Pain relief but at what cost: the need for suicidality screening during chronic pain management

Beyond the needle: expanding the role of anesthesiologists in the management of chronic non-malignant pain.

A persistent pain

Issues in Long-term Opioid Therapy: Unmet Needs, Risks, and Solutions

Navigating the complexities of pain management

Chronic pain and narcotics: a dilemma for primary care.

Chronic pain causes a tremendous burden on the society in terms of economic factors and social costs. Rates of spinal surgery, especially spinal fusion, have increased exponentially over the past decade. The opioid epidemic in the United States has been one response to the management of pain, but it has been fraught with numerous catastrophic-related adverse effects. Clinically, spinal cord stimulation (SCS)/neuromodulation has been used in the management of chronic pain (especially spine-related pain) for more than two decades. More recent advances in this field have led to new theories and approaches in which SCS can be used in the management of chronic spine-related pain with precision and efficacy while minimizing adverse effects commonly seen with other forms of chronic pain treatment (eg, narcotics, injections, ablations). Narcotic medications have adverse effects of habituation, nausea, constipation, and the like. Injections sometimes lack efficacy and can have only limited duration of efficacy. Also, they can have adverse effects of cerebrospinal fluid leak, infection, and so on. Ablations can be associated with burning discomfort, lack of efficacy, recurrent symptoms, and infection. High-frequency stimulation, burst stimulation, tonic stimulation with broader paddles, and new stimulation targets such as the dorsal root ganglion hold promise for improved pain management via neuromodulation moving forward. Although a significant rate of complications with SCS technology are well described, this can be a useful tool in the management of chronic spine-related pain.

Introduction: Chronic pain presents a public health priority, however its assessment and management remains problematic in the country posing serious obstacles in effective pain relief and improving quality of life in pain patients, in general, and in palliative patients, in particular. We aimed to study chronic pain relief quality and pain assessment and management knowledge level in primary health care institutions, being a gateway to palliative care. Methods: Cross-sectional survey was conducted in 2013-2014 on 232 randomly selected patients in palliative care clinic and 304 physicians in primary health care institutions in different regions of the country. Pain assessment tools such as Visual Analog Scale (VAS) and numeric pain rating scale along with questionnaires, composed of 20 (for patients) and 40 (for physicians) with both: open and closed questions were used. Study results were processed in SPSS software. Results: Response rates were 83% for patients and 87% for physicians. The vast majority of patients suffered of unrelieved pain at the admission to the clinic. Almost all patients (98%) were coming from primary health care institutions. Perception and expression of pain by majority of patients (85%) didn't correspond to the pain intensity, measured by the VAS and consequently, by the numerical scale (t=3.4). Pain intensity was in linear correlation with the disease stage (r=0.6). It was increasing along with the disease progression. Fifty percent of physicians in the selected primary health care facilities were unaware of WHO pain leader, 90% of them didn't use tools for evaluating of pain intensity. 89.8% prescribed opioids without a prior determination of causes and risk factors. None of the physicians knew about the role of patients in chronic pain management, resulted in the unawareness of patients toward self-management and preventive potential of chronic pain. Conclusion: 1: Majority of palliative patients are admitted to specific tertiary clinic with unrelieved pain; 2: Chronic pain assessment and management level is mainly inadequate in primary health care institutions; 3: Chronic pain education along with the enhancement of knowledge level of family physicians is of critical importance for effective pain relief.

Background: Malignancy related/ chronic abdominal and pelvic pain, most of the times is debilitating and affects survival and quality of life. Several modalities of chronic pain management for upper abdominal cancers have been proposed. Coeliac plexus block is widely used for the chronic pancreatic pain management. Most commonly used drug for celiac plexus block is 100% alcohol. This study is comparison between two drugs used for celiac plexus block.Objectives: To compare the efficacy in view of duration and pain relief with Inj. Methylprednisolone 80mg versus alcohol 50% in coeliac plexus block in chronic abdominal pain management.Materials and Methods: A Retrospective study was conducted on 18patients (group A-9 and group B-9) with chronic abdominal pain who underwent coeliac plexus block for chronic pain management, in Yenepoya Medical College and Hospital from January 2016 to December 2018.Group-A: 50% alcohol as adjuvant with 1%lignocaineGroup B: 80mg Methylprednisolone, as adjuvant with 1% lignocaineComparison of pain scores (average) were done at the end of every month for 6 months using Numerical Rating score (NRS) as per the data collected.Results: Group A had lesser NRS scores when compared to Group B. The statistical analysis was carried out using Mann Whitney U test. The U value is 5. The critical value of U at p<0.05 is 5 and hence the result is significant with P value of <0.05.Conclusion: Alcohol 50% gives better longer pain relief over methyl prednisolone 80mg in coeliac plexus block in chronic pain management.

ObjectivesTotal knee replacement can be a successful operation for pain relief. However, 10–34% of patients experience chronic postsurgical pain. Our aim was to synthesise evidence on the effectiveness of applying...

Medicinal plants used in the management of chronic joint pains in Machakos and Makueni counties, Kenya

Pain control in chronic and acute disease conditions such as cancer pain or post-operative pain is often adequate with the help of appropriate pharmacological agent. A&nbsp;comprehensive&nbsp;review of numerous studies conducted to evaluate the efficacy of hydromorphone (OROS) for the management of acute and chronic pain was performed. Data from 17 controlled trials were reviewed, taking into consideration the usefulness of hydromorphone for the management of chronic and acute pain. Heterogeneity of the studies and the small number of patients involved made the conclusion difficult. Overall the studies found that osmotic-controlled released oral delivery system (OROS) hydromorphone that is effective in the management of chronic pain. But comparative studies with other opioid analgesics find little difference in efficacy and side effect profile. OROS hydromorphone is effective in the management of chronic pain, but it&rsquo;s usefulness in acute pain is less conclusive. &nbsp; Key words:&nbsp;Hydromorphone, osmotic-controlled released oral delivery system (OROS), chronic pain, acute pain.

Physician-pharmacist collaboration on chronic non-cancer pain management during the opioid crisis: A qualitative interview study.

TENS represents a non-invasive and cost-efficient approach to alleviating chronic lower back pain, providing a viable alternative to pharmaceutical treatments. This article explores the principles, applications, and effectiveness of TENS in managing chronic lower back pain. TENS operates by delivering painless electrical currents to activate nerves beneath the skin's surface, providing flexible and customizable pain relief. It has shown promise in reducing reliance on nonsteroidal anti-inflammatory drugs (NSAIDs) and opioids, thus mitigating potential side effects associated with prolonged medication use. However, the long-term efficacy of TENS remains a subject of debate, and individual differences may influence its effectiveness. This article reviews the existing literature, highlighting the positive impact of TENS on short-term pain relief, especially in the context of lower back pain. Additionally, it discusses variations in research quality and methodology, emphasizing the need for larger-scale trials and personalized treatment plans to enhance its long-term effectiveness. In summary, TENS demonstrates considerable promise as a safe and non-invasive therapeutic choice for addressing chronic lower back pain. While questions remain regarding its long-term efficacy, TENS offers an alternative for patients seeking pain relief without the side effects associated with medication. Future research should focus on personalized approaches and comprehensive studies to further elucidate its role in chronic pain management and improve patients' quality of life.

Alternative therapies in chronic non-cancer pain management: A scoping review of randomized controlled trials.

Practice guidelines for chronic pain management: an updated report by the American Society of Anesthesiologists Task Force on Chronic Pain Management and the American Society of Regional Anesthesia and Pain Medicine.