Tag Archives: surgery

Minimally Invasive SI Joint Fusion May Lessen Pain

Minimally Invasive SI Joint Fusion May Lessen Pain, Improve Quality of Life – Practical Pain Management – May 2017

Minimally invasive sacroiliac (SI) joint fusion was associated with significant improvements in pain relief and disability, as well as a decreased reliance on opioids, according to findings of a retrospective study published in Neurosurgery.

This study compared outcomes against conservative management (CM) or SI joint denervation, demonstrating that pain and disability levels returned to baseline levels with traditional approaches.   Continue reading

Opioid-Maintained Patients Who Require Surgery

Opioid-Maintained Patients Who Require SurgeryMarch 15, 2016, – By Forest Tennant, MD, DrPH

A practical, common problem in pain management is how to handle a patient already maintained on opioids and about to undergo surgery.

The American Pain Society recently released new guidelines for the perioperative and postoperative pain management.

The guidelines recommend that clinicians should counsel patients to continue regularly prescribed opioids during the preoperative period unless there is a plan to taper or discontinue opioids.  Continue reading

Opioid Cessation Prior to Surgery?

Does Opioid Cessation Prior to Surgery Help or Hurt? – April 4, 2017 By Thomas G. Ciccone

Patients receiving opioids prior to elective abdominal surgery had slightly longer hospital stays and were at higher risk of being discharged to a rehabilitation facility than opioid-naïve patients, according to the results of a new study.

“Chronic opioid use complicates management following surgery, and increases postoperative healthcare utilization and costs independent of other risk factors.”

None of these studies consider that opioids are prescribed for severe pain. Severe pain before surgery or unsuccessful surgery is what affects continuing opioid use.   Continue reading

Acute pain management in opioid-tolerant patients

Acute pain management in opioid-tolerant patients: a growing challenge. – PubMed – NCBI – Anaesth Intensive Care. 2011 Sep –  – Free full-text article

In Australia and New Zealand the … burden of chronic pain is more widely recognized and there has been an increase in the use of opioids for both cancer and non-cancer indications.

As a result, the proportion of opioid-tolerant patients requiring acute pain management has increased, often presenting clinicians with greater challenges than those faced when treating the opioid-naïve

Treatment aims include

Interventional Pain Management for Chronic Pain

Interventional Pain Management for Chronic Pain 7/18/16

Injections, Stimulation, Pain Pumps, and Other Treatments

For many people living with chronic pain, finding pain relief can be tough. A lot of trial and error is involved to find a pain treatment that works. Interventional pain management may help chronic pain patients cope with their pain.

what makes interventional pain management different is that it uses techniques, such as injections and radiofrequency rhizotomy, to directly [and invasively] address the source of your pain.

Some conditions interventional pain management techniques commonly treat include:   Continue reading

Why ‘useless’ surgery is popular

Why ‘useless’ surgery for back and knee pain is still popular – New York Times – by 

Before a drug can be marketed, it has to go through rigorous testing to show it is safe and effective. Surgery, though, is different.

The Food and Drug Administration does not regulate surgical procedures.

So what happens when an operation is subjected to and fails the ultimate test — a clinical trial in which patients are randomly assigned to have it or not?

It looks as if the onus is on patients to ask what evidence, if any, shows that surgery is better than other options.   Continue reading

Insurance companies won’t cover opioid alternatives

Pain doctors: Insurance companies won’t cover the alternatives to opioids

Though the increased focus on pain treatment resulted in  increases in opioid prescriptions in most doctors initially, for  years now, pain specialists have advocated using alternative treatments [referring to interventional procedures, like epidurals] to alleviate their patients’ chronic pain.

There’s one problem:

Health-insurance companies are  increasingly cutting reimbursements for these alternative treatments or not covering them at all.

This is partly because they haven’t been proven to be very effective.   Continue reading

Interventional Treatments of Cancer Pain

Interventional Treatments of Cancer Pain are Effective but Under-Utilized | June 2016 | Cindy Lampner

According to many recent studies, these lauded “interventional” (i.e. invasive, traumatic, dangerous) treatments are relatively ineffective in resolving the original pain and often create new lifelong chronic pain for patients.

Perhaps it is a blessing that they are under-utilized.

A recent review by Drs. Jill Sindt and Shane Brogan of the University of Utah School of Medicine detailed the current status of a number of interventional techniques for the treatment of cancer-related pain:

  • intrathecal drug delivery,
  • vertebral augmentation,
  • neurolytic plexus blocks, and
  • image-guided percutaneous tumor ablation

Continue reading

Surgery Heightens Opioid (and Pain) Risk

Stanford Study Says Surgery Heightens Opioid Risk – National Pain Report – July 12, 2016 – By Ed Coghlan

Stanford University School of Medicine researchers say that a study of health insurance claims showed that patients undergoing 11 of the most common types of surgery were at an increased risk of becoming chronic users of opioid painkillers.

Why does no one understand that surgery is the last resort for people with painful injuries and syndromes, and that failures of these surgeries are common and account for much chronic pain?

Opioids are usually taken for a good reason: pain.

How many patients in this study were suffering from severe pain long after their surgery?   Continue reading