Harald Breivik

University of Oslo · Division of Medicine

In this issue of the Scandinavian Journal of Pain Kari Sørensen and Bjørg Christiansen publish their report on in depth interviews of young patients suffering from CRPS or from severe muscle pain [1]. These patients were recovering from their chronic pain conditions after treatment by a multidisciplinary rehabilitation team.

Background and aims: Real-life data on laxative use in patients suffering from opioid-induced constipation (OIC) are very limited, and many OIC patients are only using over the counter laxatives to resolve their constipation. Our aim was to describe laxative utilization and quality of life in participants in Norway who ever experienced OIC. Metho...

Background and aims: Opioid-induced bowel dysfunction (OIBD) is an increasing problem due to the common use of opioids for pain worldwide. It manifests with different symptoms, such as dry mouth, gastro-oesophageal reflux, vomiting, bloating, abdominal pain, anorexia, hard stools, constipation and incomplete evacuation. Opioid-induced constipation...

How to taper and discontinue methadone therapy for chronic pain management is illustrated through a case report. This report is adapted from paineurope 2014; Issue 4, ©Haymarket Medical Publications Ltd, and is presented with permission. paineurope is provided as a service to pain management by Mundipharma International, LTD and is distributed free...

The value and importance of providing herpes zoster immunization to reduce the incidence and severity of acute herpes zoster neuralgia, especially in older patients, is described. The prevention of postherpetic neuralgia can profoundly impact patients’ quality of life. This report is adapted from paineurope 2014; Issue 4, © Haymarket Medical Public...

The case of an elderly male with bilateral shoulder pain is presented. The pain had been successfully treated years earlier with surgery, but a repeat rotator cuff procedure when the pain recurred was not effective. The patient's physician asked about impact of systemic analgesics on the elderly patient and interactions with his blood pressure medi...

A case of cervicobrachialgia is presented in which the patient expressed fear of becoming addicted to opioids. Alternative analgesic approaches including anticonvulsants, transcutaneous electrical nerve stimulation (TENS), and physical therapy are discussed. This report is adapted from paineurope 2014; Issue 2, ©Haymarket Medical Publications Ltd,...

A case of a 35-year-old woman scheduled for removal of a painful breast tumor is discussed. Ways to reduce risk of chronic pain developing postoperatively are described. Preoperative medications, nerve blocks, local anesthetics, and postoperative epidural pharmacotherapy are described. This report is adapted from paineurope 2014; Issue 1, ©Haymarke...

ABSTRACT Acute pain during and immediately after total knee arthroplasty (TKA) can be well controlled by spinal anesthesia, local infiltration analgesia, and peripheral nerve blocks; this enables early or fast-track rehabilitation. However, about half of patients have clinically significant pain in the following weeks. Active movements and rehabili...

ABSTRACT A query and response regarding a patient who was taking high-dose tramadol and duloxetine is presented. The patient developed serotonin syndrome. Risks for this clinically important drug interaction and management of the syndrome are discussed. This report is adapted from paineurope 2013; Issue 4, ©Haymarket Medical Publications Ltd., and...

Chronic pain is common in Europe and elsewhere and its under treatment confers a substantial burden on individuals, employers, healthcare systems and society in general. Indeed, the personal and socioeconomic impact of chronic pain is as great as, or greater, than that of other established healthcare priorities. In light of review of recently publi...

Thoracic epidural infusion analgesia is optimised by using a triple component infusion containing a local anaesthetic, an opioid, and adrenaline. Adrenaline in solution is prone to oxidation, and stabilisers, such as antioxidants (e.g. sulphites) or chelators (edetates), are therefore commonly added. Sulphites may, however, have unwanted effects, e...

The fast liquid–liquid extraction system SISAK with continuous liquid scintillation detection was coupled to the Berkeley Gas-filled Separator to enable studies of the chemical properties of α-decaying transactinide elements. The preseparated transactinide 257Rf (4.7 s), was transported via a He/KCl-jet directly into the scintillation solution. Thi...

A grave but important problem in the treatment of pain, is suicide. While many chronic pain problems are not life threatening, self-harming, e.g. suicide attempts are. Clinicians may ask whether suicide-risk is actually higher in a population of patients with chronic pain. In this issue of the Scandinavian Journal of Pain Elsebeth Stenager and her...

Queries from European physicians about analgesic pharmacotherapy and responses from the author are presented. Topics addressed in this issue pertain to management of complex regional pain syndrome in a patient who does not tolerate gabapentinoids, and management of severe, acute pain in a patient receiving sublingual buprenorphine. This feature is...

ABSTRACT Queries from European physicians about analgesic pharmacotherapy and responses from the author are presented. Topics addressed in this issue pertain to opioids, drug interactions, and driving; and transdermal buprenorphine interactions and impact on respiratory function. This feature is adapted from paineurope 2012; Issue 1, ©Haymarket Med...

Axillary block is the most commonly performed brachial plexus block and may be guided by nerve stimulation or ultrasound. Magnetic resonance imaging (MRI) has proven to be beneficial in presenting anatomy of interest for regional anaesthesia and in demonstrating spread of local anaesthetic. The aim of this pilot study was to demonstrate the anatomy...

Background and methods Pain Study Tracking Ongoing Responses for a Year (PainSTORY) is a longitudinal study generating some quantitative and limited qualitative data concerning the experiences of individual patients with non-malignant chronic pain. Research was conducted across 13 European countries and a total of 294 patients completed the full ev...

ABSTRACT Limitations on use of nonsteroidal anti-inflammatory drugs (NSAIDs) and opioids in the pharmacotherapy of osteoarthritis (OA) leave few pharmacological options for many OA patients. Results of a recent study on the use of transdermal buprenorphine patches in OA management are discussed.

Objective Patients with osteoarthritis (OA) pain often have insufficient pain relief from non-opioid analgesics. The aim of this trial was to study efficacy and tolerability of a low dose 7-day buprenorphine transdermal delivery system, added to a NSAID or coxib regimen, in opioid-naïve patients with moderate to severe OA pain.

InthisissueofTheScandinavianJournalofPain,Sprengetal.[1]publish a well written and well performed double-blind, placebo-controlled study of the effects of adding a small dose of ketamineto a multimodal pain-preventing regimen during haemorrhoidec-tomy. The other analgesic drugs made the patients more or lesspainfree,and(therefore?)theycouldnotfindan...

Local anaesthetics may alleviate pain more effectively than any other anaesthetic method. In regional anaesthesia/analgesia, rare but serious complications make it necessary to always consider the risk-benefit ratio. The article discusses these issues and gives advice on effective and safe conduct. The article is based on non-systematic literature...

Local anaesthetics may alleviate pain more effectively than any other anaesthetic method. In regional anaesthesia/analgesia, rare but serious complications make it necessary to always consider the risk-benefit ratio. The article discusses these issues and gives advice on effective and safe conduct. The article is based on non-systematic literature...

Exposure techniques may be used to test such opposites and bring the patient into contact with the prevailing contingencies of reinforcement. For example, attempting to do an activity that has been avoided for years because it is feared that it will provoke pain, may be done to help the patient experience that another result may actually occur”. Th...

Background The “gold standard” for pain relief after thoracotomy has been thoracic epidural analgesia (TEA). The studies comparing TEA with paravertebral block (PVB) and recent reviews recommend PVB as a novel, safer method than TEA.

The national health care system in Norway benefits from a higher percentage of the BNP than most other nations in Europe. In spite of long distances in thinly populated areas, poor road and railway systems, and a lot of foul weather conditions, our national health care system takes well care of those with acute and serious diseases or trauma. Howev...

Background: Central neuraxial blocks (CNBs) for surgery and analgesia are an important part of anaesthesia practice in the Nordic countries. More active thromboprophylaxis with potent antihaemostatic drugs has increased the risk of bleeding into the spinal canal. National guidelines for minimizing this risk in patients who benefit from such blocks...

A high opioid consumption for cancer related and acute pain may indicate adequate pain treatment. Analysis of a national, compulsory and complete database of all dispensed prescription drugs in Norway (NorPD) may reveal important epidemiological data on prescription pattern of opioids. This study investigated the prevalence of opioid dispensions in...

Opioid prescription for pain relief is increasing. Codeine is the dominating opioid in several European countries, with Norway being among the highest codeine users. To determine whether codeine is primarily used for acute pain or whether there is a prescription pattern indicating problematic opioid use. All pharmacies in Norway are obliged to subm...

The Scandinavian Association for the Study of Pain (SASP) was founded in Stockholm December 1976. SASP became an extremely important network for pain researchers and pain clinicians in Denmark, Finland, Norway and Sweden, in particular because at that time each country had only a handful of pain-interested clinicians and researchers. Iceland joined...

Recent large scale surveys document that patients on opioid analgesics suffer adverse effects from increased tone in sphincters of both the upper and lower part of the gastrointestinal tract, decreased secretions into and increased absorption of fluids out of the bowel. These adverse effects often cause patients to discontinue opioid analgesics. Al...