Journal of back and musculoskeletal rehabilitation
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Myofascial pain syndrome (MPS) and fibromyalgia (FM) are common muscular pain syndromes. They are both characterized by tenderness, but MPS is further characterized by the myofascial trigger point that has a taut band and causes referred pain. FM can be either primary (idiopathic) or secondary. ⋯ Tryptophane is low in the serum and spinal fluid of FM patients, whereas substance P is elevated in the spinal fluid. Treatment of MPS is effective when the trigger point is inactivated and underlying mechanical or medical perpetuating factors are corrected. Treatment of fibromyalgia is more difficult as the drugs commonly used, such as the tricyclic antidepressants, which have uncertain benefits; and exercise, which clearly shows a short-term benefit, fail to provide long-lasting relief at 4 years.
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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.
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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.
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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.
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J Back Musculoskelet Rehabil · Jan 1995
Types of cervical disc herniation and relation to myelopathy and radiculopathy.
Cervical disc herniation is divided into three types with respect to the intraspinal location of the herniated mass: median, paramedian and lateral herniations. Median herniation presses the spinal cord against the lamina and deforms it into a boomerang shape in a cross section, thereby giving rise to myelopathy of the central cord syndrome or transverse lesion syndrome, according to Crandall's classification. Paramedian herniation presses the spinal cord unilaterally and deforms it into a comma shape. ⋯ Of our 202 patients with myelopathy, 36% had median herniation and 64% had paramedian herniation. Of our 24 patients with radiculopathy, 12% had paramedian herniation and 88% had lateral herniation. Other matters pertinent to the management of patients are described.