Pain physician
-
There is a debate on the long-term outcomes of surgical decompression for lumbar spinal stenosis (LSS) as compared to conservative treatment, with even more limited outcomes in repeat surgeries. Hence, other less invasive treatment modalities, such as neuromodulation with a modern spinal cord stimulator (SCS), could be considered in the spectrum of management options for symptoms of neurogenic claudication (NC) related to LSS as an alternative to surgery. ⋯ With modern SCS techniques, the majority of patients can achieve sustained improvement of symptoms of NC of at least a 2-year duration regardless of previous history of lumbar decompressive surgery. SCS can be considered as part of the conservative treatment options before committing to surgical decompression.
-
Observational Study
Cost-effectiveness of Radiofrequency Denervation for Zygapophyseal Joint Pain.
Chronic pain is a leading cause of disability. Radiofrequency denervation (RFD) is effective when performed according to guidelines for patients with correctly diagnosed zygapophyseal joint pain (ZJP). However, the cost-effectiveness of this method has not been fully explored. ⋯ Patients referred for RFD in Sweden report extremely low HRQoL. HRQoL significantly increased following RFD in patients with ZJP. Medications and health care consumption decreased after RFD. RFD was cost-effective, and the sensitivity analysis yielded stable results in different scenarios. Therefore, RFD is a cost-effective treatment that meets the Swedish National Board of Health and Welfare criteria for a high priority treatment.
-
Meta Analysis
Association of Cigarette Smoking with Risk of Chronic Musculoskeletal Pain: A Meta-Analysis.
Chronic musculoskeletal pain (CMP) management is a major global public health goal owing to increased social and economic burdens. However, the risk of CMP in smokers compared with nonsmokers remains uncertain. ⋯ Cigarette smoking was associated with increased risk of CMP. In view of the high prevalence of smoking in many countries and the increasing number of CMP patients worldwide, reducing tobacco use should be an important public health strategy to prevent and control the global epidemic of CMP. Future research should attempt to establish whether this association is causal and clarify its mechanisms.
-
Randomized Controlled Trial
Hemidiaphragmatic Paresis Following Interscalene Brachial Plexus Block With 2-Point Injection Technique.
An interscalene brachial plexus block is a commonly conducted nerve block for anesthesia and analgesia in shoulder surgery. Due to its proximity to the targeted nerve, the phrenic nerve, which innervates the diaphragm, is typically inadvertently blocked by ventral spread of the local anesthetic. Although hemidiaphragmatic paresis is tolerable in healthy patients, it would be an irreversible risk to patients with compromised lung reserve. ⋯ Reducing the local anesthetic volume by selective injection and observing the spread pattern resulted in a decreased incidence of hemidiaphragmatic paresis and preserved handgrip strength after interscalene block.
-
Randomized Controlled Trial
The Use of Combination Paracetamol and Ibuprofen in Postoperative Pain after Total Knee Arthroplasty, a Randomized Controlled Trial.
Adequate pain management has an important role in supporting early ambulation after total knee arthroplasty (TKA). Multimodal analgesia is one of the modalities of overcoming postoperative pain. The use of a combination of paracetamol and ibuprofen is expected to reduce the total morphine requirement after TKA. ⋯ The combination of paracetamol and ibuprofen is better in reducing the total morphine requirement after TKA when compared with the administration of paracetamol injection alone or ibuprofen injection alone. Combination paracetamol injection and ibuprofen injection also provides adequate pain management in order to help early ambulation.