Pain medicine : the official journal of the American Academy of Pain Medicine
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Complex regional pain syndrome (CRPS) is a clinical entity that has been termed in numerous ways in the last years. Clinically, CRPS describes an array of painful conditions that are characterized by a continuing (spontaneous and/or evoked) regional pain that is seemingly disproportionate in time or degree to the usual course of any known trauma or other lesion. The pain is regional and usually has a distal predominance of abnormal sensory, motor, sudomotor, vasomotor, and/or trophic findings. ⋯ This combined treatment may be a viable alternative for this syndrome; however, further investigation is needed to determine its reproducibility in large case series.
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Available percutaneous procedures for lumbar disk herniation are not sufficiently effective for large herniations. Percutaneous intradiscal high-pressure injection of saline (IDHP) is designed to tear the thinned posterior longitudinal ligament (PLL), leading to significant reduction in mechanical compression of nerves by the herniation. We evaluated the effectiveness of this new therapy for patients with refractory lumbar herniation. ⋯ IDHP leads to prompt relief of pain, with good outcome in patients with lumbar disk large herniation resistant to medical treatment.
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Clinical Trial
Pregabalin in the treatment of refractory neuropathic pain: results of a 15-month open-label trial.
Neuropathic pain associated with postherpetic neuralgia (PHN) and painful diabetic peripheral neuropathy (DPN) can be intractable and may not respond to commonly used treatments, such as tricyclic antidepressants (TCAs) and opioids. This long-term, open-label study was a preliminary evaluation of pregabalin for patients whose pain had been judged refractory to other treatments for neuropathic pain. ⋯ These results suggest that pregabalin may be beneficial in patients with neuropathic pain who have had an unsatisfactory response to treatment with other medications.
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Fabry disease (FD) is an X-linked lipid storage disorder showing a high prevalence and early occurrence of painful neuropathy. Early detection of this likely underdiagnosed disease is an important approach because a causal therapy is available. ⋯ Thus, somatosensory profiling in male patients with painful extremities may be useful in the detection of FD.
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The aim of this report is to determine the frequency of aberrant drug behaviors and their relationship to substance abuse disorders in a large primary sample of patients receiving opioids for chronic pain. ⋯ Patients who report four or more aberrant drug behaviors are associated with a current substance use disorder and illicit drug use, whereas subjects with up to three aberrant behaviors have a very low probability of a current substance abuse disorder. Four behaviors--oversedated oneself, felt intoxicated, early refills, increase dose on own--appear useful as screening questions to predict patients at greatest risk for a current substance use disorders.