Pain physician
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Newer definitions of pain remain suggestive of categorization by mainly neurological or psychological bases. All pain recruits cortical interpretation for any sort of directive effects in awareness, attention, and action. That unity of purpose in pain's multi-pathway manifestations can inspire neurophilosophical reflections on the existentiality, subjectivity, and sociality of pain. ⋯ Pain's prescription will remain unfilled until its full reality is recognized at a personal level, where comprehensive care is mobilized for the whole patient. Heeding pain looks to the central figure that is never absent from any painful situation, namely the individual person-in-pain. That holistic and humanistic value to mobilizing resources against pain should be reflected in the practice of pain medicine, and the craft of the pain physician.
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Randomized Controlled Trial
Repetitive Transcranial Magnetic Stimulation of the Dorsolateral Prefrontal Cortex for Phantom Limb Pain.
Phantom limb pain (PLP) is a prevalent and distressing occurrence in 60-80% of individuals who have undergone amputations. Recent research underscores the significance of maladaptive cortical plasticity in the genesis of PLP, emphasizing the importance of targeting cortical areas for therapeutic interventions. Repetitive transcranial magnetic stimulation (rTMS), a noninvasive tool for cortical stimulation, demonstrates effectiveness in treating various chronic pain conditions of neuropathic origin. Nevertheless, there exists a limited body of research investigating the application of rTMS as a therapeutic intervention specifically for managing PLP. Notably, the dorsolateral prefrontal cortex (DLPFC) plays a crucial role in central pain processing, suggesting its potential as a key therapeutic target in PLP treatment. There is a lack of adequate data regarding the effectiveness of DLPFC-targeting rTMS in alleviating the pain experienced by PLP patients. ⋯ A regimen of 10 sessions of real rTMS of the DLPFC was associated with significant pain relief in patients with PLP, and the effects were sustained for 2 months. Therefore, the present study shows that rTMS of the DLPFC has potential as an effective therapeutic intervention for sustained pain relief in PLP patients.
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The classic percutaneous balloon compression (PBC) technique is used to complete an operation under the guidance of C-arm radiography under general anesthesia, making communication with patients during the operation impossible. It is not accurate or objective to predict the classic technique's curative effect solely by determining whether the projection of the x-ray lateral image of the filled balloon is pear-shaped. ⋯ PBC can be completed under conscious local anesthesia and analgesia. Its curative effect and operative end standard can be determined according to the patient's chief concern. Under CT guidance, the puncture path can be designed to complete an accurate puncture and to intuitively understand the position and shape of the balloon.
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Since 1992, when the Accreditation Council of Graduate Medical Education (ACGME) acknowledged pain medicine as a subspecialty, the field has experienced significant growth in its number of programs, diversity of sponsoring specialties, treatment algorithms, and popularity among applicants. These shifts prompted changes to the educational model, overseen by program directors (PDs) and the ACGME. The pool of pain fellowship applicants also changed during that period. ⋯ This survey demonstrated that procedural volume and diversity were important factors in trainees' decisions to apply to the field of pain medicine; however, extending the duration of a pain fellowship was not an option survey participants favored. Therefore, PDs and educational stakeholders in pain fellowship training need to develop creative strategies to maintain competitive applicants' interest while they adapt to our evolving field.