Pain physician
-
Combination therapy with a gabapentinoid and an opioid improves the quality of life (QOL) of patients with chronic pain. However, the role of combination therapy in patients with spinal cord stimulation (SCS) has not been evaluated. ⋯ Combination, drug therapy, gabapentin, multimodal analgesia, opioid, pain, pregabalin, spinal cord stimulation.
-
The opioid epidemic has been called the "most consequential preventable public health problem in the United States." Though there is wide recognition of the role of prescription opioids in the epidemic, evidence has shown that heroin and synthetic opioids contribute to the majority of opioid overdose deaths. It is essential to reframe the preventive strategies in place against the opioid crisis with attention to factors surrounding the illicit use of fentanyl and heroin. Data on opioid overdose deaths shows 42,000 deaths in 2016. ⋯ Tier 1 includes an aggressive education campaign geared toward the public, physicians, and patients. Tier 2 includes facilitation of easier access to non-opioid techniques and the establishment of a National All Schedules Prescription Electronic Reporting Act (NASPER). Finally, Tier 3 focuses on making buprenorphine more available for chronic pain management as well as for medication-assisted treatment.
-
Several meta-analyses have been performed to compare unilateral percutaneous kyphoplasty (PKP) and bilateral PKP in the treatment of osteoporotic vertebral compression fractures (OVCFs), but inconsistencies in the results have led to questions as to which technique is preferable. ⋯ Osteoporotic vertebral compression fractures, percutaneous kyphoplasty, meta-analysis.
-
Randomized Controlled Trial
Transforaminal vs Interlaminar Epidural Steroid Injection for Acute-Phase Shingles: A Randomized, Prospective Trial.
The acute phase of shingles is characterized by severe pain, and one of the complications of shingles known as postherpetic neuralgia (PHN) is associated with prolonged pain. Although factors predicting the development of PHN, as well as its preventative measures, have been investigated, there is no single treatment effective for PHN. Some studies showed effectiveness of epidural injection to alleviate pain associated with acute-phase shingles. In these studies, epidural injection was performed by interlaminar (IL) approach. However, transforaminal (TF) approach may be more effective as it enables injection of steroids and local anesthetics closer to the dorsal root ganglion where inflammation primarily occurs. There have not been any studies comparing the analgesic effects of epidural injection approaches for pain associated with acute-phase shingles. ⋯ Shingles epidural steroid injection interlaminar approach; transforaminal approach, fluoroscopic, postherpetic neuralgia, VAS, SF-36.
-
Meta Analysis
High Prevalence of Hypovitaminosis D in Patients with Low Back Pain: Evidence from Meta-Analysis.
Emerging evidence suggests an association between vitamin D deficiency and low back pain (LBP). ⋯ Low back pain, hypovitaminosis D, meta-analysis, pooled prevalence, systematic review.