Pain physician
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Randomized Controlled Trial Comparative Study
Comparative effectiveness of a one-year follow-up of thoracic medial branch blocks in management of chronic thoracic pain: a randomized, double-blind active controlled trial.
Thoracic facet joints have been implicated as the source of chronic pain in the mid back or upper back in 34% to 42% of patients when the modified criteria of the International Association for the Study of Pain (IASP) is utilized. Various therapeutic techniques utilized in managing chronic thoracic pain of facet joint origin include intraarticular injections, medial branch blocks, and radiofrequency neurotomy of thoracic medial branch nerves. ⋯ NCT00355706.
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Randomized Controlled Trial Comparative Study
Reduced cognitive and psychomotor impairment with extended-release oxymorphone versus controlled-release oxycodone.
Opioids provide effective pain control, yet have risks including adverse events (AEs) (e.g., constipation, nausea/vomiting, sedation) and cognitive/psychomotor effects. ⋯ Single oral intact low and high doses of OM-ER produced less cognitive and psychomotor impairment plus less sedation than equianalgesic OC-CR in this exploratory study. ClinicalTrials.gov registration NCT00955110.
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Case Reports
Phantom radiculitis effectively treated by fluoroscopically guided transforaminal epidural steroid injections.
Lower back and extremity pain in the amputee patient can be challenging to classify and treat. Radicular compression in a patient with lower limb amputation may present as or be superimposed upon phantom limb pain, creating diagnostic difficulties. Both patients and physicians classically find it difficult to discern phantom sensation from phantom limb pain and stump pain; radicular compression is often not considered. ⋯ Lumbar radiculitis in lower extremity amputee patients may be difficult to differentiate from baseline phantom limb pain. When conservative techniques fail, fluoroscopically guided spinal nerve injection may be valuable in determining the etiology of lower extremity pain. Our experience supports the notion that epidural steroid injections can effectively treat phantom lumbar radiculitis in lower extremity amputees.
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Case Reports
Osteoid osteoma and osteoblastoma of the cervical spine: the cause of unusual persistent neck pain.
The most important symptom in patients with osteoid osteoma and osteoblastoma is a resistant localized neck pain and stiffness in the spine. ⋯ Surgical treatment of osteoid osteoma and osteoblastoma of the spine has been standardized. The most common symptom of osteoid osteoma and osteoblastoma of the cervical spine is local persistent neck pain in the region of the tumor. This symptom can be significant in the diagnosis of these tumors.
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Many studies have reported lead migration and breakage as complications of epidural spinal cord stimulation. In cases where rapid changes in physique such as those caused by pregnancy are expected, it is unclear whether extra consideration regarding possible adjustments and care to avoid complications such as lead breakage are required. ⋯ Pregnancy following implantation of a spinal cord stimulator might result in lead breakage as abdominal girth increases. The present case exemplifies how pregnancy following implantation of a spinal cord stimulator might cause lead breakage as abdominal girth increases. Extra care is required to prevent lead breakage when anchors are fixed.