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Background: Tenesmus is the unpleasant sensation of incomplete emptying of the rectum and it may be a distressing symptom for patients who suffer from rectal masses. Unlike nociceptive pain or visceral pain, little is understood about the pathway for this pain phenotype. There are also few studies examining the palliative treatment of this symptom. Case Presentation: In this case report, we describe a patient who presented with severe and refractory tenesmus secondary to a metastatic rectal lesion. Case Management: To address the patient's refractory tenesmus, a superior hypogastric plexus neurolytic block was performed with alcohol under fluoroscopic guidance. Case Outcome: Immediately after the procedure, the patient reported complete abolishment of her tenesmus symptom. This effect endured for 3 months after which the patient. Conclusion: Superior hypogastric plexus block may be an effective procedure for the management of tenesmus. The successful abolishment of tenesmus following the block alludes that the nerve fibers carrying sensation of tenesmus either synapses or passes through the superior hypogastric plexus. Future studies should consider examining the neural pathway of tenesmus. [ABSTRACT FROM AUTHOR]

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 neurotomy (RFN) is an effective minimally invasive technique for treating chronic neck pain secondary to facet joint disease. An end-on approach for this procedure has been proposed that may be technically easier and require less time while reducing post-procedural discomfort. The protocol presented here is for a study that aims to compare the efficacy of a new end-on approach using multi-tined cannulae, against the conventional parallel technique that employs straight cannulae for RFN of the CMBN in patients with chronic neck pain due to cervical facet joint disease. Methods: A multicentre randomized, non-inferior, active comparator-controlled trial will be conducted with two parallel groups and blinding of participants and outcome assessor. The study will include 72 adults with chronic neck pain secondary to facet joint disease who are candidates for RFA of the CMBN. Participants will be randomized to either the conventional parallel or the end-on approach in a 1:1 ratio. The intensity of pain and pain-related domains (function, quality of life, sleep, adverse effects of the interventions, analgesic intake) will be measured at 1, 3, 6, and 12 months after the procedure. Discussion: Neck pain secondary to cervical facet joint disease is prevalent and RFA of the CMBN is a validated treatment for relieving it. The conventional parallel technique can be technically challenging, and it can be associated with adverse effects while the newer end-on approach has the potential of being a simpler technique with less adverse effects. This trial will be the first non-inferiority study to compare the clinical efficacy of the end-on approach against the conventional parallel approach for RFN of CMBN in patients with chronic neck pain due to cervical facet joint disease. Trial registration: ClinicalTrials.gov NCT05818774. Registered on April 20, 2023. [ABSTRACT FROM AUTHOR]

BackgroundMethodsResultsConclusionChronic pain is a complex disease that requires interprofessional care for effective management. Despite the need for multidisciplinary care, disease and healthcare inequities can prevent individuals from attaining adequate treatment. Factors such as mental health, cost, and distance to a healthcare center can contribute to healthcare accessibility inequality. The aim of this study is to examine declined referrals at the Toronto Academic Pain Medicine Institute (TAPMI) to determine the reason for declining care and number of declined referrals.A retrospective chart review of all declined referrals at TAPMI in 2018 and 2022 was conducted. Referral documentation and the intake decision was extracted from the electronic medical charts by the research team and verified by the clinical intake team. Chi-square tests were conducted to determine if the proportion of declined referrals changed between the years reviewed.The number of declined referrals due to mental health complexities increased significantly from 51 (11%) in 2018 to 180 (18%) in 2022 (χ2 = 10.9, P = .0009). A significant rise in the number of declines due to mental health service requests was also observed (ꭓ2 = 24.53, P < .00001). Other common reasons for declined referrals in 2018 and 2022 included duplicate service, no primary care provider, and healthcare service changes.: Mental health complexities continue to be a significant barrier to healthcare service acquisition for individuals living with chronic pain. The increase in patient complexity from 2018 to 2022 highlights the need for integrated healthcare resources. [ABSTRACT FROM AUTHOR]

Objective: To compare NasoPore (Stryker Canada, Hamilton, ON, Canada) and a traditional middle meatal spacer (MMS) composed of Merocel ((Medtronic Xomed, Mississauga, ON, Canada) placed in a vinyl glove finger in functional endoscopic sinus surgery (FESS) with regard to postoperative bleeding, wound healing, and patient comfort. Design: A prospective, double-blind, randomized trial of 30 consecutive adults (age > 16 years) with chronic or recurrent acute rhinosinusitis undergoing bilateral FESS, excluding patients with significant difference in their sinus disease bilaterally using preoperative computed tomographic scan assessment (Lund-McKay scores > 2). Setting: Tertiary hospital, Vancouver, British Columbia. Methods: Preoperatively, all patients were randomized and blinded to receive NasoPore (Stryker Canada) on one side and Merocel on the other. Patients completed a questionnaire during their first postoperative week relating to their subjective assessment of pain, pressure, nasal blockage, swelling, and bleeding. Patients were evaluated 1 week postoperatively for packing removal and debridement, and associated discomfort and bleeding with the removal, as well as overall preference for either pack. A clinician blinded to the randomization process objectively assessed the healing status of the nasal cavities at 4 and 12 weeks postoperatively. Main Outcome Measures: Patient satisfaction, bleeding, and wound healing postoperatively. Results: Thirty patients were enrolled. There was no significant difference between the Lund-Mackay scores in both groups preoperatively (p = .80). Postoperatively, there was no significant difference between both groups with regard to patients' pain, pressure, blockage, swelling, bleeding, or discomfort on packing removal (p > .05). There was no statistical difference in the amount of bleeding associated with packing removal (p = .32). Mucosal grading at 4 weeks was significantly better for the traditional MMS (p = .03), but this difference disappeared at the 12-week visit (p = 1.00). Conclusions: The absorbable pack did not significantly reduce the risk of bleeding or patient discomfort compared with a traditional nonabsorbable MMS and was associated with significantly slower mucosal healing initially, an effect that disappeared after 3 months postoperatively. There was no significant patient preference for either pack. [ABSTRACT FROM AUTHOR]

BackgroundAimsMethodsResultsConclusionsDespite the established efficacy of multidisciplinary chronic pain care, barriers such as inflated referral wait times and uncoordinated care further hinder patient healthcare access.Here we describe the evolution of a Single-Entry Model (SEM) for coordinating access to chronic pain care across 7 hospitals in Toronto and explore the impact on patient care six-years after implementation.In 2017 an innovative SEM was implemented for chronic pain referrals in Toronto and surrounding areas. Referrals are received centrally, triaged by a clinical team, and assigned an appointment according to the level of urgency and the most appropriate care setting/provider. To evaluate the impact of the SEM, a retrospective analysis was undertaken to determine referral patterns, patient characteristics, and referral wait times over the past six-years.Implementation of a SEM streamlined the number of steps in the referral process and led to a standardized referral form with common inclusion and exclusion criteria across sites. Over the six-year period, referrals increased by 93% and the number of unique providers increased by 91%. Chronic pain service wait times were reduced from 299 (± 158) days to 176 (± 103) days. However, certain pain diagnoses such as chronic pelvic pain and fibromyalgia far exceed the average.The results indicate the SEM helped reduce wait times for pain conditions and standardized the referral pathway. Continued data capture efforts can help identify gaps in care to enable further healthcare refinement and improvement. [ABSTRACT FROM AUTHOR]