The Clinical journal of pain
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Review Case Reports
Bilateral cervicothoracic transforaminal blood patches for persistent headache from spontaneous intracranial hypotension: a case report and review.
Spontaneous intracranial hypotension (SIH) is an uncommon cause of headache that can be challenging to treat and can have serious clinical consequences. When symptoms persist despite conservative treatment, an interlaminar epidural blood patch is often performed, but may not be effective. ⋯ In this clinical report, we describe a case of spontaneous intracranial hypotension caused by a ventral dural tear at the cervicothoracic junction. Our patient suffered from recalcitrant postural headaches despite undergoing conventional interlaminar epidural blood patches. Bilateral transforaminal epidural blood patches were performed in order to deliver blood to the ventral epidural space at the site of the tear identified on magnetic resonance imaging. The transforaminal technique may be useful in patients who have failed conventional treatment, though a high degree of interventional experience and vigilance is required to safely perform this procedure.
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Randomized Controlled Trial
Ondansetron, a 5HT3-antagonist, does not alter dynamic mechanical allodynia or spontaneous ongoing pain in peripheral neuropathy.
The aim of this study was to examine whether the intensity of dynamic mechanical allodynia and spontaneous ongoing pain in patients with neuropathic pain associated with peripheral neuropathy was influenced by an intravenous infusion of the 5HT3-antagonist, ondansetron. ⋯ No influence from 8 mg of ondansetron could be shown on the intensity of brush-evoked or spontaneous ongoing pain in patients with peripheral neuropathy, indicating the lack of involvement of 5HT3-receptors in an earlier proposed spinobulbospinal loop with descending facilitation acting on spinal mechanisms related to dynamic mechanical allodynia.
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Clinical Trial
Is interfascial block with ultrasound-guided puncture useful in treatment of myofascial pain of the trapezius muscle?
Ultrasound-guided puncture is indispensable for the injection of local anesthetic in the interfascial space, the space between 2 muscle fasciae. Interfascial infiltration or block may be useful in treating myofascial pain in the trapezius muscle. ⋯ The anatomical, histological, and ultrasound findings in the cadaver study confirmed the diffusion of the solution in the interfascial space. Study in patients confirms that the interfascial block in the back musculature can be as effective as in the abdominal musculature. The presence of nerve structures in this space, confirmed by the histological study, seems to explain the pain relief reported by the patients with this interfascial technique.
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Randomized Controlled Trial
Preemptive low-dose epidural ketamine for preventing chronic postthoracotomy pain: a prospective, double-blinded, randomized, clinical trial.
Chronic postthoracotomy pain is the most common long-term complication that occurs after a thoracotomy with a reported incidence of up to 80%. Although thoracic epidural analgesia is a widely used method for managing acute postthoracotomy pain, its effects seems questionable. The objective of this prospective, double-blinded, randomized, controlled trial was to assess the effect of preemptive low-dose epidural ketamine in addition to preemptive thoracic epidural analgesia on the incidence of chronic postthoracotomy pain. ⋯ The addition of preemptive low-dose epidural ketamine (1.2 mg/h) to preemptive thoracic epidural analgesia did not have any beneficial effects in preventing chronic postthoracotomy pain.
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We report a case of a 59-year-old female with severe TN who experienced satisfactory symptom relief from a single-shot trial of intrathecal ziconotide. ⋯ Ziconotide should be considered for treatment of TN, although further investigation is recommended.