Agnes Stogicza

Development of the KnowPain-12 pain management knowledge survey

Objective:The purpose of this study was to develop a brief knowledge survey about chronic noncancer pain that could be used as a reliable and valid measure of a provider’s pain management knowledge. Methods:This study used a cross-sectional study design. A group of pain experts used a systematic consensus approach to reduce the previously validated KnowPain-50 to 12 questions (2 items per original 6 domains). A purposive sampling of pain specialists and health professionals generated from public lists and pain societies was invited to complete the KnowPain-12 online survey. Between April 4 and September 16, 2012, 846 respondents completed the survey. Results:Respondents included registered nurses (34%), physicians (23%), advanced practice registered nurses (14%), and other allied health professionals and students. Twenty-six percent of the total sample self-identified as “pain specialist.” Pain specialists selected the most correct response to the knowledge assessment items more often than did those who did not identify as pain specialists, with the exception of 1 item. KnowPain-12 demonstrated adequate internal consistency reliability (&agr;=0.67). Total scores across all 12 items were significantly higher (P<0.0001) among pain specialists compared with respondents who did not self-identify as pain specialists. Discussion:The psychometric properties of the KnowPain-12 support its potential as an instrument for measuring provider pain management knowledge. The ability to assess pain management knowledge with a brief measure will be useful for developing future research studies and specific pain management knowledge intervention approaches for health care providers.

Spinal Accessory Nerve Entrapment

The spinal accessory nerve, the 11th cranial nerve, innervates the trapezius and sternocleidomastoid muscles. It has a long superficial course in the neck, which makes it prone to injury with neck trauma or surgical interventions. Patients will present with weakness of the innervated muscles, myofascial pain, winged scapula, and shoulder pain. The symptoms can vary based on the extent of injury. The diagnosis is mainly based on the history and physical exam, although EMG, CT, and MRI can occasionally add certainty to the diagnosis. Treatment is based on physical therapy, rehabilitation and medication management, but if these options are exhausted, surgical solutions are available. Following a positive diagnostic injection, neurolytic procedures, surgical nerve repair or nerve transplant can be performed.

Glossopharyngeal Nerve Entrapment

Glossopharyngeal nerve (GN) is the ninth cranial nerve, with a short course from the jugular foramen to the ear and throat. It carries sensory, motor, and autonomic fibers. Glossopharyngeal neuralgia (GPN) is a rare disorder, with patients usually complaining about short paroxysms of pain at the ear, tonsils, throat, and jaw. Swallowing, chewing, or talking usually provokes this potentially severe GPN pain. The diagnosis of idiopathic GPN is mainly based on the patient’s history, clinical symptoms and exclusion of other pathology. It is verified by diagnostic injection that can be performed either at the styloid level or at the tonsillar fossa. Once the diagnosis is confirmed, neurolytic procedures or occasionally open surgery can provide relief.

Inferior Hypogastric Plexus Block Affects Sacral Nerves and the Superior Hypogastric Plexus

Background. The inferior hypogastric plexus mediates pain sensation through the sympathetic chain for the lower abdominal and pelvic viscera and is thought to be a major structure involved in numerous pelvic and perineal pain syndromes and conditions. Objectives. The objective of this study was to demonstrate the structures affected by an inferior hypogastric plexus blockade utilizing the transsacral approach. Study Design. This is an observational study of fresh cadaver subjects. Setting. The cadaver injections and dissections were performed at the Department of Forensic Sciences and Insurance Medicine, Semmelweis University, Budapest, Hungary after obtaining institutional review board approval. Methods. 5 fresh cadavers underwent inferior hypogastric plexus blockade with radiographic contrast and methylene blue dye injection by the transsacral fluoroscopic technique described by Schultz followed by dissection of the pelvic and perineal structures to localize distribution of the indicator dye. Radiographs demonstrating correct needle localization by contrast spread in the specific tissue plane and photographs of the dye distribution after cadaver dissection were recorded for each subject. Results. In all cadavers the dye spread to the posterior surface of the rectum and the superior hypogastric plexus. The dye also demonstrated distribution to the anterior sacral nerve roots of S1, 2, and 3 with bilateral spread in 3 cadavers and ipsilateral spread in 2 of them. Limitations. The small number of cadaver specimens in this study limits the results and generalization of their clinical significance. Conclusions. Inferior hypogastric plexus blockade by a transsacral approach results in distribution of dye to the anterior sacral nerve roots and superior hypogastric plexus as demonstrated by dye spread in freshly dissected cadavers and not by local anesthetic spread to other pelvic and perineal viscera.