Articles: pain-clinics.
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This study was a retrospective review of patients treated in a single institution. We performed a cluster analysis of the degree of preoperative stenosis to investigate the effect of indirect neural decompression in single-level lateral lumbar interbody fusion (LLIF). Surgery is generally indicated for patients with severe stenosis. ⋯ Mean midsagittal CD and axial CCA on MRI magnetic resonance imaging increased significantly in all groups, but as with DA and DH, the changes in axial CCA and midsagittal CD did not differ between groups. The numeric rating scale score did not differ between groups at any time. The cluster analysis results suggested that postoperative changes in indirect neural decompression for severe stenosis after LLIF similar for moderate and mild stenosis and that pain did not differ according to the severity of stenosis after surgery.
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Minerva anestesiologica · Nov 2021
Pain, the unknown: epistemological issues and related clinical implications.
Despite the huge development of pain management in the past decades, pain remains elusive and many patients still remain in the middle of the ford struggling between low drug efficacy and their overuse. A reason for pain elusiveness is its nature of subjective phenomenon, escaping the meshes of the objectivist, mechanist-reductionist net prevailing in medicine. Actually, pain is not only a symptom but an essential aspect of life, consciousness and contact with the world and its noetic and autonoetic components play a key role in the development of the concepts of pleasure-unpleasure and good-evil. ⋯ The outstanding effects of placebo and nocebo, behavioral and non-pharmacological techniques warrant the need for a shift from the traditional positivist idea of patient as passive carrier of disease to the patient as active player of recovery and move toward a patient's centered approach exploiting individual resources for recovery. Among the mentioned techniques, hypnosis has proved to increase pain threshold up to the level of surgical analgesia, improve acute and chronic pain as well as coping and resilience, helping to decrease both drug overuse and the costs of pharmacological therapy. The plethora of available data suggests the need for a holistic approach, aiming to take care of the individual as an inseparable mind-body unit in its interplay with the environment, where patient's inner world, his/her experience and cognition are taken into due account as powerful resources for recovery through a phenomenological-existential approach.
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Chronic postsurgical pain (CPSP) affects an estimated 10% to 50% of adults depending on the type of surgical procedure. Clinical prediction models can help clinicians target preventive strategies towards patients at high risk for CPSP. Therefore, the objective of this systematic review was to identify and describe existing prediction models for CPSP in adults. ⋯ The most common predictors identified in final prediction models included preoperative pain in the surgical area, preoperative pain in other areas, age, sex or gender, and acute postsurgical pain. Clinical prediction models may support prevention and management of CPSP, but existing models are at high risk of bias that affects their reliability to inform practice and generalizability to wider populations. Adherence to standardized guidelines for clinical prediction model development is necessary to derive a prediction model of value to clinicians.