Pain practice : the official journal of World Institute of Pain
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Case Reports
Lumbar Zygapophyseal Pain During Extension-Based Stabilization Protocol Following Lumbar Transdiscal Biacuplasty.
Transdiscal biacuplasty (TDB) is a minimally invasive procedure for the treatment of lumbar discogenic pain. Theoretically, TDB ablates the aberrant ingrowth of nerve fibers beyond the outer third of the annulus fibrosis of the lumbar intervertebral disk and treats annular tears via collagen reformation. Typically, recovery involves a robust rehabilitation protocol that emphasizes lumbar stabilization exercises, focusing on extension maneuvers while also strengthening the multifidi and transverse abdominus. New-onset postprocedural pain during recovery may occur; evaluation of nondiscogenic causes should be considered. We report 3 of 12 patients who developed zygapophyseal-mediated pain during the recovery period. ⋯ Novel postprocedural low back pain should provoke re-evaluation of potential etiologies such as persistent discogenic pathology, zygapophyseal or sacroiliac joint involvement, and other mechanical sources of pain. We postulate that extension maneuvers during rehabilitation, combined with lumbar bracing in extension, inadvertently triggered and potentially exacerbated pre-existing zygapophyseal irritation. The clinical implication of this scenario is novel distracting pain, caused by an alternative etiology to the original discogenic pain, and may present a confounder to the assessment of the efficacy of TDB.
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Comparative Study
Treatment of Neuropathic Pain with the Capsaicin 8% Patch: Is Pretreatment with Lidocaine Necessary?
The capsaicin 8% patch can effectively treat neuropathic pain, but application can cause discomfort or a burning sensation. Until March 2013, it was recommended that patients be pretreated with a topical anesthetic, for example lidocaine, before capsaicin patch application. However, speculation existed over the need for pretreatment and its effectiveness in alleviating treatment-associated discomfort. ⋯ The same proportion of pretreated and non-pretreated patients reported willingness to receive retreatment with the capsaicin patch. This analysis shows that the capsaicin 8% patch is generally tolerable, and the small discomfort associated with patch application is short-lived. Lidocaine pretreatment does not have a significant effect on tolerability, efficacy, or patient willingness to receive retreatment.
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Review Meta Analysis
Systematic Review and Meta-Analysis of Pharmacological Therapies for Painful Diabetic Peripheral Neuropathy.
Painful diabetic peripheral neuropathy (pDPN) is prevalent among persons with diabetes and increases over time. Published guidelines recommend a number of medications to treat this condition providing clinicians with a variety of treatment options. This study provides a comprehensive systematic review and meta-analysis of published pharmacologic therapies for pDPN. ⋯ Selecting an appropriate pDPN therapy is key given the large number of available treatments. Comparative results revealed relative equivalence among many of the studied interventions having the largest overall sample sizes and highlight the importance of standardization of methods to effectively assess pain.
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Randomized Controlled Trial
Bedside Ultrasound-Guided Celiac Plexus Neurolysis in Upper Abdominal Cancer Patients: A Randomized, Prospective Study for Comparison of Percutaneous Bilateral Paramedian vs. Unilateral Paramedian Needle-Insertion Technique.
Percutaneous anterior abdominal ultrasound guidance for performing celiac plexus neurolysis is a relatively new but more economical, less time-consuming, more comfortable bedside technique for interventional pain management. Paucity of studies evaluating the efficacy of single-site vs. double-site injections at celiac trunk for ultrasound-guided celiac plexus neurolysis (USCPN) prompted us to conduct a prospective, randomized, single-blind clinical trial to compare USCPN using bilateral paramedian (double needle) technique with unilateral paramedian (single needle) technique. ⋯ Ultrasound-guided celiac plexus neurolysis using unilateral paramedian (single needle) needle-insertion technique is comparable with bilateral paramedian (double needle) needle-insertion technique with regard to pain relief and side effects.
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To contrast the analgesic effect of duloxetine with antidepressants reported in other published randomized clinical trials (RCTs) and review articles in patients with chronic low back pain (CLBP). ⋯ Due to the diversity of previous studies and the pooling methods used, the conclusions regarding the analgesic effect of antidepressants in CLBP drawn from systematic reviews must be interpreted with caution. Appropriately designed and powered studies similar to recently published duloxetine studies are recommended to demonstrate the analgesic effect of antidepressants.