Pain medicine : the official journal of the American Academy of Pain Medicine
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To examine encounter-level factors associated with opioid dose increases during patients' first year on opioid therapy for chronic pain. ⋯ Most opioid prescriptions were written without face-to-face encounters. One quarter of dose increases contained no documented prescribing rationale. Documented encounter-level factors were not significantly associated with overall opioid dose escalation.
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Observational Study
Trends in Medicalization of Children with Amplified Musculoskeletal Pain Syndrome.
The objective of this survey was to describe trends over time in medicalization of children with Amplified Musculoskeletal Pain Syndrome (AMPS). ⋯ Children with amplified musculoskeletal pain syndrome are becoming increasingly medicalized. Increased medicalization introduces risk of iatrogenic injury and burdens families with unnecessary medical costs. The significant increase in medicalization of children with AMPS is not related to an increase in patient reported pain, which is evidenced by the lack of significant increase in patients' pain score, pain duration, or functional disability at the time of their initial evaluation.
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Spinal stenosis is characterized by narrowing of the spinal canal, with mechanical compression of spinal nerve roots. The latter may cause low back pain and/or leg pain, as well as neurogenic claudication. Epidural steroid injection is commonly used to treat patients with lumbar spinal stenosis (LSS), but percutaneous epidural adhesiolysis has been utilized when symptoms prove refractory. Our goal was to assess the relationship between improvement shown on epidurogram and subjective patient response to adhesiolysis. ⋯ In patients with LSS, epidurographic findings following percutaneous epidural adhesiolysis failed to correlate with level of pain reduction achieved.
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With the increasing societal awareness of the prevalence and impact of acute pain, there is a need to develop an acute pain classification system that both reflects contemporary mechanistic insights and helps guide future research and treatment. Existing classifications of acute pain conditions are limiting, with a predominant focus on the sensory experience (e.g., pain intensity) and pharmacologic consumption. Consequently, there is a need to more broadly characterize and classify the multidimensional experience of acute pain. ⋯ Significant numbers of patients still suffer from significant acute pain, despite the advent of modern multimodal analgesic strategies. Mismanaged acute pain has a broad societal impact as significant numbers of patients may progress to suffer from chronic pain. An acute pain taxonomy provides a much-needed standardization of clinical diagnostic criteria, which benefits clinical care, research, education, and public policy. For the purposes of the present taxonomy, acute pain is considered to last up to seven days, with prolongation to 30 days being common. The current understanding of acute pain mechanisms poorly differentiates between acute and chronic pain and is often insufficient to distinguish among many types of acute pain conditions. Given the usefulness of the AAPT multidimensional framework, the AAAPT undertook a similar approach to organizing various acute pain conditions.
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Tumors invading the sacrum and/or ilium often represent incurable metastatic disease, and treatment is targeted toward palliation of symptoms and control of pain. As systemic opioid therapy is frequently inadequate and limited by side effects, a variety of interventional techniques are available to better optimize analgesia. Using six patients as a paradigm for interventional approaches to pain relief, we present a therapeutic algorithm for treating sacroiliac tumor-related pain in the oncologic population. ⋯ Depending on tumor location, burden of disease, and patient preference, patients suffering from metastatic disease to the sacrum may find benefit from use of ultrasound-guided proximal sacroiliac joint corticosteroid injection, sacroiliac lateral branch radiofrequency ablation, percutaneous sacroplasty, dorsal column stimulator leads, and/or implantable neuraxial drug delivery devices. We provide a paradigm for treatment in this patient population.