473: Subcutaneous Targeted Stimulation in Chronic Pain Conditions - a 6 Year Retrospective Study

Aim: Spinal cord stimulation (SCS) is used to clinically manage and/or treat several chronic pain etiologies. A limited amount is known about the influence on patients' use of opioid pain medication. This retrospective analysis evaluated SCS effect on opioid consumption in patients presenting with chronic pain conditions. Materials & methods: Sixty-seven patients underwent a temporary trial device, permanent implant or both. Patients were divided for assessment based on the nature of their procedure(s). Primary outcome was change in morphine equivalent dose (MED), ascertained from preoperative and postoperative medication reports. Results: Postoperative MED was significantly lower in patients who received some form of neuromodulation therapy. Pretrial patients reported an average MED of 41.01 ± 10.23 mg per day while post-trial patients reported an average of 13.30 ± 5.34 mg per day (p < 0.001). Pre-implant patients reported an average MED of 39.14 ± 13.52 mg per day while post-implant patients reported an average MED of 20.23 ± 9.01 mg per day (p < 0.001). There were no significant differences between pre-trial and pre-implant MED, nor between post-trial and post-implant MED. Of the 42 study subjects who reported some amount of pre-intervention opioid use, 78.57% indicated a lower MED (n = 33; p < 0.001), 16.67% indicated no change (n = 7) and 4.76% (n = 2) indicated a higher MED, following intervention. Moreover, SCS therapy resulted in a 26.83% reduction (p < 0.001) in the number of patients with MED >50 mg per day. Conclusion: Spinal cord stimulation may reduce opioid use when implemented appropriately. Neuromodulation may represent alternative therapy for alleviating chronic pain which may avoid a number of deleterious side effects commonly associated with opioid consumption.

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Central sensitisation in chronic pain conditions: latest discoveries and their potential for precision medicine

The Lancet Rheumatology ◽

10.1016/s2665-9913(21)00032-1 ◽

2021 ◽

Vol 3 (5) ◽

pp. e383-e392

Author(s):

Jo Nijs ◽

Steven Z George ◽

Daniel J Clauw ◽

César Fernández-de-las-Peñas ◽

Eva Kosek ◽

...

Keyword(s):

Chronic Pain ◽

Precision Medicine ◽

Central Sensitisation ◽

Chronic Pain Conditions

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Use of Alfentanil in Palliative Care

Pharmacy ◽

10.3390/pharmacy8040240 ◽

2020 ◽

Vol 8 (4) ◽

pp. 240

Author(s):

José António Ferraz Gonçalves ◽

Filipa Sousa ◽

Lucy Alves ◽

Patrícia Liu ◽

Sara Coelho

Keyword(s):

Chronic Pain ◽

Palliative Care ◽

Retrospective Study ◽

Pain Relief ◽

Renal Impairment ◽

Care Service ◽

Palliative Care Service ◽

Median Number ◽

Second Line ◽

Induction Of Tolerance

Alfentanil is used for chronic pain relief in palliative care. However, there is a dearth of data on its use. For this reason, a decision was made to review the use of alfentanil in palliative care. Retrospective study was carried out in a palliative care service. The files of patients who received alfentanil as an intravenous or subcutaneous continuous infusion for pain relief, between January 2018 and April 2019. In total, 111 patients received alfentanil out of 113 admissions. Of them, 56 were male, and the median age was 70 years. The median number of days on alfentanil was 6 (range 1 to 129). The most frequent primary reasons for switching to alfentanil was uncontrolled pain in 52 (46%) patients and renal impairment in 24 (21%) patients. The median 24-h initial dose of alfentanil was 4 mg (1–20), and the median final 24-h dose of alfentanil was 5 mg (1–60), (p < 0.001). The initial 24-h median number of rescue doses was 2 (0–8), and the final median number of rescue doses was 1 (0 to 8), (p = 0.025). In 56 patients who were on alfentanil for at least 7 days, the dose decreased in 3 (5%), remained stable in 10 (18%) and increased in 43 (77%). The patient on alfentanil for 129 days maintained the same dose throughout that period. Alfentanil can be a useful second-line opioid. The induction of tolerance does not seem to be particularly rapid with alfentanil.

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Interdisciplinary Teams in Endometriosis Care

Seminars in Reproductive Medicine ◽

10.1055/s-0040-1718943 ◽

2020 ◽

Vol 38 (02/03) ◽

pp. 227-234

Author(s):

Catherine Allaire ◽

Alicia Jean Long ◽

Mohamed A. Bedaiwy ◽

Paul J. Yong

Keyword(s):

Chronic Pain ◽

Interdisciplinary Team ◽

Multidisciplinary Care ◽

Complex Problem ◽

Interdisciplinary Teams ◽

Team Approach ◽

Team Care ◽

Psychological Therapies ◽

Published Evidence ◽

Chronic Pain Conditions

AbstractEndometriosis-associated chronic pelvic pain can at times be a complex problem that is resistant to standard medical and surgical therapies. Multiple comorbidities and central sensitization may be at play and must be recognized with the help of a thorough history and physical examination. If a complex pain problem is identified, most endometriosis expert reviews and guidelines recommend multidisciplinary care. However, there are no specific recommendations about what should be the components of this approach and how that type of team care should be delivered. There is evidence showing the effectiveness of specific interventions such as pain education, physical therapy, psychological therapies, and pharmacotherapies for the treatment of chronic pain. Interdisciplinary team models have been well studied and validated in other chronic pain conditions such as low back pain. The published evidence in support of interdisciplinary teams for endometriosis-associated chronic pain is more limited but appears promising. Based on the available evidence, a model for an interdisciplinary team approach for endometriosis care is outlined.

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EAN guidelines on central neurostimulation therapy in chronic pain conditions

European Journal of Neurology ◽

10.1111/ene.13103 ◽

2016 ◽

Vol 23 (10) ◽

pp. 1489-1499 ◽

Cited By ~ 90

Author(s):

G. Cruccu ◽

L. Garcia-Larrea ◽

P. Hansson ◽

M. Keindl ◽

J.-P. Lefaucheur ◽

...

Keyword(s):

Chronic Pain ◽

Chronic Pain Conditions

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Ketamine Infusions for Complex Regional Pain Syndrome

10.2310/pm.15081 ◽

2016 ◽

Author(s):

Roy K. Esaki

Keyword(s):

Chronic Pain ◽

Complex Regional Pain Syndrome ◽

Hepatic Dysfunction ◽

Case Reports ◽

Pain Syndrome ◽

Nmda Receptor Antagonist ◽

Treatment Resistant ◽

Urinary Tract Symptoms ◽

Chronic Pain Conditions ◽

Lower Urinary

Ketamine is an N-methyl-d-aspartate (NMDA) receptor antagonist that has been increasingly used in the management of treatment-resistant chronic pain conditions, particularly representing neuropathic involvement or central sensitization. Complex regional pain syndrome (CRPS) is a prototypical condition often treated with ketamine infusions. Although the analgesic benefits of ketamine as an opioid-sparing adjunct in the preoperative period have been well studied, the use of ketamine to mitigate chronic pain conditions remains largely anecdotal, composed largely of case reports and uncontrolled small studies. The limited evidence and published reports support the use of ketamine infusions as one aspect of a comprehensive, multimodal approach for CRPS. Although ketamine infusions are relatively safe when titrated appropriately, with minimal respiratory depression, side effects include sympathetic activation, unpleasant psychomimetic effects, lower urinary tract symptoms, and hepatic dysfunction.

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