Pain medicine : the official journal of the American Academy of Pain Medicine
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Randomized Controlled Trial Comparative Study
Efficacy of interlaminar vs transforaminal epidural steroid injection for the treatment of chronic unilateral radicular pain: prospective, randomized study.
OBJECTIVE, DESIGN AND SETTINGS: The purpose of this randomized, prospective study is to compare the efficacy of two different routes in administering epidural steroid injections interlaminar (IL) vs transforaminal (TF) in patients with unilateral radicular pain. ⋯ Using either route of epidural injections to deliver steroids for unilateral chronic radiculopathy secondary to herniated intervertebral disc provided significant improvements in patients function and pain relief. However, we could not find a statistically significant difference between two indicated groups either in functional improvement or in reduction in pain, although half-dose of steroids delivered via TF route provided somewhat better long-term pain relief and functional capacity improvements.
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There has been a growing recognition of the need for better pharmacologic management of chronic pain among older adults. To address this need, the National Institutes of Health Pain Consortium sponsored an "Expert Panel Discussion on the Pharmacological Management of Chronic Pain in Older Adults" conference in September 2010 to identify research gaps and strategies to address them. Specific emphasis was placed on ascertaining gaps regarding use of opioid and nonsteroidal anti-inflammatory medications because of continued uncertainties regarding their risks and benefits. ⋯ Addressing the gaps presented in the current report was judged by the panel to have substantial potential to improve the health and well-being of older adults with chronic pain.
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Review Case Reports Clinical Trial
Peripheral nerve field stimulation for chronic pain: 100 cases and review of the literature.
To evaluate the clinical outcomes of 100 consecutive patients receiving peripheral nerve field stimulation (PNFS) for the treatment of chronic intractable pain. ⋯ This prospective 100 consecutive PNFS patient outcome study demonstrates that PNFS can be a safe and effective treatment option for, otherwise, intractable chronic pain conditions. PNFS has the potential to fundamentally change the way we think about pain management.
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Randomized Controlled Trial Comparative Study
Pre-incisional analgesia with intravenous or subcutaneous infiltration of ketamine reduces postoperative pain in patients after open cholecystectomy: a randomized, double-blind, placebo-controlled study.
In literature, there is controversy on the use of ketamine for management of postoperative pain. The aim of the present study was to evaluate the efficacy of pre-incisional intravenous or subcutaneous infiltration of ketamine on postoperative pain relief after open cholecystectomy. ⋯ A 2 mg/kg dose of subcutaneous infiltration ketamine or 1 mg/kg dose of intravenous ketamine given at approximately 15 minutes before surgery provides an adjunctive analgesia during 24 hours after surgery in patients undergoing cholecystectomy surgery.
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Review Case Reports
Spinal cord stimulation utilization to treat the microcirculatory vascular insufficiency and ulcers associated with scleroderma: a case report and review of the literature.
To report a case of scleroderma with associated Raynaud's phenomenon and its successful treatment with spinal cord stimulation. To demonstrate the use of transcutaneous oxygen pressure monitoring to guide the progression from trial to implantation and to assess post-implantation microcirculatory recovery. ⋯ We report the healing of a greater than 3-cm ischemic ulcer in an individual with normal macrocirculation but severe microcirculatory insufficiency from scleroderma. Improvements in microcirculation correlated with wound healing. Spinal cord stimulation may be considered for select individuals with microcirculatory reserves that can be modulated with treatment.