Physical medicine and rehabilitation clinics of North America
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Phys Med Rehabil Clin N Am · May 2014
ReviewSide effects of commonly prescribed analgesic medications.
Analgesics, including opioids, steroidal and nonsteroidal anti-inflammatory drugs, aspirin, acetaminophen, antiepileptics, and serotonin-norepinephrine reuptake inhibitors, are medications commonly used to treat many forms of pain. However, all of these agents may have significant adverse side effects. ⋯ It is critical that the prescribing practitioner and the dispensing pharmacist provide a thorough, understandable review of the potential side effects to all patients before these drugs are administered. Proper monitoring and follow-up during therapy are crucial.
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Carpal tunnel syndrome (CTS) is a common median nerve compression syndrome and the most common peripheral mononeuropathy. The clinical syndrome is diagnosed by history and physical examination. ⋯ Neuromuscular ultrasound imaging of the carpal tunnel provides supportive diagnostic information by revealing pathologic nerve swelling in CTS, and other anatomic anomalies that compress the median nerve. These tests cannot be used to make the diagnosis in the absence of history that includes CTS symptom criteria and excludes other causes.
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Phys Med Rehabil Clin N Am · May 2014
ReviewComplex regional pain syndrome: diagnosis and treatment.
This article discusses the diagnostic criteria, clinical course, and complications of complex regional pain syndrome. Multidisciplinary treatment including physical and occupational therapy, psychological evaluation and treatment, pharmacologic management, and more aggressive options including sympathetic blocks, sympathectomy, and spinal cord stimulation are also reviewed.
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Phys Med Rehabil Clin N Am · May 2014
ReviewEpidural steroid injections for radicular lumbosacral pain: a systematic review.
Most clinical guidelines do not recommend routine use of epidural steroid injections for the management of chronic low back pain. However, many clinicians do not adhere to these guidelines. This comprehensive evidence overview concluded that off-label epidural steroid injections provide small short-term but not long- term leg-pain relief and improvement in function; injection of steroids is no more effective than injection of local anesthetics alone; post-procedural complications are uncommon, but the risk of contamination and serious infections is very high. The evidence does not support routine use of off-label epidural steroid injections in adults with benign radicular lumbosacral pain.