Pain physician
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Randomized Controlled Trial
Adjuvants to Conventional Management of Postdural Puncture Headache Following Obstetric Surgery Under Spinal Anesthesia: Mirtazapine vs. Sumatriptan.
Postdural puncture headache (PDPH) is a debilitating, life-altering complication of the administration of obstetric spinal anesthesia (SA). The lack of evidence-based treatment for PDPH necessitates the implementation of new treatment modalities. Mirtazapine is a noradrenergic and specific serotonergic antidepressant that has been used as a prophylactic treatment for chronic tension-type headaches. Few previous studies have assessed the efficacy of sumatriptan in the treatment of PDPH. ⋯ Adding either mirtazapine or sumatriptan to the CM of PDPH following obstetric SA was associated with lower means of headache intensities, higher rates of complete response to medical treatment, and decreased incidence of refractory headaches. As an antiemetic drug, mirtazapine was found to be effective, inexpensive, safe, well-tolerated, and capable of being used on an outpatient basis.
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Cancer-related neuropathic pain significantly affects patients' quality of life. Despite existing treatments, pain control remains inadequate for many of these patients. There is a lack of strong evidence for the efficacy of the combination of pregabalin, which is often used to treat neuropathic pain, and opioids for treating cancer-related neuropathic pain. ⋯ Pregabalin combined with opioids reduces cancer-related neuropathic pain but increases dizziness, somnolence, and peripheral edema, thus supporting its use in the clinic for treating cancer-related neuropathic pain. However, further high-quality randomized controlled trials are needed to confirm these findings.
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Observational Study
Prophylactic Perioperative Fluid Infusion Strategy During Splanchnic Nerve Neurolysis to Prevent Systemic Hypotension: A Case Series of 70 Patients With Cancer.
When performing splanchnic nerve neurolysis (SNN), systemic hypotension may occur due to upper abdominal sympathetic blockade; therefore, appropriate periprocedural fluid resuscitation is crucial. ⋯ Our prophylactic perioperative fluid resuscitation for treating systemic hypotension post-SNN is sufficient and safe.
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Chronic low back pain is a global health burden with significant health care costs. Accurate diagnosis and treatment are often complicated due to its multifactorial nature. The sacroiliac joint has been identified as a major source of lower back pain, especially among the elderly and individuals with a history of lumbar fusion surgery. Conservative treatments frequently fall short in providing relief, leading to the exploration of alternative interventions such as sacroiliac joint radiofrequency ablation (RFA). ⋯ Adipose interference is minimized when a protruding electrode RFA needle is used within a posterior sacral foramen; neural approximation may be enhanced by giving 2% lidocaine prior to ablation. Considerable gaps in knowledge still exist despite advances in our understanding of the effect of tissue on RFA. Thorough research aimed at refining RFA procedures is essential to ensuring the best feasible patient care and sustainable pain relief. For sacroiliac joint RFA, perineural lateral branch ablation is a viable option that needs further clinical research.
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Guidelines on the use of opioids in chronic pain management increasingly recommend consideration of buprenorphine for patients on long-term full agonist opioid therapy. Published strategies for patients' transitions to buprenorphine vary widely in terms of study design, dose, formulation, and timing of buprenorphine initiation. A further limitation in informing an ideal transition strategy is the paucity of data describing factors that influence the likelihood of a successful transition. ⋯ Our findings support the recommendation to trial buprenorphine in patients receiving chronic opioid therapy. This study's results also suggest that patient factors and shared decision-making are more important predictors of success than are the pharmacologic properties, potency, or dose of pre-rotation opioid exposure.