The Clinical journal of pain
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The aim of this study was to analyze changes in health care utilization and cost among a sample of highly impaired children and adolescents who sought a 3-week intensive interdisciplinary pain treatment (IIPT). ⋯ The present results indicate that the health care costs of children and adolescents with severe chronic pain disorders do not significantly decrease 1 year after IIPT; however, the treatment becomes more goal-focused. Differential diagnosis measures and nonindicated therapeutic interventions decreased, and more indicated interventions, such as psychotherapy, were used. Future research is needed to investigate the economic long-term changes after IIPT.
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Chronic pain affects over 100 million adults in the United States, yet continues to be difficult to treat. Concerns continue to mount over the use of opioids to treat noncancer chronic pain (NCCP). Guidelines support the use of adjuvant medications as one of the preferred options for treating chronic pain over opioids. ⋯ Overall adjuvant usage dramatically increased during the study period. Analysis of data demonstrated adjuvant use in chronic pain varied based patient-specific characteristics. These results may allow clinicians, policy makers, and medical educators to identify potential gaps in adjuvant use in certain populations and target areas for clinical, populations-based, and educational improvements in managing NCCP.
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Observational Study
The Association between Headaches and Temporomandibular Disorders is Confounded by Bruxism and Somatic Complaints.
The objective of this observational study was to establish the possible presence of confounders on the association between temporomandibular disorders (TMD) and headaches in a patient population from a TMD and Orofacial Pain Clinic. ⋯ The findings of this study imply that there is a central working mechanism overlapping TMD and headache. Health care providers should not regard these disorders separately, but rather look at the bigger picture to appreciate the complex nature of the diagnostic and therapeutic process.
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To identify and summarize the tools currently available for diagnosing and assessing neuropathic pain (NP) in adults and children and to identify areas where further research is required to address deficiencies in the existing tools. ⋯ This article summarizes the various screening and assessment tools available to clinicians for evaluating NP. Despite the availability of the 15 tools discussed, a deficiency remains, particularly in the pediatric realm. To date, there is no well-validated NP assessment tool for children younger than 5 years, no pediatric NP screening tool that has been validated outside the domain of chemotherapy-induced peripheral neuropathy, and no consistent recommendation regarding the optimal tool to use with pediatric patients who have chronic pain. These areas, as well as others, would benefit from further research and development.
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Review Meta Analysis
Postoperative Analgesia via a Transversus Abdominis Plane Block Using Different Concentrations of Ropivacaine for Abdominal Surgery: A Meta-analysis.
Transversus abdominis plane block (TAPB) has been proven to be an effective means of postoperative anesthesia, but the optimum effective concentration of ropivacaine warrants further research. ⋯ In terms of efficacy and safety, the use of 0.375% ropivacaine for TAPB is preferred in the clinical work.