Articles: pain-management-methods.
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Neurosurg. Clin. N. Am. · Apr 2019
ReviewEvolving Techniques and Indications in Peripheral Nerve Stimulation for Pain.
Peripheral nerve stimulation is the direct electrical stimulation of named nerves outside the central neuraxis to alleviate pain in the distribution of the targeted peripheral nerve. These treatments have shown efficacy in treating a variety of neuropathic, musculoskeletal, and visceral refractory pain pathologies; although not first line, these therapies are an important part of the treatment repertoire for chronic pain. With careful patient selection and judicious choice of stimulation technique, excellent results can be achieved for a variety of pain etiologies and distributions. This article reviews current and past practices of peripheral nerve stimulation and upcoming advancements in the field.
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Reg Anesth Pain Med · Apr 2019
ReviewIntermittent bolus versus continuous infusion techniques for local anesthetic delivery in peripheral and truncal nerve analgesia: the current state of evidence.
Manually delivered intermittent bolus (MIB) and programmable intermittent bolus (PIB), alternatives to continuous infusion (CI), involve administering a set volume of solution at a set interval of time. The benefits of intermittent bolus techniques in truncal and peripheral nerve blockade (TPNB) are unclear, and studies have largely demonstrated conflicting results. Using MEDLINE, Embase, Google Scholar, and the Cochrane Library, we conducted an evidenced-based review of published randomized controlled trials comparing intermittent bolus and CI methods in TPNB. ⋯ The overall quality of current evidence was found to be low given the small sample sizes, heterogeneity of data, and the variations in intermittent bolus techniques between studies. At this time, we found limited supportive data to endorse MIB or PIB over CI in TPNB. While unable to provide data-driven conclusions for local anesthetic delivery methods at this time, we propose that future studies and quantitative analysis between techniques should be on an anatomic, site-specific basis, with greater focus on evaluation of opioid use, adverse events, patient satisfaction, and rehabilitative metrics.
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A shortcut review was carried out to establish whether pin management or sedation is indicated to improve outcome in patients who show signs of awareness during cardiopulmonary resuscitation (CPR). Seven papers presented the best evidence to answer the clinical question. ⋯ Further research is needed before definite guidance can be given. Local advice should be followed.
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Clinical Trial
The Art of Analgesia: A Pilot Study of Art Museum Tours to Decrease Pain and Social Disconnection Among Individuals with Chronic Pain.
This mixed-methods study examines the feasibility of art museum tours (Art Rx) as an intervention for individuals with chronic pain. ⋯ Art museum tours for individuals with chronic pain are feasible, and participants reported positive effects on perceived social disconnection and pain.