Neuropathic pain: mechanisms and their clinical implications

CLINICAL REVIEW

State of the Art

Neuropathic pain can develop after nerve injury, when deleterious changes occur in injured neurons and along nociceptive and descending modulatory pathways in the central nervous system. The myriad neurotransmitters and other substances involved in the development and maintenance of neuropathic pain also play a part in other neurobiological disorders. This might partly explain the high comorbidity rates for chronic pain, sleep disorders, and psychological conditions such as depression, and why drugs that are effective for one condition may benefit others. Neuropathic pain can be distinguished from non-neuropathic pain by two factors. Firstly, in neuropathic pain there is no transduction (conversion of a nociceptive stimulus into an electrical impulse). Secondly, the prognosis is worse: injury to major nerves is more likely than injury to non-nervous tissue to result in chronic pain. In addition, neuropathic pain tends to be more refractory than non-neuropathic pain to conventional analgesics, such as non-steroidal anti-inflammatory drugs and opioids. However, because of the considerable overlap between neuropathic and nociceptive pain in terms of mechanisms and treatment modalities, it might be more constructive to view these entities as different points on the same continuum. This review focuses on the mechanisms of neuropathic pain, with special emphasis on clinical implications.

Read full article: Neuropathic pain: mechanisms and their clinical implications

Steven P. Cohen 

Jianren Mao

BMJ 2014; 348 doi: http://dx.doi.org/10.1136/bmj.f7656 (Published 5 February 2014)

Cite this as: BMJ 2014;348:f7656

Treatment of Hodgkin Lymphoma: A 50-Year Perspective

The evolution of our understanding of the biology and management of the disease once called Hodgkin disease, now called Hodgkin lymphoma (HL), has closely paralleled the growth of the American Society of Clinical Oncology (ASCO) since 1964. It was the first advanced malignancy of a major organ system in adults to be cured by chemotherapy,¹ and this proof of principle of the curability of cancer by drugs served as a stimulus for the use of chemotherapy in other tumors as an adjunct to surgery or radiation. The principles developed to diagnose, stage, and treat HL crossed the specialties of medical and pediatric oncology, therapeutic radiology, diagnostic radiology, surgery, and pathology, placing HL as a model for cross-specialty collaboration in other tumors. This collaborative model led to a decrease in the US national mortality as a result of HL by 75%, even before 1980.²

Read full article: treatment of Hodgkin Lymphoma: A 50-year Perspective 

Journal of Clinical Oncology 
Canellos GP, Rosenberg SA, Friedberg JW, Lister TA, DeVita DT.
doi: 10.1200/JCO.2013.53.1194 JCO January 20, 2014 vol. 32 no. 3 163-168

Drug administration by enteral feeding tube

LAST SPRING, Nursing2013 conducted a survey in the journal and online in cooperation with the American Society for Parenteral and Enteral Nutrition (A.S.P.E.N.) to explore nurses' knowledge of evidence-based guidelines for medication administration via enteral feeding tubes. This survey was specifically geared toward best practices for medication delivery through an enteral access device and addressed how to prevent complications such as tube clogging, drug-nutrient interactions, and inadequate medication delivery. This article reviews the results of the survey, discusses best practices, and provides evidence-based rationales.

Read full article: Drug administration by enteral feeding tube

Guenter, Peggi PhD, RN; Boullata, Joseph PharmD, RPh, BCNSP

Nursing:

December 2013 - Volume 43 - Issue 12 - p 26–33

doi: 10.1097/01.NURSE.0000437469.13218.7b

People receiving dialysis in the morning have better subjective sleep quality than those who receive dialysis at other times

Implications for practice and research

• Assessment of sleep quality, with attention to disease and treatment-related factors, should be incorporated into the routine care of haemodialysis patients.
• Rigorous studies aimed at evaluating interventions for improved sleep in this population are needed.

Read full article: People receiving dialysis in the morning

Wang MY, Chan SF, Chang LI, et al. Better sleep quality in chronic haemodialyzed patients is associated with morning-shift dialysis: a cross-sectional observational study. Int J Nurs Stud 2013;50:1468–73.

Early Specialty Palliative Care: Translating Data in Oncology into Practice

For most patients with serious illness, palliative care is provided only near the end of life. A new Sounding Board article reviews studies showing that earlier palliative care can improve quality of life and reduce health care costs and argue that such care should be standard in serious illness.

The article is free to all visitors on NEJM.org:

 The New England Journal of Medicine

Reference:

Ravi B. Parikh, A.B., Rebecca A. Kirch, J.D., Thomas J. Smith, M.D., and Jennifer S. Temel, M.D. N Engl J Med 2013; 369:2347-2351 December 12, 2013 DOI: 10.1056/NEJMsb1305469

 

Interactive Medical Case

The New England Journal of Medicine

The latest Interactive Medical Case, An Unusual Case of Abdominal Pain, presents the case of a 41-year-old man who presented to the emergency department with excruciating abdominal pain of sudden onset. In addition to testing your therapeutic and diagnostic skills, you may earn CME credit or ABIM MOC points for each case you take. 

Play as a guest:  Interactive Medical Case 

 

An Unusual Case of Abdominal Pain

Russell Goodman, M.D., Ph.D., Anand Vaidya, M.D., and Paul Dellaripa, M.D.

N Engl J Med 2013; 369:e34 December 12, 2013 DOI: 10.1056/NEJMimc1302497

The effect of emergency department crowding on patient outcomes

La revista Advanced Emergency Nursing publicó en 2011 un review  sobre el efecto de la gran cantidad de pacientes en áreas de urgencias y el efecto sobre los resultados en la atención de dichos pacientes.

Para consultar el artículo completo puede hacerlo en:

The_Effect_of_Emergency_Department_Crowding

Cuenta con opción de descarga gratuita en PDF.

Para citar el artículo puede hacerlo de la siguiente manera:

Johnson KD, Winkelman C. The effect of emergency department crowding on patient outcomes. Advanced Emergency Nursing Journal. 2011; 33(1): 39-54  

Adherencia a los tratamientos a largo plazo

Durante las últimas décadas hemos presenciado varias fases en el desarrollo de los enfoques encaminados a lograr que los pacientes sigan el tratamiento de las enfermedades crónicas durante períodos largos. Al principio, se pensó que el paciente era la causa del “problema de cumplimiento”. Posteriormente, se abordó también la función del personal asistencial. En la actualidad, reconocemos que se requiere un enfoque de sistemas. La idea del cumplimiento también se asocia estrechamente con la culpa, ya sea del personal sanitario o de los pacientes, y el concepto de la adherencia terapéutica es una mejor manera de captar los cambios dinámicos y complejos necesarios de muchos actores durante períodos prolongados para mantener la salud óptima de las personas con enfermedades crónicas.

Aquí les presentamos un trabajo publicado por la Organización Panamericana de la Salud (OPS) y Organización Mundial de la Salud (OMS) dónde se abordan diferentes aspectos al respecto de esta temática, pueden consultar el texto completo en:

Adherencia a los tratamientos a largo plazo

Para citar el documento puede hacerlo de la siguiente manera:
Organización Mundial de la Salud. Adherencia a los tratamientos a largo plazo. Organización Mundial de Salud. Washington, D.C. 2004.

Prevalencia de errores en la medicación

El presente estudio analiza la prevalencia de errores en la utilización de medicamentos y su relación con eventos adversos.

Pueden consultar el artículo en:
Prevalencia de errores en la utilización de medicamentos

Para citar este artículo puede hacerlo de la siguiente manera:
Rivera RN, Moreno de Santacruz R, Escobar ES. Prevalencia de errores en la utilización de medicamentos en pacientes de alto riesgo farmacológico y análisis de sus potenciales causas en una entidad hospitalaria, Enfermería Global, 2013; 14(4): 171-184

Cuidados al catéter venoso central en pacientes con cáncer

Artículo publicado por la Asociación Americana de Oncología Clínica.

Cuidados al catéter venoso central al paciente con cáncer

Para citar este artículo puede hacerlo de la siguiente manera:
Schiffer Ac, Mangu BP, Wade CJ, Camp-Sorrell D, Cope GD, El-Rayes, et al. Central Venous Catheter Care for the Patient with Cancer: American Society of Clinical Oncology Clinical Practice Guideline. Journal of Clinical Oncology, 2013; 31 (10):1357-1370.