Pain medicine : the official journal of the American Academy of Pain Medicine
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Clinical observation has suggested the presence of ventral cervical extra-articular pain pathways in patients with C1-C2 joint pain. However, the existence of ventral innervation to the C1-C2 joint has not been documented. The objective of this study was to determine whether ventral innervation to the lateral C1-C2 joint exists, and to describe its relational anatomy. ⋯ In this study, two cervical prevertebral plexuses (superficial and deep) were identified that have not previously been described. Terminal branches of the plexuses entered the ventral joint capsule of the lateral C1-C2 joint and were seen approaching the dens. Findings provide and explanation for the clinical observation that electrical stimulation in the C2 ventral gutter can reproduce headache in patients with C1-C2 joint pain.
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Vitamin D inadequacy is associated with medication refractory musculoskeletal pain and neuromuscular dysfunction. This vitamin deficiency could subsist as an unrecognized comorbid condition among patients with chronic pain. The primary objective of this study was to determine the prevalence and clinical correlates of vitamin D inadequacy in patients seeking treatment for chronic pain. ⋯ The prevalence and clinical correlates identified in this pilot study provide the basis for the assertion that vitamin D inadequacy may represent an under-recognized source of nociception and impaired neuromuscular functioning among patients with chronic pain.
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Smoking may be a major problem in chronic low back pain (LBP) patients. The goal of this study was to determine whether smoking status affected multidisciplinary pain facility treatment outcome. ⋯ Current smoking status appears to be associated with poorer treatment outcome after multidisciplinary pain facility treatment. Return to work within smokers is predicted by pain and worker compensation status. Pain facilities should target current smokers with significant perceived pain for close treatment monitoring in an attempt to improve treatment outcome.
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The block of the obturator nerve is used in pain medicine mostly for the management of acute pain after lower limb surgery or for chronic hip pain. The aim of this study was to define an injection technique based on an anatomical investigation and a magnetic resonance (MRI) analysis. ⋯ Based on the above findings, a technique of block of the obturator nerve could be defined. The method has the potential to enable an efficient and safe identification of the target nerve in clinical practice.