Pain practice : the official journal of World Institute of Pain
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The objectives of this article were the following: (1) determine risk for self-predicted future psychopharmacological nonadherence in rehabilitation acute pain patients (APPs) and rehabilitation chronic pain patients (CPPs) vs. pain-free community controls and community patients, and (2) determine which variables predict nonadherence. ⋯ APPs and CPPs are at greater risk for self-predicted psychopharmacological nonadherence than healthy community subjects and community patients. We cannot as yet predict self-predicted psychopharmacological nonadherence at greater than the base rate. However, the identified variables could be clinically useful.
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Case Reports
Occipital neuromodulation: ultrasound guidance for peripheral nerve stimulator implantation.
We report a case of chronic left-sided occipital neuralgia in a 21-year old female patient. The patient in question suffered from chronic greater occipital neuralgia for a duration of many years, which had been refractory to other conservative medical management strategies. Blockade of the greater occipital nerve with local anesthetic was consistently useful in attenuating the patient's pain, though the effects were always short lived. ⋯ The specific use of high-frequency ultrasound guidance for this procedure simplified the initial device placement and allowed proper visualization of soft tissue structures, which facilitates precise device deployment. Additionally, the ability to identify relevant vascular structures may further increase the safety of stimulator lead placement. The potential advantages of ultrasound-augmented procedural techniques, specifically as they pertain to occipital stimulator lead placement, are discussed with particular emphasis on potentially decreasing intraoperative and postoperative complications while optimizing stimulation efficacy.
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To examine the relationship between average daily dose (ADD) of duloxetine, adherence to therapy, and health-care costs among patients with diabetic peripheral neuropathic pain (DPNP). ⋯ The findings suggest that having an ADD of 60 mg for duloxetine among commercially insured DPNP patients is associated with improved medication adherence and lower health-care costs.
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Randomized Controlled Trial Clinical Trial
The role of adding hyaluronidase to fluoroscopically guided caudal steroid and hypertonic saline injection in patients with failed back surgery syndrome: a prospective, double-blinded, randomized study.
Failed back surgery syndrome (FBSS) has been reported to account for up to 40% of patients with chronic low back pain. Epidural fibrosis may be responsible for up to 30% of all cases of FBSS. Perineural fibrosis can interfere with cerebrospinal fluid-mediated nutrition, rendering the nerve root hyperesthetic and hypersensitive to compression. Traditionally, steroid injection has been used to treat low back pain and radiculopathy. The addition of hyaluronidase to the injectate has been reported to reduce the degree of fibrosis. ⋯ The addition of hyaluronidase to fluoroscopically guided caudal epidural steroid and hypertonic saline combination improved long-term pain relief in patients with FBSS.
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Coccygodynia is painful condition localized in the region of the coccyx. In most cases a traumatic etiology is present. In the idiopathic form other causes such as infections and tumor have to be excluded. ⋯ Treatment for patients with severe pain in the chronic phase consists of manual therapy and/or a local injection of local anesthetic and corticosteroid into the painful segment (2 C+). Other interventional treatments such as intradiscal injections, ganglion impar block, radiofrequency treatment and caudal block are advised only under study conditions (0). Coccygectomy is not recommended because of long-term moderate results and the chance of major complications.