Pain physician
-
Chronic pain is one of the most often seen, but often undertreated, sequelae in survivors of cancer. Also, this population often shows significant nutritional deficiencies, which can affect quality of life, general health status, and even risk of relapse. Given the influence of nutrition on brain plasticity and function, which in turn is associated with chronic pain in the population with cancer, it becomes relevant to focus on the association between pain and nutritional aspects in this population. ⋯ The association between nutrition and chronic pain in patients with cancer /survivors of cancer is not well documented. The available studies are uncontrolled, and are therefore limited to draw firm conclusions. Additional research is highly needed, and a research agenda is proposed within this paper.
-
Overprescription of opioids has fueled an epidemic of addiction and overdose deaths. The FDA required manufacturers of extended-release/long-acting (ER/LA) opioids to fund continuing medical education (CME) on opioids as part of a Risk Evaluation and Mitigation Strategy (REMS). ⋯ Industry-funded REMS-compliant CME on opioids contain messages that misrepresent scientific evidence and may foster overprescribing of opioids.
-
Interventional radiofrequency (RF) ablation techniques are indicated when an adequate effect is not obtained with conservative measures. ⋯ RF denervation of the sacroiliac joint is effective and promotes a long-lasting analgesic effect.
-
In order to clarify the camera image and open the adhesions mechanically during epiduroscopy, saline is injected continuously in the epidural area. As a result, an increase in intracranial pressure is to be expected in theory. Increased intracranial pressure can be evaluated by measuring by optic nerve sheath diameter. ⋯ We think more prospective randomized controlled studies are required to examine the increase in the diameter of the optic nerve sheath, which is an indirect indicator of increased intracranial pressure after epiduroscopy applications, in order to determine whether the pressure increase is associated with the rate of fluid delivery, the total fluid amount, or the processing time.
-
Transforaminal epidural steroid injection (TFESI) is an interventional technique used to relieve disc herniation related back and radicular pain. Although few studies have investigated the factors predicting positive outcomes after TFESI, there is no data concerning the possible relationship between pre-procedure serum 25-hydroxyvitamin D (25(OH)D) levels and the response to TFESI. ⋯ Vitamin D deficiency is associated with a lower probability of meaningful pain relief following TFESI. It may worth assessing serum vitamin D level prior to this intervention, although prospective investigation is necessary.