The Clinical journal of pain
-
The purpose of this review was to determine how effective surgery and injection therapy are in the management of chronic pain. ⋯ Standard discectomy compared with conservative treatment for proven disc herniation (< or = 1 year) and local triamcinolone injection for lateral epicondylitis (< or = 12 weeks) are both effective for pain relief (level 2). There was limited evidence of effectiveness (level 3) of intraoperative steroid at discectomy, epidural steroid injection for sciatica with low back pain, caudal steroid injection for low back pain, local glycosaminoglycan polyphosphate injection for lateral epicondylitis, intraarticular steroid injection for shoulder arthritis, subacromial steroid injections for rotator cuff tendinitis, nonspecific injections for painful shoulder, systemic growth hormone for fibromyalgia, and intravenous adenosine for fibromyalgia. There was limited evidence (level 3) that there is no additional benefit of adding steroid to local anesthetic in caudal epidural injections. There is limited evidence (level 3) that intravenous adenosine is ineffective for fibromyalgia. The remaining evidence was inadequate (level 4a) or contradictory (level 4b).
-
Can either a history of previous similar injury, including recurrence of injury, or an individual's symptoms, including time off work, predict chronic pain and/or chronic pain disability? ⋯ The studies provide moderate evidence (level 2) that a history of previous similar pain predicts subsequent reports of pain and limited evidence (level 3) that a history of similar pain predicts poorer outcomes after recurrent injury. The studies also provide moderate evidence (level 2) that longer duration of pain predicts the occurrence of subsequent reports of pain and limited evidence (level 3) that longer time off work before treatment predicts poorer activity and poorer participation outcomes after recurrent injury.
-
Review
Headache continuum: concept and supporting evidence from recent study of chronic daily headache.
A headache continuum on the basis of the dynamic nature of headache is presented, with episodic headaches developing into daily headaches and vice versa. The concept is supported by evidence from recent study of (gradual-onset) chronic daily headache.
-
This study examined the effects of peripheral nerve block with high-concentration tetracaine for the management of trigeminal neuralgia, and evaluated sensory function by measuring the postblock current perception threshold. ⋯ Peripheral nerve block with high-concentration tetracaine is a relatively safe and useful technique in the management of trigeminal neuralgia, particularly among older patients and those with systemic problems.