Articles: pain-management-methods.
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The California Workers' Compensation system mandates the use of occupational medicine practice guidelines developed by the American College of Occupational and Environmental Medicine (ACOEM). These Guidelines cover the treatment of acute (less than three months' duration) injuries. The presence in the ACOEM Guidelines of references to procedures which may be of use after the three-month acute period creates ambiguity as to whether the ACOEM Guidelines are applicable after three months. ASIPP's "Evidence-Based Practice Guidelines for Interventional Techniques in the Management of Chronic Spinal Pain" are comprehensive, focusing on management of chronic spinal pain. ACOEM guidelines, mandated by the legislature, do not deal explicitly with chronic pain. Their application in managing chronic pain may result in denial of access to appropriate treatment. Thus, ASIPP guidelines may be supplemental to the ACOEM Guidelines. Evaluation of the two Guidelines may clarify which should be followed in the event of ambiguity or conflict. ⋯ The ASIPP Guidelines may be considered the applicable Guidelines for the treatment of work-related low back activity limitations persisting beyond three months.
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Internally powered, implanted pulse generators (IPGs) have been an important advance in spinal cord stimulation for the management of pain, but they require surgical replacement, with attendant cost and risk, when the implanted battery is depleted. Battery life is determined by the programmed settings of the implant, but until now the technical means to optimize settings for maximal battery life, delaying surgical replacement as long as possible, Materials and Methods. We have developed a patient-interactive, computerized programmer for use with IPGs. It has been designed for easy operation and comprehensive data management, which have not been features of the standard programmers available until now. ⋯ We conclude that significant potential savings in longevity of the implanted battery are possible in the majority of patients with implanted spinal cord stimulators, but have not been realized until now for lack of appropriate methods. Computerized, patient-interactive programming addresses this problem and allows optimization of estimated battery life along with other treatment goals. Long-term clinical followup will be required to establish the full magnitude of the resulting savings.
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While spinal cord stimulation has commonly been carried out using percutaneous leads, these devices have limitations in cervical implants due to problems with positional stimulation and lead migration. Paddle leads, by virtue of their design, are more stable in their apposition to the neural elements; however, mid and lower cervical insertions have been associated with both acute and subacute spinal cord injuries. These complications are likely related to limitations in canal diameter, as paddle leads occupy a greater volume than percutaneous leads. ⋯ No patient suffered neurologic sequelae as a result of this procedure. We have found C1-C2 sublaminar insertions of paddle leads to be a safe and effective way of treating neuropathic pain phenomenon involving the upper extremity. To further assess the relative benefit over percutaneous leads, a prospective trial would be required.
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Beijing Da Xue Xue Bao · Apr 2003
Randomized Controlled Trial[Effect of different methods for postoperative pain management on catecholamine response to abdominal surgery].
To observe the effect of different analgesic methods and the influence of catecholamine response to elective abdominal surgery. ⋯ Postoperative patient-controlled epidural or intravenous analgesia could provide effective analgesia. Epidural anesthesia during operation or epidural analgesia postoperation could depress stress responses, thus it is a more effective analgesic method.
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Irritation of neural structures, specifically the brachial plexus outside of the cervical spine is capable of producing pain in the upper extremity. These pain patterns may be similar to pain originating from the cervical spine, presenting a diagnostic challenge. Brachial plexus block is performed at multiple levels, including interscalene, supraclavicular, infraclavicular, and axillary. ⋯ Relevant anatomy and proposed technique of brachial plexus block is described. The procedure is performed under fluoroscopy with contrast injection. It is concluded that the proposed technique of brachial plexus block is useful for brachial plexus blockade providing precision and specificity with minimal complications.