Current review of pain
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Tremendous progress has been made in the understanding of neural pathways and tissues involved in back pain, and new treatment techniques for back pain have evolved. This article focuses on a technique called epidural neuroplasty (lysis of epidural adhesions). Originally performed as a single-catheter technique using the caudal approach, this technique now features a number of variations. These variations include emphasis on anterior placement of the catheter tip, use of a transforaminal approach, and use of one or two catheters.
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Current review of pain · Jan 1999
Subarachnoid Techniques for Cancer Pain Therapy: When, Why, and How?
For cancer patients who obtain inadequate pain relief with conservative treatment, there is a growing list of effective options for subarachnoid therapy. Morphine and bupivacaine have been the most frequently used drugs for intrathecal infusion, and their use has consistently yielded good results. ⋯ In addition to new drug options, there are various catheter delivery systems from which to choose. In reviewing the literature and experience to date with these various medications and delivery systems, we hope to better aid the clinician in tailoring the best treatment for each patient.
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Current review of pain · Jan 1999
Spinal Cord Stimulation: Indications, Mechanism of Action, and Efficacy.
Unrelieved pain is costly to the economic fabric of our society; its direct costs to patients and their families is staggering. Spinal cord stimulation for the treatment of chronic pain is cost-effective when used in the context of a pain treatment continuum. Many theories on the mechanism of action of spinal cord stimulation have been suggested, including activation of gate control mechanisms, conductance blockade of the spinothalamic tracts, activation of supraspinal mechanisms, blockade of supraspinal sympathetic mechanisms, and activation or release of putative neuromodulators. Whatever theory or theories of mechanism are correct, spinal cord stimulation has efficacy in the treatment of failed back surgery syndrome, complex regional pain syndromes, intractable pain due to peripheral vascular disease, and intractable pain due to angina.
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Current review of pain · Jan 1999
Direct Evidence of Nociceptive Input to Human Anterior Cingulate Gyrus and Parasylvian Cortex.
Many lines of evidence implicate the anterior cingulate cortex (ACC, Brodmann's area 24) and parasylvian cortex in pain perception. Clinical studies demonstrate alterations in pain and temperature sensation after lesions of these structures. Imaging studies reveal increased blood flow in ACC and parasylvian cortex, both ipsilateral and contralateral to painful stimuli. ⋯ However, these studies incorporate multiple assumptions and therefore do not establish the presence of nociceptive inputs to ACC and parasylvian cortex. We review our recent reports of intracranial potentials evoked by painful stimuli. These studies provide direct evidence of nociceptive inputs to the human ACC and parasylvian cortex.
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Current review of pain · Jan 1999
Facet Joint Pain and the Role of Neural Blockade in Its Management.
Chronic spinal pain is a common medical problem with serious financial and social consequences. Among the various structures with potential for producing pain in the spine, facet joints as sources of chronic spinal pain have attracted considerable attention and controversy. Significant progress has been made in precision diagnosis of spinal pain with neural blockade, in the face of less than optimal diagnostic information offered by imaging and neurophysiologic studies. ⋯ Lumbar intra-articular steroid injections have been proven effective to a certain extent, but evidence indicates that cervical intra-articular steroids are ineffective. The role of repeat medial branch blocks is not known. Radiofrequency neurotomy remains the only practical and validated treatment for cervical facet joint pain; however, its role in management of either lumbar or thoracic facet joint pain awaits validation.