Scholars@Duke
Padma Gulur

Padma Gulur

Professor of Anesthesiology
Anesthesiology, Pain Management

Selected Publications

Multiorganizational consensus to define guiding principles for perioperative pain management in patients with chronic pain, preoperative opioid tolerance, or substance use disorder.

Journal Article Reg Anesth Pain Med · October 8, 2024 Significant knowledge gaps exist in the perioperative pain management of patients with a history of chronic pain, substance use disorder, and/or opioid tolerance as highlighted in the US Health and Human Services Pain Management Best Practices Inter-Agency ... Full text Link to item Cite

Percutaneous lumbar interbody fusion results in less perioperative opioid usage compared to minimally invasive transforaminal lumbar interbody fusion: a single institution, multi-surgeon retrospective study.

Journal Article J Spine Surg · June 21, 2024 BACKGROUND: Ultra-minimally invasive percutaneous lumbar interbody fusion (percLIF) has been demonstrated to further minimize tissue trauma and has been associated with improved clinical outcomes including decreased blood loss, post-operative pain and leng ... Full text Link to item Cite

Duke Health Integrated Pain and Wellness Program — A Proactive Population Health Model

Journal Article NEJM Catalyst Innovations in Care Delivery · March 20, 2024 The Duke Integrated Pain and Wellness (IPW) program integrates early identification and stratification of patients at risk for poor pain outcomes, leveraging a validated two-question screening tool across select Duke Health primary and multispecialty clini ... Full text Cite

Green Light-Based Analgesia - Novel Nonpharmacological Approach to Fibromyalgia Pain: A Pilot Study.

Journal Article Pain Physician · July 2023 BACKGROUND: There continues to be significant reliance on pharmacological modalities for the management of chronic pain, with a particular focus on opioid analgesics as a singular option for pain management. Fibromyalgia is a prototypical central pain diso ... Link to item Cite

Leveraging Policy Changes Made in Response to COVID-19 to Advance Telehealth and Novel Treatment Approaches for People Who Use Opioids: Qualitative Perspectives From Two Rural North Carolina Counties.

Journal Article N C Med J · July 2023 BACKGROUND: The COVID-19 pandemic has been a catalyst for telehealth services for people who use opioids; however, the data show dramatic increases in opioid overdose deaths and ongoing lack of treatment options in North Carolina, particularly among rural ... Full text Link to item Cite

Opioids after a cesarean section: Prescribing, patient use, storage, and disposal practices.

Journal Article J Opioid Manag · 2023 Cesarean sections (C-sections) are commonly performed procedures, accounting for approximately one-third of births in the United States. This is often one of the first medical encounters for women which require prescription medications to manage post-opera ... Full text Link to item Cite

A Smart Patient Initiated Controlled Analgesic Recording Dispenser (PICARD) for Prescription Abuse Prevention

Conference 2023 IEEE World Forum on Internet of Things: The Blue Planet: A Marriage of Sea and Space, WF-IoT 2023 · January 1, 2023 In recent years, addiction to prescribed controlled substances, particularly opioids, has become a severe problem in the United States. The medical community and government officials are concerned about the abuse of these medications, whether it be through ... Full text Cite

Pain Trajectories After Valve Surgeries Performed via Midline Sternotomy Versus Mini-Thoracotomy.

Journal Article J Cardiothorac Vasc Anesth · September 2022 OBJECTIVES: Controlling moderate-to-severe pain remains a major challenge after cardiothoracic surgery. Several outcomes have been compared extensively after valve surgery performed via midline sternotomy versus mini-thoracotomy, but postoperative pain (PO ... Full text Link to item Cite

Pro-Con Debate: Anesthesiologist- Versus Hospitalist- Run Preoperative Clinics and Perioperative Care.

Journal Article Anesth Analg · March 1, 2022 In this Pro-Con commentary article, we discuss the models, value propositions, and opportunities of preoperative clinics run by anesthesiologists versus hospitalists and their role in perioperative care. The medical and anesthesia evaluation before surgery ... Full text Link to item Cite

A multisociety organizational consensus process to define guiding principles for acute perioperative pain management.

Journal Article Reg Anesth Pain Med · February 2022 The US Health and Human Services Pain Management Best Practices Inter-Agency Task Force initiated a public-private partnership which led to the publication of its report in 2019. The report emphasized the need for individualized, multimodal, and multidisci ... Full text Link to item Cite

Hospitalized Chronic Pain Patient: A Multidisciplinary Treatment Guide

Book · January 1, 2022 This practical guide provides the perspectives needed to treat acute and chronic pain in the hospital. Authored by experts of diverse specialty backgrounds, chapters bring the available evidence together with modern strategies for caring for patients with ... Full text Cite

Introduction to the Chronic Pain Patient

Chapter · January 1, 2022 There are over 50 million patients living with chronic pain in the United States. Nearly 20 million have high impact chronic pain and live each day either succeeding or failing in their attempt to manage it and live functional lives. Chronic pain as a co-m ... Full text Cite

Disk Herniation and Radiculopathy

Chapter · January 1, 2022 Disk herniations can occur in any portion of the spine. When focal disk herniations cause narrowing of the neural foramina, radicular pain or radiculopathy is a common symptom. Knowledge of spinal anatomy, along with pertinent use of physical examination m ... Full text Cite

Preface

Book · January 1, 2022 Cite

Making a business plan for starting a transitional pain service within the US healthcare system.

Journal Article Reg Anesth Pain Med · August 2021 Chronic pain imposes a tremendous economic burden of up to US$635 billion per year in terms of direct costs (such as the costs of treatment) and indirect costs (such as lost productivity and time away from work). In addition, the initiation of opioids for ... Full text Link to item Cite

Geospatial Variations and Neighborhood Deprivation in Drug-Related Admissions and Overdoses.

Journal Article J Urban Health · December 2020 Drug overdoses are a national and global epidemic. However, while overdoses are inextricably linked to social, demographic, and geographical determinants, geospatial patterns of drug-related admissions and overdoses at the neighborhood level remain poorly ... Full text Link to item Cite

Guideline summary review: an evidence-based clinical guideline for the diagnosis and treatment of low back pain.

Journal Article Spine J · July 2020 BACKGROUND CONTEXT: The North American Spine Society's (NASS) Evidence Based Clinical Guideline for the Diagnosis and Treatment of Low Back Pain features evidence-based recommendations for diagnosing and treating adult patients with nonspecific low back pa ... Full text Link to item Cite

The Opioid-Tolerant Patient: Opioid Optimization.

Journal Article J Arthroplasty · June 2020 Chronic opioid use and abuse continue to plague our country despite efforts to curtail their use. Patients on chronic opioids (opioids tolerant) who undergo total joint arthroplasty have been clearly shown to have higher rates of complications, infection, ... Full text Link to item Cite

Demographic Factors Associated with Patient-Reported Outcome Measures in Pain Management.

Journal Article Pain Physician · January 2020 BACKGROUND: Pain control is strongly correlated with the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) quality-of-care domains and overall hospital experience. Prior research implicates several factors in the variability of pati ... Link to item Cite

Preoperative Optimization of Chronic Pain Patients Undergoing Surgery

Conference Techniques in Orthopaedics · January 1, 2020 Surgery presents unique challenges in pain management for patients with chronic pain. A perioperative optimization program, starting at decision to surgery, is likely to yield the best results for this population. Perioperative optimization focuses on psyc ... Full text Cite

Persistent postoperative pain: mechanisms and modulators.

Journal Article Curr Opin Anaesthesiol · October 2019 PURPOSE OF REVIEW: Persistent postoperative pain (PPP) is a significant source of morbidity in our population. An excellent opportunity to understand the transition from acute to chronic pain states. Understanding the mechanisms that drive this and modulat ... Full text Link to item Cite

American Society for Enhanced Recovery and Perioperative Quality Initiative Joint Consensus Statement on Perioperative Management of Patients on Preoperative Opioid Therapy.

Journal Article Anesth Analg · August 2019 Enhanced recovery pathways have quickly become part of the standard of care for patients undergoing elective surgery, especially in North America and Europe. One of the central tenets of this multidisciplinary approach is the use of multimodal analgesia wi ... Full text Link to item Cite

American Society for Enhanced Recovery and Perioperative Quality Initiative-4 Joint Consensus Statement on Persistent Postoperative Opioid Use: Definition, Incidence, Risk Factors, and Health Care System Initiatives.

Journal Article Anesth Analg · August 2019 Persistent postoperative opioid use is thought to contribute to the ongoing opioid epidemic in the United States. However, efforts to study and address the issue have been stymied by the lack of a standard definition, which has also hampered efforts to mea ... Full text Link to item Cite

American Society for Enhanced Recovery and Perioperative Quality Initiative Joint Consensus Statement on Perioperative Opioid Minimization in Opioid-Naïve Patients.

Journal Article Anesth Analg · August 2019 Surgical care episodes place opioid-naïve patients at risk for transitioning to new persistent postoperative opioid use. With one of the central principles being the application of multimodal pain interventions to reduce the reliance on opioid-based medica ... Full text Link to item Cite

Perioperative Behavioral Stress in Children

Chapter · January 1, 2019 Interest in children's perioperative behavior has increased dramatically over the past few decades. In particular, the acknowledgement of the role of developmental factors in the perioperative field has prompted growth in investigation in the experience of ... Full text Cite

A Perioperative Medicine Model for Population Health: An Integrated Approach for an Evolving Clinical Science.

Journal Article Anesth Analg · February 2018 Health care delivery in the United States continues to balance on the tight rope that connects its transition from volume to value. Value in economic terms can be defined as the amount something exceeds its commodity price and is determined by extraordinar ... Full text Link to item Cite

Perioperative Behavioral Stress in Children

Chapter · January 1, 2018 Interest in children's perioperative behavior has increased dramatically over the past few decades. In particular, the acknowledgement of the role of developmental factors in the perioperative field has prompted growth in investigation in the experience of ... Full text Cite

Postoperative Pain Management in Children of Hispanic Origin: A Descriptive Cohort Study.

Journal Article Anesth Analg · February 2016 BACKGROUND: It has been established that pain is frequently undertreated in children following outpatient surgery. Very few studies, however, have investigated this phenomenon in ethnically diverse populations. METHODS: This study included 105 families of ... Full text Link to item Cite

Retrospective analysis of the incidence of epidural haematoma in patients with epidural catheters and abnormal coagulation parameters.

Journal Article Br J Anaesth · May 2015 BACKGROUND: Epidural haematoma is a rare but potentially catastrophic complication associated with epidural catheterization. The times of insertion and removal of epidural catheters are high-risk periods for epidural haematoma formation, especially with ab ... Full text Link to item Cite

Morphine versus Hydromorphone: Does Choice of Opioid Influence Outcomes?

Journal Article Pain Res Treat · 2015 Morphine has traditionally been considered the first line agent for analgesia in hospitals; however, in the last few years there has been a shift towards the use of hydromorphone as a first line agent. We conducted a hospital population based observational ... Full text Link to item Cite

Incidence of serotonin syndrome in patients treated with fentanyl on serotonergic agents.

Journal Article Pain Physician · 2015 BACKGROUND: There has been a recent surge in the literature highlighting the association of fentanyl as precipitating serotonin syndrome in patients on a serotonergic agent. OBJECTIVE: The purpose of our study was to understand the incidence of serotonin s ... Link to item Cite

Pain Management in Pregnancy: Multimodal Approaches.

Journal Article Pain Res Treat · 2015 Nonobstetrical causes of pain during pregnancy are very common and can be incapacitating if not treated appropriately. Recent reports in the literature show that a significant percentage of pregnant women are treated with opioids during pregnancy. To addre ... Full text Link to item Cite

Elevated lidocaine serum concentration after subcutaneous lidocaine administration using a needle-free device in pediatric patients.

Journal Article Pediatr Emerg Care · November 2014 We report several cases in which pediatric patients at our institution have elevated lidocaine levels in toxicology screens after subcutaneous injection of lidocaine using a needle-free device. The purpose of this article is to report 4 cases in which pedi ... Full text Link to item Cite

Epidurals in patients receiving thromboprophylaxis with unfractionated heparin three times a day: the value of activated partial thromboplastin time testing.

Journal Article Anesth Analg · November 2014 BACKGROUND: Dosing subcutaneous (SC) unfractionated heparin (UFH) 3 times a day (TID) for deep venous thrombosis prophylaxis is used for patients in the United States undergoing nonorthopedic surgery. There is a lack of data on the risks of neuraxial techn ... Full text Link to item Cite

Elevated lidocaine serum levels following the use of a needle free device in healthy adult volunteers.

Journal Article Pediatr Emerg Care · May 2014 There is increased concern regarding circulating levels of lidocaine immediately after the use of a needle-free device with buffered lidocaine. As a result, we conducted a prospective study to assess lidocaine circulation after the use of a needle-free dev ... Full text Link to item Cite

The use of an intrathecal pump to manage intractable cancer pain in a pediatric patient: a case report.

Journal Article J Pediatr Hematol Oncol · April 2014 A 15-year-old girl with combined immune deficiency syndrome, diagnosed with metastatic squamous cell cancer of the anus, had significant pain secondary to vulvar-perianal condyloma. Conventional treatment with oral and intravenous analgesics was limited by ... Full text Link to item Cite

Use of targeted transversus abdominus plane blocks in pediatric patients with anterior cutaneous nerve entrapment syndrome.

Journal Article Pain Physician · 2014 Anterior cutaneous nerve entrapment syndrome (ACNES) is a commonly overlooked source of chronic abdominal wall pain. A diagnosis of ACNES should be considered in cases of severe, localized abdominal pain that is accentuated by physical activity. Providers ... Link to item Cite

Opioid tolerance--a predictor of increased length of stay and higher readmission rates.

Journal Article Pain Physician · 2014 The increasing use of opioids to manage pain in the United States over the last decade has resulted in a subset of our population developing opioid tolerance. While the management of opioid tolerant patients during acute episodes of care is well known to b ... Link to item Cite

Intracranial hypotension caused by anterior cervical CSF leak alleviated by an epidural blood patch [corrected].

Journal Article Headache · May 2013 We present a case in which a thoracocervical epidural blood patch was used to treat an anteriorly situated cerebrospinal fluid leak following 2 failed blood patches in the lumbar region. The challenge in identifying the source of the leak, deteriorating he ... Full text Link to item Cite

Intrathecal Drug Delivery (ITDD) systems for cancer pain.

Journal Article F1000Res · 2013 Intrathecal drug delivery is an effective pain management option for patients with chronic and cancer pain. The delivery of drugs into the intrathecal space provides superior analgesia with smaller doses of analgesics to minimize side effects while signifi ... Full text Link to item Cite

Spinal cord stimulation for radicular pain following retained bullet in the spinal canal.

Journal Article Pain Physician · 2013 We are reporting on the implantation of a spinal cord stimulator to treat intractable radicular pain following a retained bullet fragment in the spinal canal. Such retained fragments are associated with risks including pain, neurological deficit, infection ... Link to item Cite

A child in pain: What health professionals can do to help

Journal Article Journal of Pain and Palliative Care Pharmacotherapy · November 11, 2011 Full text Cite

Reliability of a preliminary 3-D pain mapping program.

Journal Article Pain Med · March 2011 OBJECTIVE: The objective of this preliminary investigation was to evaluate the test-retest reliability of a new pain assessment method referred to as 3-D pain mapping. METHODS: In Study 1, 101 chronic noncancer pain patients from four sites reported their ... Full text Link to item Cite

Diagnostic and Therapeutic Blocks

Chapter · November 16, 2010 Local anesthetic blocks have limited value in diagnosing and treating chronic pain. Peripheral nerve blocks have shown some utility in treating occipital neuralgia and meralgia paresthetica. Sympathetic blocks of the upper and lower extremities can provide ... Full text Cite

Wandering epidural catheter.

Journal Article Anesthesiology · November 2010 Full text Link to item Cite

Development and longitudinal validation of the overall benefit of analgesia score: a simple multi-dimensional quality assessment instrument.

Journal Article Br J Anaesth · October 2010 BACKGROUND: The goal of this study was to develop and validate the overall benefit of analgesic score (OBAS), which assesses pain intensity and the opioid-related adverse effects. METHODS: The score was developed and validated in four trials (n=1470 patien ... Full text Link to item Cite

Pain in children

Chapter · December 1, 2009 Full text Cite

Computer Face Scale for measuring pediatric pain and mood.

Journal Article J Pain · February 2009 UNLABELLED: This investigation determined the psychometric properties and acceptability of an animated face scale presented on a hand-held computer as a means to measure pediatric pain and mood. In study 1, 79 hospitalized, pediatric patients indicated the ... Full text Link to item Cite

Pain in children

Chapter · December 10, 2008 Full text Cite

Concepts in pain management.

Journal Article Clin Podiatr Med Surg · April 2007 Pain has become an increasingly recognized symptom that plays a major role in the treatment of many podiatric patients. Management of this now accepted fifth vital sign can be accomplished through many avenues. Nonsteroidal anti-inflammatory medications an ... Full text Link to item Cite

Regional anaesthesia versus general anaesthesia, morbidity and mortality.

Journal Article Best Pract Res Clin Anaesthesiol · June 2006 The regional versus general anaesthesia debate is an age-old debate that has brought about few clear answers. Most concur that multiple factors including the patient, the surgery, the method of regional and general anaesthesia, and the quality of periopera ... Full text Link to item Cite