Ross Rieger

Purpose of Review This narrative review addresses the growing public health concern of persistent opioid use following major orthopedic surgery. It aims to identify and analyze the critical factors that contribute to the transition from acute to persistent opioid consumption in this context. Recent Findings Patient-related characteristics, including pre-existing conditions and prior substance use, are critical predictors of prolonged opioid use. Additionally, surgery-related factors such as the type and duration of procedures complicate postoperative pain management. The prevalence of persistent opioid use after surgery remains high despite the emergence of effective Enhanced Recovery After Surgery protocols and patient education initiatives. Multimodal analgesia is highlighted as a vital strategy for reducing the risk of long-term opioid dependency. Summary Persistent opioid use after orthopedic surgery poses significant challenges, including increased risks of physical and mental health complications, the development of opioid use disorder, and a substantial economic burden on healthcare systems. Targeted interventions and continuous research are essential to mitigate these risks, reduce long-term opioid dependency, and improve overall patient outcomes.

Purpose of Review The present investigation assesses efficacy of transcutaneous electrical nerve stimulation (TENS) on relief of cancer or chemotherapy-related pain. Patients with cancer experience a relatively high prevalence of pain that is reportedly undertreated. Therefore, this analysis is pertinent to determine if TENS is a useful complementary therapy considering its increase in accessibility and minimal side effect profile. Recent Findings A systematic search for eligible studies from PubMed, Google Scholar, Cochrane, and Embase was performed. The present investigation elucidated any significant differences between change in numeric rating scale of average and maximum pain scores between a TENS and non-TENS group. A nonsignificant difference was reported between TENS and non-TENS, with a mean difference of − 0.393 (95% CI − 1.780, 0.993; P = 0.578). For change in maximum pain reported, a nonsignificant difference was also found, with a mean difference of 0.128 (95% CI − 1.158, 1.414; P = 0.845). Conclusion Related to various limitations of this meta-analysis, no definitive conclusions could be concluded regarding efficacy of TENS in the treatment of cancer or chemotherapy-related pain. Additional randomized primary studies with standardized treatment protocols and pain measurements are needed for future meta-analysis and recommendations for clinical practice.

Background This analysis is a systematic literature review assessing efficacy and adverse effects of three alpha-2 agonists for the symptomatic management of autism spectrum disorder (ASD). Methods The present investigation involved an extensive systematic search for eligible studies in PubMed, Embase, Cochrane Library, and Google Scholar. Nine studies, collectively incorporating 226 patients, were assessed. Results The results demonstrated promising indications for use of alpha-2 agonists in the symptomatic management of autism spectrum disorders, including improvement of hyperactivity, impulsivity, attention deficit symptoms, irritability, and stereotypies in many of the participants studied. Conclusion The present investigation encourages physicians to consider treatment outcomes of clonidine, guanfacine, and lofexidine to determine the most effective management of ASD-related symptoms and to minimize adverse effects. However, our review cannot provide definitive treatment protocols related to various study limitations.