Pain physician
-
Symptomatic herniated intervertebral discs are debilitating. However, surgical management poses a significant challenge for endoscopic spine surgeons, especially in high-grade migrated lesions. ⋯ Computed tomography-navigated percutaneous endoscopic surgery is safe and effective for lumbar disc herniation with high-grade migration, and enhance early functional recovery even compared with conventional fluoroscopic guidance.
-
Randomized Controlled Trial
The Effect of Erector Spinae Plane Block With and Without Addition of Magnesium on Relief of Pain from Post-herpetic Neuralgia.
The best tool for management of postherpetic neuralgia (PHN) is a matter of debate. The use of ultrasound-guided erector spinae plane block (ESPB) in patients with PHN may decrease pain severity and the need for analgesics. ⋯ ESPB with or without adding magnesium sulphate is an effective pain management tool for cases of PHN. It leads to a significant decrease in pain score and analgesic requirements.
-
Radiofrequency ablation (RFA) for the lumbar facet joints has demonstrated efficacy in the management of chronic low back pain. The traditional technique uses a conventional monopolar (CM) cannula placed parallel to the putative nerve to produce a thermal lesion resulting in pain relief of the facet joints. A new multi-tined (MT) cannula has come onto the market that allows targeting the putative nerve using a perpendicular to the nerve approach. ⋯ This study demonstrated that the outcomes in terms of pain, disability, quality of life, adverse events, and fluoroscopy exposure time were equivalent between the 2 cannulae. However, RFA using the MT cannula was faster to perform and involved less local anesthetic and radiation.
-
Observational Study
An Observational Study on the Use of a Patient Navigator to Help Improve Outcomes in Patients on Chronic Opioids.
In the United States, the prevalence of opioid use disorders has increased in recent years along with an attendant rise in the incidence of chronic pain disorders and prescription opioid use. Patient navigation services have been used to improve health outcomes in cancer and other chronic disease states, but it is unclear whether the implementation of patient navigation services can facilitate improved outcomes among patients receiving chronic opioid therapy. ⋯ Patient navigation decreased opioid use and practice discharge compared with usual care in an independent pain clinic, suggesting a role for patient navigation in reducing opioid misuse and potentially reducing adverse events.
-
Preoperative exposure to opioids has recently shown to be associated with poor outcomes after elective major surgery, but little is known as to how pretreatment opioid use affects results of interventional back pain management. ⋯ Pretreatment opioid use is associated with greater pain discomfort, impairment, and reduced functional ability, as well as poorer long-term effect of interventional back pain treatment at one-month follow-up. In our study, opioid users reported the same positive effects of facet joint nerve blocks immediately after the treatment and 2 hours after the treatment, but a significantly smaller effect at one-month follow-up. This could indicate that opioid use may diminish the effects of pain treatments by affecting relearning, behavioral changes, and central pain modulation. These findings may help providers understand the effect of pretreatment opioid use on patient care, and its implications on hospital and societal costs.