Journal Article Teaching images: intrathecal pump catheter aneurysm Get access Philip Snow Lin, MD, Philip Snow Lin, MD Duke Department of Anesthesiology, Pain Medicine Division, Duke University, Durham, North Carolina, USA Correspondence to: Duke Department of Anesthesiology, Pain Medicine Division, Duke University, 749 Ninth Street Apartment #335, Durham, NC 27705, USA. E-mail: Pl213@duke.edu https://orcid.org/0000-0001-8348-1089 Search for other works by this author on: Oxford Academic PubMed Google Scholar Peter K Yi, MD, MSEd Peter K Yi, MD, MSEd Duke Department of Anesthesiology, Pain Medicine Division, Duke University, Durham, North Carolina, USA https://orcid.org/0000-0003-4316-2897 Search for other works by this author on: Oxford Academic PubMed Google Scholar Pain Medicine, Volume 24, Issue 7, July 2023, Pages 894–895, https://doi.org/10.1093/pm/pnac201 Published: 28 December 2022 Article history Received: 16 November 2022 Revision received: 01 December 2022 Accepted: 20 December 2022 Published: 28 December 2022 Corrected and typeset: 05 July 2023

Cesarean sections (C-sections) are commonly performed procedures, accounting for approximately one-third of births in the United States. This is often one of the first medical encounters for women which require prescription medications to manage post-operative pain. Our observational study looked at opioids prescribed and consumed for post-surgical C-section pain. We interviewed patients to examine handling practices of those who had excess opioids, including storage and disposal. Patients underwent a C-section at Duke University Health System from January 2017 through July 2018 and were pre-scribed opioids post-operatively. In this study, we observed 154 women who met inclusion criteria. Sixty women declined participation, and 15 could not recall the details of their opioid use. Of the 77 women who participated, most (97 percent) received oxycodone 5 mg tablets. About one-third of the women did not use any opioids, about one-third used all of their opioids, and the remainder used only a fraction of the pills prescribed. After sharing preliminary results with providers, they began prescribing fewer pills. Even then, only a fraction or none of the pills were used, and patients rarely required a renewal of pain prescriptions. We found only 1 percent of women stored their opioids in a secure location. These findings suggest an individualized approach to opioid prescribing along with nonopioid analgesics use may mitigate the consequences of excess opioid prescribing, which include lack of proper disposal and excess opioids in the community.

Local anaesthetic systemic toxicity (LAST) is a rare complication after outpatient interventional pain procedures, which can present as an emergent and life-threatening condition. Proficiency and confidence in managing this rare situation necessitates strategies to ensure team members can perform necessary tasks. The primary objective was to familiarse the pain clinic procedural staff-physicians, nurses, medical assistants, and radiation technologists-with concise and current instruction and an opportunity to practice in a controlled environment. A two-part series was designed and led by the pain physicians, with the assistance of the simulation centre and clinic staff. A 20 min didactic session was held to familiarise the providers with relevant details and information regarding LAST. Then, 2 weeks later, all team members participated in a simulation exercise intended to portray a LAST encounter, tasking participants to recognise and manage the condition in a team-based model. Before and after the didactic and simulation sessions, the staff was administered a questionnaire to assess knowledge of LAST signs, symptoms, management strategies, and priorities. Respondents were better able to identify signs and symptoms of toxicity and prioritise management steps, and felt more confident in recognising symptoms, starting treatment and coordinating care. Furthermore, participants emphasised the positive of debriefing, practicing a rare situation and learning strategies for effective communication, team dynamics and role clarity.FormatSmall group didactic session, simulation exercise in a clinical simulation lab.Target audienceAttending, fellow, and resident physicians, medical students, registered nurses, certified medical assistants, and radiation technologists working in a pain clinic procedure suite.ObjectivesTo acquaint the pain clinic procedural staff with current training related to LAST and an opportunity to practice in a controlled environment.

BackgroundOne of the unique advances in neuromodulation for chronic pain has been spinal cord stimulators (SCS) and dorsal root ganglion stimulators (DRG-S). These devices have aided in conditions such as neuropathic pain, complex regional pain syndromes, failed back surgery, and peripheral neuropathies. With these benefits, however, complications from implantable stimulators have included lead fractures and migration. The authors reviewed a lead migration, kinking, and subsequent fracture event involving a patient with complex regional pain syndrome (CRPS) II, who was treated with a DRG-S.Case PresentationThe case report follows this patient, from their past medical history to assessment of appropriate qualifications for neuromodulation, to successful surgical placement, to follow-up care. The authors further monitored assessment of inefficacy of pain relief, and identification of lead migration and kinking through imaging. In the process of removal, due to lead stress, lead fracturing occurred. After lead removal, the leads were fully replaced, and the patient was followed up and experienced improved pain relief.ConclusionThe case report assesses probable mechanisms of lead fracture and considerations for physicians for future assessment and triage of neuromodulation efficacy.

Abstract Introduction Academic departments universally communicate information about their programs using static websites. In addition to websites, some programs have even ventured out into social media (SM). These bidirectional forms of SM interaction show great promise; even hosting a live Question and Answer (Q&A) session has the potential for program branding. Artificial Intelligence (AI) usage in the form of a chatbot has expanded on websites and in SM. The potential use of chatbots, for the purposes of trainee recruitment, is novel and underutilized. With this pilot study, we aimed to answer the question; can the use of an Artificially Intelligent Chatbot and a Virtual Question-and-Answer Session aid in recruitment in a Post-COVID-19 era? Methods We held three structured Question-and-Answer Sessions over a period of 2 weeks. This preliminary study was performed after completion of the three Q&A sessions, in March–May, 2021. All 258 applicants to the pain fellowship program were invited via email to participate in the survey after attending one of the Q&A sessions. A 16-item survey assessing participants’ perception of the chatbot was administered. Results Forty-eight pain fellowship applicants completed the survey, for an average response rate of 18.6%. In all, 35 (73%) of survey respondents had used the website chatbot, and 84% indicated that it had found them the information they were seeking. Conclusion We employed an artificially intelligent chatbot on the department website to engage in a bidirectional exchange with users to adapt to changes brought on by the pandemic. SM engagement via chatbot and Q&A sessions can leave a favorable impression and improve the perception of a program.

To discuss the phenomenon of opioid induced hyperalgesia (OIH) and investigate the data and clinical recommendations available on this topic. A literature search on the topic of OIH was performed. Relevant studies pertaining to OIH were included in this review. Existing studies and reviews on the pathophysiology, diagnosis, and clinical management of OIH are discussed with updated data and literature references. As more opioids are prescribed, especially to treat chronic nonmalignant pain, OIH becomes more of a relevant and significant issue. Although the exact mechanisms of OIH are not clearly understood further research is required to broaden and develop our knowledge of this topic.

OBJECTIVE:To assess aberrant drug-related behaviors (ADRBs) in patients discharged from a community primary care practice for opioid misuse and treating physician's ability to identify predictive aberrant behaviors.DESIGN:Retrospective chart review of patients with chronic noncancer pain (CNCP) identified by their treating physician as misusing opioid analgesics, and patients with similar characteristics who had not been identified as misusing opioids. A survey of attending and resident physicians from these clinics on their knowledge of ADRBs was also collected.SETTING:Community primary care clinic.PATIENTS, PARTICIPANTS:Thirty-three patients with CNCP identified by their treating physician as misusing prescription opioid analgesics, and 33 patients randomly selected from the same clinic setting, with similar characteristics who had not been identified as misusing opioids. Twenty-four attending physicians and 42 resident physicians were surveyed on their training and knowledge of predictive aberrant behaviors.RESULTS:More identified misusers than nonmisusers reported positive history of substance abuse (p=0.001), tobacco use (p=0.011), taking multiple doses of prescribed opioids together (0.024), multiple complaints of pain requiring opioid treatment (p=0.006), and multiple phone calls to the clinic requesting opioid medications (p=0.027). Logistic regression on continuous variables revealed that only the number of phone calls to the clinic regarding opioids in the last 12 months achieved significance (p=0.028).CONCLUSIONS:Previously postulated and novel ADRBs suggestive of opioid misuse were identified in a community primary care setting. Differences in resident and attending physician's ability to identify key predictive ADRBs and lack of training in pain or addiction underscores the need for changes in medical school and residency programs.