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1.
Pain Pract ; 23(5): 559-562, 2023 06.
Artigo em Inglês | MEDLINE | ID: mdl-36478396

RESUMO

BACKGROUND: Sacral metastases represent the lowest percentage of invasion to the spine, however, as chemotherapy treatments progress, the cancer survival rate has become higher, and the percentage of sacral metastases has increased. Treatment options for sacrum metastases are surgery, radiotherapy, and minimally invasive techniques such as sacroplasty and radiofrequency ablation. Knowing the repercussions that advancing the needle anteriorly (viscera) or medially (sacral roots) can have during the sacroplasty we are describing a technique to perform c-arm sacroplasty in coaxial vision, to identify the anterior sacral cortical bone that is in the limits of the pelvic viscera as well as the sacral foraminal line. CASE PRESENTATION: In the current report, we present a 75-year-old male patient with prostate cancer metastatic to S1, S2, S3 and iliac, with severe lumbar axial pain VAS 8/10. With a caudal tilt between 35-45 degrees until aligning the sacrum in a coaxial view, a 11-gauge Jamshidi needle is advanced from s3 to s1. The trajectory of the needle during the procedure is corroborated in AP and lateral, S1 is cemented, and the needle is withdrawn to cement S2 and S3. After the sacroplasty with the coaxial access, the patient reported VAS 1-2/10. CONCLUSIONS: It is important to offer an adequate quality of life to patients with sacral fractures, whether associated with cancer or sacral insufficiency fractures (SIF). Sacroplasty, being a recently described technique, can be a very viable option for these patients, that's why it is important to have safe and reliable techniques to complement the approach of this minimally invasive technique.The coaxial access may be a safe and practical way to perform sacroplasty in these patients.


Assuntos
Dor Lombar , Fraturas da Coluna Vertebral , Masculino , Humanos , Idoso , Resultado do Tratamento , Qualidade de Vida , Cimentos Ósseos/uso terapêutico , Dor Lombar/tratamento farmacológico , Fraturas da Coluna Vertebral/cirurgia , Sacro/diagnóstico por imagem , Sacro/cirurgia
2.
Indian J Palliat Care ; 29(4): 394-406, 2023.
Artigo em Inglês | MEDLINE | ID: mdl-38058484

RESUMO

Objectives: The management of chronic pain among patients with abdominal cancer is complex; against that, the neurolysis of the celiac plexus (CPN) is the best technique at the moment to determine the efficacy and safety in the treatment of chronic pain secondary to oncological pathology of the upper abdomen. Material and Methods: This was a systematic review of controlled clinical trials between 2000 and 2021, in the sources MEDLINE/PubMed, Cochrane, Scopus, Web of Science, and Google Scholar. Three independent evaluators analysed the results of the bibliographical research. The quality of the studies was assessed with the Jadad scale and the mean difference (95% confidence interval) and heterogeneity of the studies (I2) were calculated with Review Manager 5.3. Results: Seven hundred and forty-four publications were identified, including 13 studies in the qualitative synthesis and three studies in the quantitative synthesis. No difference was found in the decrease in pain intensity between 1 and 12 weeks after the intervention, comparing the experimental group with the control (P > 0.05). The adverse effects related to neurolysis were not serious and transitory, mentioning the most frequent adverse effects and reporting a percentage between 21% and 67% (with 17% for echoendoscopic neurolysis and 49% for percutaneous neurolysis). Conclusion: Celiac plexus neurolysis for the treatment of severe chronic pain secondary to oncological pathology in the upper hemiabdomen produces similar pain relief as conventional pharmacological analgesic treatment. It is a safe analgesic technique since the complications are mild and transitory.

3.
Gac Med Mex ; 157(3): 302-308, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34667330

RESUMO

Localized neuropathic pain (LNP) is of peripheral origin and is characterized by circumscribed areas of pain with abnormal skin sensitivity or spontaneous symptoms that are characteristic of neuropathic pain, e.g., burning pain. It should be noted that LNP is confined to a specific area no larger than a letter size sheet of paper. LNP accounts for 60 % of neuropathic pain syndromes. There is no single etiology of LNP. The diagnostic approach is similar to that for other neuropathic pain conditions. General diagnostic tools are used to assess clinical features. So far, there are no specific guidelines for the management of LNP; for this reason, guidelines for general neuropathic pain are used. Topical treatments are included as part of second-line strategies in the Canadian Pain Society guidelines. Despite the lack of guidelines, 5 % lidocaine patches and 8 % capsaicin patches have been proven effective in LNP models.


El dolor neuropático localizado (DNL) es de origen periférico y se caracteriza por áreas circunscritas de dolor con sensibilidad anormal de la piel o síntomas espontáneos característicos de dolor neuropático, por ejemplo, dolor urente. Se debe resaltar que el DNL está confinado a un área específica no mayor a una hoja de papel tamaño carta. El DNL representa 60 % de las condiciones de dolor neuropático. No existe una única etiología. El abordaje diagnóstico es similar al de otros síndromes dolorosos neuropáticos. Se utilizan herramientas diagnósticas generales para evaluar las características clínicas. En la actualidad no existen guías específicas de manejo del DNL, por lo que se utilizan las guías para dolor neuropático en general. En las guías de la Sociedad Canadiense de Dolor se incluyen los tratamientos tópicos como parte de las estrategias de segunda línea. Pese a la falta de guías, los parches de lidocaína a 5 % y los parches de capsaicina a 8 % han demostrado ser efectivos en modelos de DNL.


Assuntos
Neuralgia , Canadá , Humanos , Neuralgia/diagnóstico , Neuralgia/etiologia , Síndrome
4.
Pain Med ; 21(11): 3018-3023, 2020 11 01.
Artigo em Inglês | MEDLINE | ID: mdl-32150272

RESUMO

OBJECTIVE: Vertebroplasty is a percutaneous minimally invasive procedure indicated for vertebral collapse pain treatment. Among the known complications of the procedure is the augmented risk of new vertebral fractures. There are no specific studies in this patient population describing the risk of new vertebral fractures after vertebroplasty. This study analyzed risk factors associated with new vertebral fractures after vertebroplasty in patients with multiple myeloma. METHODS: Observational retrospective study in patients with multiple myeloma. The data collection took place from January 1, 2010, to December 30, 2017, at the National Cancer Institute. Clinical data and procedural variables such as cement volume, cement leaks, fracture level, number of treated vertebrae, pedicular disease, and cement distribution pattern, with two years follow-up, were analyzed with the Wilcoxon test, and a logistic regression model was used to identify risk factors related to new vertebral fractures. A confidence interval of 95% was used for analysis. RESULTS: At one-year follow-up, 30% of fractures were reported after vertebroplasty, most of them at low thoracic and lumbar level (50% adjacent level). Vertebroplasty was most commonly performed at the thoracolumbar and lumbar area. We demonstrated a 70.7% median numerical rating scale reduction at one-year follow-up; a significant decrease in opioid consumption occurred only during the first month. CONCLUSIONS: Pedicle involvement, disc leakage, cement volume, thoracolumbar and lumbar level, and number of treated vertebrae by intervention are important risk factors when performing vertebroplasty. Prospective randomized studies are needed to evaluate these factors in this specific population.


Assuntos
Fraturas por Compressão , Mieloma Múltiplo , Osteoporose , Vertebroplastia , Cimentos Ósseos/efeitos adversos , Fraturas por Compressão/epidemiologia , Fraturas por Compressão/etiologia , Fraturas por Compressão/cirurgia , Humanos , Vértebras Lombares/diagnóstico por imagem , Vértebras Lombares/cirurgia , Mieloma Múltiplo/epidemiologia , Estudos Prospectivos , Estudos Retrospectivos , Vértebras Torácicas/cirurgia , Resultado do Tratamento , Vertebroplastia/efeitos adversos
6.
Gac Med Mex ; 155(3): 307-318, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31219471

RESUMO

The interest on cannabinoids became evident between the 1940 and 1950 decades. Although the active substance of the plant was not known, a series of compounds with cannabinomimetic activity were synthesized, which were investigated in animals and clinically. The most widely tested was Δ6a, 10a-THC hexyl. Δ6a, 10a-THC dimethylheptyl (DMHP) antiepileptic effects were studied in several children, with positive results being obtained in some cases. DMHP differs from sinhexyl in that its side chain is DMHP instead of n-hexyl. The first cannabinoid isolated from Cannabis sativa was cannabinol, although its structure was correctly characterized several years later. Cannabidiol was isolated some years later and was subsequently characterized by Mechoulam and Shvo. In 2013, the National Academy of Medicine and the Faculty of Medicine of the National Autonomous University of Mexico, through the Seminar of Studies on Entirety, decided to carry out a systematic review on a subject that is both complex and controversial: the relationship between marijuana and health. In recent years, studies have been conducted with cannabis in several diseases: controlled clinical trials on spasticity in multiple sclerosis and spinal cord injury, chronic, essentially neuropathic, pain, movement disorders (Gilles de Latourette, dystonia, levodopa dyskinesia), asthma and glaucoma, as well as non-controlled clinical trials on Alzheimer's disease, neuroprotection, intractable hiccups, epilepsy, alcohol and opioid dependence and inflammatory processes.


El interés por los cannabinoides se hizo evidente entre las décadas de 1940 y 1950. Aunque no se conocía el principio activo de la planta, se sintetizaron compuestos con actividad cannabinomimética, los cuales fueron investigados en animales y en la clínica. El más probado fue el ∆6a,10a-THC hexilo. Las acciones antiepilépticas del ∆6a,10a-THC dimetilheptil fueron estudiadas en varios niños; en algunos casos se obtuvieron resultados positivos. El ∆6a,10a-THC dimetilheptil se diferencia del sinhexil en que su cadena lateral es dimetilheptilo en vez de n-hexilo. El primer cannabinoide aislado de Cannabis sativa fue el cannabinol, si bien su estructura fue correctamente caracterizada varios años después. El cannabidiol fue aislado algunos años más tarde y caracterizado posteriormente por Mechoulam y Shvo. Durante 2013, la Academia Nacional de Medicina y la Facultad de Medicina de la Universidad Nacional Autónoma de México, a través del Seminario de Estudios sobre la Globalidad, decidieron realizar una revisión sistemática sobre un tema tan complejo como controvertido: la relación entre la marihuana y la salud. En los últimos años se han realizado estudios con cannabis en varias enfermedades: ensayos clínicos controlados sobre espasticidad en esclerosis múltiple y sobre lesiones medulares, dolor crónico fundamentalmente neuropático y trastornos del movimiento (Gilles de Latourette, distonía, discinesia por levodopa), asma y glaucoma, así como ensayos clínicos no controlados sobre Alzheimer, neuroprotección, hipo intratable, epilepsia, dependencia al alcohol y opioides y procesos inflamatorios.


Assuntos
Canabidiol/isolamento & purificação , Canabinoides/uso terapêutico , Cannabis/química , Animais , Canabidiol/química , Canabinoides/química , Canabinoides/isolamento & purificação , Canabinol/química , Canabinol/isolamento & purificação , Humanos
7.
Gac Med Mex ; 154(6): 740-741, 2018.
Artigo em Espanhol | MEDLINE | ID: mdl-30532103

RESUMO

In Mexico there is a proliferation of "centers for aesthetic medicine" that offer different treatments with laser beam, mesotherapy and hyaluronic acid and botulinum toxin injections. In numerous centers of this type, offered and performed by medical personnel that are neither trained or certified to ensure the quality of services. The National Academy of Medicine of Mexico and the National Normative Council for Medical Specialties (CONACEM) communicate their posture on this matter.


En México existe una proliferación de "centros de medicina estética" que ofrecen tratamientos diversos con rayos láser, mesoterapia, ácido hialurónico e inyecciones con toxina botulínica por personal médico que no está capacitado ni certificado para asegurar la calidad de los servicios. La Academia Nacional de Medicina y el Comité Normativo Nacional de Consejos de Especialidades Médicas (CONACEM) comunican su postura al respecto.


Assuntos
Técnicas Cosméticas , Estética , Academias e Institutos , Toxinas Botulínicas/administração & dosagem , Técnicas Cosméticas/normas , Humanos , Ácido Hialurônico/administração & dosagem , Terapia a Laser/métodos , Mesoterapia/métodos , México
8.
Gac Med Mex ; 154(6): 737-739, 2018.
Artigo em Espanhol | MEDLINE | ID: mdl-30532119

RESUMO

As a consequence of the Presidential Decree that reforms and additions the General Statute of Health with regard to medicinal and scientific use of tetrahydrocannabinol, its isomers and stereochemical variants, the National Academy of Medicine of Mexico declares its position in favor of regulating investigation and national production thereof.


Como consecuencia del decreto presidencial que reforma y adiciona la Ley General de Salud respecto al uso medicinal y científico del tetrahidrocannabinol, sus isómeros y variantes estereoquímicas, la Academia Nacional de Medicina de México declara su posición para normar la investigación y producción nacional de los mismos.


Assuntos
Cannabis/química , Dronabinol/administração & dosagem , Política de Saúde , Maconha Medicinal/administração & dosagem , Academias e Institutos , Dronabinol/química , Humanos , Isomerismo , México
9.
Gac Med Mex ; 154(6): 732-736, 2018.
Artigo em Espanhol | MEDLINE | ID: mdl-30532104

RESUMO

There are decisions at the end of life that currently are relevant as humanistic values. Respect for human life and dignity are part of human rights. The National Academy of Medicine of Mexico declares its posture about end-of-life decisions that include treatment refusal, limitation of the therapeutic effort, advance directives and palliative sedation, among others, with the purpose to favor a peaceful death.


Hay decisiones relacionadas con el final de la vida que actualmente son relevantes como valores humanísticos. El respeto y la dignidad de la vida humana están incluidos en los derechos humanos. La Academia Nacional de Medicina de México declara su postura acerca de las decisiones sobre el final de la vida que incluyen rechazo a un tratamiento, limitación del esfuerzo terapéutico, voluntad anticipada y sedación paliativa, entre otros, con la finalidad de propiciar una muerte en paz.


Assuntos
Tomada de Decisões , Direitos Humanos , Pessoalidade , Assistência Terminal/métodos , Academias e Institutos , Diretivas Antecipadas , Humanos , México , Cuidados Paliativos/métodos , Recusa do Paciente ao Tratamento
10.
Gac Med Mex ; 154(6): 716-718, 2018.
Artigo em Espanhol | MEDLINE | ID: mdl-30532120

RESUMO

Informed consent is an indispensable element to obtain adequate patient participation either in research protocols or in therapeutic design. The Committee of Ethics and Transparency in the Physician-Industry Relationship (CETREMI) of the National Academy of Medicine developed several recommendations for informed consent to be documented.


El consentimiento informado es un elemento indispensable para obtener la adecuada participación del paciente, ya sea en protocolos de investigación o en diseños terapéuticos. El Comité de Ética y Transparencia en la Relación Médico-Industria (CETREMI) de la Academia Nacional de Medicina elaboró varias recomendaciones para documentar el consentimiento informado.


Assuntos
Consentimento Livre e Esclarecido , Participação do Paciente , Médicos/organização & administração , Pesquisa Biomédica/organização & administração , Ética Médica , Direitos Humanos , Humanos , México
13.
BMJ Support Palliat Care ; 13(e3): e981-e983, 2024 Jan 08.
Artigo em Inglês | MEDLINE | ID: mdl-37380214

RESUMO

Tumours in patients with head and neck cancer (HNC) are associated with a more significant decrease in quality of life compared with the rest of patients with cancer. We present a patient with pain due to HNC successfully treated with bipolar radiofrequency ablation. A man in his 70s presented with a tumour in the left V2 and V3 region, with disabling pain, Visual Analogue Scale (VAS) score of 10/10, pain on swallowing, chewing and speaking, 3 months of evolution. The patient was evaluated in the pain management department, and the interventional treatment proposed consisted of bipolar pulsed radiofrequency, followed by bipolar thermal radiofrequency of the left V2 and V3 branches with fluoroscopic guidance to achieve better control and coverage of the affected trigeminal branches. Immediately after the procedure, the patient reported a significant improvement in pain with a 0-10 VAS; hypoesthesia in the affected V2 and V3 territory was identified, but no motor weakness. The improvement in pain was maintained for 6 months with a significant improvement in quality of life and pain, which allowed him to speak, chew and swallow without pain. Later, the patient died from complications associated with the disease. The treatment approach in these patients is both pain treatment and achieving independence by allowing better speech ability and improving eating, the above as a pillar of treatment focused on improving the patient's quality of life. This approach is a potential tool in the early stage of the disease in patients with pain due to HNC.


Assuntos
Dor do Câncer , Neoplasias , Ablação por Radiofrequência , Neuralgia do Trigêmeo , Humanos , Masculino , Dor do Câncer/cirurgia , Qualidade de Vida , Resultado do Tratamento , Neuralgia do Trigêmeo/cirurgia , Idoso
14.
Front Oncol ; 14: 1371779, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38725634

RESUMO

Cervical cancer (CC) occupies the second place in incidence and mortality among women in México. Despite this, Cervical Cancer continues to have a late diagnosis which leads to a high rate of complications. Pain represents the most feared and disabling symptom, being present in up to 86% of patients with advanced disease. The approach to managing pain in this population has not been studied and described to a full extent. In addition, there is a pressing need to provide concise recommendations to promote adequate pain control. We performed a review of the literature in CC and had experts in the field of pain management evaluate the evidence found. We then issued relevant recommendations on pharmacology and interventional pain management. Thus, the approach to pain management must be comprehensive and individualized, considering the timely and appropriate use of pharmacologic treatment as well as interventional procedures.

15.
Cureus ; 16(3): e55599, 2024 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-38586726

RESUMO

Objectives An observational, retrospective, longitudinal, and analytical study aimed to evaluate the effectiveness of the erector spinae plane (ESP) block in managing pain in patients with vertebral fractures secondary to tumoral activity. This study included patients treated at the Pain Clinic who underwent ESP block. The objectives were to describe demographic characteristics, oncological diagnosis, vertebral fracture features, imaging techniques, medications used, and the level of ESP block. Additionally, pain levels were assessed using a numerical analog scale, and the consumption of opioid analgesic medications before and after the ESP block, during follow-up consultations, along with patient satisfaction. Methodology This retrospective, observational, and analytical study was conducted at the Pain Clinic of the National Cancer Institute of Mexico. Patients with vertebral fractures secondary to tumor activity were included, with data collected from March 2020 to September 2023. A consecutive non-probabilistic sampling method was employed, and specific inclusion and exclusion criteria were applied. Data were analyzed using descriptive statistics and the Wilcoxon signed-rank test for quantitative variables, with a significance level of p ≤ 0.05. IBM SPSS Statistics v. 26.0 (IBM Corp., Armonk, NY) software was utilized. Results A sample comprising 16 individuals was obtained, with an equal distribution between males and females. Fracture levels displayed variation, with L3 (12.5%) and T6 (12.5%) being the most prevalent. The ESP approach was primarily conducted using ultrasound (68.8%), while fluoroscopy and computed tomography were utilized in 25.0% and 6.3% of cases, respectively. Predominantly, methylprednisolone and ropivacaine (75.0%) were administered, with phenol used in 18.8% and a combination of methylprednisolone and bupivacaine in 6.3%. Patient satisfaction levels were reported at 81.3% (satisfied or very satisfied). Statistically significant disparities were noted between baseline and incidental pain reduction and oral opioid equivalent dosage in milligrams of morphine per day (MME/day) before and after ESP block (p ≤ 0.05). Conclusions This research provides promising preliminary evidence supporting the effectiveness of ESP block for pain management in vertebral fractures secondary to tumoral activity, enhancing the quality and safety of care for oncology patients. The absence of complications, significant improvement in pain, and reduction in opioid dependence underscore the clinical relevance of this therapeutic approach. An observational, retrospective, longitudinal, and analytical study aimed to evaluate the effectiveness of the ESP block in managing pain in patients with vertebral fractures secondary to tumoral activity. This study included patients treated at the Pain Clinic who underwent ESP block. The objectives were to describe demographic characteristics, oncological diagnosis, vertebral fracture features, imaging techniques, medications used, and the level of ESP block. Additionally, pain levels were assessed using a numerical analogue scale, and the consumption of opioid analgesic medications before and after the ESP block, during follow-up consultations, along with patient satisfaction.

16.
Pain Pract ; 13(5): 409-15, 2013 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-22935055

RESUMO

Bone metastases are very frequent in patients with cancer and usually are located in the patient's long bones and spine. Various approaches to pain relief and stability to the affected bone have been used. The aim of the study is to report our experience with a new minimally invasive percutaneous technique in patients with bone metastases located in the head, neck, and proximal femur. The technique is performed under fluoroscopic guidance through the application of polymethylmethacrylate bone cement. Our descriptive, retrospective, longitudinal case series included 15 patients who underwent femoroplasty. All patients reported pain reduction and improved mobility, with no complications observed. The femoroplasty procedure caused pain relief by stabilizing the bone through the consolidation of the microfractures because of bone metastases.


Assuntos
Neoplasias Ósseas/secundário , Neoplasias Ósseas/cirurgia , Cementoplastia/métodos , Fêmur/patologia , Fêmur/cirurgia , Adulto , Idoso , Biópsia por Agulha/métodos , Cimentos Ósseos/uso terapêutico , Neoplasias Ósseas/complicações , Feminino , Fluoroscopia , Humanos , Imageamento por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Dor/etiologia , Manejo da Dor , Medição da Dor , Polimetil Metacrilato/administração & dosagem , Estudos Retrospectivos , Resultado do Tratamento
17.
Cureus ; 15(8): e43639, 2023 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-37719480

RESUMO

Pain is both one of the oldest complaints known to medicine and a field for some of medicine's latest breakthroughs and innovations. Pharmacologic treatment of pain is one of the oldest remedies, and opioids have been used since ancient times as an effective pain reliever but with certain specific risks for abuse. Greater knowledge of opioids led to a more thorough understanding of the complexities of pain, which may have any number of mechanisms. A greater understanding of nerve fibers and pain signaling led to the development of more drugs and the more targeted delivery of analgesics using the hollow needle. The hollow needle changed pain treatment and led to percutaneous injections and what would later become interventional pain medicine with regional anesthesia and nerve blocks. Today, imaging can be combined with interventional techniques for more precise localization of nerves for diagnosis and treatment. The role of artificial intelligence in interventional pain medicine, especially in imaging for interventional procedures, remains unknown but will likely become extremely beneficial.

18.
Anesth Pain Med (Seoul) ; 18(2): 132-138, 2023 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-37183281

RESUMO

BACKGROUND: The Gasserian ganglion is a well-known target for facial pain management, and patients with cancer present an anatomical challenge owing to tumor progression or treatment itself. Computed tomography (CT) is an alternative method for guiding these procedures. METHODS: This was an observational retrospective analysis of patients with cancer-related facial pain who underwent CT-guided Gasserian ganglion interventions using local anesthetics, local anesthetics with steroids, phenol, and radiofrequency. Demographic, clinical, and procedure-related variables were collected from January 1, 2015, to December 30, 2018, at the National Cancer Institute. Data distribution was determined using the Kolmogorov-Smirnov test. A paired sample t-test (with a cut-off of P < 0.05 for statistical significance) was used for comparing outcome. RESULTS: We observed a significant reduction in numerical rating scale (NRS) and douleur neuropathique 4 (DN4) scores from 7.6 ± 1.4 and 4.4 ± 1.4 to 3.2 ± 2.0 and 2.2 ± 1.4 points, respectively (P < 0.001). After the procedure, 70.8% of the patients were satisfied; 16.7% were very satisfied, and 12.5% were unsatisfied. No intra- or postoperative complications were observed. The most common neoplasms were head and neck tumors (83.3%). CONCLUSIONS: Our data suggest that CT guidance is an effective and safe option for managing cancer-related facial pain in patients with complex anatomy, resulting in a significant reduction in pain, high satisfaction rates, and no mechanical complications. Future research should aim to refine the role of CT guidance in multimodal pain management in this population.

19.
Cureus ; 14(3): e22992, 2022 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-35464575

RESUMO

Low back pain (LBP) is a prevalent condition associated with disability. Treating patients with LBP becomes further complicated by the potential presence of underlying conditions, such as cancer or traumatic injury, or biopsychosocial aspects. LBP usually has a neuropathic component that must be assessed and treated appropriately. Pharmacological management of LBP requires a thorough knowledge of the available agents and the mechanisms of the LBP. Although there are effective pharmacological treatments for LBP, it is important to consider safety issues. Fixed-dose combination products may be helpful, as they can reduce opioid consumption without sacrificing analgesic benefits. Neuromodulation is an important and sometimes overlooked treatment option for LBP and may be appropriate for chronic LBP requiring long-term treatment. Imaging studies support neuroplastic changes in the brain as a result of neuromodulation. Interventional approaches to chronic LBP are numerous and must be appropriately selected based on the individual patient. Evidence in support of epidural injections for LBP is strong for short-term pain control but moderate to limited for long-term relief. Rehabilitation for LBP can be an important element of long-term care, and new forms of rehabilitation programs are being developed using telemedicine. A variety of new and established treatments are available for patients with LBP, and clinicians and patients may benefit from emerging new treatment modalities.

20.
Cureus ; 14(4): e23763, 2022 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-35518528

RESUMO

Chronic postoperative pain (CPOP) is prevalent, with particularly high rates in breast surgery, thoracotomy, and amputation. As the world emerges from the coronavirus disease 2019 (COVID-19) lockdowns, it is expected that there will be an increase in surgical procedures, elevating the importance of preventing CPOP in the coming years. Risk factors are emerging to better stratify patients at high risk for CPOP. Perioperative analgesia plays an important role in managing acute postoperative pain and in some cases may limit its transition to CPOP. Acute postoperative pain is adaptive, normal, expected, and has a well-defined trajectory, while CPOP is maladaptive and, as a form of chronic pain, is challenging to treat. Good analgesia, early ambulation, and rehabilitation efforts may be helpful in preventing CPOP following certain surgeries. Enhanced Recovery After Surgery (ERAS) protocols present guidance to help promote recovery and prevent CPOP.

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