Pain physician
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For more than 3 decades, spinal cord stimulation (SCS) has successfully been employed to treat neuropathic pain. Psychological factors are assumed to be important for the efficacy of SCS. However, the impact of psychological factors on the outcome of SCS has only rarely been studied. ⋯ The outcome of SCS therapy could not be predicted on the basis of tested psychological factors anxiety/depression and pain-related disability. FESS correlated inversely with HADS-D, BDI-II, and PDI scores and showed a tendency towards correlation with the percentage of pain reduction. Further research is needed to define the impact of psychological factors on SCS outcomes.
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Patients with chronic whiplash associated disorders (WAD) demonstrate altered central pain processing and impaired endogenous analgesia. In addition, previous research reported disturbances in the autonomic nervous system and the presence of post-traumatic stress reaction in patients with chronic WAD. The autonomic nervous system, in particular the autonomic stress response, might modulate central pain processing in this population. ⋯ Results of this study refute autonomic dysfunction in response to pain in patients with chronic WAD. The autonomic nervous system activity or reactivity to acute pain appears unrelated to either pain thresholds or endogenous analgesia in patients with chronic WAD.
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Case Reports
Using pulsed radiofrequency ablation to treat pain associated with a tumor involving the brachial plexus.
Pain associated with cancer is often difficult to treat, even more so when tumors involve peripheral nerves. Therapy is complex and often requires a multimodal approach that can include medications, radiation, and interventional techniques. These components are utilized with variable success, but are also limited by known complications or adverse effects. ⋯ Pulsed radiofrequency is a poorly understood technology that has increasing evidence for certain pain conditions; however, for cancer and peripheral nerves the evidence is slim to none. Our case presents a successful use for pain management of a brachial plexopathy due to a tumor. We propose that pulsed radiofrequency may present a non-neurodestructive pain management technique for tumors involving peripheral nerves, though more data is definitely needed.
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Case Reports
Transversus abdominis plane neurolysis with phenol in abdominal wall cancer pain palliation.
Pain is commonly perceived by patients during cancer and its treatment. Although most patients respond to conservative management implemented according to the World Health Organization guidelines, a subset of patients with advanced disease develop intractable pain that may require additional interventions such as regional blocks and intrathecal therapy. Patients with terminal abdominal or pelvic cancer who have high tumor burdens are often offered a diagnostic visceral nerve block followed by neurolysis for pain palliation. ⋯ The patient tolerated the procedure well and demonstrated sustained analgesia for 45 days before dying of the disease. We also demonstrated that TAP block significantly reduces the total opioid requirement as demonstrated by the morphine equivalent daily dose score after the neurolytic procedure. This result supports our belief that TAP block with TAP neurolysis is an effective and inexpensive modality that can be used to palliate intractable abdominal wall pain in patients with terminal abdominal cancer.
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Several studies have described pain prevalence, risk factors, pain and medical variables in spinal cord injury (SCI) populations. In this study on traumatic SCI in Turkey, we surveyed the neuropathic pain experiences during in-patient rehabilitation and defined the relationships between neuropathic pain and demographic and SCI characteristics of patients. ⋯ We found the neuropathic pain due to SCI to be mostly below the lesion level with a burning or aching character and we did not find a significant relationship between the demographic and SCI-related characteristics of the patient and the pain characteristics.