Silviu Brill

Tel Aviv Sourasky Medical Center | TASMC · PAIN INSTITUTE

Purpose: While advanced medical technology and unlimited access to medical information might benefit and empower patients, these same advantages may pose some risks, especially in the cases where patients have direct access to advanced imaging studies. The aim of this work was to evaluate three domains related to patients with lower back pain: the...

Aims and objectives: In this study, we systematically reviewed qualitative studies concerning patients' experience with medicinal cannabis (MC) use, to gain insight into the negative effects of MC. Background: Over the past decades, the use of MC for therapeutic purposes has increased. However, there is conflicting and insufficient data on possi...

Background Chronic pain is prevalent but difficult to treat in patients undergoing hemodialysis (HD). Effective and safe analgesics are limited in this patient population. Our aim of this feasibility study was to evaluate the safety of sublingual oil based medical cannabis for pain management in patients undergoing HD. Methods In a prospective ran...

Objective: Relying on anthropomorphism research, Illness Personification Theory (ILL-PERF) posits that individuals living with a chronic illness ascribe human-like characteristics to their illness. Herein we examine the personification of chronic pain using a new measure: the Ben-Gurion University Illness Personification Scale (BGU-IPS). Method: Th...

Background: Chronic pain (CP) prevalence in different studies has been inconsistent, ranging from 12% in Spain to 42% in the UK. Purpose: We conducted an internet-based survey in a representative cohort of Israeli adults assembled by a large professional survey company in order to probe the prevalence of CP in Israel. Methods: 8,300 Israeli ad...

Introduction: The thoracic Erector Spinae Plane Block (ESPB) is an ultrasound-guided block that has gained popularity and is widely used in acute pain setups. However, data regarding its role in chronic and cancer-related pain are anecdotal. Material and Methods: The study is a retrospective analysis of patients who underwent ESPB. The cohort was d...

Study design and objective: Cervical radiculopathy is a common clinical condition, often treated with cervical epidural steroid injections (ESI). Retro-laminar cervical blocks (RLCB) may be considered safer than ESI as they do not require entering the neuroaxis.In this study, we evaluated the outcome of RLCB in patients with cervical radiculopathy...

Aims and objectives: To explore the ways in which stigma is experienced, and what strategies are used to manage stigma among patients using medical cannabis to ease suffering from chronic pain. Background: Various jurisdictions have legalised medical cannabis in recent decades. Despite increasing prevalence and more liberal attitudes towards med...

Objectives We investigated whether cannabis usage was associated with reduced opioid usage, and the rates of opioid and cannabis use disorders among chronic pain patients who had been prescribed medical cannabis. Methods A random sample of chronic pain patients who had license for cannabis use were interviewed by telephone about their lifetime opi...

Objective: Pain management is increasingly recognized as a formal medical subspecialty worldwide. Israel was among the first to offer a board-certified subspecialty, formalized by the Israeli Medical Association in 2010 which is open to all clinicians with a state-recognized specialization. This paper aims at evaluating the current program across...

Study design: Prospective clinical pilot study and cadaveric study. Objective: evaluate the spread of an Ultrasound guided interfascial plane blocks (UGIPB) and its potential efficacy for Cervical radiculopathy. Summary of background data: Cervical radiculopathy is a common disorder, potentially leading to severe pain and disability. Conservat...

Background: Although studied in a few randomized controlled trials, the efficacy of medical cannabis (MC) for chronic pain remains controversial. Using an alternative approach, this multicentre, questionnaire-based prospective cohort was aimed to assess the long-term effects of MC on chronic pain of various aetiologies and to identify predictors f...

e24125 Background: Despite lack of clinical trials reporting on beneficial effects of the cannabis plant for cancer-associated symptoms, its use is increasing worldwide. Approximately 10,000 Israeli cancer patients receive permits for the use of medical cannabis, making cannabis one of the most commonly prescribed oncology treatments in Israel and...

Background The use of medical marijuana (MM) for the treatment of chronic pain is rapidly growing in the United States and Europe; however there is concern regarding the specificity of its therapeutic effects and the motivation underlying its use. While research indicates that among chronic pain prescribed opioids, depression has been associated wi...

Patients with radicular low back pain (radicular LBP, sciatica) frequently describe their pain as "shooting" or "radiating." The dictionary meaning of these words implies rapid movement, and indeed, many sufferers report feeling pain moving rapidly from the lower back or buttock into the leg. But, others do not. Moreover, the sensation of movement...

Background and aims: Although the use of Herbal Cannabis (HC) for chronic pain is rising, scientific evidence for its associations with reduction in analgesics reduction is scarce. The aim of this study is to present the changes from baseline in analgesics consumption during one year of HC treatment. Methods: Patients with chronic pain for whom an...

Introduction: In recent years, medical marijuana (MM) is increasingly being used for the treatment of chronic pain. Depression and anxiety have been identified as risk factors for the problematic use of prescription opioids, yet their contribution to developing MM dependence hasn't been explored up to date. In this study we explored the associatio...

Purpose of review: The medicinal use of cannabis has recently become the focus of much medical, as well as political, attention. This reality of growing use but limited evidence creates unique dilemmas for the prescribing clinician. The purpose of this review is to explore current evidence and gaps in knowledge and offer some practical considerati...

Significant chronic pain is highly prevalent in chronic kidney disease patients and is associated with morbidity and mortality. In this study, we retrospectively evaluated the incidence and treatment of pain in the dialysis unit of our tertiary referral center. The cohort included 147 patients. Over 66% reported significant (VAS >40) chronic pain d...

The present study examined the experience of loneliness and the ways of coping with its pain as utilized by people with chronic pain and caregivers. Specifically, a large sample (N = 827) recruited in two major pain clinics in Israel, completed the Loneliness and the Coping with loneliness questionnaires. Results indicated that patients had higher...

Volitional neural modulation using neurofeedback has been indicated as a potential treatment for chronic conditions that involve peripheral and central neural dysregulation. Here we utilized neurofeedback in patients suffering from Fibromyalgia - a chronic pain syndrome that involves sleep disturbance and emotion dysregulation. These ancillary symp...

Introduction The use of medical cannabis (MC) for chronic pain is rising in many parts of the world. In Israel, approximately 32,000 patients are currently licensed to use of medical cannabis, mostly for the relief of chronic pain and 2,000 new licenses are expected to be issued yearly. Although some prospective cohorts on the effectiveness and saf...

Objective: To characterize the functional brain changes involved in δ-9-tetrahydrocannabinol (THC) modulation of chronic neuropathic pain. Methods: Fifteen patients with chronic radicular neuropathic pain participated in a randomized, double-blind, placebo-controlled trial employing a counterbalanced, within-subjects design. Pain assessments and...

Introduction The scientific study of the role of cannabis in pain medicine still lags far behind the growing use driven by public approval. Accumulated clinical experience is therefore an important source of knowledge. However, no study to date has targeted physicians who actually use cannabis in their daily practice. Methods Registered, active, b...

Purpose: It has been widely reported that minority groups receive inferior emergency pain management. We aimed to determine whether this is true in the postoperative setting, as effective postoperative analgesia is an essential component of high quality medical care. Design: A retrospective case-control study of paired 248 postsurgical Israeli p...

Background: In light of the increased rates of Prescription Opioid (PO) misuse and associated mortality in several developed countries in recent years, efforts have been made to identify populations who may be at increased risk for misuse of POs. Though the association between depression and PO misuse among pain patients is well documented, little...

Introduction The use of medical cannabis (MC) for chronic pain is rising in many parts of the world. In Israel, approximately 32,000 patients are currently licensed to use of medical cannabis, mostly for the relief of chronic pain and 2,000 new licenses are expected to be issued yearly. Although some prospective cohorts on the effectiveness and saf...

Background: Although the use of medical cannabis (MC) for chronic pain is rising, scientific evidence on its long-term effectiveness and safety is scarce. Study Aims: The aim of this study was to set up a patient registry on the treatment of MC for the relief of chronic pain in Israel, by prospectively collecting data on the effectiveness and safet...

Background: Chronic physical pain is one of modern medicine's principal challenges. Recently, there has been a keen research interest in the role of Depressive Personality Vulnerability (DPV) in the course of chronic pain. Objective: This is the first attempt to examine the role of three leading DPV dimensions - sociotropy, autonomy, and self-cr...

The aim of this study was to set up a patient registry on the treatment of MC for the relief of chronic pain in Israel. By prospectively collecting data on the effectiveness and safety of MC.

Background: Pachyonychia congenita (PC) is a rare autosomal dominant skin disease with chronic pain being the most prominent complaint. Histological studies showing alterations in sensory innervation along with few reports on alterations in mechanical sensitivity suggest that PC may be a form of neuropathy. Objective: To systematically evaluate...

Current results from the findings of the Israeli medical cannabis registry for chronic pain treatment: effectiveness and safety measures.

Objective: We examined the effects of exposure to missile attacks on patients' pain and depressive symptoms, moderated by pain-related catastrophizing. Method: One-hundred Israeli chronic pain patients were assessed both prior and subsequent to military operation "Protective Edge," during which thousands of missiles landed on populated areas acr...

Introduction  Although the use of medical cannabis (MC) for chronic pain is rising, scientific evidence on its long-term effectiveness and safety is scarce.  The aim of the study is to set up a patient registry on the treatment of MC for the relief of chronic pain in Israel. By prospectively collecting data on the effectiveness and safety of MC,...

Background: There are interrelationships between the autonomic nervous system and pain. This study aims to explore the effect of different autonomic manipulations on pain perception and modulation. Methods: Twenty healthy subjects (10 men and 10 women, mean age 25±3) participate in this single-blinded, semi-randomized, controlled study, which in...

Objective In the past two decades, chronic pain has been increasingly treated with prescription opioids, particularly in developed countries. This has drawn public concern of possible risks associated with the potential misuse of prescriptions opioids. Previous research has indicated that this may be particularly true among individuals suffering fr...

Background: In chronic pain, patients' coping affects their adaptation. In two studies, we examined the role of pain catastrophizing, a maladaptive coping strategy, in pain, distress, and disability. In Study 2 we compared catastrophizing to pain acceptance and to other coping strategies. Methods: Study 1. Chronic pain patients (N = 428) were as...

Background: High rates of depression and anxiety have been consistently reported among patients suffering from chronic pain. Prescription opioids are one of the most common modalities for pharmacological treatment of pain, however in recent years medical marijuana(MM) has been increasingly used for pain control in the US and in several countries w...

A Multi-Center Registry of Medical Cannabis (MC) for Chronic Pain: Initial Results Joshua Aviram, RN, PhC1,2, Dorit Pud, PhD1, Elon Eisenberg, MD3,4 1Faculty of Social Welfare and Health Sciences, University of Haifa, Israel; 2Internal Ward C, Rambam Medical Center, Haifa, Israel; 3Institute of Pain Medicine, Rambam Medical Center, Haifa, Israel;...

Introduction: Although the use of Medical cannabis (MC) for chronic pain is rising, scientific evidence for its long-term efficacy is scarce. Aims: A multi-center registry aimed to prospectively collect data on the effectiveness and safety of MC and to identify predictors for success\failure of MC treatment was structured in late 2015. This is an i...

Purpose: To evaluate and compare the efficacy of intra-articular and periacetabular blocks for postoperative pain control after hip arthroscopy. Methods: Forty-two consecutive patients scheduled for hip arthroscopy were randomized into 2 postoperative pain control groups. One group received preemptive intra-articular 20 mL of bupivacaine 0.5% in...

Perliminary results of the base-line time point Characteristics

Caring for a chronically-ill family member is often taking its toll in increased burden, changes in daily schedule, and increased loneliness for caregivers. This study was aimed at investigating the manner to which caregivers of chronic-pain patients cope with loneliness and other care-related effects. To this end, 247 caregivers were sampled in tw...

A Multi-Center Registry of Medical Cannabis (MC) for Chronic Pain: Initial Results Joshua Aviram1,2, Dorit Pud1, Miriam Oginitz3, Bareket Schiff-Keren4, Tamar Yashar5, Haim-Moshe Adahan6, Silviu Brill7, Itai Gur-Arie8, and Elon Eisenberg3,9. 1Faculty of Social Welfare and Health Sciences, University of Haifa, Haifa, Israel; 2Rambam Health Care Cam...

Objective. To assess prevalence rates and correlates of problematic use of prescription opioids and medicinal cannabis (MC) among patients receiving treatment for chronic pain. Design. Cross-sectional study. Setting. Two leading pain clinics in Israel. Subjects. Our sample included 888 individuals receiving treatment for chronic pain, of whom 99.4%...

Background: Recent evidence supports the beneficial effects of mindfulness meditation on pain. However, the neural mechanisms underlying this effect remain poorly understood. We used an opioid blocker to examine whether mindfulness meditation induced analgesia involves endogenous opioids. Methods: 15 healthy experienced mindfulness meditation pr...

Objective . The α 2 -agonist clonidine is an analgesic agent, whose yet uncertain action may involve either increase in pain modulation efficiency, change in autonomic function, and/or decrease in anxiety level. The present study aimed to examine the effect of oral clonidine on pain perception in healthy subjects in order to reveal its mode of acti...

Background: Local vasoconstrictor reflexes, the vascular myogenic response (VMR) and the veno-arterial reflex (VAR) are necessary for the maintenance of regional blood flow and systemic arterial blood pressure during orthostatic stress. Their molecular mechanism is unknown. We postulated that adenosine is involved in the activation of these local...

Higher parasympathetic activity is related to lower pain perception in healthy subjects and pain patients. We aimed to examine whether this relationship depends on sex, in healthy subjects. Parasympathetic activity was assessed using time- and frequency-domain heart rate variability indices and deep breathing ratio. Pain perception parameters, cons...

The current study sets out to examine the longitudinal relationship between pain, pain-related disability, and symptoms of depression and anxiety. The latter symptoms are highly prevalent in chronic pain and seriously impede functioning and quality of life. Nevertheless, the direction of the relationship involving these variables among individuals...

Suicide ideation is highly common in chronic pain patients, with prevalence ranging from 17 to 66 %.  Chronic is a multifactorial construct with congitive, emotional, sensory and behavioral aspects.  The majority of studies on suicidality in pain focus on sociodemographic rather than personality and interpersonal predictors.  Bio-psycho-social m...

Unlabelled: We report a novel symptom in many patients with low back pain (LBP) that sheds new light on the underlying pain mechanism. By means of quantitative sensory testing, we compared patients with radicular LBP (sciatica), axial LBP (LBP without radiation into the leg), and healthy controls, searching for cutaneous allodynia in response to w...

Background About 240 million patients undergo surgery every year, worldwide. Roughly 50% of these patients report clinically significant pain. Numerous barriers impede provision of adequate management. Lack of evidence about appropriateness and effectiveness of interventions is one. A registry can provide such information, eventually facilitating b...

Rationale, aims and objectives: Management of post-operative pain is unsatisfactory worldwide. An estimated 240 million patients undergo surgery each year. Forty to 60% of these patients report clinically significant pain. Discrepancy exists between availability of evidence-based medicine (EBM)-derived knowledge about management of perioperative p...

Patient ratings of satisfaction with their postoperative pain treatment tend to be high even in those with substantial pain. Determinants are poorly understood and have not previously been studied in large-scale, international datasets. PAIN OUT, a European Union-funded acute pain registry and research project, collects patient-reported outcome dat...

PAIN OUT is a European Commission-funded project aiming at improving postoperative pain management. It combines a registry that can be useful for quality improvement and research using treatment and patient-reported outcome measures. The core of the project is a patient questionnaire-the International Pain Outcomes questionnaire-that comprises key...

ABSTRACT The number of patients taking long-term opioid therapy for pain is increasing, with opioid use no longer being confined to advanced cancer patients. Challenges to peri- and postoperative pain management in chronic pain patients include complex existing drug regimens and problems arising from tolerance to opioid analgesia. Postoperatively,...

Post-operative pain exacts a high toll from patients, families, healthcare professionals and healthcare systems worldwide. PAIN-OUT is a research project funded by the European Union's 7th Framework Program designed to develop effective, evidence-based approaches to improve pain management after surgery, including creating a registry for feedback,...

Fibromyalgia syndrome (FMS), the prototypical central pain augmentation syndrome, is characterized by widespread pain and tenderness. Although patients referred to tertiary care pain clinics are recognized as suffering from chronic pain, they are generally considered to have pain attributable to discrete peripheral, nociceptive, or neuropathic etio...

Neuraxial administration of morphine is an effective way of controlling postoperative pain and reducing analgesic consumption. Some animal models have demonstrated that preemptive administration of neuraxial narcotics reduces pain, while others have revealed the contrary. In addition, there have been no consistent results in clinical settings. This...

Trigeminal neuralgia (TGN) is a challenging pain syndrome. To test the effectiveness of local instillation of ophthalmic solution of amethocaine in relieving the pain of TGN. We performed an open-label prospective study in 40 consecutive currently treated patients suffering from TGN with a reported visual analog scale (VAS) >8 (severe pain). The pa...

Bowel dysfunction, mainly constipation, is a well-known and anticipated side effect of opioids. The physician prescribing an opioid frequently confronts the challenge of preventing and treating bowel dysfunction. Different strategies have emerged for managing opioid-induced constipation. These strategies include physical activity, maintaining adequ...

Simulation techniques are increasingly being used in anesthesia training programs and to a lesser extent in evaluation of residents. We describe 7 years of experience with Objective Structured Clinical Examination-based regional anesthesia assessment in the Israeli National Board Examinations in Anesthesiology. We believe this is the first use of s...

Objective. The objective of this study was to assess opioid use during 7 years (2000–2006) among Clalit Health Services (CHS) members. Design. Purchasing data of opioids authorized for use in Israel were obtained from the computer-ized databases of CHS. Patient demographics and cancer morbidity were also extracted. The data were analyzed by convert...

According to the WHO, the yearly national consumption of opioids is one indicator of a country's investment on relieving moderate-to-severe pain. We implemented guidelines for treatment of pain in our emergency department (ED) and tracked the major analgesics used in this ED to monitor trends in pain management over a decade. The study was carried...

The objective of this study was to assess opioid use during 7 years (2000-2006) among Clalit Health Services (CHS) members. Purchasing data of opioids authorized for use in Israel were obtained from the computerized databases of CHS. Patient demographics and cancer morbidity were also extracted. The data were analyzed by converting the purchased op...

We are presenting a paper on the effectiveness of spinal cord stimulation (SCS) in 2 patients suffering pain from brachial plexus injury (BPI). After a traumatic brachial plexus lesion about 80% of patients develop pain in the deafferentated arm. This pain is considered very resistant to many forms of therapy. In the early 1970s, SCS was introduced...

Opioids are considered a cornerstone in the treatment of cancer and non-cancer pain. The World Health Organization considers a country's morphine consumption to be an important indicator of the quality of pain control. There is little or no use of opioids in nearly half of the countries in the world. To assess the change in trends of opioids use fo...

Neuraxial administration of steroids have been used in clinical practice for more than 50 years and have a well defined place in the treatment of radicular low back pain. However, steroids have widespread effects on almost all body systems, such as suppression of the pituitary-adrenal axis with consecutive weight gain and osteoporosis. We prospecti...

Complex regional pain syndrome is a painful disorder of unclear etiology, typically involving the distal part of one limb, represented by spontaneous and evoked pain as well as autonomic, motor and trophic abnormalities. It can be incapacitating and severely affect function and quality of life. Although full-blown complex regional pain syndrome can...

Our purpose was to reassess the effectiveness of phenol 4% in aqueous solution for neurolysis in patients with severe chronic nonmalignant pain syndromes who did not achieve adequate pain control (visual analog scale [VAS] <or=3) with conventional pain treatment. Forty-two patients with severe nonmalignant pain persisting for 6 months or longer wer...

In this article, we discuss the perioperative anesthesia and pain management of patients with chronic pain receiving chronic opioid administration. In our practice we may expect to be confronted with opioid-dependent patients in routine anesthesia practice and should acquire specific knowledge and skills to effectively manage the perioperative and...

Current pain treatment guidelines advise against providing analgesics for postoperative pain using intramuscular injections, as this generally provides poor pain relief. However, this route remains the most prevalent treatment method. Intravenous or epidural patient-controlled-analgesia methods reduce pain effectively but are expensive, labor inten...