scholarly journals Mental Nerve Neuropathy Following Dental Extraction

2014 ◽  
Vol 3;17 (3;5) ◽  
pp. E375-E380 ◽  
Author(s):  
Foad Elahi
Keyword(s):  
Chronic Pain ◽  
Early Recognition ◽  
Early Stage ◽  
Nerve Tissue ◽  
Pain Clinic ◽  
Dental Extraction ◽  
Pain Medicine ◽  
Mental Nerve ◽  
Accurate Identification ◽  
Nerve Blocks

Mental nerve neuropathy (MNN), colloquially referred to as numb chin syndrome, is an uncommon neurologic condition that may arise secondary to multiple local and systemic etiologies, and may mimic other pain conditions affecting the mandible. Early recognition of mental nerve neuropathy in conjunction with accurate etiologic identification is crucial, as early pain management may prevent the transition from an acute to a chronic pain condition. In this article, we will describe the clinical courses of 2 patients who presented to the pain clinic with chronic painful numbness in the mental nerve sensory distribution following dental extraction. After a period of failed conservative medical management and repetitive successful nerve blocks at the mental foramen, we decided to proceed with radiofrequency nerve ablation. In both cases, performance of radiofrequency nerve ablation demonstrated a significant decrease in pain. Within interventional pain medicine, nerve blocks are often utilized to assist with pain generator identification, and resultantly also play an integral role in treatment planning. For instance, nerve blocks are often utilized to establish accurate identification of nerve tissue viability, a preliminary role essential for the determination of whether to proceed with an ablative peripheral nerve procedure. In this article, we will additionally review these important usages of nerve blocks within interventional pain medicine. The objective of our article is to help clinicians identify and properly manage early stage mental nerve neuropathy. Moreover, we aim to advance general medical knowledge of this important pain medicine topic. During the process of preparing this article we reviewed all existing pertinent medical literature related to MNN. Key words: Mental nerve, neuropathy, radiofrequency, nerve ablation, chronic pain

scholarly journals A Survey on Teaching Ultrasound-Guided Chronic Pain Procedures in Pain Medicine Fellowship Programs

2014 ◽  
Vol 6;17 (6;12) ◽  
pp. E681-E689
Author(s):  
Bassem O. Asaad
Keyword(s):  
Chronic Pain ◽  
Ultrasound Guidance ◽  
Response Rate ◽  
Program Directors ◽  
Fellowship Training ◽  
Pain Medicine ◽  
Ultrasound Guided ◽  
Nerve Blocks ◽  
Fellowship Programs ◽  
Ultrasound Technology

Background: Over the last decade ultrasound guidance (USG) has been utilized very successfully in acute pain procedures to confirm nerves’ anatomic location and obtain live images. Not only the utilization, but the teaching, of USG has become an essential part of anesthesiology residency training. Prior to the introduction of USG, chronic pain procedures were always done either under fluoroscopy or blindly. USG offers advantages over fluoroscopy for completion of chronic pain procedures. USG decreases radiation exposure and the expenses associated with operating a fluoroscopy machine and allows live visualization of soft tissues and blood flow, a feature that fluoroscopy does not directly offer. Even today, the utilization and teaching of the technique for chronic pain procedures has not been as widely accepted as in acute pain management. Objectives: To understand the current practices and the factors affecting the teaching of ultrasound guided chronic pain procedures in chronic pain fellowship programs throughout the United States. Study Design: Survey conducted by internet and mail. The survey was distributed to program directors of ACGME-accredited pain medicine fellowships. When the survey was distributed there were 92 accredited pain medicine fellowships. Methods: REDCap survey software was used for designing the questionnaire and sending email invitations. Also, paper questionnaires were sent to those who did not respond electronically. Additional copies of the survey were mailed or faxed upon request. We received 43 responses (a response rate of 46.7%). Statistical analyses included frequencies, crosstabs, and nonparametric Spearman rank-order correlations. Results: The majority of stellate ganglion blocks, occipital nerve blocks, and peripheral nerve blocks are currently being done under ultrasound guidance. Although interest among trainees is very high, only 48.8% of the fellowship programs require fellows to learn the technique before graduation and 32.6% of the program directors agree that teaching of USG should be an ACGME requirement for pain medicine fellowship training. Faculty training is considered to be the most important factor for teaching the technique by 62.8% of directors. In the opinion of the majority of program directors, the greatest factor that stands against teaching the technique is the fact that it is time consuming. Nearly half (44.2%) of program directors believe that the technique will never replace fluoroscopy; but one quarter (25.6%) think that the new 3D ultrasound technology, when available, will replace fluoroscopy. Limitations: A moderate response rate (46.7%) may limit the generalizability of the findings. However, our survey respondents seem to represent the study population quite well, although there was a bias towards the university-based programs. Training programs located at community-based hospitals and U.S. government installations were not as well represented. Conclusion: The teaching of ultrasound guided chronic pain procedures varies significantly between individual programs. Though many program directors do require that fellows demonstrate competency in the technique before graduation, as of today there is no ACGME guideline regarding this. The advancement in ultrasound technology and the increase in number of trained faculty may significantly impact the use of USG in training fellows to perform chronic pain procedures. Key words: Ultrasound guidance, fluoroscopy, chronic pain procedures, regional nerve blocks, musculoskeletal procedures, implantable devices, pain medicine, fellowship training, anesthesia residency training

scholarly journals The Schulich Pain Medicine residency

2018 ◽  
Vol 87 (1) ◽  
pp. 65-67
Author(s):  
Dino D'Andrea ◽  
Emily N Dzongowski
Keyword(s):  
Chronic Pain ◽  
Pain Management ◽  
Residency Program ◽  
Pain Clinic ◽  
Pain Medicine ◽  
University Of Toronto ◽  
Pain Specialist ◽  
Wide Range ◽  
First Pain ◽  
The University

Dr Bellingham completed his medical school and anesthesiology residency at Western University. He followed this with a fellowship in Chronic Pain Management at the University of Toronto, with a focus on interventional pain management using fluoroscopy and ultrasound guided techniques. Dr Bellingham returned to Western University to work in the Department of Anesthesia and Perioperative Medicine in his capacity as an anesthetist and as a chronic pain specialist. Here at Western, he directs the Pain Clinic at St. Joseph’s Health Care and also played a key role in the development of Canada’s first Pain Medicine residency program. We had an opportunity to chat with Dr Bellingham and discuss a wide range of topics including his choice of career path, the Pain Medicine residency program, and other pain medicine topics in the context of the current opioid epidemic.

scholarly journals Evaluating the Relationship Between Initial Injury, Referral to A Pain Clinic, and Medical Retirement from the Army: A Retrospective Analysis

2021 ◽  
Vol 186 (Supplement_1) ◽  
pp. 502-505
Author(s):  
Justin J Stewart ◽  
Diane Flynn ◽  
Alana D Steffen ◽  
Dale Langford ◽  
Honor McQuinn ◽  
...  
Keyword(s):  
Chronic Pain ◽  
Retrospective Analysis ◽  
Extended Period ◽  
Pain Clinic ◽  
Outcome Variable ◽  
Future Research ◽  
Curvilinear Relationship ◽  
The Impact ◽  
Pain Care ◽  
The Relationship

ABSTRACT Introduction Soldiers are expected to deploy worldwide and must be medically ready in order to accomplish their mission. Soldiers unable to deploy for an extended period of time because of chronic pain or other conditions undergo an evaluation for medical retirement. A retrospective analysis of existing longitudinal data from an Interdisciplinary Pain Management Center (IPMC) was used to evaluate the temporal relationship between the time of initial duty restriction and referral for comprehensive pain care to being evaluated for medical retirement. Methods Patients were adults (>18 years old) and were cared for in an IPMC at least once between May 1, 2014 and February 28, 2018. A total of 1,764 patients were included in the final analysis. Logistic regression was used to evaluate the impact of duration between date of first duty restriction documentation and IPMC referral to the outcome variable of establishment of a permanent 3 (P3) profile. Results The duration between date of first duty restriction and IPMC referral showed a curvilinear relationship to probability of a P3 profile. According to our model, a longer duration before referral is associated with an increased probability of a subsequent P3 profile with the highest probability peaking at 19 months. The probability of P3 declines gradually for those who were referred later. Discussion This is the first time the relationship between time of initial duty restriction, referral to an IPMC, and subsequent P3 or higher profile has been tested. Future research is needed to examine medical conditions listed on the profile to see how they might contribute to the cause of referral to the IPMC. Conclusion A longer duration between initial duty restriction and referral to IPMC was associated with higher odds of subsequent P3 status for up to 19 months. Referral to an IPMC for comprehensive pain care early in the course of chronic pain conditions may reduce the likelihood of P3 profile and eventual medical retirement of soldiers.

scholarly journals C-terminal domain small phosphatase 1 (CTDSP1) regulates growth factor expression and axonal regeneration in peripheral nerve tissue

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Noreen M. Gervasi ◽  
Alexander Dimtchev ◽  
Desraj M. Clark ◽  
Marvin Dingle ◽  
Alexander V. Pisarchik ◽  
...  
Keyword(s):  
Chronic Pain ◽  
Peripheral Nerve ◽  
Neurotrophic Factor ◽  
Axon Growth ◽  
Nerve Tissue ◽  
Mesenchymal Progenitor Cells ◽  
Drg Neurons ◽  
Peripheral Neurons ◽  
Terminal Domain ◽  
Factor Expression

AbstractPeripheral Nerve Injury (PNI) represents a major clinical and economic burden. Despite the ability of peripheral neurons to regenerate their axons after an injury, patients are often left with motor and/or sensory disability and may develop chronic pain. Successful regeneration and target organ reinnervation require comprehensive transcriptional changes in both injured neurons and support cells located at the site of injury. The expression of most of the genes required for axon growth and guidance and for synapsis formation is repressed by a single master transcriptional regulator, the Repressor Element 1 Silencing Transcription factor (REST). Sustained increase of REST levels after injury inhibits axon regeneration and leads to chronic pain. As targeting of transcription factors is challenging, we tested whether modulation of REST activity could be achieved through knockdown of carboxy-terminal domain small phosphatase 1 (CTDSP1), the enzyme that stabilizes REST by preventing its targeting to the proteasome. To test whether knockdown of CTDSP1 promotes neurotrophic factor expression in both support cells located at the site of injury and in peripheral neurons, we transfected mesenchymal progenitor cells (MPCs), a type of support cells that are present at high concentrations at the site of injury, and dorsal root ganglion (DRG) neurons with REST or CTDSP1 specific siRNA. We quantified neurotrophic factor expression by RT-qPCR and Western blot, and brain-derived neurotrophic factor (BDNF) release in the cell culture medium by ELISA, and we measured neurite outgrowth of DRG neurons in culture. Our results show that CTDSP1 knockdown promotes neurotrophic factor expression in both DRG neurons and the support cells MPCs, and promotes DRG neuron regeneration. Therapeutics targeting CTDSP1 activity may, therefore, represent a novel epigenetic strategy to promote peripheral nerve regeneration after PNI by promoting the regenerative program repressed by injury-induced increased levels of REST in both neurons and support cells.

scholarly journals Sublingual Buprenorphine/Naloxone and Multi-Modal Management for High-Risk Chronic Pain Patients

2021 ◽  
Vol 10 (5) ◽  
pp. 973
Author(s):  
Shane Kaski ◽  
Patrick Marshalek ◽  
Jeremy Herschler ◽  
Sijin Wen ◽  
Wanhong Zheng
Keyword(s):  
Chronic Pain ◽  
High Risk ◽  
Pain Score ◽  
Rating Scale ◽  
Pain Treatment ◽  
Pain Clinic ◽  
Sublingual Buprenorphine ◽  
Significant Downward Trend ◽  
Chronic Pain Patients ◽  
Pain Patients

Patients with chronic pain managed with opioid medications are at high risk for opioid overuse or misuse. West Virginia University (WVU) established a High-Risk Pain Clinic to use sublingual buprenorphine/naloxone (bup/nal) plus a multimodal approach to help chronic pain patients with history of Substance Use Disorder (SUD) or aberrant drug-related behavior. The objective of this study was to report overall retention rates and indicators of efficacy in pain control from approximately six years of High-Risk Pain Clinic data. A retrospective chart review was conducted for a total of 78 patients who enrolled in the High-Risk Pain Clinic between 2014 and 2020. Data gathered include psychiatric diagnoses, prescribed medications, pain score, buprenorphine/naloxone dosing, time in clinic, and reason for dismissal. A linear mixed effects model was used to assess the pain score from the Defense and Veterans Pain Rating Scale (DVPRS) and daily bup/nal dose across time. The overall retention of the High-Risk Pain Clinic was 41%. The mean pain score demonstrated a significant downward trend across treatment time (p < 0.001), while the opposite trend was seen with buprenorphine dose (p < 0.001). With the benefit of six years of observation, this study supports buprenorphine/naloxone as a safe and efficacious component of comprehensive chronic pain treatment in patients with SUD or high-risk of opioid overuse or misuse.

Diagnostic blocks for chronic pain

2010 ◽  
Vol 1 (4) ◽  
pp. 186-192 ◽  
Author(s):  
Michele Curatolo ◽  
Nikolai Bogduk
Keyword(s):  
Chronic Pain ◽  
False Positive ◽  
Joint Pain ◽  
Prognostic Value ◽  
False Positive Rate ◽  
High Rate ◽  
Discogenic Pain ◽  
Nerve Blocks ◽  
Zygapophysial Joint ◽  
Radiofrequency Denervation

AbstractMany conditions associated with chronic pain have no detectable morphological correlate. Consequently, the source of pain cannot be established by clinical examination or medical imaging. However, for some such conditions, the source of pain can be established using diagnostic blocks. The aim of this paper is to review the available evidence concerning the validity and utility of diagnostic blocks, and to identify areas where research is needed.Diagnostic blocks for cervical and lumbar zygapophysial joint pain have been extensively studied. Single blocks are associated with about 30% false-positive responses. Patients can report relief of pain for reasons other than the effect of a local anaesthetic injected during a diagnostic block, e.g. as the result of placebo effect. Therefore, in order to be valid, diagnostic blocks must be controlled in each patient. Many practitioners find limitations in the clinical applicability of placebo-controlled blocks. Comparative blocks (comparison lidocaine-bupivacaine for each block within each patient) have been investigated as alternatives to placebo-controlled blocks. A positive response requires short-lasting relief when lidocaine is used, and long-lasting relief when bupivacaine is used. The validity of comparative blocks is high when the disease under investigation is common. This is the case for zygapophysial joint pain after whiplash injury. However, the validity of comparative blocks strongly decreases with decreasing prevalence of the condition. This is the case for lumbar zygapophysial joint pain in young subjects: in these patients, the expected false-positive rate with comparative blocks is unacceptably high. Diagnostic blocks for cervical and lumbar zygapophysial joint have therapeutic utility. When positive, radiofrequency denervation is expected to produce substantial pain relief in 60-80% of patients.For all other types of blocks, very little research has been conducted. The few studies that have been published did not use controlled blocks. This may have produced a high rate of false-positive responses. Some data on spinal nerve root blocks suggest that these procedures may be valid for the diagnosis of radicular pain and are perhaps predictive for the success of surgery. The validity of diagnostic sympathetic blocks and their prognostic value in relation to outcomes of sympathectomy are unclear. There is lack of data on the validity of diagnostic intra-articular blocks. Discogenic pain is typically diagnosed by provocative discography, but this procedure remains controversial. Intradiscal and sinuvertebral nerve blocks with local anaesthetics are possible alternatives to provocation discography. At present, the sparse data available on these procedures do not allow an estimation of their validity.In conclusion, nerve blocks have an important potential role in the management of chronic pain. These procedures are not suitable to identify the pathology that is the cause of the pain (e.g. inflammatory, neuropathic, etc.). However, they can reveal the anatomical source of pain, thereby allowing the development of targeted treatments. Unfortunately, there is currently very little research on the validity and prognostic value of blocks. The potential usefulness of this practice remains therefore largely unexplored.

scholarly journals Case Report of a Massive Thigh Hematoma after Adductor Canal Block in a Morbidly Obese Woman Anticoagulated with Apixaban

2018 ◽  
Vol 2018 ◽  
pp. 1-4 ◽  
Author(s):  
Katherine L. Koniuch ◽  
Bradley Harris ◽  
Michael J. Buys ◽  
Adam W. Meier
Keyword(s):  
Early Recognition ◽  
Obese Woman ◽  
Rare Event ◽  
Morbidly Obese ◽  
Adductor Canal Block ◽  
Nerve Blocks ◽  
Adductor Canal ◽  
Morbidly Obese Patient ◽  
Anterolateral Thigh ◽  
Anticoagulated Patient

Hematoma formation after peripheral nerve block placement is a rare event. We report a case of a morbidly obese patient who was anticoagulated with apixaban and developed a massive thigh hematoma after an ultrasound-guided adductor canal block. Despite continuous visualization of the block needle, an unrecognized vascular injury occurred leading to a 14-cm hematoma in the anterolateral thigh. Morbid obesity warrants additional risk consideration when placing nerve blocks in an anticoagulated patient. In addition, early recognition and expert consultation are both important in the management of block-related hematomas.

scholarly journals Epidemiological features and medical care-seeking process of patients with COVID-19 in Wuhan, China

2020 ◽  
Vol 6 (2) ◽  
pp. 00142-2020 ◽  
Author(s):  
Jing Hua ◽  
Rongzhang Chen ◽  
Liming Zhao ◽  
Xiaodong Wu ◽  
Qian Guo ◽  
...  
Keyword(s):  
Medical Care ◽  
Early Recognition ◽  
Early Stage ◽  
Evaluation Process ◽  
Clinical Information ◽  
Healthcare Setting ◽  
Care Seeking ◽  
Medical Visit ◽  
Illness Onset ◽  
Clinical Recovery

BackgroundWe aimed to investigate the epidemiological and clinical features, and medical care-seeking process of patients with the 2019 coronavirus disease (COVID-19) in Wuhan, China, to provide useful information to contain COVID-19 in other places with similar outbreaks of the virus.MethodsWe collected epidemiological and clinical information of patients with COVID-19 admitted to a makeshift Fangcang hospital between 7 and 26 February, 2020. The waiting time of each step during the medical care-seeking process was also analysed.ResultsOf the 205 patients with COVID-19 infection, 31% had presumed transmission from a family member. 10% of patients had hospital-related transmission. It took as long as a median of 6 days from the first medical visit to receive the COVID-19 nucleic acid test and 10 days from the first medical visit to hospital admission, indicating early recognition of COVID-19 was not achieved at the early stage of the outbreak, although these delays were shortened later. After clinical recovery from COVID-19, which took a mean of 21 days from illness onset, there was still a substantial proportion of patients who had persistent SARS-CoV-2 infection.ConclusionsThe diagnostic evaluation process of suspected patients needs to be accelerated at the epicentre of the outbreak and early isolation of infected patients in a healthcare setting rather than at home is urgently required to stop the spread of the virus. Clinical recovery is not an appropriate criterion to release isolated patients and as long as 4 weeks' isolation for patients with COVID-19 is not enough to prevent the spread of the virus.

scholarly journals The Effect of Initiatives to Overcome Language Barriers and Improve Attendance: A Cross-Sectional Analysis of Adherence in an Inner City Chronic Pain Clinic

Pain Medicine ◽  
2016 ◽  
Vol 18 (2) ◽  
pp. 265-274 ◽  
Author(s):  
Michael H. Andreae ◽  
Robert S. White ◽  
Kelly Yan Chen ◽  
Singh Nair ◽  
Charles Hall ◽  
...  
Keyword(s):  
Chronic Pain ◽  
Inner City ◽  
Language Barriers ◽  
Pain Clinic ◽  
Cross Sectional ◽  
Cross Sectional Analysis ◽  
Sectional Analysis ◽  
Chronic Pain Clinic

scholarly journals Glucocorticoid-Induced Avascular Bone Necrosis: Diagnosis and Management

2012 ◽  
Vol 6 (1) ◽  
pp. 449-457 ◽  
Author(s):  
KL Chan ◽  
CC Mok
Keyword(s):  
Early Recognition ◽  
Early Stage ◽  
Weight Bearing ◽  
Plain Radiograph ◽  
Core Decompression ◽  
Bone Necrosis ◽  
Avascular Bone Necrosis ◽  
Magnetic Resonance Imaging Mri ◽  
High Index Of Suspicion

Glucocorticoid use is one of the most important causes of avascular bone necrosis (AVN). The pathogenesis of glucocorticoid-induced AVN is not fully understood but postulated mechanisms include fat hypertrophy, fat emboli and intravascular coagulation that cause impedance of blood supply to the bones. Data regarding the relationship between AVN and dosage, route of administration and treatment duration of glucocorticoids are conflicting, with some studies demonstrating the cumulative dose of glucocorticoid being the most important determining factor. Early recognition of this complication is essential as the prognosis is affected by the stage of the disease. Currently, there is no consensus on whether universal screening of asymptomatic AVN should be performed for long-term glucocorticoid users. A high index of suspicion should be exhibited for bone and joint pain at typical sites. Magnetic resonance imaging (MRI) or bone scintigraphy is more sensitive than plain radiograph for diagnosing early-stage AVN. Conservative management of AVN includes rest and reduction of weight bearing. Minimization of glucocorticoid dose or a complete withdrawal of the drug should be considered if the underlying conditions allow. The efficacy of bisphosphonates in reducing the rate of collapse of femoral head in AVN is controversial. Surgical therapy of AVN includes core decompression, osteotomy, bone grafting and joint replacement. Recent advances in the treatment of AVN include the use of tantalum rod and the development of more wear resistant bearing surface in hip arthroplasty.

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