Pain medicine : the official journal of the American Academy of Pain Medicine
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Lower-limb edema is recognized as an untoward side effect of intrathecal opioid therapy. Cellulitis, an acute, spreading pyogenic inflammation of the dermis and subcutaneous tissue, predisposed by persistent leg edema, can become problematic in patients on intraspinal opioid infusion therapy. ⋯ Intrathecal Baclofen and Clonidine may be used as alternatives to provide spinally mediated antinociception when intraspinal opioid fails due to pharmacological side effects such as persistent edema.
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In response to the Accreditation Council for Graduate Medical Education's (ACGME) new pain medicine fellowship requirement, which emphasizes multidisciplinary training strategies aimed at providing improved clinical care for pain patients, we developed a multidisciplinary team training education model for trainees in our institution's Fellowship Program in Pain Medicine. Although the biopsychosocial model guides the delivery of care by multidisciplinary pain teams, there is a gap on how to improve team attitudes and functioning within an already extensive pain medicine curriculum. The current study aimed to fill that gap by developing and incorporating an educational model that focuses on interpersonal relationships among team members and strategies for improving team performance over time. ⋯ Mean assessment scores increased from the beginning of the fellowship to the end of the fellowship on interdisciplinary pain team knowledge, current team skills, and attitude toward health care teams. The current study demonstrated effective ways for assessing team attitudes and functioning and including this educational component into a 1-year pain medicine curriculum. Based on our results, we will continue to teach and model effective teamwork in an effort to enhance our trainees' attitudes toward working on an interdisciplinary pain team.
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Randomized Controlled Trial Comparative Study
Clinical effectiveness of botulinum toxin A compared to a mixture of steroid and local anesthetics as a treatment for sacroiliac joint pain.
The sacroiliac joint (SIJ) is one of the sources of low back pain and referred pain to the lower limb. Steroid injections have been used to treat SIJ pain, but this frequently necessitates repeated injections. Botulinum toxin (BT) type A has been shown to provide significant reduction of joint pain, and functional improvements. This study investigated the efficacy of BT for reducing SIJ pain and maintaining a clinical effect, compared with steroid injections. ⋯ BT shows clinical usefulness in pain reduction and for functional improvement in patients with SIJ pain. This effect was maintained for 3 months following the injection, by which time the effects of TA had diminished.
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The primary aim of the present study was to investigate whether there is a relationship between central hypersensitivity (assessed by pressure pain thresholds of uninjured tissues) and intradiscal pain threshold during discography. The secondary aim was to test the hypothesis that peripheral noxious stimulation dynamically modulates central hypersensitivity. ⋯ Central hypersensitivity may influence intradiscal pain threshold, but with a modest quantitative impact. The diagnostic value of provocation discography is therefore not substantially impaired. Regional, but not generalized central hypersensitivity is dynamically modulated by ongoing peripheral nociceptive input.
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Randomized Controlled Trial Multicenter Study
Maintenance of effect of duloxetine in patients with chronic low back pain: a 41-week uncontrolled, dose-blinded study.
To assess the maintenance of the effect of duloxetine in the treatment of chronic low back pain. ⋯ In this study, the analgesic effect of duloxetine in patients with chronic low back pain was not only maintained for 41 weeks, but additional statistically significant improvement in pain and function was observed.