Pain physician
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Comparative Study
Pain relief scale is more highly correlated with numerical rating scale than with visual analogue scale in chronic pain patients.
The pain relief scale (PRS) is a method that measures the magnitude of change in pain intensity after treatment. The present study aimed to evaluate the correlation between PRS and changes in pain determined by the visual analogue scale (VAS) and numerical rating scale (NRS), to confirm the evidence supporting the use of PRS. Sixty patients with chronic spinal pain that had a VAS and NRS recorded during an initial examination were enrolled in the study. ⋯ Compared to PRS, the VAS and NRS percentile scores exhibited higher correlation coefficients than scores based on the raw data differences. Furthermore, even when converted to a percentile, the NRS%-PRS R (0.968) was higher than the VAS%-PRS R (0.904), P = 0.0001. The results indicated that using the PRS together with NRS in pain assessment increased the objectivity of the assessment compared to using only VAS or NRS, and may have offset the limitations of VAS or NRS alone.
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Case Reports
Spontaneous muscle contraction with extreme pain after thoracotomy treated by pulsed radiofrequency.
Chronic post thoracotomy pain (CPTP) was a common complication after thoracotomy, while spontaneous muscle contraction (SMC) was very rare. Neuropathic pain components appeared in some CPTP patients. The patients with neuropathic pain (NPP) often suffered from more severe pain. ⋯ Pulsed radiofrequency provided good efficacy in CPTP with SMC in this case.
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Review Meta Analysis
The impact of genetic variation on sensitivity to opioid analgesics in patients with postoperative pain: a systematic review and meta-analysis.
Individual response to opioid analgesics varies among patients. ⋯ The results indicate that among the genetic SNPs we studied which include those affecting analgesic drug metabolism, transport of analgesic agents across the blood-brain barrier, and their activity at target receptors and ion channels and in the modulation of neurotransmitter pathways, the A118G allele variant of OPRM1 has the most potent influence on pain management of postoperative patients. Opioid receptor gene information may provide valuable information for clinicians to properly manage the analgesic use of opioids individually for better pain management.
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Hospital admissions for back pain are prolonged, costly, and common. Epidural steroid injections are frequently performed in an outpatient setting with an excellent safety and efficacy profile. ⋯ An ED patient cohort with severe refractory pain was treated with an interlaminar ESI after failing maximal medical pain management while in the ED. Complete pain relief was achieved safely and rapidly. The need for inpatient admission was eliminated after injection. Costs were lower in the group that received an epidural injection. Narcotic requirements upon discharge were decreased as well.
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Transforaminal endoscopic discectomy and foraminotomy is a well-described minimally invasive technique for surgically treating lumbar radiculopathy caused by a herniated disc and foraminal narrowing. ⋯ Transforaminal endoscopic discectomy and foraminotomy could be used as a safe, yet, minimally invasive and innovative technique for the treatment of lumbar radiculopathy in the setting of previous instrumented lumbar fusion. IRB approval: Meridian Health: IRB Study # 201206071J