A&A practice
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Case Reports
Transcutaneous Electrical Nerve Stimulation in Treatment of Occipital Neuralgia: A Case Report.
Occipital neuralgia is the third most common headache syndrome after migraine and tension type headaches. There is no well-established treatment regimen for a reliable cure. The current case presents a 39-year-old woman, diagnosed with occipital neuralgia of idiopathic cause. ⋯ The patient was started on conventional transcutaneous electrical nerve stimulation, 3 sessions per week. After the procedure, the patient achieved significant pain relief: 1-2/10 on the numeric rating scale, pain initially being 10/10. With maintenance therapy consisting of physical therapy, deep tissue massage, and muscle relaxants, 12 months after starting transcutaneous electrical nerve stimulation therapy, she is pain free.
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Patients with upper motor neuron disease, such as multiple sclerosis, can present with severe spasticity in the perioperative period. In most cases, this can be managed with a combination of preoperative oral medications, regional or neuraxial anesthetic techniques, and intravenous muscle relaxants. We describe the clinical presentation of a patient with multiple sclerosis and the successful use of intravenous dantrolene sodium postoperatively for the treatment of exacerbated spasticity refractory to traditional management.
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Case Reports
Treatment of Postherpetic Neuralgia With Intravenous Administration of Zinc Sulfate: A Case Report.
Gabapentinoids (gabapentin and pregabalin) are first-line drugs for postherpetic neuralgia (PHN), but some PHN patients have inadequate therapeutic response. Zinc deficiency has been identified as a risk factor for PHN. ⋯ The aforementioned findings provide a molecular pain-relieving basis for zinc supplements as an add-on therapy to pregabalin. We report 2 zinc-deficient PHN patients who received zinc sulfate intravenously as an add-on therapy to pregabalin and responded well.
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Case Reports
Naloxegol to Treat Constipation in a Patient Taking Opioids for Cancer Pain: A Case Report.
Opioid-induced constipation (OIC) is a common gastrointestinal adverse effect of opioids, which can severely affect compliance and adherence to pain medication regimens and quality of life. Naloxegol has demonstrated efficacy against OIC in several studies involving patients with nonmalignant chronic pain. Here we report efficacy and tolerability of naloxegol in a 68-year-old patient with metastatic lung cancer and severe pain, treated with opioids, who presented with OIC resistant to traditional measures. Addition of naloxegol produced rapid improvement in his OIC symptoms and no apparent adverse effects while taking extended-release morphine 130 mg orally every 12 hours.
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Case Reports
Axillary Artery Dissection After Ultrasound-Guided Infraclavicular Brachial Plexus Block: A Case Report.
A 52-year-old man with end-stage renal disease underwent ultrasound-guided infraclavicular brachial plexus block for revision of an arteriovenous fistula. On postoperative day 2, the patient developed pain and loss of motor function in the surgical extremity. ⋯ Sensory deficits resolved over the next 3 days. Smoking, hypertension, diabetes mellitus, and chronic intake of a calcineurin inhibitor might have predisposed the patient to iatrogenic arterial dissection.