Pain practice : the official journal of World Institute of Pain
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Epidural blood patch is the gold standard for the treatment of postdural puncture headache (PDPH) when conservative treatments have failed to provide any relief. However, alternative therapies are lacking when epidural blood patch persistently fails to improve symptoms. Failure to treat PDPH may lead to significant functional impairment of daily living. Alternative therapies should be sought to accelerate recovery from PDPH. ⋯ Percutaneous injection of fibrin glue to seal the dural defect demonstrated promising outcomes for both immediate and long-lasting resolution of persistent PDPH in our patient. In the event of epidural blood patch failure, epidural fibrin glue patch may be a reasonable alternative for the treatment of persistent PDPH.
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Radiofrequency therapy (RFT) generates molecular motion and produces heat and electromagnetic effects on tissues, which attenuate pain sensation and thereby relieve pain. This study was to observe the altering trend of physiological parameters after RFT for chronic cervical or lumbar pain. ⋯ This study showed significant efficacy of RFT in patients with chronic cervical or lumbar pain. The changes of HRV and PPG parameters may explain part of the mechanisms of RFT.
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Review
Postoperative Pain Control Following Craniotomy: A Systematic Review of Recent Clinical Literature.
Pain intensity after craniotomy is considered to be moderate to severe during the first 2 postoperative days. The ideal pain treatment to facilitate a rapid postoperative recovery and optimize outcome is unknown. ⋯ No definite recommendations can be made based on this systematic review of pharamacological interventions following craniotomy due to significant divergence in the methodology of available studies. Limited evidence on scalp infiltration/block suggests an adequate analgesic effect in the early postoperative period. Analgesic efficacy of dexmedetomidine and multipoint electro-acupuncture needs further evaluation.
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Observational Study
Content Validity of the Credibility and Expectancy Questionnaire in a Pain Rehabilitation Setting.
Content validity, the proper reflection of the concept to be measured, is yet unknown for the Credibility and Expectancy Questionnaire (CEQ). It is frequently used in pain rehabilitation because treatment expectancy is influential on the outcome. ⋯ After small changes, the CEQ appeared to be a content-valid measurement instrument for patients waiting for treatment. However, for patients who had already undergone treatment, the content validity of the CEQ was less, and considerable changes were necessary.
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Case Reports
A Computed Tomography-Guided Demonstration of the Unilateral Distribution of Low-Volume Epidural Injectate.
The primary objective of this case report was to demonstrate the unilateral distribution of the low volume injectate given in the epidural space when paramedian interlaminar approach is utilized under computed tomography guidance. ⋯ There was primarily unilateral distribution of low-volume injectate in the epidural space when paramedian interlaminar approach is utilized.