Pain physician
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There may be a relationship between proton pump inhibitors (PPIs) and iron absorption. PPIs may decrease the amount of iron absorbed gastrointestinally specifically due to alteration of the pH in the duodenum. Restless legs syndrome (RLS) is a sensorimotor disorder that includes an urge to move legs, accompanied or caused by uncomfortable and unpleasant sensations in the legs; the urge to move begins or worsens during periods of rest or inactivity, the urge to move is partially or totally relieved by movement, and the urge is worse or only occurs at night. ⋯ The authors theorize that there may be a possible correlation between PPIs and the symptoms (e.g. pain) associated with RLS. The authors propose that PPIs, such as omeprazole, may interfere with iron absorption in certain patients and that a subpopulation of patients who develop significant iron deficiency characterized by low serum ferritin levels while on PPIs may also develop RLS-like symptoms (including RLSAP). While there is no robust direct evidence to support any associations of PPIs and iron deficiency or PPIs associated with RLS-like symptoms (including RLSAP), it is hoped that this manuscript may spark research efforts on this issue.
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Appropriate diagnosis is essential in providing proper and effective therapy. The field of diagnostic accuracy tests is dynamic with new tests being developed at a fast pace along with improvement in technology of existing tests on a continuous basis. Well-designed diagnostic test accuracy studies can help in making appropriate health care decisions, provided that they transparently and fully report their participants, tests, methods, and results. ⋯ The validity of all diagnostic techniques has been described with variable accuracy and reliability. Lack of understanding of reference standards and their unavailability with interventional diagnostic techniques and misinterpretation secondary to interpretation bias may adversely influence the applicability of diagnostic interventions. This manuscript provides a review of the literature, a checklist, and a flow diagram describing the preferred way to present the abstract, introduction, methods, results, and discussion sections of the report of an analysis in a systematic review of diagnostic accuracy studies.
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Neurolytic celiac plexus block is a well established intervention to palliate pain, and it potentially improves quality of life in patients suffering from an upper abdominal malignancy, specifically pancreatic cancer. ⋯ It may be beneficial for patients with a history of gastritis, duodenitis or GI bleeding to undergo a careful upper GI evaluation prior to celiac plexus neurolysis.
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Relief of regional, non-appendicular pain, particularly low back pain, through spinal cord stimulation (SCS) has proven challenging. Recently, peripheral nerve stimulation (PNS), also known as peripheral nerve field stimulation (PNFS) depending on the stimulation area, has demonstrated efficacy for the treatment of well-localized, small areas of pain involving the abdomen, inguinal region, pelvis, face, occipital area, and low back. More widespread application of peripheral nerve stimulation has been limited by its narrow field of coverage in a larger group of patients with diffuse or poorly localized pain. ⋯ The use of the PNSCT technique allows for significant analgesia for large painful areas that have been poorly captured using traditional SCS techniques and not considered as an option with the current application of peripheral nerve stimulation.
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Case Reports
Sacral nerve stimulation as a treatment modality for intractable neuropathic testicular pain.
Chronic testicular pain, or "chronic orchalgia," is defined as testicular pain 3 months or longer in duration that significantly interferes with the daily activities of the patient. For patients failing to respond to conservative treatment, microsurgical denervation of the spermatic cord, epididymectomy, and vasovasostomy have all shown a degree of relief. However, these are all invasive procedures and no treatment has proven efficacy when these options fail. ⋯ The above case demonstrates the potential benefit of sacral nerve stimulation with neuropathic intractable testicular pain in a patient that failed conservative treatment. In this case, the patient had exhausted medical and surgical management, including advanced interventional pain options. We were unable to find any previous published cases of neurostimulation used as a modality of treatment for testicular pain, and further studies are needed to gain a better understanding of the efficacy in this setting.