The Clinical journal of pain
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Clinical Trial
Unipedicular vertebroplasty for osteoporotic compression fracture using an individualized needle insertion angle.
In the classic transpedicular vertebroplasty, second needle placement is routinely required at the same level. However, each patient requires a different needle insertion angle (NIA) at each site. Therefore, precise NIA is required for each fractured vertebral body. In this study, we performed a unipedicular approach through an individualized NIA that had been evaluated with axial magnetic resonance imaging before vertebroplasty. ⋯ Unipedicular PVP can be performed safely, provided the operator has a thorough knowledge of the bony landmarks and the anatomy of the pedicle. A unipedicular approach could be considered first using individualized NIA at each vertebral level.
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The purpose of this study was to compare sleep of adolescents with chronic pain and healthy adolescents using both subjective and objective sleep assessments, and to identify correlates of poor sleep. ⋯ Adolescents with chronic pain evidenced poorer sleep quality, increased insomnia symptoms, and less efficient sleep with more wake bouts in comparison with healthy adolescents, findings that require replication in a larger sample. Assessment and management of sleep disturbances is an important aspect of care for children and adolescents with chronic pain.
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To present different aspects and advantages of the laparoscopic approach to the pelvic nerves aimed at treating intractable pelvic neuralgia. ⋯ Laparoscopic approach to the pelvic nerves opens new possibilities for the diagnosis and treatment of pelvic neuralgia, and offers new curative surgical techniques.
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Numerous potential complications are associated with the use of programmable intrathecal (IT) drug delivery systems. Radiation is often assumed to cause dysfunctions of the programmable IT device. However, radiation-induced failure of this device and limits of dose exposure have not clinically documented. ⋯ Estimated cumulative doses to the pump were in the range of 28.5 to 36 Gy when the alarm occurred after 20 daily treatments. The IT pump itself exposed to this high-dose radiation did not pose any risk to the patient or the environment. This is the first case description about the pump malfunction secondary to clinical radiotherapy, which is very useful to physicians who manage the pain and radiotherapy for cancer patients.
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Physicians frequently express dissatisfaction about caring for patients with chronic pain and frequently report that inadequate training and concern about addiction are impediments to prescribing opioids. Elderly patients with chronic pain may be at increased risk of experiencing uncontrolled pain and this patient population is increasingly being cared for by geriatricians rather than internists. We sought to determine if there is a differential impact on internists and geriatricians of the factors that adversely affect attitudes toward opioid prescribing. ⋯ Factors shown to have an adverse affect on opioid prescribing disproportionately impact on the attitudes of internists compared with geriatricians. Further research is needed to determine if there is also a differential impact on how internists care for their elderly patients with chronic pain.