Pain physician
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An 80-year-old woman presented with chronic lumbosacral pain since her laminectomy and instrumentation 10 years ago. Examination was consistent with left sacroiliitis, and the patient underwent an elective left sacroiliac joint injection. Two days following her procedure she fell and landed on her left hip and on the next day, she presented to the emergency room with acutely worsening left gluteal pain. ⋯ The only effective methods to eliminate the spores is to heat them at a temperature greater than 100 degrees Celsius for 10 minutes or with use of a 10% potassium hydroxide (KOH) solution. We hypothesize that clostridium spores were present on the patient's skin from previous stool soiling, and that these were introduced directly into the soft tissue by needle trauma. Rare complications such as this one are scarcely reported in the literature and thus it becomes difficult to adequately identify risk factors or to formulate strategies to improve practice management.
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Breast cancer-related lymphedema (BCRL) not only has physical implications, but also affects the quality of life in breast cancer survivors. Despite numerous studies of various therapies, the optimal treatment for BCRL is unknown. ⋯ TSGB in BCRL patients appears to be effective in decreasing the affected arm circumference. TSGB may be an alternative option in BCRL patients who do not respond to conservative therapy.
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The prevalence of HIV-related neuropathy may rise nationwide as Highly Active Antiretroviral Therapy (HAART) usage and HIV-survival rates increase, resulting in higher referral rates to pain practitioners for analgesic strategies. However, if patients' symptoms are refractory to conservative measures, an advanced interventional approach may be indicated. ⋯ These 2 cases demonstrate that SCS neuromodulation is a safe, viable, and efficacious option for patients whose HIV-related neuropathic type pain is refractory to conventional treatment modalities. Our patients appear to be the first case reports that show a remarkable efficacy of SCS in the management of HIV-related polyneuropathy.