Pain physician
-
A major component of a systematic review is an assessment of the methodological quality and bias of randomized trials. The most commonly utilized methodological quality assessment and bias assessment for randomized trials is by the Cochrane Review Group. While this is not a "gold standard," it is an indication of the current state-of-the-art review methodology. There is, however, no specific instrument to assess the methodological quality of manuscripts published for interventional techniques. ⋯ We have developed a new comprehensive instrument to assess the methodological quality of randomized trials of interventional techniques. This instrument is superior to Cochrane review methodology criteria in that it provides more extensive and specific information for interventional techniques that will be useful in assessing the methodologic quality and bias of interventional techniques.
-
Randomized Controlled Trial
Thoracic interlaminar epidural injections in managing chronic thoracic pain: a randomized, double-blind, controlled trial with a 2-year follow-up.
Reports of prevalence of spinal pain indicate the prevalence of thoracic pain in approximately 13% of the general population compared to 32% of the population with neck pain and 43% of the population with low back pain during the past year. Even though, thoracic pain is less common than neck or low back pain, the degree of disability resulting from thoracic pain disorders seems to be similar to other painful conditions. Interventions in managing chronic thoracic pain are also less frequent, leading to the paucity of literature about various interventions in managing chronic thoracic pain. Thoracic intervertebral discs and thoracic facet joints have been shown to be pain generators, even though thoracic radicular pain is very infrequent. Thoracic epidural injections are one of the commonly performed procedures in managing thoracic pain. The efficacy of thoracic epidural injections has not been well studied. ⋯ Based on the results of this trial, it is concluded that chronic thoracic pain of non-facet joint origin may be managed conservatively with thoracic interlaminar epidural injections with or without steroids.
-
Randomized Controlled Trial
High dose intrathecal morphine for major abdominal cancer surgery: a prospective double-blind, dose-finding clinical study.
Despite 30 years of clinical research, we still do not know the optimal dose of intrathecal morphine (ITM) when used alone. ⋯ One mg ITM provided superior analgesia for 48 hours postoperative compared with 0.2 mg and 0.5 mg ITM with a nonsignificant difference in the incidence of side effects. Further studies of larger sample size are recommended to confirm these findings.
-
About 1% of patients suffering from chronic migraine do not respond to medications and require more invasive treatments. Occipital nerve stimulation (ONS) is one of these new therapeutic options. The aim of this data review is to evaluate the clinical impact of ONS and whether the neuropsychological aspects of anxiety and depression can be considered as predictors of therapeutic effects. ⋯ ONS seems to be an effective and safe treatment for chronic migraine. The effects of ONS can be optimized by a multidisciplinary diagnostic and therapeutic approach, especially for the importance of the psychological factors in pain perception and their correlation with a good therapeutic outcome. Our experience highlighted that a multidisciplinary team which includes psychological support and psychosocial rehabilitation is essential for the success of this therapy.