Pain physician
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Spinal cord stimulation is an intervention that has become increasingly popular due to the growing body of literature showing its effectiveness in treating pain and the reversible nature of the treatment with implant removal. It is currently approved by the FDA for chronic pain of the trunk and limbs, intractable low back pain, leg pain, and pain from failed back surgery syndrome. In Europe, it has additional approval for refractory angina pectoris and peripheral limb ischemia. ⋯ Spinal cord stimulation has demonstrated clinical efficacy in randomized control trials for the approved indications. In addition, several open label observational studies on peripheral nerve field stimulation, hybrid leads, dorsal root ganglion stimulation, and high frequency stimulation show some promising results. However, large randomized control trials demonstrating clear clinical benefit are needed to gain evidence based support for their use.
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Rising prescription opioid use and abuse have prompted widespread concern. However, to date there have been few rigorous investigations into the policies and events which may have contributed to these trends. ⋯ This study provides temporal evidence for a rise in prescription opioid use after implementation of health organization accreditation criteria requiring standardized management of all individuals with pain.
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Multicenter Study
Examination of symptom clusters in acute and chronic pain patients.
Symptom clusters have not been previously explored in acute pain patients (APPs) and chronic pain patients (CPPs) with non-cancer pain. ⋯ APPs and CPPs are characterized by symptom comorbidities that form clusters. In CPPs, cluster number and cluster symptom makeup are affected by pain level. This has implications for clinical practice and future research.
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Bone metastases occur frequently in advanced cancer. The spine, pelvis, ribs, skull and femur are the most affected sites. It is reported that up to 83% of the patients develop pain at some point of the disease. The patient can also develop fractures and disability, particularly in the femur.. ⋯ The results of the current report suggest that femoroplasty, a percutaneous cement placement analogous to a vertebroplasty, might be a therapeutic option for patients with metastatic bone disease of the proximal femur, providing the patient an analgesic reduction and a better quality of life.