Pain physician
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Multiple reviews have shown that interventional techniques for chronic pain have increased dramatically over the years. Of these interventional techniques, both sacroiliac joint injections and facet joint interventions showed explosive growth, followed by epidural procedures. Percutaneous adhesiolysis procedures have not been assessed for their utilization patterns separately from epidural injections. ⋯ Percutaneous adhesiolysis utilization increased moderately in Medicare beneficiaries from 2000 to 2011. Overall, there was an increase of 47% in the utilization of adhesiolysis procedures per 100,000 Medicare beneficiaries, with an annual geometric average increase of 3.6%.
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Randomized Controlled Trial Comparative Study
A pressure comparison between midline and paramedian approaches to the cervical epidural space.
In the cervical spine, the ligamentum flavum (LF) is often incompletely fused at the midline. Therefore, accessing the epidural space (ES) using the loss of resistance (LOR) technique via the midline approach could be less reliable than the paramedian approach. Since the tactile sensation of LOR is due to abrupt loss of pressure upon entering the ES, we have compared pressure changes between the 2 different cervical epidural techniques. ⋯ NCT01009385. Institutional Review Board (IRB): H-1208-107-422.
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Randomized Controlled Trial
Short-term treatment with parecoxib for complex regional pain syndrome: a randomized, placebo-controlled double-blind trial.
Complex regional pain syndrome (CRPS) is characterized by signs and symptoms of peripheral inflammation, which leads to peripheral neural sensitization associated most frequently (in about 70%) with blunt pressure hyperalgesia. Therefore, we hypothesized that treatment of CRPS patients with a selective COX-2-inhibitor would alleviate the abnormally low pressure pain threshold (PPT) and reduce pain intensity and edema. ⋯ In the present proof-of-concept trial, short-term treatment with the selective COX-2-inhibitor parecoxib influenced neither PPT nor edema or pain. COX-2 might be less important than previously assumed. However, the results are limited due to the small number of patients, short-term treatment, and focus on the PPT, which could have led to false negative results of the present study and covered the expected therapeutic effect.
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Review
Long-term neuropsychological effects of opioid use in children: a descriptive literature review.
Use of opioids in the management of pain and its consequences in children presents a substantial challenge. A significant concern in pediatric pain management is the long-term neuropsychological consequences of opioids. ⋯ Opioid medications have the potential to produce long-lasting neuropsychological side effects. However, given the negative consequences of untreated pain, the potential benefit may offset their risk. More studies are needed to clarify this complex interaction.
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Treating pain associated with acute coccyx fractures can be challenging. Intranasal calcitonin has been used to treat acute pain after vertebral fracture, and may even accelerate fracture healing. However, intranasal calcitonin has never previously been published as part of the treatment of acute coccyx fractures. ⋯ We propose that clinicians consider use of intranasal calcitonin for the treatment of pain due to acute coccyx fractures.