Chronic postoperative inguinal pain
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The effect of repetitive infiltrations as a part of a new multidisciplinary algorithm for chronic postoperative groin pain
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Humble Syst Rv Periop NeuP 2015 EJP
Gabapentin reduced acute pain after mastectomy and decreased the incidence of chronic pain in two studies. A single dose of gabapentin was ineffective for reducing thoracotomy pain when an epidural was also used. Regional anesthesia and intravenous lidocaine reduced chronic pain incidence after mastectomy or thoracotomy in several studies. Ketamine and intercostal cryoanalgesia did not reduce chronic pain. Total intravenous anesthesia may reduce post-thoracotomy pain in one study.
Supplement maarten-loos
This document describes the background and findings of Maarten Loos' thesis on the surgical management of chronic inguinal pain syndromes. It provides details about Loos' education and research focusing on chronic pain after hernia repair and Pfannenstiel incisions. The summary describes Loos' research finding high rates of chronic pain after these procedures, identifying nerve entrapment as a common cause. It also outlines Loos' classification of post-herniorrhaphy pain syndromes and studies evaluating treatments like nerve blocks and neurectomy.
Acupuncture for postoperative pain
The document summarizes a systematic review that analyzed 15 randomized controlled trials on the use of acupuncture and related techniques for postoperative pain management. The review found that acupuncture was associated with significant reductions in postoperative opioid consumption, pain intensity, and opioid-related side effects such as nausea, dizziness, and sedation, compared to sham controls. Specifically, acupuncture reduced opioid use by 23-29 mg at 8-72 hours postoperatively and decreased pain scores at 8 and 72 hours. The studies involved a variety of surgeries and acupuncture methods.
DYNAMIC MONITORING OF THE EFFECT OF SPECIAL KINESITHERAPEUTIC PROGRAM ON PAIN...
DYNAMIC MONITORING OF THE EFFECT OF SPECIAL KINESITHERAPEUTIC PROGRAM ON PAIN...International Journal of Technical Research & Application
Objective: To assess the effect of a kinesitherapeutic
program of special exercises for treatment of pain intensity and
endurance of the extensor trunk muscles in patients with
chronic lumbalgy.
Methods: The study included 110 patients with chronic
lumbalgy, equally distributed in two treatment groups.
Participants in the experimental group performed the
recommended special exercises 3 times a week at home, while
those in the control group only followed the guidelines of a
physician. At the beginning of the study and 12 months later,
the pain intensity of all the participants was assessed by means
of Visual Analog Scale.
Results: In contrast to the participants in the control
group, those in the experimental group at the end of observation
were reported to experience a significant reduction in pain
intensity.
Conclusions: Treatment with specific exercises proved
more effective in terms of pain complaints in patients with
chronic lumbalgy.
Management of fms Hauser 2017
The document summarizes guidelines from Canada, Germany, Israel, and Europe for the diagnosis and management of fibromyalgia (FM). Key points include:
- FM is a prevalent condition affecting approximately 2% of the population. It is characterized by chronic widespread pain, fatigue, sleep disturbances, and other symptoms.
- Diagnosis is based on a history and exam showing widespread tenderness. Basic tests can rule out other conditions.
- Optimal management begins with education and a graduated approach focusing first on lifestyle changes like exercise. Cognitive behavioral therapy and medications may also be considered.
- Guidelines agree the diagnosis is clinical. Exams and tests aim to rule out other conditions causing pain. History should include symptoms of pain, fatigue,
ZMPCZM016000.11.08
This article reviews recent literature on the application of transcutaneous electrical nerve stimulation (TENS) for pain management. Several studies have found TENS to be effective for acute postoperative pain, reducing medication needs and facilitating earlier recovery. TENS placed near surgical incisions reduced pain and medication requirements after procedures like laparotomy, cholecystectomy, and laminectomy. TENS may also benefit rehabilitation after knee surgery by reducing pain and narcotic use, allowing for earlier quadriceps strengthening and range of motion. While specific stimulation settings do not seem to impact outcomes, proper electrode placement is important. Overall, TENS is an effective non-pharmacological option for acute pain that facilitates recovery after surgery and injury.
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Effect of Intraoperative Bupivacaine Infiltration for Post-Operative Pain Rel...International Journal of Science and Research (IJSR)
A single blind RCT to evaluate the effect of intraoperative bupivacaine infilteration fro post operative pain relief was conducted. Observations based on the VAS and mean duration for requirement of 1st analgesic dose post operatively. Results compared with other similar studies and found that the there is significant reduction in the VAS of post operative pain and increase in the duration for requirement for the 1st dose of the analgesic postoperatively
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The main findings of upper endoscopy in 133 patients with laryngopharyngeal reflux were:
1. Gastritis was found in 77% of patients, esophagitis in 59%, and hypofunction of the cardia in 40%.
2. Hiatal hernia was identified in 32% of patients.
3. Barrett's esophagus and neoplasms were found in 9% and 2.2% of patients respectively.
4. Only 12% of patients had a normal endoscopy.
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The dry needling of myofascial pain syndrome trigger points provided pain relief compared to sham needling.
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Humble Syst Rv Periop NeuP 2015 EJP
Gabapentin reduced acute pain after mastectomy and decreased the incidence of chronic pain in two studies. A single dose of gabapentin was ineffective for reducing thoracotomy pain when an epidural was also used. Regional anesthesia and intravenous lidocaine reduced chronic pain incidence after mastectomy or thoracotomy in several studies. Ketamine and intercostal cryoanalgesia did not reduce chronic pain. Total intravenous anesthesia may reduce post-thoracotomy pain in one study.
Supplement maarten-loos
This document describes the background and findings of Maarten Loos' thesis on the surgical management of chronic inguinal pain syndromes. It provides details about Loos' education and research focusing on chronic pain after hernia repair and Pfannenstiel incisions. The summary describes Loos' research finding high rates of chronic pain after these procedures, identifying nerve entrapment as a common cause. It also outlines Loos' classification of post-herniorrhaphy pain syndromes and studies evaluating treatments like nerve blocks and neurectomy.
Acupuncture for postoperative pain
The document summarizes a systematic review that analyzed 15 randomized controlled trials on the use of acupuncture and related techniques for postoperative pain management. The review found that acupuncture was associated with significant reductions in postoperative opioid consumption, pain intensity, and opioid-related side effects such as nausea, dizziness, and sedation, compared to sham controls. Specifically, acupuncture reduced opioid use by 23-29 mg at 8-72 hours postoperatively and decreased pain scores at 8 and 72 hours. The studies involved a variety of surgeries and acupuncture methods.
DYNAMIC MONITORING OF THE EFFECT OF SPECIAL KINESITHERAPEUTIC PROGRAM ON PAIN...
DYNAMIC MONITORING OF THE EFFECT OF SPECIAL KINESITHERAPEUTIC PROGRAM ON PAIN...International Journal of Technical Research & Application
Objective: To assess the effect of a kinesitherapeutic
program of special exercises for treatment of pain intensity and
endurance of the extensor trunk muscles in patients with
chronic lumbalgy.
Methods: The study included 110 patients with chronic
lumbalgy, equally distributed in two treatment groups.
Participants in the experimental group performed the
recommended special exercises 3 times a week at home, while
those in the control group only followed the guidelines of a
physician. At the beginning of the study and 12 months later,
the pain intensity of all the participants was assessed by means
of Visual Analog Scale.
Results: In contrast to the participants in the control
group, those in the experimental group at the end of observation
were reported to experience a significant reduction in pain
intensity.
Conclusions: Treatment with specific exercises proved
more effective in terms of pain complaints in patients with
chronic lumbalgy.
Management of fms Hauser 2017
The document summarizes guidelines from Canada, Germany, Israel, and Europe for the diagnosis and management of fibromyalgia (FM). Key points include:
- FM is a prevalent condition affecting approximately 2% of the population. It is characterized by chronic widespread pain, fatigue, sleep disturbances, and other symptoms.
- Diagnosis is based on a history and exam showing widespread tenderness. Basic tests can rule out other conditions.
- Optimal management begins with education and a graduated approach focusing first on lifestyle changes like exercise. Cognitive behavioral therapy and medications may also be considered.
- Guidelines agree the diagnosis is clinical. Exams and tests aim to rule out other conditions causing pain. History should include symptoms of pain, fatigue,
ZMPCZM016000.11.08
This article reviews recent literature on the application of transcutaneous electrical nerve stimulation (TENS) for pain management. Several studies have found TENS to be effective for acute postoperative pain, reducing medication needs and facilitating earlier recovery. TENS placed near surgical incisions reduced pain and medication requirements after procedures like laparotomy, cholecystectomy, and laminectomy. TENS may also benefit rehabilitation after knee surgery by reducing pain and narcotic use, allowing for earlier quadriceps strengthening and range of motion. While specific stimulation settings do not seem to impact outcomes, proper electrode placement is important. Overall, TENS is an effective non-pharmacological option for acute pain that facilitates recovery after surgery and injury.
Effect of Intraoperative Bupivacaine Infiltration for Post-Operative Pain Rel...
Effect of Intraoperative Bupivacaine Infiltration for Post-Operative Pain Rel...International Journal of Science and Research (IJSR)
A single blind RCT to evaluate the effect of intraoperative bupivacaine infilteration fro post operative pain relief was conducted. Observations based on the VAS and mean duration for requirement of 1st analgesic dose post operatively. Results compared with other similar studies and found that the there is significant reduction in the VAS of post operative pain and increase in the duration for requirement for the 1st dose of the analgesic postoperatively
BRAINCOMS 2012 - Book of Abstracts
The main findings of upper endoscopy in 133 patients with laryngopharyngeal reflux were:
1. Gastritis was found in 77% of patients, esophagitis in 59%, and hypofunction of the cardia in 40%.
2. Hiatal hernia was identified in 32% of patients.
3. Barrett's esophagus and neoplasms were found in 9% and 2.2% of patients respectively.
4. Only 12% of patients had a normal endoscopy.
5. Helicobacter pylori was positive in 30% of patients.
The dry needling of myofascial pain syndrome trigger points provided pain relief compared to sham needling.
Clinical effect and safety of pulsed radiofrequency treatment for pudendal ne...
The document describes a prospective, randomized controlled clinical trial that compared the clinical effect and safety of pulsed radiofrequency (PRF) treatment combined with pudendal nerve block (NB) to NB alone for treating pudendal neuralgia. Eighty patients were randomly assigned to receive either PRF+NB or NB. Pain levels, depression scores, treatment effects, analgesic use, and adverse events were assessed over 3 months. The results showed that PRF+NB provided significantly greater pain relief and improved depression scores compared to NB alone, with no severe adverse events reported for either group.
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This document discusses approaches to reducing acute and chronic peripheral neuropathic pain. It finds that acute neuropathic pain in the perioperative period after procedures like amputation, mastectomy and thoracotomy is under-recognized and may be treatable with agents targeting neuropathic symptoms. Several trials found gabapentinoids, regional anesthesia and antidepressants reduced chronic pain when used in the perioperative period for high-risk surgeries. However, interventions like ketamine and cryoanalgesia were ineffective. The document recommends screening for neuropathic pain and using routine anti-neuropathic drugs perioperatively to potentially decrease the burden of chronic pain.
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This study examined predictors of pain experienced during oocyte retrieval among 837 women undergoing IVF or ICSI treatment. The mean reported pain level was 1.95 on a 7-point scale. High pain (5-6) was reported by 7% of women. Negative gynecological experiences and hormonal side effects predicted high pain before retrieval, while anxiety, low perceived control, and longer procedure duration predicted high pain after retrieval according to multiple logistic regression. The findings suggest psychological factors like anxiety and perceived control influence pain levels during oocyte retrieval and should be considered in pain management.
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Aquatic vertical traction and land-based supine flexion were compared in patients with low back pain to determine their effectiveness in elongating the spine and reducing pain symptoms. Both interventions significantly increased spinal height and reduced pain compared to pre-treatment levels. However, aquatic vertical traction produced significantly greater reductions in pain. Positive correlations were also found between spinal height increases from aquatic vertical traction and improvements in pain and centralization. While the study had some validity threats, its findings suggest aquatic vertical traction may be more effective than land-based flexion for immediately reducing low back pain symptoms.
Pemf on early knee osteoarthritis
This randomized, double-blind pilot study examined the effects of pulsed electromagnetic field (PEMF) therapy on pain in patients with early knee osteoarthritis. 34 patients were randomly assigned to either an active PEMF device group (n=15) or a sham device group (n=19). The PEMF signal was designed to modulate the calcium/calmodulin dependent nitric oxide signaling pathway. Results showed a 50% reduction in pain scores from baseline in the active group starting on day 1 and persisting to day 42, while no significant reduction was seen in the sham group. The overall decrease in pain was nearly threefold greater in the active group. The rapid and sustained pain relief seen with PEMF therapy suggests it may reduce inflammation
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dr. Muh. Takdir - Patient Controlled AnalgesiaDepartment of Anesthesiology, Faculty of Medicine Hasanuddin University
PCA is neither “ one size fits all “ or a “ set and forget “ therapy
An Anesthesiologist style ……….
no fixed dose of drug fits all patient
make patient analgesia and take care Evaluating Chronic Pain Patients Using Methods from Johns Hopkins Hospital Ph...
This article describes the use of physiological testing, instead of anatomical testing, to evaluate chronic pain. The efficacy of this approach is documented by published outcome studies.,, Patient require surgery 50%-63% of the time to improve.
CIPNDrRusso
This pilot study examined the effects of 10 weeks of weekly acupuncture treatments on 11 patients experiencing chemotherapy-induced peripheral neuropathy (CIPN). Acupuncture points targeting nerves affected by CIPN were used. Quality of life, pain levels, and neuropathy symptoms were measured before, during, and after treatment. The results showed significant reductions in neuropathic pain, CIPN symptoms, and improvements in sensory conditions. Non-significant positive trends were also observed for other quality of life measures. The study concluded that acupuncture may reduce pain, symptoms and improve quality of life for those with CIPN.
TF route
A systematic review of 9 studies comparing PEG and NG tube feeding in adults with swallowing disturbances found:
1) PEG was associated with a lower risk of treatment failure, especially in patients with neurological diseases.
2) There was no significant difference in complication rates between PEG and NG tubes.
3) PEG may be associated with a decreased risk of pneumonia compared to NG tubes and longer survival time.
Acti patch relieves delayed onset muscle soreness
This study investigated the efficacy of pulsed electromagnetic field therapy (PEMF) in reducing delayed onset muscle soreness (DOMS) in marathon runners. A double-blind randomized controlled trial assigned 133 marathon runners to either an active PEMF device or placebo device to use for 20 minutes, 4 times per day for 5 days after a marathon. The primary outcome was thigh pain assessed using a visual analog scale during squats. Subjects using the active PEMF device had significantly lower pain scores compared to the placebo group, indicating PEMF reduced DOMS in marathon runners.
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The document discusses the technique of complete mesocolic excision (CME) for colon cancer surgery. It describes CME as the standardized removal of the entire mesocolon and central ligation of supplying arteries based on embryological planes. Studies from Erlangen, Germany show that using CME results in improved lymph node harvest, lower complication rates, reduced local recurrence, and increased 5-year cancer-related survival for colon cancer patients compared to conventional surgery. The expertise of the surgeon also impacts postoperative outcomes.
Tratamiento del cáncer de colon localmente avanzado
This document discusses strategies for treating locally advanced colon cancer. It begins with comparisons to Napoleon's military strategies, emphasizing appreciation of terrain, timing, steady nerve, and teamwork. It then discusses specific challenges of locally advanced colon cancer like invasion of adjacent organs or abdominal wall. Multivisciplinary treatment including neoadjuvant chemotherapy and multivisceral resection is discussed. Recurrent colon cancer and complications of treatment are also mentioned. Throughout, surgical strategies are compared to Napoleon's tactical approaches to warfare.
MCC 2011 - Slide 28
The document discusses total mesorectal excision (TME) as the standard surgery for rectal cancer. It summarizes several trials showing that TME combined with preoperative radiotherapy reduces local recurrence rates compared to radiotherapy and older surgery techniques. The document also discusses techniques to improve quality of TME surgery and reduce sexual dysfunction, as well as standardizing multimodal therapy for rectal cancer.
The Surgery for Rectal Cancer
This document discusses surgical considerations for rectal cancer, including:
1. The total mesorectal excision (TME) technique aims to remove the mesorectum containing all lymph nodes, leading to low local recurrence rates of 3-4% after 5-10 years.
2. Pre-operative chemoradiotherapy can downstage tumours and improve survival, especially for T3/T4 tumours.
3. A modified TME removing the mesorectum at least 5cm below the tumour is acceptable for high and mid rectal cancers, as distal spread beyond this is rare.
4. Good surgical outcomes depend on meticulous technique, surgeon experience operating in the pelvis, and multidis
Surgery for Rectal Cancer
1. Surgery for rectal cancer aims to remove the tumor and surrounding tissue while preserving nerve function to maintain bowel and bladder control.
2. The gold standard surgery is total mesorectal excision (TME), which provides a low local recurrence rate below 10% due to complete removal of surrounding tissue.
3. TME requires meticulous technique by an experienced colorectal surgeon to dissect the rectum from the surrounding tissue while preserving nerves.
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Similar to Chronic postoperative inguinal pain
Inguinodynia by Prof. Ajay Khanna, IMS, BHU, Varanasi, India
Chronic groin pain, known as inguinodynia, occurs in approximately 11% of patients after hernia surgery, with 1/3 of cases being severe enough to interfere with daily activities. This rate of chronic pain is more common than hernia recurrence. Prevention through careful identification and handling of nerves during surgery is important. For select patients who do not find relief through medications, surgical neurectomy combined with mesh removal provides relief from pain in 80-95% of cases. Proper patient selection and surgical technique are needed to minimize the risk of chronic pain after hernia repair.
Do ngoc hieu ta
This document reports on 3 cases of end-stage cancer pain management using long-term epidural catheters at a central transport hospital in Da Lat, Vietnam. In all 3 cases, epidural catheters were inserted and fixed just under the skin to provide long-term pain relief via drugs like morphine and bupivacaine. This resulted in significantly reduced pain levels and ability to perform daily activities with minimal side effects. The document concludes that long-term epidural catheter analgesia is an effective and inexpensive method for managing end-stage cancer pain with few complications.
Prof. Husni - Improving Postoperative Pain Management
Prof. Husni - Improving Postoperative Pain ManagementDepartment of Anesthesiology, Faculty of Medicine Hasanuddin University
To improving postoperative pain management, we need to;
- Always applies multi-modal analgesia. (get the advantages of multimodal analgesia)
- Implementation of the existing EB regarding the use of non-opioid + opioid on as needed basis.
- Use available specific evidence for optimizing multimodal pain management procedure (PROSPECT Web site).ZMPCZM016000.11.08
This article reviews recent literature on the use of transcutaneous electrical nerve stimulation (TENS) to manage acute and chronic pain. For acute pain, TENS has been shown to reduce postoperative pain and medication use when electrodes are placed near incisions and used continuously for 48-72 hours. Studies of TENS for acute dental pain and labor also found it provided pain relief. Treatment outcomes are evaluated using subjective pain ratings and objective measures like pulmonary function and range of motion. While TENS provides pain relief for many acute conditions, its effectiveness for chronic pain varies more between individuals. More research is needed to determine which chronic pain patients respond best to TENS.
ZMPCZM016000.11.08 Applications of TENS in the management of Patients with pain
This article reviews recent literature on the application of transcutaneous electrical nerve stimulation (TENS) for pain management. Several studies have found TENS to be effective for acute postoperative pain, reducing medication needs and facilitating earlier recovery. TENS placed near surgical incisions reduced pain and medication requirements after procedures like laparotomy, cholecystectomy, and laminectomy. TENS may also benefit rehabilitation after knee surgery by reducing pain and narcotic use, allowing for earlier quadriceps strengthening and range of motion. While specific stimulation settings do not seem to impact outcomes, proper electrode placement is important. Overall, TENS is an effective non-pharmacological option for acute pain that facilitates recovery after surgery and injury.
ZMPCZM016000.11.23 Electrotherapy for pain management
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Percutaneous fenestration.pdf
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postoperative-pain-management-good-clinical-practice.pdf
1. The document provides general recommendations and principles for effective postoperative pain management. It discusses goals of pain treatment, physiology of pain including peripheral and central sensitization, tools for pain assessment, patient education, treatment options, and special considerations for different patient groups.
2. Key recommendations include using a multimodal balanced analgesia approach, regular pain assessment with specific tools, patient education, and tailoring strategies to individual needs such as in pediatric patients and the elderly.
3. Effective pain management is important for reducing patient suffering as well as facilitating rapid recovery and early discharge from the hospital.
Pressures sensitivity & phenotypic changes in patients with suspected oih bei...
1) The study assessed changes in pain phenotype and pressure sensitivity in 20 patients with suspected opioid-induced hyperalgesia (OIH) after transitioning from full mu opioid agonists to buprenorphine therapy.
2) Patients on higher opioid doses (≥100 mg oral morphine equivalents) had significant improvements in measures of pain, mood, and function 1 week after starting buprenorphine, with eventual return to baseline.
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PA I N M E D I C I N EVolume 8•Number 8.docx
PA I N M E D I C I N E
Volume 8
•
Number 8
•
2007
© American Academy of Pain Medicine 1526-2375/07/$15.00/657 657–668 doi:10.1111/j.1526-4637.2006.00257.x
Blackwell Publishing IncMalden, USAPMEPain Medicine1526-23752006 Blackwell Publishing Ltd? 200788657668Original
Article
Efficacy and Safety of Fentanyl ITSMinkowitz et al.
Reprint requests to:
Harold S. Minkowitz, MD, Department
of Anesthesiology, Memorial Hermann Memorial City
Hospital, 921 Gessner Rd, Houston, TX 77024, USA.
Tel: 713-932-3436; Fax: 713-242-3664; E-mail:
[email protected]
The current multicenter study was conducted at 39 cen-
ters, which are listed, along with the principal investigator
at each center, in Appendix 1.
Efficacy and Safety of the Fentanyl Iontophoretic Transdermal
System (ITS) and Intravenous Patient-Controlled Analgesia (IV PCA)
with Morphine for Pain Management Following Abdominal or
Pelvic Surgery
Harold S. Minkowitz, MD,* James P. Rathmell, MD,
†
Sue Vallow, RPh, MBA, MA,
‡
Kathryn Gargiulo, RN, MPA,
§
C. V. Damaraju, PhD,
¶
and David J. Hewitt, MD
§
*Department of Anesthesiology, Memorial Hermann Memorial City Hospital, Houston, Texas;
†
Department of Anesthesia
and Critical Care, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts;
‡
Outcomes Research
and Primary Care, Ortho-McNeil Janssen Scientific Affairs, LLC, Titusville, New Jersey;
§
Medical Affairs, Ortho-McNeil,
A B S T R A C T
Inc., Raritan, New Jersey;
¶
Biostatistics, Ortho-McNeil Janssen Scientific Affairs, LLC, Raritan, New Jersey, USA
ABSTRACT
Objective.
The fentanyl HCl iontophoretic transdermal system (ITS) has effectively managed pain
following several types of surgery. This study evaluated the efficacy, safety, and ease of care
associated with fentanyl ITS and morphine intravenous patient-controlled analgesia (IV PCA) for
pain management following abdominal or pelvic surgery.
Design.
This open-label, multicenter, randomized, active-controlled, parallel-group, phase IIIb
study enrolled 506 postoperative patients at 39 U.S. sites. Patients received fentanyl ITS (40
µ
g
fentanyl/dose) or morphine IV PCA (1 mg morphine/dose). The primary efficacy measure was
demonstrating equivalence on the patient global assessment (PGA) of the method of pain control
in the first 24 hours of treatment between the groups.
Results.
Percentages of patients in the fentanyl ITS and morphine IV PCA groups reporting PGA
ratings of “good” or “excellent” in the first 24 hours were statistically equivalent (84.9% vs 84.3%,
respectively; difference
=
0.7%, 95% CI:
−
5.6% to 7.0%). Equivalence was also demonstrated based
on mean last pain intensity scores in the first 24 hours (3.0 vs 2.9, respectively; difference
=
0.1,
95% CI:
−
0.28 to 0.43). Overall discontinuation rates were not significantly different between
groups (16.7% vs 11.8%, respectively;
P
=
.
Pulsed Radiofrequency of Pudendal Nerve for Treatment in Patients with Pudend...
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Percutaneous fenestration for chronic heel pain - البروفيسور فريح ابوحسان – ...
Percutaneous fenestration for chronic heel pain - البروفيسور فريح ابوحسان – ...Prof Freih Abu Hassan البروفيسور فريح ابوحسان
This document describes a study examining the effectiveness of percutaneous fenestration of the anteromedial aspect of the calcaneus for treating chronic heel pain syndrome. 34 patients with chronic heel pain for at least 6 months that did not improve with conservative treatment underwent the fenestration procedure. Pain levels decreased significantly after the procedure based on patient reported pain scores. At 12 months follow up, 100% of patients reported excellent results with no pain. The procedure provides an effective minimally invasive treatment option for recalcitrant heel pain after conservative treatments have failed.‘Neurodynamics as a therapeutic intervention; the effectiveness and scientifi...
This document discusses the evidence for neural mobilization as a treatment for nerve disorders. It begins by reviewing animal studies showing that movement such as exercise prevents neuropathic pain development, aids nerve recovery after injury, and reduces neuropathic pain. However, the evidence for neural mobilization and nerve gliding exercises in humans is limited. A systematic review found limited evidence that neural mobilization is more effective than minimal interventions for pain and disability in carpal tunnel syndrome, but not more effective than other treatments. Another review found limited evidence for the effectiveness of nerve gliding exercises in carpal tunnel syndrome. The document concludes that while movement may be beneficial, the evidence does not clearly support neural mobilization over other conservative treatments, and more high-quality research is
Acupuncture for hysterectomy
This randomized controlled trial investigated the effect of preoperative electric ear acupuncture (EEA) on postoperative pain in patients undergoing abdominal hysterectomy. 56 patients were randomized to receive either EEA using needles in 4 auricular points before and after surgery or spinal anesthesia alone. The EEA group had significantly lower postoperative morphine use in the first 24 hours and better pain scores. No adverse effects were reported from EEA. While EEA showed potential as an analgesic adjuvant, the study was limited by not differentiating the effects of preoperative versus postoperative EEA stimulation and only using one non-opioid analgesic postoperatively. Future studies could compare different types of acupuncture stimulation and utilize multiple non-opioid analgesics.
Preemptive analgesia
Preemptive analgesia is an antinociceptive treatment that prevents the establishment of altered processing of afferent input which amplifies postoperative pain. It was first formulated by Crile who advocated regional blocks in addition to general anesthesia to prevent intraoperative nociception and formation of painful scars. There are three definitions of preemptive analgesia: treatment starting before surgery to prevent central sensitization caused by incisional injury; treatment preventing central sensitization caused by incisional and inflammatory injuries; and treatment covering the period of surgery and initial postoperative period. While some studies found no difference between preincisional and postincisional treatment, others reported modest benefits with preincisional analgesia.
Pain score in ed
This study compared patient pain scores to those assessed by emergency healthcare providers (doctors and triage nurses) in the emergency department of a large Malaysian hospital. The mean patient pain score on arrival was 6.8 out of 10, significantly higher than scores assessed by doctors (5.6) and triage nurses (4.3). Significant differences were found for 5 specific conditions: soft tissue injury, headache, abdominal pain, fracture, and abscess/cellulitis. Upon discharge or admission, nearly half of patients still reported moderate pain, suggesting undertreatment of pain in the emergency department. Accurately assessing patient-reported pain scores is important for effective pain management in emergency medicine.
MBST UZA
This document provides information about Magnetic Resonance Therapy (MRT) treatments using MBST Medical devices. It discusses the company history and international use of over 700 devices. MRT non-invasively treats conditions like arthritis, osteoporosis, and muscle/tendon injuries through cell regeneration. Several clinical studies demonstrate its effectiveness, showing improvements like increased cartilage volume and reduced pain. The document also outlines MRT treatment principles, available MBST device models, pricing, and the treatment process. It encourages questions and provides contact information.
Predicting Medical Test Results and Intra-Operative Findings in Chronic Pain ...
The Pain Validity Test can predict which patient will have abnormal medical test results with 95% accuracy, and surgical abnormalities with 94% accuracy. This on-line questionnaire takes only 5 minutes of staff time to administer, and takes only 15 minutes of patient time.Results are available immediately. This test can be used to document "medical necessity" for insurance pre-authorization for testing and surgery.
ORIGINAL ARTICLE HIP - ANESTHESIAA randomized controlled.docx
ORIGINAL ARTICLE � HIP - ANESTHESIA
A randomized controlled trial of postoperative analgesia following
total knee replacement: transdermal Fentanyl patches
versus patient controlled analgesia (PCA)
M. J. Hall1 • S. M. Dixon2 • M. Bracey3 • P. MacIntyre4 • R. J. Powell3 •
A. D. Toms3
Received: 13 November 2014 / Accepted: 12 February 2015 / Published online: 11 March 2015
� Springer-Verlag France 2015
Abstract
Background This randomized controlled trial compared a
standard patient controlled analgesic (PCA) regime with a
transdermal and oral Fentanyl regime for post-operative
pain management in patients undergoing total knee
replacement.
Methods One hundred and ninety-six patients undergoing
total knee replacement were recruited. Pre- and post-op-
eratively Visual Analogue Score (VAS), Oxford Knee
Score, Health Anxiety and Depression Score and Brief Pain
Inventory Score were completed. According to the day 1,
VAS score patients were randomly allocated to either a
PCA regime or a Fentanyl transdermal/oral regime. Patient
reported outcomes were measured until the patients were
discharged.
Results The results demonstrate that in terms of analgesic
effect, day of discharge and side effect profile the two
regimes are comparable.
Conclusions We conclude that a Fentanyl transdermal
regime provides adequate analgesic effect comparable to a
standard PCA regime in conjunction with a low side effect
profile. Using a transdermal analgesic system provides ef-
ficient continuous delivery enabling a smooth transition
from hospital to home within the first week. Transdermal
Fentanyl provides an alternative analgesic regime that can
provide an equivalent analgesic effect so as to enable a
satisfactory outcome for the patient in terms of function
and pain.
Level of evidence II.
Keywords Total knee replacement � Post-operative
analgesia � Patient controlled analgesia � Fentanyl patches
Introduction
Knee replacement surgery has proved a successful and
cost-effective method for relieving pain and restoring
function in patients with osteoarthritis [1]. However, pain
management after knee replacement surgery remains a
significant problem, with patients reporting this as a major
concern prior to surgery [2]. Implementing relevant pre-
operative screening methods may facilitate the identifica-
tion of individuals at high risk of experiencing high post-
operative pain [3]. Despite recent advances in the aetiology
of pain, improved pain treatments and the development of
clinical guidelines for pain assessment, the under-treatment
of post-operative pain remains a challenge to both surgeon
and anaesthetist. Recent studies have clearly demonstrated
that patient satisfaction following total knee replacement is
multifactorial with the most significant predictor of dis-
satisfaction being a painful total knee replacement [1].
Providing effective pain relief in the post-operative pe-
riod is essential to enable early mobili.
clarity study
- This interim analysis of an ongoing observational study found that topical analgesics may reduce pain severity and interference scores and decrease primary pain complaints and oral pain medication use for patients with neuropathic or musculoskeletal pain.
- Overall patient satisfaction with topical analgesics was high and they were found to be safe and well-tolerated.
- The results were consistent with a previous interim analysis and warrant continuation of the larger OPERA study, though more analysis is still needed.
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ZMPCZM016000.11.08 Applications of TENS in the management of Patients with pain
ZMPCZM016000.11.23 Electrotherapy for pain management
ZMPCZM016000.11.23 Electrotherapy for pain management
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ORIGINAL ARTICLE HIP - ANESTHESIAA randomized controlled.docx
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11. Describe the axes of leads (hexagonal reference system)
12. Comprehend the vectorial analysis of the normal ECG
13. Determine the mean electrical axis of the ventricular QRS and appreciate the mean axis deviation
14. Explain the concepts of current of injury, J point, and their significance
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. Chapter 3, Cardiology Explained, https://www.ncbi.nlm.nih.gov/books/NBK2214/
7. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
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Chronic postoperative inguinal pain
- 1. The effect of repetitive infiltrations as a part of a new multidisciplinary algorithm for chronic postoperative groin pain Nijs Y, Peeters E, Verbeke H, Bruyninckx F, Theys T, Morlion B, Miserez M
- 2. Department Abdominal Surgery, University Hospitals Gasthuisberg, Leuven, Belgium
- 3. Introduction - Chronic postoperative groin pain • 11% to 54% of patients • Subgroup moderate to severe in 1,9% to 3% • Severe impact • QoL/Social/ Physical/Mental/ Sexual • No standardisation • Diagnosis/Work-up/Treatment • Aim - Multidisciplinary standardised protocol • Surgeons, pain therapists, neurosurgery, physical medicine Loos et al, Chronic sequelae of common elective groin hernia repair , Hernia 2007
- 4. Material and methods Inclusion criteria Chronic post-operative groin pain > 6 months and suggestive neuropathic pain (DN4 ≥ 4 and/or LANSS ≥ 12) Exclusion criteria Nociceptive pain, meshoma, hernia relapse, complex pain problems, previous surgery infra-umbilical M. rectus abdominis EMG intake 4 Repetitive injections EMG at 3 months Multidisciplinary decision => Outcome
- 5. Uitsluiten centrale sensitisatie ? Intake EMG 1ste infiltratie 2de infiltratie 3de infiltratie Maand 1 2 weken 2 weken 2 weken 4de infiltratie EM Chirurgie of pijntherapie Maand 2 Maand 3 INTERVENTIE 2 weken 1 maand 2 maanden Evaluatie pijntherapie EMG EMG Maand 3 na interventie Maand 6 Maand 12 1 maand 3 maanden 6 maanden Nadien 6 maandelijkse FU tot jaar 2 met jaarlijkse controle EMG •History •Anamnesis •Clinical examination •Questionnaires
- 6. Multidisciplinary work-up EMG Why ? Sensible nerve conduction studies not possible Selective nerve stimulation unfeasible Inguinal region unfavorable anatomy Severity and chronicity nerve damage Radiculopathy Carpal tunnel Prognostic factor CRD’s ? Crampy contractions Local muscle ischaemia How ? Blinded EMG Rest / Contraction Subcategorized
- 7. • Repetitive injections • Ultra-sound and/or nerve- stimulation guided • Lidocaïn hydrochloride 2% 5ml • Interval 2 weeks • 1st injection ilio- inguinal/ilio-hypogastric nerve • 2nd injection genitofemoral nerve 3rd injection repetition of the most successful 4th injection differential epidural block or transforaminal infiltration Central sensitisation ? Ilioinguinal nerve Iliohypogastric nerve ter Meulen et al, Clin Neurol Neurosurg 2007 Gucev et al, Anesth Analg 2008
- 8. Material and methods VASmax scores Pre-injection, 30 and 60 minutes post-injection, clinical visits Individual plots VASmax post/pre ratio Nijs et al, Long-term outcome of surgical treatment of chronic postoperative groin pain, Hernia 2013
- 9. Material and methods 10 patients Median age 49,4 (30-72) 8 male, 2 female Patient Sex Age Previous Surgery Hernia location Lap/Open Previous neurecto my ? Previous mesh resection ? 1 F 27 Pfannenstiel NA Open 0 0 2 M 31 TAPP Right Lap 0 0 3 M 50 Lichtenstein Left Open 0 0 4 M 38 TEP Right Lap 0 1 5 M 53 Stoppa Bilateral Open 0 1 6 M 46 TEP Right Lap 0 0 7 M 30 Lichtenstein Right Open 0 0 8 V 73 Lichtenstein Right Open 0 0 9 M 60 Lichtenstein Right Open 0 0 10 V 59 TEP Right Lap 0 0
- 10. Results 2 patients complete pain relief Long term result After 3 injections Long-term follow-up VASmax post/pre ratio 0 0 Mean ratio = Median ratio 0 Mean FU 10,80 months (10,45 – 11,16) VASmax post/pre 0 0
- 11. • Results 6 patients intermittent pain relief After each injection No permanent effect VASmax post/pre 1,5 1,625 7 VASmax post/pre 1,25 1,14 0,93 Median ratio 1,37 (0,93 – 7) Mean FU 14,14 months (10,13-16,47)
- 12. Results 2 patients no pain relief Follow-up VASmax post/pre 1,14 0,93 Median ratio = Mean ratio 1,03 Mean FU 14,79 months (10,13 – 19,46) VASmax post/pre 1,14 0,92
- 13. Conclusions Multidisciplinary standardised protocol Repetitive injections Small subset 20% permanent pain relief Long-term effect 1st injection no effect => non- responder Preliminary results Larger prospective multi-center studies needed
- 14. Thank You !!