Pain physician
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Randomized Controlled Trial
Unreliability of the visual analog scale in experimental pain assessment: a sensitivity and evoked potentials study.
Pain is a universal but subjective experience, making it difficult to obtain objective information about the experiential dimensions of pain. Although the visual analog scale (VAS) is ubiquitously used in pain assessment, its reliability has been questioned. The properties of this rating scale, especially its anchor points likely to be reinterpreted by subjects, may bias the results. ⋯ Taken together, our psychophysical and SEP results suggest that healthy individuals reinterpret the "no pain" anchor on the classical pain-VAS commonly used in the experimental assessment of pain, by rating the intensity of the stimulation rather than pain perception.
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The Patient Protection and Affordable Care Act (ACA), informally referred to as ObamaCare, is a United States federal statute signed into law by President Barack Obama on March 23, 2010. ACA has substantially changed the landscape of medical practice in the United States and continues to influence all sectors, in particular evolving specialties such as interventional pain management. ObamaCare has been signed into law amidst major political fallouts, has sustained a Supreme Court challenge and emerged bruised, but still very much alive. ⋯ ObamaCare may provide insurance for all, but with cuts in Medicare to fund Obamacare, a limited expansion of Medicaid, the inadequate funding of exchanges, declining employer health insurance coverage and skyrocketing disability claims, the coverage will be practically nonexistent. ObamaCare is composed of numerous organizations and bureaucracies charged with controlling the practice of medicine through the extension of regulations. Apart from cutting reimbursements and reducing access to interventional pain management, administration officials are determined to increase the role of midlevel practitioners and reduce the role of individual physicians by liberalizing the scope of practice regulations and introducing proposals to reduce medical education and training.
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Persistent postsurgical pain (PPSP) affects between 10% and 50% of surgical patients, the development of which is a complex and poorly understood process. To date, most studies on PPSP have focused on specific surgical procedures where individuals do not suffer from chronic pain before the surgical intervention. Individuals who have a chronic nerve injury are likely to have established peripheral and central sensitization which may increase the risk of developing PPSP. Concurrent analyses of the possible factors contributing to the development of PPSP following lumbar discectomy have not been examined. ⋯ We demonstrated that the occurrence of PPSP can be predicted using a small set of variables easily obtained at the preoperative visit. This a prediction rule that could further optimize perioperative pain treatment and reduce attendant complications by allowing the preoperative classification of surgical patients according to their risk of developing PPSP.
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Facial pain occurring after traumatic injury of the facial branches of the trigeminal nerve is a medical condition that is often very difficult to treat. Patients are quite disabled by their symptoms and most therapies are ineffective in relieving this pain. Peripheral nerve stimulation has been used as a treatment to provide pain relief for this type of intractable atypical facial pain. ⋯ This surgical technique for placing peripheral nerve stimulators allows for a minimally invasive approach for the treatment of intractable posttraumatic trigeminal neuralgia with potentially less risk of facial nerve damage. This case confirms the need for further studies to be done in the future to prove the safety and effectiveness of this technique.
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Case Reports
Utility of intercostal nerve conventional thermal radiofrequency ablations in the injured worker after blunt trauma.
Intercostal nerve blocks offer short-term therapeutic relief and serve as a diagnostic test for intercostal neuralgia. This original case report demonstrates the efficacy of radiofrequency ablations for long-term pain relief of intercostal neuralgia. To date, there have been no studies that demonstrate the efficacy of thermal conventional intercostal nerve radiofrequency ablations for intercostal neuralgia. ⋯ Following conventional thermal radiofrequency ablations of the intercostal nerves, 5 of the 6 patients experienced either long-term pain relief or required no additional care. The treatment has potential efficacy for injuries, including rib fractures or intercostal neuralgia, stemming from blunt trauma to the chest wall. In addition, there may be a potential for this treatment to help patients suffering from postthoracotomy pain.