The Clinical journal of pain
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The treatment of trigeminal neuralgia (TN), which is resistant to medical therapy, has benefited from many surgical techniques. It is not possible, in light of the present level of knowledge, to establish exactly which method is the most suitable. It does, however, seem significant that certain side effects appear, in varying percentages, in all kinds of operations. ⋯ The tip of the needle is accurately placed among the roots desired under fluoroscopic control. The clinical effects on the conscious patient of a prognostic block with local anesthetics are evaluated before producing the neurolysis. Follow-up has been long enough to show that SETN is a highly selective procedure, which shouldn't be underrated in the centers that use it routinely.
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Case Reports
Utilization of transcutaneous electrical nerve stimulation in managing craniofacial pain.
This article describes a protocol for clinical application of variable parameter transcutaneous electrical nerve stimulation (TENS) for the management of craniofacial pain. The method described is easily applied and has been used successfully for several years in clinical practice. Several selected cases are presented that demonstrate the use of TENS along the prescribed protocol.
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A retrospective survey of 1,661 patients seen over a 10-year period at a pain clinic yielded 55 patients with intractable neck pain as the presenting complaint. In 89% there was an industrial or motor vehicle accident as the precipitating event, 78% were involved in legal proceedings relating to the accident, and in 87% the pain radiated to neighboring structures. ⋯ Treatment mainly by psychotherapy or tricyclic antidepressants resulted in some benefit for 56% of patients. Legal compensation and change in occupation were not major factors influencing the outcome of treatment.
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Spinal cord stimulation was undertaken in 45 patients referred to the University Hospital in Ghent. Failed back surgery was the major indication for implantation. Raynaud's phenomenon, causalgia, polyneuropathy, phantom limb pain, and diverse causes were the other indications. ⋯ Eight patients stopped using the stimulation system. To ensure good results, strict selection criteria and many surgical reinterventions seemed to be necessary. Although spinal cord stimulation is a nonablative technique, many complications may occur.
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Continuous spinal opiate administration via permanently implantable drug delivery devices has been proven to provide profound analgesia for chronic pain conditions. We present a case in which the catheter of an implantable subarachnoid device was misplaced into the subdural/extra-arachnoid space despite the free flow of cerebrospinal fluid. ⋯ It is postulated that this misplacement of the catheter likely occurred as a result of recent lumbar punctures the patient had undergone. Extravasation of cerebrospinal fluid created a false space and contributed to the misplacement and ultimate failure of the device to provide analgesia.