Effectiveness and safety of 1470-nm diode laser fulguration in the management of diffuse venous malformations
Publication date: Available online 7 December 2019Source: Journal of Vascular Surgery: Venous and Lymphatic DisordersAuthor(s): Elena Marín-Manzano, Covadonga Mendieta-Azcona, Luis Riera-del-Moral, Juan Carlos López-GutiérrezAbstractBackgroundVenous malformations (VMs) are the most frequent congenital vascular malformations. Pain and deformity are the main symptoms and usually progressive in untreated patients. Current therapeutic options are surgery (frequently partial resections with an uncomfortable postoperative period), sclerotherapy (often limited because of the need for high doses and the potential subsequent toxicity), and percutaneous intralesional laser treatment. The main objective of our study was to analyze efficiency and safety of 1470-nm diode laser treatment in the management of diffuse VMs.MethodsWe included patients treated between 2012 and 2018 whose quality of life was severely impaired. Data regarding laser settings, previous and subsequent D-dimer and fibrinogen blood levels, preprocedural and postprocedural assessment of pain by means of a visual analog scale, and reported complications were collected.ResultsTwenty-six procedures were performed in 17 patients (76% women); 59% were sporadic VMs, 70% had previously undergone other treatments, and 53% needed continuous analgesic treatment. The median pain reduction after the intervention, measured on the visual analog scale, was 5 points (P
ConclusionSubstantial agreement exists among experts regarding many strong recommendations for the improvement of practice concerning the use of muscle relaxants and reversal agents during anaesthesia. In particular, the French Society of Anaesthesia and Intensive Care (SFAR) recommends the use of a device to monitor neuromuscular blockade throughout anaesthesia.
DiscussionThis is the first case, to our knowledge, which reports the successful use of SCS in a patient with spinal dAVF-related pain. Spinal vascular malformations, even when cured with treatment, may result in permanent spinal cord damage and engender chronic neuropathic pain for which SCS below the level of injury may be considered.
CONCLUSION: Living with chronic pain is predominantly represented as a struggle, with a lesser focus on the ability to successfully self-manage and live a meaningful life. The limited emphasis on each of the non-pharmacological strategies suggest that the reports failed to communicate that these strategies should be a key component of self-managing chronic pain. New Zealand healthcare providers and researchers can collaboratively work with the media to provide evidence-based information on both non-pharmacological and pharmacological pain management strategies. PMID: 31945046 [PubMed - in process]
CONCLUSIONS: The severity of neuropathic pain and the pain-related interference in daily life were greater in NMOSD patients than in MS patients. Individualized analgesic management should be considered based on a comprehensive understanding of neuropathic pain in these patients. PMID: 31942768 [PubMed]
Publication date: Available online 16 January 2020Source: Surgery (Oxford)Author(s): Nimesh G. Patel, Andrew D. Toms, Ben WatersonAbstractThe painful knee is one of the most common musculoskeletal presentations to primary and secondary care. It is important to distinguish between acute and chronic causes of knee pain, since the urgency of diagnosis and management can be vastly different. This short review covers the common diagnoses that are frequently encountered, with a systematic approach to confirming the diagnosis, and a management strategy.
Table 1 in the article “Validating the Functional Pain Scale for Hospitalized Adults” (October 2019) contained an error. Here is the corrected table in its entirety.
If we can say anything for certain about caring for persons in pain over the past decade is that it has prompted concern and confusion on how to provide the best care. Consider the following: Do we have an opioid epidemic or an opioid crisis in the United States? Does the difference in these words matter? What about the “other” less publicized public health crisis; chronic pain; where did that conversation go? Are opioid analgesics good or bad to treat people in pain? Should nurses be prepared in pain care, addiction care or both? What are the differences in state policies that govern and guide nursing practice...