Articles: chronic.
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Spinal Cord Stimulation (SCS) is a treatment option for chronic pain patients. The most common indication for SCS is the failed back syndrome with leg pain. In the last decade, advances in our understanding of appropriate stimulation programming, lead placement and the physiology of SCS, have led to changes in multi-site stimulation, and stimulation with differing programs. In the past, low back, axial neuropathic type pain was not responsive to SCS. With dual electrode arrays, and dual stimulation with alternating programs of stimulation, steering of stimulation paresthesia, and versatile programmable stimulation parameters, SCS has become a more versatile form of analgesia. ⋯ SCS is the most effective treatment for limb pain not amenable to surgical decompression. The success of SCS in this chronic pain group is 80% successful in treatment of leg pain, and much less effective in treatment of axial pain.
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Curr Opin Anaesthesiol · Jun 2003
Anaesthetic considerations in patients with chronic pulmonary disease.
Chronic pulmonary diseases are getting more important in daily anaesthetic practice, because prevalence is increasing and improved anaesthetic techniques have led to the abandonment of previous contraindications to anaesthesia. It is therefore essential for the anaesthetist to be up to date with current clinical concepts and their impact on the conduction of anaesthesia as well as new insights into how to anaesthetise these patients safely. ⋯ Assessing the functional status of patients admitted for surgery remains a difficult task, and in patients identified as being at risk by clinical examination additional spirometry and blood gas measurements may be helpful. If there are flow limitations and signs of respiratory failure, the anaesthetist should be highly alarmed and monitor the patient closely and invasively, yet there is no reason to deny any patient a substantially beneficial operation.
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Postoperative pulmonary complications, including pneumonia, bronchospasm, respiratory failure and prolonged mechanical ventilation, occur commonly and are a significant source of morbidity and mortality. This review will discuss the etiology of postoperative pulmonary complications and the interventions that reduce their risk. ⋯ Understanding risk factors for the development of postoperative pulmonary complications allows targeted interventions aimed at reducing their frequency and severity. Further research is needed to define the role of regional analgesic and anesthetic techniques in reducing postoperative pulmonary complications, and also to define the nature of risk factors and develop better predictive models of patients at risk of developing postoperative pulmonary complications.
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This study sought to determine the efficacy of fluoroscopic caudal epidural steroid injections as a conservative treatment in patients with presumably chronic lumbar discogenic pain. ⋯ At greater than two year follow-up, the efficacy of fluoroscopically guided caudal epidural steroid injections in patients with chronic lumbar discogenic pain is poor. Patient satisfaction exceeds the reported rate of efficacy. Patients responding to injection have significantly lower pre-injection pain scores.
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Drug abuse with illicit drugs and licit drugs has been increasing steadily over the past decade. A recent National Household Survey on Drug Abuse found statistically significant increases between 2000 and 2001 in the use of multiple drugs, including marijuana, cocaine, and non-medical use of pain relievers and tranquilizers. Prescription controlled substance abuse is a major issue in chronic pain management. ⋯ Only one patient tested positive for a combined use of both marijuana and cocaine. This study showed that, in an interventional pain management setting, there is significant use of illicit drugs (16%) with 13% use of marijuana and 3% use of cocaine in patients who are considered as non-abusers of prescription controlled substances and those who are adherent to controlled substance agreements. However, if cocaine is considered as a hardcore drug in contrast to marijuana, abuse of hardcore illicit drugs is only 3%.