Management of Lower Extremity Pain from Chronic Venous Insufficiency: A Comprehensive Review.

PURPOSE OF REVIEW: Chronic venous insufficiency is found to some extent in a large proportion of the world's population, especially in the elderly and obese. Despite its prevalence, little research has been pursued into this pathology when compared to similarly common conditions. Pain is often the presenting symptom of chronic venous insufficiency and has significant deleterious effects on quality of life. This manuscript will describe the development of pain in chronic venous insufficiency, and will also review both traditional methods of pain management and novel advances in both medical and surgical therapy for this disease. RECENT FINDINGS: Pain in chronic venous insufficiency is a common complication which remains poorly correlated in recent studies with the clinically observable extent of disease. Although lifestyle modification remains the foundation of treatment for pain associated with chronic venous sufficiency, compression devices and various pharmacologic agents have emerged as safe and effective treatments for pain in these patients. In patients for whom these measures are insufficient, recently developed minimally invasive vascular surgical techniques have been shown to reduce postsurgical complications and recovery time, although additional research is necessary to characterize long-term outcomes of these procedures. This review discusses the latest findings concerning the pathophysiology of pain in chronic venous insufficiency, conservative and medical management, and surgical strategies for pain relief, including minimally invasive treatment strategies.

Factors associated with academic rank among chronic pain medicine faculty in the USA.

BACKGROUND: Numerous factors are considered in the academic promotion of pain medicine physicians. In this study, we investigated the importance of research productivity, career duration, leadership, and gender on attaining professorship in chronic pain medicine fellowship programs in the USA. METHODS: We identified 98 pain fellowship programs in the American Medical Association Fellowship and Residency Electronic Interactive Database. Faculty demographics and institutional characteristics were obtained from institutional websites, and h-index (number of publications (h) cited at least h times) and m-index (h-index divided by research career duration) were calculated from Scopus. A nested mixed effect hierarchical modeling was used to determine factors that were associated with attaining professorship. RESULTS: A total of 696 chronic pain medicine faculty members from 98 academic pain fellowship programs were identified, of whom 74.7% were males. For the 15.5% who were full professors, the median h-index was 16.5 (6.0 to 30.0), the median career duration was 20.5 (16.0 to 27.0) years, and the median m-index was 0.7 (0.3 to 1.3). In an adjusted analysis, the top quartile (compared with bottom) h-index (OR 6.27; 95% CI: 2.11 to 18.59), publication citations (OR 1.13; 95% CI: 1.10 to 1.21), division chief position (OR 3.72; 95% CI: 1.62 to 8.50), institutions located in the western region (OR 3.81; 95% CI: 1.52 to 9.57), and graduating from a foreign medical school (OR 1.98; 95% CI: 1.10 to 3.92) were independently associated with attaining professorship (p<0.05), but gender was not (p=0.71). CONCLUSIONS: Our study shows that, higher h-index, publication citations, division chief position, affiliation at a lower tier medical school, and location in the Western region were independently associated with full professorship, whereas gender was not. The identified variables for professorship may be considered as factors in faculty promotions.

Chronic Pain Practices: An Evaluation of Positive and Negative Online Patient Reviews.

BACKGROUND: The role of patient satisfaction continues to play an important role in health care quality measures. The use of online review platforms has been adopted by patients to share their perceptions about the quality of care provided by physicians. Chronic pain practice has unique challenges regarding patient satisfaction. OBJECTIVES: The main goal of this study is to identify the themes associated with positive and negative reviews of chronic pain physicians at publicly available online review platforms. STUDY DESIGN: A retrospective study design. SETTING: We evaluated publicly available online patient-generated reviews of chronic pain physicians from Yelp and Healthgrades. METHODS: This retrospective study evaluated patient-generated reviews of chronic pain physicians from 2 online platforms-Yelp and Healthgrades-between the September 1, 2018 through November 1, 2018. Ninety chronic pain physicians were randomly selected from 4 diverse geographic cities in the United States: New York (NY), Houston (TX), Chicago (IL), and Seattle (WA). Primary outcome was defined as high and low rating scores. Secondary outcome was the proportion of positive and negative attributes (patient, physician, procedure, and administrative attributes) that was associated with high and low rating scores. RESULTS: A total of 1,627 reviews were extracted from 90 physicians evaluated at Yelp and Healthgrades. Of this total review, 1,296 (79.7%) were high scoring and (331) 20.3% were low scoring. Chronic pain providers who were high scoring had positive reviews that consisted of physician attributes (63.5%), administrative attributes (23.4%), and patient attributes (12.2%). The highest proportion of the first 3 physician attributes associated with high ratings were knowledgeable, helpful, and caring. Chronic pain providers who were low scoring had negative reviews that consisted of physician attributes (41.4%), administrative attributes (52.1%), and procedure attributes (5.2%). The highest proportion of the first 3 physician attributes associated with low ratings were disrespectful, unhelpful, and uncaring. LIMITATIONS: First, this study looks at reviews of 4 large cities, thus we may have excluded patient populations with substantially different preferences as health care consumers. Second, it is impossible to confirm the validity of individual reviewers' interactions with the pain management specialist who provided care or validate the identity of the reviewers. Third, it is very difficult, or even impossible, to tell if the rater is a patient or someone posing as a patient, such as an unhappy employee or a business competitor. CONCLUSIONS: Online platforms provide a medium that facilitates immediate communication among patients. These platforms may provide timely data for chronic pain physicians to gain more insight into the quality of care perceived by patients, thereby aiding providers to improve on ways to optimize patient-care experiences and encounters. KEY WORDS: Chronic pain practice, online review, patient review, patient satisfaction.