Pain medicine : the official journal of the American Academy of Pain Medicine
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The primary aim was to evaluate the prevalence of inadvertent intradiscal injection during fluoroscopically guided contrast-enhanced lumbar transforaminal epidural steroid injections. The secondary aim was to determine if there are any risk factors for or adverse events as a result of inadvertent intradiscal contrast injection. ⋯ Intradiscal contrast injection is an infrequently reported event during lumbar transforaminal epidural steroid injections. Our data support that the prevalence is very low and there might be an association with ipsilateral foraminal stenosis. Although there is potential for significant adverse complications with intradiscal injection, our data set did not show serious sequelae.
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"They don't want anything to do with you": patient views of primary care management of chronic pain.
Chronic pain is one of the most frequent complaints of patients in primary care, yet both patients and providers report low satisfaction with chronic pain care. This study was designed to explore the views held by a diverse sample of patients with chronic pain complaints about their care experiences to identify ways to improve care. ⋯ Implementing patient-centered approaches in caring for individuals with chronic pain and using principles drawn from the chronic disease management model to improve care systems may improve both patient and provider satisfaction with chronic pain care.
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The purpose of this study was to better characterize the intraforaminal location of the great anterior radiculomedullary artery (artery of Adamkiewicz [AKA]) within the neural foramen that would allow safer targeting of thoracic and lumbar transforaminal epidural steroid injections. ⋯ The AKA was overwhelmingly located in the superior aspect of the neural foramen. Contrary to traditional teaching, the safest needle placement for an epidural steroid injection, particularly at L3 and above, may not be in the superior aspect of the foramen, but rather in an inferior and slightly posterior position within the foramen and relative to the nerve.
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Multicenter Study
Predictors and patterns of chronic pain three months after cardiac surgery in Taiwan.
Clinicians and researchers have a very limited understanding of how acute pain after cardiac surgery may develop into chronic pain. The aims of this study were to describe the pattern of pain during the first 3 months after cardiac surgery and to examine the predictors of surgery-related chronic pain. ⋯ Patients reporting a pattern of increasing pain starting about 10 days after surgery and holding negative beliefs about opioid use are at risk of developing chronic pain and may require more careful monitoring and pain treatment. The possible benefits of interventions that minimize pain during the weeks after surgery and that alter negative beliefs about opioid use should be examined in future research.
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Understanding the actions of opioids now encompasses pronociceptive as well as antinociceptive mechanisms. Opioid-induced hyperalgesia (OIH) refers to increased pain sensitivity due to high-dose or prolonged opioid exposure. It has become more important as patients with pain remain on opioids at higher doses for longer periods of time. One setting that highlights the dilemma of OIH is in the opioid-tolerant patient who is hospitalized for painful medical conditions or procedures and is unable to achieve adequate analgesia despite escalating opioid doses. This patient population often requires agents that act synergistically with opioids through different mechanisms to achieve analgesia. Dexmedetomidine is an alpha-2 adrenergic agonist that has been shown to synergize with opioids. ⋯ The cases presented provide support for the clinical utility of alpha-2 agonists during opioid dose reduction in patients with OIH as well suggesting that they may contribute to the recovery of normal nociceptive and antinociceptive responses.