Articles: pain-management-methods.
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Opioid tapering may be necessary for patients on long-term opioids. Here, the authors presented a patient who had uncontrolled chronic musculoskeletal pain while on chronic methadone. ⋯ Using multidisciplinary interventions of patient education and counseling, physical interventions, and nonopioid medications, patient's methadone was discontinued after longer than one year tapering with relatively good pain control. The tapering process highlights the importance of pain management during opioid tapering using multidisciplinary interventions to prevent and treat opioid withdrawal and pain relapses.
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Randomized Controlled Trial
Fascia iliaca block in the emergency department for hip fracture: a randomized, controlled, double-blind trial.
Hip fracture causes moderate to severe pain and while fascia iliaca block has been reported to provide analgesic benefit, most previous trials were unblinded, with subsequent high risks of performance, selection and detection biases. In this randomized, control double-blind trial, we tested the hypothesis that a fascia iliaca block provides effective analgesia for patients suffering from hip fracture. ⋯ Fascia iliaca block following anatomic landmarks may not provide supplementary analgesia for patients suffering from hip fracture, when low pain scores are reported after prehospital morphine. Additional larger trials will help reach definitive conclusion.
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Recently, denervation therapy has been applied clinically for the treatment of intractable osteoarthritis (OA). This therapy provides an alternative for patients who are insensitive to conservative therapies or unwilling to receive surgery and general anesthesia. However, therapeutic effect of this method, especially the long-term efficacy, is still controversial. ⋯ Osteoarthritis, denervation therapy, radiofrequency, chronic pain, function, systematic review, meta-analysis.
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Randomized Controlled Trial
Efficacy of Atlantoaxial Joint Glucocorticoid Injection in Patients with Rheumatoid Arthritis: A Randomized Trial.
The atlantoaxial joint (AAJ) plays a pivotal role in the cervical spine motion. Unfortunately, it is the most common cervical spine joint that is affected in patients with rheumatoid arthritis. Inflammation of the AAJ results in neck disability, nerve root compression, and finally spinal cord compression. ⋯ Rheumatoid arthritis, atlantoaxial joint injection.
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To examine the impact of the presence of facet tropism on the results of transforaminal epidural steroid injection for unilateral radicular pain induced by lumbar disc herniation. ⋯ Facet tropism correlates with less success of transforaminal epidural steroid injection; therefore, facet tropism may be a worthwhile measurement in a discussion with patients of the benefits of the procedure.