Journal of back and musculoskeletal rehabilitation
-
J Back Musculoskelet Rehabil · Jan 1997
Pain management: Establishing a role for implantable technologies.
Pain due to terminal illness such as AIDS and cancer-related pain should be managed according to the guidelines set forth by the World Health Organization. These guidelines suggest a pharmacologic tailoring approach to the level and intensity of the patient's pain. These guidelines obey the KISS principal (keep it simple) suggesting the use of less potent analgesic agents before utilizing more potent agents. ⋯ Interventional strategies and certainly implantable technologies for pain control have a place as 'tools' for the management of cancer, AIDS, and non-malignant-related pain syndromes. Since these therapies are costly and invasive, they should be used only after the failure of more conservative, less invasive and less costly therapies. This paper outlines a rational place for the use of implantable modalities for the treatment of cancer, AIDS and non-malignant pain.
-
J Back Musculoskelet Rehabil · Jan 1997
Epidural steroid injections for the treatment of lumbosacral radiculopathy.
While there is an extensive body of literature concerning the use of epidural steroid injections in the treatment of sciatica, most of the literature is descriptive or anecdotal. There are few controlled studies regarding efficacy of this treatment modality. While there are few published reports of serious complications of this therapy, warnings about the hazards of epidural steroid injections occasionally appear in both medical and lay literature. It is the purpose of this review to assess the existing evidence for efficacy of epidural steroid injections for sciatica and to assess the risks of this procedure. ⋯ The majority of the published literature supports the notion that epidural steroids provide relief of pain from lumbosacral radiculopathy. There is anecdotal evidence that multiple intrathecal steroid injections may be associated with neurological dysfunction, but there is very little evidence that epidural steroids are neurotoxic.
-
J Back Musculoskelet Rehabil · Jan 1997
Pain, psychological status, and functional recovery in chronic pain patients on daily opioids: a case comparison.
Long-term opioid therapy for chronic benign pain remains controversial. Most studies on the effectiveness of such regimens have been case series or case comparisons and very few randomized placebo-controlled studies are available. Overall, this research has produced mixed results. ⋯ Statistical removal of the effects of pain differences did not alter the pattern of results for psychological and functional measures. Although the study design employed did not allow determination of causality, it is consistent with previous work which has failed to reveal any advantage to use of daily opioids in the chronic pain population with regard to analgesia, decreased adjunctive medication use, or functional recovery. Well-designed, prospective, randomized studies are needed, but the current results suggest continued caution in the use of daily opioids until such studies become available.