Picturing oneself over time: a multi-modal interpretative phenomenological analysis of pain management trajectories.

BACKGROUND: Chronic pain (CP) can be a disabling condition with impacts that affect the sense of identity of those who live with it. This article idiographically describes the longitudinal evolution of the sense of self of participants following their referral to a pain management service and participation in a pain management programme (PMP). METHODS: Participants were interviewed three times: before they attended a PMP, and 1 and 6 months after the PMP. Data included the drawings of themselves that participants created at each interview and the transcripts of the interviews guided by the drawings, analysed longitudinally using interpretative phenomenological analysis. RESULTS: This paper describes in detail the cases of four participants: two who experienced a positive albeit troubled trajectory following their PMP and two who did not experience any positive change. The results provide a nuanced account of how the impacts of CP on identity can evolve, with different people engaging with different aspects of a PMP and some people not engaging at all, and how pain self-management strategies enable those that do engage to cope in times of difficulty. CONCLUSIONS: Participant responses to PMP participation are idiosyncratic and interviews with drawings of self analysed longitudinally can help illustrate processes of change. SIGNIFICANCE: Not enough is understood about why some people get limited benefits from pain services. This idiographic longitudinal study illustrates how the impact of CP on identity can evolve when people are introduced to pain self-management, with some embracing change and others resisting it. For clinicians, this study describes four detailed CP individual paths, showing the interaction between contextual and idiosyncratic aspects. This is also the first study to use multiple drawings of self to explore the impacts of illness on identity longitudinally. In a person-centred approach to treatment, the drawings of self could also be adopted as a tool in clinician-patient conversations to gain a deeper understanding of the impacts of living with CP.

Magnetic resonance imaging evaluation of the adolescent patient with idiopathic scoliosis before spinal instrumentation and fusion. A prospective, double-blinded study of 140 patients.

STUDY DESIGN: This was a prospective, double-blinded study of the magnetic resonance imaging findings in the neural axis of 140 neurologically normal typical adolescents with idiopathic scoliosis who were scheduled for scoliosis surgery. OBJECTIVE: To detect the prevalence of spinal cord and neural axis abnormalities in this select population. SUMMARY OF BACKGROUND DATA: No similar study exists, although a few related studies were published. METHODS: Full-length neural axis magnetic resonance imaging studies were reviewed independently by two radiologists who specialize in the spine. RESULTS: Only four patients had a definite abnormality-one a small thoracic syrinx and the other three with a Chiari malformation. None of these required neurosurgery. All 140 patients had their scoliosis surgery without necrologic compromise. CONCLUSION: Routine magnetic resonance imaging evaluation of neurologically normal, typical adolescents with idiopathic scoliosis is not warranted, based on this study.

Mediastinal masses: alternative approaches to CT-guided needle biopsy.

PURPOSE: To determine how the use of alternative anatomic approaches to mediastinal masses in biopsies guided with computed tomography (CT) affects success and complication rates. MATERIALS AND METHODS: The medical records and imaging studies in 36 consecutive patients who underwent percutaneous mediastinal biopsy were reviewed. Alternative techniques to avoid penetration of the visceral pleura during biopsy of mediastinal masses were used in 12 patients. These included a pleural space approach through pleural effusion or iatrogenic pneumothorax, lateral decubitus positioning, and direct semicoronal scanning to guide suprasternal biopsy. RESULTS: Adequate material for diagnosis was obtained in 34 of 36 patients (94%), 22 of 22 biopsies (100%) of anterior mediastinal masses, six of eight biopsies (75%) of middle mediastinal masses, and six of six biopsies (100%) of posterior mediastinal masses. Pneumothorax occurred in two of 36 patients (6%); this low complication rate was associated with infrequent use of the transpulmonary approach. CONCLUSION: CT guidance can enable an individualized approach to a mediastinal mass to avoid penetration of the visceral pleura, large blood vessels, and bronchial tree and thereby lower the rate of complications.