PCH and describes mechanisms for its development, such as injury to the sensory nerves supplying the scalp and underlying tissues or to the perivascular nerves that supply sensation to the dura mater. Pain management following craniotomy is a balancing act of achieving adequate analgesia while avoiding oversedation, respiratory depression, hypercapnia, nausea, vomiting, and hypertension. Current evidence suggests that a balanced, multimodal approach to the treatment of acute PCH is often required to optimize pain control, minimize undesired side effects, and prevent the development of persistent PCH.

Pain Management

2018 ◽  
Author(s):  
Eelco F. M. Wijdicks ◽  
Sarah L. Clark
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Pain Management ◽  
Side Effects ◽  
Pain Control ◽  
Pain Syndrome ◽  
Opioid Analgesics ◽  
Narcotic Analgesics

Adequate pain control has a high priority. In any acute neurologic pain syndrome it must be assumed that pain management is possible, effective, and simple; unfortunately, most patients in pain have been poorly managed. The pharmacopeia of pain management is growing and changing and several trends have been noted. Pain is underreported in the intensive care unit and should be treated when indicated. Acetaminophen is often the first agent used in pain management. Next are weak narcotic analgesics which could have less severe side effects than stronger opioid analgesics. This chapter discusses types of pain in the neurosciences intensive care unit and specific pharmacologic approaches.

Fentanyl iontophoretic transdermal system versus morphine intravenous patient-controlled analgesia for pain management following orthopedic surgery: A pooled analysis of randomized, controlled trials

2016 ◽  
Vol 12 (1) ◽  
pp. 37 ◽  
Author(s):  
Craig T. Hartrick, MD ◽  
Donald M. Knapke, MD ◽  
Li Ding, MS, MA ◽  
Hassan Danesi, MD ◽  
James B. Jones, MD
Keyword(s):  
Pain Management ◽  
Orthopedic Surgery ◽  
Pain Control ◽  
Global Assessment ◽  
Control Method ◽  
Pooled Analysis ◽  
Patient Controlled Analgesia ◽  
Open Label ◽  
Parallel Group ◽  
Iontophoretic Transdermal System

Objective: To compare the efficacy and safety of patient-controlled pain management following orthopedic surgery using either fentanyl iontophoretic transdermal system (ITS) or morphine intravenous (IV) patient-controlled analgesia (PCA).Setting: Acute Care Hospital.Patients: Three-open-label, multicenter, randomized, active-controlled, parallel-group phase 3B studies (N = 2095) were conducted that compared fentanyl ITS with morphine IV PCA for postoperative pain in hospitalized postoperative patients. A subgroup of orthopedic surgery patients (N = 1,216) was pooled for this analysis; of which 819 completed treatment.Interventions: A total of 590 patients received fentanyl ITS (40 μg/dose) and 626 patients received morphine IV PCA (1 mg/dose) for up to 72 hours.Main outcome measures: Efficacy measures included the patient global assessment (PGA) and the investigator global assessment (IGA) of the method of pain control.Results: Patients had a mean age of about 60 years, were predominantly Caucasian (90.5 percent), and the majority underwent hip replacement (80.3 percent). There were more patients treated with fentanyl ITS who rated their pain control method as “excellent” compared to morphine IV PCA at 24 hours postsurgery (44.8 percent vs 33.0 percent, respectively; p < 0.001), 48 hours (37.5 percent vs 25.3 percent, respectively; p < 0.001), and at the last assessment (54.3 percent vs 39.6 percent, respectively; p < 0.001). There were more investigators who rated treatment with fentanyl ITS as “excellent” compared to morphine IV PCA at the last assessment (57.4 percent vs 36.9 percent, respectively; p < 0.001).Conclusions: Following orthopedic surgery, patients and investigators more frequently reported global assessment of pain control as “excellent” on the PGA and IGA assessments with fentanyl ITS than with morphine IV PCA.

scholarly journals In Search of a Histopathological Pattern of Immune-Mediated Gastritis from Nivolumab Therapy: A Case Report with Literature Review

2021 ◽  
pp. 1-3
Author(s):  
Flor M Fernández-Gordón Sánchez ◽  
Flor M Fernández-Gordón Sánchez ◽  
Elena Gomez Dominguez ◽  
Cristina Garfia Castillo ◽  
Jorge Arroyo Andres ◽  
...  
Keyword(s):  
Case Report ◽  
Side Effects ◽  
Literature Review ◽  
Checkpoint Inhibitor ◽  
Checkpoint Inhibitors ◽  
Gastrointestinal Symptoms ◽  
Specific Pattern ◽  
Immune Mediated ◽  
Upper Gastrointestinal Symptoms ◽  
Upper Gastrointestinal

Immunotherapy with checkpoint inhibitors is associated with termed inflammatory and immune-related side effects (irAE). Upper gastrointestinal symptoms are infrequent and appear mainly in patients on combination therapy with two checkpoint inhibitor drugs. We present the case of a patient with IIIB stage cutaneous melanoma treated with Nivolumab in monotherapy who developed an immune-mediated gastritis. Histopathologically, due to the paucity of published cases, no specific pattern of Nivolumab-immune-mediated gastritis has been described. We have reviewed the literature and compared the histopathology of the cases available in the literature.

Poster 487 Incomplete Spinal Cord Injury Following a Traumatic Baseball Collision: Case Report and Literature Review

PM&R ◽  
2012 ◽  
Vol 4 ◽  
pp. S356-S357
Author(s):  
Henry K. Lee ◽  
L. Adriana Arenas ◽  
Junney M. Baeza Dager ◽  
Jamil Bashir ◽  
Jackson Cohen ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Injury ◽  
Case Report ◽  
Literature Review ◽  
Incomplete Spinal Cord Injury ◽  
Cord Injury
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