Pain medicine : the official journal of the American Academy of Pain Medicine
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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.
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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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Clinical Trial
Intrathecal midazolam as supplementary analgesia for chronic lumbar pain--15 years' experience.
The antinociceptive effect of intrathecal midazolam is based on its affecting spinal gamma-amino butyric acid receptors. ⋯ Intrathecal midazolam is a useful supplement to standard analgesic therapy with opioids, non-opioids, or spinal steroids.
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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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We report a case of malignancy-related testicular pain successfully treated by placement of spinal cord stimulator electrodes. Effective analgesia was provided by epidural lead placement over the dorsal columns. The rationale for our technique was based on contemporary understanding of spinal cord stimulation mechanism in conjunction with analysis of our patient's anatomical lesion location. ⋯ Testicular pain may be difficult to treat particularly in patients unable to tolerate opioid analgesics. In cases that have failed conservative therapy, a trial of spinal cord stimulation should be explored.