Pain practice : the official journal of World Institute of Pain
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Case Reports
A Case Report on Spinal Cord Stimulation in an Atrophic Spinal Cord- What Exactly Are We Stimulating?
We present a patient with paraplegia secondary to anterior spinal cord infarct below T6, with subsequent development of chronic low-back and bilateral lower-extremity neuropathic pain with an atrophic cord. In this patient with reduced spinal cord mass and modified neuroanatomy, spinal cord stimulation was surprisingly very effective. ⋯ Traditionally accepted mechanisms of action of dorsal column stimulation and suppression of wide-dynamic-range neurons are unlikely to explain the relief obtained in our patient with an atrophic spinal cord. No single consensus has been reached on the primary mechanism through which spinal cord stimulation renders its therapeutic effects. Spinal cord stimulator therapy is promising, and the future direction of its study is discussed.
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Trigeminal neuralgia (TN) is the most common cause of facial pain, leading to significant disability and impacting a patient's quality of life. Percutaneous procedures like continuous radiofrequency, pulsed radiofrequency (PRF), and combined continuous and pulsed radiofrequency have been studied in past years comparing different voltages in order to find more effective therapies with fewer complications (eg, numbness and masseter muscle weakness). With regard to young patients, there is still insufficient evidence on the most appropriate procedure in this patient population. PRF does not cause thermal damage. The mechanism of action involves delivering an electrical field to targeted nerves or tissues, modulating pain. We propose that bipolar pulsed radiofrequency (2 parallel cannulas) in the trigeminal ganglion produce a denser and larger field resulting in more effective controlled pain. ⋯ Bipolar PRF could be a non-neurodestructive option for young people with TN and deserves further investigation as a treatment option.
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Review Meta Analysis
Bilateral Erector Spinae Plane Block for Postoperative Analgesia in Laparoscopic Cholecystectomy: A Systematic Review and Meta-analysis of Randomized Controlled Trials.
Erector spinae plane (ESP) block is a novel regional anesthetic technique. Its application for postoperative analgesia has been increasing since 2016; however, its effectiveness remains uncertain and varies according to the type of surgery. This meta-analysis aimed to assess the analgesic efficacy of ESP block in patients undergoing laparoscopic cholecystectomy. ⋯ This meta-analysis showed that bilateral ultrasound-guided ESP block could be considered as an effective option to reduce opioid consumption and the time to first rescue analgesic and seems to be also a safe technique in adults undergoing laparoscopic cholecystectomy.
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Spinal malignancy-related pain results from tumor, fracture, instability, inflammation, and/or nerve root/spinal cord compression. Systemic corticosteroids are commonly used but have many undesirable adverse effects that impact quality of life and continuation of cancer treatments. Epidural steroid injections (ESIs) may be a viable alternative pain treatment. ⋯ There is inconclusive evidence to use ESIs to treat spinal malignancy-related pain in the current literature. Our retrospective review provides level III evidence for our conclusion that ESIs are safe and efficacious to treat spinal malignancy-related pain. Thoracic/lumbosacral injections led to significantly better pain relief compared with caudal injections.
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The reliability of pain assessment in frail and older adults has seldom been assessed. This study aims to assess the test-retest reliability of (1) the number of painful body sites, (2) pain intensity, and (3) pain extent in institutionalized older adults. ⋯ The vertical pain rating scale and the body chart seem reliable to assess pain intensity and number of pain sites, respectively. The wide CI for the ICC found for pain area and the high measurement error compromise its potential clinical relevance.