Pain medicine : the official journal of the American Academy of Pain Medicine
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The objective of the study was to develop and begin to evaluate a new measure of the centrality of pain in patients' lives. ⋯ The COPS has excellent internal consistency and construct validity. Additional studies are needed to further validate the scale.
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Failed back surgery syndrome (FBSS) is a chronic pain condition that has considerable impact on the patient and health care system. Despite advances in surgical technology, the rates of failed back surgery have not declined. The factors contributing to the development of this entity may occur in the preoperative, intraoperative, and postoperative periods. Due to the severe pain and disability this syndrome may cause, more radical treatments have been utilized. Recent trials have been published that evaluate the efficacy and cost-effectiveness of therapeutic modalities such as spinal cord stimulation for the management of patients with failed back surgery. ⋯ FBSS is a challenging clinical entity with significant impact on the individual and society. To better prevent and manage this condition, knowledge of the factors contributing to its development is necessary. While research on FBSS has increased in recent years, perhaps the best strategy to reduce incidence and morbidity is to focus on prevention. Patients diagnosed with FBSS should be managed in an interdisciplinary environment. More radical treatments for FBSS have now been extensively studied providing clinicians with much needed evidence on their efficacy. Incorporating these results into our current knowledge provides a basis on which to construct an evidence-based guide on how best to manage patients who suffer from FBSS.
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US soldiers injured in Iraq, and civilian burn trauma patients are treated at the US Army Institute of Surgical Research. Burn patients experience extreme pain during wound care, and they typically receive opioid analgesics and anxiolytics for debridement. Virtual Reality (VR) has been applied as an adjunct to opioid analgesics for procedural pain. We describe the first use of ketamine combined with immersive VR to reduce excessive pain during wound care. ⋯ Results from these first two cases suggest that a moderate dose of ketamine combined with immersive virtual reality distraction may be an effective multimodal analgesic regimen for reducing acute procedural pain during severe burn wound cleaning.
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Intrathecal pump drug refill may result in significant adverse outcome and complications. Thus far, 351 reports from around the world have been received by Medtronic Inc. related to occurrence of pocket fill, including eight lethal events. Ultrasound-assisted pump port access has been previously described, but did not result in wide acceptance in routine practice due to cumbersome and unreliable setup. This study outlines the methodology of real-time ultrasound-guided pump refill. ⋯ Ultrasound-guided intrathecal pump access is a feasible and simple technique that may improve maintenance, routine device care, and prevent serious complications related to erroneous subcutaneous injections of concentrated medications. Clinical validation will be necessary in the future.
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Pain perception is affected by psychological, social, medical, and environmental conditions, and contributes to the patient's treatment satisfaction and response. Better understanding of pain perception will likely improve pain assessment and treatment selection. The objective of this study was to define a range of verbal and nonverbal pain responses to a clinical stimulus in a clinical population. ⋯ This study shows normal distribution of verbal pain response to a clinical pain stimulus in a clinical population. Body movement and anxiety correlated with verbal pain intensity ratings. Subcutaneous injections of lidocaine may be a useful model for exploration of pain sensitivity in a clinical population.