Pain physician
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Percutaneous vertebroplasty (PVP) is commonly used to treat symptomatic vertebral compression fractures. However, its long-term effectiveness and safety for use in the treatment of symptomatic Schmorl's nodes (SNs) refractory to conservative treatment is uncertain. ⋯ PVP is an effective and safe procedure for the treatment of symptomatic SNs, which are refractory to medical or physical therapy.Key words: Percutaneous vertebroplasty, symptomatic Schmorl's nodes, vertebral endplate fracture, endplate osteonecrosis, Modic changes.
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Chronic pain often results in cognitive impairment. Our previous study showed that trigeminal neuralgia induced by cobra venom leads to spatial learning and memory deficits, although the underlying mechanism remains unclear. However, recent evidence indicates that the c-AMP-responsive element binding protein (CREB)/brain derived neurotrophic factor (BDNF) pathway plays a critical role in various etiologies of cognitive deficits. ⋯ The findings suggest that cognitive impairment caused by cobra venom-induced trigeminal neuralgia is associated with downregulation of the CREB/BDNF pathway in the hippocampus and PFC.Key words: Cognitive impairment, the CREB/BDNF pathway, cobra venom, trigeminal neuralgia, hippocampus, prefrontal cortex, free behavior, Morris water maze.
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The progression of cervical kyphosis due to injury to the facet joints and musculature is a major concern for posterior foraminotomy especially for patients with cervical lordosis of less than 10°. However, cervical hypo-lordosis (cervical lordosis < 10°) may be improved with the alleviation of pain and muscle spasms, which corresponds with the disappearance of a positive Spurling's test. When surgery is necessary, the spontaneous recovery of cervical curvature may be minimally offset using minimally invasive surgical techniques, such as posterior percutaneous endoscopic cervical foraminotomy (P-PECF). ⋯ Cervical hypo-lordosis less than 10° may not be a contra-indication for P-PECF when the change of cervical curvature is not a structural change. A larger study is necessary to identify prognostic factors. Key words: Alignment, cervical vertebrae, disc, percutaneous, endoscopes, biomechanical phenomena, surgery, lordosis, kyphosis.
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Scars can cause pain, even without symptoms of underlying nerve damage. A lack of knowledge on intrinsic scar pain hampers effective treatment of these complaints. ⋯ Burn and pathologic scars often lead to high intensity pain symptoms. This pain has many characteristics of neuropathic pain that could be caused by an imbalance of C-fibers subtypes. The scar tissue itself may alter the nerve fiber distribution; the imbalance results in ongoing neuro-inflammation and pain symptoms. Key words: Systematic review, scar, pain, epidermal innervation, prevalence, neuro inflammatory response, peptidergic fibers.
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Case Reports
Pneumocephalus Following Unidentified Dural Puncture: A Case Report with an Unusual Neurological Presentation.
Pneumocephalus is a rare consequence of epidural anesthesia, which may occur following inadvertent or unidentified dural puncture when the loss of resistance to air technique is applied to identify the epidural space. Headache is the most common symptom presented in this condition, usually with sudden onset. This case report describes an unusual presentation of diffuse pneumocephalus after an unidentified dural puncture. ⋯ The patient presented no neurological signs or symptoms at this time. Although headache is the most common symptom presented in reported cases of pneumocephalus, this case shows the need for the clinician to be aware of other signs and symptoms that may be indicative of this condition, in order to properly diagnose and treat these patients. Key words: Pneumocephalus, continuous epidural analgesia, ischemic chronic pain, loss-of-resistance to air technique, dural puncture, headache, unusual presentation.