Articles: pain-clinics.
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J Coll Physicians Surg Pak · May 2022
Case ReportsBilateral Temporomandibular Joint Dislocation Following Arthrocentesis Plus Hyaluronic Acid Injection.
Arthrocentesis plus intra-articular hyaluronic acid (HA) injection for temporomandibular joint (TMJ) disorders is known to be a safe and minimally invasive surgical procedure. Arthrocentesis plus HA injection has a pain-reducing effect on TMJ disorders. It is also a palliative treatment that yields positive results in terms of clinical findings such as clicking and mouth opening. ⋯ This case report presents bilateral TMJ dislocation following arthrocentesis plus intra-articular HA injection that developed within a few hours and resisted manual Hippocrates manoeuvre in a 21-year male. Herein, his treatment with systemic corticosteroid therapy, myorelaxant and anti-inflammatory drugs is also presented. Key Words: Arthrocentesis, Hyaluronic acid, Joint dislocation, Temporomandibular joint, Steroids.
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Randomized Controlled Trial Multicenter Study Pragmatic Clinical Trial
CT or Invasive Coronary Angiography in Stable Chest Pain.
In the diagnosis of obstructive coronary artery disease (CAD), computed tomography (CT) is an accurate, noninvasive alternative to invasive coronary angiography (ICA). However, the comparative effectiveness of CT and ICA in the management of CAD to reduce the frequency of major adverse cardiovascular events is uncertain. ⋯ Among patients referred for ICA because of stable chest pain and intermediate pretest probability of CAD, the risk of major adverse cardiovascular events was similar in the CT group and the ICA group. The frequency of major procedure-related complications was lower with an initial CT strategy. (Funded by the European Union Seventh Framework Program and others; DISCHARGE ClinicalTrials.gov number, NCT02400229.).
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Cochrane Db Syst Rev · Apr 2022
ReviewAlgorithm-based pain management for people with dementia in nursing homes.
People with dementia in nursing homes often experience pain, but often do not receive adequate pain therapy. The experience of pain has a significant impact on quality of life in people with dementia, and is associated with negative health outcomes. Untreated pain is also considered to be one of the causes of challenging behaviour, such as agitation or aggression, in this population. One approach to reducing pain in people with dementia in nursing homes is an algorithm-based pain management strategy, i.e. the use of a structured protocol that involves pain assessment and a series of predefined treatment steps consisting of various non-pharmacological and pharmacological pain management interventions. ⋯ There is no clear evidence for a benefit of an algorithm-based pain management intervention in comparison with pain education for reducing pain intensity or challenging behaviour in people with dementia in nursing homes. We found that the intervention may reduce proxy-rated pain compared with usual care. However, the certainty of evidence is low because of the small number of studies, small sample sizes, methodological limitations, and the clinical heterogeneity of the study populations (e.g. pain level and cognitive status). The results should be interpreted with caution. Future studies should also focus on the implementation of algorithms and their impact in clinical practice.
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Initial clinical studies have shown that the stimulation of the dorsal root ganglion (DRG) can significantly reduce chronic intractable pain. However, clinical data on long-term results and complications of these systems are limited. The aim of this prospective study is to report on a single center long-term follow-up of DRG stimulation for intractable chronic pain. ⋯ The findings were generally robust to imputation methods of missing data. Implantable pulse generators of 8 patients were explanted because of dissatisfaction with pain relief. In conclusion, DRG stimulation can provide effective pain relief and improved quality of life in patients suffering with neuropathic pain, although this study had a revision rate of 42% within the first 24 months, and 56% of IPGs that were replaced because of battery depletion had a shorter than expected battery life.