Pain practice : the official journal of World Institute of Pain
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The present study was designed to evaluate the relative degree and type of emotional distress in high-risk acute low back pain (ALBP) subjects (defined as less than 3 months since initial injury) vs. high-risk chronic low back pain (CLBP) subjects (defined as greater than 3 months since initial injury). It is an extension of earlier findings that demonstrated the significant role that such emotional distress may play in the development of CLBP disability if not appropriately treated in the acute phase. This work stems from a conceptual three-stage model, which characterizes the progression from acute to chronic pain. ⋯ The ANCOVA procedure in SPSS was used to compare groups, controlling for gender, ethnicity, and age. Results revealed that CLBP subjects had higher rates of certain measures of emotional distress and depression relative to ALBP subjects. These findings further support the importance of effectively managing emotional distress factors early, when treating musculoskeletal disorders such as low back pain.
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The nonselective alpha-adrenergic antagonist, phenoxybenzamine, has been used in the treatment of neuropathic pain syndromes, specifically, complex regional pain syndrome (CRPS) types I and II. This agent has also previously been used in intravenous regional peripheral blocks for treatment of CRPS I; however, an intravenous preparation of phenoxybenzamine is not currently available in the U. S. ⋯ We report an apparent clinical benefit in three of the four patients following oral administration. We postulate that this may be due to the noncompetitive (irreversible) blockade of alpha(1)- and alpha(2)-adrenergic receptors. We further hypothesize that this blockade could reduce stimulation of an increased population of adrenergic receptors in hyperalgesic skin, blunt the stimulation by norepinephrine of alpha(2)-adrenergic receptors on macrophages, and ultimately reduce the release of proinflammatory cytokines from cellular elements.
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The sympathetic nervous system has been implicated in numerous pain syndromes ranging from neuropathic pain to vascular pain to visceral pain. In light of this, sympathetic ganglia have been the target of local anesthetic blockade to determine the sympathetic role in the transmission of pain. If analgesia is afforded with local anesthetic blockade, chemical or thermal neurolysis have been utilized to attempt to provide long-term relief. ⋯ Many case reports and case series have been published, but few placebo-controlled, blinded studies exist. This manuscript will review the literature on sympathetic blocks and summarize existing studies for each of the sympathetic blocks. The goal is to provide past, current, and future pain physicians with evidence that they can use to provide appropriate care for their patients.
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Injury to the ilioinguinal nerve commonly follows during lower abdominal and pelvic surgery, especially with inguinal hernia repair, appendectomy, and hysterectomy. Other potential causes include low abdominal blunt trauma, iliac crest bone graft, psoas abscess, Pott's disease, and prolonged wearing of abdominally constrictive clothing. The actual incidence of ilioinguinal neuralgia is uncertain, as reported percentage ranges between 12% and 62%. ⋯ We present three cases of successful pain control of ilioinguinal neuralgia with peripheral nerve stimulation. These cases demonstrate the potential benefits of neurostimulation including durable effective pain relief and decreased use of medication. Putative mechanisms of effect(s) and caveats for continued research to inform prudent employment of this technique are presented.
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Case Reports
Thoracic spinal cord stimulation for post-ablation cardiac pain in a patient with permanent pacemaker.
Spinal cord stimulation (SCS) is increasingly utilized for inoperable, intractable chest pain because of ischemia. Because patients with ischemic heart disease commonly have permanent cardiac pacemakers (PPM) or automated implantable cardio-defibrillators (AICD), concurrent use of SCS and PPM or AICD may grow. Interference between SCS and PPM or AICD devices is potentially dangerous and has been previously reported. ⋯ Others have reported SCS implantation in patients with PPM. This is the first report to describe safe and effective use of an Advanced Bionics SCS in a patient with a Guidant PPM. In addition, we speculate that this patient's cardiac pain may have been other than ischemic in origin. As such, this case may represent a unique clinical scenario. Despite many cases series and case reports demonstrating safety of concurrent SCS and PPM or AICD, the complexity of these technologies requires continued demonstration of device compatibility in novel contexts.