Anesthesiology clinics
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Painful conditions of the musculoskeletal system, including myofascial pain syndrome, constitute some of the most important chronic problems encountered in a clinical practice. A myofascial trigger point is a hyperirritable spot, usually within a taut band of skeletal muscle, which is painful on compression and can give rise to characteristic referred pain, motor dysfunction, and autonomic phenomena. ⋯ Invasive treatments for myofascial trigger points include injections with local anesthetics, corticosteroids, or botulism toxin or dry needling. The etiology, pathophysiology, and treatment of myofascial trigger points are addressed in this article.
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This article reviews the evidence for several common interventional techniques for the treatment of chronic pain, including: intraspinal delivery of analgesics, reversible blockade with local anesthetics, augmentation with spinal cord stimulation, and ablation with radiofrequency energy or neurolytic agents. The role of these techniques is defined within the framework of a multidisciplinary approach to the neurobehavioral syndrome of chronic pain. Challenges to the study of the analgesic efficacy of procedural interventions are explored, as are the practical issues raised by their clinical implementation, with the aim of helping nonspecialist physicians identify the patients most likely to benefit from these approaches.
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Nonopioid analgesics represent a varied collection of analgesic agents, many of which also possess antipyretic or anti-inflammatory actions. As a group, nonopioid analgesics represent reasonable first-line analgesics for a variety of mild to moderate painful conditions and also often may be useful in conjunction with other analgesics (eg, opioids) for a myriad of severe painful conditions. Clinicians treating pain should be familiar with the actions, adverse effects, and individual agents in the group of nonopioid analgesics.
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Vertebral compression fractures occur more frequently than hip and ankle fractures combined. These fragility fractures frequently result in both acute and chronic pain, but more importantly are a source of increased morbidity and possibly mortality. ⋯ The history, technique, and results of vertebroplasty and kyphoplasty are reviewed. Both methods allow for the introduction of bone cement into the fracture site with clinical results indicating substantial pain relief in approximately 90% of patients.
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Anesthesiology clinics · Dec 2007
ReviewInvasive and minimally invasive surgical techniques for back pain conditions.
This article summarizes current issues related to invasive and minimally invasive surgical techniques for back pain conditions. It describes pain generators and explains theories about how discs fail. ⋯ Problems related to current imaging are also presented. The article concludes with a discussion about physical therapy.