Pain physician
-
The diagnosis and treatment of neuropathic pain is often clinically challenging, with many patients requiring treatments beyond oral medications. To improve our percutaneous treatments, we established a clinical pathway that utilized ultrasound (US) guidance for steroid injection and alcohol ablation for patients with painful neuropathy. ⋯ US-guided percutaneous treatments for neuropathic pain present a growing opportunity for interprofessional collaboration between neurosurgery, clinicians who treat chronic pain, and sonologists. US can provide valuable diagnostic information and guide accurate percutaneous treatments in skilled hands. Further studies are warranted to determine whether a US-guided treatment pathway can prevent unnecessary open surgical management.
-
Obstructive sleep apnea (OSA) is the most common form of sleep-disordered breathing. While patients on chronic opioids are at increased risk of sleep-disordered breathing, there is a lack of data on the relationship between opioid dose and OSA risk in particular. The STOP-Bang Questionnaire (SBQ) is a common screening tool for OSA, but it has not been well studied in patients on chronic opioid therapy. ⋯ We found no relationship between the opioid dose and the risk of OSA as measured by the SBQ score in this chronic opioid population. Opioids may be more associated with sleep apnea due to central rather than obstructive processes, and additional screening tools beyond the SBQ may be needed to better screen for sleep apnea in this population.
-
Morphine is one of the preferred drugs for the clinical treatment of pain. Both clinical and preclinical studies have reported sexual dimorphism in morphine analgesia. Different circulating levels of estrogen could be involved in sex differences in response to morphine analgesia. In our previous research, we found that capsaicin injection into the cervix of rats caused acute visceral pain that could be relieved by morphine. The role of estrogen in morphine analgesia in rats under uterine cervix pain and its underlying mechanisms remain to be explored. ⋯ This is the first evidence that spinal CaV1.2 is involved in estrogenic modulation of morphine antinociception in rats under uterine cervix pain. Our results will provide new ideas and references for estrogen-related differential prescription of opioids.
-
Complex Regional Pain Syndrome (CRPS) is a chronic debilitating neuropathic pain condition characterized by autonomic and inflammatory features that typically occurs after a traumatic event. Spinal cord stimulation (SCS) has been shown to be effective in the treatment of chronic CRPS refractory to conventional treatment modalities. The collective evidence of novel parameters of SCS for treating CRPS has not been characterized extensively. ⋯ LF-SCS is superior to conventional therapy/placebo SCS stimulation. However, more evidence is required to demonstrate that novel SCS parameters are superior to LF-SCS in improving pain scores and functional outcomes.