Pain Physician

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BACKGROUND: Mild traumatic brain injury (mTBI), or concussion, is the most common presentation of TBI in the emergency department (ED), but a diagnosis of mTBI may be missed in patients presenting with other acute injuries after a motor vehicle collision (MVC). OBJECTIVE: To estimate the frequency of missed diagnoses of mTBI in patients seen in the ED after MVC who later developed chronic pain syndromes. STUDY DESIGN: Retrospective cohort study...

BACKGROUND: The standard solutions for epidural labor analgesia include both local anesthetics and opioids. The concept of the standard epidural use of local anesthetics in labor analgesia has shifted from high concentrations to high volumes with low concentrations. However, the optimal dosage of opioids needed to initiate and maintain epidural labor analgesia in different phases during the first labor stage has rarely been studied. OBJECTIVE: The present study aimed to determine the optimal sufentanil dose for epidural initiation in the latent and active phases during the first stage of labor...

BACKGROUND: Recurrence of lumbar disc herniation (LDH) is an adverse event after percutaneous endoscopic transforaminal discectomy (PETD). Accurate prediction of the risk of recurrent LDH (rLDH) after surgery remains a major challenge for spine surgeons. OBJECTIVES: To develop and validate a prognostic model based on risk factors for rLDH after PETD. STUDY DESIGN: Retrospective study. SETTING: Inpatient surgery center...

BACKGROUND: Spinal cord stimulation (SCS) is an effective treatment for chronic refractory pain. The evidence of pain reduction, improvement of function, quality of life, and cost-effectiveness are strong in developed countries. Nevertheless, there is still a lack of economic studies of SCS in the context of low- and middle-income countries. OBJECTIVES: To evaluate the cost-effectiveness and cost-utility of additional SCS to conventional management (CMM) in patients with chronic refractory pain in Thailand...

BACKGROUND: Pain assessments are an important aspect of health care quality because the high prevalence of pain in inpatients may contribute to complications. Several studies revealed a gap in the pain intensity evaluated by nurses (PEN) and patients (PEP). The aim of the present study was to analyze the correlation and agreement between pain assessments conducted by nurses and patients, and to determine patients at high risk of misestimated pain. OBJECTIVES: To compare the difference of pain intensity between the questionnaires conducted by additional assessors and electronic records by nursing staff...

BACKGROUND: Osteoporotic vertebral compression fractures (OVCF) are common. A few patients with thoracic vertebral fracture show pain in the bilateral rib region but not at the fracture site. The point of specific tenderness in the rib region cannot be located. It is not clear whether percutaneous kyphoplasty (PKP) can relieve the pain in the bilateral rib region in these patients. OBJECTIVE: To check whether PKP can alleviate the rib region pain in thoracic vertebral fracture patients without local pain at the fractured vertebra...

BACKGROUND: Postdural puncture headache (PDPH) is one of the serious complications after lumbar puncture, but there is no effective tool to predict it. OBJECTIVES: To explore whether ultrasound measurement of optic nerve sheath diameter (ONSD) as a predictor of PDPH can be a reliable tool supported by reliable protocols and data. STUDY DESIGN: A prospective observational study. SETTING: Department of Anesthesiology. METHODS: This prospective observational study was performed in 156 patients undergoing cesarean section (CS)...

BACKGROUND: Trigeminal neuralgia (TN) is usually established using characteristic clinical features such as sudden, severe, and unilateral facial pain. Studies about diverse clinical features and epidemiologic data of TN have been reported previously; however, most of the previous studies have evaluated in and focused on Caucasian and Western populations. OBJECTIVES: The purpose of this study was to evaluate diverse clinical features, currently applied types of treatment, and brain imaging studies in patients with TN in a Korean population...

BACKGROUND: The controversy continues on how to best become proficient in contemporary minimally invasive spinal surgery techniques (MISST). Postgraduate training programs typically lag behind the innovation. Other subspecialty spine care providers often compete with spine surgeons particularly when they do not offer the treatments needed by their patients. The public debate centers around who should be taught and credentialed in providing surgical spine care. OBJECTIVES: The purpose of this study was to conduct an opinion survey amongst spine care providers regarding the learning curve of MISST and which credentialing standards should be established...

BACKGROUND: The postsurgical management of patients with ankylosing spondylitis is often only focused on the incision pain, and the pain caused by abdominal skin traction is paid little attention. OBJECTIVES: To explore the effectiveness of ultrasound-guided transversus abdominis plane block (TAPB) in treating abdominal skin tension pain after kyphosis surgery. STUDY DESIGN: Randomized controlled trial. SETTING: This prospective study consecutively enrolled patients scheduled to undergo kyphosis correction surgery at the Department of Orthopedics of Xijing Hospital from March 2021 to December 2021...

BACKGROUND: How to minimize postoperative pain following spinal surgery has been a great challenge for both surgeons and patients. We hypothesized that intraoperative multi-drug wound infiltration could relieve postoperative pain following single-level transforaminal lumbar interbody fusion (TLIF) surgery. OBJECTIVES: To evaluate the effect of intraoperative multi-drug wound infiltration for postoperative pain following single-level TLIF surgery. STUDY DESIGN: A randomized, double-blinded controlled trial (RCT)...

BACKGROUND: Postoperative nausea and vomiting (PONV) are common unpleasant adverse effects after surgery. The incidence of PONV in pediatric patients is often twice as high as in adults. OBJECTIVES: This study aimed to evaluate the effects of dexmedetomidine, dexamethasone, and ondansetron for preventing PONV in children undergoing dental rehabilitation surgery. STUDY DESIGN: A prospective, randomized controlled clinical trial. SETTING: Sharurah Armed Forces Hospital, Ministry of Defense Medical Services, Saudi Arabia...

BACKGROUND: Patients with osteonecrosis of the femoral head  commonly present with sensorimotor anomalies. With independent component analysis, it is possible to explore the intrinsic alternations in highly specific functional networks. We used independent component analysis to examine the intrinsic changes and interactive connectivity between related functional resting-state networks. OBJECTIVE: The purpose of this study was to strengthen the theoretical basis of brain plasticity after osteonecrosis of the femoral head to provide new insights into clinical treatment...

BACKGROUND: Newly-introduced minimally invasive interventions have filled a gap between conservative care and open surgical procedures in the treatment and management of lumbar spinal stenosis (LSS), allowing expanded access to patient care. This spectrum of care involves an important interplay between advanced practice providers, interventional pain physicians, and spine surgeons. OBJECTIVES: Using an integrated team approach starting with history taking; static and dynamic imaging; and conservative care, we developed a simple, understandable clinical algorithm that serves as a foundation for physicians to confidently make objective decisions regarding diagnosing and treating LSS throughout the entire clinical course of the condition...

BACKGROUND: With increased hospitalizations and deaths related to opioid use disorder, there is an impetus for federal and private insurance companies to provide coverage for integrative treatments that address pain. The Centers for Disease Control and Prevention (CDC) and the current literature recommend that nonpharmacological and nonopioid treatments must be considered for chronic pain management. The continued examination of potential coverage and cost-effectiveness for opioid-sparing alternatives with proven efficacy is critical for physicians who treat chronic pain...

BACKGROUND: We aim to explore the factors related to job satisfaction among pain physicians and identify the reasons why individuals minimize or stop practicing outpatient pain medicine. OBJECTIVES/STUDY DESIGN: This is a survey-based study with the primary goal to identify factors determining job satisfaction and dissatisfaction among pain medicine fellowship graduates who continue to practice and those who are no longer practicing interventional pain. A secondary goal is to elucidate reasons for anesthesiologists trained in pain medicine to leave pain medicine, despite an additional year of training, and to work as general anesthesiologists...

BACKGROUND: Ultrasound imaging is shown to be superior to other imaging tools for the evaluation of shoulder disorders in a primary care settings. In addition to its diagnostic utility, ultrasound diathermy is useful as a deep heat modality for the management of shoulder pain. OBJECTIVE AND STUDY DESIGN: In this study, we analyzed the bibliometric data of publications that have focused on ultrasound imaging/therapy for shoulder-related pain syndrome. METHODS: We searched the Web of Science (WoS) database for articles published between January 1, 1976, and June 24, 2022...

BACKGROUND: Approximately 700,000 individuals experience osteoporotic vertebral compression fractures (OVCF) every year in the United States. Chronic complications from patients and increasing economic burdens continue to be major problems with OVCFs. Multiple treatment options for OVCF are available, including conservative management, surgical intervention, and minimally invasive vertebral augmentation. Prior studies have investigated the utility of vertebral augmentation techniques such as percutaneous vertebroplasty (PVP), balloon vertebroplasty (BVP), and vertebral augmentation with the KivaTM implant on patient mortality with favorable results...

BACKGROUND: Chronic pain is a common and growing problem in the United States with variable strategies for its treatment. Surgical interventions are necessary in some cases but not required for all patients with new-onset pain. For some patients, interventional pain management (IPM) techniques can treat chronic pain without the cost or risk associated with surgical intervention. OBJECTIVE: The objective of this study was to compare healthcare utilization and costs for new-onset chronic pain treated by IPM specialists to those treated by providers with surgical specialties (i...