Pain medicine : the official journal of the American Academy of Pain Medicine
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Studies suggest that rape increases risk of medically unexplained pain in women. At present it is not clear whether rape is associated with pain at specific locations or at multiple locations. In this study we tested the hypothesis that rape was associated with a preferential increase in risk of pelvic pain that was not explained by pain at other sites. ⋯ In accord with the localization hypothesis, self-reported rape was uniquely associated with pelvic pain. Future efforts to account for pain in the aftermath of rape must specify a mechanism that can simultaneously cause widespread pain as well as increase risk of localized pain.
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The war in Iraq has resulted in a high incidence of severe extremity injury requiring multiple surgical procedures and extensive rehabilitation. We describe the use of advanced regional anesthesia to meet this significant medical challenge. ⋯ Advanced regional anesthetic techniques allowed for safe perioperative surgical anesthesia and analgesia in the management of the modern combat casualty.
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Randomized Controlled Trial Comparative Study
Comparative effectiveness of cervical transforaminal injections with particulate and nonparticulate corticosteroid preparations for cervical radicular pain.
Cervical transforaminal epidural injections of corticosteroids have been used in the treatment of radicular pain. Particulate agents have been associated with rare adverse neurological outcomes. It is unknown whether nonparticulate preparations are any less effective than particulate preparations. Therefore, a study was designed to determine whether there is a basis for promoting a theoretically safer nonparticulate corticosteroid preparation. ⋯ The study found that the effectiveness of dexamethasone was slightly less than that of triamcinolone, but the difference was neither statistically nor clinically significant. A theoretically safer nonparticulant agent appears to be a valid alternative to particulate agents that have been used to date, and which have been associated with hazard.
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Intrathecal infusion of morphine using implantable pumps is an accepted practice for long-term management of chronic pain. Despite clinical benefit, development of tolerance and side-effects associated with intrathecal morphine has prompted investigators to explore alternative opioids such as the potent anilinopiperidine analogs, fentanyl, and sufentanil. Relevant preclinical and clinical literature from the MEDLINE database was used primarily for this review. ⋯ Preclinical studies of limited duration have demonstrated efficacy, but safety-toxicology studies have been limited to intermittent boluses of sufentanil only. Few clinical reports on the use of intrathecal sufentanil or fentanyl for chronic pain are available. Although results confirm potency and efficacy with intrathecal administration, further studies are needed to support the long-term use of either opioid in chronic pain management.
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To describe a series of older adult patients with postherpetic myofascial pain, a heretofore rarely described complication of herpes zoster. ⋯ Postherpetic pain is traditionally conceptualized as a purely sensory phenomenon. Identification of the intrusion of a myofascial component may be worthwhile, both from the standpoint of enhanced pain relief and reduction in the need for oral analgesics. Formal exploration of this phenomenon is needed.