Daniel Krashin - Academia.edu (original) (raw)

Papers by Daniel Krashin

Pain physician

Echogenicity of regional anesthesia needles has been tested on different preclinical models; howe... more Echogenicity of regional anesthesia needles has been tested on different preclinical models; however, previous studies were done in an ideal experimental setting utilizing high-frequency insonation and superficially located targets. Because steep-angle deep injections are typically required for spinal and other chronic pain procedures, and low-frequency transducers are used, further feasibility study is warranted. To determine effectiveness of steep-angle deep injections, typically required for spinal and other chronic pain procedures. Experimental laboratory study. Willed Body Program, University of Washington. In-plane lumbar spine procedures with 50° and 70° angles were performed on a human cadaver. The images and video clips of a non-echogenic (Quincke-type) and echogenic (SonoPlex, StimuQuick, and EchoStim) needle placements were presented to 3 blinded assessors who rated the needle visibility on a 4-point scale. The data was statistically analyzed to determine the differences ...

Physical medicine and rehabilitation clinics of North America, 2015

Chronic daily headache (CDH) is a challenging condition to treat. CDH is often accompanied by sig... more Chronic daily headache (CDH) is a challenging condition to treat. CDH is often accompanied by significant comorbidities, such as chronic fatigue, depression, anxiety, and insomnia, which further complicate treatment. Unrealistic expectations of treatment goals can lead to patient frustration, and, as a result, decrease treatment adherence. Patients often desire headache-free status, but this outcome is not realistic for many patients with CDH. By contrast, an effective treatment goal starts with establishing the correct diagnosis and creating a multimodal treatment plan to improve function and well-being. With proper comprehensive treatment, the condition improves in most patients.

Pain Physician, Jul 1, 2012

Background: Human Immunodeficiency Virus (HIV) patients have an increased rate of chronic pain, p... more Background: Human Immunodeficiency Virus (HIV) patients have an increased rate of chronic pain, particularly peripheral neuropathy. This disease burden causes considerable disability and negatively affects quality of life. Pain is undertreated and more complex to manage in these patients for a number of reasons, including complex anti-retroviral drug regimens, higher risks of side effects, and higher rates of comorbid psychiatric illness and substance abuse. Pain management must take these factors into account and use all available modalities, including nonopioid pain relievers, adjuvant medications, and psychosocial therapies in addition to opioid analgesics. Here we review recent recommendations regarding acute and chronic opioid treatment of pain and the treatment of opioid dependence in HIV-infected patients, and provide suggestions regarding aberrant behavior in pain treatment.

Military medicine

Risperidone, an atypical antipsychotic medication, has gained wide acceptance as a first-line dru... more Risperidone, an atypical antipsychotic medication, has gained wide acceptance as a first-line drug for several indications. Recently, interest has arisen in the use of risperidone as an adjunct therapy in post-traumatic stress disorder (PTSD). PTSD is a possible sequela of exposure to traumatic events. The military population, because of occupational exposure, is at a higher risk than the general population to develop PTSD, and the treatment of PTSD may be a significant issue for military practitioners. PTSD may be complicated by social issues and comorbid psychiatric conditions, and it is often difficult to treat. We present two case reports on the use of risperidone in the treatment of the intrusive thoughts and subsequent emotional reactivity experienced by some PTSD patients, along with a discussion of some possible mechanisms of action for the efficacy of risperidone in the treatment of these symptoms.

Expert Opinion on Drug Safety, 2015

Pain management with opioids is a fundamental element of palliative medicine. Since the risks of ... more Pain management with opioids is a fundamental element of palliative medicine. Since the risks of chronic opioid therapy have emerged, a reassessment of these risks in the setting of palliative care is warranted. This article presents information about opioid-related risks including i) sedation, cognitive impairment and falls; ii) constipation; iii) addiction to opioids and associated aberrant behavior; and iv) death due to respiratory depression. For this article, the medical literature was searched using PubMed and Web of Science for appropriate terms including 'palliative care' and 'opioid risk.' Medical subject headings were used to identify suitable articles including 'Analgesics, Opioid', 'Pain/drug therapy,' 'Palliative Care' and 'Hospice Care.' Further sources were identified by following cross-references within the literature and with the help of the University of Washington library staff. Palliation of severe pain at the end of life is probably the most widely accepted indication for chronic opioid therapy. At increased doses, adverse effects of opioids may limit or interfere with the benefits of treatment. Careful screening and follow-up will allow risk factors to be recognized and addressed when possible. The use of adjunctive treatments for pain may reduce opioid requirements and yield better outcomes.

Textbook of Addiction Treatment: International Perspectives, 2014

Pain physician

Echogenicity of regional anesthesia needles has been tested on different preclinical models; howe... more Echogenicity of regional anesthesia needles has been tested on different preclinical models; however, previous studies were done in an ideal experimental setting utilizing high-frequency insonation and superficially located targets. Because steep-angle deep injections are typically required for spinal and other chronic pain procedures, and low-frequency transducers are used, further feasibility study is warranted. To determine effectiveness of steep-angle deep injections, typically required for spinal and other chronic pain procedures. Experimental laboratory study. Willed Body Program, University of Washington. In-plane lumbar spine procedures with 50° and 70° angles were performed on a human cadaver. The images and video clips of a non-echogenic (Quincke-type) and echogenic (SonoPlex, StimuQuick, and EchoStim) needle placements were presented to 3 blinded assessors who rated the needle visibility on a 4-point scale. The data was statistically analyzed to determine the differences ...

Pain physician, 2012

Human Immunodeficiency Virus (HIV) patients have an increased rate of chronic pain, particularly ... more Human Immunodeficiency Virus (HIV) patients have an increased rate of chronic pain, particularly peripheral neuropathy. This disease burden causes considerable disability and negatively affects quality of life. Pain is undertreated and more complex to manage in these patients for a number of reasons, including complex anti-retroviral drug regimens, higher risks of side effects, and higher rates of comorbid psychiatric illness and substance abuse. Pain management must take these factors into account and use all available modalities, including nonopioid pain relievers, adjuvant medications, and psychosocial therapies in addition to opioid analgesics. Here we review recent recommendations regarding acute and chronic opioid treatment of pain and the treatment of opioid dependence in HIV-infected patients, and provide suggestions regarding aberrant behavior in pain treatment. The objective of this comprehensive review is to assess and summarize the complicating factors involved in treati...

Physical Medicine and Rehabilitation Clinics of North America, 2015

Chronic daily headache (CDH) is a challenging condition to treat. CDH is often accompanied by sig... more Chronic daily headache (CDH) is a challenging condition to treat. CDH is often accompanied by significant comorbidities, such as chronic fatigue, depression, anxiety, and insomnia, which further complicate treatment. Unrealistic expectations of treatment goals can lead to patient frustration, and, as a result, decrease treatment adherence. Patients often desire headache-free status, but this outcome is not realistic for many patients with CDH. By contrast, an effective treatment goal starts with establishing the correct diagnosis and creating a multimodal treatment plan to improve function and well-being. With proper comprehensive treatment, the condition improves in most patients.

Case Studies in Pain Management, 2014

Case Studies in Pain Management, 2014

Case Studies in Pain Management, 2014

Current Psychiatry Reports, 2012

Substance use disorders are a large public health problem in the United States. Over the past dec... more Substance use disorders are a large public health problem in the United States. Over the past decade, there has been a trend of increased prescription drug misuse, morbidity, and mortality related to prescription opioids. For providers who treat pain, this has led to clinical dilemmas as the newly appreciated risks must be balanced with the benefits of treatment, particularly in patients with known substance use disorders. Acute, chronic, and palliative each present distinct issues in pain treatment. A best practices model of pain treatment, including risk stratification and integrative treatment, may provide the best prospect for safe and effective treatment.

Suffering and Bioethics, 2014

Case Studies in Pain Management, 2014

Case Studies in Pain Management, 2014

Pain physician

Echogenicity of regional anesthesia needles has been tested on different preclinical models; howe... more Echogenicity of regional anesthesia needles has been tested on different preclinical models; however, previous studies were done in an ideal experimental setting utilizing high-frequency insonation and superficially located targets. Because steep-angle deep injections are typically required for spinal and other chronic pain procedures, and low-frequency transducers are used, further feasibility study is warranted. To determine effectiveness of steep-angle deep injections, typically required for spinal and other chronic pain procedures. Experimental laboratory study. Willed Body Program, University of Washington. In-plane lumbar spine procedures with 50° and 70° angles were performed on a human cadaver. The images and video clips of a non-echogenic (Quincke-type) and echogenic (SonoPlex, StimuQuick, and EchoStim) needle placements were presented to 3 blinded assessors who rated the needle visibility on a 4-point scale. The data was statistically analyzed to determine the differences ...

Physical medicine and rehabilitation clinics of North America, 2015

Chronic daily headache (CDH) is a challenging condition to treat. CDH is often accompanied by sig... more Chronic daily headache (CDH) is a challenging condition to treat. CDH is often accompanied by significant comorbidities, such as chronic fatigue, depression, anxiety, and insomnia, which further complicate treatment. Unrealistic expectations of treatment goals can lead to patient frustration, and, as a result, decrease treatment adherence. Patients often desire headache-free status, but this outcome is not realistic for many patients with CDH. By contrast, an effective treatment goal starts with establishing the correct diagnosis and creating a multimodal treatment plan to improve function and well-being. With proper comprehensive treatment, the condition improves in most patients.

Pain Physician, Jul 1, 2012

Background: Human Immunodeficiency Virus (HIV) patients have an increased rate of chronic pain, p... more Background: Human Immunodeficiency Virus (HIV) patients have an increased rate of chronic pain, particularly peripheral neuropathy. This disease burden causes considerable disability and negatively affects quality of life. Pain is undertreated and more complex to manage in these patients for a number of reasons, including complex anti-retroviral drug regimens, higher risks of side effects, and higher rates of comorbid psychiatric illness and substance abuse. Pain management must take these factors into account and use all available modalities, including nonopioid pain relievers, adjuvant medications, and psychosocial therapies in addition to opioid analgesics. Here we review recent recommendations regarding acute and chronic opioid treatment of pain and the treatment of opioid dependence in HIV-infected patients, and provide suggestions regarding aberrant behavior in pain treatment.

Military medicine

Risperidone, an atypical antipsychotic medication, has gained wide acceptance as a first-line dru... more Risperidone, an atypical antipsychotic medication, has gained wide acceptance as a first-line drug for several indications. Recently, interest has arisen in the use of risperidone as an adjunct therapy in post-traumatic stress disorder (PTSD). PTSD is a possible sequela of exposure to traumatic events. The military population, because of occupational exposure, is at a higher risk than the general population to develop PTSD, and the treatment of PTSD may be a significant issue for military practitioners. PTSD may be complicated by social issues and comorbid psychiatric conditions, and it is often difficult to treat. We present two case reports on the use of risperidone in the treatment of the intrusive thoughts and subsequent emotional reactivity experienced by some PTSD patients, along with a discussion of some possible mechanisms of action for the efficacy of risperidone in the treatment of these symptoms.

Expert Opinion on Drug Safety, 2015

Pain management with opioids is a fundamental element of palliative medicine. Since the risks of ... more Pain management with opioids is a fundamental element of palliative medicine. Since the risks of chronic opioid therapy have emerged, a reassessment of these risks in the setting of palliative care is warranted. This article presents information about opioid-related risks including i) sedation, cognitive impairment and falls; ii) constipation; iii) addiction to opioids and associated aberrant behavior; and iv) death due to respiratory depression. For this article, the medical literature was searched using PubMed and Web of Science for appropriate terms including 'palliative care' and 'opioid risk.' Medical subject headings were used to identify suitable articles including 'Analgesics, Opioid', 'Pain/drug therapy,' 'Palliative Care' and 'Hospice Care.' Further sources were identified by following cross-references within the literature and with the help of the University of Washington library staff. Palliation of severe pain at the end of life is probably the most widely accepted indication for chronic opioid therapy. At increased doses, adverse effects of opioids may limit or interfere with the benefits of treatment. Careful screening and follow-up will allow risk factors to be recognized and addressed when possible. The use of adjunctive treatments for pain may reduce opioid requirements and yield better outcomes.

Textbook of Addiction Treatment: International Perspectives, 2014

Pain physician

Echogenicity of regional anesthesia needles has been tested on different preclinical models; howe... more Echogenicity of regional anesthesia needles has been tested on different preclinical models; however, previous studies were done in an ideal experimental setting utilizing high-frequency insonation and superficially located targets. Because steep-angle deep injections are typically required for spinal and other chronic pain procedures, and low-frequency transducers are used, further feasibility study is warranted. To determine effectiveness of steep-angle deep injections, typically required for spinal and other chronic pain procedures. Experimental laboratory study. Willed Body Program, University of Washington. In-plane lumbar spine procedures with 50° and 70° angles were performed on a human cadaver. The images and video clips of a non-echogenic (Quincke-type) and echogenic (SonoPlex, StimuQuick, and EchoStim) needle placements were presented to 3 blinded assessors who rated the needle visibility on a 4-point scale. The data was statistically analyzed to determine the differences ...

Pain physician, 2012

Human Immunodeficiency Virus (HIV) patients have an increased rate of chronic pain, particularly ... more Human Immunodeficiency Virus (HIV) patients have an increased rate of chronic pain, particularly peripheral neuropathy. This disease burden causes considerable disability and negatively affects quality of life. Pain is undertreated and more complex to manage in these patients for a number of reasons, including complex anti-retroviral drug regimens, higher risks of side effects, and higher rates of comorbid psychiatric illness and substance abuse. Pain management must take these factors into account and use all available modalities, including nonopioid pain relievers, adjuvant medications, and psychosocial therapies in addition to opioid analgesics. Here we review recent recommendations regarding acute and chronic opioid treatment of pain and the treatment of opioid dependence in HIV-infected patients, and provide suggestions regarding aberrant behavior in pain treatment. The objective of this comprehensive review is to assess and summarize the complicating factors involved in treati...

Physical Medicine and Rehabilitation Clinics of North America, 2015

Chronic daily headache (CDH) is a challenging condition to treat. CDH is often accompanied by sig... more Chronic daily headache (CDH) is a challenging condition to treat. CDH is often accompanied by significant comorbidities, such as chronic fatigue, depression, anxiety, and insomnia, which further complicate treatment. Unrealistic expectations of treatment goals can lead to patient frustration, and, as a result, decrease treatment adherence. Patients often desire headache-free status, but this outcome is not realistic for many patients with CDH. By contrast, an effective treatment goal starts with establishing the correct diagnosis and creating a multimodal treatment plan to improve function and well-being. With proper comprehensive treatment, the condition improves in most patients.

Case Studies in Pain Management, 2014

Case Studies in Pain Management, 2014

Case Studies in Pain Management, 2014

Current Psychiatry Reports, 2012

Substance use disorders are a large public health problem in the United States. Over the past dec... more Substance use disorders are a large public health problem in the United States. Over the past decade, there has been a trend of increased prescription drug misuse, morbidity, and mortality related to prescription opioids. For providers who treat pain, this has led to clinical dilemmas as the newly appreciated risks must be balanced with the benefits of treatment, particularly in patients with known substance use disorders. Acute, chronic, and palliative each present distinct issues in pain treatment. A best practices model of pain treatment, including risk stratification and integrative treatment, may provide the best prospect for safe and effective treatment.

Suffering and Bioethics, 2014

Case Studies in Pain Management, 2014

Case Studies in Pain Management, 2014