Pain physician
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In recent years, transforaminal epidural injections have emerged as an alternative to interlaminar and caudal epidural steroid injections. The rationale for utilizing transforaminal epidural injections has been described for diagnostic as well as therapeutic purposes. The evidence for lumbar transforaminal epidural steroid injections in managing lumbar nerve root pain is strong, whereas it is moderate in managing cervical nerve root pain. However, these techniques are also associated with rare, but catastrophic, neurologic complications. ⋯ This case report describes vascular injury leading to an infarction of the spinal cord following a thoracolumbar transforaminal epidural steroid injection. Alternative approaches to, or alternatives means of, performing transforaminal injections should be considered to avoid devastating neurological complications.
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Meralgia paresthetica is a clinical syndrome of pain, dysesthesia or both, in the anterolateral thigh. It is associated with an entrapment mononeuropathy of the lateral femoral cutaneous nerve. Diagnosis of meralgia paresthetica is typically made clinically and is based on the characteristic location of pain or dysesthesia, sensory abnormality on exam, and absence of any other neurological abnormality in the leg. The majority of patients with meralgia paresthetica respond well to conservative treatment. ⋯ An implanted spinal cord stimulator may be an ideal treatment for intractable meralgia paresthetica after conservative treatments have failed because it is not destructive and can always be explanted without significant permanent adverse effects.
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Multiple studies have documented the incidence of illicit drug use and abuse of opioids. Over the years, several hypotheses have been proposed. Short-acting opioids such as hydrocodone are generally considered to predispose patients to poor pain management, dependency, misuse, or abuse; whereas long-acting opioids such as methadone are thought to provide sustained pain management without dependency or abuse. ⋯ There were no significant differences as to illicit drug use and/or misuse of opioids in patients treated with hydrocodone or methadone. These findings suggest that the use of a long acting opioid formulation by patients with chronic pain does not reduce the risk of drug abuse or improve compliance with medical therapy.
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Sedation is commonly provided for patients undergoing interventional pain management procedures. Although many pain management interventionalists have trained in anesthesiology, the use of sedatives, analgesics and hypnotics, as well as monitoring techniques, may vary considerably between practices. This review provides an update on recent advances in the pharmacology of drugs commonly used for sedation, anxiolysis and analgesia. ⋯ In addition to providing the right drug for the procedure, patient monitoring must be appropriate for the patient and the clinical circumstances. Undertaking a sedation analgesic course of therapy in support of an interventional procedure will require that patients are monitored appropriately during the course of treatment. Guidelines for monitoring patients during sedation are available.
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This case report identifies a patient with complex regional pain syndrome Type 2 (causalgia) with sympathetically maintained pain in a distal extremity associated with an anterior sacroiliac fusion with local bone graft. ⋯ Complex regional pain syndrome Type 2 with sympathetically maintained pain is a condition that can result in serious disability and can be associated with spinal procedures and sacroiliac arthrodesis. Early intervention is recommended to provide long-term resolution of the condition.