Articles: pain-management-methods.
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Evaluation of low-back pain guidelines using Appraisal of Guidelines Research and Evaluation (AGREE) criteria has shown weaknesses, particularly in stakeholder involvement and applicability of recommendations. The objectives of this project were to: 1) develop a primary care interdisciplinary clinical practice guideline aimed at preventing prolonged disability from low-back pain, using a community of practice approach, and 2) assess the participants' impressions with the process, and evaluate the relationship between participant characteristics and their participation. ⋯ The community of practice approach was a successful method to develop guidelines on low-back pain, with participants providing information to improve guideline recommendations. The information technology infrastructure that was developed remains for continuous interdisciplinary exchanges and updating of the guidelines.
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To report on the process and effect of a quality improvement project on end-of-life (EOL) care in a state veterans' home. ⋯ EOL care in nursing homes is rated lower than care in all other venues and must be improved. EOL care can be improved using patient representative surveys as the springboard for staff and hospice interdisciplinary team QI processes. The interdisciplinary team must include the care staff of the home along with hospices serving the institution. We present here one process that we have found effective in improving EOL care. The critical issue is the dedication of the institution and staff to improve EOL care rather than the manner in which it is accomplished.
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Introduction. Since its first application in 1967, numerous case series indicate that spinal cord stimulation (SCS) is an effective treatment for the management of failed back surgery syndrome (FBSS). However, only one randomized controlled trial has demonstrated that SCS provides more effective pain relief than re-operation and conventional medical management. The PROCESS randomized, controlled, multicenter trial aims to assess the clinical effectiveness and cost-effectiveness of SCS when added to conventional medical management compared to conventional medical management alone in patients with FBSS. ⋯ At the 6-month visit, patients will be classified as successful (≥ 50% pain relief in the legs) or unsuccessful (< 50% pain relief in the legs). If the results of the randomized treatment are unsuccessful, patients can cross over to the alternative treatment arm. Discussion. This paper highlights the rationale, design, methods, and challenges of an ongoing prospective, randomized, controlled, multicenter clinical trial that has been undertaken to obtain conclusive evidence of the clinical efficacy and cost-effectiveness of an SCS system in patients with FBSS.
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Introduction. Neuromodulation, mediated by invasive electric stimulation, has been shown to be effective when applied to patients with refractory and intractable neuropathic pain. Recent advances in neurostimulation have broadened the therapeutic uses of this therapy, with the placement of extraspinal electrodes for peripheral nerve stimulation. Methods. Four patients with long-evolving, persistent, severe, uncontrolled, and localized pain in the occipital region, in whom other management options had been tried and failed, were treated with a peripheral, occipital, extraspinal electric stimulation (C1-C2-C3). ⋯ Results. In all cases, stimulation of the occipital region yielded good or very good global results. In all patients, continuous pain disappeared, the frequency and severity of the episodic pain decreased, function improved, and restful sleep improved. As a result of stimulation we were either able to reduce or discontinue medication usage in all of our patients.
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The interscalene brachial plexus block (ISBPB) is a most reliable and commonly performed technique for regional anesthesia of the upper extremity. It has widespread clinical applicability, ranging from use for shoulder surgery as well as diagnostic and therapeutic uses in pain management. Traditional methods described for performing the ISBPB involve identifying surface anatomy landmarks. Unfortunately, in patients with less than ideal landmarks (those with short, thick necks and those lacking adequate muscle tone in the neck area) it becomes increasingly challenging to identify these landmarks. As a result there is greater uncertainty in accurately locating the brachial plexus, and consequently greater risk in performing the block. ⋯ It is concluded that this technique represents a safe, reproducible, and highly successful method for use by anesthesiologists and pain physicians alike.