
Marco PappagalloAlbert Einstein College of Medicine, NYC, USA · Anesthesiology
Marco Pappagallo
MD
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115
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July 2006 - June 2011
July 2006 - June 2011
July 2003 - June 2006
Publications
Publications (115)
Opioid-induced constipation (OIC), a prevalent and distressing side effect of opioid therapy, does not reliably respond to treatment with conventional laxatives. OIC can be a treatment-limiting adverse event. Recent advances in medications with peripherally acting μ-opioid receptor antagonists, such as methylnaltrexone, naloxegol, and alvimopan, ho...
Introduction:
This is a case presentation of a 45-year-old male with chronic donor site pain following autologous iliac crest bone harvest successfully treated with superior cluneal nerve blockade. Donor site pain following autologous bone harvest is a common postoperative complication of lumbar fusion procedures that can cause significant morbidi...
In Part One of this two-part series, we discussed skin physiology and anatomy as well as generalities concerning topical analgesics. This modality of therapy has lesser side effects and drug-drug interactions, and patients tolerate this form of therapy better than many oral options. Unfortunately, this modality is not used as often as it could be i...
Chronic pain is a complex disorder with multiple etiologies for which the pathologic mechanisms are still largely unknown, making effective treatment a difficult clinical task. Achieving pain relief along with improved function and quality of life is the primary goal of pain clinicians; however, most patients and healthcare professionals consider 3...
The invention is directed to a method of treating chronic spinal mechanical pain by intravenous administration to a subject in need of chronic spinal mechanical pain relief of an effective amount of bisphosphonate.
When researchers conduct large prospective studies, they provide results generating statistical analysis; therefore readers need considerable familiarity with descriptive and inferential statistics. If quantitative judgments are based on interpreting odds ratios as though they were relative risks, they are unlikely to be seriously in error. Because...
The use of odds ratio as relative risk (RR) in large cohort study is.
Value-based purchasing and the Hospital Consumer Assessment of Healthcare Providers and Systems are tying patient-centric measures to reimbursements. Hospitals should be particularly concerned about management of postoperative pain and control of postoperative nausea and vomiting (PONV), known to adversely impact overall patient satisfaction. Anest...
The treatment of neuropathic pain is difficult. Oral pharmaceuticals have significant side effects, and treatment efficacy tends to be modest. The use of topical analgesics reduces the potential for systemic side effects and allows direct application of medications to the area of pain. The natural spicy substance, capsaicin, has historically been k...
Osteoarthritis (OA) is a common and chronic disease causing frequently pain and motor disability. Furthermore, joint pain in OA is associated with substantial disability and consequently inflicts considerable burden on affected individuals and society. Symptomatic relief from pain and reducing functional disability are the main goals in the treatme...
Intravenous (IV) bisphosphonates relieve pain in conditions such as Paget's disease of bone, metastatic bone disease and multiple myeloma. Based on positive findings from a prior case series, we conducted a randomized, placebo-controlled study to assess the analgesic effect of IV pamidronate in subjects with chronic low back pain (CLBP) and evidenc...
http://www.minervamedica.it/it/riviste/gazzetta-medica-italiana/articolo.php?cod=R22Y2013N03A0211
La tendinopatia calcificica di spalla è una patologia piuttosto comune caratterizzata da proprie manifestazioni cliniche e radiologiche. E’ un patologia auto limitantesi nel tempo per la quali precoci suggerimenti riabilitativi restano essenziali. Soli...
please see also review
http://anesthesiology.pubs.asahq.org/article.aspx?articleid=1918169
Essential Pain Pharmacology: The Prescriber's Guide expertly reviews the most important medications used to relieve pain, now considered by many physicians as the fifth vital sign. The catalogue of analgesics has expanded rapidly, and this text presents the...
Background: Topical analgesics are important products in the armamentarium for pain relief.
Methods and Findings: This study compared a topical analgesic product containing menthol to the same product with the addition of oxygenated glycerol triesters (OGTs) (also called essential oxygen oil) in 66 healthy adult subjects with acute musculoskeletal...
Essential Pain Pharmacology: The Prescriber's Guide expertly reviews the most important medications used to relieve pain, now considered by many physicians as the fifth vital sign. The catalogue of analgesics has expanded rapidly, and this text presents the most up-to-date, comprehensive array of agents available for prescribing. Each clear and con...
Topical analgesics may play an increasingly important role in managing acute and chronic pain as acetaminophen, NSAIDs, and opioid drugs come under heightened scrutiny. This article reviews studies about essential oxygen oil, a topical over-the-counter (OTC) analgesic new to the American market but available for many years in Europe. Prospective st...
To inform physicians who utilise over-the-counter (OTC) analgesics to treat osteoarthritis (OA) pain on differences among agents and to guide decisions in therapy selection.
A search of medical literature was conducted to identify articles on the treatment of OA published between 1990 and 2009. MEDLINE, EMBASE and SCISEARCH databases were searched...
Opioid guidelines recommend opioid rotation and switching for patients who do not achieve adequate pain relief or who experience intolerable adverse events (AEs) with their current opioid. However, specific recommendations and protocols for opioid rotation are lacking, making the practice time consuming and difficult for primary care physicians to...
This article provides a broad overview of the higher brain structures involved in pain perception and modulation in chronic pain syndromes as revealed through neuroimaging. Furhter, this article highlights the findings of reviews and meta-anlaysis of neuroimaging in chronic pain, and focuses on the findings of cortical modulation of pain. Neuroimag...
Breakthrough pain is experienced by many cancer patients who are being treated with opioids for the management of chronic persistent pain. There is currently no ‘gold standard’ approach for the pharmacologic symptomatic treatment of breakthrough pain but proposed strategies include the implementation of primary therapies (e.g. chemotherapy, radioth...
Chronic Pain syndromes and Major Depressive Disorder account for two of the most costly and prevalent illnesses worldwide and are frequently comorbid and treatment resistant. In this review, we examine the current role of ketamine, a potent NMDA (N-methl-D-aspartic acid) receptor blocker, in treating chronic pain and major depression. The role of t...
Opioid combination has been shown to reduce the need for escalating doses for the treatment of cancer pain. A prospective study was planned to evaluate the addition of tramadol to a stronger opioid for the treatment of severe pain as a result of osteoarthritis, previously uncontrolled by non-opioid analgesics or weak opioids.
All subjects received...
Essential oxygen oil (OxyRub from CreoMed Inc., Naples, FL, U.S.A.) is a novel topical analgesic currently commercially available in Europe and now available in the U.S.A. It represents an important alternative to other treatments (nonsteroidal anti-inflammatory drugs, acetaminophen, menthol, camphor) for managing mild to moderate acute and chronic...
This chapter seeks to provide a concise overview of the pharmacologic armamentarium available to treat pain. Drugs will be discussed in terms of their indications, mechanisms of action, and major side effects. For the purposes of this chapter, analgesics will be divided into two groups: current and emerging; current analgesics will be further subdi...
Dear editor, in the year 2009, a series of disasters have occurred. Abruzzi: 293 fatalities and 1500 wounded people. Viareggio: 29 fatalities and 30 wounded people. Messina: 35 fatalities and 40 wounded people. Samoa Island: more than 1000 dead and more than 700 wounded people. These are just some of the tragic events that have occurred in 2009 ove...
The pharmacological management of osteoarthritis normally begins with the administration of acetaminophen or a nonselective nonsteroidal anti-inflammatory drug. However, acetaminophen may not be efficacious in all patients, and nonsteroidal anti-inflammatory drugs may be associated with gastrointestinal and cardiovascular adverse effects.
A 79-year...
NeurogesX Inc is developing NGX-4010, a rapid-delivery dermal patch application system that contains high-concentration trans-capsaicin, for the treatment of peripheral neuropathic pain. Capsaicin evokes a lasting and reversible refractory state in primary sensory neurons involved in the generation and maintenance of neuropathic pain. NGX-4010 can...
Les processus dégénératifs à l’origine de la coxarthrose sont responsables de modifications anatomiques et biomécaniques dans et autour de l’articulation. Une bonne compréhension de l’anatomie de la hanche et des forces exercées sur l’articulation permet de mieux appréhender les pathologies de hanche et les possibilités thérapeutiques actuelles. L’...
Complex regional pain syndrome (CRPS) type I, also known as reflex sympathetic dystrophy, usually develops after trauma or immobilization, is characterized by focal pain and autonomic dysregulation, and sometimes focal trophic changes such as osteoporosis. The pathophysiology is unknown and there have been few controlled treatment trials. The purpo...
The degenerative processes underlying osteoarthritis of the hip produce both anatomical and biomechanical changes in and around the involved joint. A good understanding of hip anatomy and the forces crossing the hip joint is essential to understand both hip pathology and current treatment techniques. Total hip arthroplasty (THA) has become a mainst...
In approximately 80-85% of patients with chronic nonspecific low back pain (NSLBP), a precise pathoanatomical diagnosis cannot be identified. Mechanisms of bone nociception may contribute to NSLBP.
To determine whether findings on bone scans, which provide a pathophysiological picture of functional activity, are associated with self-reports of NSLB...
In this review, we explain our current understanding of the molecular basis for pain relief by capsaicin and other transient receptor potential vanilloid subfamily, member 1 (TRPV1) agonists. We summarize disease-related changes in TRPV1 expression and its implications for therapy and potential adverse effects. Last, we provide an overview of the c...
Neuropathic pain is a sequela of dysfunction, injuries, or diseases of the peripheral and/or central nervous system pain pathways, which has historically been extremely difficult to treat. Complex regional pain syndrome (CRPS) types 1 and 2 are neuropathic pain conditions that have a long history in the medical literature but whose pathophysiology...
Adjuvant analgesics represent a diverse group of drugs that were originally developed for a primary indication other than pain. Many of these medications are currently used to enhance analgesia under specific circumstances. The proper use of adjuvant drugs is one of the keys to success in effective pain management. Since adjuvant analgesics are typ...
Approximately 30% of patients with multiple sclerosis (MS) have central pain (CP). The anticonvulsant lamotrigine has been shown to be efficacious in some types of CP, but its efficacy in MS-related CP has not been confirmed.
The aim of this pilot trial was to provide preliminary data for a planned larger trial.
A randomized, double-blind, placebo-...
Despite recent research advances, the origin of nociception in migraine headaches remains unclear and continues to be a topic of intense examination. Experiments using animal models of dural neurogenic plasma extravasation (DNPE) as an index of meningeal inflammation provided the basis for the meningeal inflammation hypothesis of migraine pain.
We...
Unlabelled:
We determined the profiles of the board-certified pain physician workforce and the profiles of those residing near medical pain practices. Data from a mail survey of U.S. pain specialists were compared with U.S. Census data, and different settings and types of practices were contrasted. The 750 respondents (32.1%) were similar to the e...
We describe a case of
atypical primary headache strongly
responsive to prolonged pressure in
the anterior aspect of the neck. We
hypothesize that, at least in this
case, the trigemino-cervical system
and its connections with the vagus
nerve are involved.
The purpose of the trial was to evaluate the efficacy of suprascapular nerve block (SSNB) to relieve the shoulder pain, ameliorate recovery after physiotherapy and reduce disability due to a rotator cuff tendinitis (RCT). A prospective, randomized, comparison cross over investigation was performed in the setting of a large inpatient rehabilitation...
We conducted a pilot trial to assess the effect of botulinum toxin B on palmar pain and discomfort in carpal tunnel syndrome (CTS) patients. Design. Randomized, double-blind, placebo-controlled.
Twenty ambulatory CTS patients. Intervention. Botulinum toxin B or placebo injections into three hypothenar muscles anatomically linked or attached to the...
Complex regional pain syndrome (CRPS), formerly known as reflex sympathetic dystrophy (RSD), is a debilitating pain syndrome that has been recognized for more than a century. Despite the long history of this disorder, both the natural course and the pathophysiology of CRPS have not been clearly determined. However, current research has begun to mak...
Contemporary standard pharmacological care for the treatment of noncancer pain includes the use of opioid medications. The responsiveness of neuropathic pain to opioids has long been an area of controversy. Evidence from multiple randomized controlled trials indicates that opioids can relieve pain in a variety of neuropathic pain syndromes. Opioids...
Both neuropathic pain and migraine are now being treated with a variety of newer antiepileptic drugs (AEDs). The proven efficacy of gabapentin in postherpetic neuralgia (PHN) and painful diabetic neuropathy (PDN), and of divalproex sodium in the prevention of migraine has led to increased clinical investigation of the newer AEDs for these condition...
We explored the effect of intravenous infusions of a bisphosphonate, pamidronate, in the management of chronic mechanical spinal pain, a worldwide public health problem in terms of lost workdays, medical treatment costs, and suffering. Bisphosphonates have an anti-nociceptive effect in animals. In humans, intravenous pamidronate relieves numerous p...
Postherpetic neuralgia, which occurs most typically in older persons, is one of the most common and serious complications of herpes zoster (or shingles). It is a chronic neuropathic pain syndrome and remains one of the most difficult pain disorders to treat.
Known beneficial agents include antidepressants, antiepileptic drugs, opioid analgesics, lo...
Tricyclic antidepressants (TCA) provide less than satisfactory pain relief for postherpetic neuralgia (PHN), and the role of opioids is controversial.
To compare the analgesic and cognitive effects of opioids with those of TCA and placebo in the treatment of PHN.
Seventy-six patients with PHN were randomized in a double-blind, placebo-controlled, c...
Opioid bowel dysfunction (OBD) is a common adverse effect associated with opioid therapy. OBD is commonly described as constipation; however, it is a constellation of adverse gastrointestinal (GI) effects, which also includes abdominal cramping, bloating, and gastroesophageal reflux. The mechanism for these effects is mediated primarily by stimulat...
This article reviews the use of modafinil in palliative care, and its use in promoting vigilance and wakefulness. Modafinil's therapeutic and chemical class, mechanism of action, pharmacokinetics, indications, dosage, side effects, and drug interactions are also discussed. Modafinil seems to fit the requirements of portmanteau, using one drug to tr...
The American Pain Society estimates that 50 million Americans are partially or totally disabled by pain. This striking statistic is certain to increase as our population continues to age. In order to combat this growing problem, healthcare professionals must arm themselves with information. By developing the appropriate pain assessment skills and b...
As the global population continues to grow, the need for palliative care becomes more important than ever. In 1990, the world population reached 5.3 billion and was expected to increase to 6.2 billion by 2000 and 8.9 by 2030. The size of the population 60 and older also is increasing, representing 8.4% of the world population in 1980 and 9.3% in 19...
Complex regional pain syndromes (CRPS) are challenging neuropathic pain states quite difficult to comprehend and treat. Although not yet fully understood, advances are being made in the knowledge of the mechanisms involved with CRPS. Patients often present with incapacitating pain and loss of function. Patients suffering from these disorders need t...
"What's new in therapeutics?" will examine and evaluate drugs that may have a place in hospice, palliative, and long-term care. Mirtazepine will be examined and evaluated. Mirtazepine is a potential alternative anti-depressant with multiple additional benefits. It is an atypical anti-depressant, which has both noradrenergic and specific serotonergi...
Postherpetic neuralgia (PHN) is considered by some investigators to be predominantly a deafferentation-type central pain syndrome; others suggest that activity of remaining peripheral nociceptors plays a critical role. The authors investigated the sensory dysfunction in subjects with PHN of varying duration and at different sites to gain further in...