Pain practice : the official journal of World Institute of Pain
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This review summarizes the present and emerging knowledge base on the pathophysiology, diagnosis, and management of fibromyalgia. ⋯ Several agents, including serotonin-norepinephrine reuptake inhibitors (ie, duloxetine and milnacipran), opioids (ie, tramadol), and the alpha2-delta ligand pregabalin, which recently received U.S. regulatory approval for the treatment of fibromyalgia, have been evaluated in clinical trials, demonstrating benefit in terms of pain reduction and improvement in core symptoms (ie, fatigue and sleep disturbance). The European League Against Rheumatism has developed updated guidelines for the management of fibromyalgia.
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Case Reports
Cranial magnetic resonance imaging in spontaneous intracranial hypotension after epidural blood patch.
Spontaneous intracranial hypotension (SIH) is a syndrome characterized by orthostatic headache, nausea, vomiting, photophobia, and diplopia. Subdural effusion, diffuse dural enhancement, dilatation of epidural veins, and increased height of hypophysis are cranial magnetic resonance (MR) imaging findings in SIH. ⋯ We present the follow-up MR imaging findings in a case of SIH after a successful epidural blood patch treatment. We propose that cranial MR imaging as an objective test to evaluate the success of epidural blood patch treatment.
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We present a case report in which spinal cord stimulator trial lead became lodged in the posterior lumbar soft tissue. The lead could not be removed even with moderate force or with spine in the flexed position. Radiologic evaluation revealed that edge of metallic lead was wedged into the soft tissue. We were able to remove the lead only after placing the patient in an extreme tuck position (knee-to-chest); thus possibly avoiding surgical intervention.