Pain physician
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Although headache is the most common complication of dural puncture, knowledge gaps remain about patient-related risks. Data are lacking on the role, if any, of tobacco smoking, race, anxiety, depression, and Post Traumatic Stress Disorder (PTSD) in conferring risk for post-dural puncture headache (PDPH). ⋯ Most notably, smokers had a considerably reduced rate of PDPH in comparison with non-smokers. This information could be a useful addition to the clinical assessment of relative risk for PDPH. Further research into the mechanisms by which tobacco smoking may inhibit PDPH, such as nicotine stimulation of dopamine neurotransmission or alterations in coagulation, appears warranted.
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While the use of opioids for chronic non-cancer pain (CNCP) has increased dramatically in the past 2 decades, concern exists about the safety of opioids, particularly with the extensive use among individuals with CNCP. ⋯ This study found no association between use of opioids and risk of T2D among non-cancer adults.
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Opioids have been the mainstay analgesics for postoperative, cancerous, and chronic noncancerous pain. Common concerns regarding the use of opioids include the development of physical dependence and addiction. However, as a potential complication of opioid therapy, opioid-induced hyperalgesia (OIH) is often overlooked. ⋯ We present 2 cases of OIH resulting from administration of tramadol, which is a synthetic analogue of codeine and exhibits 10-fold less affinity for mu-opioid receptors, in patients suffering from chronic pain. The 2 cases presented herein imply the importance of recognizing OIH in patients medicated with tramadol if analgesic effects are lost in the context of dose titration, when generalized pain is reported without any evidence of disease exacerbation. While OIH associated with ultra-low dose opiates seems to be quite rare, if it is suspected, switching to other drugs and an appropriate treatment should be considered.
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Excluding a vascular origin of exercise-related pain is often difficult in clinical practice. Recent papers have underlined the frequent association of concurrent lumbar spine degenerative disease and peripheral arterial disease. Furthermore, even when suspected, isolated exercise-induced proximal ischemia is difficult to diagnose. Measurement of transcutaneous oxygen pressure (tcpO2) is an interesting and accurate method to differentiate proximal (buttock) from distal (calf) regional blood flow impairment (RBFI) during exercise. ⋯ Isolated proximal-without distal RBFI is found in approximately one out of 7 patients complaining of symptom limiting claudication with a borderline or normal resting ABI. Exercise-tcpO2 may help to discriminate patients with arterial claudication that could benefit from invasive vascular investigations and procedures.
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Clinical Trial
Effectiveness of percutaneous transforaminal adhesiolysis in patients with lumbar neuroforaminal spinal stenosis.
Lumbar foraminal spinal stenosis (LFSS) is a narrowing of the bony exit of a nerve root, which causes mechanical compression of spinal nerve roots. Low back pain and/or leg pain, and possibly neurogenic claudication, may result due to mechanical neural compression. Transforaminal epidural steroid injections (TFESIs) are commonly used for treating LFSS. Patients refractory to TFESIs may benefit from percutaneous epidural adhesiolysis. ⋯ Short-term results indicate that percutaneous TFA is an effective treatment for LFSS, although therapeutic outcomes and the severity of LFSS showed no correlation.