Pain practice : the official journal of World Institute of Pain
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Randomized Controlled Trial Comparative Study
Comparison of Ultrasound-Guided Supraclavicular and Interscalene Brachial Plexus Blocks in Postoperative Pain Management After Arthroscopic Shoulder Surgery.
The interscalene brachial plexus block (ISBB) is an effective procedure for minimizing postoperative opioid consumption and pain following arthroscopic shoulder surgery. The ultrasound (US)-guided supraclavicular brachial plexus block (SCBB) seems to be an alternative technique for arthroscopic shoulder surgery. However, evidence is lacking regarding the impact of SCBB on postoperative pain management and recovery after arthroscopic shoulder surgery. The aim of this study was to compare the effects of SCBB with ISBB in terms of postoperative pain and quality of recovery after arthroscopic shoulder surgery. ⋯ This study showed that US-guided SCBB is as effective as ISBB in reducing postoperative pain and improving the quality of recovery for arthroscopic shoulder surgery.
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Observational Study
Differences in Characteristics and Downstream Drug Use among Opioid Naïve and Prior Opioid Users with Low Back Pain.
Recent clinical practice guidelines have suggested conservative treatment approaches, including physical therapy, are indicated as first-line treatment for patients with low back pain (LBP); however, LBP continues to be managed with opioids, despite decreases in function, morbidity, and insignificant improvements in pain. ⋯ In patients presenting with LBP, prior opioid exposure appears to be related to increased analgesic use (opioid and non-opioid) and longitudinal analgesic utilization at 1 year after the index date.
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Observational Study
Prospective cohort analysis of DRG stimulation for failed back surgery syndrome pain following lumbar discectomy.
Surgical lumbar discectomy is a commonly performed routine spinal procedure that is usually undertaken to alleviate lumbar radicular symptoms caused by a herniated intervertebral disc. Surgical lumbar discectomy can also lead to chronic postsurgical leg and/or back pain (failed back surgery syndrome [FBSS]), a condition that can be refractory to conventional medical management. Early clinical results on the use of dorsal root ganglion (DRG) stimulation for FBSS have supported the use of this treatment alternative. ⋯ These results suggest that DRG stimulation induces pain relief in subjects diagnosed with FBSS. These reductions in pain were also associated with improvements in quality of life and disability. Additional prospective studies are warranted to further investigate this potential application of DRG stimulation, as well as to optimize patient selection, lead placement, and programming strategies.
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Recent systematic reviews show promising effects for multidisciplinary biopsychosocial (BPS) interventions in patients with chronic low back pain (CLBP). Nowadays, BPS interventions have also been developed for primary care physiotherapy settings. Our aim was to systematically review the evidence on the effectiveness of primary care BPS interventions in improving functional disability, pain, and work status for patients with CLBP. Secondly, we aimed to provide an elaborated overview of BPS intervention designs, physiotherapist training programs, and process-related factors (practical implementation). ⋯ BPS interventions seem more effective than education/advice and were found to be as effective as physical activity interventions in patients with CLBP. BPS interventions with a clear focus on psychosocial factors (understanding pain, unhelpful thoughts, coping styles, and goal setting) seem most promising. Sufficient delivery of BPS elements is expected when physiotherapists participate in training programs with extensive support prior and during delivery (manual, supervision, and informative resources).
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Observational Study
Influence of the menstrual cycle phase on pain perception and analgesic requirements in young women undergoing gynecological laparoscopy.
The influence of the gonadal hormones on some aspects of the human physiology has been studied with uncertain results. Still a confusion exists in relation to the real effects of the female hormones on the perception of pain. The existing data refer mainly to experimental studies and have provided results not always useful in the clinical practice. ⋯ The results of this study have demonstrated that in postoperative female patients pain is perceived significantly more in the luteal phase of the menstrual period, than in the follicular phase. This could suggest that female in child-bearing age should be scheduled for elective surgery preferentially during the follicular phase, unless differently necessary. It would guarantee a more comfortable postoperative period, with reduced necessity of analgesics.