Pain practice : the official journal of World Institute of Pain
-
Piriformis syndrome is a collection of symptoms and signs of pain from piriformis muscle and is characterized by pain in buttock with variable involvement of sciatic nerve. This syndrome is often overlooked in clinical practice because its presentation has similarities with other spine pathologies. A major problem with the clinical diagnosis of piriformis syndrome is the lack of consistent objective findings and an absence of single test that is specific for piriformis syndrome. Therefore, a precise and reliable clinical method of diagnosing piriformis syndrome should be developed by clinicians. ⋯ Piriformis syndrome is a painful condition that is often overlooked in the differential diagnosis of chronic buttock or low back pain. The modified FAIR test together with piriformis muscle injection is potentially a reliable method for the clinical diagnosis of piriformis syndrome.
-
Letter Case Reports
Use of opioids for pain relief while driving: when the patient meets the police.
-
Despite an increasingly sophisticated understanding of pain mechanisms, acute and chronic pain remain undertreated throughout the world. This situation reflects the large gap that exists between evidence and practice in pain management and is typified by inappropriate use of nonsteroidal anti-inflammatory drugs (NSAIDs). The scientific evidence around these drugs continues to expand at a high rate, yet physicians are often unaware of best practice. ⋯ The panel agreed that nsNSAIDs and coxibs are effective analgesics with similar efficacy for acute pain; for chronic musculoskeletal pain, NSAIDs are significantly more effective than either placebo or paracetamol. Coxibs offer important safety advantages over nsNSAIDs, including gastrointestinal safety and preservation of platelet function; notably, the cardiovascular safety of coxibs has been the subject of much recent debate. Furthermore, the panel agreed there is substantial evidence to indicate that cost savings can be achieved by using celecoxib in patients at moderate to high risk of gastrointestinal adverse events, even in countries with moderate healthcare expenditures.
-
Poorly controlled acute pain during the postoperative setting after abdominal surgery can be detrimental to the patient. Current pain management practices for the postoperative abdominal surgery patient rely heavily on opioids, which are associated with many unwanted side effects. Recently, interest surrounding regional anesthesia has been growing owing to its demonstrated efficacy and safety outcomes. ⋯ However, the short duration of the pain block causes the patient to still rely on other analgesics throughout the additional postoperative days. Preliminary studies using continuous infusion catheters placed in the TAP has been one of the ways to prolong the nerve block in the abdomen; however, technical and operational issues currently limit the widespread adoption of this method. In this review, current studies will be presented and summarized to update the field on the potential benefits of the TAP block procedure, in addition to providing insight into the future direction of the drugs that could be used for TAP block.