Early Experience of a Multidisciplinary Group Pain Program with Cognitive Behavioural Strategies, Physiotherapy and Peer Support for Patients with Chronic Noncancer Pain.

BACKGROUND: Chronic non-cancer pain affects about 20% of the population worldwide. The effect of medical treatment in isolation is often limited. A multidisciplinary approach has been strongly advocated to help manage patients' pain more effectively. AIMS: The primary purpose was to reduce pain severity, pain interference on patients'daily activities and improve their levels of self-efficacy despite pain. The secondary aim was to evaluate the possible changes in patients' depression, anxiety, and stress symptoms after amultidisciplinary group pain program. The program content and structure were also evaluated. DESIGN: This scholarly project used within-subject pre- and post-test design. SETTINGS/SUBJECTS: Fifty-six patients were recruited from the project center pain clinic. METHODS: An evidence-based eight-hour multidisciplinary group pain program was implemented. Data was collected before and 3 months after the program. INTERVENTIONS: The program covered pain physiology, cognitive behavioural strategies, demonstration of various exercises, self-management skills, medication management, and peer support. RESULTS: Three months postprogram, there was a statistically significant improvement in patients' pain severity (ß = -0.9, 95% CI: -1.73 to -0.14, p = .023) and self-efficacy (ß = 5.6, 95% CI: 0.85 to 10.41, p = .023). Pain interference on their daily activities was also significantly reduced (ß = -2.0, 95% CI: -2.90 to -0.83, p = .001). Patients provided positive and encouraging feedback about the program. CONCLUSION: Initial improvements in patients' ability to cope with pain and to perform daily activities were demonstrated following participation in the brief multidisciplinary group pain program. Future randomized controlled trials are needed to confirm that the results are due to patients' participation in the program.

Uncommon primary Group A streptococcal erector spinae pyomyositis diagnosed as muscle strain in a fit young male.

Acute lower back pain in a fit healthy male with recent strenuous physical activity is often attributed to muscle strain. We report a rare case of erector spinae pyomyositis developing in a young and otherwise healthy young adult male that was almost misdiagnosed as muscle strain. Despite admission and close monitoring, diagnosis was only confirmed on a magnetic resonance imaging of the spine later during the hospital stay. Early diagnosis in this case allowed successful treatment with intravenous antibiotics alone, without requiring further surgical drainage or development of further neurological sequelae, common in later stages of erector spinae pyomyositis.

Continuous spinal anaesthesia: A retrospective analysis of 318 cases.

BACKGROUND AND AIMS: Continuous spinal anaesthesia (CSA) is an underutilised anaesthetic technique. Our objectives were to evaluate the use of CSA in our institution, its efficacy, ease to use and safety. METHODS: This was a retrospective analysis conducted in a tertiary centre. Records of all patients who underwent surgery and received CSA between December 2008 and July 2017 were reviewed. Their demographic profiles, type and duration of surgery were analysed. The outcomes measured were the success of CSA, technical evaluation and difficulties encountered, intraoperative haemodynamics, usage of vasopressors and any reported complications. Statistical analysis was done using Chi-square test. RESULTS: Three hundred and eighteen patients (94%) successfully underwent surgery using CSA. Twenty cases (6%) had failed CSA, of which five of them had CSA insertion failure, while the rest failed to complete the operation under CSA, thus requiring conversion to general anaesthesia. Patients who have had an initial intrathecal local anaesthetic (LA) volume ≥1.5 ml had higher odds (odds ratio (OR) 2.78; 95% confidence interval [CI], 1.70-4.57) of developing hypotension compared to those who had <1.5 ml (P < 0.001). There were no reported post-dural puncture headache, neurological sequelae or infection. CONCLUSION: CSA is a useful anaesthetic technique with low failure rate. The key to achieving haemodynamic stability is by giving a small initial bolus, then titrating the block up to required height using aliquots of 0.5 ml of intrathecal LA through the catheter.