Tag Archives: surgery

Undiagnosed Osteoporosis in Spine Fusion Surgery

Study: CT Scan Prior to Spine Fusion Surgery Finds Significant Number of Patients Had Undiagnosed Osteoporosis – Mar 2019

For patients contemplating spinal fusion surgery to alleviate pain, bone health is an important consideration.

If a patient is found to have low bone density prior to surgery, it could affect the treatment plan before, during and after the procedure. A study at Hospital for Special Surgery (HSS) in New York City found that a CT scan of the lumbar spine prior to surgery indicated that a significant number of patients had low bone density that was previously undiagnosed.

And I assume they then had the surgery in spite of it.  Continue reading

IV APAP of Little Benefit for Cardiothoracic Post-op Pain

IV APAP of Little Benefit for Cardiothoracic Post-op Pain – Pain Medicine Newsby Kenneth Bender – Aug 2019

This is an amazingly honest negative evaluation of IV Tylenol, which some people claimed was just as effective as opioids. But this study is a reality check and brings more science and less hype to the overcrowded field of opioid/pain studies.

Intravenous acetaminophen provided little benefit in multimodal analgesia regimens for cardiothoracic postoperative pain and posed a risk for hypotension, according to a study of outcomes in a real-world population.

I’m thrilled to hear it stated so definitively after so many years of hearing how great of a pain killer Tylenol is.  Continue reading

Invasive Surgery to Relieve Chronic Pain?

Invasive Surgery: Effective in Relieving Chronic Pain? By Sunali Wadehra, MD – Feb 2019

Invasive surgery may not be any more effective than sham procedures in reducing chronic pain, according to a meta analysis published by Wayne B. Jonas, MD, in Pain Medicine last September.

Dr. Jonas and his team performed a systematic review of 25 randomized controlled trials published between 1959 and 2013, involving 2,000 patients undergoing surgery for chronic pain.

This article explains a concept I haven’t seen elsewhere: chronic pain versus protracted pain. Especially in the case of EDS, this means we can hurt every day, but still not have true “chronic pain”. Continue reading

FDA Safety Alert About Intrathecal Delivery of Pain Meds

FDA Issues Safety Alert Regarding Intrathecal Delivery of Pain Meds – Diana Ernst, RPh – November 15, 2018

The Food and Drug Administration (FDA) has issued a safety communication regarding the risks associated with implanted pumps for intrathecal administration of pain medications

Reports of pump failure, dosing errors, as well as other possible safety issues have prompted the Agency to issue an alert to make prescribers aware of the dangers associated with using medications not specifically approved for intrathecal administration with the implantable pump.

Examples of drugs not identified in implantable pump labeling include hydromorphone, bupivacaine, fentanyl, clonidine, as well as any mixture of 2 or more different drugs; compounded medicines are also not included in the current labeling for implanted pumps.   Continue reading

Surgery for Chronic Pain: Real or Sham?

Surgery for Chronic Pain: Risky and Costly  by Christopher Cheney, HealthLeaders Media – September 23, 2018

While I agree with the basic results of this study, I have great qualms about how these studies (and there are apparently more than a few) are conducted.

There is inadequate evidence to justify surgical procedures to treat chronic pain, recent research shows.

“Given their high cost and safety concerns, more rigorous studies are required before invasive procedures are routinely used for patients with chronic pain, researchers reported in Pain Medicine.

Most pain specialists and researchers now understand chronic pain as a bio-psycho-social disorder and involving central sensitization, ruling out any structural or biochemical problems. This kind of pain, by definition, cannot be treated with surgery. Continue reading

Spinal Surgery Does Not End Opioid Use for Pain

Expectations Versus Reality: Spinal Surgery Does Not End Opioid Use for Pain – RELIEF: PAIN RESEARCH NEWS, INSIGHTS AND IDEAS By Stephani Sutherland – July 2018

People seeking medical treatment for back pain often end up in a surgeon’s office.

Most of those individuals hope—and expect—that surgery will reduce their pain enough to make opioid painkillers unnecessary after the operation.

But that scenario seems to be the exception rather than the rule, according to a new report published in the journal PAIN.   Continue reading

The Pain Industry’s New & Dangerous Fall-Back

Opinion: The Pain Industry’s New & Dangerous FALL-BACK – June 27, 2018 – By Dennis J. Capolongo / Director ENDC

From my perspective, preventative measures to reduce iatrogenic harm should be among the list of alternatives to help reduce opioid consumption.

Recently published reviews authored by outspoken physicians Dr. Martin Makary of John’s Hopkins and Dr. Jana Friedly of the U.W. Medical Center have pointed a finger at an industry that has literally run amok.

Here’s the other nightmare being foisted upon pain patients: “interventional” pain management, with needles and knives that leave patients in even more agony afterward.   Continue reading

Many Orthopedic Surgeries Don’t Work

Many Orthopedic Surgeries Don’t Work — BETTER MOVEMENT

Unlike drugs, orthopedic surgeries can be sold to the public before they undergo any rigorous testing to ensure they are safe and effective.

Thus, millions of surgeries for knee, shoulder, and back pain have been done even without any research to confirm they actually work.

Recently, a significant amount of such research has been completed, and it has found that many popular surgeries work no better than a placebo. And yet many of these surgeries are still being performed at the rate of hundreds of thousands per year.   Continue reading

Genetics May Play Role in Chronic Pain After Surgery

Genetics May Play Role in Chronic Pain After Surgery – 14-Dec-2017 – Newswise

Genetics may play a role in determining whether patients experience chronic pain after surgery, suggests a study published today in the Online First edition of Anesthesiology, the peer-reviewed medical journal of the American Society of Anesthesiologists (ASA).

Aside from genetic factors, the study also found patients younger than 65 years old, males and those with a prior history of chronic pain were at increased risk.

“Our study not only shows there are common genetic variations among people that may help to identify whether they are at high-risk for developing chronic pain after surgery, but it also helps explain why only a fraction of patients ever even experience persistent pain,” said lead researcher Matthew T.V. Chan, M.D

Chronic postsurgical pain is one of the most common and serious complications after surgery.

…the authors say it is likely that millions of patients worldwide suffer from pain around the surgical wound area months, or even years, after surgery.

The researchers collected blood samples from 1,152 surgical patients to look for genetic variations in 54 “pain-related” genes, which have been shown to be associated with pain sensation.

One year after surgery, 21 percent of patients reported chronic postsurgical pain. Among these patients, 33 percent rated their pain as severe.

During the follow-up period, patients with pain reported difficulties with

  • general activity,
  • mood,
  • walking, 
  • relations with others,
  • sleep, and
  • enjoyment of life.

General health status was also adversely affected by pain.

One genetic variation in particular – a gene found in the nervous-system called brain-derived neurotrophic factor (BDNF) – was found to be most associated with increased chronic postsurgical pain. Researchers also confirmed the finding in a mouse model.

The authors concluded that genetic variations accounted for a higher percentage of chronic postsurgical pain (between 7 percent and 12 percent) compared to clinical risk factors such as age, sex, smoking history or anesthesia technique (between 3 percent and 6 percent).

Original article: Genetics May Play Role in Chronic Pain After Surgery

Warning: Persistent Post-Surgical Pain Common

Persistent Postsurgical Pain – Practical Pain Management

Surgery is often counterproductive for chronic pain, so beware!

More than 45 million surgical procedures are performed in the United States each year. It has been estimated that acute postoperative pain will develop into persistent postoperative pain (PPP) in 10% to 50% of individuals after common operations.

Since chronic pain can be severe in up to 10% of these patients, PPP represents a major clinical problem—affecting at least 450,000 people each year.  Continue reading