Pain Management Unit Research Articles

Coping with cancer pain: a qualitative study to explore pain perception and self-coping strategies of patients with cancer in Sri Lanka

Pain is one of the most debilitating symptoms of cancer, substantially diminishing one’s quality of life. The level of pain experienced is eventually determined by the pain coping strategies adopted...

Role of artificial intelligence in perioperative monitoring in anaesthesia.

Artificial intelligence (AI) is making giant strides in the medical domain, and the field of anaesthesia is not untouched. Enhancement in technology, especially AI, in many fields, including medicine, has proven to be far superior, safer and less erratic than human decision-making. The intersection of anaesthesia and AI holds the potential for augmenting constructive advances in anaesthesia care. AI can improve anaesthesiologists' efficiency, reduce costs and improve patient outcomes. Anaesthesiologists are well placed to harness the advantages of AI in various areas like perioperative monitoring, anaesthesia care, drug delivery, post-anaesthesia care unit, pain management and intensive care unit. Perioperative monitoring of the depth of anaesthesia, clinical decision support systems and closed-loop anaesthesia delivery aid in efficient and safer anaesthesia delivery. The effect of various AI interventions in clinical practice will need further research and validation, as well as the ethical implications of privacy and data handling. This paper aims to provide an overview of AI in perioperative monitoring in anaesthesia.

Virtual group psychotherapy for chronic pain: exploring the impact of the virtual medium on participants' experiences.

Virtual psychotherapy for chronic pain (CP) has been shown to be feasible, efficacious, and acceptable; however, little is known about how virtual delivery of group psychotherapy affects participants' experiences. This study aimed to explore the impact of a virtual medium during the coronavirus disease 2019 (COVID-19) pandemic on social interactions and therapeutic processes in the context of group psychotherapy for CP management. This qualitative, interview-based study collected data on 18 individuals who participated in virtual group psychotherapy in a tertiary care pain management unit. Results of the thematic analysis showed 4 themes. First, the ability to participate and connect was modified by not meeting in person. Connections also occurred differently as the usual patterns of interactions changed. Participants described important shifts in how emotions are communicated and subsequent experience of empathy. Finally, the commonality of chronic pain experience was identified as a central driver of connection between participants. Mixed impacts of the virtual medium on group psychotherapy dynamics and processes were found. Future research could explore ways to mitigate the negative impacts.

Guided Self-Help for People with Chronic Pain: Integrated Care in a Public Tertiary Pain Clinic-A Pilot Study.

Globally, chronic pain affects more than 30% of people worldwide and is the leading cause of disability and health care utilisation. Access to timely, person-centred, cost-effective programs is unattainable for most. People living in regional, rural and remote areas are disproportionately affected due to scarcity of services and qualified, multidisciplinary health and medical professionals. Caring and supporting people with chronic pain involves a range of interventions that incorporate a multifaceted bio-psychosocial approach. Tertiary and primary chronic pain services are optimally placed to deliver integrated models of care. This pilot study explored the effectiveness of an integrated Guided Self-Help (GSH) program within a multidisciplinary tertiary pain unit in a public hospital in Australia. A service delivery evaluation was undertaken and a pilot study implemented to determine feasibility and useability of an integrated GSH program for people with chronic pain. A single-group pre-post evaluation was provided to a convenience sample of 42 people referred to the Flinders Medical Centre Pain Management Unit (FMC PMU). Delivered via telehealth or in person by postgraduate students, a manualised GSH workbook was utilised to support adherence and fidelity. Content included goal setting, pain conceptualisation, psychoeducation, activity scheduling, pacing and cognitive strategies. The purpose of the integrated GSH pilot program was to support participants in gaining increased pain literacy, knowledge of effective physical and psychological strategies and enhance self-management of their chronic pain. Levels of psychological distress (PHQ-9 and GAD-7), pain catastrophising (PCS), and pain severity/interference (BPI) were assessed at the beginning and end of support. Integrating the program within a multidisciplinary pain unit intended to facilitate and provide participants with an understanding of their pain through a psychosocial lens, build self-efficacy, and recognise the benefits of other non-medical supports to manage their chronic pain in the future. Outcome data were routinely collected as part of FMC PMU usual practice for clinical and quality assurance purposes, then analysed retrospectively. Thus, under the National Health and Medical Research Council (NHMRC) Ethical Considerations in Quality Assurance and Evaluation Activities guidelines (NHMRC, 2014), and verified by the Southern Adelaide Local Health Network (SALHN) Research Committee (our institutional review board) via email (dated 10/09/2020), ethical review and approval were not required for this project as it constituted a quality improvement activity - specifically, a service delivery evaluation. This project is registered with the SALHN Quality Library (for quality assurance activities that are exempt from ethical approval) (Quality Register ID 3390). Participants showed statistically significant improvements on the PHQ-9 [i.e., mean drop of 2.85 (t = 3.16)], GAD [mean drop of 2.52 (t = 2.71)], and PCS [mean drop of 7.77 (t = 3.47)] with small-to-moderate effect sizes. BPI scores did not change. Results were similar when stratifying analyses by those who completed 2-5 versus 6-12 sessions. Integrating a GSH program for people with chronic pain into a multidisciplinary tertiary pain clinic is an efficacious and scalable way to increase access to effective strategies that can increase self-efficacy and self-management. Novel, scalable, and effective solutions are needed to improve quality of life and address disparities for people with chronic pain. The psychological shifts and benefits observed support efficacy towards self-management strategies that can increase autonomy and quality of life.

Effectiveness of a hybrid arts-based Cognitive Behavioral Therapy intervention for patients with non-malignant chronic pain.

Chronic Pain (CP) is defined as pain that persists or recurs for more than 3 to 6 months and may be conceived as a health condition in its own right. CP is a frequent condition, affecting an estimated 20% of people worldwide and requires special treatment and care. CP can contribute to depression, anxiety, sleep disturbances, poor quality of life and increased health care costs. Psychosocial approaches based on a cognitive conceptualization of pain can provide a solid foundation for research and clinical work. The development of a 10 week-session group treatment was based on key principles from the literature on Cognitive Behavioral Therapy for Chronic Pain (CBT-CP) and Creative Arts Therapy, integrated with advances in research on CP management framework. The aim of this study is to evaluate a CBT-CP arts-based group intervention for patients with non-malignant CP addressing the biopsychosocial factors that influence pain perception. A total of 100 University Pain Management Unit outpatients participated, 50 in the intervention group and 50 in the control group (treatment as usual). In analyses of the pretest-posttest research design intervention including all participants, treatment gains were observed in almost all domains examined: severity of pain measured by the Brief Pain Inventory, conceptualization of mental pain measured by the Orbach and Mikulincer Mental Pain Scale, tolerance for psychological pain measured by the Tolerance for Mental Pain Scale, anxiety and depression levels measured by the Hospital Anxiety and Depression Scale, and quality of life measured by the WHO Quality of Life-BREF Questionnaire. The participants' mean age was 52.3 years and most were female (84%). Findings suggest that postprogram, there was significant reduction in pain intensity (p<0.001), depressive symptoms (p<0.001), confusion about pain (p=0.037), and improvement of emotional distress tolerance (p=0.012) and global health-related quality of life (p<0.001) in the intervention group. Beneficial effects can be expected from the implementation of an integrated CP intervention (including: creative and CBT techniques) reappraising some of the coping responses defined as adaptive within current psychosocial non-malignant CP regimens.

Median Nerve Neural Mobilization Adds No Additional Benefit When Combined with Cervical Lateral Glide in the Treatment of Neck Pain: A Randomized Clinical Trial.

Background: This study aimed to compare the effectiveness of cervical lateral glide (CLG) added to median nerve neural mobilization (MNNM) in patients with neck pain (NP). Methods: A single-blinded randomized controlled clinical trial was carried out in a Pain Management Unit from a Hospital. A total sample of 72 patients with NP was recruited from a hospital. Patients were randomized to receive isolated CLG (n = 36) or CLG + MNNM (n = 36). Bilateral elbow extension range of motion (ROM) on upper limb neurodynamic test 1 (ULNT1), bilateral pressure pain thresholds (PPT) on the median nerve at elbow joint, C6 zygapophyseal joint and tibialis anterior, Visual analogue scale (VAS), body chart distribution of pain, active cervical ROM (CROM), Neck Disability Index (NDI), and Tampa Scale of Kinesiophobia (TSK-11) were measured at baseline as well as immediately, 15 days, and 1 month after treatment. Results: There were no statistically significant interactions (p > 0.05) between treatment and time for median nerve mechanosensitivity outcomes, pain intensity, symptom distribution, and PPT of the widespread pain assessment, as well as cervical function, and kinesiophobia. Conclusions: MNNM gave no additional benefit to CLG in patients with NP regarding pain intensity, symptom distribution, mechanosensitivity, functionality, and kinesiophobia. Only two treatment sessions and the short follow-up are important issues, therefore, justifying further studies to answer the research question with better methodology.

Pulsed Radiofrequency of the Occipital Nerves: Results of a Standardized Protocol on Chronic Headache Management.

BackgroundPulsed radiofrequency (PRF) of the occipital nerves has neuromodulative properties and is used for chronic pain management. However, its role in various types of chronic headaches has not been adequately investigated so far.ObjectivesΤhis was an observational, open-label, prospective study aiming to assess the efficacy of PRF of occipital nerves on various types of chronic headache management.MethodsPatients with chronic headaches followed up at the pain management unit were scheduled for PRF of both occipital nerves after a positive diagnostic nerve block. PRF was applied following a standardized protocol at 42°C, and the number of headaches per month was assessed as a primary outcome at baseline (before treatment), as well as after 1, 3, and 6 months. Pain intensity during headache crises was recorded using the Numeric Rating Scale (NRS, 0 - 10),ResultsFifty-seven patients suffering from chronic migraines, cluster headaches, tension-type headaches, and occipital neuralgia were studied. PRF significantly improved the number of headache episodes per month, as well as the pain intensity of the crises. The median number of headache episodes per month was significantly reduced in patients with migraine, from 14.5 to 4 after 1 month, and to 6.5 after 6 months. The same was seen for patients with clusters, who were also improved. A statistically significant reduction in NRS values over time was seen for all types of headaches.ConclusionsPRF of the occipital nerves can lead to a reduction of the number of headache episodes per month, improving the intensity of pain during each episode.

Observational Study of Qigong as a Complementary Self-Care Practice at a Tertiary-Care Pain Management Unit.

Qigong, which can be characterized in many different ways, is offered as a complementary self-care practice at a tertiary-care pain management unit in Halifax, Nova Scotia. This report provides a quantitative and qualitative assessment of two groups engaged in qigong practice in this context as part of two Research in Medicine (RIM) projects (2014-15, 2016-17). It includes assessments of pain, mood, quality of life, sleep, and fatigue, considers outcomes in relation to the amount of practice, and considers whether health attitudes would help determine who might benefit from the practice. There were 43 participants (28 ongoing practitioners, 15 new to qigong). The ongoing practice group in RIM2 had significant benefits over time in pain, mood, quality of life, and fatigue in quantitative scores, but changes were not significant in RIM 1. There were no differences in any measures in those new to qigong. Qualitative comments in core and other domains reflected good or better outcomes in 16 subjects in the ongoing group who practiced consistently. In those who practiced less, results were more variable. In most of those new to qigong, the practice was limited and comments indicate minimal changes. Those engaged in qigong have a stronger internal health locus of control than control subjects. Diligent qigong practice provides multiple health benefits for those with chronic pain, and qualitative assessments are essential for documenting these effects. For those new to qigong, factors needed to effectively engage practice need to be explored further to optimize program delivery. The trial is registered with http://www.clinicaltrials.gov (NCT04279639).

Catastrophe Disguised as a Complication After Epiduroscopy-A Case Study

Background: Epiduroscopy is a minimally invasive technique that enables diagnosis and treatment within the epidural space with direct vision. Previously reported complications of this technique have been mostly mild neurological complications of a transitory nature. In the present case, we describe a serious complication following an epiduroscopy, resulting in death. Case Report: The patient was a 39-year-old woman with lower back and lower limb pain who had undergone 3 surgical interventions previously on the lumbar spine. Only limited results from conservative and interventional treatment had been observed. She underwent an epiduroscopy in the Pain Management Unit. Immediately after the procedure, which was completed without incident, the patient presented neurological symptoms with areflexic paraplegia and a loss of sensation in the lower limbs and the upper left limb. Imaging tests identified signs of craniospinal hypotension that progressed slowly despite medical intervention. Ventricular dilation and cerebral edema without remission occurred, which ultimately caused the patient’s death 2 months after admission to the intensive care unit. Conclusion: Epiduroscopy has the potential to present adverse effects and complications. A thorough evaluation of the clinical history and the imaging tests are advisable Key words: Complications, epiduroscopy, low back pain, spinal cord, spinal endoscopy

Interventional pain management during SARS-CoV-2 pandemic

Background: SARS-CoV-2 virus resulted in a sudden dreadful outbreak, posing a serious global public health problem consuming most of the healthcare resources. Requirement to allocate the existing resources for SARS-CoV-2 management during the pandemic has led to significant challenges in pain management as well as in other healthcare services. Objectives: This study aimed to report the outcomes of an interventional pain management unit of a COVID-free hospital, where a fraction of medical services is being provided through telemedicine, and where patients and healthcare workers are screened periodically, in addition to the implementation of guideline-recommended key precautions. Study design: Retrospective chart review. Setting: Pain clinic of a private COVID-free hospital. Methods: A total of 83 patients asymptomatic for SARS-CoV-2 and scheduled for interventional pain management (epidural injection, epidural neuroplasty, peripheral nerve and sympathetic ganglion block, and radiofrequency interventions for non-malignant pain; celiac-splanchnic impar ganglion neurolysis and epidural-spinal port catheter implantation for malignant pain) were screened using reverse transcriptase polymerase chain reaction (RT PCR), Immunoglobulin G and Immunoglobulin M antibodies, and computerized tomography (CT) imaging prior to the intervention and were then followed-up for a minimum duration of 30 days. All healthcare workers of the hospital as well as the staff in the pain management center were monitored with RT-PCR tests performed every 5 days. The efficacy of pain management interventions was assessed using a 10-point visual analogue scale (VAS), while a 5-point post-intervention questionnaire was used to measure the patient satisfaction regarding telemedicine practices, where 5 indicates maximum satisfaction. Results: Patients were finally diagnosed as follows: 2 (2.4%) patients, PCR-confirmed SARS-CoV-2 infection; 3 (3.6%) patients, previous SARS-CoV-2 infection; 13 (15.7%) patients, suspected SARS-CoV-2 infection; and 65 (78.3%) patients, no SARS-CoV-2 infection. Three out of the 517 healthcare workers (0.6%) had PCR positivity in routine screening performed throughout the study, and all these three subjects were asymptomatic. Following interventional treatment, VAS scores were significantly reduced at 2 weeks when compared to baseline (3.9 ± 1.3 vs. 8.6 ± 1.0, P &lt; 0.001), and this reduction was maintained until month 1. Mean satisfaction scores for the communication with the physician using telemedicine methods and for the follow-up management using telemedicine methods were 3.0 ± 0.9 and 3.7 ± 0.6, respectively. None of the patients had steroid-related side effects and none developed new-onset SARS-Cov-2 confirmed or suspected infection throughout the study. Limitations: Retrospective design and relatively small sample size. Conclusion: Our findings suggest that effective diagnostic tests/imaging studies aimed at detecting infected patients and healthcare workers, and telemedicine practices contribute to the provision of safe and feasible pain management practices during the SARS-CoV-2 pandemic.

Patients' perspectives on methods of assessing pain

Pain questionnaires often serve as an assessment tool for initial consultations in chronic pain clinics. The Pain Management Unit (PMU) is a tertiary care centre in Halifax, Nova Scotia. A number of clinicians in the PMU have noted that some patients express that questionnaires are time consuming to complete and believe they are not used in a manner that is helpful to their health care. The effectiveness of questionnaire-based pain evaluation is an area of active research. Text-heavy questionnaires have been criticized for their reliance on literacy and for the format’s inability to facilitate patient self-expression. Other methods of assessing pain have been suggested, including those that use pictograms, photographs and technology. This study was designed to gauge patients’ opinions on the current pain assessment method used in the PMU. In addition, it aimed to evaluate if incorporating art and technology appealed to current patients. The ultimate goal of this study was to evaluate if improvements could be made to patients’ pain assessment experience. Thirty patients were interviewed following their initial consultation appointments at the PMU. Interviews were transcribed verbatim and analyzed using NVivo Software to look for themes expressed by research participants. The study yielded a total of 20 different themes, such as repetition within the questionnaires, and the patient’s desire to incorporate different technologies such as an iPad or computer. Recommendations are proposed based on these themes to help guide the creation or modification of pain assessment tools.

Can Pulsed Radiofrequency of the Occipital Nerves Cause Sedation? A New Perspective of Existing Knowledge.

BackgroundPulsed radiofrequency stimulation (PRF) of the greater and lesser occipital nerves (GON and LON) has neuromodulative and analgesic properties.ObjectivesThe aim of this study was to investigate whether the PRF of the occipital nerves can cause sedation.MethodsThis is an observational case series study in Pain Management Unit of Attikon University Hospital. Patients suffering from primary headaches were scheduled for PRF of occipital nerves following a standardized protocol. The Bispectral Index device was applied and recorded every minute throughout the procedure.Results22 patients were studied. BIS values were lowered in all but three patients during GON stimulation, and in all patients during LON stimulation. Values of decline compared to baseline ranged between 0 - 23 (median 8.5) for GON and 1 - 27 (median 14) for LON, with LON decline being significantly lower.ConclusionsPRF at the occipital nerves led to mild sedation in all patients. Further studies are required to investigate this effect and clarify the exact mode of action of pulsed radiofrequency.

Impact of combining pulsed and thermal radiofrequency on long-term therapy of idiopathic trigeminal neuralgia: A prospective study

ABSTRACT Background Trigeminal neuralgia (TN) is a painful condition characterized by sudden onset, severe unilateral, brief, stabbing recurrent episodes electric shock like pain in the distribution of one or more branches of the trigeminal nerve. Many approaches were used for treatment of TN as balloon decompression, thermocoagulation radiofrequency (TRF), and pulsed radiofrequency (PRF). Objectives This study evaluated the effectiveness of combined PRF and TRF for long-term therapy of patients with idiopathic TN. Patient and methods Our prospective study was carried out after the approval of ethical committee of Zagazig University Hospital Pain Management Unit from June 2017 to May2019. Overall, 20 adult patients suffering from idiopathic TN who treated with combining PRF and TRF for the gasserian ganglion. PRF (continuous for 20 min, at 42°C) followed by TRF (for 60 s at 70°C, then for 60 s, at 75°C) was performed to the gasserian ganglion. The post-operative pain relief and complications were evaluated at first day, 1, 3, 6, 12, 18, and 24 months after treatment. Results There were significant improvements of pain relief as regards Visual Analog Scale showed baseline VAS [8.65 ± 0.59] and first day, 1, 3, 6, 12, 18, 24 months [3.60 ± 1.09, 2.55 ± 0.69, 1.7 ± 0.65, 1.05 ± 0.68, 0.85 ± 0.67, 0.80 ± 0.69, 0.9 ± 0.69], respectively, facial numbness and postoperative masseter muscle weakness recovered more rapidly in patients receiving combined PRF and TRF therapy. Conclusion Combination of PRF followed by TRF is effective in treating TN pain with minimal postoperative complications.

Opioides fuertes y dolor crónico no oncológico en Cataluña. Análisis del patrón de prescripción por parte de los médicos de familia

ObjectiveTo identify family doctor prescription patterns for strong opioids for chronic, non-cancer-related pain. Materials and methodsDesign A descriptive study based on a self-administered email questionnaire. LocationAll primary health care centres in Catalonia. Participants3,602 family doctors, all members of the Catalan Society of Family and Community Medicine. InterventionsEmail survey of Catalan family doctors. Main measurementsDemographic data, number of patients treated with potent opioids for chronic non-cancer pain, type of opioid used and indications, prescribing patterns and relationship with the Pain Management Unit. ResultsA total of 551 answers were obtained from 3,602 questionnaires sent (response rate of 15.3%), in which 480 physicians (87%) prescribed strong opioids for musculoskeletal pain, 268 (48.6%) prescribed ultra-rapid fentanyl and 434 (78.7%) reduced benzodiazepines dosage when prescribing potent opioids. The most common adverse effects were constipation and nausea. The main problems related with opioid prescription were improper use (341, 71%) and patient and/or practitioner reluctance (87, 18.1%). The assessment of the relationship with Pain Management Units was 2±1 (on a 1 to 5 scale), with communication (271, 52.2%) and accessibility (141, 27.1%) being the areas most in need of improvement. ConclusionsOpioid prescribing patterns generally follow clinical guidelines (e.g. reduction of benzodiazepine use or dose titration). However, there are some areas of improvement, such as sparse use of laxatives or use of ultra-rapid opioids for unapproved indications and in patients with no background opioid therapy. Family doctors perceive patient reluctance to adhere to the prescribed treatment, and call for specific training and better relationships with Pain Management Units.

Chemotherapy-induced neuropathic pain characteristics in Mexico's National Cancer Center pain clinic.

Introduction: Chemotherapy (CT) is one of the most commonly used pharmacological approaches in cancer treatment. However, CT induces damage to several tissues causing significant deleterious effects in cancer survivors being chemotherapy-induced neuropathic pain (CINP) among the most commonly reported. CINP is thought to be present in up to 68.1% of the patients within 1 month of receiving CT. Due to the fact that reliable statistic information is scarce in several Latin American countries’ diagnosis and treatment of this side-effect may be delayed directly affecting patients. Therefore, the aim of the present study was to determine and present the incidence and features of CINP in patients with cancer attending the Pain Management Clinic at Mexicos’ National Institute of Cancerology in Mexico City.Methods: We performed a retrospective, file-based analysis of all the patients treated in the Pain Management Clinic at the National Institute at Cancer in Mexico from January 2016 to January 2017.Results: CINP was found in 30.9% of the patients. The basal VAS was on average 2.5 upon arrival to the Pain Management Unit and 2.4 at the end of treatment (p>0.05). The patients with the highest risk of developing CINP were those treated with paclitaxel Odds ratio 8.3 (p<0.01), followed by platins OR 4 (p<0.01), vincristine OR 1.5 (p=0.01) and thalidomide OR 1.1 (p=0.01).Conclusion: Incidence of CINP was similar to previous reports; however, the number of variables related to this type of pain in our cohort may open a new line of research and highlight the importance of this particular issue to our health system. It is necessary to develop a mechanism to predict the risk of patients to suffer CINP and to search the mechanism to control and reduce the suffering related to the current treatments.

Occupational exposure to sevoflurane following topical application to painful wounds.

Background:Occupational exposure to halogenated anesthetics employed for general anesthesia has been extensively studied. Conversely, a new modality of treatment of painful wounds with topical sevoflurane lacks exposure studies.Objectives:To evaluate the magnitude of acute occupational exposure to sevoflurane following topical application to painful wounds.Methods:Four patients with chronic painful wounds were treated with topical sevoflurane (20, 20, 20 and 10 mL) following an approved therapeutic protocol in our Pain Management Unit. Eight passive dosimeters were placed at different locations of a treatment room with a volume of 163 m3 and 3.3 air changes per hour: 3 for near peak (for 20-50 min) and 1 overall exposure (for 3.4 h) at the nurse’s breathing zone, and 4 for area exposure (for 3-3.4 h). Worst-case scenario theoretical concentrations of sevoflurane were also calculated.Results:The highest levels were obtained for two dosimeters worn by the nurse at the breathing zone (8.28 and 9.12 ppm-TWA [parts per million-Time-Weighted Average]), while the lowest level was obtained from the dosimeter placed on the most distant wall from patients (0.73 ppm-TWA). Theoretical concentrations were calculated from standard volatilization principles and were in agreement with the concentrations measured.Discussion-Conclusions:All air concentrations measured were lower than exposure limits set by occupational safety agencies from Finland, Sweden and Norway, which range from 10 ppm for a TWA of 8 hours to 20 ppm for short-term exposures (15 min). Application of topical sevoflurane on wounds seems to be environmentally safe for health-care professionals as it produces exposure levels lower than the established limits for anesthetic procedures.

Fluoroscopic Guided Radiofrequency of Genicular Nerves for Pain Alleviation in Chronic Knee Osteoarthritis: A Single-Blind Randomized Controlled Trial

Nowadays, pain and disability due to chronic knee arthritis is a very common problem in middle aged people. A lot of modalities for management are available, including conservative analgesics and up to surgical interventions. Radiofrequency ablation of genicular nerves is assumed to be an effective less invasive and safe pain alleviation modality. To evaluate the efficacy of fluoroscopic guided radiofrequency neurotomy of the genicular nerves for alleviation of chronic pain and improvement of function in patients with knee osteoarthritis. A single-blind randomized controlled trial. Pain management unit, and Rheumatology and Rehabilitation clinics of Assiut University hospitals, Assiut, Egypt. This study involved 60 patients with chronic knee osteoarthritis. Radiofrequency neurotomy of the genicular nerves was done for 30 patients (Group A) while the other 30 patients (Group C) received conventional analgesics only. The outcome measures included visual analog scale (VAS), Western Ontario and McMaster Universities Index (WOMAC), and Likert scale for patient satisfaction in the 2nd week,3rd, and 6th months. There were significant differences regarding the VAS in the 2nd week, 3rd, and 6th months between the 2 groups, and a significant difference in total WOMAC index in the 6th month only. There were significant changes when comparing pretreatment values with the values during the whole follow-up period with regard to the VAS and total WOMAC index in both groups. No diagnostic block was done prior to radiofrequency. We recommend the use of such a technique on a larger number of OA patients, with a longer follow-up period. RF can ameliorate pain and disability in chronic knee osteoarthritis in a safe and effective manner. Chronic pain, radiofrequency (RF), knee osteoarthritis.

The utility of universal urinary drug screening in chronic pain management

ABSTRACT Background A recent systematic review found few studies that assessed the value of urinary drug screening (UDS) in the management of chronic pain. The Pain Management Unit in Halifax, Nova Scotia, has recently implemented tandem mass spectrometry (TMS) UDS for all new patients. Aims To study the prevalence of unexpected TMS UDS results at a hospital-based chronic pain center, to assess which drugs are most likely to contribute to an unexpected result and to assess the clinical utilization of unexpected results by pain physicians. Methods From June 2014 to June 2016, a total of 664 patients with chronic non-cancer pain (CNCP) were seen for initial consult. Charts were reviewed and used to create a database containing sex, age, UDS result, physician, and medication/illicit drug history. For all unexpected UDS results, an interview was conducted with the treating physician to determine its clinical implications. Results For the general pain specialists, the overall percentage of patients with an unexpected UDS result was 16.67%. Excluding codeine, at most 4.47% of patients tested unexpectedly positive for a strong opioid. Although eight out of nine physicians found UDS helpful in general, only 29.58% of unexpected results were helpful in the management of their patients and directly influenced their care. Conclusions The prevalence of an unexpected UDS result in patients with CNCP is significant. Most physicians agree that UDS is helpful but in only a limited number of cases did the unexpected result provide helpful information that significantly influenced patient care.

Botulinum toxin improves pain in chronic anal fissure

IntroductionChronic anal fissure is a common condition associated with intense pain. Local botulinum toxin injection is a valid option in its management. The purpose of this study was to evaluate the efficacy of botulinum toxin on pain relief in chronic anal fissure patients. MethodsWe conducted a retrospective cohort study, involving 81 consecutive patients referred to a chronic pain management unit due to a chronic anal fissure for treatment with botulinum toxin, during a 4 year period. Data were collected from hospital records regarding pre-treatment and post-treatment pain (numeric rating scale), side effects, need for botulinum toxin reinjection and need for surgical treatment. We used standard statistical methods for inter (t-test and qui2) and intra-group (paired sample t-test) comparisons, according to variables distribution. ResultsPain intensity rest score significantly improved after BoNT injection [variation: −4.2±2.9 (p<0.001)], as did pain post-defecation score [variation: −5.1±3.0 (p<0.001)]. 8.6% needed botulinum toxin reinjection and 23.5% were submitted to surgery. Side effects were reported in 8.6%. DiscussionThe efficacy of botulinum toxin use on pain reduction along with its non-permanent and minor side effects support its role in the resolution of chronic anal fissure. However, treatment failure in the long term is still significant. ConclusionBotulinum toxin is effective on pain relief in patients with chronic anal fissure, which supports its inclusion in the management algorithm of this condition.

Assessment of predictors of the impact of fibromyalgia on health-related quality of life 12 months after the end of an interdisciplinary treatment

ObjectiveFibromyalgia is a chronic pain disorder with a range of comorbid symptoms, including anxiety. We aimed to prospectively identify predictors of the long-term impact of fibromyalgia on health-related quality of life after the end of an interdisciplinary intervention. Methods138 patients with fibromyalgia, selected from a hospital pain management unit, participated in a 6-week interdisciplinary treatment that combined coordinated psychological, medical, educational, and physiotherapeutic interventions. Participants completed the Fibromyalgia Impact Questionnaire and the Hospital Anxiety and Depression Scale at baseline and 6 weeks, 6 months, and 12 months after the intervention. Multivariable generalized linear mixed models were developed, using the Fibromyalgia Impact Questionnaire score as a continuous variable. ResultsVariables that were significant predictors of the long-term impact of fibromyalgia on health-related quality of life in patients who completed a 6-week interdisciplinary treatment were marital status, the number of concurrent conditions, years since the onset of pain, and symptoms of anxiety. In the longitudinal analysis, patients with symptoms of anxiety had lower rates of improvement than those without symptoms of anxiety. DiscussionOur results suggest that patients with lower level of anxiety have less impact on their HRQoL. The results also provide evidence that starting interventions as soon as possible is an important factor for improving health-related quality of life.