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1.
Clin Pract ; 11(2): 190-192, 2021 Mar 30.
Artigo em Inglês | MEDLINE | ID: mdl-33808063

RESUMO

Regional anesthesia is an important aspect of the overall anesthetic plan for patients. It has the potential to offer superior benefits compared to opioid-based treatment and is an important component of Enhanced Recovery after Surgery (ERAS) protocols. The use of the pectoral type I (PECS I) and pectoral type II blocks (PECS II) has been shown to reduce postoperative pain and opioid consumption in patients undergoing complete mastectomy and breast surgery. We describe the use of dexamethasone and dexmedetomidine to prolong the analgesic effects of these regional blocks in a patient undergoing total mastectomy with lymph node dissection.

3.
Cardiol Ther ; 2021 Mar 11.
Artigo em Inglês | MEDLINE | ID: mdl-33704678

RESUMO

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.

6.
Cureus ; 12(10): e10758, 2020 Oct 01.
Artigo em Inglês | MEDLINE | ID: mdl-33150109

RESUMO

Abdominal pain related to gastrointestinal malignancy can be notoriously difficult to manage and can lead to significant morbidity and suffering. The blockade of the celiac plexus has traditionally been performed for alleviating abdominal pain related to malignancy. Visceral structures that are innervated by these nerves include the pancreas, liver, gallbladder, mesentery, omentum, and the gastrointestinal tract from the stomach to the transverse colon. Alternatively, this pain can be treated by disrupting visceral nociceptive signals at the splanchnic nerves. In this report, we describe our experience of treating a 50-year-old male patient suffering from severe abdominal pain related to pancreatic cancer with multiple liver metastases. The patient failed medication management and had an international normalized ratio of 1.6, which was a concern for performing a celiac plexus block given the proximity of major vascular structures. The patient instead underwent radiofrequency ablation (RFA) as well as alcohol neurolysis of the bilateral splanchnic nerves and obtained significant relief from the procedure.

7.
Proc (Bayl Univ Med Cent) ; 33(4): 699-700, 2020 Aug 03.
Artigo em Inglês | MEDLINE | ID: mdl-33100576

RESUMO

As the COVID-19 pandemic overwhelmed health care systems around the world, new strategies to mitigate its spread and provide patients access to health care have been employed. Although a critical component of this strategy, telemedicine is not a perfect solution for many scenarios and is often limited. Overall, telemedicine has been an invaluable tool to improve access to care and minimize the risk of person-to-person transmission of COVID-19.

8.
Psychopharmacol Bull ; 50(4): 60-82, 2020 Sep 14.
Artigo em Inglês | MEDLINE | ID: mdl-33012873

RESUMO

Purpose of Review: This is a comprehensive review of the literature regarding the use of asenapine for the treatment of schizophrenia (SZ) in adults. It covers an introduction, epidemiology, risk factors, pathophysiology, and current treatment modalities regarding SZ, provides a background on the mechanism of action of asenapine, and then reviews the existing evidence for use of asenapine in both its sublingual and transdermal formulation in the treatment of SZ. Recent Findings: SZ is a complex and multifactorial mental disorder which is thought to combine several genetic, epigenetic, and environmental factors causing abnormalities in the dopaminergic system. Symptoms are categorized in delusions, hallucinations, disorganization, and negative presentations like affective flattening and apathy. Current treatment focuses on antipsychotic medications by means of oral administration or long-acting injection. Asenapine is a second-generation antipsychotic with 5HT-2A antagonist and 5HT-1A/1B partial agonist properties, which provides a favorable profile in targeting schizophrenic symptoms, while reducing motor side effects and improving mood and cognition. Asenapine in its sublingual formulation was FDA approved for treatment of SZ and bipolar I disorder in adults in August of 2009 and has been proven to be both effective and safe. Transdermal patch of asenapine (Secuado) was FDA approved in October of 2019, the first and only FDA approved patch for SZ in adults, which offers another strategy for treatment to improve compliance and ease of administration. Summary: SZ is a chronic and debilitating disease which is still not well understood and comes at great cost with regards to the quality of life for patients. Medication side-effects and compliance are enormous issues which take a toll on health care systems in industrialized nations and keep patients from achieving stability with their disease. Transdermal asenapine is a new first-in-class dosage form and provides a novel modality of administration. It has been shown to be effective in reducing positive, as well as negative symptoms, while still maintaining a favorable side-effect profile.

9.
Neurol Ther ; 9(2): 375-394, 2020 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-33001385

RESUMO

Acupuncture is a form of traditional Chinese medicine that is performed by placing needles or pressure in specific locations on a patient's skin to achieve a therapeutic effect. Although used to treat a variety of disorders, one of the most common applications of acupuncture is to treat chronic pain, especially headache and migraine pain. Migraines are difficult to treat, and pharmacotherapies are often the first line of treatment, although these options have many unwanted side effects, such as exacerbation of headache pain in those with chronic migraine. Many complimentary and integrative therapies are available to treat migraine (including nutraceuticals, yoga, tai chi, and biofeedback), among which acupuncture as a treatment is gaining increasing attention. In this review, we provide an overview of the current understanding of both acupuncture and migraine and of current research investigating the effectiveness of acupuncture in treating migraine and chronic migraine.

10.
Best Pract Res Clin Anaesthesiol ; 34(3): 369-382, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-33004154

RESUMO

Primary osteoarthritis (OA) hinders an aging global population as one of the leading causes of years-lost-to-disability (YLD). OA in most patients is considered to be an overuse injury that results in degenerative inflammation of the joints with the associated formation of bony outgrowths. Due to the escalating nature of this chronic pain disease, treatment management for OA can initially begin with a more conservative approach. It can eventually lead to more invasive surgical procedures. At present, the standard of care remains initial conservative management with lifestyle changes, including weight loss with concurrent anti-inflammatory regimens. Injections are frequently used for the escalation of care, but a significant number of patients ultimately resort to total knee arthroplasty. This review will focus specifically on knee OA, providing a brief overview of risk factors and early management and in-depth exploration of the invasive interventions that can offer symptomatic relief and return of function.

11.
Best Pract Res Clin Anaesthesiol ; 34(3): 409-426, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-33004156

RESUMO

Chronic pelvic pain (CPP) in women is defined as noncyclical and persistent pain lasting more than six months perceived to be related to the pelvis. There are many etiologies that can cause CPP, including gynecologic, urologic, gastrointestinal, musculoskeletal, neurologic, and psychosocial. There is a strong association between psychological factors and CPP. It has been noted that almost half of women being treated for CPP report a history of sexual, physical, or emotional trauma. Women with CPP have been noted to have higher rates of psychological disorders in comparison to their peers. For men, the most common etiology for CPP is chronic prostatitis and there are also correlations with psychological disorders. There are many different treatment options for CPP: surgical, pharmacological, and non-pharmacological (alternative therapies). Cognitive-behavioral therapy may be another option when treating chronic pelvic pain syndrome and should be considered.

12.
Cureus ; 12(8): e9821, 2020 Aug 17.
Artigo em Inglês | MEDLINE | ID: mdl-32953331

RESUMO

Chronic back pain affects 20% of the adult population in the United States and is a significant source of disability and healthcare expenditure. One of the most common causes of chronic back pain is spondylosis. These changes result from age-related degeneration of the lumbar spine. As a result of this degeneration, spondylolisthesis can develop. Spondylolysis is a fracture of the pars interarticularis. It affects younger patients and is more prevalent in adolescents and elite athletes. It can be a debilitating condition that may force athletes into retirement as well as impair them with chronic pain and disability. Traditional treatment options include conservative management such as medications, rest, physical therapy, and rehabilitation. Surgery is reserved for patients who do not respond to conservative measures. Here we present the case of a 39-year-old mixed martial arts fighter with bilateral L4 pars interarticularis fractures and chronic low back pain. After failing conservative treatment options, this patient finally obtained significant relief with steroid injections at the level of the defect. The patient continues to do well with occasional injections and is able to maintain his mixed martial arts career. This case report provides evidence that injection therapy is a feasible alternative to surgery in patients who fail conservative therapy.

15.
Cureus ; 12(8): e9733, 2020 Aug 14.
Artigo em Inglês | MEDLINE | ID: mdl-32944451

RESUMO

Vertebral compression fractures are often found in the elderly population with known risk factors. Less commonly, they may occur in otherwise healthy patients following traumatic falls and can cause significant pain requiring opioid therapy. This case emphasizes the use of percutaneous balloon kyphoplasty as an effective treatment strategy in a young opioid-dependent patient as a means to support the return to baseline functionality.

16.
Adv Ther ; 37(11): 4614-4626, 2020 11.
Artigo em Inglês | MEDLINE | ID: mdl-32935285

RESUMO

INTRODUCTION: Chronic pain remains an important public health problem as it continues to increase healthcare-related cost. Comorbidities like obesity have been associated with efficacy of spinal cord stimulator (SCS) therapy and worse outcomes. The goal of this study is to investigate the trends of obesity amongst hospitalized patients with SCS therapy as well as healthcare utilization outcomes. METHODS: Using the International Classification of Diseases (ICD) ninth and tenth procedure and diagnosis code, we investigated the National Inpatient Sample (NIS) for patients with SCS implants between 2011 and 2015. Patients received a diagnosis of obesity based on the following categories: class I, II and III obesity. Age, gender, and comorbid conditions of patients with obesity were matched 1:1 on propensity score to those without obesity diagnosis. Our primary outcome was defined as trend of obesity diagnosis. Our secondary outcome, healthcare utilization, included in-hospital cost, length of stay, and discharge location. RESULTS: Between 2011 and 2015, a total of 3893 patients with SCS implants were identified (average age 56 ± 15 years, 58% female, 0.70 ± 1.1 Charlson Comorbidity Index, CCI). Of this cohort, 640 patients were identified as obese. The proportion of patients with obesity diagnosis increased significantly from 13.75% in 2011 to 19.36% in 2015 (p < 0.001). After 1:1 matching on propensity score, 597 patients with obesity were successfully matched to 597 patients without obesity. The total hospital cost for SCS patients with obesity (median $104,845, IQR $74,648-144,292) was not significantly different from patients without obesity diagnosis (median $111,092, IQR $68,990-145,459) (p = 0.161). CONCLUSIONS: The data from our study suggests that there is an increasing rate of obesity diagnosis amongst patients with SCS therapy. However, there was no difference in healthcare utilization between patients with and without obesity. Additional studies may provide more insight into our findings.

17.
Case Rep Womens Health ; 28: e00248, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32874930

RESUMO

Tarlov cysts are an uncommon and often incidentally noted source of low back pain in women. Because these cysts can be asymptomatic, they can be overlooked on radiological imaging. This case is of a 49-year-old woman who presented with a chronic history of low back pain and bilateral radiculopathy who on magnetic resonance imaging (MRI) was found to have multiple Tarlov cysts. This case illustrates the need for large observational studies to show the incidence of Tarlov cysts as a cause of low back pain in women.

19.
Cureus ; 12(7): e8988, 2020 Jul 03.
Artigo em Inglês | MEDLINE | ID: mdl-32775070

RESUMO

The erector spinae plane (ESP) block is a regional block that has become more commonly utilized in the setting of acute pain and post-operative analgesia. This block has been successfully utilized for pain management after a variety of surgical procedures for immediate post-operative pain management. This block is now gaining more utilization in the chronic pain setting for neuropathic pain conditions. We describe the use of this block at our pain clinic for the treatment of two patients with refractory neuropathic pain after thoracotomy as well as video-assisted thoracic surgery (VATS). Our cases further demonstrate the utility of this block for long-term pain control of neuropathic pain conditions, especially post-thoracotomy pain.

20.
Psychopharmacol Bull ; 50(3): 76-96, 2020 Jul 23.
Artigo em Inglês | MEDLINE | ID: mdl-32733113

RESUMO

Purpose of Review: This is a comprehensive review of the literature regarding the use of Lofexidine for opiate withdrawal symptoms. It covers the background and necessity of withdrawal programs and the management of withdrawal symptoms and then covers the existing evidence of the use of Lofexidine for this purpose. Recent Findings: Opiate abuse leads to significant pain and suffering. However, withdrawal is difficult and often accompanied by withdrawal symptoms and renewed cravings. These symptoms are driven mostly by signaling in the locus coeruleus and the mesolimbic system and a rebound increase in noradrenaline, producing symptoms such as anxiety, gastrointestinal upset, and tension. Lofexidine, an alpha-2 agonist, can be used to manage acute withdrawal symptoms before starting maintenance treatment with either methadone or buprenorphine. Lofexidine, if FDA approved for management of withdrawal symptoms and has been proved to be both effective and safe. Summary: Opiate addiction is increasing and plaguing the western world and specifically the U.S. It takes a large toll on both a personal and societal level and carries a high cost. Withdrawal is difficult, both related to withdrawal symptoms and renewed cravings. Lofexidine has been shown to be effective in reducing the former and could potentially aid in recovery and withdrawal.

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