Pain physician
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Clinical Trial
Intravesical botulinum toxin a injections do not benefit patients with ulcer type interstitial cystitis.
Ulcer type and non-ulcer type interstitial cystitis/bladder pain syndromes (IC/BPS) are considered different disease entities. Thus, intravesical botulinum toxin A (BoNT-A) treatment outcomes could differ for each entity. ⋯ Repeated intravesical BoNT-A injections provided effective treatment outcomes at the end-point in half of the patients with non-ulcer IC/BPS, but did not benefit any patient with ulcer type IC/BPS. Ulcer type IC/BPS should be treated as a different disease than non-ulcer IC/BPS. INSTITUTIONAL REVIEW: This study was approved by the Institutional Review Board of the Tzu-chi General Hospital (TCGH 100-06).
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Clinical Trial
The effect of oxygen administration on regional cerebral oxygen saturation after stellate ganglion block on the non-blocked side.
Stellate ganglion block (SGB) causes sympathetic denervation of the head, neck, and upper extremities. In some studies, it has been reported that cerebral blood flow on the non-blocked side decreases after SGB, so when performing an SGB for pain management of the head, neck, and arm, the increased risk of cerebral ischemia should be considered. ⋯ NCT01532713. IRB No.: 4-2011-0358.
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Placement of an intrathecal drug delivery system (IDDS) may provide substantial benefit to certain patients. However, placement of these devices is not without complications, and minimal data exist describing the rates of these complications. Specifically, there is a paucity of data describing the incidence of post dural puncture headache (PDPH) following IDDS placement. ⋯ Though the development of PDPH after IDDS implantation was found to be fairly common (23% incidence), the majority of these patients had self-limited symptoms that resolved with conservative medical management. Epidural blood patch or application of epidural fibrin glue was therapeutically successful for the remainder of PDPH patients who were refractory to conservative measures.
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Pancreatic cancer pain is often severe and refractory to conservative therapies. Several interventional techniques have been described for the management of end-stage pancreatic cancer pain, with variable results and complications. ⋯ Radiofrequency thermocoagulation of both splanchnic nerves may offer a safe and effective technique for pain management and quality of life improvement in patients with end-stage pancreatic cancer towards the end of life.
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Case Reports
Spinal cord stimulation for radicular pain following retained bullet in the spinal canal.
We are reporting on the implantation of a spinal cord stimulator to treat intractable radicular pain following a retained bullet fragment in the spinal canal. Such retained fragments are associated with risks including pain, neurological deficit, infection, toxic effects, and migration. Our patient was a young man with radicular pain and history of a gunshot entering the abdomen. ⋯ There was no evidence of infection or migration, and excellent pain relief was achieved. Bullets and other foreign bodies retained in the spinal canal can cause progressive neurologic symptoms through reactive tissue formation and compression. Spinal cord stimulation can relieve radicular pain while avoiding risks associated with altering the location of the offending foreign body.