The purpose of this study is to determine whether a new medical technology can help reduce post-operative total knee or hip pain when combined with a Cognitive-Behavioral intervention (CBI).
This new medical technology, is called transcranial direct current stimulation (tDCS), it uses a very small amount of electricity to temporarily stimulate specific areas of the brain thought to be involved in pain reduction. The electrical current passes through the skin, scalp, hair, and skull and requires no additional medication, sedation, or needles.
This study will investigate the effects of tDCS, the Cognitive-Behavioral (CB) intervention and their combination on pain among veterans following total knee arthroplasty (TKA) or total hip arthroplasty (THA). You may benefit in the form of decreased pain and opioid requirements following your knee or hip replacement surgery. However, benefit is only likely if you are randomized to one of the 3 (out of 4) groups.
This study hopes to determine the effects of these interventions and their combined effect on post-operative pain, opioid use and functioning during the 48-hour post-operative period following a total knee or hip replacement.
Sickle Cell Disease (SCD) is an inherited disease that can cause sudden and severe pain. Pain management involves the use of analgesic medications. Often, providers are reluctant to follow evidence-based guidelines fo analgesic treatment for various reasons and some patients with SCD perceive they are treated differently from other patients. To understand the causes and solutions for this potential discordance, the first step is establishing a way to measure concordance of perceptions within the fast paced Emergency Department (ED) environment. The purpose of this study is to determine the feasibility of developing a process to measure concordance of perceptions between the patient with SCD and their ED provider after an interaction in the ED.
Youth with one or more chronic diseases are at increased risk of further complications, disease, or even early death as they enter their adult years. Recent increases in both asthma and obesity among youth have led to high health care utilization, increased health-related complications, and expanded risks of subsequent cardiovascular disease burden. The research team will develop educational content in core areas (e.g., fatigue, physical activity) for Managing AsThma AnD Obesity Related Symptoms (MATADORS), an mHealth technology-enhanced nurse-guided intervention. Youth with asthma and obesity and their primary caregivers will participate in interviews to explore their perspectives on barriers, facilitators, needs, and preferences toward adopting health behaviors, medication adherence, disease awareness, symptom self-management behaviors, and utilization of a mobile smartphone platform. Additional details on content availability, delivery approaches, system needs, and functionality will be explored through semi-structured interview questions. Health care providers (physicians, nurses, nurse practitioners, dietitians, and respiratory and exercise therapists) will be invited to participate in interviews to seek their input on patient-caregiver needs, priority clinical focal areas, recommendations for symptom self-management, and preferences for intervention delivery. Interview findings will be used to inform intervention and app design. Providing youth with strategies to enhance symptom self-management may result in decreased symptom prevalence, improved quality of life, and long-term reduction of cardiovascular morbidity and mortality as they move into adulthood.
Chronic pancreatitis is a scarring condition of the pancreas that often results in debilitating pain. When pancreatic duct drainage appears to be impaired by the presence of a blocking stone or scar tissue, pancreatic endotherapy (procedures performed through the mouth using a lighted tube with special instruments to enter the pancreatic duct) is often offered in clinical practice. The rationale for this study is that while pancreatic endotherapy is logical, there are limited studies to suggest it helps patients with their pain. Furthermore, these procedures are costly and have potential risks. This is a preliminary study to perform the first sham (like a placebo) study of pancreatic endotherapy in patients with chronic pancreatitis and evidence of impaired pancreatic duct drainage by radiology scans.
The objectives of this study are to: 1) determine the feasibility of a sham-controlled pancreatic endotherapy trial, and 2) optimize enrollment criteria and outcome measures for a subsequent, definitive study.
Under this study, we would like to collect specimens from CP patients who will undergo pancreatic resection at the VA Hospital for in vitro experiments. In these experiments, we will determine whether immune cells from CP patients are different from cells from healthy donors purchased from ATCC or other commercial sources. We will then assess whether pre-culture of immune cells from CP patients with MSCs can shift them to less pro-inflammatory phenotypes that won't induce inflammation in neuronal cells. All studies will be done in vitro in the cell culture system. Exploring mechanisms that contribute to chronic pain is vital for veterans' health and VA healthcare.
The purpose of this study is to find out whether a web-based intervention using a mobile device is helpful for teens learning to care for and manage symptoms of their sickle cell disease. The intervention lasts 12 weeks with a 3-month follow up period, and uses a smartphone or a tablet. For more information, please contact Shannon at 843-792-9379.
Pain control after tonsillectomy is imperative but often difficult. Current post-operative pain medication regimens include opioid analgesics and are often still inadequate. Though not standard of care, it is our practice to prescribe a single dose of oral steroid medication on the third day after surgery, when pain and swelling are at their peak, in order to assist with pain control and reduce opioid consumption. Though this practice has a rational theoretical basis, there is no prospective data supporting or discounting it. We aim to compare pain control, opioid consumption, and complication rates in children receiving post-operative steroids versus those who do not.
Sickle cell disease (SCD) is a group of inherited blood disorders associated with recurrent pain, which may evolve into a chronic state over time. Acute and chronic pain approaches in SCD frequently involve the use of opioid medications. The purpose of this study is to understand opioid knowledge and perceptions of the benefits and risks of opioid medication in patients with SCD (all ages) and their caregivers (in the case of pediatric patients).
Chronic pain is a serious public health problem with estimates as high as nearly half of the adult population experiencing some form of pain that lasts for more than 6 months. This issue negatively impacts quality of life, is financially burdensome, and has contributed to the opioid crisis in the United States. Therefore, a non-pharmacologic, non-invasive approach for alleviating chronic pain like prefrontal repetitive transcranial magnetic stimulation (rTMS) is an appealing avenue for research into chronic pain management. While rTMS has already been approved for use in treating depression, it has shown promise in treating chronic pain as well. However, there is a debate about which coil designs are most effective and which regions of the brain respond best to rTMS therapy. This study will examine the use of two novel coil designs the H1 coil which is designed to increase activity of the dorsolateral prefrontal cortex and the H7 coil which is designed to decrease activity of the medial prefrontal cortex. To evaluate the efficacy of the two treatment strategies, patients will undergo thermal pain testing before and after the rTMS interventions. The relative efficacy of these two treatment strategies will be useful for establishing rTMS as an effective strategy for chronic pain management and determining the direction for future rTMS research.
The purpose of this study is to develop transcranial magnetic stimulation (TMS) as a novel, non-pharmacologic approach to decreasing pain in individuals with chronic pain. This study will test whether rTMS over the prefrontal cortex can produce a reduction in your perception of pain, your desire to use opiates, and your brain's response to opiate cues. The results of this study will be used to design and develop a large clinical trial of rTMS as an innovative, new treatment option for chronic lower back pain in individuals that may have used chronic opiates.