Chronic Pain Practices: An Evaluation of Positive and Negative Online Patient Reviews

BACKGROUND: The role of patient satisfaction continues to play an important role in health care quality measures. The use of online review platforms has been adopted by patients to share their perceptions about the quality of care provided by physicians. Chronic pain practice has unique challenges regarding patient satisfaction. OBJECTIVES: The main goal of this study is to identify the themes associated with positive and negative reviews of chronic pain physicians at publicly available online review platforms. STUDY DESIGN: A retrospective study design. SETTING: We evaluated publicly available online patient-generated reviews of chronic pain physicians from Yelp and Healthgrades. METHODS: This retrospective study evaluated patient-generated reviews of chronic pain physicians from 2 online platforms-Yelp and Healthgrades-between the September 1, 2018 through November 1, 2018. Ninety chronic pain physicians were randomly selected from 4 diverse geographic cities in the United States: New York (NY), Houston (TX), Chicago (IL), and Seattle (WA). Primary outcome was defined as high and low rating scores. Secondary outcome was the proportion of positive and negative attributes (patient, physician, procedure, and administrative attributes) that was associated with high and low rating scores. RESULTS: A total of 1,627 reviews were extracted from 90 physicians evaluated at Yelp and Healthgrades. Of this total review, 1,296 (79.7%) were high scoring and (331) 20.3% were low scoring. Chronic pain providers who were high scoring had positive reviews that consisted of physician attributes (63.5%), administrative attributes (23.4%), and patient attributes (12.2%). The highest proportion of the first 3 physician attributes associated with high ratings were knowledgeable, helpful, and caring. Chronic pain providers who were low scoring had negative reviews that consisted of physician attributes (41.4%), administrative attributes (52.1%), and procedure attributes (5.2%). The highest proportion of the first 3 physician attributes associated with low ratings were disrespectful, unhelpful, and uncaring. LIMITATIONS: First, this study looks at reviews of 4 large cities, thus we may have excluded patient populations with substantially different preferences as health care consumers. Second, it is impossible to confirm the validity of individual reviewers\u27 interactions with the pain management specialist who provided care or validate the identity of the reviewers. Third, it is very difficult, or even impossible, to tell if the rater is a patient or someone posing as a patient, such as an unhappy employee or a business competitor. CONCLUSIONS: Online platforms provide a medium that facilitates immediate communication among patients. These platforms may provide timely data for chronic pain physicians to gain more insight into the quality of care perceived by patients, thereby aiding providers to improve on ways to optimize patient-care experiences and encounters. KEY WORDS: Chronic pain practice, online review, patient review, patient satisfaction

Neuromodulation for Management of Chronic Pelvic Pain: A Comprehensive Review

Abstract Introduction Chronic pelvic pain (CPP) is a symptom that derives from a complex group of heterogeneous pathologies of the pelvic organs. The aim of this study was to review the available evidence on efficacy of neuromodulatory modalities including sacral neuromodulation, dorsal root ganglion stimulation, dorsal column neuromodulation, and pudendal nerve stimulation. Methods This narrative review focuses on updated information on neuromodulation for management of chronic pelvic pain. In 2022, we searched English-language studies on neuromodulation, pelvic pain, and chronic pain in a comprehensive search. We searched the following databases: PubMed, Medline, SciHub, Cochrane Database of Systematic Reviews, and Google Scholar. We used the following combinations of keywords: neuromodulation, pelvic pain, chronic pain, chronic pelvic pain, pelvic pain treatment. We tried to include as many recent manuscripts as possible (within the last 3 years) but also included papers older than 3 years if they were particularly relevant to our topic. We also attempted to search for, use, and cite primary manuscripts whenever possible. Results CPP is a challenging entity to treat because of diagnostic inconsistencies and limited evidence for therapeutic modalities. Our review found evidence suggestive of benefit for all modalities reviewed but the data was of overall low quality with numerous limitations. The literature highlights a lack of randomized controlled trials for neuromodulatory therapies but suggests a growing role for such techniques in treating refractory chronic pelvic pain syndrome (CPPS). Conclusions This review explores the available evidence on efficacy of neuromodulatory modalities for CPPS and contextualizes the results with information about the type of neuromodulation, lead location and waveform, pain outcomes and assessment timepoints, and reported adverse effects

Intravenous Lidocaine Infusion for the Management of Early Postoperative Pain: A Comprehensive Review of Controlled Trials

Previously used as anti-arrhythmic, intravenous lidocaine infusion is becoming popular for use in management of acute pain. There is still much to be understood about its pharmacokinetics and pharmacodynamics, especially with regard to optimal dosing to avoid side effects. In this article, we selected and reviewed randomized controlled trials to summarize the pharmacokinetics, antinociceptive effects, anti-hyperalgesic effects, anti-inflammatory effects, side effects, and role of intravenous lidocaine in the management of early postoperative pain. The mechanisms of action of lidocaine are still unclear but there are many theories postulated. Optimal dosing of lidocaine is not known but general consensus indicates that a loading dose of 1-2 mg/kg, followed by 1-2 mg/kg/hr continuous infusion during early postoperative pain control while recovering from anesthesia to achieve therapeutic levels of 0.5-5 mcg/kg clearly improves analgesia in the immediate postoperative period. Although lidocaine was initially studied and proven to have clear analgesic effects following laparoscopic and open abdominal surgeries, it has now been shown to be applicable in different clinical settings perioperatively including following spinal, breast, ENT and other surgeries. It is generally safe, with hypotension, headache and vomiting being the more common side effects. Serious adverse effects include cardiovascular block and arrhythmias, neuro-excitability and hypersensitivity, although the frequency of these are not known