Peer support has found applications beyond the mental health field and is useful for managing several chronic disorders and supporting healthy lifestyle choices. Communication through telephone and the Internet allows for greater access to those who cannot meet in person. Adolescent chronic pain would seem ideally suited to benefit from online peer support groups. Research is lacking, however, to characterize benefit in terms of pain and function, despite a clear desire among adolescents for access to such programs. More rapid development of online applications is needed for peer support, and research into the associated outcomes will be necessary to optimally design such programs.

Light scattering, vapour pressure osmometry, conductivity and surface tension techniques have been used to examine aqueous solutions of several narcotic analgesics for evidence of association. Contrary to a previous report, no significant association could be detected in solutions of morphine sulphate and codeine phosphate. Other drugs which showed no evidence of aggregation in water included morphine hydrochloride, ethylmorphine hydrochloride, oxycodone hydrochloride and dihydrocodeine tartrate. Self‐association of ethylmorphine hydrochloride, oxycodone hydrochloride and codeine phosphate was observed in the presence of 0·5 mol dm−3 electrolyte, the pattern of association conforming to that of a stepwise association process with all association constants of equal value. The association of pethidine hydrochloride in 0·5 mol dm−3 sodium chloride could be represented by an association scheme in which association constants KN increased sequentially with aggregation number N according to the relation KN = K(N — 1)/N.

The solution properties of several analgesics including dextropropoxyphene hydrochloride, methadone hydrochloride, dextromoramide acid tartrate and dipipanone hydrochloride have been examined using light scattering, conductivity, vapour pressure osmometry and surface tension techniques. A micellar pattern of association was established for dextropropoxyphene hydrochloride and methadone hydrochloride and critical micelle concentrations and aggregation numbers are reported. The hydrophobic contribution to the free energy of micellization of dextropropoxyphene was determined from measurements of the critical micelle concentration in the presence of added electrolyte.

Background: In the pediatric population, complex regional pain syndrome (CRPS) is a debilitating chronic pain syndrome that is classically treated with escalating polypharmacy and physical therapy. Failure of therapy is often encountered in both adult and pediatric patients with CRPS, after which invasive neuromodulatory therapy might be considered. Intrathecal drug delivery systems and spinal cord stimulation (SCS) have been reported in the literature as forms of neuromodulation effective in adult CRPS; however, SCS remains inadequately researched and underreported in the pediatric CRPS population. Owing to the differences in patient population characteristics and the specific vulnerability of adolescents to drugs that might be used to manage refractory cases, including but not limited to opioids, we believe that early effective pain management without the use of chronic pain medications is of paramount importance. Methods: Recent evidence suggests that neuromodulation can be useful toward improving function and managing pain, while also reducing medication use in chronic pain patients. A representative case a review of the literature is performed. Results: We report the effective treatment of CRPS in a pediatric patient following implantation of an SCS device typifying the improved pain scores, decreased medication use, and substantially improved functional abilities in pediatric patients following SCS. Conclusions: The manuscript objective is to stimulate a discussion for SCS use earlier in the therapeutic management of CRPS in children. &