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APS 2015

APS 2015

New research was presented at APS 2015, the American Pain Society’s annual scientific meeting, from May 13 to 16 in Palm Springs, CA. The features below highlight some of the studies that emerged from the conference. Migraine Prevalent in Patients With Fibromyalgia The Particulars: Fibromyalgia has been shown in several studies to be highly prevalent in patients with migraine. However, few studies have explored the prevalence of migraines in patients with fibromyalgia. Data Breakdown: For a study, more than 1,000 patients with fibromyalgia completed a survey with questions about medical history, demographics, and migraine. More than half of respondents participating in the study met criteria for migraine headaches. Those who met the criteria were significantly more likely to report hypertension, asthma, IBS, chronic fatigue syndrome, depression, anxiety, and PTSD. Take Home Pearls: Migraines appear to be common among patients with fibromyalgia. Several additional medical and psychiatric comorbidities appear to be common in this patient population. Influences on Health Behavior Change in Chronic Pain The Particulars: Treatment non-adherence and dropout are common among patients who are prescribed behavioral therapy for pain. Assessing the influences of health behavior change in patients with chronic pain could help identify those at risk for treatment dropout. Data Breakdown: University of Florida investigators assessed the cognitive motivational influences on health behavior change among adults with chronic musculoskeletal pain who participated in a study. Patients expected that engaging in health behavior changes would improve their pain-related symptoms by 21% to 34% but reported they would require improvements of 45% to 52% in order to feel that it was worthwhile to practice these behaviors. Participants frequently endorsed...

What’s the Point of Medical Licensing?

A surgeon emailed me the following:. OK, I know this is radical but consider my argument… Medical licensing protects no one and costs physicians hundreds to thousands of dollars each year. If a physician is negligent, can the injured party sue the state that licensed him? I’m guessing not. When I moved to my current location, I had to send lots of documentation to the state medical board so they could verify that I was a true and competent surgeon. I provided my employer with the same info so they could also verify my credentials. Now my employer can and will get sued if I commit a negligent act and absolutely should verify my credentials prior to handing me a scalpel. But the state? Its license is useless. Most people choose a surgeon based on recommendations and word-of-mouth reputation, and these are by far better indicators of quality than any credentialing board. Nobody asks to see my license, and, even if they did, it would not protect them any more than their trust in the health system in which I work. If I was in private practice and had my license displayed on my wall, it may give some reassurance to my patients, but it does not say anything about the quality of my work. Most doctors who really screw up due to negligence are licensed by the state. I contend again, that word of mouth and reputation are the best indicators of a surgeon’s ability, anything beyond that is useless. Caveat emptor, “let the buyer beware” remains the mantra of the informed consumer. Thanks for letting me vent....
Relieving Pain in Colorectal Surgery

Relieving Pain in Colorectal Surgery

Researchers have developed enhanced recovery pathways (ERP) to improve outcomes and reduce readmissions in colorectal surgery patients. “ERP protocols use a set of standardized pre- and postoperative orders,” explains Conor P. Delaney, MD, PhD, FACS, FASCRS. “Research clearly shows that these protocols can help speed recovery and improve outcomes.” ERP protocols emphasize early mobilization after surgery, optimal analgesia, and control of intravenous fluid volumes. Patients are also encouraged to eat the day after their procedure rather than wait several days. To further improve outcomes, it has been hypothesized that adding a transversus abdominis plane (TAP) block to ERP protocols may allow patients to bypass or reduce narcotics use after surgery. TAP blocks are usually administered with ultrasound guidance, but a laparoscopic technique has been developed in which regional analgesia is injected into the abdominal wall between the oblique muscles and the transversus abdominis. “The TAP block can be given after surgery to reduce pain in the operative area,” says Dr. Delaney. “While narcotics help alleviate pain, they can slow recovery. The TAP block is different in that it wears off in time for patients to avoid the worst pain that typically occurs immediately after surgery.” Encouraging Data In a study of 100 patients published in the Journal of the American College of Surgeons, Dr. Delaney and colleagues tested the use of a laparoscopically administered TAP block as part of ERP protocols. After the block, patients were also given intravenous painkillers. According to findings, the average hospital stay after surgery dropped to less than 2.5 days for those receiving the TAP block. This was significantly lower than the 3.7 days...
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