Articles: pain-management-methods.
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Opioids are overprescribed after surgical procedures, leading to dependence and diversion into the community. This can be mitigated by evidence-based prescribing practices. We investigated the feasibility of an opioid-sparing pain management strategy after surgical procedures. ⋯ Patients reported minimal or no opioid use after implementation of an opioid-sparing pathway, and still reported high satisfaction and pain control. These results demonstrate the effectiveness and acceptability of major reduction and even elimination of opioids after discharge from minor surgical procedures.
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Aging & mental health · Sep 2019
Mental health disorder, pain, and pain treatment among long-term care residents: Evidence from the Minimum Data Set 3.0.
Objective: This study evaluated: (a) associations between long-term care residents' mental health disorder diagnoses and their pain self-reports and pain treatments, and (b) the extent to which communication, cognitive, and physical functioning problems help explain disparities in the pain and pain treatments of long-term care residents with and without mental health disorders. Method: Minimum Data Set 3.0 records of 8,300 residents of Department of Veterans Affairs Community Living Centers were used to determine statistically unadjusted and adjusted cross-sectional associations between residents' mental health diagnoses and their pain and pain treatments. Results: Residents diagnosed with dementia and serious mental illness (SMI) were less likely, and those diagnosed with depressive disorder, post-traumatic stress disorder (PTSD), and substance use disorder (SUD) were more likely, to report recent, severe, and debilitating pain. ⋯ In general, these associations remained even after statistically adjusting for residents' demographic characteristics, other mental health disorder diagnoses, and functioning. Conclusion: Long-term care residents with mental health disorders experience disparities in pain and pain treatment that are not well-explained by their functioning deficits. They may benefit from more frequent, thorough pain assessments and from more varied and closely tailored pain treatment approaches.
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Comparative Study Observational Study
Persistent Postsurgical Pain Following Thoracotomy: A Comparison of Thoracic Epidural and Paravertebral Blockade as Preventive Analgesia.
Persistent postsurgical pain (PPP) is common following thoracotomy. Thoracic epidural (TEB) and paravertebral blockade (PVB) are both established forms of perioperative analgesia for thoracotomy. There is currently a lack of data on their influence on PPP; this study aims to evaluate both techniques on PPP. ⋯ There was no statistical difference in the development of persistent postsurgical pain between patients who received a TEB or a PVB; however, patients who developed PPP had a significantly lower quality of life, which was worse with a neuropathic component.
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Internal medicine journal · Sep 2019
Prevalence and healthcare usage of knee pain in South Australia: a population-based study.
It is known that South Australia (SA) has the highest rate of knee arthroscopy use of any state in Australia; however, Level 1 evidence demonstrates that knee arthroscopy in patients with uncomplicated knee osteoarthritis confers no benefit. In SA, which patients are presenting with knee pain and what treatments are they receiving? ⋯ Knee pain affects large proportions of the SA population. Knee pain was persistent with underuse of non-pharmacological treatments and high use of specialist referral. These data support the need for a national strategy to manage osteoarthritis effectively.
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Radicular pain is related to lesions that either directly compromise the dorsal root ganglion (DRG) or indirectly compromise the spinal nerve and its roots by causing ischemia or inflammation of the axons. ⋯ Outcomes after PRF at the DRG did not show strong differences according to electrodiagnostic findings in FBSS patients with chronic intractable lumbosacral radicular pain.