scholarly journals How Well Do Current Laboratory Biomarkers Inform Clinical Decision-Making in Chronic Pain Management?

2021 ◽  
Vol Volume 14 ◽  
pp. 3695-3710
Author(s):  
Jonathan M Hagedorn ◽  
Joshua Gunn ◽  
Ryan Budwany ◽  
Ryan S D'Souza ◽  
Krishnan Chakravarthy ◽  
...  
Keyword(s):  
Decision Making ◽  
Chronic Pain ◽  
Pain Management ◽  
Clinical Decision Making ◽  
Clinical Decision ◽  
Chronic Pain Management ◽  
Laboratory Biomarkers

Provider decision making in chronic pain management: influence of patient sex, race, and depression

2012 ◽  
Vol 13 (4) ◽  
pp. S106
Author(s):  
A. Hirsh ◽  
N. Hollingshead ◽  
J. Wu ◽  
M. Bair ◽  
M. Matthias ◽  
...  
Keyword(s):  
Decision Making ◽  
Chronic Pain ◽  
Pain Management ◽  
Chronic Pain Management

scholarly journals THE UTILITY OF MRI IN CLINICAL DECISION-MAKING FOR PEDIATRIC ATHLETES WITH SYMPTOMATIC SUBFIBULAR OSSICLES

2020 ◽  
Vol 8 (4_suppl3) ◽  
pp. 2325967120S0023
Author(s):  
James G. Gamble ◽  
Charles M Chan ◽  
Lawrence A Rinsky ◽  
Steven L. Frick ◽  
Kevin G. Shea
Keyword(s):  
Decision Making ◽  
Chronic Pain ◽  
Clinical Decision Making ◽  
Clinical Decision ◽  
Operative Management ◽  
Lateral Malleolus ◽  
Ankle Fractures ◽  
Mri Findings ◽  
Avulsion Fractures ◽  
Non Operative Management

Background: Pediatric athletes commonly sustain inversion-type ankle fractures.1,2 Approximately 1% will form post-traumatic subfibular ossicles (SO), especially after tip avulsion fractures.3,4 Athletes with SOs can have pain and recurrent sprains.5,6,7 Here we show the utility of magnetic resonance imaging (MRI) in clinical decision-making for athletes with ankle symptoms and the presence of a SO. Our hypothesis is that MRI can predict which athletes have a stable SO and will respond to non-operative management, and which athletes have an unstable SO and will need surgery. Methods: We performed an IRB approved retrospective cohort study. Children were eligible from our practices if (1) they had radiographic evidence of a SO, (2) they had symptoms of pain and recurrent sprains, and (3) they had undergone MRI during their clinical evaluation. We identified 19 eligible children (20 ankles;) eight girls and eleven boys, ages 5–19 years. Nine involved the left ankle; 11 the right ankle. Most frequent sport was soccer (12/16) followed by basketball (3/14.) From the radiograph we determined ossicle size and location. MRI images were considered positive if fluid-sensitive sequences showed a high-intensity signal between the SO and the fibular epiphysis. Main outcome was treatment (non-surgical or surgical) relative to the MRI findings. Results: Size shape and location: Size and shape were variable. Width ranged from 2 – 10.4 mm and length from 4 – 13.5 mm. Concerning location all were in the distal 1/3 pf the epiphysis. Six were anterior and 14 were anterior-inferior to the fibular tip. MRI findings: Sixteen of the 20 ankles (80%) had positive MRI findings (figure 1), and 4 had negative findings (figure 2). The ATFL attached directly to the fragment in 11 of the 16 MRI positive ankles. Clinical decision making: All athletes with negative MRI findings responded to non-operatively management. Ten of the 16 ankles with positive MRIs have had surgery. Eight had excision of the ossicle and two had internal fixation based on the size of the ossicle. Surgical findings confirmed attachment of the ATFL to the fragment (figure 3.) Six athletes with positive MRIs continue to be under observation. Conclusions The results support our hypothesis that MRI has predictive value in clinical decision-making for symptomatic athletes with a SO. When fluid-sensitive MRI sequences show high signal intensity between the ossicle and the fibular epiphysis, and when the ATFL attaches to the ossicle, the athlete has a poor prognosis for non-operative management. [Figure: see text][Figure: see text] References: Su AW, Larson AN. Pediatric ankle fractures: Concepts and treatment principles. Foot Ankle Clin. 2015;20(4):705-719. Pommering TL, Kluchurosky L, Hall SL. Ankle and foot injuries in pediatric and adult athletes. Prim Care 2005;32(1):133-161. Han SH, Choi WJ, Kim S, Kim S-J, Lee JW. Ossicles associate with chronic pain around the malleoli of the ankle. 2008;90-B:1049-1054. Gamble JG, Sugi M, Tileston KR, Chan CM, Livingston KS. The natural history of type VII all-epiphyseal fractures of the lateral malleolus. Orthop J Sports Med. 2019; 7(3) (suppl 1) DOI 10.1177/2325967119S00116. Pill SG, Hatch M, Linton JM, Davidson RS. JBJS 2013;95: e115(1-6). Han SH, Choi WJ, Kim S, Kim SJ, Lee JW. Ossicles associated with chronic pain around the malleoli of the ankle. J Bone Joint Surg Br. 2008;90(8):1049-1054. Danielsson LG. Avulsion fracture of the lateral malleolus in children. Injury 12:165-167

Avoiding anchoring bias in unexplained chronic pain: an unexpected diagnosis of synovial osteochondromatosis

2021 ◽  
Vol 14 (4) ◽  
pp. e240462
Author(s):  
Rehana Murani ◽  
Ranita Harpreet Kaur Manocha
Keyword(s):  
Decision Making ◽  
Chronic Pain ◽  
Clinical Decision Making ◽  
Clinical Decision ◽  
Diagnostic Error ◽  
Synovial Osteochondromatosis ◽  
Unexplained Pain ◽  
Anchoring Bias ◽  
History Of ◽  
Yellow Flags

Unconscious biases may influence clinical decision making, leading to diagnostic error. Anchoring bias occurs when a physician relies too heavily on the initial data received. We present a 57-year-old man with a 3-year history of unexplained right thigh pain who was referred to a physiatry clinic for suggestions on managing presumed non-organic pain. The patient had previously been assessed by numerous specialists and had undergone several imaging investigations, with no identifiable cause for his pain. Physical examination was challenging and there were several ‘yellow flags’ on history. A thorough reconsideration of the possible diagnoses led to the discovery of hip synovial osteochondromatosis as the cause for his symptoms. Over-reliance on the referral information may have led to this diagnosis being missed. In patients with unexplained pain, it is important to be aware of anchoring bias in order to avoid missing rare diagnoses.

969 CAN THE PAIN CATASTROPHIZING SCALE AND THE TAMPA SCALE OF KINESIOPHOBIA BE USED FOR CLINICAL DECISION MAKING IN CHRONIC PAIN?

2006 ◽  
Vol 10 (S1) ◽  
pp. S251-S251
Author(s):  
I.E. Lame ◽  
M.L. Peters ◽  
A.H. Kessels ◽  
M. Kleef ◽  
J. Patijn
Keyword(s):  
Decision Making ◽  
Chronic Pain ◽  
Clinical Decision Making ◽  
Pain Catastrophizing ◽  
Clinical Decision ◽  
Pain Catastrophizing Scale

Clinical decision making in pain management: Contributions of physician and patient characteristics to variations in practice

2003 ◽  
Vol 4 (1) ◽  
pp. 29-39 ◽  
Author(s):  
Carmen R. Green ◽  
John R.C. Wheeler ◽  
Frankie LaPorte
Keyword(s):  
Decision Making ◽  
Pain Management ◽  
Clinical Decision Making ◽  
Patient Characteristics ◽  
Clinical Decision

scholarly journals Clinical Decision Making in Renal Pain Management

2012 ◽  
Vol 20 (1) ◽  
pp. 18
Author(s):  
Damir Aganovic ◽  
Alen Prcic ◽  
Benjamin Kulovac ◽  
Osman Hadziosmanovic
Keyword(s):  
Decision Making ◽  
Pain Management ◽  
Clinical Decision Making ◽  
Clinical Decision

scholarly journals Knowledge, Attitude and Clinical Decision-Making Abilities of Pediatric Nurses Regarding Pain Management

2020 ◽  
Author(s):  
Nesrin ŞEN CELASİN ◽  
Şadiye DUR ◽  
Dilek ERGİN ◽  
Duygu KARAARSLAN
Keyword(s):  
Decision Making ◽  
Pain Management ◽  
Clinical Decision Making ◽  
Clinical Decision ◽  
Pediatric Nurses

scholarly journals A Clinical Decision Support System for Chronic Pain Management in Primary Care: Usability testing and its relevance

2015 ◽  
Vol 22 (3) ◽  
pp. 329-332 ◽  
Author(s):  
Kalpana Maria Nair ◽  
Raheleh Malaeekeh ◽  
Inge Schabort ◽  
Paul Taenzer ◽  
Arun Radhakrishnan ◽  
...  
Keyword(s):  
Primary Care ◽  
Chronic Pain ◽  
Decision Support ◽  
Pain Management ◽  
Decision Support System ◽  
Clinical Decision Support ◽  
Support System ◽  
Clinical Decision Support System ◽  
Clinical Decision ◽  
Chronic Pain Management
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