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Opioid stewardship is one essential function of pain and palliative care pharmacists and a critical need in the United States. In recent years, this country has been plagued by two public health emergencies: an opioid crisis and the COVID-19 pandemic, which has exacerbated the opioid epidemic through its economic and psychosocial toll. To develop an opioid stewardship program, a systematic approach is needed. This will be detailed in part here by the Opioid Stewardship Taskforce of the Society of Pain and Palliative Care Pharmacists (SPPCP), focusing on the role of the pharmacist. Many pain and palliative care pharmacists have made significant contributions to the development and daily operation of such programs while also completing other competing clinical tasks, including direct patient care. To ensure dedicated time and attention to critical opioid stewardship efforts, SPPCP recommends and endorses opioid stewardship models employing a full time, opioid stewardship pharmacist in both the inpatient and outpatient setting. Early research suggests that opioid stewardship pharmacists are pivotal to improving opioid metrics and pain care outcomes. However, further research and development in this area of practice is needed and encouraged. [ABSTRACT FROM AUTHOR]

This document was developed by a group of over two dozen pain clinicians and investigators from Austria, Belgium, Denmark, France, Germany Ireland, Israel, Italy, The Netherlands, Norway. Poland, Portugal, Spain, Sweden, Switzerland and the United Kingdom and funded by an educational grant form Mundipharma International, Limited. The stated aim of the White Paper is to identify inequalities in government policies towards opioids that contribute to inadequate treatment of pain. It calls for their replacement with policies that will support doctors and patients in their efforts to relieve pain. [ABSTRACT FROM AUTHOR]

Presents information on several papers completed and published by the American College of Physicians-American Society of Internal Medicine to provide information on improving care at the End-of-Life. 'Care at the End of Life: Guiding Practice Where There Are No Easy Answers,' by Bernard Lo, Lois Snyder, and Harold C. Cox; Discussing Palliative Care With Patients,' by Bernard Lo, Timothy Quill, and James Tulsky.

This document was developed by a group of over two dozen pain clinicians and investigators from Austria, Belgium, Denmark, France, Germany Ireland, Israel, Italy, The Netherlands, Norway, Poland, Portugal. Spain, Sweden, Switzerland and the United Kingdom and funded by an educational grant form Mundipharma International, Limited. The stated aim of the White Paper is to identify inequalities in government policies towards opioids that contribute to inadequate treatment of pain. It calls for their replacement with policies that will support doctors and patients in their efforts to relieve pain. [ABSTRACT FROM AUTHOR]

The existential suffering of members of the Havasupai Indian tribe are described by a physician-anthropologist who spent some time serving as an interim medical provider for the tribe. Pain is often described as having both physical and emotional dimensions. In this paper, the existential dimension is explored through a narrative of the author's experiences. [ABSTRACT FROM AUTHOR]

Pain disorders affect a large number of individuals throughout the world and are costly. Although randomized clinical trials assess the efficacy (i.e., how well treatments work in controlled settings) of pain pharmacotherapy, clinical trials do not assess effectiveness (i.e., how well treatments work in real-world settings). The number of observational studies that use real-world data to assess the effectiveness of medications is increasing rapidly in many disease areas. It is important for clinicians to understand how real-world data may be used to assess the effectiveness of medications. This paper aims to review the current body of literature assessing the effectiveness of pain pharmacotherapy using medical records. To do this, a literature search was conducted to identify papers published between January 2013 and September 2015 that examined the effectiveness of pain pharmacotherapy using electronic medical records. The search found only three papers meeting these criteria, which were described, reviewed, and critiqued in this paper. Electronic medical records are an underutilized source of data to assess pain outcomes in real-world settings. Although there are many methodological challenges in using these data, there is also great opportunity to impact clinical practice and explore the real-world effectiveness of pharmacotherapy used in pain management. [ABSTRACT FROM AUTHOR]

Chronic pain is a common and costly healthcare problem where standard of care often involves the use of opioids and patient response varies widely. Designing a treatment plan based upon an individual's genetic signature provides an individualized patient-centered care approach that can improve functional status, quality of life, and reduce adverse drug events (ADEs). This paper will discuss the ethical implications of pharmacogenetic (PGx) testing using the principlism framework of the four moral principles: beneficence, non-maleficence, autonomy, and justice. Beneficence involves balancing the benefits and risks associated with PGx testing. Non-maleficence is the directive to do no harm to the patient in the delivery or use of PGx test results. Autonomy encompasses self-determination; the patient's right to select PGx testing. Justice is concerned with distributing benefits and burdens of PGx testing access and costs. Maximizing patient autonomy and beneficence during treatment promotes patient-centered care. Principlism supports PGx testing for patients experiencing chronic pain. Integrating PGx testing impact treatment plans and may improve the outlook for patients with chronic pain. [ABSTRACT FROM AUTHOR]

The main goal of palliative care is to relieve suffering. Opioids are an essential part of the pharmacological options required to address suffering by helping to relieve the pain and chronic breathlessness that may be experienced by someone with a life-limiting illness. This paper considers the recent history and current issues of the 'opioid crisis' providing recommendations to which regulatory and peak bodies can work with the Australian government, ensuring consistent adherence to WHO guidelines maintaining access to evidence based opioid management for palliative care patients whilst actively avoiding unintended suffering restricted access can cause. The recommendations are as follows: Review of the Palliative Care schedule of the Pharmaceutical Benefit Scheme Support of prescribers with current evidence, clinical practice guidelines and regulatory frameworks National opioid prescribing policies promoting linkages between palliative care and pain and addiction specialists. National real time monitoring of all opioid prescriptions Palliative care involvement in all opioids stewardship programs in acute services. Reform Medical Benefits Schedule to improve access for primary and other speciality practitioners to provide palliative care services. Compulsory palliative care education in undergraduate medical, nursing and allied health tertiary courses. Adequate, consistent stock of evidence based opioids for palliative care in community pharmacies and residential aged care facilities. These recommendations provide the regulatory guidance required to ensure persons with life limiting illness have continued access to safe and effective medication that can relieve suffering. [ABSTRACT FROM AUTHOR]

The article offers information on the process of peer review in scientific literature, focusing on how to think like a peer reviewer and provide a detailed assessment of each section of a manuscript. Topics covered include preparing for a review, evaluating the title, abstract, introduction, methods, results, tables and figures, and the discussion section of a research article. It emphasizes the importance of following reporting guidelines and ethical considerations during the review process.

The Cochrane Library of Systematic Reviews is published quarterly. It now contains 2435 complete reviews. 1606 protocols of reviews and 5340 one page summaries of systematic reviews published in the general medical literature. In addition there are citations of 454.449 randomized controlled trials, 20 methodology reviews and 7059 cited papers in the Cochrane methodology register. The health technology assessment database contains 4620 citations. This edition of the Library contains 79 new reviews of which 6 have potential relevance for practitioners in pain and palliative medicine. [ABSTRACT FROM AUTHOR]

Technology that can improve the ability to provide quick symptom control while decreasing the cost and burden of care could help hospice agencies deal with current hospice industry challenges. This paper describes how the use of a new rectal medication delivery technology at a large hospice in western New York has improved patient care and nursing efficiency while at the same time decreasing the cost of care. [ABSTRACT FROM AUTHOR]

This paper reviews the economic evaluation literature on pharmacotherapy for migraine and identifies important trends and gaps in the literature. Given the tremendous economic burden of migraine and the availability of various therapies for migraine treatment, economic evaluation of alternative therapies plays a critical role in identifying the most cost-effective therapy to optimize health care resource allocation and clinical decisions. Particularly, physicians and clinical administrators are expected to take an active role in resource allocation decisions at the clinical level. Thus, it is important for them to be familiar with the economic evaluation in migraine pain management, and most importantly, methodologies of economic analyses and the associated shortcomings of published estimates. In this paper, the methodological characteristics of these studies are examined and their results are compared and interpreted. Alternative treatment and health outcome measures are defined and data sources described while methods for assessing the direct and indirect costs are explored. Directions for future research are identified and discussed. [ABSTRACT FROM AUTHOR]

Cochrane Library of Systematic Reviews is published quarterly. It now contains 3094 complete reviews, 1707 protocols for reviews in production and 6817 one page summaries of systematic reviews published in the general medical literature. In addition there are citations of 495,000 randomized controlled trials, and 9,458 cited papers in the Cochrane methodology register. The health technology assessment database contains 6,817 citations. This edition of the Library contains 97 new reviews of which 9 have potential relevance for practitioners in pain and palliative medicine. [ABSTRACT FROM AUTHOR]

Prominent and distressing emotions, cognitions, and behaviors frequently accompany chronic pain. In many cases, these psychological symptoms will be sufficiently severe to qualify the patient for a diagnosis of a mental disorder, as defined in the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision (DSM-IV-TR). This article introduces mental disorders that are frequently diagnosed in patients with chronic pain. Mental disorders are common co-morbidities with chronic pain. This paper presents an overview of the extent and nature of co-morbidity between mental disorders and chronic pain, as well as an outline of the structure of DSM-IV-TR, especially with respect to its use of a five-axis system for structuring mental disorder diagnoses. [ABSTRACT FROM AUTHOR]

The Cochrane Library of Systematic Reviews is published quarterly. It now contains 2356 complete reviews, 1569 protocols of reviews and 5205 one page summaries of systematic reviews published in the general medical literature. In addition there are citations of 446,156 randomised controlled trials, 19 methodology reviews and 6855 cited papers in the Cochrane methodology register. The health technology assessment database contains 4548 citations. In this edition of the Library, there were 107 new reviews of which six have direct or potential relevance for practitioners in pain and palliative medicine. In 2004, the format of the citation has changed with the move to publication of the Cochrane Library by John Wiley & Sons. Citations will probably change again in the future as currently there is no indication of the date when a review was first published. [ABSTRACT FROM AUTHOR]

The Cochrane Library of Systematic Reviews is published quarterly. Issue two for 2004 of the library was published in April 2004. The Cochrane Library now contains 1,999 complete reviews, 1,441 protocols of reviews, and 4,645 one-page summaries of systematic reviews published in the general (non-Cochrane) medical literature. In addition there are citations of 405,580 randomized controlled trials, 18 methodology reviews and 5,414 cited papers in the Cochrane methodology register. The health technology assessment database now contains 3,848 citations. This edition of the Library contains the results of an extensive search for randomized controlled trials (RCTs) on EMBASE. The latest library contains 78 new reviews, 10 of which are considered relevant to practitioners in pain and palliative care. References are published in the same format as the citation for Cochrane reviews. [ABSTRACT FROM AUTHOR]

Patients with advanced, irreversible disease need palliative care in both developing and developed countries. The philosophy of palliative care is universal. Despite differences among individuals and cultural groups, basic needs, cares, and wants are common to humankind. For truly effective palliative care, cultural subtleties and nuances must be considered. Challenging assumptions based on one's own culture is essential to the development of knowledge and insight into others. Keeping open minds about what is new or different within different cultures where we provide care can extend and intensify quality of care. This paper reflects the author's experience as a New Zealand Nurse and of her visit to the Pain and Palliative Care Clinic in Calicut, India. This was a journey that crossed cultural boundaries and it illustrates the importance of building bridges to care. [ABSTRACT FROM AUTHOR]

In June and July 2001, Dr. Nell Muirden traveled from Melbourne, Australia to Port Moresby General Hospital and Angau Memorial Hospital located in Lae, in Papua New Guinea. This visit was sup, ported through an International Association for Hospice and Palliative Care Traveling Fellowship. Dr. Muirden's visit greatly increased awareness about cancer pain and the importance of palliative care and pain relief in cancer and other terminally ill patients. She developed a discussion paper relating to the drugs needed for palliative care and the changes that should be made. The Pharmaceutical Advisory Committee subsequently adopted these recommendations, which will lead to a better range of medications to treat pain becoming available throughout Papua New Guinea. [ABSTRACT FROM AUTHOR]

The provision of palliative care for convicted criminals ignites debate about morality and equality. The New Zealand prison population includes a higher proportion of smokers, Maori (native New Zealanders), and intravenous drug users than is found in the general community; prisoners as a group are therefore at greater risk of developing a terminal illness. The sparse literature mostly originates from America, which necessitates consideration of the relevance to corrections systems in other societies. This paper examines some of the issues surrounding the provision of palliative care for prisoners in the New Zealand correction system. These issues may challenge some of the basic principles on which modem hospice care has been developed. [ABSTRACT FROM AUTHOR]

The need for high quality end-of-life care in the developing world is increasingly becoming recognized. One of the core parts of such a service is adequate pain control. Poor health care infrastructures and lack of access to opioid analgesics are common problems. This makes establishing appropriate, sustainable end-of-life care particularly challenging in resource poor settings. Hospice Africa-Uganda has ten years of experience in developing such a service. This paper discusses some of the challenges encountered and how these have been addressed. These include access to opioids, educating of health care workers and influencing policy makers. Factors that have been important in making the service a success, such as choosing an appropriate model of care, and future directions for the organization are discussed. [ABSTRACT FROM AUTHOR]

Pain is a complex problem, for both those who are enduring it and those trying to relieve it. Most people in the developed world have access to adequate treatment and management of pain, the availability of trained and educated doctors and nurses, feasible opioid prescribing policies, as well as ready access to appropriate medication. Often, this is not the case in developing countries such as Thailand. This paper is based on recent experience in the southeast of Thailand providing pain relief for persons with HIV and AIDS in Rayong Province at the Camillian Social Centre. The severity and frequency of pain endured by this group of individuals presented a daily challenge. Problems encountered in providing pain relief for these patients and some potential solutions are described. There is a lack of literature on pain relief in Thailand. [ABSTRACT FROM AUTHOR]

The Cochrane Library of Systematic Reviews is published monthly online (http://www.thecochranelibrary.com). The library currently contains 7332 complete reviews and 2520 protocols for reviews in production. In addition, there are citations of 1,055,253 randomized controlled trials and 15,764 cited papers in the Cochrane Methodology Register. The Health Technology Assessment database contains some 17,000 citations. The impact factor of the Cochrane Library stands at 6.1. This report attempted to identify all relevant reviews published in the 2 months to May 31, 2017. Eight reviews have been identified that have potential relevance for practitioners in pain and palliative medicine. Readers are encouraged to access the full report for any articles of interest, as only a brief commentary is provided. [ABSTRACT FROM AUTHOR]

The Cochrane Library of Systematic Reviews is published quarterly as a DVD and monthly online (). The July 2014 issue (3rd DVD for 2014) contains 6050 complete reviews, 2,359 protocols for reviews in production, and 31,000 short summaries of systematic reviews published in the general medical literature. In addition, there are citations of 789,000 randomized controlled trials, and 15,700 cited papers in the Cochrane Methodology Register. The Health Technology Assessment database contains some 14,000 citations. Ninety-six new reviews have been published in the previous 3 months of which five have potential relevance for practitioners in pain and palliative medicine. The impact factor of the Cochrane Library stands at 5.715. Readers are encouraged to access the full report for any articles of interest as only a brief commentary is provided. [ABSTRACT FROM AUTHOR]

The Cochrane Library of Systematic Reviews is published quarterly as a DVD and monthly online (). The July 2013 issue (3rd DVD for 2013) contains 5631 complete reviews, 2337 protocols for reviews in production and 24,500 short summaries of systematic reviews published in the general medical literature. In addition there are citations of 704,000 randomized controlled trials, and 15,700 cited papers in the Cochrane Methodology Register. The Health Technology Assessment database contains some 12,000 citations. One hundred and thirty-five new reviews have been published in the previous three months of which nine have potential relevance for practitioners in pain and palliative medicine. The impact factor of the Cochrane Library stands at 5.715. Readers are encouraged to access the full report for any articles of interest as only a brief commentary is provided. [ABSTRACT FROM AUTHOR]

The March 2006 issue of PLoS Medicine contains the following editorial and a thoughtful debate on the issue of direct-to-consumer advertising of prescription drugs. The same issue contains a fascinating article on a "low tech" approach to information management, the blue trunk approach. This electronic journal is one of several published by the non-profit Public Library of Science (PLoS), a non-profit organization of scientists and physicians committed to making the world's scientific and medical literature a freely available public resource. PLoS Medicine is an open-access, on-line journal that contains timely discussions and new findings on a broad range of medically-related topics. Readers are referred to the PLoS Medicine website: http://www/plosmedicne.org to read the full pro and con debate mentioned in this paper and to learn more about this valuable intellectual resource. [ABSTRACT FROM AUTHOR]

A 2009 systematic review found that the total cost of prescription opioid abuse in 2001 in the United States was approximately $8.6 billion and medical expenses were estimated to be $15,884 for opioid abusers and $1,830 for nonabusers. A search was conducted for English publications on the cost of prescription opioid abuse and misuse from 2009 to 2014. The initial literature search identified 5,412 citations. Title and abstract review selected 59 for further review. The final review process resulted in 16 publications for inclusion that examined cost from the payer perspective. Mean costs to the payer for abusers were $23,000–$25,000 per year and excess costs approximately $15,000 per patient. Three papers were identified that presented societal costs, including direct and indirect costs such as criminal justice costs and costs associated with lost productivity. The strongest evidence suggests that societal cost is in excess of $50 billion per year in the United States. Prescription opioid abuse and misuse is a common and important problem throughout the world that has significant associated societal costs and excess medical costs. [ABSTRACT FROM AUTHOR]

Correct use of terms in a manuscript or policy statement is important to meet the objectives of the paper. Inappropriate terms can be counter-productive. The World Health Organization (WHO) recommends the following: 'Terminology in national drug control legislation and policies should be clear and unambiguous in order not to confuse the use of controlled medicines for medical and scientific purposes with misuse' and terminology should always be respectful. This commentary lists English language terminology that can impair access to controlled medicines for the treatment of pain and suffering (an objective of the international substance control conventions), including pain management and the treatment of opioid dependence. The commentary also suggests alternative wording. Assessment of terminology correctness is language sensitive and should therefore be conducted by native speakers. In all language communities, advocates should explore and discuss the terminology with health-care professionals and their clients/patients, and they should promote the use of correct vocabulary. [ABSTRACT FROM AUTHOR]

The Cochrane Library of Systematic Reviews is published quarterly. Issue 4 for 2008 contains 3625 complete reviews, 1921 protocols for reviews in production, and 9025 one-page summaries of systematic reviews published in the general medical literature. In addition, there are citations of 549,000 randomized controlled trials, and 10,900 cited papers in the Cochrane methodology register. The health technology assessment database contains 7500 citations. This edition of the Library contains 84 new reviews of which 5 have potential relevance for practitioners in pain and palliative medicine. [ABSTRACT FROM AUTHOR]

The Cochrane Library of Systematic Reviews is published quarterly. Issue 2 2009 contains 3737 complete reviews, 1939 protocols for reviews in production, and 9403 one-page summaries of systematic reviews published in the general medical literature. In addition, there are citations of 564,000 randomized controlled trials, and 11,000 cited papers in the Cochrane methodology register. The health technology assessment database contains 7591 citations. This edition of the Library contains 112 new reviews of which 6 have potential relevance for practitioners in pain and palliative medicine. [ABSTRACT FROM AUTHOR]

The Cochrane Library of Systematic Reviews is published quarterly. Issue Three for 2008 contains 3539 complete reviews, 1868 protocols for reviews in production, and 8349 one-page summaries of systematic reviews published in the general medical literature. In addition, there are citations of 540,000 randomized controlled trials, and 10,000 cited papers in the Cochrane methodology register. The health technology assessment database contains 7400 citations. This edition of the Library contains 75 new reviews, of which 7 have potential relevance for practitioners in pain and palliative medicine. [ABSTRACT FROM AUTHOR]

The Cochrane Library of Systematic Reviews is published quarterly. It now contains 2524 complete reviews, 1589 protocols of reviews and 5585 one page summaries of systematic reviews published in the general medical literature. In addition there are citations of 463,763 randomized controlled trials, 20 methodology reviews and 7484 cited papers in the Cochrane methodology register. The health technology assessment database contains 4733 citations. This edition of the Library contains 89 new reviews of which 6 have potential relevance for practitioners in pain and palliative medicine. [ABSTRACT FROM AUTHOR]

TheCochrane Library of Systematic Reviewsis now only published monthly online (http://www.thecochranelibrary.com). The methods for searching have changed and are in flux. This report attempted to identify all relevant reviews published in the last 3 months to March 30, 2017. The current version contains 7243 complete reviews and 2544 protocols for reviews in production. In addition, there are citations of 1,036,153 randomized controlled trials (first time passing the million mark) and 15,700 cited papers in the Cochrane Methodology Register. The Health Technology Assessment database contains some 17,000 citations. Six reviews have been identified that have potential relevance for practitioners in pain and palliative medicine. The impact factor of theCochrane Librarystands at 6.1. Readers are encouraged to access the full report for any articles of interest, as only a brief commentary is provided. [ABSTRACT FROM AUTHOR]

Outcomes research studies use clinical and administrative data generated in the course of patient care or from patient surveys to examine the effectiveness of treatments. Health care providers need to understand the limitations and strengths of the real-world data sources used in outcomes studies to meaningfully use the results. This paper describes five types of databases commonly used in the United States for outcomes research studies, discusses their strengths and limitations, and provides examples of each within the context of pain treatment. The databases specifically discussed are generated from (1) electronic medical records, which are created from patient-provider interactions; (2) administrative claims, which are generated from providers' and patients' transactions with payers; (3) integrated health systems, which are generated by systems that provide both clinical care and insurance benefits and typically represent a combination of electronic medical record and claims data; (4) national surveys, which provide patient-reported responses about their health and behaviors; and (5) patient registries, which are developed to track patients with a given disease or exposure over time for specified purposes, such as population management, safety monitoring, or research. [ABSTRACT FROM AUTHOR]

Prescription opioid misuse and addiction among chronic pain patients are problems of growing medical and social significance. Chronic pain patients often require intervention to improve their well-being and functioning, and yet, the most commonly available form of pharmacotherapy for chronic pain is centered on opioid analgesics-drugs that have high abuse liability. Consequently, health care and legal systems are often stymied in their attempts to intervene with individuals who suffer from both pain and addiction. As such, novel, nonpharmacologic interventions are needed to complement pharmacotherapy and interrupt the cycle of behavioral escalation. The purpose of this paper is to describe how the downward spiral of chronic pain and prescription opioid misuse may be targeted by one such intervention, Mindfulness-Oriented Recovery Enhancement (MORE), a new behavioral treatment that integrates elements from mindfulness training, cognitive-behavioral therapy, and positive psychology. The clinical outcomes and neurocognitive mechanisms of this intervention are reviewed with respect to their effects on the risk chain linking chronic pain and prescription opioid misuse. Future directions for clinical and pharmacologic research are discussed. [ABSTRACT FROM AUTHOR]

An increase in the prescribing of opioids in an effort to improve management of chronic pain has led to enhanced availability of controlled substances for diversion and abuse. Evidence suggests that the use of prescription monitoring programs (PMPs) may help curtail this growing public health issue. The current use of PMPs varies widely from state to state but there have been important changes improving interconnectivity of PMPs across states. This paper describes current data on the effect of prescription monitoring programs on reducing abuse and diversion of controlled substances. It also offers suggestions on how PMPs may be incorporated into practice and clinical decision-making to ensure appropriate pain management and patient safety. [ABSTRACT FROM AUTHOR]

The objective of this study was to assess recent data on the prevalence of chronic pain as part of chronic diseases; the prevalence of chronic pain as a chronic condition in its own right; the costs attributed to chronic pain; and the European Union (EU) policies to addressing chronic pain. Recent literature was reviewed for data on the prevalence and cost implications of chronic pain in the EU. Following on from an earlier systematic review, 8 databases were searched for prevalence and 10 for cost information from 2009 to 2011 and relevant EU organizations were contacted. Ten cost and 29 prevalence studies were included from the 142 full papers screened. The general adult population reported an average chronic pain prevalence of 27%, which was similar to those for common chronic conditions. Fibromyalgia had the highest unemployment rate (6%; Rivera et al., Clin Exp Rheumatol. 2009;27[Suppl 56]:S39-S45) claims for incapacity benefit (up to 29.9%; Sicras-Mainar et al., Arthritis Res Ther. 2009;11:R54), and greatest number of days of absence from work (Rivera et al., Clin Exp Rheumatol. 2009;27[Suppl 56]:S39-S45). Chronic pain is common and the total population cost is high. Despite its high impact, chronic pain as a condition seems to have had little specific policy response. However, there does appear to be sufficient evidence to at least make addressing chronic pain a high priority alongside other chronic diseases as well as to conduct more research, particularly regarding cost. [ABSTRACT FROM AUTHOR]

An editorial is presented on the importance of peer review in scientific publications and the role of peer reviewers in the Journal of Pain and Palliative Care Pharmacotherapy (JPPCP). It discusses the types of decision recommendations that peer reviewers can make for JPPCP submissions interested in peer reviewing and reminds them of ethical guidelines to follow during the peer review process.

Opioids are commonly used to treat moderate to severe pain. Opioid-induced hyperalgesia is a paradoxical response to opioid agonists resulting in an increased perception of pain rather than an antinociceptive effect. Even though there is a debate regarding its clinical relevance, it is becoming a challenge in both acute and chronic pain settings. The study of opioid-induced hyperalgesia is an emerging field with multiple challenges faced by investigators with regard to defining the diagnosis and characterizing the findings. The objective of this study was to review the preliminary evidence related to the treatment and management of opioid-induced hyperalgesia. Lack of data, small patient numbers, short-term follow-up, and variations in study design limited the review. With the literature on this subject being sparse, this study attempts to provide a preliminary look at the available data and to set the stage for an eventual meta-analysis. Case reports in the literature have shown success with various pharmacological interventions. Possible treatment regimens include ketamine, dextromethorphan, and nonsteroidal anti-inflammatory drugs (NSAIDs), opioid switching, amantadine, buprenorphine, α2 agonists, and methadone. These agents are briefly discussed in this paper. Further well-designed, placebo-controlled trials are needed to assess the effectiveness of the interventions investigated in this review. [ABSTRACT FROM AUTHOR]

Anxiety disorders are the most prevalent type of mental disorder, and they frequently co-occur with various medical conditions, including chronic pain. Anxiety disorders are associated with higher health care costs, and comorbid chronic pain and anxiety disorder leads to worse outcomes. Despite their prevalence, anxiety disorders often go unrecognized in pain care facilities, compromising clinical benefit of pain treatment. Differential diagnosis among the anxiety disorders can be very difficult, and the high comorbidity with mood disorders, unexplained physical symptoms, and medical disorder makes the precise assessment complicated. Nevertheless, a better understanding of the research and theory that has accumulated can help clinicians accurately diagnose, conceptualize, and treat the patient's symptomatology. In this paper, the authors provide comprehensive review of the diagnostic criteria, epidemiology, differential diagnosis, and relation to chronic pain. [ABSTRACT FROM AUTHOR]

Osteoarthritis (OA) is the most common debilitating joint disease worldwide. Clinicians have many therapeutic modalities and prescription medications in their arsenals to treat chronic inflammatory pain. However, as patients age, and develop numerous comorbidities, the most common, and often most effective pharmacologic treatment for OA, nonsteroidal anti-inflammatory drugs (NSAIDs), becomes problematic in that it may exacerbate or even cause cardiovascular, renal, and/or gastrointestinal pathology. This paper reviews the metabolism of arachidonic acid as it relates to the clinical treatment of inflammation, and explores a novel botanical therapy, flavocoxid, that has shown equal efficacy to naproxen in treating pain associated with mild to moderate OA of the knee. Flavocoxid has demonstrated balanced inhibition of the three primary enzymes responsible for processing AA, cyclooxygenases 1 and 2, and 5-lipoxygenase. Researchers have proposed that balanced inhibition of AA metabolism offers the promise of analgesia similar to NSAIDs without the associated cardiovascular, renal, or gastrointestinal side effects. [ABSTRACT FROM AUTHOR]