Pain medicine : the official journal of the American Academy of Pain Medicine
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Lumbar intervertebral disk herniation (LDH) is considered one of the major risk factors for lower back pain, mainly caused by irritation of a spinal nerve or its root. One of the genes related to pain perception is SCN9A, which encodes the voltage gated sodium channel NaV1.7, a key molecule involved in peripheral pain processing. It had been presented before that a common polymorphism within SCN9A (rs6746030: G > A, R1150W) might influence nociception in the general population. Hence, the present study was aimed at investigating the association between SCN9A polymorphism and pain sensitivity. ⋯ Our results suggest that the SCN9A rs6746030 polymorphism may be associated with pain intensity in patients suffering from symptomatic disc herniation.
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Review
Review of Factors, Methods, and Outcome Definition in Designing Opioid Abuse Predictive Models.
Several opioid risk assessment tools are available to prescribers to evaluate opioid analgesic abuse among chronic patients. The objectives of this study are to 1) identify variables available in the literature to predict opioid abuse; 2) explore and compare methods (population, database, and analysis) used to develop statistical models that predict opioid abuse; and 3) understand how outcomes were defined in each statistical model predicting opioid abuse. ⋯ We identified variables used to predict opioid abuse from electronic health records and administrative data. Medication variables are the recurrent variables in the articles reviewed (33 variables). Age and gender are the most consistent demographic variables in predicting opioid abuse. Overall, there is similarity in the sampling method and inclusion/exclusion criteria (age, number of prescriptions, follow-up period, and data analysis methods). Intuitive research to utilize unstructured data may increase opioid abuse models' accuracy.
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The purpose of this study was to assess the correlation between skin-to-epidural space depth, as measured on cervical magnetic resonance imaging (MRI), and actual needle depth, as measured by Tuohy needle markings during cervical epidural steroid injections. ⋯ Estimates of needle depth made with MRI were consistently slightly deeper than the actual loss-of-resistance needle depth, indicating that the provider should employ caution when using MRI predictive depths. Information garnered from preprocedure MRIs can be used to improve the safety of cervical epidural steroid injection procedures.
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Quality improvement (QI) is an underutilized approach among pain medicine specialists to improve comprehensive pain assessment and the delivery of multimodal pain care. We report the results of a QI program that utilized peer review and financial incentives to improve these processes in interventional pain clinics. ⋯ The results of this QI project suggest that pain clinics can make this value-based transition and offer high-quality multidisciplinary assessment and treatment, with good compliance among a group of physicians in primarily intervention-based practices.
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Multiple processes have been identified as potential contributors to chronic pain, with increasing evidence illustrating an association with aberrant levels of neuroimmune mediators. The primary objectives of the present study were to examine central nervous system cytokines, chemokines, and growth factors present in a chronic pain population and to explore patterns of the same mediator molecules over time. Secondary objectives explored the relationship of central and peripheral neuroimmune mediators while examining the levels of anxiety, depression, sleep quality, and perception of pain associated with the chronic pain patient experience. ⋯ These data indicate that IL-8 should be further investigated and psychobehavioral components considered in the overall chronic pain paradigm. Future studies examining the interactions between these factors and IL-8 may identify novel targets for treatment of persistent pain states.