ABSTRACT
BACKGROUND AND AIM: This study examined the psychosocial profile of patients who responded or did not respond to trigger point injection therapy for chronic myofascial pain. METHODS: Seventy one patients with a diagnosis of chronic myofascial pain of the paraspinous muscles completed a pretreatment questionnaire measuring demographic and social factors, and validated scales to assess pain intensity, pain interference (physical and emotional), and defined psychological characteristics (pain catastrophizing, pain acceptance, pain self-efficacy, mood and anxiety). Trigger point injection therapy of the affected areas of myofascial pain was performed and follow-up was conducted by telephone at one week (n = 65) and one month (n = 63) post intervention to assess treatment outcome (pain intensity and pain-related physical interference). RESULTS: At one week follow-up and one-month follow-up, using pain-related physical interference as the outcome measure, we found that those who responded well to treatment were characterized by a lower level of pretreatment anxiety and a higher level of pain acceptance, with anxiety being the strongest predictor. CONCLUSION: These results suggest that responses to interventional pain management in chronic myofascial paraspinous pain may be influenced by psychological characteristics, especially pretreatment anxiety.
Subject(s)
Adaptation, Psychological , Analgesics/administration & dosage , Anxiety/psychology , Catastrophization/psychology , Myofascial Pain Syndromes/drug therapy , Myofascial Pain Syndromes/psychology , Adult , Aged , Anxiety/complications , Catastrophization/complications , Chronic Disease , Female , Humans , Injections, Intramuscular , Male , Middle Aged , Myofascial Pain Syndromes/complications , Treatment Outcome , Trigger PointsABSTRACT
Anesthesiologists in every subspecialty encounter, with varying regularity, patients presenting for surgery during the course of pregnancy. With the increasing sophistication of surgical and anesthetic techniques, increasingly complex surgeries are being undertaken. In this review, we address the fundamental physiologic principles central to the care of pregnant patients and fetuses in this difficult clinical situation.
Subject(s)
Anesthesia, Obstetrical/methods , Pregnancy Complications/surgery , Pregnancy/physiology , Abnormalities, Drug-Induced/etiology , Anesthesia, Obstetrical/adverse effects , Anesthetics/adverse effects , Anesthetics/pharmacokinetics , Anesthetics/pharmacology , Female , Fetal Monitoring , Heart Rate, Fetal , Humans , Hypotension/etiology , Hypotension/therapyABSTRACT
UNLABELLED: When using the needle-through-needle combined spinal-epidural (CSE) technique for labor analgesia, failure to obtain cerebrospinal fluid (CSF), paresthesias, and intrathecal or intravascular migration of the catheter are of concern. Epidural needles with spinal needle apertures, such as the back-hole Espocan (ES) needles, are available and may reduce these risks. We describe the efficacy and adverse events associated with a modified epidural needle (ES) versus a conventional Tuohy needle for CSE. One-hundred parturients requesting labor analgesia (CSE) were randomized into 2 groups: 50-ES 18-gauge modified epidural needle with 27-gauge Pencan atraumatic spinal needle, 50-conventional 18-gauge Tuohy needle with 27-gauge Gertie Marx atraumatic spinal needle. Information on intrathecal or intravascular catheter placement, paresthesia on introduction of spinal needle, failure to obtain CSF through the spinal needle after placement of epidural needle, unintentional dural puncture, and epidural catheter function was obtained. No intrathecal catheter placement occurred in either group. Rates of intravascular catheter placement and unintentional dural puncture were similar between the groups. Significant differences were noted regarding spinal needle-induced paresthesia (14% ES versus 42% Tuohy needles, P = 0.009) and failure to obtain CSF on first attempt (8% ES versus 28% Tuohy needles, P < 0.02). Use of ES needles for CSE significantly reduces paresthesia associated with the insertion of the spinal needle and is associated with more frequent successful spinal needle placement on the first attempt. IMPLICATIONS: The use of modified epidural needles with a back hole for combined spinal-epidural technique significantly reduces paresthesia associated with the insertion of the spinal needle and is associated with more frequent successful spinal needle placement on the first attempt.
Subject(s)
Analgesia, Epidural/instrumentation , Analgesia, Obstetrical/instrumentation , Anesthesia, Spinal/instrumentation , Needles , Adolescent , Adult , Analgesia, Epidural/adverse effects , Analgesia, Epidural/economics , Analgesia, Obstetrical/adverse effects , Analgesia, Obstetrical/economics , Anesthesia, Spinal/adverse effects , Anesthesia, Spinal/economics , Catheterization , Cerebrospinal Fluid/physiology , Costs and Cost Analysis , Female , Heart Rate/drug effects , Heart Rate, Fetal/drug effects , Humans , Middle Aged , Needles/adverse effects , Needles/economics , Pain Measurement , Paresthesia , PregnancyABSTRACT
Diagnostic infusion therapy has several advantages over other routes of drug administration in the management of chronic pain. Although systemic side effects may occur, the procedure is relatively noninvasive and is generally well tolerated by patients. Infusion techniques have a potential use in the blinded evaluation of a patient's response to a specific therapy, and thus may minimize placebo responses associated with the more invasive diagnostic nerve blocks. Infusion tests may be useful prognostic indicators of the potential efficacy of a class of oral drugs in a patient. This article reviews the scientific and clinical background behind the major classes of drugs used in diagnostic infusion testing, namely local anesthetics, opioids, and a-adrenergic blockers. Clinical application of these agents in the management of chronic pain also is outlined.
