Pain medicine : the official journal of the American Academy of Pain Medicine
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Available percutaneous procedures for lumbar disk herniation are not sufficiently effective for large herniations. Percutaneous intradiscal high-pressure injection of saline (IDHP) is designed to tear the thinned posterior longitudinal ligament (PLL), leading to significant reduction in mechanical compression of nerves by the herniation. We evaluated the effectiveness of this new therapy for patients with refractory lumbar herniation. ⋯ IDHP leads to prompt relief of pain, with good outcome in patients with lumbar disk large herniation resistant to medical treatment.
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To ascertain the self-reported reasons for participation in the clinical research of chronic low back pain and to evaluate those reasons in the context of informed consent and the concept of therapeutic misconception. This is the belief that research participation is equivalent to clinical care. ⋯ Assessing the adequacy of informed consent requires a thorough understanding of how subjects viewed a study and their reasons for participation. Quantitative-based surveys may not capture the complexities of reasons for study participation. Reasons of personal benefit, seemingly contradictory reasons for participation, or overriding desire for relief may all affect the quality of informed consent. Yet, these issues may not automatically signal the presence of TM.
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Oral ketamine has been found to be effective during invasive procedures in children with malignancy. To the best of our knowledge, analgesic effects of oral ketamine have not been reported in pediatric cancer pain management. We described a patient with end-stage cancer pain that was resistant to opioids and was relieved by oral ketamine.
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Case Reports
Therapeutic pudendal nerve blocks using corticosteroids cure pelvic pain after failure of sacral neuromodulation.
A patient with bladder frequency and urgency associated with pelvic pain had no control of symptoms by previous bladder distention, hysterectomy, or sacral nerve root stimulator. A clinical and neurophysiological diagnosis of pudendal neuropathy was made. Treatment with a nerve protection program and pudendal nerve perineural injections of local anesthetics and corticosteroids has provided total symptomatic relief that is durable.
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Invasive stimulation of the motor cortex has been used for years to alleviate chronic intractable pain in humans. In our study, we have investigated the effect of transcranial direct current stimulation (tDCS), a noninvasive stimulation method, for manipulating the excitability of cortical motor areas on laser evoked potentials (LEP) and acute pain perception. DESIGNS AND SETTINGS: The amplitude of the N1, N2, and P2 LEP components of 10 healthy volunteers were evaluated prior to and following anodal, cathodal, and sham stimulation of the primary motor cortex. In a separate experiment subjective, pain rating scores of 16 healthy subjects in two perceptual categories (warm sensation, mild pain) were also analyzed. ⋯ The possible underlying mechanisms of our findings in view of recent neuroimaging studies are discussed. To our knowledge this study is the first to demonstrate the mild antinociceptive effect of tDCS over the primary motor cortex in healthy volunteers.