Pain practice : the official journal of World Institute of Pain
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The ganglion impar, a single structure usually found at the anterior aspect of the sacrococcygeal joint, is the lowest ganglion of the paravertebral sympathetic chain. Its blockade is indicated in visceral pain syndromes and/or sympathetic pain syndromes of the perineal region. Several approaches to this block have been described, mainly through the anococcygeal or sacrococcygeal ligaments. ⋯ After therapy the VAS decreased by an average of 50% in the whole group. There were no adverse events. Our result show that this proposed modified approach to the block and use of radiofrequency for the ganglion impar is useful for the treatment of perineal noncancer-related pain.
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The skin to lumbar epidural space distance (SLED) is variable, and therefore the ability to clinically predict the SLED may help increase the success of epidural anesthesia/analgesia. The goal of this study was to determine the relationship between the SLED and demographic/anthropometric variables in the Greek population, and develop a mathematical model for its prediction. ⋯ While mathematical models of SLED can be a useful tool, they should not be exclusively relied on in the clinical setting, but rather should be used as an adjunct to standardized techniques to improve the safety and efficacy of epidural anesthesia/analgesia.
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Pregabalin is a new analog of the neurotransmitter gamma-aminobutyric acid (GABA). It is an alpha2-delta (alpha2-delta) ligand that has analgesic, anticonvulsant, and anxiolytic activity. ⋯ Pregabalin binds potently to the alpha2-delta subunit resulting in modulation of calcium channels and reduction in the release of several neurotransmitters, including glutamate, norepinephrine, serotonin, dopamine, and substance P. This review discusses the pharmacology of this medication as well as available studies in patients.
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Pulsed radiofrequency (PRF) has been used for the treatment of radicular pain, due to a herniated intervertebral disc, but so far the data are anecdotal. This is a retrospective study on 13 consecutive patients with this type of pain, at levels L3 to S1. All patients had a diagnosis confirmed by imaging, all had neurological abnormalities, and all were scheduled for surgical intervention. ⋯ Neurological abnormalities resolved except in one patient, who had decreased sensibility in a small area in the L3 dermatome at the last follow-up. All professionally active patients went back to work after 0.49 months (0.1 to 1). It is concluded that PRF may potentially be a viable alternative for epidural steroid injections in the treatment of acute radicular pain, due to a herniated intervertebral disc, and that further studies, including a control group, should be carried out to establish the value of this method.
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Chronic pain has only recently been recognized as an important health care issue. There is no widely shared agreement as to the best ways to diagnose and treat chronic pain patients. ⋯ The current chaotic state confuses patients, health care providers, and payers. It is possible that pain management may disappear from health care if we do not improve our understanding of chronic pain and how to best treat those who suffer.