Pain physician
-
The shoulder region is a common area for pain. The shoulder has the largest range of motion and the most complex mechanical anatomy. The shoulder girdle and related tendons allow for numerous painful disorders to occur. Also, given the overall use of the shoulder, arthritic deformities are all too common. Finally, pain from more complex states such as poststroke shoulder pain and status post total shoulder arthroplasty pain have always been a difficult diagnosis to treat with effectiveness. The innervation to the shoulder predominantly comes from the suprascapular and axillary nerves. Both nerves relatively follow an expected anatomic course and whereby they can be targeted with ultrasound or fluoroscopy. Recently, there has been an increase in evidence that suggests peripheral nerve stimulation can make a difference in these patients with shoulder pain. ⋯ Overall there is fair to moderate evidence for peripheral nerve stimulation to treat shoulder pain in hemiplegic poststroke patients. There is limited evidence when treating other shoulder pain etiologies. Utilizing ultrasound or fluoroscopic guidance, the procedure has proven to be safe allowing proper placement of the electrodes near the target nerves. Considering the high prevalence of shoulder pain from degenerative conditions and overuse, future studies are undoubtedly warranted to evaluate whether peripheral nerve stimulation can modify our treatment algorithm for management of these conditions.
-
Intraarticular pulsed radiofrequency (IAPRF) for the treatment of painful knee osteoarthritis (KOA) is a less invasive treatment method. It has fewer adverse effects and can quickly reduce KOA-related pain and improve knee joint dysfunction. ⋯ CT-guided high-voltage IAPRF is more beneficial in reducing knee pain and improving knee function compared with low-voltage IAPRF. In addition, patients who received high-voltage IAPRF were more satisfied with their treatment.
-
Interventional procedures are offered routinely to patients seen in McGill University's interdisciplinary cancer pain management program. However, publications on these procedures are scarce, making it difficult to predict which patients may benefit from them. ⋯ In this cohort of cancer pain patients, interventional cancer pain procedures provided effective pain relief and other benefits, including pain relief, reduced burden of symptoms, and reduction of opioid intake, while demonstrating a favorable safety profile. Patients with poorer ratings of depression and fatigue derived less benefit from procedures, suggesting that offering such procedures as part of patients' treatment plan would be sensible, rather than leaving interventions for later stages.
-
Randomized Controlled Trial
The Efficacy of Scrambler Therapy for the Management of Head, Neck and Thoracic Cancer Pain: A Randomized Controlled Trial.
Pain is still a common feature in all types of cancers including head and neck and thoracic cancer. Neuromodulatory techniques have gained popularity over opioids in recent times because of the risks associated with chronic opioid therapy. There are no clinical trials evaluating the efficacy of scrambler therapy (ST) for the management of pain due to head and neck and thoracic cancer. ⋯ The trial showed that ST is an effective treatment for the management of pain due to head and neck and thoracic cancer. On the basis of this study, the use of ST for the management of refractory cancer pain in head and neck and thoracic cancer is recommended.
-
Lumbar facet joints are a clinically important source of chronic low back pain. There have been extensive diagnostic accuracy studies, along with studies of influence on the diagnostic process, but most of them have utilized the acute pain model. One group of investigators have emphasized the importance of the chronic pain model and longer lasting relief with diagnostic blocks. ⋯ This study demonstrated that the chronic pain model is more accurate and reliable with concordant pain relief. This updated assessment also showed prevalence and false-positive rates of 34.1% and 49.8%.