Articles: pain-clinics.
-
The prevalence of gout is increasing worldwide, and the symptoms of acute arthritis appearing in gout patients seriously affect the quality of life. The pain and functional limitation caused by acute gouty arthritis (AGA) bring great pain to patients. At present, mainstream drugs have problems such as poor efficacy and side effects. Traditional Chinese medicine has extensive clinical experience in the prevention and treatment of gout, and it also shows clear advantages in the treatment of AGA. Clinical studies have confirmed that si-miao-san decoction (SMSD), a traditional Chinese medicine decoction, can improve the clinical symptoms and signs of AGA patients. Therefore, we will conduct a systematic review to clarify the effectiveness and safety of SMSD for AGA. ⋯ INPLASY202040163.
-
Anesthesia and analgesia · Aug 2020
ReviewThirty-five Years of Acute Pain Services: Where Do We Go From Here?
Acute pain services (APS) have developed over the past 35 years. Originally implemented solely to care for patients with regional catheters or patient-controlled analgesia after surgery, APS have become providers of care throughout the perioperative period, with some institutions even taking the additional step toward providing outpatient services for patients with acute pain. Models vary considerably in terms of tasks and responsibilities, staffing, education, protocols, quality, and financing. ⋯ Development of APS in the future will require us to face urgent questions, such as, "What are meaningful outcome variables?" and, "How do we define high quality?" It is obvious that focusing exclusively on pain scores does not reflect the complexity of pain and recovery. A broader approach is needed-a common concept of surgical and anesthesiological services within a hospital (eg, procedure-specific patient pathways as indicated by the programs "enhanced recovery after surgery" or the "perioperative surgical home"), with patient-reported outcome measures as one central quality criterion. Pain-related functional impairment, treatment-induced side effects, speed of mobilization, as well as return to normal function and everyday activities are key.
-
While the COVID-19 pandemic still rages on in the United States, leaving in its wake hundreds of thousands of infected patients, families shattered by the untimely death of their loved ones, an economy in free fall that hit all-time highs barely a few months ago, and a fearful citizenry unsure of what the future holds, the effect it has had on residency and fellowship training programs across the country may appear inconsequential to the general populace. However, if you are a graduating trainee confronted with this unusual set of circumstances, fear of the virus is not the only thing that is foremost in your mind. ⋯ A narrative review with paucity of literature.
-
Cochrane Db Syst Rev · Jul 2020
ReviewTopical anaesthesia plus intracameral lidocaine versus topical anaesthesia alone for phacoemulsification cataract surgery in adults.
Phacoemulsification cataract surgery is usually performed in adults under local anaesthesia. Topical anaesthesia, which involves instilling anaesthetic drops to the ocular surface prior to and during surgery, has found large acceptance internationally. It is safe and allows for rapid patient turnover and visual recovery. Some surgeons have supplemented topical anaesthesia with intracameral lidocaine, reasoning that this may further reduce intraoperative pain, particularly during surgical stages involving manipulation of intraocular structures and rapid changes in fluid dynamics. This review, originally published in 2006 and updated in 2020, explores the efficacy and safety of using supplementary intracameral lidocaine in phacoemulsification cataract surgery. ⋯ There is moderate-quality evidence that supplementation of topical anaesthesia with intracameral lidocaine 0.5% to 1% for phacoemulsification cataract surgery in adults reduces participant perception of intraoperative pain. The odds of experiencing any pain (as opposed to no pain) were 60% less for the topical anaesthesia plus intracameral lidocaine group versus the topical anaesthesia-only group. However, the numerical amplitude of the effect may not be of great clinical significance on the continuous pain score scale. Generally, the pain scores were consistently low for both techniques. We found moderate-quality evidence that there is no additional benefit of intracameral lidocaine on postoperative pain. There is insufficient evidence to determine the impact on participant satisfaction and need for additional intraoperative anaesthesia due to low-quality evidence. There is moderate-quality evidence that intracameral lidocaine supplementation does not increase measures of intraocular toxicity, specifically loss of corneal endothelial cells. There is low-quality evidence that the incidence of intraoperative adverse events is unchanged with intracameral lidocaine supplementation, but as RCTs are not the optimum medium for looking at this, this result should be interpreted with caution. Further research specifically investigating the adverse effects of intracameral anaesthesia might help to better determine its safety profile. Economic evaluations would also be useful for detailing cost implications.