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2022 ◽  
Author(s):  
Leon Moskatel

Background and Objective: Medication-overuse headache (MOH) is a common, disabling, and treatable cause of chronic daily headache. This study evaluates the characteristics of a cohort of patients with MOH seen in a pain medicine clinic. Methods: We conducted a retrospective study of consecutive patients seen by a neurologist in the pain medicine clinic at the University of California, San Diego. Demographics, headache diagnoses, and overused medications were extracted from clinical records from 83 patients ≥ 18 years of age where a diagnosis of MOH was entered into the electronic medical record September 12, 2017-March 30, 2020. Results: Opioids were the most overused medications (42/83, 50.6%) followed by caffeine-containing compounds (20/83, 24.1%), triptans (12/83, 14.5%) and non-steroidal anti-inflammatory drugs (10/83, 12.9%). Chronic migraine was the most common underlying headache syndrome (54/83, 65.1%), followed by secondary headache disorder (13/83, 15.7%) and tension-type headache (8/83, 9.6%). Men were more likely to be overusing opioids (OR 3.3, p = 0.026) while women were more likely to be overusing caffeine-containing compounds (OR 5.4, p = 0.041). Discussion and Conclusions: It is crucial for pain specialists to recognize MOH in the pain clinic setting. Opioid overuse headache is more common among men, likely in part due to migraine being underrecognized in men and therefore men not receiving migraine-specific medications. Caffeine-containing compound overuse is more common among women; these are over-the-counter (OTC) and often do not appear on patients’ medications lists. Pain specialists should specifically ask patients with headache whether they are using OTC caffeine-containing compounds.


BMJ Open ◽  
2022 ◽  
Vol 12 (1) ◽  
pp. e052703
Author(s):  
Ingrid Schuttert ◽  
Hans Timmerman ◽  
Gerbrand J Groen ◽  
Kristian Kjær Petersen ◽  
Lars Arendt-Nielsen ◽  
...  

IntroductionPatients with chronic low back pain radiating to the leg (CLBPr) are sometimes referred to a specialised pain clinic for a precise diagnosis based, for example, on a diagnostic selective nerve root block. Possible interventions are therapeutic selective nerve root block or pulsed radiofrequency. Central pain sensitisation is not directly assessable in humans and therefore the term ‘human assumed central sensitisation’ (HACS) is proposed. The possible existence and degree of sensitisation associated with pain mechanisms assumed present in the human central nervous system, its role in the chronification of pain and its interaction with diagnostic and therapeutic interventions are largely unknown in patients with CLBPr. The aim of quantitative sensory testing (QST) is to estimate quantitatively the presence of HACS and accumulating evidence suggest that a subset of patients with CLBPr have facilitated responses to a range of QST tests.The aims of this study are to identify HACS in patients with CLBPr, to determine associations with the effect of selective nerve root blocks and compare outcomes of HACS in patients to healthy volunteers.Methods and analysisA prospective observational study including 50 patients with CLBPr. Measurements are performed before diagnostic and therapeutic nerve root block interventions and at 4 weeks follow-up. Data from patients will be compared with those of 50 sex-matched and age-matched healthy volunteers. The primary study parameters are the outcomes of QST and the Central Sensitisation Inventory. Statistical analyses to be performed will be analysis of variance.Ethics and disseminationThe Medical Research Ethics Committee of the University Medical Center Groningen, Groningen, the Netherlands, approved this study (dossier NL60439.042.17). The results will be disseminated via publications in peer-reviewed journals and at conferences.Trial registration numberNTR NL6765.


Author(s):  
Ji Hee Hong ◽  
Ho Woo Lee ◽  
Yong Ho Lee

BackgroundSpontaneous intracranial hypotension occurs due to cerebrospinal fluid leakage from the spinal column, and orthostatic headache is the most common clinical presentation. Recent studies showed that bilateral greater occipital nerve blockade demonstrated clinical efficacy in relieving post-dural puncture headache after caesarean section. CaseA 40-year-old male who presented severe orthostatic headache was consulted to our pain clinic from neurology department. He initially felt a dull nature pain over the whole occipital area which then spread over the frontal and parietal areas. His headache was combined with nausea and vomiting. An epidural blood patch was delayed until final cisternography, and bilateral greater occipital nerve blockade using ultrasound guidance was performed instead. After the blockade, the previously existing headache around the occipital and parietal areas disappeared completely, but mild headache persisted around the frontal area.ConclusionsGreater occipital nerve blockade could be a good therapeutic alternative to improve headache resulting from spontaneous intracranial hypotension.


2021 ◽  
pp. 1-14
Author(s):  
Chun Shing Kwok ◽  
Debbie Jackson ◽  
Sadie Bennett ◽  
Jacopo Tafuro ◽  
Adrian Large ◽  
...  

Background/Aims Chest pain is a common symptom, but its presentation and cause varies widely, making diagnosis a challenge. This study describes the authors' experience of a nurse-led rapid access chest pain clinic, and associated use of investigation and patient outcomes. Methods A retrospective service evaluation of patients referred to a nurse-led rapid access chest pain clinic was performed. Routinely-recorded data on patient demographics, symptoms, comorbidities, medications, cardiology clinic attendances and investigations were collected. In addition, admissions to accident and emergency or inpatient, death, acute myocardial infarction and percutaneous coronary intervention within 1 year were obtained. Results A total of 279 patients were included in the evaluation between January and February 2019. Chest pain was present as a symptom in 92.8% of patients, while 37.6% of patients had shortness of breath. Only 16.8% had typical angina, while 34.4% had atypical angina. The majority (93.9%) had two or fewer cardiology clinic appointments, the most common imaging investigation used was computed tomography coronary angiogram (47.3%) and 8.2% had a stress echocardiogram or invasive angiogram. Approximately one in five patients had a hospital admission within 1 year. The mortality rate within 1 year was 1.4%, but were all non-cardiac causes. Only 3.6% underwent percutaneous coronary intervention and there was only one mortality. Conclusions This service evaluation shows that a nurse-led rapid access chest pain clinic can be safe, efficient and closely adhere to National Institute for Health and Care Excellence guidelines. Many patients do not require unnecessary and potentially harmful investigations and revascularisation rates are low.


2021 ◽  
Vol 12 ◽  
Author(s):  
Sneh Patel ◽  
Rhiya Mittal ◽  
Elizabeth R. Felix ◽  
Konstantinos D. Sarantopoulos ◽  
Roy C. Levitt ◽  
...  

Background: Dysfunction at the ocular system via nociceptive or neuropathic mechanisms can lead to chronic ocular pain. While many studies have reported on responses to treatment for nociceptive pain, fewer have focused on neuropathic ocular pain. This retrospective study assessed clinical responses to pain treatment modalities in individuals with neuropathic component ocular surface pain.Methods: 101 individuals seen at the University of Miami Oculofacial Pain Clinic from January 2015 to August 2021 with ≥3 months of clinically diagnosed neuropathic pain were included. Patients were subcategorized (postsurgical, post-traumatic, migraine-like, and laterality) and self-reported treatment outcomes were assessed (no change, mild, moderate, or marked improvement). One-way ANOVA (analysis of variance) was used to examine relationships between follow up time and number of treatments attempted with pain improvement, and multivariable logistic regression was used to assess which modalities led to pain improvement.Results: The mean age was 55 years, and most patients were female (64.4%) and non-Hispanic (68.3%). Migraine-like pain (40.6%) was most common, followed by postsurgical (26.7%), post-traumatic (16.8%) and unilateral pain (15.8%). The most common oral therapies were α2δ ligands (48.5%), the m common topical therapies were autologous serum tears (20.8%) and topical corticosteroids (19.8%), and the most common adjuvant was periocular nerve block (24.8%). Oral therapies reduced pain in post-traumatic (81.2%), migraine-like (73%), and unilateral (72.7%) patients, but only in a minority of postsurgical (38.5%) patients. Similarly, topicals improved pain in post-traumatic (66.7%), migraine-like (78.6%), and unilateral (70%) compared to postsurgical (43.7%) patients. Non-oral/topical adjuvants reduced pain in postsurgical (54.5%), post-traumatic (71.4%), and migraine-like patients (73.3%) only. Multivariable analyses indicated migraine-like pain improved with concomitant oral α2δ ligands and adjuvant therapies, while postsurgical pain improved with topical anti-inflammatories. Those with no improvement in pain had a shorter mean follow-up (266.25 ± 262.56 days) than those with mild (396.65 ± 283.44), moderate (652 ± 413.92), or marked improvement (837.93 ± 709.35) (p < 0.005). Identical patterns were noted for number of attempted medications.Conclusion: Patients with migraine-like pain frequently experienced pain improvement, while postsurgical patients had the lowest response rates. Patients with a longer follow-up and who tried more therapies experienced more significant relief, suggesting multiple trials were necessary for pain reduction.


2021 ◽  
Vol 1 (2) ◽  
pp. 1-5
Author(s):  
Olivia Lee ◽  
◽  
Lawrence Robbins ◽  

2021 ◽  
Vol 15 (1) ◽  
Author(s):  
Hiroki Hanawa ◽  
Ryo Nagaoka ◽  
Yuya Fukuda ◽  
Kazuya Akutsu ◽  
Teppei Yamada ◽  
...  

Abstract Background Facial onset sensory and motor neuropathy is a very rare sensorimotor disorder characterized by facial onset and gradual progression, with approximately 100 cases reported worldwide in 2020. We report on our experience with a facial onset sensory and motor neuropathy case in our outpatient pain clinic. Case presentation A 71-year-old Japanese man with a previous diagnosis of trigeminal nerve palsy complained of facial paresthesia, cervical pain, and arm numbness. Cervical facet arthropathy was diagnosed initially, but neither pharmacotherapy nor nerve blocking alleviated his symptoms. We suspected bulbar palsy based on the presence of tongue fasciculation, which prompted referral to a neurologist. Based on a series of neurological examinations, facial onset sensory and motor neuropathy was ultimately diagnosed. Conclusions Pain clinicians must be mindful of rare diseases such as facial onset sensory and motor neuropathy; if they are unable to make a diagnosis, they should consult with other competent specialists.


2021 ◽  
Vol 18 (4) ◽  
Author(s):  
Atefeh Lotfi Jabali ◽  
Mina Mojtabaei ◽  
Malek Mirhashemi

Background: A variety of pharmacological and nonpharmacological methods are used to treat chronic pain. Transcranial direct current stimulation (tDCS) through stimulating the central and peripheral nerves is a different and promising method for the treatment of chronic pain. Objectives: The present study aimed to investigate the effectiveness of tDCS and pharmacotherapy in pain management in patients with chronic pain in Tehran, Iran. Methods: The present study followed a clinical trial design. The statistical population comprised all patients with chronic pain who were referred to Pardis Multidisciplinary Pain Clinic in Tehran within 2020 - 21. A total of 60 patients willing to participate in the study were selected using convenience sampling. The participants were randomly divided into three groups, including pharmacotherapy (treatment by gabapentin with a dosage of 600 mg twice per day), tDCS, and control (n = 20 per group). The research instrument included the McGill Pain Questionnaire. The data were analyzed using repeated-measures analysis of variance with SPSS software (version 24.0). Results: The results showed that both pharmacotherapy and tDCS interventions led to a reduction in the mean scores of pain management components, compared to the control group (P < 0.001). Furthermore, there was no significant difference between the effects of the two experimental groups on pain management components. Conclusions: The tDCS and pharmacotherapy were both shown to be effective in pain management in patients with chronic pain. Therefore, in addition to pharmacotherapy, tDCS is also recommended for the treatment of chronic pain.


2021 ◽  
Author(s):  
Mamata Pandey ◽  
Radhika Marwah ◽  
Maeve McLean ◽  
Elan Paluck ◽  
Amanda M Oliver ◽  
...  

Aim: The chronic pain clinic (CPC) is a multi-disciplinary program that incorporates pharmacological and non-pharmacological methods, including First Nations healing strategies, to manage pain, improve functioning and reduce opioid misuse among patients with chronic pain in Regina, Canada. Materials & methods: The care experiences of ten current clients were explored using a narrative interview approach. Results: The CPC provides high-quality and safe care for effective chronic pain management. Clients noted pain reduction and improvements in sleep, mobility, functionality, and mood. First Nation clients emphasized the importance of traditional healing strategies. Conclusion: This unique comprehensive multi-modal approach which incorporates First Nations healing strategies is effective in supporting the unique needs of local clients.


Author(s):  
Amit Kumar Kamewad ◽  
Shambhu Prasad Sharma ◽  
Sunny Eapen ◽  
Tarun Gupta

Background: Science of anaesthesia has revolutionized from traditional only application of relieving patient from pain induced during surgery to wide spectrum approaches like palliative care, critical care, perioperative care along with pain management. Despite of such critical roles in health care sector there is still a lack of awareness about anaesthesiology and anaesthesiologists. Current investigation was aimed towards assessing the awareness of paramedical staff regarding the role of anesthesiology.Methods: Current investigation was a prospective cross-sectional questionnaire-based study conducted on 100 paramedical staff posted in different departments of military hospital Jaipur.  All the study participants were interviewed face to face orally by an investigator using the set of questions listed in the questionnaire. Participants responses were documented and statistically represented as percentage.Results: Current study findings reveal that even though majority of the study participants (91) had experience more than 5 years in the hospital and most of them (˃90%) of participants were having educational level of higher secondary or graduation still the role of anaesthesiologist outside operation theatre was poorly known to paramedical staff. It was also observed in current investigation that role of anesthetist in pain clinic was poorly known to most of the participating paramedical staff.Conclusions: Providing knowledge about expertise of anesthesiologist among paramedical staffs by incorporating anaesthesia in the curriculum, in house training programs, use of pamphlets, internet and other easily assessable techniques is highly desirable for spreading awareness of anaesthesia and anesthetist among paramedical staff, so that patient can avail anaesthesia related services effectively.


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