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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]

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]

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]

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Aim: The aim of this prospective, randomized, double-blind study was to evaluate whether adding metamizol to tramadol in an i.v. patient controlled analgesia (PCA) system improved the analgesic efficacy compared to i.v. PCA with tramadol plus metamizol administered when needed. Methods: Forty-six adult patients undergoing elective hemicolectomy were randomly assigned to either a tramadol group (group T; n = 23) or a tramadol plus metamizol group (group TM; n = 23) for postoperative pain treatment. Loading doses of i.v. 100 mg tramadol (group T) or i.v. 100 mg tramadol plus 1000 mg metamizol (group TM) were administered intra-operatively. Postoperatively, the PCA pump was programmed to deliver, on demand, doses of tramadol 20 mg (group T) or tramadol 20 mg plus metamizol 200 mg (group TM) without any baseline infusion. Lock-out time was set to 5 min and the 4-h dose limit was 400 mg and 4000 mg for tramadol and metamizol, respectively. Group T patients received i.v. metamizol when necessary as a rescue medication. Pain intensity (NRS), patient satisfaction, tramadol consumption and side effects were the outcome measures. Results: The first effective pain relief was reached at 4 h in group TM patients (NRS in group TM, 3.22; in group T, 4.57; P < 0.001); however, beyond 4 h. pain relief was similar. The incidence and severity score of postoperative nausea and vomiting were low in the TM group (P < 0.05). There were no significant differences between groups in terms of patient satisfaction. Conclusions: Tramadol combined with metamizol in a concentration of 1:10 mg in the PCA system provided slightly earlier pain relief and a decrease in the nausea/vomiting score compared to tramadol PCA plus, when needed, metamizol. Adding metamizol to a PCA system may be a practical and convenient option for postoperative analgesia. [ABSTRACT FROM AUTHOR]

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.