Pain practice : the official journal of World Institute of Pain
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Case Reports
The Effect of Peripheral Neuromodulation on Pain from the Sacroiliac Joint: A Retrospective Cohort Study.
We report here a retrospective review of the longer-term results of peripheral neuromodulation in 12 patients with significant chronic sacroiliac joint pain who had previously failed multiple conservative and interventional pain therapies. To allow for the assessment of meaningful longer-term outcome, implants for all 12 patients had been in place for a minimum of 18 months to a maximum of 36 months prior to the formal review. Compared to the preimplantation baseline, the longer-term follow-up revealed a significant and sustained reduction in visual analog scale pain scores from 8.7 ± 1.1 to 1.1 ± 1.0 (P < 0.001), with a 75% reduction in analgesia requirement, and improvement in pain impact on daily function from 94.1% ± 5.9% to 5.8% ± 6.0% (P < 0.001). These preliminary results merit a prospective randomized trial of peripheral neuromodulation.
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Review Meta Analysis
Nervous System Sensitization as a Predictor of Outcome in the Treatment of Peripheral Musculoskeletal Conditions: A Systematic Review.
Research suggests that peripheral and central nervous system sensitization can contribute to the overall pain experience in peripheral musculoskeletal (MSK) conditions. It is unclear, however, whether sensitization of the nervous system results in poorer outcomes following the treatment. This systematic review investigated whether nervous system sensitization in peripheral MSK conditions predicts poorer clinical outcomes in response to a surgical or conservative intervention. ⋯ This systematic review found insufficient evidence to support an independent predictive relationship between QST measures of nervous system sensitization and treatment outcome. Self-report measures demonstrated better predictive ability. Further high-quality prognostic research is warranted.
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Postoperative pain management protocols that use patient-controlled analgesia (PCA) can hinder mobility due to attached machinery and tubing. Immobility in the postoperative setting can increase complications, length of stay (LOS), and costs. Early and enhanced mobilization can reduce the cost of care while improving patient outcomes. A needle-free, compact, patient-activated, and portable fentanyl iontophoretic transdermal system (fentanyl ITS, IONSYS; The Medicines Company, Parsippany NJ) has been shown to provide comparable efficacy and tolerability to intravenous (IV) PCA morphine that promotes improved mobility. ⋯ Due to improved mobility with fentanyl ITS, complications are expected to be less frequent than with IV PCA and epidural PCA. Incorporation of this strategy into postoperative pain management protocols may reduce LOS and total hospital costs.
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The purpose of this study was to discuss the safety, treatment profile, and clinical effectiveness of 12-month treatment with fentanyl patch (FP), a strong opioid, in medical practice in Japan under the risk minimization action plan (RMAP). ⋯ Our results identified a reasonable risk-benefit profile for the management of moderate-to-severe chronic noncancer pain in patients previously treated with opioids under long-term treatment with FP under the RMAP. Respiratory depression, drug dependency, and drug withdrawal were rarely observed even under the RMAP in Japan.
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Plancarte first described a fluoroscopy-guided superior hypogastric plexus block to manage pelvic pain in 1990. Modifications have since been described using different imaging modalities. Ultrasound-guided approach has been described in a clinical outcome study. ⋯ Additional transabdominal long-axis scanning of the lumbosacral segment was and the needle trajectory was modified to aim for the apex of the L5/S1 disk. Bilateral spread was achieved by strict midline placement of the needle tip and real-time observation of injection. The modified ultrasound-guided technique resulted in a similar spread of injectate as the traditional fluoroscopy-guided technique that in a clinical scenario would offer complete block of the superior hypogastric plexus.