Pain physician
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Randomized Controlled Trial Comparative Study
Distribution range of cervical interlaminar epidural injections: a comparative study with 2.5 mL, 5 mL, and 10 mL of contrast.
Cervical interlaminar epidural injection (CIEI) is widely used in the management of acute or chronic neck and upper extremity pain. There is no consensus regarding the optimal volume of solution to be used for CIEI. ⋯ Five mL for CIEI at C7-T1 could be an optimal volume for distribution to the lower cervical spine for degenerative cervical spinal diseases, as well as to the upper cervical spine for head and facial pain.
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Randomized Controlled Trial
Does acetaminophen activate endogenous pain inhibition in chronic fatigue syndrome/fibromyalgia and rheumatoid arthritis? A double-blind randomized controlled cross-over trial.
Although enhanced temporal summation (TS) and conditioned pain modulation (CPM), as characteristic for central sensitization, has been proved to be impaired in different chronic pain populations, the exact nature is still unknown. ⋯ This is the first study comparing the influence of acetaminophen on central pain processing in healthy controls and patients with CFS/FM and RA. It seems that CFS/FM patients present more central pain processing abnormalities than RA patients, and that acetaminophen may have a limited positive effect on central pain inhibition, but other contributors have to be identified and evaluated.
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Review
Pharmacovigilance: a review of opioid-induced respiratory depression in chronic pain patients.
Opioids may induce life-threatening respiratory depression, but limited knowledge is available on factors that contribute to opioid-induced respiratory depression (OIRD). This is especially true for patients with chronic pain on prolonged opioid therapy. There are no good quality case control studies or randomized controlled trials available on this topic. Here we present and analyze all case series since 1980 on OIRD in chronic pain patients extracted from PubMed. ⋯ Our case review confirms that life-threatening OIRD in chronic pain patients involves a series of complex often-interacting factors. In spite of the factors identified in this cases series, OIRD remains unpredictable and safe opioid prescribing requires careful titration of opioid dosages and continuous monitoring to prevent life-threatening OIRD.
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The symptom severity of back pain/leg pain is not correlated with the severity of degenerative changes and canal stenosis in lumbar stenosis. Considering the individual pain sensitivity might play an important role in pain perception, this discordance between the radiologic findings and clinical symptoms in degenerative lumbar stenosis might originate from the individual difference of pain sensitivity for back pain and/or leg pain. ⋯ The current study suggests that the pain sensitivity could be a determining factor for symptom severity in the degenerative spinal disease.
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Patients with lumbar spinal stenosis (LSS) are at a great risk of a fall and fracture, which vitamin D protects against. Vitamin D deficiency is expected to be highly prevalent in LSS patient, and pain is thought to have a profound effect on vitamin D status by limiting activity and sunlight exposure. ⋯ Vitamin D deficiency was highly prevalent in LSS patients (74.3%), and severe pain was associated with higher prevalence of vitamin D deficiency and osteoporosis which could be potential risk factors or a fall and fracture. As evidenced by the present study, assessment of serum 25-OHD and bone mineral density are recommended in LSS patients with severe pain, and active treatment combining vitamin D, calcium, or bisphosphonate should be considered according to the status of the bone metabolism.