Pain medicine : the official journal of the American Academy of Pain Medicine
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Case Reports
Treatment of Ulnar Neuropathic Pain with Peripheral Nerve Stimulation: Two Case Reports.
Ulnar neuropathy is a condition that manifests with symptoms of neuropathic pain, numbness, tingling, and even possible motor deficits in the ulnar distribution of the arm. This debilitating painful condition may be refractory to conservative, pharmacologic, and surgical interventions. Peripheral nerve stimulation (PNS) technology has advanced significantly in recent years allowing for conditions such as ulnar neuropathy to be treated in a minimally invasive manner. ⋯ The patients also experienced significant improvement in functional outcomes, including return to employment, ability to perform activities of daily living without any impairment, and improved quality of life measures. While the results presented in our two case reports are promising, we only provide observational data over a 6 to 15-month period post-implantation. Future well-powered, large-scale, and long-term randomized controlled trials are warranted to determine efficacy and long-term pain and functional outcomes from PNS therapy for treatment of ulnar neuropathy.
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Clinical outcomes following lumbar medial branch radiofrequency ablation (RFA) have been inconsistent. One possible reason is less-than-optimal placement of the electrode along the medial branch at the lateral neck of superior articular process (SAP). Needle angles that define optimal placement (i.e., parallel to the medial branch) may be helpful for consistent technical performance of RFA. Despite its importance, there is a lack of anatomical studies that quantify RFA needle placement angles. ⋯ Variability of needle angles suggest a standard "one-size-fits-all" approach may not be the optimal technique. Future research is necessary to determine optimal patient-specific needle angles from a more detailed and granular analysis of fluoroscopic landmarks.
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Meta Analysis
Size reduction of the right amygdala in chronic pain patients with emotional stress: A systematic review and meta-analysis.
The structural impact of chronic pain on amygdala in chronic pain (CP) patients remains unclear, although major depression and anxiety are known to be associated with its increase and decrease in size, respectively. This study aimed at examining the relationship between emotional stress and amygdala size in CP patients. The effects of mediating and moderating variables were also examined. ⋯ Besides, pain from a single body region was more likely to impact the amygdala size compared to diffuse pain (P = .02). Regression analysis revealed no significant association between continuous variables (age, gender, pain duration/intensity) and amygdala size. Our findings demonstrated that emotional stress was associated with a reduced right amygdala size in CP patients.
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Patients within the safety net, defined as gap healthcare services for un- or under-insured persons, disproportionately suffer high impact chronic pain. The purpose of this review was to examine pain-related outcomes from multidisciplinary programs for patients with chronic pain within the safety net. A scoping review was conducted based on the Arksey and O'Malley framework coupled with the Preferred Reporting Items for Systematic reviews and Meta-Analyses-Scoping Review checklist. ⋯ Of the studies that employed quantitative measures, most demonstrated improvements in pain-related outcomes post-intervention, although not all statistically significant. Multidisciplinary pain programs may be of benefit to safety net patients with chronic pain. Further data collection is needed to determine the efficacy of these programs.