Pain physician
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Percutaneous epidural neuroplasty (PEN) is a minimally invasive intervention designed to treat neck, back, and low back pain. The efficacy of lumbar PEN has been relatively well investigated, but clinical effectiveness according to catheter position has not yet been established. ⋯ In this short-term follow-up study, the effects of lumbar PEN on VAS scores were different according to the position of the catheter tip in patients with single-level lumbar disc herniation. Better outcomes in the Ventral group may have been achieved by more localized treatment with a selective block in the epidural space closer to the dorsal root ganglion and ventral aspect of the nerve root.
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Patients with complex regional pain syndrome type I (CRPS I) show a cortical reorganization with contralateral shrinkage of cortical maps in S1. The relevance of pain and disuse for the development and the maintenance of this shrinkage is unclear. ⋯ The association between recovery of the cortical representation and pain relief supports the hypothesis that pain could be a relevant factor for changes of somatosensory cortical maps in CRPS, and that these are rapidly reversible.
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Complex regional pain syndrome (CRPS) is a pain disorder characterized by sensory, motor, trophic and autonomic dysfunction. The hallmark of the disorder is pain out of proportion of the inciting event. CRPS is difficult for clinicians to manage as there is no gold standard for diagnosis or treatment. ⋯ The immediate pain relief from topical lidocaine allowed the patient to tolerate physical therapy sessions directed at her CRPS. A successful outcome was measured subjectively and objectively by our patient's reduction in symptoms and improvement in ROM and function, respectively. This case study provides preliminary support for improved pain and functional outcome with early adjunct treatment of CRPS with topical lidocaine.
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Letter Case Reports
Therapeutic success with local botulinum toxin in erythromelalgia.
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Review Comparative Study
Chronic opioid therapy for chronic non-cancer pain: a review and comparison of treatment guidelines.
Long-term opioid use for chronic non-cancer pain has increased substantially in recent years despite the paucity of strong supporting scientific data and concerns regarding adverse effects and potential misuse. ⋯ There is a growing body of scientific evidence to support opioid use in chronic pain. Future work should focus on continuing to generate good-quality evidence on the long-term benefits of opioid therapy, as well as scientific data to guide drug choice and dosing for specific conditions, populations, and situations.