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Chen Y, Wang E, Sites BD, Cohen SP. Integrating mechanistic-based and classification-based concepts into perioperative pain management: an educational guide for acute pain physicians. Reg Anesth Pain Med 2024; 49:581-601. [PMID: 36707224 DOI: 10.1136/rapm-2022-104203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Accepted: 01/13/2023] [Indexed: 01/28/2023]
Abstract
Chronic pain begins with acute pain. Physicians tend to classify pain by duration (acute vs chronic) and mechanism (nociceptive, neuropathic and nociplastic). Although this taxonomy may facilitate diagnosis and documentation, such categories are to some degree arbitrary constructs, with significant overlap in terms of mechanisms and treatments. In clinical practice, there are myriad different definitions for chronic pain and a substantial portion of chronic pain involves mixed phenotypes. Classification of pain based on acuity and mechanisms informs management at all levels and constitutes a critical part of guidelines and treatment for chronic pain care. Yet specialty care is often siloed, with advances in understanding lagging years behind in some areas in which these developments should be at the forefront of clinical practice. For example, in perioperative pain management, enhanced recovery protocols are not standardized and tend to drive treatment without consideration of mechanisms, which in many cases may be incongruent with personalized medicine and mechanism-based treatment. In this educational document, we discuss mechanisms and classification of pain as it pertains to commonly performed surgical procedures. Our goal is to provide a clinical reference for the acute pain physician to facilitate pain management decision-making (both diagnosis and therapy) in the perioperative period.
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Affiliation(s)
- Yian Chen
- Anesthesiology, Stanford University School of Medicine, Stanford, California, USA
| | - Eric Wang
- Anesthesiology and Critical Care Medicine, The Johns Hopkins Hospital, Baltimore, Maryland, USA
| | - Brian D Sites
- Anesthesiology and Orthopaedics, Dartmouth College Geisel School of Medicine, Hanover, New Hampshire, USA
| | - Steven P Cohen
- Anesthesiology, Neurology, Physical Medicine & Rehabilitation and Psychiatry & Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
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Sydora BC, Whelan LJ, Abelseth B, Brar G, Idris S, Zhao R, Leonard AJ, Rosenbloom BN, Clarke H, Katz J, Beesoon S, Rasic N. Identification of Presurgical Risk Factors for the Development of Chronic Postsurgical Pain in Adults: A Comprehensive Umbrella Review. J Pain Res 2024; 17:2511-2530. [PMID: 39100136 PMCID: PMC11297490 DOI: 10.2147/jpr.s466731] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2024] [Accepted: 07/15/2024] [Indexed: 08/06/2024] Open
Abstract
Purpose Risk factors for the development of chronic postsurgical pain (CPSP) have been reported in primary studies and an increasing number of reviews. The objective of this umbrella review was to compile and understand the published presurgical risk factors associated with the development of CPSP for various surgery types. Methods Six databases were searched from January 2000 to June 2023 to identify meta-analyses, scoping studies, and systematic reviews investigating presurgical CPSP predictors in adult patients. Articles were screened by title/abstract and subsequently by full text by two independent reviewers. The selected papers were appraised for their scientific quality and validity. Data were extracted and descriptively analyzed. Results Of the 2344 retrieved articles, 36 reviews were selected for in-depth scrutiny. The number of primary studies in these reviews ranged from 4 to 317. The surgery types assessed were arthroplasty (n = 13), spine surgery (n = 8), breast surgery (n = 4), shoulder surgery (n = 2), thoracic surgery (n = 2), and carpal tunnel syndrome (n = 1). One review included a range of orthopedic surgeries; six reviews included a variety of surgeries. A total of 39 presurgical risk factors were identified, some of which shared the same defining tool. Risk factors were themed into six broad categories: psychological, pain-related, health-related, social/lifestyle-related, demographic, and genetic. The strength of evidence for risk factors was inconsistent across different reviews and, in some cases, conflicting. A consistently high level of evidence was found for preoperative pain, depression, anxiety, and pain catastrophizing. Conclusion This umbrella review identified a large number of presurgical risk factors which have been suggested to be associated with the development of CPSP after various surgeries. The identification of presurgical risk factors is crucial for the development of screening tools to predict CPSP. Our findings will aid in designing screening tools to better identify patients at risk of developing CPSP and inform strategies for prevention and treatment.
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Affiliation(s)
- Beate C Sydora
- Department of Surgery Strategic Clinical Network, Alberta Health Services, Edmonton, AB, Canada
| | - Lindsay Jane Whelan
- Department of Surgery Strategic Clinical Network, Alberta Health Services, Edmonton, AB, Canada
- Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Benjamin Abelseth
- Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Gurpreet Brar
- Health Systems Knowledge and Evaluation, Alberta Health Services, Edmonton, AB, Canada
| | - Sumera Idris
- Health Systems Knowledge and Evaluation, Alberta Health Services, Edmonton, AB, Canada
| | - Rachel Zhao
- Knowledge Resource Service, Alberta Health Services, Edmonton, AB, Canada
| | | | | | - Hance Clarke
- Department of Anesthesia and Pain Management, Toronto General Hospital, UHN, Toronto, ON, Canada
| | - Joel Katz
- Department of Anesthesia and Pain Management, Toronto General Hospital, UHN, Toronto, ON, Canada
- Department of Psychology, York University, Toronto, ON, Canada
| | - Sanjay Beesoon
- Department of Surgery Strategic Clinical Network, Alberta Health Services, Edmonton, AB, Canada
| | - Nivez Rasic
- Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
- Department of Anesthesiology, Perioperative & Pain Medicine, University of Calgary, Calgary, AB, Canada
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Masood R, LeRoy TE, Moverman MA, Feldman MW, Rogerson A, Salzler MJ. Functional Somatic Syndromes Are Associated With Varied Postoperative Outcomes and Increased Opioid Use After Spine Surgery: A Systematic Review. Global Spine J 2024; 14:1601-1608. [PMID: 38124313 DOI: 10.1177/21925682231217706] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2023] Open
Abstract
STUDY DESIGN Systematic Review. OBJECTIVE To perform a systematic review assessing the relationship between functional somatic syndromes (FSSs) and clinical outcomes after spine surgery. METHODS A systematic review of online databases (PubMed and Web of Science) through December 2021 was conducted via PRISMA guidelines to identify all studies investigating the impact of at least one FSS (fibromyalgia, irritable bowel syndrome (IBS), chronic headaches/migraines, interstitial cystitis, chronic fatigue syndrome, multiple chemical sensitivity) on outcomes after spine surgery. Outcomes of interest included patient reported outcome measures (PROMs), postoperative opioid use, cost of care, complications, and readmission rates. RESULTS A total of 207 records were identified. Seven studies (n = 40,011 patients) met inclusion criteria with a mean MINORS score of 16.6 out of 24. Four studies (n = 21,086) reported postoperative opioid use; fibromyalgia was a strong risk factor for long-term opioid use after surgery whereas the association with chronic migraines remains unclear. Two studies (n = 233) reported postoperative patient reported outcome measures (PROMs) with mixed results suggesting a possible association between fibromyalgia and less favorable PROMs. One study (n = 18,692) reported higher postoperative complications in patients with fibromyalgia. CONCLUSION Patients with fibromyalgia and possibly migraines are at higher risk for prolonged postoperative opioid use and less favorable PROMs after spine surgery. There is limited research on the relationship between other Functional somatic syndromes (FSSs) and outcomes following spine surgery. Growing evidence suggests the variation in outcomes after spine procedures may be attributed to non-identifiable organic patient factors such as FSSs.
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Affiliation(s)
- Raisa Masood
- Department of Orthopaedic Surgery, Tufts Medical Center, Boston, MA, United States
| | - Taryn E LeRoy
- Department of Orthopaedic Surgery, Tufts Medical Center, Boston, MA, United States
| | - Michael A Moverman
- Department of Orthopaedic Surgery, Tufts Medical Center, Boston, MA, United States
| | | | - Ashley Rogerson
- Department of Orthopaedic Surgery, Tufts Medical Center, Boston, MA, United States
| | - Matthew J Salzler
- Department of Orthopaedic Surgery, Tufts Medical Center, Boston, MA, United States
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Sanchez JG, Rancu AL, Diatta FH, Jonnalagadda A, Dhodapkar MM, Knoedler L, Kauke-Navarro M, Grauer JN. Increased Risk of 90-Day Complications in Patients With Fibromyalgia Undergoing Total Shoulder Arthroplasty. J Am Acad Orthop Surg Glob Res Rev 2024; 8:01979360-202405000-00007. [PMID: 38722914 PMCID: PMC11081627 DOI: 10.5435/jaaosglobal-d-24-00102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2024] [Accepted: 03/25/2024] [Indexed: 05/13/2024]
Abstract
INTRODUCTION Anatomic and reverse total shoulder arthroplasties (TSAs) are effective treatment options for end-stage glenohumeral osteoarthritis. Those undergoing TSA may also have fibromyalgia, a musculoskeletal condition. However, the association of fibromyalgia with shorter and longer term outcomes after TSA has not been well characterized. METHODS Patients undergoing TSA for osteoarthritis indications were identified in the PearlDiver M165 database from January 2016 to October 2022. Exclusion criteria included age younger than 18 years, shoulder infection, neoplasm, or trauma within 90 days before surgery, and inactivity in the database within 90 days of surgery. Patients with fibromyalgia were matched in a 1:4 ratio to patients without based on age, sex, and Elixhauser Comorbidity Index. Ninety-day adverse events were compared using univariable and multivariable analyses. Five-year revision-free survival was compared using the log-rank test. RESULTS Of 163,565 TSA patients, fibromyalgia was identified for 9,035 (5.52%). After matching, cohorts of 30,770 non-fibromyalgia patients and 7,738 patients with fibromyalgia were identified. Multivariable analyses demonstrated patients with fibromyalgia were at independently increased odds ratios (ORs) for the following 90-day complications (decreasing OR order): urinary tract infection (OR = 4.49), wound dehiscence (OR = 3.63), pneumonia (OR = 3.46), emergency department visit (OR = 3.45), sepsis (OR = 3.15), surgical site infection (OR = 2.82), cardiac events (OR = 2.72), acute kidney injury (OR = 2.65), deep vein thrombosis (OR = 2.48), hematoma (OR = 2.03), and pulmonary embolism (OR = 2.01) (P < 0.05 for each). These individual complications contributed to the increased odds of aggregated minor adverse events (OR = 3.68), all adverse events (OR = 3.48), and severe adverse events (OR = 2.68) (P < 0.05 for each). No statistically significant difference was observed in 5-year revision-free survival between groups. DISCUSSION This study found TSA patients with fibromyalgia to be at increased risk of adverse events within 90 days of surgery. Proper surgical planning and patient counseling are crucial to this population. Nonetheless, it was reassuring that those with fibromyalgia had similar 5-year revision-free survival compared with those without.
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Affiliation(s)
- Joshua G. Sanchez
- From the Yale Department of Orthopaedics and Rehabilitation (Mr. Sanchez, Mr. Rancu, Mr. Jonnalagadda, Ms. Dhodapkar, and Dr. Grauer), and the Yale Department of Plastic and Reconstructive Surgery, New Haven, CT (Dr. Diatta, Mr. Knoedler, and Dr. Kauke-Navarro)
| | - Albert L. Rancu
- From the Yale Department of Orthopaedics and Rehabilitation (Mr. Sanchez, Mr. Rancu, Mr. Jonnalagadda, Ms. Dhodapkar, and Dr. Grauer), and the Yale Department of Plastic and Reconstructive Surgery, New Haven, CT (Dr. Diatta, Mr. Knoedler, and Dr. Kauke-Navarro)
| | - Fortunay H. Diatta
- From the Yale Department of Orthopaedics and Rehabilitation (Mr. Sanchez, Mr. Rancu, Mr. Jonnalagadda, Ms. Dhodapkar, and Dr. Grauer), and the Yale Department of Plastic and Reconstructive Surgery, New Haven, CT (Dr. Diatta, Mr. Knoedler, and Dr. Kauke-Navarro)
| | - Anshu Jonnalagadda
- From the Yale Department of Orthopaedics and Rehabilitation (Mr. Sanchez, Mr. Rancu, Mr. Jonnalagadda, Ms. Dhodapkar, and Dr. Grauer), and the Yale Department of Plastic and Reconstructive Surgery, New Haven, CT (Dr. Diatta, Mr. Knoedler, and Dr. Kauke-Navarro)
| | - Meera M. Dhodapkar
- From the Yale Department of Orthopaedics and Rehabilitation (Mr. Sanchez, Mr. Rancu, Mr. Jonnalagadda, Ms. Dhodapkar, and Dr. Grauer), and the Yale Department of Plastic and Reconstructive Surgery, New Haven, CT (Dr. Diatta, Mr. Knoedler, and Dr. Kauke-Navarro)
| | - Leonard Knoedler
- From the Yale Department of Orthopaedics and Rehabilitation (Mr. Sanchez, Mr. Rancu, Mr. Jonnalagadda, Ms. Dhodapkar, and Dr. Grauer), and the Yale Department of Plastic and Reconstructive Surgery, New Haven, CT (Dr. Diatta, Mr. Knoedler, and Dr. Kauke-Navarro)
| | - Martin Kauke-Navarro
- From the Yale Department of Orthopaedics and Rehabilitation (Mr. Sanchez, Mr. Rancu, Mr. Jonnalagadda, Ms. Dhodapkar, and Dr. Grauer), and the Yale Department of Plastic and Reconstructive Surgery, New Haven, CT (Dr. Diatta, Mr. Knoedler, and Dr. Kauke-Navarro)
| | - Jonathan N. Grauer
- From the Yale Department of Orthopaedics and Rehabilitation (Mr. Sanchez, Mr. Rancu, Mr. Jonnalagadda, Ms. Dhodapkar, and Dr. Grauer), and the Yale Department of Plastic and Reconstructive Surgery, New Haven, CT (Dr. Diatta, Mr. Knoedler, and Dr. Kauke-Navarro)
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Gurel R, Vidra M, Elbaz E, Factor S, Kazum E, Bivas A, Maman E, Chechik O, Rotman D. Arthroscopic rotator cuff repair in fibromyalgia patients had comparable outcomes to a matched control group. J Orthop Traumatol 2023; 24:21. [PMID: 37169977 PMCID: PMC10175519 DOI: 10.1186/s10195-023-00706-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Accepted: 05/01/2023] [Indexed: 05/13/2023] Open
Abstract
BACKGROUND Although fibromyalgia is associated with poor outcomes following orthopedic surgeries, several studies show some benefit from surgical intervention and nevertheless recommend operative treatment when indicated. There is sparse evidence of the effect of fibromyalgia on the outcomes of shoulder surgery. The purpose of this study was to investigate the effect of fibromyalgia on patient-reported outcomes of arthroscopic rotator cuff repair (ARCR). METHODS All patients with a confirmed diagnosis of fibromyalgia who underwent ARCR in one institution between 2010 and 2021 were included. Data retrieved from medical records included demographics, characteristics of the cuff tear and the surgical procedure, and preoperative and last follow-up (minimum 1 year) postoperative Disabilities of the Arm, Shoulder and Hand (DASH) score, Subjective Shoulder score (SSV), and Numeric Pain Rating Scale (NPRS). A matched controlled group of patients without fibromyalgia who had undergone ARCR was selected according to age, sex, and preoperative DASH, SSV, and NPRS scores. RESULTS There were no significant differences in demographics, cuff tear and surgical procedure characteristics, and preoperative scores between the fibromyalgia and control groups. The fibromyalgia patients' postoperative scores for all 3 measurements showed significant improvement: SSV by 32.1 (P = 0.004), DASH by 20.3 (P = 0.016), and NPRS by 2.33 (P = 0.017). There were no significant differences in the postoperative DASH, SSV, and NPRS between the fibromyalgia and control groups. CONCLUSION Fibromyalgia patients with rotator cuff tears who undergo ARCR do not have inferior patient-reported outcomes compared with non-fibromyalgia controls. Fibromyalgia should not be a considered a contraindication for ARCR. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Ron Gurel
- Department of Orthopedic Surgery, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel.
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
| | - Matias Vidra
- Department of Orthopedic Surgery, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Etay Elbaz
- Department of Orthopedic Surgery, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Shai Factor
- Department of Orthopedic Surgery, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Efi Kazum
- Department of Orthopedic Surgery, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Assaf Bivas
- Department of Orthopedic Surgery, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Eran Maman
- Department of Orthopedic Surgery, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ofir Chechik
- Department of Orthopedic Surgery, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Dani Rotman
- Department of Orthopedic Surgery, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Masood R, Mandalia K, Moverman MA, Puzzitiello RN, Pagani NR, Menendez ME, Salzler MJ. Patients With Functional Somatic Syndromes-Fibromyalgia, Irritable Bowel Syndrome, Chronic Headaches, and Chronic Low Back Pain-Have Lower Outcomes and Higher Opioid Usage and Cost After Shoulder and Elbow Surgery. Arthroscopy 2022; 39:1529-1538. [PMID: 36592697 DOI: 10.1016/j.arthro.2022.12.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Revised: 12/06/2022] [Accepted: 12/15/2022] [Indexed: 12/31/2022]
Abstract
PURPOSE To perform a systematic review assessing the relationship between functional somatic syndromes (FSSs) and patient-reported outcome measures (PROMs), postoperative opioid consumption, and hospitalization costs after shoulder and elbow surgery. METHODS A systematic review of the PubMed and Web of Science databases was conducted according to Preferred Reporting Items for Systematic Review and Meta-Analysis guidelines to identify all studies evaluating the effect of having at least 1 FSS (fibromyalgia, irritable bowel syndrome, chronic headaches, chronic low back pain) on outcomes after shoulder and elbow surgeries. Outcomes of interest included postoperative analgesic use, PROMs, and hospitalization costs. RESULTS The review identified a total of 320 studies, of which 8 studies met the inclusion criteria. The total number of participants in our 8 included studies was 57,389. Three studies (n = 620) reported PROMs. These studies demonstrated that the presence of at least 1 FSS is predictive of significantly greater pain scores and lower quality of recovery, Disability Arm Shoulder and Hand, American Shoulder and Elbow Surgeons Shoulder Score, and Single Assessment Numeric Evaluation scores postoperatively. Although scores were inferior in among patients with FSS, 2 of the 3 studies showed improvement in PROMs in this group of patients. Seven studies (n = 56,909) reported postoperative opioid use. Of these, 5 reported that a diagnosis of at least 1 FSS was a strong risk factor for long-term opioid use after surgery. One study (n = 480) found that time-driven activity-based costs were significantly greater in patients with FSSs. CONCLUSIONS Patients with functional somatic syndromes have less-favorable PROMs postoperatively, consume more opioids postoperatively, and have greater health care costs after elective shoulder and elbow procedures. Although PROMs among patients with FSSs are inferior compared with those without FSSs, PROMs still improved compared with baseline. LEVEL OF EVIDENCE Level III, systematic review of Level II-III studies.
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Affiliation(s)
- Raisa Masood
- Department of Orthopaedic Surgery, Tufts Medical Center, Boston, Massachusetts, U.S.A
| | - Krishna Mandalia
- Tufts University School of Medicine, Boston, Boston, Massachusetts, U.S.A
| | - Michael A Moverman
- Department of Orthopaedic Surgery, Tufts Medical Center, Boston, Massachusetts, U.S.A
| | - Richard N Puzzitiello
- Department of Orthopaedic Surgery, Tufts Medical Center, Boston, Massachusetts, U.S.A
| | - Nicholas R Pagani
- Department of Orthopaedic Surgery, Tufts Medical Center, Boston, Massachusetts, U.S.A
| | - Mariano E Menendez
- Midwest Orthopaedics at Rush, Rush University Medical Center, Chicago, Illinois, U.S.A
| | - Matthew J Salzler
- Department of Orthopaedic Surgery, Tufts Medical Center, Boston, Massachusetts, U.S.A.
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Rivera Redondo J, Díaz Del Campo Fontecha P, Alegre de Miquel C, Almirall Bernabé M, Casanueva Fernández B, Castillo Ojeda C, Collado Cruz A, Montesó-Curto P, Palao Tarrero Á, Trillo Calvo E, Vallejo Pareja MÁ, Brito García N, Merino Argumánez C, Plana Farras MN. Recommendations by the Spanish Society of Rheumatology on Fibromyalgia. Part 1: Diagnosis and treatment. REUMATOLOGIA CLINICA 2021; 18:131-140. [PMID: 34649820 DOI: 10.1016/j.reumae.2021.02.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Accepted: 02/04/2021] [Indexed: 12/14/2022]
Abstract
OBJECTIVE To prevent the impairment of fibromyalgia patients due to harmful actions in daily clinical practice that are potentially avoidable. METHODS A multidisciplinary team identified the main areas of interest and carried out an analysis of scientific evidence and established recommendations based on the evidence and "formal evaluation" or "reasoned judgment" qualitative analysis techniques. RESULTS A total of 39 recommendations address diagnosis, unsafe or ineffective treatment interventions and patient and healthcare workers' education. This part I shows the first 27 recommendations on the first 2 areas. CONCLUSIONS Establishing a diagnosis improves the patient's coping with the disease and reduces healthcare costs. NSAIDs, strong opioids and benzodiazepines should be avoided due to side effects. There is no good evidence to justify the association of several drugs. There is also no good evidence to recommend any complementary medicine. Surgeries show a greater number of complications and a lower degree of patient satisfaction and therefore should be avoided if the surgical indication is not clearly established.
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Affiliation(s)
- Javier Rivera Redondo
- Servicio de Reumatología, Hospital General Universitario Gregorio Marañón, Madrid, Spain.
| | | | | | | | | | | | | | | | | | - Eva Trillo Calvo
- Medicina de Familia, Centro de Salud Campo de Belchite, Belchite, Zaragoza, Spain
| | - Miguel Ángel Vallejo Pareja
- Departamento de Psicología Clínica, Facultad de Psicología, Universidad Nacional de Educación a Distancia (UNED), Madrid, Spain
| | - Noé Brito García
- Unidad de Investigación, Sociedad Española de Reumatología, Madrid, Spain
| | | | - M Nieves Plana Farras
- Hospital Príncipe de Asturias, CIBER de Epidemiología y Salud Pública, Meco, Madrid, Spain
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Luceri F, Cucchi D, Pichierri I, Zaolino CE, Menon A, Nikhil JM, Arrigoni PA, Randelli PS. Validation of a Practical Forearm Supination Strength Measurement Technique in the Large Sample Cohort. Indian J Orthop 2020; 54:292-296. [PMID: 33194104 PMCID: PMC7609524 DOI: 10.1007/s43465-020-00239-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2020] [Accepted: 08/17/2020] [Indexed: 02/04/2023]
Abstract
INTRODUCTION The strength of forearm in pronation and supination (P/S) is an important clinical assessment during pre-operative examination as well as in post-operative evaluation. Many clinical trials concerning the measurement of forearm P/S strength were performed using a dynamometer fixed on the wall. The aim of this study was to bring out a simple and reliable technique for the measurement of P/S strength using a dynamometer manually supported and stabilized by an examiner. We hypothesized that there are no differences in evaluation of elbow P/S strength using the dynamometer fixed or the dynamometer stabilized by an operator in healthy people. METHODS The study was performed on a cross-sectional cohort of 100 healthy subjects without any history of injuries or previous surgery of the upper limbs. Isometric forearm P/S strengths were measured on the dominant and non-dominant forearms, using the dynamometer fixed on a table, and using the same dynamometer kept by an operator. The measurements were repeated in triplicate at 45°, 90° and 120° of elbow flexion in both upper limbs for all patients. RESULTS A total of 100 subjects (50 females, 50 males) were included in the study group. The mean age was 46.5 years (range 25-52 years). Female and male subjects showed no significant differences concerning the mean age (F/M ratio 0.50/0.50). The mean body mass index of all participants was 24.34 ± 3.66 kg/m2.No significant statistics difference was reported between the P/S strength measured using the two detection methods in our study group (45°, 90° and 120° of elbow flexion and both upper limbs). CONCLUSION The manually stabilized technique is a valid and reliable technique to assess the P/S strength of the forearm. This is a simple and effective method that may be reproduced in our daily clinical practice as well as in sportive practice.
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Affiliation(s)
- Francesco Luceri
- IRCCS Istituto Ortopedico Galeazzi, Via Riccardo Galeazzi, 4, 20161 Milan, Italy
| | - Davide Cucchi
- Department of Orthopaedics and Trauma Surgery, Universitätsklinikum Bonn, Sigmund- Freud-Str. 25, 53127 Bonn, Germany
| | - Ivan Pichierri
- U.O.C. Clinica Ortopedica e Traumatologica Universitaria CTO, Azienda Socio Sanitaria Territoriale Centro Specialistico Ortopedico Traumatologico Gaetano Pini-CTO, Piazza Cardinal Ferrari 1, 20122 Milan, Italy
- Università degli Studi di Milano, Via Mangiagalli 31, 20133 Milan, Italy
| | - Carlo Eugenio Zaolino
- U.O.C. Clinica Ortopedica e Traumatologica Universitaria CTO, Azienda Socio Sanitaria Territoriale Centro Specialistico Ortopedico Traumatologico Gaetano Pini-CTO, Piazza Cardinal Ferrari 1, 20122 Milan, Italy
| | - Alessandra Menon
- U.O.C. Clinica Ortopedica e Traumatologica Universitaria CTO, Azienda Socio Sanitaria Territoriale Centro Specialistico Ortopedico Traumatologico Gaetano Pini-CTO, Piazza Cardinal Ferrari 1, 20122 Milan, Italy
- Laboratorio di Biomeccanica Applicata, Dipartimento di Scienze Biomediche per la Salute, Università degli Studi di Milano, Via Mangiagalli 31, 20133 Milan, Italy
| | | | - Paolo Angelo Arrigoni
- U.O.C. Clinica Ortopedica e Traumatologica Universitaria CTO, Azienda Socio Sanitaria Territoriale Centro Specialistico Ortopedico Traumatologico Gaetano Pini-CTO, Piazza Cardinal Ferrari 1, 20122 Milan, Italy
- Università degli Studi di Milano, Via Mangiagalli 31, 20133 Milan, Italy
| | - Pietro Simone Randelli
- U.O.C. Clinica Ortopedica e Traumatologica Universitaria CTO, Azienda Socio Sanitaria Territoriale Centro Specialistico Ortopedico Traumatologico Gaetano Pini-CTO, Piazza Cardinal Ferrari 1, 20122 Milan, Italy
- Laboratorio di Biomeccanica Applicata, Dipartimento di Scienze Biomediche per la Salute, Università degli Studi di Milano, Via Mangiagalli 31, 20133 Milan, Italy
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Fossati C, Vitale M, Forin Valvecchi T, Gualtierotti R, Randelli PS. Management of Painful Shoulder Arthroplasty: A Narrative Review. Pain Ther 2020; 9:427-439. [PMID: 32676775 PMCID: PMC7648774 DOI: 10.1007/s40122-020-00186-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Indexed: 11/24/2022] Open
Abstract
Despite the recent advances in surgical techniques, the percentage of painful shoulder arthroplasties is still high (more than 10%). The causes of residual pain after shoulder arthroplasty, and the resulting treatment solutions, are many and different. The most common complications of shoulder prosthesis are infections, aseptic loosening, modular components disassembling, metal hypersensitivity, and instability. There are also implant-related complications such as glenoid wear in hemiarthroplasty, rotator cuff tear in anatomical total shoulder arthroplasty, scapular notching, and acromion fracture in reverse shoulder arthroplasty. Several of these complications can be avoided with a careful selection of the implants, a proper surgical technique and a precise implant positioning. The execution of a more accurate preoperative planning and the possible use of patient-specific implants are expected to translate into better clinical results in the future. We provide the reader with recent evidence on the causes and therapeutic options of this condition.
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Affiliation(s)
- Chiara Fossati
- 1° Clinica Ortopedica, ASST Centro Specialistico Ortopedico Traumatologico Gaetano Pini-CTO, Piazza Cardinal Ferrari 1, 20122, Milan, Italy. .,Laboratorio di Biomeccanica Applicata, Dipartimento Scienze Biomediche per la Salute, Università degli Studi di Milano, via Mangiagalli 31, 20133, Milan, Italy.
| | - Marianna Vitale
- 1° Clinica Ortopedica, ASST Centro Specialistico Ortopedico Traumatologico Gaetano Pini-CTO, Piazza Cardinal Ferrari 1, 20122, Milan, Italy.,Laboratorio di Biomeccanica Applicata, Dipartimento Scienze Biomediche per la Salute, Università degli Studi di Milano, via Mangiagalli 31, 20133, Milan, Italy
| | - Tommaso Forin Valvecchi
- 1° Clinica Ortopedica, ASST Centro Specialistico Ortopedico Traumatologico Gaetano Pini-CTO, Piazza Cardinal Ferrari 1, 20122, Milan, Italy.,Laboratorio di Biomeccanica Applicata, Dipartimento Scienze Biomediche per la Salute, Università degli Studi di Milano, via Mangiagalli 31, 20133, Milan, Italy
| | - Roberta Gualtierotti
- Dipartimento di Fisiopatologia medico-chirurgica e dei trapianti, Università degli studi di Milano, via Pace 9, 20122, Milan, Italy
| | - Pietro S Randelli
- 1° Clinica Ortopedica, ASST Centro Specialistico Ortopedico Traumatologico Gaetano Pini-CTO, Piazza Cardinal Ferrari 1, 20122, Milan, Italy.,Laboratorio di Biomeccanica Applicata, Dipartimento Scienze Biomediche per la Salute, Università degli Studi di Milano, via Mangiagalli 31, 20133, Milan, Italy
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