Pain medicine : the official journal of the American Academy of Pain Medicine
-
The objective of the study was to collect data on the direct and indirect economic cost of chronic pain among patients attending a pain management clinic in Ireland. ⋯ The cost of chronic pain among intensive service users is significant, and when extrapolated to a population level, these costs represent a very substantial economic burden.
-
Patients with lumbosacral spinal stenosis (LSS) do not always obtain satisfactory pain relief from transforaminal epidural steroid injection (TFESI) because perineural/epidural adhesions prevent the spread of injectate into the epidural space. Percutaneous adhesiolysis (PA) can eliminate the deleterious effects of adhesion. This study was to evaluate the effectiveness of PA among patients with LSS refractory to TFESI and to ascertain the prognostic factors determining PA efficacy. ⋯ PA may be a useful treatment in patients with LSS refractory to TFESI and reduce the surgical requirement. Previous surgery, spondylolisthesis, and foraminal stenosis may be associated with poor prognosis.
-
We examined stereotyping of chronic pain sufferers among women aged 18-40 years and determined whether perceived stereotyping affects seeking care for women with chronic vulvar pain. ⋯ Perceived negative stereotyping among chronic pain sufferers is common, particularly negative perceptions about physicians. In fact, chronic vulvar pain sufferers who felt stigmatized were more likely to have sought care than those who did not feel stigmatized.
-
Clinical Trial
MRI verification of ultrasound-guided infiltrations of local anesthetics into the piriformis muscle.
Patients presenting with buttock pain syndromes are common. Up to 8% of these conditions may be attributed to piriformis syndrome. Included in several therapeutic and diagnostic approaches, injections directly into the piriformis muscle may be performed. Because the muscle lies very close to neurovascular structures, electromyographic, fluoroscopic, computed tomographic, and magnetic resonance imaging (MRI) guidance have been employed. In few studies, an ultrasound-guided technique was used to inject a local anesthetic into the piriformis muscle without impairing adjacent neuronal structures. ⋯ MRI confirmed the correct placement of the local anesthetic within the muscle. The dispersion of the fluid 30 minutes after the injection could be visualized. Moreover, only one subject experienced slight motor deficits without anatomical correlate. This ultrasound-guided method will be further employed in ongoing clinical studies.
-
To assess the cost impact of dose escalation with intrathecal drug therapy and polyanalgesic admixtures and determine if increased cost is justified by improved pain control. ⋯ Polyanalgesia, while more costly, is justified based on its effectiveness in restoring pain control. Superior results are achieved when polyanalgesia is initiated early. Cost modeling enabled price prediction for the purposes of developing program budgets.