Physical medicine and rehabilitation clinics of North America
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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.
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Parsonage-Turner syndrome (PTS) is a rare disorder typically characterized by an abrupt onset of upper extremity pain followed by progressive neurologic deficits, including weakness, atrophy, and occasionally sensory abnormalities. The exact cause and pathophysiology of PTS are complex and incompletely understood. ⋯ Most patients with PTS are treated with a multidisciplinary approach that includes both physical therapy and pharmacologic treatment, often with multiple agents. Further research is needed.
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Most lumbar disk herniations improve over time with or without medical treatment. Disk herniations and annular tears may not be symptomatic and are shown to exist in patients without any symptoms. ⋯ Treatment of chronic pain of diskal cause can be challenging and have varying results in terms of success. The diagnosis, cause, and treatment options are reviewed in this article.
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This article discusses current trends in managing cancer pain, with specific regard to opioid transmission, descending pathway inhabitation, and ways to facilitate the endogenous antinociceptive chemicals in the human body. Various techniques for opioid and nonopioid control of potential pain situations of patients with cancer are discussed. The benefits of using pharmacogenetics to assess the appropriate medications are addressed. Finally, specific treatment of abdominal cancer pain using radiofrequency lesioning is discussed.
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Phys Med Rehabil Clin N Am · May 2014
ReviewOpioid syndrome: failed opioid therapy for chronic noncancer pain.
Treatment of chronic noncancer pain (CNCP) with high-dose opioids (HDOs) has burgeoned over the past 2 decades in the United States. Characteristic domains and features of the failed CNCP management patient using long-term HDOs are described herein as the/an opioid syndrome (Schreiber AL, personal communication. 2013). Reversing or even modulating HDO use in patients with CNCP requires a paradigm shift on the part of physician, patient, and the societal "quick fix" medical culture. This review offers measures, agents, and strategies to consider in management of this pervasive, erosive medical and societal challenge.