Pain medicine : the official journal of the American Academy of Pain Medicine
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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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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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Complex regional pain syndrome (CRPS) is a clinical entity that has been termed in numerous ways in the last years. Clinically, CRPS describes an array of painful conditions that are characterized by a continuing (spontaneous and/or evoked) regional pain that is seemingly disproportionate in time or degree to the usual course of any known trauma or other lesion. The pain is regional and usually has a distal predominance of abnormal sensory, motor, sudomotor, vasomotor, and/or trophic findings. ⋯ This combined treatment may be a viable alternative for this syndrome; however, further investigation is needed to determine its reproducibility in large case series.
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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.