Pain physician
-
Cost utility or cost effective analysis continues to take center stage in the United States for defining and measuring the value of treatments in interventional pain management. Appropriate cost utility analysis has been performed for caudal epidural injections, percutaneous adhesiolysis, and spinal cord stimulation. However, the literature pertaining to lumbar interlaminar epidural injections is lacking, specifically in reference to cost utility analysis derived from randomized controlled trials (RCTs) with a pragmatic approach in a practical setting. ⋯ This cost utility analysis of lumbar interlaminar epidural injections in patients nonresponsive to conservative management in the treatment of disc herniation, central spinal stenosis, and axial or discogenic low back pain in the lumbar spine shows the clinical effectiveness and cost utility of these injections of $1,976.58 for direct costs with a total cost of $3,301 per QALY.
-
Comparative Study
The Effectiveness and Safety of Selective Lumbar Decompression in Diagnostic Doubt Patients: A Retrospective Control Study.
Our previous study demonstrated that selective nerve root block (SNRB) can influence decision-making in lumbar surgery by guiding the selection of nerve roots targeted for decompression in diagnostic doubt patients (DDPs). However, further studies were needed to determine whether this selective decompression (SD) procedure would result in similar clinical outcomes and reduce the perioperative parameters and postoperative complications as compared to the non-selective decompression (NSD) procedure. ⋯ On the basis of the 5-year follow-up data, we suggest that the SD procedure guided by SNRB is an effective and safe method for the surgical treatment of DDPs. This procedure produces superior perioperative parameters when compared with the conventional NSD procedure, but has a comparable clinical outcome. Moreover, the benefits of SD surgery include fewer perioperative and postoperative complications.
-
Improved intrathecal (IT) pump technology is increasing the accuracy of IT opioid bolus dosing and promising advances in pain therapy. Opioid bolus dosing can be used with a minimal continuous infusion or it can function as the sole therapy. Bolus-only dosing is characterized by minimal use of opioid (often less than 1 mg of IT morphine). ⋯ With new bolus dosing possibilities, IT pumps can be used earlier in the treatment algorithm instead of being a late-stage treatment for patients who responded poorly to conservative treatments. We hypothesize that morphine bolus-only IT dosing will have comparable adverse effect rates, and possibly increased safety as compared to the more conservative continuous delivery method. We further predict that bolus-only delivery will provide better therapy satisfaction, improved functional scores, lower 24 hour opioid dose, and less dose escalation.
-
Diabetic peripheral neuropathy (DPN) is the most common complication of diabetes and more than half of the patients with DPN have self-reported symptoms referring to painful diabetic neuropathy (PDN). Nerve growth factor (NGF) is a key factor for the nervous system, but the role of it in the neuropathic pain of diabetic patients is unclear. ⋯ In diabetic neuropathic pain, the dynamic changes of the NGF expression in dorsal horn and DRG is involved in the development of hyperalgesia and allodynia respectively. Exogenous mNGF may relieve diabetic neuropathic pain by increasing the NGF expression in dorsal horn and DRG.
-
Randomized Controlled Trial
Epidural Dexamethasone Influences Postoperative Analgesia after Major Abdominal Surgery.
Epidurally administered dexamethasone might reduce postoperative pain. However, the effect of epidural administration of dexamethasone on postoperative epidural analgesia in major abdominal surgery has been doubtful. ⋯ Epidural dexamethasone was effective for reducing postoperative pain. Especially, an epidural dexamethasone dose of 10 mg was more effective than a lower dose in patients undergoing gastrectomy which was associated with moderate to severe postoperative pain.