Pain medicine : the official journal of the American Academy of Pain Medicine
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A 47-year-old female was referred for evaluation of chronic lower back pain. A magnetic resonance imaging of her lumbar spine revealed a broad-based disc herniation at L4-L5 with bilateral neural foraminal narrowing. A decision was made to treat her with bilateral L4-5 transforaminal epidural steroid injections. ⋯ Several days after each injection, the patient experienced unusually heavy and painful menstrual bleeding. We postulate that the introduction of exogenous corticosteroids directly into the neuraxial space can initiate a negative feedback loop on the hypothalamic-pituitary-ovarian axis. As a result, this may lead to decreased levels of circulating hormones, resulting in episodes of menorrhagia in the premenopausal population.
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Illness uncertainty (IU) theory proposes that patients with chronic illness may have difficulty adjusting to the illness if there is significant diagnostic or prognostic uncertainty. Two dimensions of IU theory are "lack of information about diagnoses or severity of the illness" (LIDSI) and "complexity regarding the health care system" (CRHCS). The primary objective of this study was then to compare the prevalence of IU in community nonpatients, community patients, and rehabilitation patients without pain/chronic pain patients (CPPs)/acute pain patients (APPs) as represented by two items with possible face validity for LIDSI ("doctors puzzled by my problems,"doctors missed something important") and three items with possible CRHCS face validity ("doctors don't believe me,"I need to prove my problem is real,"doctors think my problems are in my head"). The secondary objectives were to determine if the LIDSI items are associated with the CRHCS items and to develop predictor models for the LIDSI items in APPs and CPPs. ⋯ LIDSI and CRHCS IU is not unusual in nonpatient and patient groups. However, rehabilitation CPPs are at significantly greater risk than community patients for LIDSI and CRHCS IU. LIDSI IU is associated with CRHCS IU, and LIDSI IU is predicted by a large number of items, the most notable of these being perception of not being believed and dissatisfaction with the physician.
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To explore the effect of pain symptoms and improvements in pain on depression outcomes. ⋯ Pain symptoms are present in the majority of depressed primary care patients beginning antidepressant therapy. Pain symptoms are associated with worse depression outcomes, while improvement in pain is associated with significantly better depression outcomes. Attention to comorbid pain may be important in enhancing depression care.
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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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To present a case of inadvertent intradiscal flow during a L4/5 transforaminal epidural steroid injection. ⋯ Flow of contrast indicating needle entry into extruded disc material with filling of the L4/5 disc. CONCLUSION; This case demonstrates the possibility of needle entry into disc material in the presence of a large lateral disc extrusion with cephalad migration during a transforaminal epidural steroid injection.