Pain physician
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Randomized Controlled Trial Comparative Study
Lumbar interlaminar epidural injections are superior to caudal epidural injections in managing lumbar central spinal stenosis.
Epidural injections are performed to manage lumbar central spinal stenosis pain utilizing caudal, interlaminar, and transforaminal approaches. The literature on the efficacy of epidural injections in managing lumbar central spinal stenosis pain is sparse; lacking multiple, high quality randomized trials with long-term follow-up. ⋯ The results of this assessment showed significant improvement in patients suffering with chronic lumbar spinal stenosis with caudal and interlaminar epidural approaches with local anesthetic only, or with steroids in a long-term follow-up of up to 2 years, in contemporary interventional pain management setting, with the interlaminar approach providing significantly better results.
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Observational Study
The role of pain catastrophizing in the provision of rescue analgesia by health care providers following major joint arthroplasty.
After surgery, patient reports or health care professional evaluations of heightened acute pain intensity should lead to extra analgesia provision, which is designated by rescue analgesia (RA). Whether RA is administered or not, it is not directly dependent on the patient but rather on clinical decisions, which should be based on pain management guidelines. There is a general lack of studies focusing on pain-related decision-making regarding RA provision. ⋯ The findings of this study shed light on the importance of psychological factors in determining RA provision following MJA. This encourages further reflection on acute post-surgical pain management by health care providers, namely by raising clinicians' awareness about the factors that influence patient-provider interactions, as well as their impact on decision-making regarding RA provision. A global assessment of patients, wherein psychological variables are taken into account, is warranted in order to improve the quality of surgical pain management. Finally, these findings provide support for the design of acute post-surgical pain management interventions directed at clinicians, in order to augment professionals' awareness about the potential influence of patient-related psychological factors on RA decisions.
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Randomized Controlled Trial
Development of an effective topical liposomal formulation for localized analgesia and anti-inflammatory actions in the Complete Freund's Adjuvant rodent model of acute inflammatory pain.
Peripheral opioid receptor targeting has been well established as a novel target in clinical pain management for acute and chronic peripheral inflammatory pain. The physiochemical properties of the peripheral mu-opioid receptor agonist, loperamide HCl, limit the use of the free drug as an analgesic or anti-inflammatory agent, particularly for dermal delivery across intact skin. ⋯ The study demonstrates that topically applied loperamide encapsulated within liposomal systems has improved therapeutic efficacy over conventional formulations for the local treatment of acute peripheral inflammatory pain conditions where the skin has remained intact. Once in the inflamed peripheral tissue, loperamide provides analgesic and anti-inflammatory effects in a similar manner to peripheral endogenous opioids. This preparation optimises the retention of drug at the site where action is required.
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Lumbar degenerative spondylolisthesis is a common entity and occurs mainly in elderly patients. The trend in surgery has been to offer decompression with instrumented fusion based on patient-based outcome data and the inherent instability of the condition. ⋯ Endoscopic discectomy is a safe and effective alternative to open back surgery. The one year follow-up data presented here appears to indicate that an ultra-minimally invasive approach to the treatment of lumbar radiculopathy in the setting of spondylolisthesis that has a low complication rate, avoids general anesthesia, and is outpatient might be worth studying in a prospective, longer term way. IRB approval: Meridian Health: IRB Study # 201206071J.