scholarly journals Review of the Safety of Bipolar Radiofrequency Ablation in Patients with Chronic Pain with Implantable Cardiac Rhythm Management Devices

2021 ◽  
pp. E169-E176
Keyword(s):  
Chronic Pain ◽  
Radiofrequency Ablation ◽  
Pain Management ◽  
Adverse Events ◽  
Persistent Pain ◽  
Narrative Review ◽  
Cardiac Conduction ◽  
Systematic Assessment ◽  
Bipolar Radiofrequency ◽  
Cardiac Devices

BACKGROUND: Chronic pain, especially low back pain and hip pain, has been a growing public health concern that affects over 100 million Americans annually. Radiofrequency ablation (RFA) has distinct advantages over other chronic pain management modalities and its use has been increasing over the past decade. Among the growing population with comorbid conduction disorders and persistent pain, RFA and its potential interference with implantable cardiac devices is of concern. RFA is becoming a foundational element of persistent pain management and has been shown to be effective in a multitude of chronic pain syndromes. Cardiac implantable electronic devices (CIED), such as cardiac pacemakers or implantable cardioverter defibrillators, have been used in the treatment of cardiac conduction diseases for a number of decades. With our aging population, these diseases have increased in both incidence and prevalence. Chronic pain and cardiac conduction diseases are both common in our increasingly aging population. OBJECTIVES: This study aims to determine if the literature supports the hypothesis that patients with CIEDs can safely use RFA with minimal to no interaction. STUDY DESIGN: Systematic assessment of literature with a modified approach with bipolar RFA. METHODS: A narrative review with systematic assessment of the literature was carried out. In this review, we included randomized controlled trials (RCTs), open non-randomized control studies, prospective studies, retrospective studies, case series, and case reports. All types of radiofrequency utilized for pain management including pulsed and conventional were included. Outcome measures included interactions between the cardiovascular implantable electronic device (CIED) and radiofrequency ablation (RFA), adverse events, RFA efficacy in treating the pain using pain scores, and other complications. RESULTS: Our search criteria yielded 4 studies for inclusion, with inclusion of 33 patients and 71 bipolar radiofrequency for treatments. No adverse events or interactions occurred between the bipolar radiofrequency device and the implanted cardiac devices in any of these patients. Bipolar radiofrequency was utilized in all patients (n = 33). Overall there were no complications or malfunctions. LIMITATIONS: Small sample size, narrative review. CONCLUSIONS: This study provides evidence that bipolar RFA can be safely used in patients with CIEDs for chronic pain provided that proper precautions are employed. Considerations for safe use are provided. KEY WORDS: Chronic pain, CIED, radiofrequency ablation

Gender based differences, pharmacogenetics and adverse events in chronic pain management

2019 ◽  
Vol 20 (2) ◽  
pp. 320-328 ◽  
Author(s):  
Beatriz Planelles ◽  
César Margarit ◽  
María-del-Mar Inda ◽  
Pura Ballester ◽  
Javier Muriel ◽  
...  
Keyword(s):  
Chronic Pain ◽  
Pain Management ◽  
Adverse Events ◽  
Chronic Pain Management ◽  
Gender Based

scholarly journals Management of Cardiac Implantable Electrical Devices in Patients Undergoing Radiofrequency Ablation for Spine Pain: Physician Survey and Review of Guidelines

2020 ◽  
Vol 4;23 (7;4) ◽  
pp. E335-E342
Author(s):  
Jason Friedrich
Keyword(s):  
Decision Making ◽  
Chronic Pain ◽  
Radiofrequency Ablation ◽  
Joint Pain ◽  
Risk Mitigation ◽  
Narrative Review ◽  
Mitigation Strategies ◽  
Web Based ◽  
Electrical Devices ◽  
Risk Mitigation Strategies

Background: More patients with cardiac implantable electrical devices (CIEDs) are presenting to spine and pain practices for radiofrequency ablation (RFA) procedures for chronic pain. Although the potential for electromagnetic interference (EMI) affecting CIED function is known with RFA procedures, available guidelines do not specifically address CIED management for percutaneous RFA for zygapophyseal (z-joint) joint pain, and thus physician practice may vary. Objectives: To better understand current practices of physicians who perform RFA for chronic z-joint pain with respect to management of CIEDs. Perioperative CIED management guidelines are also reviewed to specifically address risk mitigation strategies for potential EMI created by ambulatory percutaneous spine RFA procedures. Study Design: Web-based provider survey and narrative review. Setting: Multispecialty pain clinic, academic medical center. Methods: A web-based survey was created using Research Electronic Data Capture (REDCap). A survey link was provided via e-mail to active members of the Spine Intervention Society (SIS), American Society of Regional Anesthesia and Pain Medicine, as well as distributed freely to community Pain Physicians and any receptive academic departments of PM&R or Anesthesiology. The narrative review summarizes pertinent case series, review articles, a SIS recommendation statement, and multi-specialty peri-operative guidelines as they relate specifically to spine RFA procedures. Results: A total of 197 clinicians participated in the survey from diverse clinical backgrounds, including anesthesiology, physical medicine and rehabilitation, radiology, neurosurgery, and neurology, with 81% reporting fellowship training. Survey responses indicate wide variability in provider management of CIEDs before, during, and after RFA for z-joint pain. Respondents indicated they would like more specific guidelines to aid in management and decision-making around CIEDs and spine RFA procedures. Literature review yielded several practice guidelines related to perioperative management of CIEDs, but no specific guideline for percutaneous spine RFA procedures. However, combining the risk mitigation strategies provided in these guidelines, with interventional pain physician clinical experience allows for reasonable management recommendations to aid in decision-making. Limitations: Although this manuscript can serve as a review of CIEDs and aid in management decisions in patients with CIEDs, it is not a clinical practice guideline. Conclusions: Practice patterns vary regarding CIED management in ambulatory spine RFA procedures. CIED presence is not a contraindication for spine RFA but does increase the complexity of a spine RFA procedure and necessitates some added precautions. Key words: Radiofrequency ablation, neurotomy, cardiac implantable electrical device, zygapophyseal joint, spondylosis, neck pain, low back pain, chronic pain

scholarly journals Moving With Pain: What Principles From Somatic Practices Can Offer to People Living With Chronic Pain

2021 ◽  
Vol 11 ◽  
Author(s):  
Emma Meehan ◽  
Bernie Carter
Keyword(s):  
Chronic Pain ◽  
Pain Management ◽  
External Environment ◽  
Persistent Pain ◽  
Self Management ◽  
Chronic Pain Management ◽  
Social Environments ◽  
Subjective Experiences ◽  
Pain Experiences ◽  
Internal Body

This article brings together research from the fields of chronic pain management and somatic practices to develop a novel framework of principles to support people living with persistent pain. These include movement-based approaches to awareness of the internal body (interoception), the external environment (exteroception) and movement in space (proprioception). These significantly work with the lived subjective experiences of people living with pain, to become aware of body signals and self-management of symptoms, explore fear and pleasure of movement, and understand how social environments impact on pain. This analysis has potential to create new ways of supporting, understanding and articulating pain experiences, as well as shaping the future of somatic practices for chronic pain.

Virtual reality for acute and chronic pain management in adult patients: a narrative review

Anaesthesia ◽  
2020 ◽  
Author(s):  
A. Chuan ◽  
J. J. Zhou ◽  
R. M. Hou ◽  
C. J. Stevens ◽  
A. Bogdanovych
Keyword(s):  
Chronic Pain ◽  
Virtual Reality ◽  
Pain Management ◽  
Narrative Review ◽  
Adult Patients ◽  
Chronic Pain Management

Interdisciplinary management for chronic pain in central neurological disorders: a retrospective study

2020 ◽  
Vol 27 (1) ◽  
pp. 1-7
Author(s):  
Jamie Young ◽  
Steven Mantopoulos ◽  
Megan Blanchard ◽  
Hilarie Tardif ◽  
Malcolm Hogg ◽  
...  
Keyword(s):  
Chronic Pain ◽  
Retrospective Study ◽  
Pain Management ◽  
Outcome Measures ◽  
Neurological Disorders ◽  
Neurological Disorder ◽  
Persistent Pain ◽  
Interdisciplinary Management ◽  
Management Service ◽  
Pain Outcomes

Background/aims Chronic pain in central neurological disorders is common and the current management of chronic pain is through an interdisciplinary approach. The aim of this study was to compare outpatient interdisciplinary-based treatment for chronic pain in patients with central neurological disorders to those without central neurological disorders. Methods This was a retrospective study and pain-related outcome measures were collected from a clinical outcomes registry (electronic Persistent Pain Outcomes Collaboration). This registry contained data on people who attended a pain management service who, for the purpose of this study, were categorised into those with a central neurological disorder and those without a central neurological disorder. The two sample t-test was used to determine the significance of the difference between the groups and statistical significance was defined as P<0.05. Outcome measures compared included the Brief Pain Inventory, Depression, Anxiety and Stress Scale 21, Patient Self-efficacy Questionnaire and Patient Catastrophisation Scale. Results There was a total of 1924 participants with a central neurological disorder. The electronic Persistent Pain Outcomes Collaboration registry shows that after engagement with an interdisciplinary pain management service, there was a reduction in pain severity scores, interference, mean depression, anxiety and stress in both groups at end of an episode of care compared to referral. There was a significant difference in mean changes for pain catastrophising between those with a central neurological disorder (−10.3) and those without (−7.8). Conclusions This study shows that people with central neurological disorders can also benefit from interdisciplinary management and have similar results to those without these conditions.

Use of multidomain management strategies by community dwelling adults with chronic pain: evidence from a systematic review

2019 ◽  
Vol 19 (1) ◽  
pp. 9-23 ◽  
Author(s):  
David R. Axon ◽  
Mira J. Patel ◽  
Jennifer R. Martin ◽  
Marion K. Slack
Keyword(s):  
Systematic Review ◽  
Chronic Pain ◽  
Pain Management ◽  
Adverse Events ◽  
Management Strategies ◽  
Community Dwelling ◽  
Controlled Vocabulary ◽  
Self Management ◽  
Patient Reported ◽  
Pain Outcomes

AbstractBackground and aimsMultidomain strategies (i.e. two or more strategies) for managing chronic pain are recommended to avoid excessive use of opioids while producing the best outcomes possible. The aims of this systematic review were to: 1) determine if patient-reported pain management is consistent with the use of multidomain strategies; and 2) identify the role of opioids and non-steroidal anti-inflammatory drugs (NSAIDs) in patient-reported pain management.MethodsBibliographic databases, websites, and reference lists of included studies were searched to identify published articles reporting community-based surveys of pain self-management from January 1989 to June 2017 using controlled vocabulary (and synonyms): pain; self-care; self-management; self-treatment; and adult. Two independent reviewers screened studies and extracted data on subject demographics, pain characteristics, pain self-management strategies, and pain outcomes. Pain self-management strategies were organized according to our conceptual model. Included studies were assessed for risk of bias. Differences between the researchers were resolved by consensus.ResultsFrom the 3,235 unique records identified, 18 studies published between 2002 and 2017 from 10 countries were included. Twenty-two types of pharmacological strategies were identified (16 prescription, six non-prescription). NSAIDs (15 studies, range of use 10–72%) and opioids (12 studies, range of use 5–72%) were the most commonly reported prescription pharmacological strategies. Other prescription pharmacological strategies included analgesics, acetaminophen, anticonvulsants, antidepressants, anxiolytics, salicylates, β-blockers and calcium channel blockers, disease-modifying anti-rheumatic drugs and steroids, muscle relaxants, topical products, triptans, and others. Twenty-two types of non-pharmacological strategies were identified: four medical strategies (10 studies), 10 physical strategies (15 studies), four psychological strategies (12 studies), and four self-initiated strategies (15 studies). Medical strategies included consulting a medical practitioner, chiropractic, and surgery. Physical strategies included exercise, massage, hot and cold modalities, acupuncture, physical therapy, transcutaneous electrical nerve stimulation, activity modification or restriction, assistive devices, and altering body position/posture. Psychological strategies included relaxation, prayer or meditation, therapy, and rest/sleep. Self-initiated strategies included dietary or herbal supplements, dietary modifications, and complementary and alternative medicine. Overall, the number of strategies reported among the studies ranged from five to 28 (out of 44 identified strategies). Limited data on pain outcomes was reported in 15 studies, and included satisfaction with pain management strategies, pain interference on daily activities, adverse events, lost work or restricted activity days, emergency department visits, and disabilities.ConclusionsA wide variety and large number of pharmacological and non-pharmacological strategies to manage chronic pain were reported, consistent with the use of multidomain strategies. High levels of use of both NSAIDs and opioids also were reported.ImplicationsComprehensive review and consultation with patients about their pain management strategies is likely needed for optimal outcomes. Additional research is needed to determine: how many, when, and why multidomain strategies are used; the relationship between opioid use, multidomain management strategies, and level of pain; how multidomain strategies relate to outcomes; and if adding strategies to a pain management plan increases the risk of adverse events or interactions, and increases an individuals pain management burden.

scholarly journals Utilizing Multidisciplinary Medicine in Pain Management: A Narrative Review

2021 ◽  
pp. 369-378
Keyword(s):  
Chronic Pain ◽  
Pain Management ◽  
Behavioral Health ◽  
Clinical Outcomes ◽  
Management Practice ◽  
Treatment Plan ◽  
Narrative Review ◽  
Key Words Pain ◽  
Health Factors

BACKGROUND: The role of psychological factors influencing chronic pain has been well documented. This review includes a historical perspective and current examination of the literature on psychological and behavioral health characteristics and their influence on chronic pain. OBJECTIVES: To identify psychological and behavioral health factors involved with chronic pain, as well as the challenges and opportunities of integrating multidisciplinary care into a pain management practice. STUDY DESIGN: Narrative review of peer-reviewed literature examining psychological and behavioral health factors associated with poor clinical outcomes with an emphasis on orthopedics. METHODS: The Medline database was reviewed to identify peer-reviewed research that discussed psychological and behavioral health factors relevant to pain management or orthopedics. RESULTS: The evidence provided suggests that these constructs should receive strong consideration when managing chronic pain. The incorporation of such factors may improve patient care and clinical outcomes and reduce total health care costs. LIMITATIONS: This narrative review is not systematic in nature, but rather focused on the impacts on orthopedics and pain management. CONCLUSIONS: Psychological and behavioral health factors should be an integral component of a pain management practice as there is substantial overlap between depression and anxiety with chronic pain. Positive affect, such as resilience, may act as a buffer and confer some protection against the sequelae of chronic pain. There is evidence that psychological screeners offer further insight into the patient condition and would contribute to the treatment plan. The novel role of a behavioral health navigator in a pain management clinic is worthy of further exploration as it has proved beneficial in other chronic health conditions. KEY WORDS: Pain management, chronic pain, psychological, multidisciplinary, behavioral health navigator, resiliency, opioids

scholarly journals Pain Management Strategies and Lessons from the Military: A Narrative Review

2015 ◽  
Vol 20 (5) ◽  
pp. 261-268 ◽  
Author(s):  
April Hazard Vallerand ◽  
Patricia Cosler ◽  
Jack E. Henningfield ◽  
Pam Galassini
Keyword(s):  
Chronic Pain ◽  
Pain Management ◽  
General Population ◽  
Management Strategies ◽  
The United States ◽  
Narrative Review ◽  
Chronic Pain Management ◽  
Management Guidelines ◽  
Us Military ◽  
The Us

BACKGROUND: Wounded soldiers often experience substantial pain, which must be addressed before returning to active duty or civilian life. The United States (US) military has instituted several guidelines and initiatives aimed at improving pain management by providing rapid access to medical care, and developing interdisciplinary multimodal pain management strategies based on outcomes observed both in combat and hospital settings.OBJECTIVE: To provide a narrative review regarding US military pain management guidelines and initiatives, which may guide improvements in pain management, particularly chronic pain management and prevention, for the general population.METHODS: A literature review of US military pain management guidelines and initiatives was conducted, with a particular focus on the potential of these guidelines to address shortcomings in chronic pain management in the general population.DISCUSSION: The application of US military pain management guidelines has been shown to improve pain monitoring, education and relief. In addition, the US military has instituted the development of programs and guidelines to ensure proper use and discourage aberrant behaviours with regard to opioid use, because opioids are regarded as a critical part of acute and chronic pain management schemes. Inadequate pain management, particularly inadequate chronic pain management, remains a major problem for the general population in the US. Application of military strategies for pain management to the general US population may lead to more effective pain management and improved long-term patient outcomes.

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