Neck pain is common and has multiple sources, but correct diagnosis and matched treatment provide... more Neck pain is common and has multiple sources, but correct diagnosis and matched treatment provide the best outcomes. The first description of ultrasound-guided dorsal scapular nerve blockade using a single-shot local anesthetic technique for the diagnosis and treatment of neck pain is reported. A 38-year-old female patient presented with neck pain, and the history and clinical examination strongly suggested myofascial pain affecting the middle scalene muscle. The pain had been unresponsive to pharmacological therapy or physiotherapy. After identifying the dorsal scapular nerve (DSN) in the body of the middle scalene muscle, an ultrasound-guided nerve block was performed using a single injection of local anesthetic to alleviate the patient's pain. It has been demonstrated that the dorsal scapular nerve can be identified in the neck and effectively blocked using ultrasound guidance. This technique has the potential to assist in the diagnosis and treatment of neck pain originating from the middle scalene muscle.
We describe an innovative technique of ultrasound-guided greater occipital nerve (GON) hydrodisse... more We describe an innovative technique of ultrasound-guided greater occipital nerve (GON) hydrodissection for treatment of cervicogenic headache and occipital neuralgia. A 35-year-old female presented to the pain clinic with severe chronic cervicogenic headache impacting her sleep, work and activities of daily living. Conservative management had failed to adequately resolve her pain. Ultrasound-guided suboccipital hydrodissection of the greater occipital nerve was performed with the patient in the prone position. After skin sterilization, the linear ultrasound transducer was oriented in a transverse orientation at the level of the C2-C3 vertebrae. The needle was advanced from medial to lateral "in-plane" under direct ultrasound visualization, until the needle was positioned at the C2 lamina. After confirming the needle tip position, 10 ml of hydrodissection fluid was injected with good visualization of distribution of the solution. The patient described immediate and significant improvement in her symptoms. She reported a sustained decrease in pain scores when followed up in the pain clinic at six and twelve weeks respectively. To the best of our knowledge this is the first application of ultrasoundguided hydrodissection of the GON for cervicogenic headache. It offers a novel, safe and effective technique to aid in the diagnosis and treatment of a common pain condition.
Chronic pain affects a significant proportion of the world’s population and causes great emotiona... more Chronic pain affects a significant proportion of the world’s population and causes great emotional and physical suffering to patients. As it is not yet fully understood, further research into chronic pain sources and treatment modalities is required. At present, prescription opioids are commonly prescribed in chronic pain, but the perceived benefits are paralleled by numerous adverse effects. In terms of protocol for this systematic review, the rationale was to investigate and assess the current literature on chronic pain patients’ perceptions of prescription opioids, and the planned methods used are outlined below. An initial scoping review of the literature was conducted followed by the construction of inclusion and exclusion criteria. The electronic databases that were systematically searched in July 2019 included PubMed, Scopus, MEDLINE, and Cochrane. Multiple keyword variation searches were used: chronic pain OR pain AND patients AND perception OR view OR attitude OR opinion OR understanding OR impression AND prescription opioids. A number of common perceptions arose from the review. These included patients feeling stigmatised by others, fears of addiction, usefulness in controlling pain, concerns of opioids impairing work and interfering with functioning despite their perceived role in regaining independence and healthcare professionals’ unease prescribing and discussing opioids with patients. Understanding patients’ perceptions and unique pain experiences may benefit the relationship between doctor and patient, enabling a mutual decision-making process. This may enhance treatment outcomes and result in more compassionate care in chronic pain.
Study Objective: To determine the feasibility of ultrasound-guided femoral nerve blockade perform... more Study Objective: To determine the feasibility of ultrasound-guided femoral nerve blockade performed by orthopaedic trainees.Methods: This was a prospective study involving patients presenting to Acciedent & Emergency with fractured femurs requiring analgesia. Physicians performing the nerve blocks were orthopaedic trainees who had participated in a 1-hour training session. The participants underwent ultrasonography-guided femoral nerve blocks to provide analgesia. Any additional analgesia required was recorded. Subjects rated their pain on a Numerical Pain Rating Scale (NRS) before the nerve block and 30 & 60minutes after the nerve block. The primary outcomes for feasibility were the requirement for additional analgesia following injection and the median reduction in pain on the Numerical Pain Rating Scale after the nerve block. Secondary outcomes for feasibility included the median time for completion of the entire nerve block procedure for each subject (from initiation of ultrason...
BACKGROUND This study explores live and recorded music listening in the outpatient pain clinic. T... more BACKGROUND This study explores live and recorded music listening in the outpatient pain clinic. There is evidence demonstrating the effectiveness of live and recorded music in a hospital setting but a comparison study of this kind has yet to be conducted. METHODS A multimethod survey study design was used. A questionnaire utilizing rating scales was self-administered across two outpatient pain clinic waiting rooms. Patients were included through convenience sampling. In one clinic, a playlist of recorded music curated by two of the authors was provided. In the second clinic, a music therapy student played live music using guitar, flute, and voice. The questionnaire gathered data on music's impact on pain and emotional states, as well as attitudes toward music in the waiting room. Quantitative data was analyzed using descriptive statistics and qualitative data, gathered in the questionnaires open ended question, was analyzed using thematic analysis. RESULTS The questionnaire was completed by 200 adult patients. Patients reported lowered levels of anxiety, stress, and pain in both clinics, as well as a shorter waiting time and more caring experience. Patients in the live music clinic reported that music lowered levels of stress, nervousness, agitation, and pain more than in the recorded music clinic. CONCLUSIONS Participants in this study identified that music is a useful tool in the pain clinic waiting room. This study contributes to evidence that music should be considered as a complimentary treatment for people living with pain and in the wider hospital setting. Additional research is warranted with a control group, pre- and posttesting, and studies of music in hospitals in a range of cultural contexts.
Introduction Despite its clinical utility, progressive reliance on imaging technology can lead to... more Introduction Despite its clinical utility, progressive reliance on imaging technology can lead to devaluing the physical examination in patients with chronic pain. The primary objective of this study was to determine whether chronic pain patients have a positive or negative perception of the physical examination. Methods After institutional ethics committee approval, 120 adult patients as a convenience sample who attended a chronic pain clinic were included. Participants completed a 10-item survey regarding their overall perception of the physical examination. Kruskal-Wallis and Mann-Whitney U test analyses were conducted to explore associations between test items and patient ages, gender, employment, pain diagnosis, and duration of pain. All cross-tabulations of categorical variables were analyzed using Fisher’s exact test for associations. Results The majority of participants were male (51%), aged 50–70 (44%). The most common pain diagnosis was back pain (62%). Most patients (77%) indicated that the overall experience of being examined was highly positive. Patients believe in the value of the physical examination as a diagnostic tool (97%). Patients believe in the relational value of the physical examination (92%). Age, gender, employment, pain diagnosis, and duration of pain were not associated with a more positive perception of the physical examination. Conclusion Patients with chronic pain indicate that the physical examination is a highly positive aspect of their care. There are some negative aspects of been examined which physicians should be aware of. This study adds to our knowledge regarding the physical exam in chronic pain patients. It will inform practice and training.
Background and Aims: Nerve entrapment is a cause of chronic pain in the foot and ankle. The diagn... more Background and Aims: Nerve entrapment is a cause of chronic pain in the foot and ankle. The diagnosis and treatment is often difficult due to the variable anatomy of foot and ankle nerves. 2 We describe the successful treatment of chronic pain in the Sural nerve distribution with the use of ultrasound.
We describe a case report and technique for using an ultrasound scanner and a linear transducer t... more We describe a case report and technique for using an ultrasound scanner and a linear transducer to guide serratus posterior superior (SPS) muscle injection. A 43-year-old female presented with chronic pain centered under the right upper portion of her scapula impacting her activities of daily living. For the ultrasound-guided SPS muscle injection, the patient was placed in the prone position. The transducer was oriented in a transverse orientation at the level of the C6-T1 vertebrae. Here the SPS muscle attaches to the lower portion of the ligament nuchae and the intervening interspinous ligaments. The muscle fibers run inferiorly and laterally to attach to the 2nd-5th ribs which were identified along with the lateral portion of the serratus posterior superior muscle which is covered by the scapula. Real-time imaging was used to direct a spinal needle into the trigger points of the SPS muscle, where solution was injected under direct vision. The patient's pain symptoms improved ...
In their article, the Italian Group for Antiemetic Research (May 25 issue) 1 did not give informa... more In their article, the Italian Group for Antiemetic Research (May 25 issue) 1 did not give information about the mean number of vomiting episodes during days 2 through 5 in patients who had emesis; the times at which these episodes occurred in relation to the ...
Neck pain is common and has multiple sources, but correct diagnosis and matched treatment provide... more Neck pain is common and has multiple sources, but correct diagnosis and matched treatment provide the best outcomes. The first description of ultrasound-guided dorsal scapular nerve blockade using a single-shot local anesthetic technique for the diagnosis and treatment of neck pain is reported. A 38-year-old female patient presented with neck pain, and the history and clinical examination strongly suggested myofascial pain affecting the middle scalene muscle. The pain had been unresponsive to pharmacological therapy or physiotherapy. After identifying the dorsal scapular nerve (DSN) in the body of the middle scalene muscle, an ultrasound-guided nerve block was performed using a single injection of local anesthetic to alleviate the patient's pain. It has been demonstrated that the dorsal scapular nerve can be identified in the neck and effectively blocked using ultrasound guidance. This technique has the potential to assist in the diagnosis and treatment of neck pain originating from the middle scalene muscle.
We describe an innovative technique of ultrasound-guided greater occipital nerve (GON) hydrodisse... more We describe an innovative technique of ultrasound-guided greater occipital nerve (GON) hydrodissection for treatment of cervicogenic headache and occipital neuralgia. A 35-year-old female presented to the pain clinic with severe chronic cervicogenic headache impacting her sleep, work and activities of daily living. Conservative management had failed to adequately resolve her pain. Ultrasound-guided suboccipital hydrodissection of the greater occipital nerve was performed with the patient in the prone position. After skin sterilization, the linear ultrasound transducer was oriented in a transverse orientation at the level of the C2-C3 vertebrae. The needle was advanced from medial to lateral "in-plane" under direct ultrasound visualization, until the needle was positioned at the C2 lamina. After confirming the needle tip position, 10 ml of hydrodissection fluid was injected with good visualization of distribution of the solution. The patient described immediate and significant improvement in her symptoms. She reported a sustained decrease in pain scores when followed up in the pain clinic at six and twelve weeks respectively. To the best of our knowledge this is the first application of ultrasoundguided hydrodissection of the GON for cervicogenic headache. It offers a novel, safe and effective technique to aid in the diagnosis and treatment of a common pain condition.
Chronic pain affects a significant proportion of the world’s population and causes great emotiona... more Chronic pain affects a significant proportion of the world’s population and causes great emotional and physical suffering to patients. As it is not yet fully understood, further research into chronic pain sources and treatment modalities is required. At present, prescription opioids are commonly prescribed in chronic pain, but the perceived benefits are paralleled by numerous adverse effects. In terms of protocol for this systematic review, the rationale was to investigate and assess the current literature on chronic pain patients’ perceptions of prescription opioids, and the planned methods used are outlined below. An initial scoping review of the literature was conducted followed by the construction of inclusion and exclusion criteria. The electronic databases that were systematically searched in July 2019 included PubMed, Scopus, MEDLINE, and Cochrane. Multiple keyword variation searches were used: chronic pain OR pain AND patients AND perception OR view OR attitude OR opinion OR understanding OR impression AND prescription opioids. A number of common perceptions arose from the review. These included patients feeling stigmatised by others, fears of addiction, usefulness in controlling pain, concerns of opioids impairing work and interfering with functioning despite their perceived role in regaining independence and healthcare professionals’ unease prescribing and discussing opioids with patients. Understanding patients’ perceptions and unique pain experiences may benefit the relationship between doctor and patient, enabling a mutual decision-making process. This may enhance treatment outcomes and result in more compassionate care in chronic pain.
Study Objective: To determine the feasibility of ultrasound-guided femoral nerve blockade perform... more Study Objective: To determine the feasibility of ultrasound-guided femoral nerve blockade performed by orthopaedic trainees.Methods: This was a prospective study involving patients presenting to Acciedent & Emergency with fractured femurs requiring analgesia. Physicians performing the nerve blocks were orthopaedic trainees who had participated in a 1-hour training session. The participants underwent ultrasonography-guided femoral nerve blocks to provide analgesia. Any additional analgesia required was recorded. Subjects rated their pain on a Numerical Pain Rating Scale (NRS) before the nerve block and 30 & 60minutes after the nerve block. The primary outcomes for feasibility were the requirement for additional analgesia following injection and the median reduction in pain on the Numerical Pain Rating Scale after the nerve block. Secondary outcomes for feasibility included the median time for completion of the entire nerve block procedure for each subject (from initiation of ultrason...
BACKGROUND This study explores live and recorded music listening in the outpatient pain clinic. T... more BACKGROUND This study explores live and recorded music listening in the outpatient pain clinic. There is evidence demonstrating the effectiveness of live and recorded music in a hospital setting but a comparison study of this kind has yet to be conducted. METHODS A multimethod survey study design was used. A questionnaire utilizing rating scales was self-administered across two outpatient pain clinic waiting rooms. Patients were included through convenience sampling. In one clinic, a playlist of recorded music curated by two of the authors was provided. In the second clinic, a music therapy student played live music using guitar, flute, and voice. The questionnaire gathered data on music's impact on pain and emotional states, as well as attitudes toward music in the waiting room. Quantitative data was analyzed using descriptive statistics and qualitative data, gathered in the questionnaires open ended question, was analyzed using thematic analysis. RESULTS The questionnaire was completed by 200 adult patients. Patients reported lowered levels of anxiety, stress, and pain in both clinics, as well as a shorter waiting time and more caring experience. Patients in the live music clinic reported that music lowered levels of stress, nervousness, agitation, and pain more than in the recorded music clinic. CONCLUSIONS Participants in this study identified that music is a useful tool in the pain clinic waiting room. This study contributes to evidence that music should be considered as a complimentary treatment for people living with pain and in the wider hospital setting. Additional research is warranted with a control group, pre- and posttesting, and studies of music in hospitals in a range of cultural contexts.
Introduction Despite its clinical utility, progressive reliance on imaging technology can lead to... more Introduction Despite its clinical utility, progressive reliance on imaging technology can lead to devaluing the physical examination in patients with chronic pain. The primary objective of this study was to determine whether chronic pain patients have a positive or negative perception of the physical examination. Methods After institutional ethics committee approval, 120 adult patients as a convenience sample who attended a chronic pain clinic were included. Participants completed a 10-item survey regarding their overall perception of the physical examination. Kruskal-Wallis and Mann-Whitney U test analyses were conducted to explore associations between test items and patient ages, gender, employment, pain diagnosis, and duration of pain. All cross-tabulations of categorical variables were analyzed using Fisher’s exact test for associations. Results The majority of participants were male (51%), aged 50–70 (44%). The most common pain diagnosis was back pain (62%). Most patients (77%) indicated that the overall experience of being examined was highly positive. Patients believe in the value of the physical examination as a diagnostic tool (97%). Patients believe in the relational value of the physical examination (92%). Age, gender, employment, pain diagnosis, and duration of pain were not associated with a more positive perception of the physical examination. Conclusion Patients with chronic pain indicate that the physical examination is a highly positive aspect of their care. There are some negative aspects of been examined which physicians should be aware of. This study adds to our knowledge regarding the physical exam in chronic pain patients. It will inform practice and training.
Background and Aims: Nerve entrapment is a cause of chronic pain in the foot and ankle. The diagn... more Background and Aims: Nerve entrapment is a cause of chronic pain in the foot and ankle. The diagnosis and treatment is often difficult due to the variable anatomy of foot and ankle nerves. 2 We describe the successful treatment of chronic pain in the Sural nerve distribution with the use of ultrasound.
We describe a case report and technique for using an ultrasound scanner and a linear transducer t... more We describe a case report and technique for using an ultrasound scanner and a linear transducer to guide serratus posterior superior (SPS) muscle injection. A 43-year-old female presented with chronic pain centered under the right upper portion of her scapula impacting her activities of daily living. For the ultrasound-guided SPS muscle injection, the patient was placed in the prone position. The transducer was oriented in a transverse orientation at the level of the C6-T1 vertebrae. Here the SPS muscle attaches to the lower portion of the ligament nuchae and the intervening interspinous ligaments. The muscle fibers run inferiorly and laterally to attach to the 2nd-5th ribs which were identified along with the lateral portion of the serratus posterior superior muscle which is covered by the scapula. Real-time imaging was used to direct a spinal needle into the trigger points of the SPS muscle, where solution was injected under direct vision. The patient's pain symptoms improved ...
In their article, the Italian Group for Antiemetic Research (May 25 issue) 1 did not give informa... more In their article, the Italian Group for Antiemetic Research (May 25 issue) 1 did not give information about the mean number of vomiting episodes during days 2 through 5 in patients who had emesis; the times at which these episodes occurred in relation to the ...
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