Articles: pain.
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Arch Orthop Trauma Surg · Jan 2025
Randomized Controlled Trial Comparative StudyContinuous local infiltration analgesia is equal to femoral and sciatic nerve block for total knee arthroplasty.
Total knee arthroplasty (TKA) is associated with moderate to severe postoperative pain. Pain control is crucial for rapid mobilisation and reduces side effects as well as the length of hospital stay. In this context, a variety of multimodal pain control regimes show good pain relief, including several nerve blocks, iPACK and local infiltration analgesia (LIA). To compare the analgesic potency of LIA and the combination of continuous femoral nerve block + sciatic single-shot nerve block under general anaesthesia, we conducted a prospective, randomized, controlled, non-blinded single-centre study. ⋯ Both techniques are well established, provide equal pain relief for TKA and support early postoperative mobilisation.
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Curr Pain Headache Rep · Jan 2025
ReviewA Review of Leveraging Artificial Intelligence to Predict Persistent Postoperative Opioid Use and Opioid Use Disorder and its Ethical Considerations.
Artificial intelligence (AI) offers a new frontier for aiding in the management of both acute and chronic pain, which may potentially transform opioid prescribing practices and addiction prevention strategies. In this review paper, not only do we discuss some of the current literature around predicting various opioid-related outcomes, but we also briefly point out the next steps to improve trustworthiness of these AI models prior to real-time use in clinical workflow. ⋯ Machine learning-based predictive models for identifying risk for persistent postoperative opioid use have been reported for spine surgery, knee arthroplasty, hip arthroplasty, arthroscopic joint surgery, outpatient surgery, and mixed surgical populations. Several machine learning-based models have been described to predict an individual's propensity for opioid use disorder and opioid overdose. Natural language processing and large language model approaches have been described to detect opioid use disorder and persistent postsurgical opioid use from clinical notes. AI holds significant promise in enhancing the management of acute and chronic opioids, which may offer tools to help optimize dosing, predict addiction risks, and personalize pain management strategies. By harnessing the power of AI, healthcare providers can potentially improve patient outcomes, reduce the burden of opioid addiction, and contribute to solving the opioid crisis.
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This review discusses the diagnosis and treatment of nervus intermedius neuralgia (NIN) and identifies gaps in the literature. ⋯ The nervus intermedius is a branch of the facial nerve. NIN presents as a rare neuralgia of this nerve, causing deep ear pain, which may radiate to the auditory canal, auricle, mastoid, soft palate, temple, and angle of the jaw. NIN most commonly presents in middle-aged women; neurovascular compression involving the anterior inferior cerebellar artery is the most common etiology described. Despite its diagnostic criteria in the International Classification of Headache Disorders, 3rd edition (ICHD-3), NIN may lack a trigger zone and may manifest as achy or neuralgiform pain instead of the typically described sharp or shooting pain. Like trigeminal neuralgia, NIN can be divided into classic, idiopathic, secondary, or painful neuropathy. Although there are no established guidelines for treating NIN, many possible treatments are used. Experience from treating trigeminal neuralgia suggests that carbamazepine or oxcarbazepine can be considered first-line. Patients with medically refractory NIN may benefit from neurosurgery referral for microvascular decompression or nerve sectioning. More research is needed to elucidate the range of clinical presentations in patients with NIN. Current data are limited and suggest that symptoms may diverge from the ICHD-3 diagnostic criteria. Although various treatments have been attempted, they often lack solid evidence and are typically derived from approaches used for other neuralgias. Proper diagnosis is crucial, particularly when considering surgical referral, due to the potential overlap of NIN with other neuralgias affecting the head and neck.
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J Pain Symptom Manage · Jan 2025
Arts in Medicine for the Reduction of Pain and Stress in Cancer Patients During Chemotherapy.
Rates of pain and stress are found in greater numbers in cancer patients than in the general population. Cancer patients often are concerned about unwanted side effects that can arise from taking medications to lower their pain and stress. As doctors are reaching for evidence-based, nonpharmaceutical, adjunct modalities, previous research indicates that visual art-making shows promise to help improve perceptions of pain and stress caused by a cancer diagnosis and treatment. ⋯ This suggests that a watercolor visual arts intervention is a viable and feasible nonpharmaceutical complementary alternative to opioid prescriptions for pain management.
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We have previously demonstrated that an extrafascial injection of 20 ml of local anaesthetic for interscalene brachial plexus block (ISB) reduces the rate of hemidiaphragmatic paralysis by 70% compared with an intrafascial injection, with similar efficacy. In this double-blind trial, we tested the hypothesis that a local anaesthetic volume of 10 ml injected extrafascially would reduce the rate of hemidiaphragmatic paralysis vs a volume of 20 ml, while providing similar analgesia. ⋯ NCT04726280.