Pain physician
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Meta Analysis
Association of Cigarette Smoking with Risk of Chronic Musculoskeletal Pain: A Meta-Analysis.
Chronic musculoskeletal pain (CMP) management is a major global public health goal owing to increased social and economic burdens. However, the risk of CMP in smokers compared with nonsmokers remains uncertain. ⋯ Cigarette smoking was associated with increased risk of CMP. In view of the high prevalence of smoking in many countries and the increasing number of CMP patients worldwide, reducing tobacco use should be an important public health strategy to prevent and control the global epidemic of CMP. Future research should attempt to establish whether this association is causal and clarify its mechanisms.
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Numerous combination intrathecal drug therapy (CIDT) strategies exist and are utilized for varying pain syndromes, typically when monotherapy dose escalation or medication alternation is deemed untenable or unfeasible. Unfortunately, the supportive evidence basis for the use of these strategies and specific drug combinations is generally lacking and unclear, with many medications being used for off-label indications. ⋯ CIDT strategies and polyanalgesia combinations can be effective for treating various patient populations with chronic pain. The appropriate use of these strategies may be limited by increased or compounded risk of adverse effects, both of which are highly patient and scenario dependent. Therefore, practitioners should maintain a particularly low threshold of suspicion for adverse effects in patients with CIDT such that safety profiles associated with this therapy can be favorably maintained.
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Randomized Controlled Trial
Quadratus Lumborum Block Spares Postoperative Opioid Usage but Does Not appear to Prevent the Development of Chronic Pain After Gastrointestinal Surgery.
Regional anesthesia has been used to reduce acute postsurgical pain and to prevent chronic pain. The best technique, however, remains controversial. ⋯ Ultrasound-guided QLB provided superior short-term analgesia and reduced oxycodone consumption and the incidence of PONV after gastrointestinal surgery. However, the incidence of chronic pain was not significantly affected by this anesthetic technique.
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The biopsychosocial-spiritual model recognizes the impact of religious factors in modulating the experience of pain. Religious beliefs are factors that can influence perceptions, emotions, and behavior, all of which have important implications on health, pain experience, and treatment outcomes. ⋯ This systematic review shows low evidence and conflicting results for the presence of associations between religiosity and different pain domains such as pain intensity, disability, and pain-related cognitions or emotions in people with chronic musculoskeletal pain.
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Observational Study
Patterns of Use of Opioid Sparing Adjuncts for Perioperative Pain Management of Patients on Chronic Opioids.
Perioperative pain management of patients on chronic opioids is challenging. Although experts recommend regional anesthesia and multimodal analgesics for their opioid sparing effects, their use and predictors of use are unknown. ⋯ Despite consensus guidelines, regional anesthesia remains underutilized. Multimodals are used frequently and are modestly associated with preoperative narcotic scores.