The Clinical journal of pain
-
The only way some patients with intractable angina pectoris can endure the daily pain is by using opiates. Epidural morphine or spinal cord stimulation (SCS) for out-patients is a possibility for this patient group. The aim of this study was to determine whether patients previously treated with epidural injections had more frequent electrode migration, higher stimulation needs, and less effect of SCS treatment. ⋯ SCS in patients previously treated with epidural catheters has an effect equal to that in other patients.
-
Randomized Controlled Trial Clinical Trial
Analysis of peak magnitude and duration of analgesia produced by local anesthetics injected into sympathetic ganglia of complex regional pain syndrome patients.
Pain-relieving effects of lidocaine/bupivicaine local anesthetic (LA) and saline (S) block of sympathetic ganglia (stellate block, 4 patients; lumbar sympathetic block, 3 patients) were compared in 7 complex regional pain syndrome (CRPS) patients on a double-blind crossover basis to evaluate the diagnostic and therapeutic value of local anesthetic sympathetic blocks. ⋯ The combination of these results provides evidence that duration of pain relief is affected by injection of local anesthetics into sympathetic ganglia. These results indicate that both magnitude and duration of pain reduction should be closely monitored to provide optimal efficacy in procedures that use local anesthetics to treat CRPS.
-
Randomized Controlled Trial Clinical Trial
Vibration pain provocation can improve the specificity of MRI in the diagnosis of symptomatic lumbar disc rupture.
The purpose of this study was to determine if vibration pain provocation could be combined with magnetic resonance imaging (MRI) to increase its specificity in identifying symptomatic disc disruption identified by discography. ⋯ A small hand-held vibrator could produce pain provocation results similar to those obtained by discography. Results of this noninvasive pain provocation method can improve the specificity and accuracy of MRI in identifying symptomatic disc lesions.
-
Sensory and motor abnormalities are common among patients with complex regional pain syndrome (CRPS). The purpose of the present study was to define and characterize these abnormalities and to develop a hypothesis regarding the area of the central nervous system from which they derive. ⋯ Nearly half of CRPS patients had abnormalities of spinothalamic, trigeminothalamic, and corticospinal function that may represent dysfunction of the medulla. One-third of the remaining CRPS patients had neuroimaging evidence of spinal cord or brain pathology. The majority of CRPS patients in this study have measurable abnormalities of the sensory and motor systems or neuroimaging evidence of spinal cord or brain dysfunction.
-
Clinical Trial
Can we screen for problematic back pain? A screening questionnaire for predicting outcome in acute and subacute back pain.
Because musculoskeletal pain is the second most frequent reason for seeking health care, the aims of this study were to determine the value of psychosocial variables in evaluating risk for developing chronic back pain problems and to develop a screening methodology to identify patients likely to have a poor prognosis. ⋯ Potent psychosocial risk factors associated with future sick absenteeism were identified. Because the total score was related to outcome, the instrument may have use in screening patients with acute or subacute spinal pain in clinical situations.