Tag Archives: surgery

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

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

Post-Surgical Spine Syndrome

Post-surgical spine syndrome – free full-text PMC3205485 – Sep 2011

It is our view that the diagnostic terms post laminectomy syndrome (ICD-9 code 722.8) or failed back syndrome are inaccurate, misleading, can be construed as disparaging, and should be discarded.

Disparaging to whom? I suspect doctors do not like any term that insinuates their methods failed, no matter how true that is.

These authors couldn’t even bring themselves to call this painful syndrome by its *real* name: it’s not called “failed back syndrome”, but rather “failed back surgery syndrome” because, in this case, it is the surgery that failed, not the back. Continue reading

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