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Introduction
Current institution
Publications
Publications (84)
Objectives:
To systematically review and conduct a meta-analysis of studies on peripheral magnetic stimulation (PMS) for fibromyalgia (FM) treatment.
Methods:
MEDLINE, EMBASE, CENTRAL, CINHAL, Web of Science, and ProQuest databases were searched from inception to July 2023 for studies in adult patients with FM treated with PMS. Studies using tra...
BACKGROUND
Whether regional anesthesia impacts the development of chronic postsurgical pain is currently debateable, and few studies have evaluated an effect on prolonged opioid use. We sought to systematically review the effect of regional anesthesia for adults undergoing noncardiac elective surgery on these outcomes.
METHODS
A systematic search...
Repetitive peripheral magnetic stimulation (rPMS) is a non-pharmacological, non-invasive analgesic modality with limited side effects. However, there is a paucity of controlled studies demonstrating its efficacy compared to existing pain management tools. Here, in an initial sample of 100 healthy participants (age 18-40), we compared the analgesic...
Hypotension after induction of general anesthesia is common and is associated with significant adverse events. Identification of patients at high risk can inform the use of preoperative mitigation strategies. We conducted a systematic review and meta-analysis to assess the diagnostic accuracy of the inferior vena cava collapsibility index (IVC-CI)...
Introduction
Fibromyalgia is associated with chronic widespread pain and disturbed sleep. Multidisciplinary, multimodal management often includes pharmacotherapy; however, current drugs used to treat fibromyalgia provide meaningful benefit to only 30–60% of treated individuals. Combining two or more different drugs is common in clinical practice wi...
Purpose of Review
This review investigates the roles of artificial intelligence (AI) and virtual reality (VR) in enhancing cognitive pain therapy for chronic pain management. The work assesses current research, outlines benefits and limitations and examines their potential integration into existing pain management methods.
Recent Findings
Advances...
Background
Persistent pain is a common yet debilitating complication after breast cancer surgery. Given the pervasive effects of this pain disorder on the patient and healthcare system, post-mastectomy pain syndrome (PMPS) is becoming a larger population health problem, especially as the prognosis and survivorship of breast cancer increases. Interv...
Background
Chronic postsurgical pain (CPSP) is common following musculoskeletal and orthopedic surgeries and is associated with impairment and reduced quality of life. Several interventions have been proposed to reduce CPSP; however, there remains uncertainty regarding which, if any, are most effective. We will perform a systematic review and netwo...
Hypotension after induction of general anesthesia (GAIH) is common and is associated with postoperative complications including increased mortality. Collapsibility of the inferior vena cava (IVC) has good performance in predicting GAIH; however, there is limited evidence whether a preoperative fluid bolus in patients with a collapsible IVC can prev...
BACKGROUND
Understanding the association of acute pain intensity and opioid consumption after cardiac surgery with chronic postsurgical pain (CPSP) can facilitate implementation of personalized prevention measures to improve outcomes. The objectives were to (1) examine acute pain intensity and daily mg morphine equivalent dose (MME/day) trajectorie...
Background
Despite the established efficacy of multidisciplinary chronic pain care, barriers such as inflated referral wait times and uncoordinated care further hinder patient health care access.
Aims
Here we describe the evolution of a single-entry model (SEM) for coordinating access to chronic pain care across seven hospitals in Toronto and expl...
Objectives
To provide a systematic review of the literature on the effects of peripheral magnetic stimulation (PMS) in the treatment of chronic peripheral neuropathic pain.
Methods
A systematic search of MEDLINE, EMBASE, CENTRAL, CINHAL, Web of Science, and ProQuest was conducted from inception to July 2023 to identify studies of any design publis...
Background
Cervical facet joint disease is a common source of neck pain and its prevalence increases with aging. Conservative multimodal management options (e.g., strengthening of neck muscles, non-steroidal anti-inflammatory medications, massage, and thermal modalities) often fail to relieve pain. Cervical medial branch nerve (CMBN) radiofrequency...
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Background and Aims
Rebound intracranial hypertension (RIH) is a complication in patients with spontaneous intracranial hypotensio...
Background
Cervical facet joint disease is a common source of neck pain and its prevalence increases with aging. Conservative multimodal management options (e.g., strengthening of neck muscles, non-steroidal anti-inflammatory medications, massage, and thermal modalities) often fail to relieve pain. Cervical medial branch nerve (CMBN) radiofrequency...
Point-of-care ultrasound (PoCUS) is used by health care professionals of various specialties worldwide, with excellent results demonstrating significant potential to advance patient care. However, in low resource areas of the world, where other imaging modalities are scarce and the potential of handheld pocket-sized PoCUS devices with great versati...
Objective: Persistent pain is a common complication after breast cancer surgery. We sought to determine the characteristics of persistent pain after breast cancer surgery and identify perioperative risk factors associated with its development. Methods: This prospective cohort study uses data from a prior randomized controlled trial of 100 patients...
Health disparities in pain management remain a pervasive public health crisis. Racial and ethnic disparities have been identified in all aspects of pain management from acute, chronic, pediatric, obstetric, and advanced pain procedures. Disparities in pain management are not limited to race and ethnicity, and have been identified in multiple other...
Background:
Chronic post-surgical pain is a common complication of surgery. The role of psychological risk factors like depression and anxiety is substantially understudied in cardiac surgery. This study sought to identify perioperative factors associated with chronic pain at 3, 6, and 12 months after cardiac surgery. We hypothesize that baseline...
Background:
Chronic daily headaches (CDH) are common and associated with significant morbidity, poor quality of life, and substantial burden on the healthcare system. CDH tends to be refractory to conventional medical management and/or patients cannot afford expensive treatments. It is stipulated that CDH share a mechanism of central sensitization...
Peripheral magnetic stimulation is a potentially promising modality to help manage postoperative pain. We systematically reviewed the effect of peripheral magnetic stimulation on acute and chronic postoperative pain. MEDLINE, Cochrane CENTRAL, EMBASE, ProQuest Dissertations, and ClinicalTrials.gov were searched from inception until May 2021. We inc...
Aims
Repetitive peripheral magnetic stimulation (rPMS) is a novel non-pharmacological treatment modality. This non-invasive approach can stimulate peripheral nerves to provide analgesia through neuromodulation. We report the first case of ultrasound-guided rPMS to treat a case of severe refractory glossopharyngeal neuralgia.
Methods
A 70-year-old...
This chapter discusses the bedside management strategies for joint, tendon, and muscle-related pain. The historical approaches to these types of procedures are discussed as well as ultrasound-guided procedures, which has become the current standard of care for these interventions. Traditional injection medications for these injections including loc...
PurposeGenitofemoral neuralgia (GFN) is a chronic pain condition that may be refractory to commonly employed treatment modalities. Implantation of a peripheral nerve stimulator (PNS) may provide significant pain relief; however, few reports have described placement of and response to a GFN PNS implant.Clinical featuresWe implanted a StimRouter® PNS...
Importance
Chronic, non-cancer pain affects approximately 20–30% of the population in North America, Europe, and Australia, with surgery and trauma frequently cited as inciting events. Prospective studies of fracture patients have demonstrated an association between somatic pre-occupation, poor coping, and low recovery expectations following surger...
Purpose of Review
The goal of this clinical review was to provide an update about the existing treatment options and associated evidence for various radiofrequency ablation techniques for sacroiliac joint pain.
An electronic literature search on radiofrequency for the treatment of sacroiliac joint pain was conducted using PubMed, NCBI and Google Sc...
Background:
Chronic lower back pain (LBP) with or without leg pain (LP) is the most commonly reported anatomical site of pain among Canadian adults with chronic pain. A common cause for LBP and LP arises from dysfunction of the sacroiliac joint (SIJ) complex. When conventional medical management or rehabilitative efforts for SIJ-related LBP and LP...
Executive Summary
In the past several years, many national events have illuminated the inequities faced by the Black community in all aspects of life, including healthcare. To close the gap in healthcare equity, it is imperative that clinicians examine their practices for disparities in the treatment of minority patients and for racial injustice an...
Background
The purpose of this study was to determine the incidence, characteristics, impact, and risk factors associated with persistent incisional pain. The hypothesis was that patient demographics and perioperative interventions are associated with persistent pain.
Methods
This was a secondary analysis of an international prospective cohort stu...
PurposeChronic post-surgical pain (CPSP) is a highly prevalent complication following thoracic surgery. This is a prospective cohort study that aims to describe the pain trajectories of patients undergoing thoracic surgery beginning preoperatively and up to 1 year after surgery
Methods
Two hundred and seventy nine patients undergoing elective thora...
Fortunately, with advances in screening and management, the prognosis of breast cancer has substantially improved. However, as patients with breast cancer are living much longer, consequences of management are becoming increasingly apparent, particularly persistent pain after breast cancer surgery. This pain disorder, referred to as Post-Mastectomy...
Objective:
To assess the efficacy and safety of N-acetylcysteine in the treatment of chronic pain.
Methods:
A systematic search was carried out until April 2020 for clinical studies of N-acetylcysteine in the management of any persistent or recurrent chronic pain condition for adults ≥ 18 years old. Risk of Bias was assessed using the validated...
Background
Naltrexone (NTX) is an opioid antagonist traditionally used as a treatment for alcohol and opioid use disorders, but various studies have documented its involvement in cancer progression, exploring possible anticancer potential, when administered at high doses or as low dose naltrexone (LDN). Herein we present a systematic review of canc...
Background:
Inadvertent perioperative hypothermia is a common complication of surgery, and active body surface warming (ABSW) systems are used to prevent adverse clinical outcomes. Prior data on certain outcomes are equivocal (ie, blood loss) or limited (ie, pain and opioid consumption). The objective of this study was to provide an updated review...
Background
The prevalence and intensity of persistent post-surgical pain (PPSP) after breast cancer surgery are uncertain. We conducted a systematic review and meta-analysis to further elucidate this issue.
Methods
We searched MEDLINE, Embase, CINAHL, and PsycINFO, from inception to November 2018, for observational studies reporting persistent pai...
Objective:
Despite evidence of the analgesic benefits of cannabis, there remains a relative scarcity of research on the short- and long-term effects of cannabis use in individuals with chronic pain.
Design:
The current study is a secondary analysis of clinical data from the Collaborative Health Outcomes Information Registry (CHOIR).
Setting:
D...
Purpose of Review
The measurement and assessment of pain outcomes is critical to the design, analysis, and interpretation of a pain clinical trial. Results from clinical research impact a number of stakeholders, but it can be argued that patients are the most affected. The purpose of this review is to summarize the most important pain outcomes to p...
Breast cancer is one of the most commonly diagnosed cancers among women, and since the prognosis of breast cancer has substantially improved in past decades, complications of management are becoming increasingly apparent. Persistent pain lasting greater than 3 months after breast cancer surgery is unfortunately a common complication affecting appro...
BACKGROUND
The most commonly used means to assess pain is through patient self-reported questionnaires. These questionnaires have traditionally been completed using paper-and-pencil, telephone, or in-person methods, which may result in the introduction of several reporting biases and data entry errors into the collected data. Electronic data captur...
Background:
The most commonly used means to assess pain is by patient self-reported questionnaires. These questionnaires have traditionally been completed using paper-and-pencil, telephone, or in-person methods, which may limit the validity of the collected data. Electronic data capture methods represent a potential way to validly, reliably, and f...
Background: Electronic data collection is increasingly available as a means to collect pain-related clinical trial data; however, effectiveness and costs relative to traditional data collection are uncertain.
Aims: The aim of this study was to evaluate data quality, protocol adherence, satisfaction, and resource requirements of electronic data coll...
Tobacco smoking is associated with adverse health effects and its relationship to pain is complex. The longitudinal effect of smoking on patients attending a tertiary pain management center is not wellestablished. Using the Collaborative Health Outcomes Information Registry (CHOIR) of patients attending the Stanford Pain Management Center from 2013...
What we already know about this topic:
Perioperative hypotension is associated with cardiovascular events in patients having noncardiac surgery, but it is unknown if the severity of preexisting coronary artery disease determines susceptibility to the cardiovascular risks of perioperative hypotension WHAT THIS ARTICLE TELLS US THAT IS NEW: In patie...
Persistent postsurgical pain is defined as pain localized to the area of surgery of a duration of ≥2 months and is, unfortunately, a common complication after breast cancer surgery. Although there is insufficient evidence to support any preventative strategy, prior literature suggests the possible efficacy of intravenous lidocaine and perioperative...
Introduction
Approximately 400 000 Americans and 36 000 Canadians undergo cardiac surgery annually, and up to 56% will develop chronic postsurgical pain (CPSP). The primary aim of this study is to explore the association of pain-related beliefs and gender-based pain expectations on the development of CPSP. Secondary goals are to: (A) explore risk f...
Hip denervation comprising radiofrequency lesioning of the obturator and femoral articular branches is used in adults with refractory hip pain who are not surgical candidates. Persistent hip pain infrequently occurs in pediatric patients and there is limited data on the safety and efficacy of this procedure in a pediatric population. We provide a c...
Purpose
Breast cancer surgery is associated with unemployment. Identifying high-risk patients could help inform strategies to promote return to work. We systematically reviewed observational studies to explore factors associated with unemployment after breast cancer surgery.
Methods
We searched MEDLINE, EMBASE, CINAHL, and PsycINFO to identify stu...
Background and Objective
Breast cancer surgery is associated with acute and chronic pain. We sought to systematically evaluate the effect of gabapentin and pregabalin on post-surgical pain among patients undergoing breast cancer surgery.
Databases and Data Treatment
We searched MEDLINE, EMBASE, CENTRAL, Web of Science, and ProQuest from inception...
Background:
Chronic postsurgical pain (CPSP) is a debilitating and costly condition. Risk factors for CPSP after autologous breast reconstruction have not been clearly established. Previously, we demonstrated that transversus abdominis plane (TAP) catheters delivering intermittent local anesthetic reduced postoperative morphine consumption. This p...
Background:
The association of patient expectations about recovery with the development of chronic post-surgical pain (CPSP) is uncertain.
Methods:
Three hundred and fifty-nine patients enrolled in the SPRINT trial completed the Somatic Preoccupation and Coping (SPOC) questionnaire six weeks after a traumatic tibial fracture repair. The SPOC que...
Background:
Tens of thousands of cardiac and vascular surgeries (CaVS) are performed on seniors in Canada and the United Kingdom each year to improve survival, relieve disease symptoms, and improve health-related quality of life (HRQL). However, chronic postsurgical pain (CPSP), undetected or delayed detection of hemodynamic compromise, complicati...
Background: Persistent pain after breast cancer surgery affects up to 60% of patients. Early identification of those at higher risk could help inform optimal management. We conducted a systematic review and meta-analysis of observational studies to explore factors associated with persistent pain among women who have
undergone surgery for breast can...
Background:
Persistent pain after breast cancer surgery affects up to 60% of patients. Early identification of those at higher risk could help inform optimal management. We conducted a systematic review and meta-analysis of observational studies to explore factors associated with persistent pain among women who have undergone surgery for breast ca...
Purpose:
To review the literature on the efficacy and safety of perineural steroid injections around the ilioinguinal, iliohypogastric, and genitofemoral nerves for chronic postoperative inguinal pain (CPIP).
Methods:
A scoping review was performed to find all relevant case reports, case series, prospective or retrospective cohort studies, case-...
Background:
Postoperative pain continues to be undertreated after noncardiac surgery. Preoperative analgesic administration may enhance postoperative analgesia.
Objective:
To determine the effects of preoperative administration of celecoxib in noncardiac surgery on pain and postoperative outcomes.
Design:
Systematic review and meta-analysis of...
Study objective:
There exists no commonly accepted regimen for an intravenous lidocaine infusion (IVLI). This study aims to determine an appropriate end time for an IVLI during bowel surgery.
Design:
A systematic search for randomized controlled trials assessing IVLI for bowel surgery was conducted using Ovid MEDLINE, EMBASE, CINAHL, Cochrane CE...
This Teachable Moment emphasizes that preoperative investigations must be used judiciously to avoid treatment delay and that complete history, clinical risk stratification, and careful patient selection can identify most patients at high risk who may benefit from further investigations.Article InformationCorresponding Author: Abhinav Sharma, MD, Ma...
We assessed associations between intraoperative neuraxial block and postoperative epidural analgesia, and a composite primary outcome of death or non-fatal myocardial infarction, at 30 days post-randomization in POISE-2 Trial subjects.
10 010 high-risk noncardiac surgical patients were randomized aspirin or placebo and clonidine or placebo. Neuraxi...
We conducted this study to determine the preferences of anesthesia residents training in Canada for fellowship training, research, and future practice location and to identify the factors that influence those preferences.
Using a cross-sectional study design, a survey was sent to all anesthesia residents enrolled at an accredited Canadian anesthesi...
Postoperative atrial fibrillation (POAF) is the most common perioperative cardiac arrhythmia. A major risk factor for POAF is advanced age, both in non-cardiac and cardiac surgery. Following non-cardiac surgery, it is important to correct reversible conditions such as electrolytes imbalances to prevent the occurrence of POAF. Management of POAF con...
Background: Live donor liver resections are associated with significant postoperative pain. Epidural analgesia is the gold standard for postoperative pain management, although it is often refused or contraindicated. Surgically-placed abdominal wall catheters (AWCs) are a novel pain modality that can potentially provide pain relief in those unable t...
Purpose of review:
Recent investigations have substantially improved our understanding of myocardial injury after noncardiac surgery (MINS).
Recent findings:
MINS is defined as a prognostically relevant myocardial injury due to ischemia that occurs during or within 30 days after noncardiac surgery. MINS occurs in 8% of adults undergoing major no...
Changes in electroencephalogram (EEG) patterns correlate well with changes in cerebral perfusion pressure (CPP) and hence entropy and bispectral index values may also correlate with CPP. To highlight the potential application of entropy, an EEG-based anesthetic depth monitor, on indicating cerebral perfusion in patients with increased intracranial...
The current standard for pain control following liver surgery is intravenous, patient-controlled analgesia (IV PCA) or epidural analgesia. We have developed a modification of a regional technique called medial open transversus abdominis plane (MOTAP) catheter analgesia. The MOTAP technique involves surgically placed catheters through the open surgi...
Importance
Bilateral anterior nasal packing is used after septoplasty with the goals of decreasing the risk of postoperative bleeding and adhesions. However, multiple studies caution against the use of nasal packing because of the risk of cardiopulmonary complications.Objective
To evaluate the cardiopulmonary risks associated with bilateral anter...
Previous studies discussing the risk of medical misconduct amongst anesthesiologists differ in their conclusions. In Canada, there is a paucity of data regarding demographic information, disciplinary findings, and penalties received by anesthesiologists. The aim of this study was to identify potential characteristics for discipline within the speci...
Herein is reported the case of a 51-year-old woman who underwent total laparoscopic hysterectomy in the steep Trendelenburg position who developed postoperative benign paroxysmal positional vertigo. The etiology of benign paroxysmal positional vertigo is examined and the Trendelenburg position during surgery as the triggering factor is explored.
