Journal of pain research
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Journal of pain research · Jan 2019
Postoperative analgesia after combined thoracoscopic-laparoscopic esophagectomy: a randomized comparison of continuous infusion and intermittent bolus thoracic epidural regimens.
Judicious postoperative pain management after thoracoscopic-laparoscopic esophagectomy (TLE) facilitates enhanced rehabilitation. Thoracic epidural analgesia (TEA) offers many benefits in esophagectomy, while several complications are associated with the delivery mode by continuous epidural infusion. This study compared the efficiency and safety of intermittent epidural bolus to continuous epidural infusion for pain management after TLE. ⋯ Compared with continuous epidural infusion, TEA by on-demand intermittent bolus greatly reduced the consumption of local anesthetics and opioids with comparable pain relief and little impairment in hemodynamics when used for pain management after TLE.
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Calcitonin gene-related peptide (CGRP) is a major player in migraine pathophysiology, and CGRP monoclonal antibodies including fremanezumab may be a safe effective preventive therapy. Phase IIb studies in episodic migraine (EM) and chronic migraine (CM) demonstrated efficacy at both the monthly 225 mg and quarterly 675 mg doses. The Phase III trials for EM and CM both showed a reduction in the primary endpoint of monthly migraine days (MMD). ⋯ No changes in vitals or ECG were reported. The long-term effects are not known, but the American Headache Society recommends that CGRP monoclonal antibodies be considered in EM or CM depending on previous medication trials and headache disability/frequency. Further, post-market studies are required, but for EM and CM fremanezumab is a new option for migraine preventive treatment.
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Journal of pain research · Jan 2019
Impact of transcutaneous electrical nerve stimulation on sleep in chronic low back pain: a real-world retrospective cohort study.
The purpose of this study was to determine if transcutaneous electrical nerve stimulation (TENS) improves sleep in chronic low back pain (CLBP). ⋯ Regular TENS improved self-reported and objective sleep measures in individuals with CLBP. When compared to the unimproved group, the improved group had longer total sleep time and fewer PLMs. Sleep may be an important outcome for TENS effectiveness in CLBP.
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Journal of pain research · Jan 2019
Microvascular decompression and radiofrequency for the treatment of trigeminal neuralgia: a meta-analysis.
Surgical treatments are used for trigeminal neuralgia (TN) when drug treatment fails. Surgical options can be divided into two categories: ablation (destructive) or non-ablation. Microvascular decompression (MVD) is primarily a non-ablation option, while radiofrequency thermocoagulation/rhizotomy (RF) is an ablation option. The aim of this study was to compare outcomes of MVD versus RF in the treatment of TN. ⋯ MVD had a lower risk of requiring a secondary procedure and facial numbness after surgery. RF could be considered in patients who are unfit for MVD or refused invasive treatment.
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Journal of pain research · Jan 2019
Prediction of Hemodynamic Reactivity by Electroencephalographically Derived Pain Threshold Index in Children Undergoing General Anesthesia: A Prospective Observational Study.
The pain threshold index (PTI) is a novel measure of nociception based on integrated electroencephalogram parameters during general anesthesia. The wavelet index (WLI) reflects the depth of sedation. This study aims to evaluate the ability of the PTI and WLI to predict hemodynamic reactivity after tracheal intubation and skin incision in pediatric patients. ⋯ The PTI can predict hemodynamic reactivity with the best cutoff values of 62 and 60 after tracheal intubation and skin incision in pediatric patients during general anesthesia. The WLI failed in predicting hemodynamic changes.