Pain physician
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Interventional pain management involves diagnosis and treatment of chronic pain. This specialty utilizes minimally invasive procedures to target therapeutics to the central nervous system and the spinal column. A subset of patients encountered in interventional pain are medicated using anticoagulant or antithrombotic drugs to mitigate thrombosis risk. Since these drugs target the clotting system, bleeding risk is a consideration accompanying interventional procedures. Importantly, discontinuation of anticoagulant or antithrombotic drugs exposes underlying thrombosis risk, which can lead to significant morbidity and mortality especially in those with coronary artery or cerebrovascular disease. This review summarizes the literature and provides guidelines based on best evidence for patients receiving anti-clotting therapy during interventional pain procedures. ⋯ Perioperative bleeding, bleeding risk, practice patterns, anticoagulant therapy, antithrombotic therapy, interventional techniques, safety precautions, pain.
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Observational Study
Transforaminal Epiduroscopy in Patients with Failed Back Surgery Syndrome.
Epiduroscopy is a useful diagnostic and therapeutic tool for managing failed back surgery syndrome (FBSS). The conventional approach is via either the sacral hiatus or the interlaminar. Major causes of FBSS include epidural fibrosis, disc herniation, and stenosis. When these problems are located at the intervertebral foramen level, it can be difficult to reach the lateral recess and the foramen with the epiduroscope. Transforaminal epiduroscopy could be a useful alternative approach in patients with FBSS located at the foraminal level. ⋯ Epidural, epiduroscopy, chronic pain, spinal cord, back surgery.
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Spinal cord stimulation (SCS) relieves pain by delivering doses of electric current to the dorsal column of the spinal cord and has been found to be most effective in the treatment of neuropathic pain. Psychological distress is a significant risk factor for the development of chronic pain and has been found to affect the outcome of SCS. Childhood trauma is a risk factor for chronic pain, but has not previously been studied in SCS patients. ⋯ Spinal cord stimulation, the Trauma and Distress Scale, chronic pain, childhood trauma, childhood abuse, childhood neglect, chronic back pain, back pain, psychological distress, neuropathic pain.
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To investigate the therapeutic effectiveness of percutaneous kyphoplasty (PKP) combined with zoledronic acid in treatment of primary osteoporotic vertebral compression fractures. ⋯ Kyphoplasty, zoledronic acid, primary osteoporotic vertebral compression fractures.
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Observational Study
OPRM1 Gene Interaction with Sleep in Chronic Pain Patients Treated with Opioids.
The experience of chronic non-cancer pain (CNCP) is one of the most common reasons individuals seek medical attention. Patients with CNCP frequently experience concomitant sleep-related problems. ⋯ OPRM1, pharmacogenetics, MOS-Sleep, opioids, chronic noncancer pain, sleep related problems, sleep problem index SLP-6 and SLP-9.