The Clinical journal of pain
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Loin pain hematuria syndrome (LPHS) is a rare pain syndrome, which is somewhat poorly characterized and challenging to treat. The condition of LPHS is still controversial and there is no consensus of validated diagnostic criteria or optimal treatment strategies. ⋯ Curiously, for such a controversial pain syndrome there is substantially more written in the literature regarding surgical-type treatments than conservative treatments. A brief review of LPHS potential pathophysiology and potential treatment approaches is presented.
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Chronic opioid therapy (COT) for chronic noncancer pain (CNCP) is characterized by both high rates of patient-initiated discontinuation and by perceived helpfulness among those who sustain opioid use. This study examines predictors of the desire to cut down or stop opioid therapy among patients receiving COT who report that opioids are helpful for relieving pain. ⋯ There are high rates of ambivalence about opioid use among COT recipients who consider opioids helpful for pain relief. Depressed patients are more likely to be ambivalent about use of prescribed opioids. Eliciting patient ambivalence may be helpful in patients who are not benefiting from long-term opioid use as an initial step toward consideration of discontinuation.
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With the exception of interdigital neuromas, cutaneous neuromas are relatively rare and often present a diagnostic challenge. ⋯ The diagnosis of cutaneous neuroma should be considered in all patients who have intractable pain and allodynia at unusual locations and in atypical patterns. In addition, ultrasonography can prove very useful in the detection of small cutaneous neuromas if the site of symptoms can be precisely localized.
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To evaluate if sensory, motor, and psychological factors are different in severe lateral epicondylalgia compared with less severe cases and control. ⋯ Lateral epicondylalgia patients presenting with severe pain and disability could be distinguished by hypersensitivity to thermal stimuli, notably bilateral cold hyperalgesia. Findings may implicate a combination of central, peripheral, and sympathetic nervous system processes and may help explain the poorer outcomes found in this subpopulation.