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  • 1
    In: Pain Medicine, Oxford University Press (OUP), Vol. 24, No. 1 ( 2023-01-04), p. 79-88
    Abstract: To investigate the opioid consumption and the healthcare resource utilization in patients with the intrathecal drug delivery system (IDDS) therapy and the comprehensive medical management (CMM) alone. Design A retrospective cohort study with a customized claims database. Setting In a university-based hospital. Subjects Patients with complex regional pain syndrome, post-laminectomy syndrome, and fibromyalgia. Methods Using propensity score matching (1:3), we selected patients with morphine infusion through IDDS (IDDS group) and CMM alone (CMM group). The primary endpoints were comparisons of average morphine equivalents daily dosages (MEDD, mg/day) for 6 and 12 months from an index date. The number of emergency room (ER) visits and hospitalizations and the total medical expenditures were compared as secondary outcomes. Results In total, 82 patients (N = 23 in the IDDS group and N = 59 in the CMM group) were analyzed. Although a 6-month average MEDD did not reach statistical significance, a 12-month average MEDD was significantly decreased in the IDDS group compared to the CMM group (53.2 ± 46.3 vs 123.9 ± 176.4, respectively; P = 0.008). ER visits were more frequent in the IDDS group than the CMM group at baseline (5.4 vs 0.5, respectively; P = .002), which was maintained for 12 months (P  & lt; 0.001). Otherwise, the number of hospitalization and the medical expenditures for pain management were not different between the groups for 12 months. Conclusions The combined IDDS therapy had some benefits in reducing opioid consumption for 1-year follow-up compared to the CMM alone in chronic noncancer pain patients.
    Type of Medium: Online Resource
    ISSN: 1526-2375 , 1526-4637
    Language: English
    Publisher: Oxford University Press (OUP)
    Publication Date: 2023
    detail.hit.zdb_id: 2023869-1
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  • 2
    Online Resource
    Online Resource
    Aerospace Medical Association ; 2017
    In:  Aerospace Medicine and Human Performance Vol. 88, No. 5 ( 2017-05-01), p. 476-480
    In: Aerospace Medicine and Human Performance, Aerospace Medical Association, Vol. 88, No. 5 ( 2017-05-01), p. 476-480
    Type of Medium: Online Resource
    ISSN: 2375-6314
    Language: English
    Publisher: Aerospace Medical Association
    Publication Date: 2017
    detail.hit.zdb_id: 2812234-3
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  • 3
    In: Pain Medicine, Oxford University Press (OUP), Vol. 23, No. 10 ( 2022-09-30), p. 1670-1678
    Abstract: We investigated the thoracic segment corresponding to the inferior margin of the rhomboid major muscle (RMM) using ultrasound (US) to evaluate its potential as a reliable anatomic landmark for segment identification. Design A prospective observational study. Setting An operating room. Subjects Patients who underwent procedures around the thoracic spine. Methods Four hundred segments corresponding to the RMM’s inferior margin were identified through the use of paravertebral sagittal US and confirmed by fluoroscopy in 100 participants in the prone position with upward and downward shoulder rotation, comprising four datasets (up-right, up-left, down-right, and down-left). The US identification of the RMM’s inferior margin was dichotomously scored (clear vs ambiguous). Each dataset was divided into two groups (dominant segment group vs remaining segments group), which were compared. Factors relevant to the dominant segment associated with the RMM’s inferior border were determined through univariable analyses. Results The T6 segment was observed most commonly (59.5%) along the RMM’s inferior border on paravertebral sagittal US acquired in the prone position, followed by T5 (25.0%), T7 (12.8%), and T4 (2.7%). The segments corresponding to the RMM remained unchanged by shoulder posture in most participants (n = 74, 74%). The RMM’s inferior border was clearly distinguishable in 330 cases (82.5%). When the RMM’s inferior border was clearly identified, the corresponding segment was likely to match T6 in all datasets, with odds ratios ranging from 3.24 to 6.2. Conclusions The RMM’s inferior border over the transverse process corresponded to T6 most frequently on paravertebral sagittal US, and its deep fascia was clearly visible in most cases.
    Type of Medium: Online Resource
    ISSN: 1526-4637
    Language: English
    Publisher: Oxford University Press (OUP)
    Publication Date: 2022
    detail.hit.zdb_id: 2023869-1
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  • 4
    In: Regional Anesthesia & Pain Medicine, BMJ
    Abstract: Thoracic sympathetic ganglion block (TSGB) is a procedure to manage sympathetically maintained upper extremity pain (sympathetically maintained pain). To date, only a few studies have evaluated the clinical effectiveness of TSGB in pain medicine. This study investigated (1) the relationship between technical success of TSGB and pain reduction in patients with chronic upper extremity pain and (2) relevant clinical factors for a positive TSGB outcome. Methods We retrospectively reviewed medical data in 232 patients who received TSGB from 2004 to 2020. Technical success and a positive outcome of TSGB were defined as a temperature increase of ≥1.5°C at 20 min and a pain reduction with ≥2 points on the 11-point Numerical Rating Scale at 2 weeks post-TSGB, respectively. Correlations were assessed using correlation coefficients (R), and multivariable regression model was used to identify factors relevant to TSGB outcomes. Results 207 patients were ultimately analyzed; among them, 115 (55.5%) patients positively responded to TSGB, and 139 (67.1%) achieved technical success after TSGB. No significant relationship existed between the pain reduction and the temperature increase after TSGB ( R =0.013, p=0.855). Comorbid diabetes (OR 4.200) and adjuvant intake (OR 3.451) were positively associated, and psychiatric comorbidity (OR 0.327) and pain duration (OR 0.973) were negatively associated with TSGB outcome. Conclusions We found no significant association between the temperature increase and pain reduction after TSGB. Further studies are warranted to identify significant factors associated with TSGB outcomes in patients with complex regional pain syndrome and neuropathic pain diseases.
    Type of Medium: Online Resource
    ISSN: 1098-7339 , 1532-8651
    Language: English
    Publisher: BMJ
    Publication Date: 2023
    detail.hit.zdb_id: 2028901-7
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