Pain medicine : the official journal of the American Academy of Pain Medicine
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The aim of this study is to evaluate prospectively the efficacy of caudal epidural steroid injection (CESI) and transforaminal epidural steroid injection (TFESI) in lumbar spinal stenosis patients with sciatic pain. ⋯ The effectiveness of transforaminal steroid injection for the stenosis patients with sciatica was superior to caudal at 6 months postinjection.
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We sought to determine the prevalence of chronic post-thoracotomy pain, defined as persistent or recurring incisional pain for at least 2 months after thoracotomy, in children. ⋯ Our study reports a low prevalence of post-thoracotomy pain in childhood and adolescence, and stands in contrast to previously published adult data.
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Multicenter Study Observational Study
Sustained effectiveness of 10 kHz high-frequency spinal cord stimulation for patients with chronic, low back pain: 24-month results of a prospective multicenter study.
The aim of this study was to investigate the long-term efficacy and safety of paresthesia-free high-frequency spinal cord stimulation (HF10 SCS) for the treatment of chronic, intractable pain of the low back and legs. ⋯ In patients with chronic low back pain, HF10 SCS resulted in clinically significant and sustained back and leg pain relief, functional and sleep improvements, opioid use reduction, and high patient satisfaction. These results support the long-term safety and sustained efficacy of HF10 SCS.
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There has been a widespread call for an ethics in the management of patients with chronic pain which is patient centered and takes into account the lived experience of the patient. It has been argued in literature that current "duty" or principlist-based models of ethics (so-called 3rd person ethics) have not adequately addressed the needs of either patients or practitioners in this area. ⋯ We outline a patient-centered ethics to underpin contemporary collaborative, multimodal approaches in the management of chronic pain. We firstly describe an agency-oriented, neo-Aristotelian 1st person ethics and then outline a hermeneutic relationship with extant "duty-based," 3rd person bioethics. The utility of the ethics model we propose (the ethical reasoning bridge) lies in its capacity for developing a sense of moral agency for both practitioner and patient, resonating with the current emphasis of seeking active engagement of patients in management.
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A performance improvement continuing medical education (PI CME) activity was designed to assist clinicians with accurately identifying and appropriately managing persistent pain in long-term care facility (LTCF) residents. ⋯ This CME activity allowed for collection of data demonstrating performance improvement in persistent pain management. The tools used as part of the intervention (available at http://www.achlpicme.org/LTC/toolkit) may help other clinicians enhance their management of LTCF residents with persistent pain.