Pain practice : the official journal of World Institute of Pain
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Report the successful use of stellate ganglion blocks (SGBs) in two patients experiencing symptoms of post-traumatic stress disorder (PTSD). ⋯ Selective blockade of the right stellate ganglion at C6 level is a safe and minimally invasive procedure that may provide durable relief from PTSD symptoms, allowing the safe discontinuation of psychiatric medications. blacksquare, square, filled.
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Randomized Controlled Trial Comparative Study
Effect of intravenous lidocaine on manifestations of fibromyalgia.
The objective of our study was to evaluate the effect of intravenous lidocaine on the manifestations of fibromyalgia. ⋯ The addition of 240 mg intravenous lidocaine (once a week) to 25 mg amitriptyline for 4 weeks did not modify pain intensity or manifestations in patients with fibromyalgia compared with amitriptyline alone.
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Lumbosacral radicular pain is characterized by a radiating pain in one or more lumbar or sacral dermatomes; it may or may not be accompanied by other radicular irritation symptoms and/or symptoms of decreased function. The annual prevalence in the general population, described as low back pain with leg pain traveling below the knee, varied from 9.9% to 25%, which means that it is presumably the most commonly occurring form of neuropathic pain. The patient's history may give a suggestion of lumbosacral radicular pain. ⋯ For refractory lumbosacral radicular pain, adhesiolysis and epiduroscopy can be considered (2 B+/-), preferentially study-related. In patients with a therapy-resistant radicular pain in the context of a Failed Back Surgery Syndrome, spinal cord stimulation is recommended (2 A+). This treatment should be performed in specialized centers.
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Randomized Controlled Trial
Consistent and clinically relevant effects with fentanyl buccal tablet in the treatment of patients receiving maintenance opioid therapy and experiencing cancer-related breakthrough pain.
Fentanyl buccal tablet (FBT) has shown efficacy and tolerability in patients with cancer-related persistent pain treated with maintenance opioids. We conducted a combined analysis of two similarly designed, randomized, placebo-controlled studies to further evaluate the consistency and clinical relevance of analgesia outcomes. Of the 252 patients enrolled, 150 fulfilled the criteria for efficacy analysis and experienced 1,417 breakthrough pain episodes. ⋯ Application-site (buccal) abnormalities were infrequent and led to withdrawal of three patients. There were no serious adverse events or deaths attributable to FBT. This analysis suggests that FBT provides an analgesic effect that is consistent across multiple clinically relevant efficacy measures.
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Approximately 5% of the patients referred to outpatient pain clinics suffer thoracic pain. Thoracic pain in this article is limited to thoracic radicular pain and pain originating from the thoracic facet joints. Thoracic radicular pain is characterized by radiating pain in the localized area of a nervus intercostalis. ⋯ However, extensive skills are required to perform this procedure above the level of Th7. This treatment should take place in specialized centers. For thoracic facet pain, radiofrequency treatment of the ramus medialis of the thoracic rami dorsales is recommended (2 C+).