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Pain Management

Ippokratis Pountos, Peter V Giannoudis
The fixation of impending or pathologic fractures is challenging and their successful management can have a favourable impact on the quality of life of the patient. The progression of the metastatic bone disease can cause significant pain and disability but also could result in the loosening and subsequent failure of the implants. To prevent the additional local growth, postoperative radiotherapy is often recommended, and many patients receive endocrine or chemotherapy Areas Covered: Several reports support the antineoplastic drugs to bone cement as an adjuvant to improve implant stability as well as to prevent local cancer progression and failure of reconstructive devices used to treat patients with pathologic fractures...
March 21, 2018: Expert Review of Medical Devices
Jacquelyn J Cragg, Freda M Warner, Matthew S Shupler, Catherine R Jutzeler, Neil Cashman, David G T Whitehurst, John K Kramer
BACKGROUND: The prevalence of pain among people with a variety of individual neurological conditions has been estimated. However, information is limited about chronic pain among people with neurological conditions overall, and about the conditions for which chronic pain is most prevalent. To fill these information gaps, a common method of pain assessment is required. DATA AND METHODS: The data are from the Survey on Living with Neurological Conditions in Canada, a cross-sectional national survey...
March 21, 2018: Health Reports
Robert Strohal, Martina Mittlböck, Gilbert Hämmerle
OBJECTIVE: Critical colonization or local infection is very common in chronic wounds, but clinically problematic. Because therapeutic options for these conditions are limited in number and efficacy, the study authors tested a new acid-oxidizing solution (AOS [Nexodyn]; APR Applied Pharma Research S.A., Balerna, Switzerland) to determine its ancillary antimicrobial properties and potential support for wound healing. DESIGN AND SETTING: This open-label clinical case series was conducted with a prospective, single-arm design at the Federal County Hospital in Bregenz, Austria...
April 2018: Advances in Skin & Wound Care
Hesham Elsharkawy, Amit Pawa, Edward R Mariano
Ultrasound-guided interfascial plane blocks are a recent development in modern regional anesthesia research and practice and represent a new route of transmission for local anesthetic to various anatomic locations, but much more research is warranted. Before becoming overtaken with enthusiasm for these new techniques, a deeper understanding of fascial tissue anatomy and structure, as well as precise targets for needle placement, is required. Many factors may influence the ultimate spread and quality of resulting interfascial plane blocks, and these must be understood in order to best integrate these techniques into contemporary perioperative pain management protocols...
March 20, 2018: Regional Anesthesia and Pain Medicine
Michael Galgano, Jared Fridley, Adetokunbo Oyelese, Albert Telfian, Thomas Kosztowski, David Choi, Ziya L Gokaslan
Metastatic spinal disease is a source of significant morbidity in patients with cancer. Recent advancements in adjuvant oncologic therapy has led to increased survival for many patients who harbor neoplastic disease. As a result of this, the chance of developing metastatic spinal disease over the course of a cancer patient's lifespan has increased. Symptomatic metastatic spinal disease can cause significant morbidity including severe pain, neurologic deficit, and loss of ambulation. Current treatment of these patients typically involves the use of multiple modalities, including surgery, radiation, and chemotherapy...
March 21, 2018: Expert Review of Anticancer Therapy
Yan Wang, Zi-Nan Guo, Zhen Yang, Shun Wang
OBJECTIVE: To observe the effect of electroacupuncture (EA) combined with neural mobilization (NM) in the treatment of occipital neuralgia. METHODS: A total of 62 occipital neuralgia patients were randomized into EA group (19 cases), NM group (22 cases) and EA+NM group (21 cases). EA was applied at acupoint-pairs as Yuzhen (BL 9)- Tianzhu (BL 10), Fengchi (GB 20)- Wangu (GB 12), etc. NM intervention consisted of occipital muscle group mobilization, C2 spinous process mobilization, cervical joint passive movement management mobilization, etc...
March 25, 2018: Zhen Ci Yan Jiu, Acupuncture Research
Cassandra Wasson, Telianne Chon
A 28-year-old term G3P0020 received an epidural with complete pain relief. Approximately 19 hours after the epidural placement, the pain increased. Sensory levels were rechecked and were bilateral and adequate at T8. Further discussion revealed that the pain was unrelated to her contractions; it was in her buttocks and radiating down the leg. The possibility of the fetus being positioned occiput posterior (OP) was discussed. The patient was placed into knee-chest position with instantaneous relief of her pain...
January 17, 2018: Curēus
Sepideh Gareh Sheyklo, Sakineh Hajebrahimi, Ahmad Moosavi, Fatemeh Pournaghi-Azar, Saber Azami-Aghdash, Morteza Ghojazadeh
Background and aim: Entonox was one of the important methods for pain management in the delivery process. In previous years some studies have assessed the effect of this method in Iran. In this regard, the aim of this study was to systematically review studies addressing the effect of Entonox for pain management in labor. Methods: This systematic review and meta-analysis study was conducted in 2016. The required data was collected using keywords such as "Entonox", "nitrous oxide", "vaginal delivery", "pain relief", "obstetric", "labor pain", and "labor analgesia", from databases including Google scholar, PubMed, Science Direct, Magiran, SID, and Scopus, and hand-searching of related and valid journals and references of articles...
December 2017: Electronic Physician
Heitham Wady, Zain Badar, Zerwa Farooq, Palma Shaw, Katsuhiro Kobayashi
Popliteal artery entrapment syndrome (PAES), a condition predominantly affecting young individuals, is a rare clinical entity that can result in significant morbidity. The presence of lower limb pain and claudication in young, physically active individuals should prompt consideration for PAES. Early diagnosis and management is crucial to prevent long-term complications; however, diagnosis is fraught with challenges due to the rarity of the disease and its similar clinical presentation with more common conditions...
2018: Case Reports in Medicine
Maaike Van Den Houte, Lukas Van Oudenhove, Ilse Van Diest, Katleen Bogaerts, Philippe Persoons, Jozef De Bie, Omer Van den Bergh
Background: Several studies have shown that patients with functional somatic syndromes (FSS) have, on average, deficient endogenous pain modulation (EPM), as well as elevated levels of negative affectivity (NA) and high comorbidity with depression and reduced resting heart rate variability (HRV) compared to healthy controls (HC). The goals of this study were (1) to replicate these findings and (2) to investigate the moderating role of NA, depression, and resting HRV in EPM efficiency within a patient group with fibromyalgia and/or chronic fatigue syndrome (CFS)...
2018: Frontiers in Psychology
Blake S Raggio, Samuel C Ficenec, Jason Pou, Brian Moore
Background: Acute calcific tendonitis of the longus colli (ACTLC) is an aseptic inflammatory response to deposition of calcium in the longus colli muscle tendons. Although reports in the literature are scarce, ACTLC likely represents an underreported disease process that routinely goes misdiagnosed. We report a case of ACTLC and provide a brief review of the literature. Case Report: A 45-year-old otherwise healthy female presented with a 3-day history of progressive neck pain, decreased neck mobility, and odynophagia...
2018: Ochsner Journal
Alaa Abd-Elsayed, Samuel Lee, Markus Jackson
Background: Intercostal neuralgia is a complex and difficult-to-treat condition. We present 2 cases that demonstrate the safe and effective use of thermal radiofrequency ablation (RFA) to achieve significant pain relief. Case Reports: Our first patient was a 62-year-old female who developed chronic chest pain following lumpectomy for breast cancer and failed conservative management. Two intercostal diagnostic nerve blocks were performed with good results. One block provided pain relief for 3 weeks, and the other provided pain relief for 5 weeks...
2018: Ochsner Journal
Alaa Abd-Elsayed, Markus Jackson, Elizabeth Plovanich
Background: Sural neuralgia is persistent pain in the distribution of the sural nerve that provides sensation to the lateral posterior corner of the leg, lateral foot, and fifth toe. Sural neuralgia is a rare condition but can be challenging to treat and can cause significant limitation. We present 2 cases of sural neuralgia resistant to conservative management that were effectively treated by pulsed radiofrequency ablation. Case Reports: A 65-year-old female developed sural neuralgia after a foot surgery and failed conservative management...
2018: Ochsner Journal
Alaa Abd-Elsayed, Laura Kreuger, Susanne Seeger, Douglas Dulli
Background: Trigeminal neuralgia is the most common cause of facial pain but can be challenging to treat. Some patients fail on medications, and while surgical procedures achieve short-term efficacy, they can be associated with numerous complications. We present a case series suggesting the efficacy and safety of using pulsed radiofrequency (PRF) through the transcoronoid approach to treat trigeminal neuralgia. Methods: This retrospective analysis included 8 cases with data collected from the electronic medical record...
2018: Ochsner Journal
Joseph Guarisco, Adam Salup
Background: Pain management is one of the most common reasons patients visit the emergency department. Understanding the contributions of emergency medicine-and specifically Ochsner Health System's emergency providers-to the opioid crisis is important. Benchmark prescribing data indicated that Ochsner Health System emergency medicine providers' opioid prescription rates were significantly higher than the national average in emergency medicine. Methods: Data relevant to visit and opioid prescription counts were extracted from the organization's electronic health record system...
2018: Ochsner Journal
Eboni G Price-Haywood, Wanda Robinson, Jewel Harden-Barrios, Jeffrey Burton, Todd Burstain
Background: Opioid prescription drug abuse is a major public health concern. Healthcare provider prescribing patterns, especially among non-pain management specialists, are a major factor. Practice guidelines recommend what to do for safe opioid prescribing but do not provide guidance on how to implement best practices. Methods: We describe the implementation of electronic medical record clinical decision support (EMR CDS) for opioid management of chronic noncancer pain in an integrated delivery system...
2018: Ochsner Journal
Takaaki Kobayashi, Nitzy Munoz Casablanca, Matthew Harrington
We present a case of pyeloduodenal fistula in an 89-year-old woman with history of nephrolithiasis and recurrent urinary tract infection (UTI) who presented to the emergency department with back pain. CT revealed a malrotated right kidney with a large renal stone and possible fistulous connection between the second portion of the duodenum and the right renal collecting system. Technetium-99m scintigraphy confirmed presence of the fistula. The patient declined intervention and was discharged from the hospital with oral antibiotic suppressive therapy...
March 20, 2018: BMJ Case Reports
Thaís Romera Bergamo, Carolina de Oliveira Cruz Latorraca, Daniela Vianna Pachito, Ana Luiza Cabrera Martimbianco, Rachel Riera
INTRODUCTION: Major concerns regarding the use of medication during pregnancy justify the need for safer interventions. Acupuncture is an emerging alternative for several clinical conditions during this period. The objective of this study is to summarise evidence derived from systematic reviews (SRs) focusing on acupuncture for pregnancy-related acute conditions. METHODS: Review of SRs. A systematic literature search was carried out in several electronic databases, aiming to include all SRs assessing the effects of acupuncture for acute conditions during pregnancy...
March 20, 2018: Acupuncture in Medicine: Journal of the British Medical Acupuncture Society
Yasmin van Kasteren, Jill Freyne, M Sazzad Hussain
BACKGROUND: The growth in patient-centered care delivery combined with the rising costs of health care have perhaps not unsurprisingly been matched by a proliferation of patient-centered technology. This paper takes a multistakeholder approach to explore how digital technology can support the cocreation of value between patients and their care teams in the delivery of total knee replacement (TKR) surgery, an increasingly common procedure to return mobility and relieve pain for people suffering from osteoarthritis...
March 20, 2018: Journal of Medical Internet Research
Harleen K Sandhu, Kristofer M Charlton-Ouw, Katherine Jeffress, Samuel Leake, Alexa Perlick, Charles C Miller, Ali Azizzadeh, Hazim J Safi, Anthony L Estrera
BACKGROUND: Patients presenting with acute aortic dissection may develop spinal cord ischemia (SCI). We sought to determine how SCI and its recovery affects outcomes. METHODS: We reviewed patients with SCI in acute type A aortic dissection (ATAAD) and acute type B aortic dissection (ATBAD) from September 1999-May 2014. SCI was defined as paraplegia or paraparesis present on admission. Monoparesis/plegia, paraesthesia, or numbness was defined as ischemic neuropathy (IN)...
March 17, 2018: Annals of Thoracic Surgery
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