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Wireless powered implants, each smaller than a grain of rice, have the potential to scan and stimulate brain cells. Further research may lead to next-generation brain-machine interfaces for controlling prosthetics, exoskeletons, and robots, as well as "electroceuticals" to treat disorders of the brain and body. In conditions that can be particularly alleviated with brain stimulation, the use of such mini devices may pose certain challenges. Health professionals are becoming increasingly more accountable in decision-making processes that have impacts on the life quality of individuals. It is possible to transmit such stimulation using remote control principles. Perhaps, the most important concern regarding the use of these devices termed as "neural dust" is represented by the possibility of controlling affection and other mental functions via waves reaching the brain using more advanced versions of such devices. This will not only violate the respect for authority principle of ethics, but also medical ethics, and may potentially lead to certain incidents of varying vehemence that may be considered illegal. Therefore, a sound knowledge and implementation of ethical principles is becoming a more important issue on the part of healthcare professionals. In both the ethical decision-making process and in ethical conflicts, it may be useful to re-appraise the principles of medical ethics. In this article, the ethical considerations of these devices are discussed. [ABSTRACT FROM AUTHOR]

To compare the efficacy, safety, and impact on daily activity of peripherally administered morphine plus a local anesthetic with that of a local anesthetic alone in patients with chronic ischemic lower extremity pain. Fifty patients with lower extremity ischemic pain due to peripheral vascular disease who had undergone surgical sympathectomy and who were not responding to systemic analgesics were included. Study treatments were bupivacaine plus morphine or bupivacaine alone administered via popliteal catheter. Each patient received both study treatments consecutively, with a washout period, in a double-blind fashion. The effects of treatments on pain severity (numerical rating scale), duration of analgesia, and daily activity were evaluated. Then, patients were asked to state which one of the treatments they preferred for the long term, during which catheter outcomes were evaluated. Both treatments provided significant pain control compared to baseline at all time points, both at rest and during activity. However, the combination treatment provided superior pain control at 8 and 12 h, and longer analgesia duration (12 ± 2 h vs 9 ± 1 h; P < 0.001). During the long term, treatments were similar in terms of analgesia. The combination treatment had a higher incidence of side effects (30% vs 0%; P < 0.001). A peripherally administered bupivacaine plus morphine combination provided better and longer analgesia for ischemic pain compared to bupivacaine alone for the short term, but not for the long term. On the other hand, our results show that continuous popliteal treatment is an effective, safe, and comfortable modality for long-term use in the home setting for patients with intractable chronic pain. [ABSTRACT FROM AUTHOR]

Aim: Chronic postthoracotomy pain (CPTP) seems to be a combination of both nociceptive and neuropathic pain. The mechanism of CPTP based on neuropathic origin results in amitryptiline and gabapentine to be regarded attractive adjuvant analgesics. Aim of this trial is to compare the efficacy of gabapentine and amitryptiline in CPTP. Material and Method: 40 patients with chronic nonmalignant postthoracotomy pain (burning, stabbing and shooting pain) received gabapentine or amitryptiline as a single drug therapy. Study drugs were increased to effective and tolerable doses gradually throughout the study (4 weeks). Assessment variables were the intensity of burning, stabbing and shooting pain (assessed on VAS), side effects and patients' satisfaction (assessed with 7-points Likert's scale). The assessments were done before the study drugs treatments, at one and 4 weeks of study. Results: The burning, stabbing and shooting pain scores mean VAS values were lower in gabapentine group compared with amitryptiline group (p<0,05). Side effects were also high (55 %) in amitryptiline group (p<0,001). Patients satisfaction measured with Likert's scale was statistically significantly high in gabapentine grup (6,35±0,7; 50 % improvements) compared with amitryptiline group (4,55±0,9; 25 %). Conclusion: Gabapentin appears safe and well tolerated when used for chronic postthoracotomy pain. Gabapentin as one of the first line agents used in neuropathic pain are preferable in postthoracotomy pain. [ABSTRACT FROM AUTHOR]

Abstract: Objective: Effectiveness of antidepressants and antiepileptic drugs has already been demonstrated for migraine prophylaxis as monotherapy. In the present study, the efficacy and tolerability of amitriptyline and topiramate combination is examined in the prevention of migraine attacks, in comparison to the monotherapy of each drug. Methods: A total of 73 patients with migraine headache with or without aura are included in this single-center, double-blind, randomized, and controlled trial. Patients were assigned to receive topiramate alone, amitriptyline alone or a combination of these drugs. Frequency, duration and severity of migraine attacks, accompanied symptoms, depressive state, consumption of medications, side effects and patient satisfaction were evaluated. Results: All treatments resulted in significant improvements in all efficacy measures (p <0.001 for all comparisons). However, patients receiving combination treatment had higher patient satisfaction compared with other groups both at 8 and 12 weeks (p =0.006 and p <0.001, respectively). Patients receiving amitriptyline and combination treatments had better depression scores compared with the topiramate group. Combination group had fewer side effects with a less amount of amitriptyline consumption. Conclusion: Amitriptyline and topiramate combination may be beneficial for patients with migraine and comorbid depression, particularly in terms of side effects and associated displeasure due to monotherapy. [Copyright &y& Elsevier]

Abstract: Neuropathic cancer pain represents a major challenge. Treatment often requires adjuvant analgesics, including gabapentin, to complement the effects of opioids. This study aimed to compare the effectiveness and safety of gabapentin combined with an opioid versus opioid monotherapy for the management of neuropathic cancer pain. Seventy-five cancer patients who were receiving opioid therapy and reported sufficient pain relief of nociceptive, but not neuropathic, pain were enrolled. Sixty-three patients completed the study. Patients were randomized to one of the following treatment protocols: 1) gabapentin adjuvant to ongoing opioid treatment titrated according to pain response while opioid dose was kept constant (group GO), and 2) continuation of opioid monotherapy according to the World Health Organization treatment ladder approach (group OO). Changes in pain intensity, allodynia, and analgesic drug consumption were evaluated at Day 4 and Day 13. Side effects were also recorded. Both treatments resulted in a significant reduction of pain intensity at Day 4 and Day 13 compared to baseline. However, mean pain intensity for burning and shooting pain was significantly higher in the OO group compared to the GO group at both the fourth (P =0.0001) and 13th (P =0.0001) days of the study. An earlier significant decrease (at Day 4, P =0.002) was observed for allodynia in the GO group compared to the OO group. The rate of side effects in the GO group was significantly lower than that in the OO group (P =0.015). These data suggest that gabapentin added to an opioid provides better relief of neuropathic pain in cancer patients than opioid monotherapy; this combination of gabapentin and an opioid may represent a potential first-line regimen for the management of pain in these patients. [Copyright &y& Elsevier]

A letter to the editor is presented which describes the use of gabapentin as a medical treatment of neuropathic pain due to sciatic nerve damage by intramuscular injections in an eight-year-old boy.

Objective: The present study aimed to examine the effectiveness of intravenous administration of paracetamol added to morphine in the control of cancer pain and its possible contribution as reduction of opioid consumption and opioid-related side effects.Materials and Methods: A total of 43 patients with chronic cancer pain without neuropathic origin aged between 18 and 76 years and receiving step 2 treatment according to the World Health Organization analgesic ladder were included. Patients were randomized to receive intravenous administration of saline (control) or 1 g of paracetamol on top of morphine. Visual analog scale (VAS), patient rating index (PRI), Eastern Cooperative Oncology Group (ECOG) status, patient satisfaction, and safety were evaluated.Main Results: Both treatments resulted in improved VAS and PRI scores compared to baseline. However, groups did not differ in terms of VAS and PRI scores, morphine consumption, side-effect frequencies, laboratory values, ECOG status, and patient satisfaction.Conclusions: Although safe and there are signals for a true analgesic efficacy, our results failed to confirm any benefits of add-on treatment with intravenous administration of paracetamol. However, the study was underpowered, and future studies in this important area need to be wary of background noise and the risk of a type II error. [ABSTRACT FROM AUTHOR]