Pain practice : the official journal of World Institute of Pain
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Healthcare resource utilization (HCRU) and associated costs specific to pain are a growing concern, as increasing dollar amounts are spent on pain-related conditions. Understanding which pain conditions drive the highest utilization and cost burden to the healthcare system would enable providers and payers to better target conditions to manage pain adequately and efficiently. The current study focused on 36 noncancer chronic and 14 noncancer acute pain conditions and measured the HCRU and costs per member over 365 days. ⋯ The conditions ranked highest for both per-member and total healthcare costs were hip fractures, childbirth, and non-hip, non-spine fractures. Among these, hip fractures in the Medicare member population had the highest mean cost per member (adjusted per-member cost was $21,058). Further examination specific to how pain is managed in these high-cost conditions will enable providers and payers to develop strategies to improve patient outcomes through appropriate pain management.
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This study was designed to evaluate incidence and characteristics of acute referred orofacial pain caused by a posterior single tooth pulpitis in an Iranian population. ⋯ The results of the present study show the prevalence of referred pain in the head, face, and neck region is moderately high. Therefore, in patients with orofacial pain, it is essential to carefully examination before carrying out treatment that could be inappropriate.
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Low back pain is usually self-limited. The transition from acute to chronic LBP is influenced by physical and psychological factors. Identification of all contributing factors, in a mass emergency setting, differentiating primary and secondary life-threatening forms of LBP, is the best approach for success. Aims of the present report were to estimate the prevalence of LBP in population afferent to four advanced medical presidiums (AMPs) during postseismic emergency period and to evaluate frequency of use, types of pain killers administered to patients and short-term efficacy of them. ⋯ The emotional stress induced by natural disaster tends to heighten norepinephrine and sympathetic nervous system activity, which may further amplify nociception through peripheral or central mechanisms that result in consistent prevalence of primary NSLBP and become potential risk factor for pain chronicization.
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Diabetic lumbosacral radiculoplexus neuropathy (DLRPN) is a rare painful peripheral neuropathic complication of diabetes mellitus. The clinical features of DLRPN include severe neuropathic pain, weakness, atrophy, and sensory loss in the lower limbs with asymmetrical distribution. Nerve ischemia due to inflammation and microvasculitis has been suggested as the pathophysiological mechanism for DLRPN. ⋯ We measured serum cytokines before and after IVIg; serum tumor necrosis factor α was increased when the patient reported pain and normalized after IVIg in parallel with pain improvement. Our data extend the notion that some types of pain, including peripheral neuropathic pain, may respond to IVIg and give some clue on the mechanism of this therapeutic effect. They are also consistent with the suggested role of the immune system in the pathophysiology of neuropathic pain and offer support to the hypothesis that cytokines may contribute to the pathogenesis of neuropathic pain.
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Case Reports
Lumbar Zygapophyseal Pain During Extension-Based Stabilization Protocol Following Lumbar Transdiscal Biacuplasty.
Transdiscal biacuplasty (TDB) is a minimally invasive procedure for the treatment of lumbar discogenic pain. Theoretically, TDB ablates the aberrant ingrowth of nerve fibers beyond the outer third of the annulus fibrosis of the lumbar intervertebral disk and treats annular tears via collagen reformation. Typically, recovery involves a robust rehabilitation protocol that emphasizes lumbar stabilization exercises, focusing on extension maneuvers while also strengthening the multifidi and transverse abdominus. New-onset postprocedural pain during recovery may occur; evaluation of nondiscogenic causes should be considered. We report 3 of 12 patients who developed zygapophyseal-mediated pain during the recovery period. ⋯ Novel postprocedural low back pain should provoke re-evaluation of potential etiologies such as persistent discogenic pathology, zygapophyseal or sacroiliac joint involvement, and other mechanical sources of pain. We postulate that extension maneuvers during rehabilitation, combined with lumbar bracing in extension, inadvertently triggered and potentially exacerbated pre-existing zygapophyseal irritation. The clinical implication of this scenario is novel distracting pain, caused by an alternative etiology to the original discogenic pain, and may present a confounder to the assessment of the efficacy of TDB.