Pain medicine : the official journal of the American Academy of Pain Medicine
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Randomized Controlled Trial Multicenter Study
Maintenance of effect of duloxetine in patients with chronic low back pain: a 41-week uncontrolled, dose-blinded study.
To assess the maintenance of the effect of duloxetine in the treatment of chronic low back pain. ⋯ In this study, the analgesic effect of duloxetine in patients with chronic low back pain was not only maintained for 41 weeks, but additional statistically significant improvement in pain and function was observed.
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A 47-year-old female was referred for evaluation of chronic lower back pain. A magnetic resonance imaging of her lumbar spine revealed a broad-based disc herniation at L4-L5 with bilateral neural foraminal narrowing. A decision was made to treat her with bilateral L4-5 transforaminal epidural steroid injections. ⋯ Several days after each injection, the patient experienced unusually heavy and painful menstrual bleeding. We postulate that the introduction of exogenous corticosteroids directly into the neuraxial space can initiate a negative feedback loop on the hypothalamic-pituitary-ovarian axis. As a result, this may lead to decreased levels of circulating hormones, resulting in episodes of menorrhagia in the premenopausal population.
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Chinese is the most commonly spoken language in the world, and back pain is as prevalent in China as it is elsewhere. Nevertheless, there is a paucity of measures in Chinese to evaluate back pain treatment. We assemble a set of Chinese measures to evaluate outcomes in diverse domains. A set of measures is necessary, because measures in one domain may vary independently from measures in another. Chinese measures are in four domains: pain intensity, global rating of improvement, physical disability, and emotional functioning. The Oswestry Disability Index (ODI) represents the domain of physical disability, and both the World Health Organization Five-Item Well-being Index (WHO-5) and the Center for Epidemiological Studies-Depression Scale (CES-D depression scale) represent the domain of emotional functioning. ⋯ In the Appendix (available online, in supplemental materials for this article), we present the West China Hospital set of measures in Chinese to evaluate back pain treatment.
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Case Reports
A novel CT-guided transpsoas approach to diagnostic genitofemoral nerve block and ablation.
Inguinal hernia repair is associated with a high incidence of chronic postsurgical pain. This pain may be caused by injury to the iliohypogastric, ilioinguinal, or genitofemoral nerves. It is often difficult to identify the specific source of the pain, in part, because these nerves are derived from overlapping nerve roots and closely colocalize in the area of surgery. It is therefore technically difficult to selectively block these nerves individually proximal to the site of surgical injury. In particular, the genitofemoral nerve is retroperitoneal before entering the inguinal canal, a position that puts anterior approaches to the proximal nerve at risk of transgressing into the peritoneum. We report a computed tomography (CT)-guided transpsoas technique to selectively block the genitofemoral nerve for both diagnostic and therapeutic purposes while avoiding injury to the nearby ureter and intestines. ⋯ CT-guided transpsoas genitofemoral nerve block is a viable option for safely and selectively blocking the genitofemoral nerve for diagnostic or therapeutic purposes proximal to injury caused by inguinal surgery.
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Randomized Controlled Trial
Double-blinded, placebo-controlled, prospective randomized trial evaluating the efficacy of paravertebral block with and without continuous paravertebral block analgesia in outpatient breast cancer surgery.
Paravertebral block (PVB) is an effective alternative to general anesthesia for breast cancer surgery. Continuous paravertebral block (CPVB) anesthesia may extend postoperative analgesia at home and improve quality of early postoperative recovery of breast cancer patients. ⋯ The current study does not support the routine use of continuous paravertebral catheter anesthesia in patients undergoing operative treatment for breast cancer.