Pain physician
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Review Case Reports
Cooled sacroiliac radiofrequency denervation for the treatment of pain secondary to tumor infiltration: a case-based focused literature review.
The sacroiliac (SI) joint is a common cause of low back pain, for which radiofrequency (RF) denervation has been shown to provide long-term relief. However, controversy exists surrounding the innervation, which treatment paradigm to utilize, and how best to select patients who might benefit. ⋯ This is the first report of cooled SI joint RF ablation to treat cancer pain. Our patient's positive response to the procedure suggests the possibility that the lateral branches innervate not only the posterior ligaments, but also the bony articulation. The decision to proceed with RF ablation on the same day as a prognostic lateral branch block was based on our patient's terminal condition, and the fact that cooled RF does not require sensory stimulation to ensure proximity to the target nerves. Because of her transitional anatomy, we elected to target L4.
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Randomized Controlled Trial
Influence of CYP2D6 activity on pre-emptive analgesia by the N-methyl-D-aspartate antagonist dextromethorphan in a randomized controlled trial of acute pain.
There is some evidence that dextromethorphan (DM) is effective as a pre-emptive analgesic agent. DM is mainly metabolized to dextrorphan (DOR) by CYP2D6 whose activity can be inhibited by pharmacologic intervention. ⋯ CYP2D6 inhibition by quinidine influenced the pre-emptive analgesic effectiveness of DM confirming that CYP2D6 phenotypic switch increases the neuromodulatory effect of oral dextromethorphan.
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Although headache is the most common complication of dural puncture, knowledge gaps remain about patient-related risks. Data are lacking on the role, if any, of tobacco smoking, race, anxiety, depression, and Post Traumatic Stress Disorder (PTSD) in conferring risk for post-dural puncture headache (PDPH). ⋯ Most notably, smokers had a considerably reduced rate of PDPH in comparison with non-smokers. This information could be a useful addition to the clinical assessment of relative risk for PDPH. Further research into the mechanisms by which tobacco smoking may inhibit PDPH, such as nicotine stimulation of dopamine neurotransmission or alterations in coagulation, appears warranted.
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Prescription opioid abuse is not homogeneous due to varying patterns of use and different geographic preferences. Because doctor shopping is one of the main sources of diversion, it has previously been used to estimate drug abuse. ⋯ These results confirm important variations in the 3 French regions despite them being geographically close. Besides, they highlight different rates of opioid abuse between opioids for mild to moderate pain, opioids for moderately severe to severe pain, and opioid maintenance treatments, as well as differences within these groups.
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Clinical Trial
Repeated onabotulinumtoxin-a injections provide better results than single injection in treatment of painful bladder syndrome.
Onabotulinumtoxin-A (BoNT-A) is effective for the treatment of interstitial cystitis/painful bladder syndrome (IC/PBS). However, long-term follow-up does not show successful outcome after a single injection. ⋯ Repeated intravesical BoNT-A injections were safe and effective for pain relief and they increased bladder capacity and provided a better long-term success rate than a single injection did for treatment of IC/PBS.