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Multidisciplinary pain

Heidi N Overton, Marie N Hanna, William E Bruhn, Susan Hutfless, Mark C Bicket, Martin A Makary
BACKGROUND: One in 16 surgical patients prescribed opioids become long-term users. Overprescribing opioids after surgery is common and the lack of multidisciplinary procedure-specific guidelines contributes to the wide variation in opioid prescribing practices. We hypothesize a single-institution, multidisciplinary expert panel can establish consensus on ideal opioid prescribing for select common surgical procedures. STUDY DESIGN: We used a 3-step modified Delphi method involving a multidisciplinary expert panel of 6 relevant stakeholder groups (surgeons, pain specialists, outpatient surgical nurse practitioners, surgical residents, patients, and pharmacists) to develop consensus ranges for outpatient opioid prescribing at the time of discharge after 20 common procedures in 8 surgical specialties...
August 2, 2018: Journal of the American College of Surgeons
Roxana M Grasu, Juan P Cata, Anh Q Dang, Claudio E Tatsui, Laurence D Rhines, Katherine B Hagan, Shreyas Bhavsar, Sally R Raty, Radha Arunkumar, Yury Potylchansky, Ian Lipski, Benjamin A Arnold, Thomas M McHugh, Justin E Bird, Andrea Rodriguez-Restrepo, Mike Hernandez, Keyuri U Popat
OBJECTIVE Enhanced Recovery After Surgery (ERAS) programs follow a multimodal, multidisciplinary perioperative care approach that combines evidence-based perioperative strategies to accelerate the functional recovery process and improve surgical outcomes. Despite increasing evidence that supports the use of ERAS programs in gastrointestinal and pelvic surgery, data regarding the development of ERAS programs in spine surgery are scarce. To evaluate the impact of an Enhanced Recovery After Spine Surgery (ERSS) program in a US academic cancer center, the authors introduced such a program and hypothesized that ERSS would have a significant influence on meaningful clinical measures of postoperative recovery, such as pain management, postoperative length of stay (LOS), and complications...
August 17, 2018: Journal of Neurosurgery. Spine
Michela Starace, Aurora Alessandrini, Emi Dika, Bianca Maria Piraccini
Squamous cell carcinoma (SCC) of the nail apparatus is a rare malignant tumor that usually originates underneath the nail plate and grows slowly with possible bone invasion. The etiology remains unknown, although a strong association with different conditions, such as high-risk human papillomavirus (HPVs), trauma, or radiation exposure has been demonstrated. Nail SCC is called "the great mimicker nail tumor" because different clinical presentations may coexist, resembling benign or malignant nail lesions...
July 2018: Dermatology Practical & Conceptual
Charlotte Walters, Simon West, Tanya A Nippita
BACKGROUND: Pelvic girdle pain (PGP) in pregnancy is a common condition that can cause significant physical disability and has an important psychosocial impact on pregnant women and their families. It is often under-reported and poorly managed by obstetric caregivers, and this can result in poorer outcomes, reduced quality of life and chronic pain. OBJECTIVE: The objective of this article is to discuss the practical assessment and management of PGP in pregnancy...
July 2018: Australian journal of general practice
Annarita Tagliaferri, Massimo Franchini, Gianna F Rivolta, Stefania Farace, Gabriele Quintavalle, Antonio Coppola
INTRODUCTION: Persons with haemophilia (PWH) experience recurrent joint bleeding which leads from early synovitis to irreversible joint damage. Pain strongly affects patients' quality of life, as PWH suffer from acute pain associated with haemarthroses and chronic pain due to arthritic and degenerative complications. AIM: To investigate pain issues among PWH and their treaters in Italy. METHODS: Persons with haemophilia and specialist physicians responded to a survey focused on pain characteristics, assessment, and management by phone call and online, respectively...
August 16, 2018: Haemophilia: the Official Journal of the World Federation of Hemophilia
Quratulain Fatima Masood, Anika Naeem, Syed Maaz Tariq, Ali Asad, Sara Habib
Takayasu arteritis is an idiopathic chronic vasculitis that involves large blood vessels, including the aorta and its main branches. This disease presents typically as ischemia or aneurysms that could be prevented by timely diagnosis and vigilant management. We present here the case of a 19-year-old male who presented with a history of visual disturbance, chest pain, dizziness, and a feeble pulse.
June 11, 2018: Curēus
Dalila R Veiga, Liliane Mendonça, Rute Sampaio, José C Lopes, Luís F Azevedo
Background: High rates of opioid use for chronic noncancer pain (CNCP) have been reported worldwide, despite its association with adverse events, inappropriate use, and limited analgesic effect. Opioid-induced constipation (OIC) is the most prevalent and disabling adverse effect associated with opioid therapy. Our aim was to assess the incidence, health related quality of life (HRQOL), and disability in OIC patients. Methods: A prospective cohort study was performed, with 6 months of follow-up, of adult CNCP patients consecutively admitted in 4 multidisciplinary pain clinics (MPC)...
2018: Pain Research and Treatment
Miel Ap Vugts, Margot Cw Joosen, Agali Mert, Aglaia Me Zedlitz, Hubertus Jm Vrijhoef
BACKGROUND: Current evidence for the effectiveness of specialist multidisciplinary programs for burdensome chronic pain and functional somatic syndromes drives the effort to improve approaches, strategies, and delivery modes. It remains unknown to what extent and in what respect serious gaming during the regular outpatient rehabilitation can contribute to health outcomes. OBJECTIVE: The objectives of our study were to determine the effect of additional serious gaming on (1) physical and emotional functioning in general; (2) particular outcome domains; and (3) patient global impressions of change, general health, and functioning and to determine (4) the dependency of serious gaming effects on adherence...
August 15, 2018: Journal of Medical Internet Research
Karolina Piotrowicz, Krzysztof Rewiuk, Stanisław Górski, Weronika Kałwak, Barbara Wizner, Agnieszka Pac, Michał Nowakowski, Tomasz Grodzicki
BACKGROUND: In hospital settings, delirium affects as many as 50% of older patients, aggravating their symptoms and worsening their condition, and therefore increasing the risk of in-hospital complications and death. The aim of this study is to assess the efficacy of structured, non-pharmacological care, delivered to older hospitalised patients by trained volunteers (students of medical fields), on the reduction of incidence of adverse health-related outcomes. METHODS/DESIGN: This trial will be a randomised, investigator-blind, controlled trial conducted in an internal medicine and geriatric ward in Poland...
August 14, 2018: Trials
Zati Alessandro, Cavazzuti Lorenzo, Colori Biagio Carmine Maria, Benedetti Maria Grazia
BACKGROUND: Nonspecific Chronic Low Back Pain (CLBP) is a condition difficult to treat due to multiple etiopathogenesis and there is wide consensus on the multidisciplinary approach. Among physiotherapy the Medium Frequencies (MF) diathermy has recently been introduced but without enough evidence of effectiveness. OBJECTIVE: To explore the effects of a deep heating therapy (DHT) produced by a MF diathermy for the treatment of CLBP compared with a superficial heating therapy (SHT)...
July 20, 2018: Journal of Back and Musculoskeletal Rehabilitation
Sameeh Al-Maharbi, Abdullah Bakr Abolkhair, Hani Al Ghamdi, Mamdouh Haddara, Yasser Tolba, Ahmed El Kabbani, Adwa Al Sadoun, Evelyn Pangilinan, Jaya Joy, Shadi Abu Khait, May Wathiq Al-Khudhairy
Introduction: Mental health issues, especially depression, are common in chronic pain patients. Depression affects these patients negatively and could lead to poor control of their pain. Some risk factors for both chronic pain and depression are known and need to be targeted as part of the management in a multidisciplinary approach. This study was conducted to estimate the prevalence of depression among chronic pain patients attending a pain clinic and to explore the association between depression in chronic pain patients and other factors such as sociodemographic features, number of pain sites, severity of pain, and types of pain...
July 2018: Saudi Journal of Anaesthesia
Susana Aideé González-Chávez, César Pacheco-Tena, Rosa María Campos Torres, Celia María Quiñonez-Flores, Greta Reyes-Cordero, Teresita de Jesús Caraveo Frescas
OBJECTIVE: To characterize the orofacial abnormalities in patients with rheumatoid arthritis (RA) and compare them with those in a reference population. METHODS: The study included 30 RA patients and 30 consecutive patients in an odontology clinic in whom RA was ruled out. Patients underwent a clinical dental examination which included: 1) clinical and radiographic abnormalities of the temporomandibular joint; 2) biomechanical craniocervical analysis; 3) state of dentition and treatment needs; 4) periodontal status; 5) oral hygiene status; and 6) facial pain, which was compared among study groups...
August 7, 2018: Reumatología Clinica
Nicola Imperatore, Giancarlo Micheletto, Gianpiero Manes, Davide Giuseppe Redaelli, Elisa Reitano, Germana de Nucci
BACKGROUND: Hepatic hematoma (HH) is a rare but severe adverse event following endoscopic retrograde cholangiopancreatography (ERCP). AIMS: To perform a systematic literature review and describe two additional cases, one of which presenting multiple subcapsular/intrahepatic hematomas after ERCP. METHODS: The literature review was performed in PubMed/MEDLINE, EMBASE, and SCOPUS to identify all cases reporting on HH after ERCP. RESULTS: A total of 48 cases (females 63%, mean age 58...
July 20, 2018: Digestive and Liver Disease
Júlia Azevedo Miranda, Públio César Cavalcante Viana, Luciana Rodrigues Meirelles, Pedro Sergio Brito Panizza, Ricardo Jureidini, Natally Horvat
Lipomas of the gastrointestinal tract are uncommon benign tumors of mature adipocytes and may occur in any portion along the gut. Depending on location they may have a variety of clinical presentations and even simulate malignant neoplasms. We report a case of a 58-year-old woman who presented with acute pelvic pain. An emergency sonogram detected a hyperechogenic mass in the left adnexal region, with no vascularization on Doppler. A computed tomography confirmed the hypothesis of a fat containing tumor with signals of torsion...
October 2018: Radiology Case Reports
A Tomasian, T J Hillen, R O Chang, J W Jennings
BACKGROUND AND PURPOSE: Percutaneous radiofrequency ablation combined with vertebral augmentation has emerged as a minimally invasive treatment for patients with vertebral metastases who do not respond to or have contraindications to radiation therapy. The prevalence of posterior vertebral body metastases presents access and treatment challenges in the unique anatomy of the spine. The purpose of this study was to evaluate the safety and efficacy of simultaneous bipedicular radiofrequency ablation using articulating bipolar electrodes combined with vertebral augmentation for local tumor control of spinal metastases...
August 9, 2018: AJNR. American Journal of Neuroradiology
Lisa Kumar, Amanda H Kumar, Stuart A Grant, Jeff Gadsden
Enhanced recovery after surgery (ERAS) programs for orthopedics involve a multidisciplinary approach to accelerating return to function, reducing pain, improving patient comfort and satisfaction, reducing complications from the surgical procedure, reducing hospital length of stay, and reducing costs. ERAS pathways for patients receiving total knee arthroplasty are different from those having intracavitary surgery; they are less focused on fluid homeostasis and gut motility than they are with optimizing systemic and local analgesics and providing a balance between the highest quality pain control and accelerated return to ambulation...
September 2018: Anesthesiology Clinics
Christopher A J Webb, T Edward Kim
Acute pain management is an expanding perioperative specialty and there is a renewed focus on implementing and developing an acute pain service (APS) in nonacademic hospitals (ie, "private practice"). An anesthesiologist-led APS can improve patient care by decreasing perioperative morbidity and potentially reducing the risk of chronic postsurgical pain syndromes. Elements of a successful APS include multidisciplinary collaboration to develop perioperative pain protocols, education of health care providers and patients, and regular evaluation of patient safety and quality of care metrics...
September 2018: Anesthesiology Clinics
Hibah Osman, Sudip Shrestha, Sarah Temin, Zipporah V Ali, Rumalie A Corvera, Henry D Ddungu, Liliana De Lima, Maria Del Pilar Estevez-Diz, Frank D Ferris, Nahla Gafer, Harmala K Gupta, Susan Horton, Graciela Jacob, Ruinuo Jia, Frank L Lu, Daniela Mosoiu, Christina Puchalski, Carole Seigel, Olaitan Soyannwo, James F Cleary
Purpose The purpose of this new resource-stratified guideline is to provide expert guidance to clinicians and policymakers on implementing palliative care of patients with cancer and their caregivers in resource-constrained settings and is intended to complement the Integration of Palliative Care Into Standard Oncology Care: American Society of Clinical Oncology Clinical Practice Guideline Update of 2016. Methods ASCO convened a multidisciplinary, multinational panel of experts in medical oncology, family medicine, radiation oncology, hematology/oncology, palliative and/or hospice care, pain and/or symptom management, patient advocacy, public health, and health economics...
July 2018: Journal of Global Oncology
Karleen F Giannitrapani, R Thomas Day, Azin Azarfar, Sangeeta C Ahluwalia, Steven Dobscha, Karl A Lorenz
Objectives: We aimed to understand providers' experiences and preferences regarding several brief pain screening measures. Methods: We collected two waves of data for this analysis. Wave one: We conducted nine focus groups with multidisciplinary Department of Veterans Affairs (VA) providers. Wave two: To understand an emergent theme in wave one, we conducted 15 telephone interviews with prescribing providers where we used a semistructured guide comparing screening measures currently used in VA practices...
July 30, 2018: Pain Medicine: the Official Journal of the American Academy of Pain Medicine
B Emily Esmaili, Kearsley A Stewart, Nestory A Masalu, Kristin M Schroeder
Purpose Palliative care remains an urgent, neglected need in the developing world. Global disparities in end-of-life care for children, such as those with advanced cancers, result from barriers that are complex and largely unstudied. This study describes these barriers at Bugando Medical Center, one of three consultant hospitals in Tanzania, to identify areas for palliative care development suitable to this context. Methods In-depth interviews were conducted with 20 caregivers of pediatric patients with cancer and 14 hospital staff involved in pediatric end-of-life care...
July 2018: Journal of Global Oncology
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