Pain medicine : the official journal of the American Academy of Pain Medicine
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US soldiers injured in Iraq, and civilian burn trauma patients are treated at the US Army Institute of Surgical Research. Burn patients experience extreme pain during wound care, and they typically receive opioid analgesics and anxiolytics for debridement. Virtual Reality (VR) has been applied as an adjunct to opioid analgesics for procedural pain. We describe the first use of ketamine combined with immersive VR to reduce excessive pain during wound care. ⋯ Results from these first two cases suggest that a moderate dose of ketamine combined with immersive virtual reality distraction may be an effective multimodal analgesic regimen for reducing acute procedural pain during severe burn wound cleaning.
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Intrathecal pump drug refill may result in significant adverse outcome and complications. Thus far, 351 reports from around the world have been received by Medtronic Inc. related to occurrence of pocket fill, including eight lethal events. Ultrasound-assisted pump port access has been previously described, but did not result in wide acceptance in routine practice due to cumbersome and unreliable setup. This study outlines the methodology of real-time ultrasound-guided pump refill. ⋯ Ultrasound-guided intrathecal pump access is a feasible and simple technique that may improve maintenance, routine device care, and prevent serious complications related to erroneous subcutaneous injections of concentrated medications. Clinical validation will be necessary in the future.
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Pain perception is affected by psychological, social, medical, and environmental conditions, and contributes to the patient's treatment satisfaction and response. Better understanding of pain perception will likely improve pain assessment and treatment selection. The objective of this study was to define a range of verbal and nonverbal pain responses to a clinical stimulus in a clinical population. ⋯ This study shows normal distribution of verbal pain response to a clinical pain stimulus in a clinical population. Body movement and anxiety correlated with verbal pain intensity ratings. Subcutaneous injections of lidocaine may be a useful model for exploration of pain sensitivity in a clinical population.
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The present study was performed to ascertain whether sacroiliac joint (SIJ) pain represents a potential source of pain in patients who have undergone lumbar or lumbosacral fusions. ⋯ SIJ pain is a potential source of pain after lumbar and lumbosacral fusion surgeries. Provocating SIJ maneuvers represent reliable tests for SIJ pain. The characteristics of postoperative SIJ pain frequently differ from those of preoperative pain.
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Clinical Trial
Percutaneous radiofrequency treatment for refractory anteromedial pain of osteoarthritic knees.
Although severe knee osteoarthritis with refractory pain is commonly treated surgically, this is often not an option for patients with poor health status or unwillingness to undergo major surgery. We examined the efficacy of radiofrequency application to sensory nerves as a novel alternative treatment for refractory knee pain. ⋯ Some patients were able to benefit substantially from radiofrequency treatment. Even if its effective period is limited, radiofrequency application is a promising treatment to alleviate refractory anteromedial knee pain with osteoarthritis. Further experience and technical improvements are needed to establish its role in the management of knee osteoarthritis.