Articles: pain-clinics.
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Comparative Study
Establishing a nurse-based, anesthesiologist-supervised inpatient acute pain service: experience of 4,617 patients.
To describe our nurse-based Acute Pain Services (APS) and present the results of 4617 patients treated by our service. ⋯ A nurse-based APS provides effective and safe postoperative pain management.
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A day centre was established to determine whether an alternative approach to the management of uncomplicated sickle pain would improve the quality of care and reduce hospital admissions in patients with sickle cell disease. Since the centre opened there has been a 43% decrease in hospital admissions and 49% decrease in occupied bed days. ⋯ A centre offering day case management of painful crisis reduced unnecessary hospital admissions for uncomplicated pain. This approach is safe and cost-effective.
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The use of epidural steroid injections as a treatment for patients with degenerative lumbar scoliotic spinal stenosis and radiculopathy has received sparse attention in the literature. Even though it has been reported that patients with scoliosis may respond differently than other patient groups to conservative therapeutic interventions for low back pain and radiculopathy, patients with scoliosis have rarely, if ever, been excluded from clinical studies of epidural steroid injections. To date, there are no studies investigating the efficacy of fluoroscopic transforaminal epidural steroid injections as a treatment for patients with radiculopathy and radiographic evidence of degenerative lumbar scoliotic stenosis. ⋯ Fluoroscopic transforaminal epidural steroid injections appear to be an effective nonsurgical treatment option for patients with degenerative lumbar scoliotic stenosis and radiculopathy and should be considered before surgical intervention.
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Since the first medical description of post-amputation phenomena reported by Ambrose Paré, persistent phantom pain syndromes have been well recognized. However, they continue to be difficult to manage. The three most commonly utilized terms include phantom sensation, phantom pain, and stump pain. ⋯ While numerous treatments have been described, there is little clinical evidence supporting drug therapy, psychological therapy, interventional techniques or surgery. This review will describe epidemiology, etiology and pathophysiological mechanisms, risk factors, and treatment modalities. The review also examines the effectiveness of various described modalities for prevention, as well as management of established phantom pain syndromes.
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There are numerous treatments for complex regional pain syndrome (CRPS). These treatments are varied in scope and include pain management therapies, psychological therapies, and physiotherapy. Treatment guidelines have been published in the past, but little information exists as to how clinicians utilize these guidelines. Moreover, there has been a paradigm shift from the older "reflex sympathetic dystrophy" (RSD) nomenclature, with largely sympathetic block driven diagnosis and therapy to more recent trends towards more inclusive "CRPS" diagnostic criteria and multidisciplinary treatment. There remains controversy regarding the selection of various techniques, and the timing of advancement through the treatment algorithm to the more aggressive, interventional techniques. We set out to determine current CRPS treatment practices of interventional pain specialists. ⋯ Our survey results revealed the use of a treatment algorithm for CRPS that consists of treatment using medical therapies (pharmacologic, blocks, catheters, and implantable devices), psychological therapies, and physiotherapy in a coordinated fashion. The trend among our survey respondents is to utilize increasingly interventional techniques after a failed 2- to 4-week trial of any one particular therapy.