Pain physician
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Comparative Study
Pain relief scale is more highly correlated with numerical rating scale than with visual analogue scale in chronic pain patients.
The pain relief scale (PRS) is a method that measures the magnitude of change in pain intensity after treatment. The present study aimed to evaluate the correlation between PRS and changes in pain determined by the visual analogue scale (VAS) and numerical rating scale (NRS), to confirm the evidence supporting the use of PRS. Sixty patients with chronic spinal pain that had a VAS and NRS recorded during an initial examination were enrolled in the study. ⋯ Compared to PRS, the VAS and NRS percentile scores exhibited higher correlation coefficients than scores based on the raw data differences. Furthermore, even when converted to a percentile, the NRS%-PRS R (0.968) was higher than the VAS%-PRS R (0.904), P = 0.0001. The results indicated that using the PRS together with NRS in pain assessment increased the objectivity of the assessment compared to using only VAS or NRS, and may have offset the limitations of VAS or NRS alone.
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Review Meta Analysis
The impact of genetic variation on sensitivity to opioid analgesics in patients with postoperative pain: a systematic review and meta-analysis.
Individual response to opioid analgesics varies among patients. ⋯ The results indicate that among the genetic SNPs we studied which include those affecting analgesic drug metabolism, transport of analgesic agents across the blood-brain barrier, and their activity at target receptors and ion channels and in the modulation of neurotransmitter pathways, the A118G allele variant of OPRM1 has the most potent influence on pain management of postoperative patients. Opioid receptor gene information may provide valuable information for clinicians to properly manage the analgesic use of opioids individually for better pain management.
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Randomized Controlled Trial
Ultrasound-guided greater occipital nerve block: an efficient technique in chronic refractory migraine without aura?
The effectiveness of greater occipital nerve block (GONB) in patients with primary headache syndromes is controversial. Few studies have been evaluated the usefulness of GONB in patients with migraine without aura (MWOA). ⋯ Ultrasound guided GONB with 1.5 mL of 0.5% bupivacaine for the treatment of migraine patients is a safe, simple, and effective technique without severe adverse effects. To increase the effectiveness of the injection, and to implement the isolated GONB, ultrasonography guidance could be suggested.
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In summary, the SGR continues to hang like Damocles sword over physicians. To understand health care needs, we need to separate basic health care needs from economic mandates, and health insurance from health care coverage. The SGR flux represents another meaningful uncertainty to this health care conundrum.
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Blood testing is quickly becoming a useful laboratory tool for opioid prescribers who wish to document and assess patient tolerance, more objectively monitor patient safety, and evaluate patient compliance using information that is not available with traditional urine drug testing (UDT). Blood testing does not need to be performed as frequently as UDT but provides extremely valuable information which can be used to more accurately evaluate patient compliance and assist with interpreting blood toxicology results commonly used in impairment or overdose cases. This narrative review presents the current evidence supporting the use of blood testing within the chronic pain management setting. ⋯ Prescribers must also be aware that this type of laboratory testing need only be administered to chronic pain patients receiving daily opioid therapy. Patients taking infrequent, low dose, or as needed medications are not anticipated to benefit from this type of test. Based on the complexity of both achieving acceptable outcomes with opioid treatment and the legal and societal issues at hand, we feel that the addition of blood concentration levels will become the standard of care in the near future.