Pain Relief and Palliative Care Society

Background: Failed Back Surgery Syndrome is an unsatisfactory outcome of a patient who underwent spiral surgery irrespective of type or intervention area with persistent pain in the lumbosacral region with or without it radiating to the leg. The multifactorial etiology of this condition makes it challenging for the clinicians to completely treat this. Some of the causes like poor patients selection for surgery, incorrect diagnosis, suboptimal selection of surgery, poor technique, failure to achieve surgical goals, and/or recurrent pathology, pre-surgical mental status of patient.Methods: This non systemic review searched databases including medline via PubMed. The Cochrane Library and Embase using the terms Failed Back Syndrome. Post spine surgery, chronic pain, clinical trials, cohort studies, scientific reports were reviewed of last 15 years.Conclusion: A multidisciplinary approach is most appropriate for patients who are unlikely to benefit from further formal surgical intervention. Team work including physicians, psychologists, physiotherapists, and other allied health professionals is essential in improving outcomes for patients with failed back surgery syndrome.

Project ECHO (Extension of Community Healthcare Outcomes) is an innovative modelof online education which has been proposed to enhance access to palliative carein resource-limited settings. There is limited literature describing how healthcare providers in low-and middle-income countries benefit from and learn fromthis type of training. This qualitative description study explores the learningexperiences of participants in a Project ECHO program on pediatric palliativecare in South Asia through focus group discussions. Discussions weretranscribed, coded, independently verified, and arranged into overarchingthemes. We identified learning themes including the importance of creating asupportive learning community; the opportunity to share ideas and experiences;gaining knowledge and skills, and access to additional learning materials.Designing future programs to ensure a supportive and interactive learningcommunity with attention cultural challenges may enhance learning from futureProject ECHO programs.

Breakthrough pain is a transitory flare of pain occurring in most cancer patients against a background of otherwise controlled persistent pain. Treatment of breakthrough pain is a challenging phenomenon. Oral transmucosal fentanyl citrate (OTFC; brand name Actiq, Chephalon Inc., West Chester, PA), a new opioid formulation with a unique delivery system, reflects the characteristics of breakthrough pain (rapid onset of action and short duration), making it an effective treatment for cancer patients who already receive opioids and experience flares of pain. This review article aims to present the role of oral transmucosal fentanyl citrate in the management of breakthrough pain in cancer patients. In particular, it is going to discuss the synthesis, clinical pharmacology, pharmacokinetic and pharmacodynamic properties, toxicity, and clinical efficacy of this novel agent.

A total sympathetic block of head and neck by a combination of stellate ganglion and sphenopalatine ganglion block is described as a therapeutic modality in a 55-year-old woman with postherpetic neuralgia involving the opthalmic division of the trigeminal nerve with complete pain relief.