Tag Archives: surgery

NoL Index Measures Patients’ Pain During Surgery

Nociception Level Index Detects Patients’ Pain During Surgery – Pain Medicine News – Mar 14, 2017

Israeli researchers have devised a multivariable index that appears to accurately reflect patients’ experience of pain during surgery.

This kind of objective “pain measurement” is the holy grail of pain management, but I wouldn’t trust it – would you?

I suspect not.

Pain is such a primal sensation with a literally overpowering impact that I cannot bring myself to trust some device, no matter how ingenious, to detect the enormity and full significance of this sensation.   Continue reading

Ketamine effective in surgery? Studies say No and Yes

Ketamine not effective in surgery study | National Institutes of Health (NIH) by Tianna Hicklin, Ph.D. – June 20, 2017

At a Glance:

Researchers found that low doses of ketamine did not reduce delirium, postoperative pain, or other complications related to major surgeries.

The results suggest that the common practice of giving ketamine to patients during surgery may need to be re-evaluated.   Continue reading

What is worse, the Opioid Epidemic or the Stupidity Epidemic?

What is worse, the Opioid Epidemic or the Stupidity Epidemic? – National Pain Report – June 8, 2017-  By Dr. Jay Joshi, CEO/Medical Director – National Pain Centers in Chicago.

I didn’t get far into this article before I began to doubt what the author was saying:.

When other physicians, especially in the university setting, were prescribing “opiates for everyone”, “there are no dose limits”, and “opiates are not addictive as long as you have pain”, I felt compelled to stand up for logic and common sense.

Challenging a valid statement about dose limits is a denial of fact.

From what I’ve read about pain and opioids,  there is no valid dosage limit or maximum dosage for opioids as long as enough tolerance has developed over time.   Continue reading

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