Pain medicine : the official journal of the American Academy of Pain Medicine
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To assess the efficacy of fluoroscopically guided, contrast-enhanced lumbar interlaminar epidural steroid injections (IL-ESI) for lower limb pain greater than axial low back pain using self-reported pain scores. ⋯ This prospective, single-arm pilot study demonstrates that subjects who have had fluoroscopically guided, contrast-enhanced lumbar IL-ESIs for radicular > axial pain can have improved (lowered) NPRS for at least 3 months. It would be worthwhile to pursue a more rigorous study.
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Case Reports
Continuous transversus abdominis plane (TAP) block catheters in a combat surgical environment.
The ongoing conflict in Afghanistan continues to generate a large number of complex trauma injuries and provides unique challenges to military anesthetists working in forward field hospitals. We report successful use of ultrasound-guided continuous transversus abdominis plane (TAP) block in two Afghan war casualties who sustained major trauma with coagulopathy. The use of bilateral continuous TAP blocks following major thoracoabdominal trauma in a combat environment is unique in the literature. ⋯ A continuous TAP block technique can be utilized to provide excellent analgesia following major abdominal surgery when neuraxial anesthesia is contraindicated. The TAP block's ease of placement under ultrasound guidance makes this technique particularly useful in the austere battlefield hospital environment.
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Randomized Controlled Trial Multicenter Study
A novel 12-week study, with three randomized, double-blind placebo-controlled periods to evaluate fentanyl buccal tablets for the relief of breakthrough pain in opioid-tolerant patients with noncancer-related chronic pain.
To evaluate the time of onset, overall efficacy, and safety of fentanyl buccal tablet (FBT) for noncancer-related breakthrough pain (BTP) in opioid-tolerant adults over 12 weeks. ⋯ FBT showed continued clinically important analgesic effects and was generally well tolerated over 12 weeks of treatment.
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Randomized Controlled Trial
Botulinum toxin A for treatment of allodynia of complex regional pain syndrome: a pilot study.
To investigate the efficacy and tolerability of Botulinum toxin A (BoNT-A) in allodynia of patients with complex regional pain syndrome. ⋯ Intrademal and subcutaneous administration of BoNT-A into the allodynic skin of the patients with complex regional pain syndrome (CRPS) failed to improve pain and was poorly tolerated.
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There is a renewed interest in analgesic testing, influenced by several studies reporting robust surgical results when the diagnosis of discogenic pain is confirmed by relief of pain post-provocative discography after injecting local anesthetic into painful discs. ⋯ Using an equal mixtures of injected local anesthetic and contrast during provocative discography in a cohort of patients did not provide significant overall subjective pain relief compared to using contrast alone in a comparative separate cohort.