ABSTRACT
OBJECTIVE: To determine, using the Delphi method, standardized recommendations for the follow-up of patients undergoing an interventional procedure for the treatment of chronic pain in Spain. METHODS: First, a systematic literature review was performed to identify the literature on the management of patients with chronic pain undergoing interventional techniques; subsequently, a two-round Delphi survey with 108 questions was conducted. The questionnaire was validated by a Scientific Committee (5 experts) and sent to 47 experts specialized in chronic pain. "Consensus" or "intermediate consensus" was determined when ≥ 75% or < 75% to ≥ 65% of the experts selected the same answer for each item, respectively. Then, a face-to-face deliberation process was held with the Scientific Committee to analyze and discuss the results. RESULTS: The questionnaire was completed by 24 panelists (51%). Consensus was reached on 88.4% of the questions. The panelists identified pain, drug consumption, and quality of life as essential variables in the follow-up of patients with chronic pain. Consensus was reached on most of the scales/questionnaires to be used in measuring outcomes during follow-up, except for psychological status. Regarding the follow-up frequency, in radicular spinal chronic pain, a consensus was reached on the first visit 1-2 months after the intervention, during the first year, at 1, 3, 6, and 12 months, and then every 6 months thereafter. For non-radicular spinal chronic pain, the first visit 1-2 months after surgery was agreed upon, however, there was no consensus on follow-up during the first year. For non-spinal chronic pain, consensus was reached regarding the first visit at 1-2 months after surgery and during the first year at 1, 3, 6, and 12 months. No consensus was reached on follow-up frequency for oncological chronic pain. After receiving a permanent neurostimulator implant for chronic pain, the first visit was agreed upon at 1-3 weeks, during the first year, at 2 weeks, 1, 3, 6, and 12 months, and after, every 6 months. For intrathecal infusion, it was agreed that the first visit should occur during the first month, and thereafter whenever the pump requires a refill. CONCLUSIONS: These findings provide recommendations in relation to the frequency of follow-up and the scales to be used with chronic pain patients undergoing interventional techniques in Spain.
Subject(s)
Chronic Pain , Humans , Follow-Up Studies , Chronic Pain/therapy , Delphi Technique , Quality of Life , SpainABSTRACT
BACKGROUND AND OBJECTIVES: Osteoarthrosis is a main cause of knee pain in the elderly. Pain associated with this condition is often refractory to conservative treatment. Total knee replacement may be the best option for severe pathologies; however, the occurrence of a chronic pain state after knee replacement has been well documented in the literature. The previous descriptions of the genicular nerves have been considered somewhat inaccurate. This innervation is complex and exhibits significant interindividual variability. A precise description of these nerves will increase our knowledge on different patterns and targets, to guide treatment and improve outcomes. The objective of this study was to determine sensory innervation patterns of the knee joint and correlate them with dynamic visualization via ultrasound imaging. METHODS: Systematic cadaveric dissections were performed to determine different patterns of sensory innervation of the knee followed by ultrasonographic correlation. A short-axis ultrasound view of the nerves was used to inject India ink at several points along their course to facilitate the anatomic dissection and confirm their location among adjacent structures. RESULTS: The visualized structures were the following: infrapatellar branch of the saphenous nerve, the branches to vastus medialis, intermedius, and lateralis muscles; obturator nerve; and lateral retinacular and recurrent peroneal nerves. CONCLUSIONS: We conclude that reproducible correlations showing the sensory innervations for the knee are linked to muscular structures. However, high variability among individuals makes it difficult to predict their paths. Our systematic approach, using direct visualization via ultrasound, allows a more accurate placement of the needle for therapeutic purposes.
