Pain medicine : the official journal of the American Academy of Pain Medicine
-
Case Reports
Successful treatment of phantom radiculopathy with fluoroscopic epidural steroid injections.
Phantom limb pain has been well described in the literature. However, new-onset lumbar radicular pain superimposed on baseline lower extremity phantom pain is a clinical scenario that can be challenging to recognize. Furthermore, literature on recognition and treatment of phantom radiculopathy is all but lacking. We present a patient who experienced new-onset lumbar radiculopathy superimposed on her phantom pain that was successfully treated with fluoroscopic interlaminar and transforaminal epidural steroid injections.
-
For lack of a criterion standard for lumbar discogenic pain, the validity of lumbar discography cannot be determined directly. The false-positive rate of discography, however, can be inferred from the prevalence of positive responses in asymptomatic volunteers. Responses in normal volunteers have been reported in only three studies, and the prevalence of positive responses has been "occasionally, zero, and 10%." None of these studies, however, controlled for both pressure of injection and intensity of response. ⋯ Lumbar discs in asymptomatic volunteers can be made painful, but as a rule, the pain is mild and requires high pressures of injection. If attention is paid to pressure of injection and intensity of response, operational criteria can be defined that provide lumbar discography with a potential false-positive rate of zero or less than 10%.
-
The long-term use of sustained-release morphine for chronic pain was examined by reviewing charts from 68 patients taking Kadian (morphine sulfate sustained-release capsules; Alpharma U. S. Human Pharmaceuticals Branded Products Division, Piscataway, NJ) from 1998 to 2003 (mean treatment period 12 months). ⋯ Dosing frequency was in accordance with prescribing information for 97.1% of patients; over half of these patients were maintained on a once-daily dose. Mean pain scores (visual numeric scale of 0-10) at the end of the observation period were reduced from a baseline mean of 7.7-4.9. Kadian use did not result in escalation of dose strength or frequency, and was safe and efficacious regardless of patient age.
-
Comparative Study
Disparities between black and white patients with cancer pain: the effect of perception of control over pain.
Pain continues to be a problem in ambulatory patients with cancer. Disparities in minority patients with pain have been previously identified. ⋯ Perception of control over pain is an important factor in understanding responses to pain. Increasing a patient's perception of control over pain may decrease disparities and increase functional status.
-
Comparative Study
Alexithymia and pain in three chronic pain samples: comparing Caucasians and African Americans.
African Americans often report greater pain than do Caucasians, but the factors responsible for this discrepancy are not known. We examined whether alexithymia-the trait of difficulty identifying and describing one's feelings and lacking introspection-may contribute to this ethnic group difference. We tested whether the mean level of alexithymia is higher, and whether alexithymia and pain are more highly correlated, among African Americans than among Caucasians in patients with chronic pain disorders. ⋯ Alexithymia is more correlated with pain severity among African Americans with chronic pain disorders than among Caucasians, potentially contributing to the higher pain reports among African Americans.