Articles: pain-management-methods.
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Randomized Controlled Trial
Neural Tension Technique Improves Immediate Conditioned Pain Modulation in Patients with Chronic Neck Pain: A Randomized Clinical Trial.
To determine the immediate effect of neural tension technique (NTT) on conditioned pain modulation in patients with chronic neck pain. A secondary objective was to determine the immediate effect of neural tensioner technique on pain intensity and cervical range of movement. ⋯ This study suggests that neural tension technique enhances immediate conditioned pain modulation in patients with chronic neck pain, but not pain intensity or cervical range of movement.
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J. Gastrointest. Surg. · Jun 2019
ReviewMorpheus and the Underworld-Interventions to Reduce the Risks of Opioid Use After Surgery: ORADEs, Dependence, Cancer Progression, and Anastomotic Leakage.
Perioperative pain management is a key element of enhanced recovery after surgery (ERAS) programs. A multimodal approach to analgesia as part of a coordinated ERAS includes the reduction of opioid use. This review aims to discuss opioid-related adverse events, strategies to reduce opioid use after surgery, and the relevance to the present "opioid crisis" in North America. ⋯ There are substantial benefits in incorporating opioid reduction strategies into ERAS and clinical practice guidelines. These include faster return of function and mobility, and decreased opioid-related adverse drug events (ORADEs), postoperative morbidity and mortality, and length of hospital stay. Improved oncological outcomes after cancer surgery may be an additional benefit. Evidence-based interventions can also reduce opioid abuse and diversion in the community.
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Paediatric anaesthesia · Jun 2019
The Society for Pediatric Anesthesia recommendations for the use of opioids in children during the perioperative period.
Opioids have long held a prominent role in the management of perioperative pain in adults and children. Published reports concerning the appropriate, and inappropriate, use of these medications in pediatric patients have appeared in various publications over the last 50 years. ⋯ The goal of the recommendations was to address the most important issues concerning opioid administration to children after surgery, including appropriate assessment of pain, monitoring of patients on opioid therapy, opioid dosing considerations, side effects of opioid treatment, strategies for opioid delivery, and assessment of analgesic efficacy. Regular updates are planned with a re-release of guidelines every 2 years.
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The increase in opioid-related deaths in the United States (and other countries) has prompted a national debate in medicine about the appropriateness of opioids for the treatment of acute and chronic pain, and specifically in children, if medical opioid use causes or increases the risk of opioid use disorder (OUD) later in life. Some in the medical community and in government advocate withholding opioids from children after an arbitrary number of days of treatment, regardless of diagnosis. Here, I argue that opioid experimentation and misuse is no more common in children and adolescents today than 2 or 3 decades ago, that there is no compelling evidence that appropriate medical use of opioids leads to OUD, and that the epidemic of inadequately treated pain in children remains the more compelling issue.
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Case Reports
Salvage Therapy With Burst Spinal Cord Stimulation for Chronic Pancreatitis: A Case Report.
Pain associated with chronic pancreatitis is often difficult to treat. On many occasions, interventional techniques may be necessary. In recent years, spinal cord stimulation techniques have been used successfully in the treatment of these patients. However, only the use of traditional tonic stimulation based on paresthesias has been published for this purpose. Spinal cord burst stimulation has been shown to be more effective than tonic stimulation, especially in failed back surgery syndrome. ⋯ A sustained pain score reduction of over 50% on the visual analogue scale was seen, as were a decrease in opioid consumption and a high degree of satisfaction with the therapy by our patient.