Pain medicine : the official journal of the American Academy of Pain Medicine
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A 17-year-old female with type 1 Von Willebrand Disease (vWD) developed left medial calf pain while running track. Over the next 6 months, orthopedic surgery, sports medicine, vascular surgery, and neurology treated her under various working diagnoses; however, the pain, allodynia, coldness, and pale skin color worsened. ⋯ Additional outcome measures were distance of ambulation and assistive device usage; from admission to inpatient rehabilitation to 2 months postdischarge, her weight-bearing tolerance progressed from nonweight-bearing to partial weight-bearing, and ambulation improved from 20 feet with a three-point crutch gait to unlimited distances with a four-point crutch gait. This is the first known case of a bleeding disorder as the likely underlying microvascular pathology associated with CRPS, a theory exposed in 2010.
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Case Reports
Resolution of migraine-like headache by coil embolization of a primitive trigeminal artery aneurysm.
We report a rare case of migraine-like headache associated with an unruptured primitive trigeminal artery (PTA) aneurysm with a coincident finding of anterior cerebral artery (ACA) fenestration. We discuss the possible mechanism of the headache and review the relevant literature. ⋯ Both primitive trigeminal artery aneurysm and fenestration of the cerebrovascular system are rare developmental anomalies. The PTA courses alongside and is in anatomical proximity to the trigeminal nerve. Therefore, PTA aneurysms are more likely to cause symptoms, due to compression of the trigeminal nerve. The trigeminovascular system has been implicated in the genesis of migraine headaches. We propose the high-velocity pulsatile flow through the aneurysm across the surface of the trigeminal nerve as the etiology of the migraine-like headaches. Endovascular embolization might be a preferred procedure for dealing with patients in this setting.
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Erythromelalgia is a rare clinical syndrome characterized by episodic attacks of burning pain, erythema, and increased temperature, primarily affecting the extremities, and in rare instances, involving the ear, face, neck, and the scrotum. The dermatoscopic features of erythromelalgia in a case with solely facial involvement have never been described previously. ⋯ The present case is considered to be a variant of erythromelalgia. Its erythema may be resulted from the dilated vessels. Combination of modalities may provide effective management for erythromelalgia. "Erythermalgia" may be better than "erythromelalgia" to describe such conditions.
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Randomized Controlled Trial Multicenter Study
Single-entity hydrocodone extended-release capsules in opioid-tolerant subjects with moderate-to-severe chronic low back pain: a randomized double-blind, placebo-controlled study.
A single-agent, extended-release formulation of hydrocodone (HC) has been developed for treatment of chronic moderate-to-severe pain. This study was designed to examine the safety and efficacy of HC extended release in opioid-experienced adults with moderate-to-severe chronic low back pain (CLBP). ⋯ Extended-release HC is well tolerated and effective, without acetaminophen-associated risks of liver toxicity, for treatment of CLBP.