Pain physician
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Chronic pain syndromes are poorly understood and challenging to treat. However, intrathecal drug delivery systems (IDDS) have been shown to have good efficacy in treating various pain subtypes and patient populations. The success of IDDS interventions is largely dependent on consideration of and adherence to varying practice patterns. ⋯ Incorporation of the principles found in this evidence-based narrative, which is comprised of the highest level of evidence supportive of various facets of IDDS practice management, is essential to optimize outcomes, treatment efficacy, and safety profiles.
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Loss of efficacy (LOE) is a well-known phenomenon associated with spinal cord stimulation (SCS) and is the leading cause of explant. Although recent advances in neuromodulation have resulted in a decreased incidence of LOE, it still occurs. Intuition suggests that when LOE ensues, switching to a different SCS therapy/platform could potentially be a viable clinical option; however, there are no data presently available to validate this theory. ⋯ LOE is an unfortunate occurrence with few evidence-based solutions presently available to reverse it. Our findings suggest that implementing D-Burst stimulation may be an effective option for treating LOE, as well as potentially reducing opioid consumption, regardless of the prior SCS system.
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Gene polymorphism is an important factor affecting the efficacy and dosage of opioids. A recent study showed RETN rs3745367 was associated with postoperative pain intensity. OPRM1 gene was confirmed to affect the postoperative analgesic consumption of morphine and other opioids. ⋯ RETN rs3745367 was associated with postoperative average pain intensity, OPRM1 rs2075572 and rs9322447 may influence postoperative maximal pain intensity.
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Clinical Trial
The Influence of Bupivacaine Temperature on Supraclavicular Plexus Block Characteristics: A Randomized, Controlled Trial.
Changes in local anesthetics temperature may influence the characters of the peripheral nerve block. The effect of warmed bupivacaine on supraclavicular brachial plexus block has not yet been evaluated. ⋯ Warming bupivacaine 0.5% to 37°C improves the characteristics of supraclavicular plexus block. It promotes rapid onset of sensory-motor block and provided better quality of postoperative analgesia.
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Cervicogenic headache (CEH) is a type of headache that is considered to be originated from the upper cervical spine. There are conflicting results in studies showing changes in the cervical spine in patients with CEH. ⋯ According to cervical lateral x-ray, there was no significant difference in posture in patients with CEH and neck pain.