Current pain and headache reports
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Opioid misuse and abuse in the USA has evolved into an epidemic of tragic pain and suffering, resulting in the estimated death of over 64,000 people in 2016. Governmental regulation has escalated alongside growing awareness of the epidemic's severity, both on the state and federal levels. ⋯ This article reviews the timeline of government interventions from the late 1990s to today, including the declaration of the opioid crisis as a national public health emergency and the resultant changes in funding and policy across myriad agencies. Aspects of the cultural climate that fuel the epidemic, and foundational change that may promote sustained success against it, are detailed within as well. As a consequence of misuse and abuse of opioids, governmental regulation has attempted to safeguard society, and clinicians should appreciate changes and expectations of prescribers.
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Curr Pain Headache Rep · May 2019
ReviewEvolving Spinal Cord Stimulation Technologies and Clinical Implications in Chronic Pain Management.
Spinal cord stimulation (SCS), based on the gate theory of nociception, has been shown to be effective in the management of chronic pain conditions. While early-generation technology offered many patients improvement in their pain and symptoms, limitations including paresthesia, dependence on mapping, decreased chronological efficacy, and inadequate coverage left many patients with persistent pain and overt therapeutic failure. ⋯ New advances in neuromodulation technology circumvent many of these previous limitations and offer patients improved pain relief and quality of life. In this review, an update on recent technological developments in the field of SCS and peripheral neuromodulation is presented with discussion on differentiating characteristics which may help guide applicability to individual patient needs.
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Curr Pain Headache Rep · May 2019
ReviewMembrane Stabilizer Medications in the Treatment of Chronic Neuropathic Pain: a Comprehensive Review.
Neuropathic pain is often debilitating, severely limiting the daily lives of patients who are affected. Typically, neuropathic pain is difficult to manage and, as a result, leads to progression into a chronic condition that is, in many instances, refractory to medical management. ⋯ Gabapentinoids, belonging to the calcium channel blocking class of drugs, have shown good efficacy in the management of chronic pain and are thus commonly utilized as first-line therapy. Various sodium channel blocking drugs, belonging to the categories of anticonvulsants and local anesthetics, have demonstrated varying degrees of efficacy in the in the treatment of neurogenic pain. Though there is limited medical literature as to efficacy of any one drug, individualized multimodal therapy can provide significant analgesia to patients with chronic neuropathic pain.
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Curr Pain Headache Rep · Apr 2019
ReviewEssential Elements for Enhanced Recovery After Intra-Abdominal Surgery.
Enhanced recovery pathways provide a framework outlining the best perioperative care for intra-abdominal surgical procedures. To date, no evidence-based umbrella guidelines exist for all intra-abdominal surgeries. ⋯ PubMed and worldwide web searches were performed with the keywords: "ERAS," "Enhanced Recovery After Surgery," +/- "protocol." Manuscripts addressing intra-abdominal procedures were selected with the date range 2012-2017. The enhanced recovery philosophy is based in the realization that a traditional hospital works in silos that need to be broken to ensure a care protocol that follows and optimizes the journey the patient makes during the perioperative care. Enhanced recovery interventions can be categorized into preoperative, perioperative, and postoperative interventions. By design each intervention is planned and coordinated by a multidisciplinary ERAS team. The interventions discussed in this manuscript should be applied to patients on an individual basis depending on their needs. In this review, the most common elements of ERAS protocols in intra-abdominal procedures are reviewed, particularly those which provided the best outcomes and are generalized to all intra-abdominal procedures.