Disparities in Pain Management.

Health disparities in pain management remain a pervasive public health crisis. Racial and ethnic disparities have been identified in all aspects of pain management from acute, chronic, pediatric, obstetric, and advanced pain procedures. Disparities in pain management are not limited to race and ethnicity, and have been identified in multiple other vulnerable populations. This review targets health care disparities in the management of pain, focusing on steps health care providers and organizations can take to promote health care equity. A multifaceted plan of action with a focus on research, advocacy, policy changes, structural changes, and targeted interventions is recommended.

Strategies to Promote Racial Healthcare Equity in Pain Medicine: A Call to Action.

In the past several years, many national events have illuminated the inequities faced by the Black community in all aspects of life, including healthcare. To close the gap in healthcare equity, it is imperative that clinicians examine their practices for disparities in the treatment of minority patients and for racial injustice and take responsibility for improving any issues. As leaders in pain medicine, we can start by improving our understanding of healthcare disparities and inequities among racial and ethnic minorities and translating that knowledge into a cultural transformation to improve the care of those impacted. In this paper, we identify the areas of medicine in which pain assessment and treatment are not equitably delivered. As we acknowledge these disparities, we will highlight reasons for these incongruences in care and clarify how clinicians can act to ensure that all patients are treated equitably, with equal levels of compassion.

An unusual recurrent intrathoracic goiter: Case report.

Most intrathoracic goiters are located in the anterior mediastinum, frontal to the recurrent laryngeal nerve and anterolateral to the trachea. Posterior mediastinal goiters account for only 10 to 15% of all intrathoracic goiters and arise from the posterolateral portion of the thyroid gland. We present a case involving a 59-year-old man with history of gradual-onset dyspnea who was referred to us for evaluation of a large mediastinal mass. He had undergone bilateral thyroid lobectomy for a cervical goiter 10 years previously, with no subsequent complications. Contrast-enhanced computed tomography demonstrated a large, well-circumscribed mass extending paratracheally from the thoracic inlet to the posterior mediastinum. The mass was removed via a transcervical and transthoracic approach.

Gold laser tonsillectomy--a safe new method.

OBJECTIVES: To determine if Gold laser tonsillectomy is an acceptably safe method of removing tonsils by comparing its complication rates to other established methods, namely Coblation tonsillectomy and cold steel dissection tonsillectomy. STUDY DESIGN: A retrospective review of 748 consecutive patients, ages 2-18, undergoing tonsillectomy at a pediatric teaching institution. METHODS: Tonsillectomy with or without adenoidectomy was performed utilizing either the Gold laser (n=435), Coblation device (n=153), or by cold steel dissection (n=160) between August 2005 and August 2007. Hospital charts were then reviewed to determine the rates of post-tonsillectomy hemorrhage and dehydration requiring hospital admission. RESULTS: In the Gold laser group there were 7 bleeding events (1.61%) and 7 dehydration admissions (1.61%). The Coblation group had 9 bleeding events (5.88%) and 1 dehydration admission (0.65%). The cold steel group had 1 bleed (0.63%) and 2 dehydration admissions (1.25%). The hemorrhage rate associated with Gold laser tonsillectomy was statistically equivalent to cold steel dissection (p=0.3710) and significantly lower than in our Coblation control group (p=0.0286). CONCLUSIONS: Tonsillectomy by means of the Gold laser can be safely performed in the pediatric population.