The Clinical journal of pain
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Multicenter Study
Long-term Results of Percutaneous Lumbar Decompression for LSS: Two-Year Outcomes.
The aim of this report was to evaluate the long-term effectiveness and safety of mild lumbar decompression for the treatment of neurogenic claudication associated with lumbar spinal stenosis. This technique uses a percutaneous dorsal approach to remove small portions of ligament and lamina, thereby restoring space and decompressing the spinal canal. ⋯ In this report of 2-year follow-up on 45 patients treated with mild percutaneous lumbar decompression, patients experienced statistically significant pain relief and improved functionality.
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Randomized Controlled Trial
Transcranial Direct Current Stimulation (tDCS) Reduces Postsurgical Opioid Consumption in Total Knee Arthroplasty (TKA).
Although pain is often a symptom that precedes total knee arthroplasty (TKA), the procedure itself is associated with considerable postoperative pain lasting days to weeks. Postoperative pain control is an important factor in determining recovery time, hospital length of stay, and rehabilitation success. Several brain stimulation technologies including transcranial direct current stimulation (tDCS) have demonstrated promise as treatments for a variety of pain conditions. The present study examined the effects of 4 sessions of tDCS on post-TKA pain and opioid consumption. ⋯ Results from this pilot feasibility study suggest that tDCS may be able to reduce post-TKA opioid requirements. Although these results are preliminary, the data support further research in the area of adjunctive cortical stimulation in the management of postsurgical pain.
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Comparative Study
Sensory Hyperalgesia is Characteristic of Nonspecific Arm Pain: A Comparison With Cervical Radiculopathy and Pain-Free Controls.
Nonspecific arm pain (NSAP) is a common clinical entity, the pathophysiological mechanisms of which are poorly understood. The purpose of this study was to investigate sensory profiles in individuals with nonspecific arm pain compared with cervical radiculopathy and pain-free controls. ⋯ Sensory profiles in NSAP and cervical radiculopathy differ. NSAP is characterized by widespread sensitivity to thermal and pressure pain in the absence of thermal hypoaesthesia, whereas cervical radiculopathy is characterized by the presence of thermal and vibratory hypoaesthesia as well as more localized cold and pressure pain sensitivity. The identification of widespread sensory hypersensitivity in NSAP has important implications for clinical decision making.
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Case Reports
Favorable Outcome of an Acute Complex Regional Pain Syndrome With Immunoglobulin Infusions.
To emphasize that complex regional pain syndrome (CRPS), a disabling disorder with the implication of aberrant inflammation, vasomotor dysfunction, and maladaptive neuroplasticity, might be treated with a high dose of intravenous immunoglobulin infusions (IVIG). ⋯ This observational study emphasizes that high-dose IVIG may be a treatment option in the acute phase of CRPS.
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Epidemiologic studies in the non-human immunodeficiency virus (HIV) positive population have shown greater health care utilization among persons with chronic non-cancer pain on opioid therapy. However, we are not aware of any similar data in the HIV positive population. ⋯ In our study HIV positive individuals with chronic pain were more likely to be seen in the ER and be hospitalized if they were on opioids. However, after controlling for other variables, the association with opioids no longer remained significant.