Background: Thermal Microcautery (TMC) is a form of peripheral nerve field stimulation and is a technique used in Traditional Indian Medicine (Agnikarma) to manage chronic pain. The aim was to asses TMC in painful kne...Background: Thermal Microcautery (TMC) is a form of peripheral nerve field stimulation and is a technique used in Traditional Indian Medicine (Agnikarma) to manage chronic pain. The aim was to asses TMC in painful knee osteoarthritis (PKO). Methods: A non-randomized controlled trial was employed. All PKO patients on a waiting list for knee replacement were offered PNFS-TMC. Patients in the intervention group received 4 sessions (2 weeks apart) of PNFS-TMC by a pin-point tip of a metal rod. The rod was heated over a flame for 5 minutes before being used to induce a single 1 mm second-degree burn over points of tenderness. The control group was selected from the same waiting list. The primary outcome was assessed by Visual Analogue Scale (VAS) scores. The secondary outcomes were changes in levels of physical day to day activity, sleep and analgesics. Results: 16 PNFS-TMC intervention group patients and 15 control group patients were subject to analysis. Baseline VAS score was higher in PNFS-TMC group [9 ± 1.23 (95% CI 8.38 - 9.61) versus 5.93 ± 2.11 (95% CI 4.81 - 7.06) in the control, P Conclusions: PNFS-TMC could offer a simple, safe, cheap and effective method of pain management in chronic PKO patients.展开更多
Background: Pain is a major problem for patients suffering from chronic pancreatitis. Unfortunately, medical therapy often fails to adequately control pain. Coeliac plexus block (CPB) is sometimes performed to treat i...Background: Pain is a major problem for patients suffering from chronic pancreatitis. Unfortunately, medical therapy often fails to adequately control pain. Coeliac plexus block (CPB) is sometimes performed to treat intractable pain in patients with chronic pancreatitis. Aims: Our primary objective was to determine the effect of CPB for pain management in a cohort of patients with chronic pancreatitis. We also sought to quantify opioid use in patients with chronic pancreatitis. Methods: We reviewed the database of pain referrals for chronic pancreatitis and recorded opioid use for each patient. We interviewed all patients who underwent CPB for chronic pancreatitis at TUH from January 2018-December 2020. Effect of the block, duration of pain relief, analgesia requirements, complications and patient satisfaction were recorded. Results: 62 inpatient referrals were made to the pain service over a 3-year period regarding pain management in chronic pancreatitis. 76% of patients referred for chronic pancreatitis pain management require regular long-term opioids. Mean daily oxycodone requirement in this group was 52 mg. 11 of these patients underwent CPB over a 3-year period. Mean age of patients who underwent CPB was 44 years. Effective reduction in pain scores (>50% improvement) was achieved in 7 of 11 patients. The mean NRS pain score decreased from 9.2 (±0.9) to 4.4 (±3.1). Mean duration of pain relief experienced was 69 days. Transient diarrhoea was reported by 1 patient. 4 patients reported a temporary decrease in oral analgesia requirement, while 3 patients reported a sustained decrease in analgesia requirement post CPB. For those who had further CPBs, the effect of repeated interventions was comparable to the initial procedure. Conclusion: High regular opioid consumption is common in patients with chronic pancreatitis. CPB can provide significant improvement in pain control and quality of life in appropriately selected patients. CPB can assist with opioid reduction and containment. It is not effective in all ca展开更多
We present the case of a 60 yrs old male who, following a routine, uneventful, fluoroscopically guided L5/S1 facet joint rhizolysis and sacro-iliac joint (SIJ) injection developed an unexpected inability to stand or w...We present the case of a 60 yrs old male who, following a routine, uneventful, fluoroscopically guided L5/S1 facet joint rhizolysis and sacro-iliac joint (SIJ) injection developed an unexpected inability to stand or walk, a condition known as astasia-abasia. Initial concern had been that this neurological phenomenon was as a result of complications of his chronic pain intervention. Despite an essentially normal neurological examination and dedicated battery of neurological imaging and special testing, no cause was identified. Over a 7-day period of in-patient admission and physical rehabilitation symptoms resolved entirely. In the course of the workup for this episode, it was suggested that the phenomenon was the result of a side effect of dexamfetamine, an agent that had been prescribed for the patient by his neurologist for treatment of his narcolepsy. On the back of this episode, this treatment was discontinued by his neurologist following an outpatient consultation. Subsequent repeated SIJ injections were entirely uneventful and the patient experienced no further occurrences of this phenomenon.展开更多
文摘Background: Thermal Microcautery (TMC) is a form of peripheral nerve field stimulation and is a technique used in Traditional Indian Medicine (Agnikarma) to manage chronic pain. The aim was to asses TMC in painful knee osteoarthritis (PKO). Methods: A non-randomized controlled trial was employed. All PKO patients on a waiting list for knee replacement were offered PNFS-TMC. Patients in the intervention group received 4 sessions (2 weeks apart) of PNFS-TMC by a pin-point tip of a metal rod. The rod was heated over a flame for 5 minutes before being used to induce a single 1 mm second-degree burn over points of tenderness. The control group was selected from the same waiting list. The primary outcome was assessed by Visual Analogue Scale (VAS) scores. The secondary outcomes were changes in levels of physical day to day activity, sleep and analgesics. Results: 16 PNFS-TMC intervention group patients and 15 control group patients were subject to analysis. Baseline VAS score was higher in PNFS-TMC group [9 ± 1.23 (95% CI 8.38 - 9.61) versus 5.93 ± 2.11 (95% CI 4.81 - 7.06) in the control, P Conclusions: PNFS-TMC could offer a simple, safe, cheap and effective method of pain management in chronic PKO patients.
文摘Background: Pain is a major problem for patients suffering from chronic pancreatitis. Unfortunately, medical therapy often fails to adequately control pain. Coeliac plexus block (CPB) is sometimes performed to treat intractable pain in patients with chronic pancreatitis. Aims: Our primary objective was to determine the effect of CPB for pain management in a cohort of patients with chronic pancreatitis. We also sought to quantify opioid use in patients with chronic pancreatitis. Methods: We reviewed the database of pain referrals for chronic pancreatitis and recorded opioid use for each patient. We interviewed all patients who underwent CPB for chronic pancreatitis at TUH from January 2018-December 2020. Effect of the block, duration of pain relief, analgesia requirements, complications and patient satisfaction were recorded. Results: 62 inpatient referrals were made to the pain service over a 3-year period regarding pain management in chronic pancreatitis. 76% of patients referred for chronic pancreatitis pain management require regular long-term opioids. Mean daily oxycodone requirement in this group was 52 mg. 11 of these patients underwent CPB over a 3-year period. Mean age of patients who underwent CPB was 44 years. Effective reduction in pain scores (>50% improvement) was achieved in 7 of 11 patients. The mean NRS pain score decreased from 9.2 (±0.9) to 4.4 (±3.1). Mean duration of pain relief experienced was 69 days. Transient diarrhoea was reported by 1 patient. 4 patients reported a temporary decrease in oral analgesia requirement, while 3 patients reported a sustained decrease in analgesia requirement post CPB. For those who had further CPBs, the effect of repeated interventions was comparable to the initial procedure. Conclusion: High regular opioid consumption is common in patients with chronic pancreatitis. CPB can provide significant improvement in pain control and quality of life in appropriately selected patients. CPB can assist with opioid reduction and containment. It is not effective in all ca
文摘We present the case of a 60 yrs old male who, following a routine, uneventful, fluoroscopically guided L5/S1 facet joint rhizolysis and sacro-iliac joint (SIJ) injection developed an unexpected inability to stand or walk, a condition known as astasia-abasia. Initial concern had been that this neurological phenomenon was as a result of complications of his chronic pain intervention. Despite an essentially normal neurological examination and dedicated battery of neurological imaging and special testing, no cause was identified. Over a 7-day period of in-patient admission and physical rehabilitation symptoms resolved entirely. In the course of the workup for this episode, it was suggested that the phenomenon was the result of a side effect of dexamfetamine, an agent that had been prescribed for the patient by his neurologist for treatment of his narcolepsy. On the back of this episode, this treatment was discontinued by his neurologist following an outpatient consultation. Subsequent repeated SIJ injections were entirely uneventful and the patient experienced no further occurrences of this phenomenon.
