Rejected

The management of pain by GPs for residents of aged care facilities (ACFs) is very common.

Opioid abuse is a significant public health problem in the United States. We evaluate the clinical effectiveness and economic impact of abuse-deterrent formulations (ADF) of opioids relative to non-ADF opioids in preventing abuse.

Chronic back pain is a disease many people suffer from it and they have different problems and needs.

Although the first publications on clinical use of peripheral nerve stimulation for the treatment of chronic pain came out in the mid-1960s, it took 10 years before this approach was used to stimulate the occipital nerves. The future for occipital nerve stimulation is likely to bring new indications, devices, stimulation paradigms, and a decrease in invasiveness. As experience increases, one may expect that occipital nerve stimulation will eventually gain regulatory approval for more indications, most likely for occipital neuralgia, migraines and cluster headaches. This process may require additional studies, at least for approval from the US Food and Drug Administration.

Major abdominal surgery often requires postoperative opioid analgesia. However, there is growing recognition of the potential for abuse. We previously reported a significant reduction in opioid consumption after implementation of an enhanced recovery after surgery (ERAS) protocol following ventral hernia repair (VHR) focusing on opioid reduction. Epidural use was routine for post-operative pain control in this protocol. Recently we have transitioned to transversus abdominis plane (TAP) block instead of epidural analgesia. We hypothesize this modification reduces length of stay (LOS) and lowers opioid usage in VHR.

Cast syndrome, commonly known as superior mesenteric artery (SMA) syndrome is a rare cause of small bowel obstruction caused by compression of third part of duodenum from narrowing of the angle between superior mesenteric artery and abdominal aorta resulting in symptoms of duodenal outflow obstruction. A 46-year-old male presented with acute worsening of chronic abdominal pain, nausea and vomiting aggravated with eating. Computed tomography of abdomen and pelvis revealed the dilatation of gastric and proximal duodenum due to compression of third part of duodenum between superior mesenteric artery and aorta. Conservative management with total parental nutrition failed and patient underwent gastrojejunostomy with relief of his symptoms. Cast syndrome is a rare condition but should be kept in mind in patients with abdominal pain, vomiting, early satiety and weight loss. CT abdomen usually reveals the diagnosis but upper GI endoscopy helps to rule out other causes of duodenal obstruction and gastric dilatation.

Correcting false cognitions and establishing preventive behaviors in patients with chronic low-back pain can improve self-efficacy and self-discovery of these patients against the physical and psychological consequences of chronic back pain through reinforcing thoughts and constructive behaviors.

A total pancreatectomy and intraportal islet cell autotransplant (TPIAT) is increasingly being offered to patients with chronic pancreatitis (CP). The benefits include removal of the root cause of pain and amelioration of diabetes. However, the long-term durability of this operation remains unclear.