Pain physician
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Review
A Scoping Review of Chronic Low Back Pain Classification Schemes Based on Patient-Reported Outcomes.
In 2014, the National Institutes of Health Pain Consortium Research Task Force recommended that patients with chronic low back pain (CLBP) be stratified by its impact on their lives. They proposed the Impact Stratification Score (ISS) to help guide therapy and facilitate study comparability. The ISS has been evaluated as a continuous measure, but not for use as a stratification or classification scheme. ⋯ The methods used to develop these successful classification schemes, especially those that use straightforward scoring schemes, should be considered for use in the development of a scheme based on the ISS.
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Cervicogenic headache (CGH) can often be difficult to treat, given the overlapping clinical features of other headaches and the varying sources of pain that patients report. While imaging is not useful in diagnosing CGH, anesthetic blockade of the atlanto-occipital joint, lateral atlantoaxial joint, or specific cervical zygapophyseal joints can be used to confirm the diagnosis. When conservative treatment measures, such as physical therapy, fail, interventional techniques, such as intraarticular steroid injections, have been shown in observational studies to provide relief in some patients. ⋯ Our findings suggest that therapeutic intraarticular cervical facet injections may be effective in the treatment of CGH. Because of the heterogeneity among the studies, these results should be interpreted with caution.
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Multicenter Study
Aspirin Cessation Before Interventional Procedures: Not Blindly Following Guidelines but Making Test-based Decisions.
Deciding whether to continue or discontinue aspirin prior to interventional procedures is a major concern for pain physicians. Many guidelines have been published on the discontinuation of aspirin before invasive procedures; however, the recommendations are inconsistent and do not consider individual platelet function. Furthermore, many studies have shown a high prevalence of aspirin resistance in patients taking this medication. ⋯ The high prevalence of normal platelet function in patients taking aspirin suggests no necessity of discontinuation before procedures in such patients. Abnormal platelet function can occur even in patients who are not taking aspirin. Therefore, platelet function should be measured and considered on a case-by-case basis prior to interventional procedures, and discontinuation of aspirin should be decided based on these factors.
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Epidural steroid injections (ESI) are one of the most commonly performed pain procedures; however, there has been variation in techniques and approaches amongst pain physicians in the United States. The formation of a multidisciplinary working group was made with considerations to help guide ESI practice. ⋯ Since the 2015 multidisciplinary pain workgroup recommendations were made for ESI, there appears to be a trend towards following these guidelines compared to prior surveys looking at ESI practices. However, our survey shows there continues to be variations in ESI practice that deviates from these guidelines.
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Clinical Trial
Impact of Chronic Foot Pain Related Quality of Life: A Retrospective Case-Control Study.
Chronic foot pain (CFP) is a widespread condition worldwide; however, few studies that relate CFP and foot health-related quality of life have been reported. ⋯ CFP patients, regardless of gender, recorded a negative influence on QoL-related foot health that seems to be linked with the presence of this chronic condition.