Current pain and headache reports
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Curr Pain Headache Rep · May 2019
ReviewA Review of Current Denervation Techniques for Chronic Hip Pain: Anatomical and Technical Considerations.
Percutaneous radiofrequency (RF) denervation of articular sensory nerves of the hip joint is a minimally invasive neurotomy technique that can provide pain relief in patients with chronic hip pain. There has been an increase in the number of publications on RF denervation of the hip over the last few years although many questions remain regarding anatomical targets, technical aspects, selection criteria, and evidence for effectiveness. ⋯ For this updated review, publications were identified by searching MEDLINE and other medical literature databases from inception through November 30, 2018. Existing knowledge of hip joint innervation was reviewed and data on patient selection, prognostication of analgesic benefit from ablation by using local anesthetic blocks, current techniques of performing hip joint ablation, analgesic success, functional outcomes, and adverse effects were critically reviewed and analyzed. Sensory denervation of the anterior hip joint using RF current is a viable treatment option for management of chronic hip pain after conservative methods fails to do so. We have synthesized knowledge from papers on techniques of ablation and from recently elaborated anatomical details. We also provide suggestions regarding anticipated outcomes of the procedure. Our review of existing literature indicates evidence for analgesic benefits, improvement in function, and a low incidence of adverse effects of RF ablation of sensory innervation to the hip joint. Future research should focus on refining the technique of ablation and monitoring of long-term outcomes.
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Curr Pain Headache Rep · May 2019
ReviewEvolving Spinal Cord Stimulation Technologies and Clinical Implications in Chronic Pain Management.
Spinal cord stimulation (SCS), based on the gate theory of nociception, has been shown to be effective in the management of chronic pain conditions. While early-generation technology offered many patients improvement in their pain and symptoms, limitations including paresthesia, dependence on mapping, decreased chronological efficacy, and inadequate coverage left many patients with persistent pain and overt therapeutic failure. ⋯ New advances in neuromodulation technology circumvent many of these previous limitations and offer patients improved pain relief and quality of life. In this review, an update on recent technological developments in the field of SCS and peripheral neuromodulation is presented with discussion on differentiating characteristics which may help guide applicability to individual patient needs.
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Curr Pain Headache Rep · Apr 2019
ReviewEssential Elements for Enhanced Recovery After Intra-Abdominal Surgery.
Enhanced recovery pathways provide a framework outlining the best perioperative care for intra-abdominal surgical procedures. To date, no evidence-based umbrella guidelines exist for all intra-abdominal surgeries. ⋯ PubMed and worldwide web searches were performed with the keywords: "ERAS," "Enhanced Recovery After Surgery," +/- "protocol." Manuscripts addressing intra-abdominal procedures were selected with the date range 2012-2017. The enhanced recovery philosophy is based in the realization that a traditional hospital works in silos that need to be broken to ensure a care protocol that follows and optimizes the journey the patient makes during the perioperative care. Enhanced recovery interventions can be categorized into preoperative, perioperative, and postoperative interventions. By design each intervention is planned and coordinated by a multidisciplinary ERAS team. The interventions discussed in this manuscript should be applied to patients on an individual basis depending on their needs. In this review, the most common elements of ERAS protocols in intra-abdominal procedures are reviewed, particularly those which provided the best outcomes and are generalized to all intra-abdominal procedures.
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Curr Pain Headache Rep · Apr 2019
ReviewMetabolic and the Surgical Stress Response Considerations to Improve Postoperative Recovery.
Enhanced recovery pathways are a multimodal, multidisciplinary approach to patient care that aims to reduce the surgical stress response and maintain organ function resulting in faster recovery and improved outcomes. ⋯ A PubMed literature search was performed for articles that included the terms of metabolic surgical stress response considerations to improve postoperative recovery. The surgical stress response occurs due to direct and indirect injuries during surgery. Direct surgical injury can result from the dissection, retraction, resection, and/or manipulation of tissues, while indirect injury is secondary to events including hypotension, blood loss, and microvascular changes. Greater degrees of tissue injury will lead to higher levels of inflammatory mediator and cytokine release, which ultimately drives immunologic, metabolic, and hormonal processes in the body resulting in the stress response. These processes lead to altered glucose metabolism, protein catabolism, and hormonal dysregulation among other things, all which can impede recovery and increase morbidity. Fluid therapy has a direct effect on intravascular volume and cardiac output with a resultant effect on oxygen and nutrient delivery, so a balance must be maintained without excessively loading the patient with water and salt. All in all, attenuation of the surgical stress response and maintaining organ and thus whole-body homeostasis through enhanced recovery protocols can speed recovery and reduce complications. The present investigation summarizes the clinical application of enhanced recovery pathways, and we will highlight the key elements that characterize the metabolic surgical stress response and improved postoperative recovery.