Articles: pain-management-methods.
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Recent systematic reviews show promising effects for multidisciplinary biopsychosocial (BPS) interventions in patients with chronic low back pain (CLBP). Nowadays, BPS interventions have also been developed for primary care physiotherapy settings. Our aim was to systematically review the evidence on the effectiveness of primary care BPS interventions in improving functional disability, pain, and work status for patients with CLBP. Secondly, we aimed to provide an elaborated overview of BPS intervention designs, physiotherapist training programs, and process-related factors (practical implementation). ⋯ BPS interventions seem more effective than education/advice and were found to be as effective as physical activity interventions in patients with CLBP. BPS interventions with a clear focus on psychosocial factors (understanding pain, unhelpful thoughts, coping styles, and goal setting) seem most promising. Sufficient delivery of BPS elements is expected when physiotherapists participate in training programs with extensive support prior and during delivery (manual, supervision, and informative resources).
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Curr Opin Anaesthesiol · Feb 2019
ReviewPain therapy for the elderly patient: is opioid-free an option?
Chronic noncancer pain is an increasing problem in elderly because of rising life expectancy together with an increase of potentially painful medical conditions. Concomitantly, adequate treatment of elderly is often limited by coexisting diseases and polypharmacy.This review summarizes the most important specifics presented by elderly patients and discusses the pharmacological and nonpharmacological options of pain management. ⋯ Adequate pain management of elderly patients constitutes numerous pharmacological options including nonopioids, opioids, coanalgesics and topical agents. Due to age-related characteristics, all systemic analgesics have to be given very cautiously ('start low, go slow'). Whenever possible, treatment should be performed as a multimodal approach based on the biopsychosocial model of chronic pain.
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Randomized Controlled Trial Comparative Study
Comparison of Ultrasound-Guided Supraclavicular and Interscalene Brachial Plexus Blocks in Postoperative Pain Management After Arthroscopic Shoulder Surgery.
The interscalene brachial plexus block (ISBB) is an effective procedure for minimizing postoperative opioid consumption and pain following arthroscopic shoulder surgery. The ultrasound (US)-guided supraclavicular brachial plexus block (SCBB) seems to be an alternative technique for arthroscopic shoulder surgery. However, evidence is lacking regarding the impact of SCBB on postoperative pain management and recovery after arthroscopic shoulder surgery. The aim of this study was to compare the effects of SCBB with ISBB in terms of postoperative pain and quality of recovery after arthroscopic shoulder surgery. ⋯ This study showed that US-guided SCBB is as effective as ISBB in reducing postoperative pain and improving the quality of recovery for arthroscopic shoulder surgery.
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Herpes zoster is a painful, eruptive, viral condition occurring with reactivation in immunosuppressed individuals. The selection of an effective analgesic method in the acute phase of herpes zoster can decrease the incidence of postherpetic neuralgia by reducing neural sensitization. The erector spinae plane block has been reported to provide diffuse and effective analgesia in the cervical, thoracic, and lumbar regions. We report an effective decrease in pain with the application of the high-thoracic erector spinae plane block in the emergency department in a patient with herpes zoster pain in the cervicothoracic and shoulder region.