Pain practice : the official journal of World Institute of Pain
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Posterior femoral cutaneous nerve (PFCN) neuropathy is an uncommon, potentially under-recognized cause of low back, buttock, perineal, and posterior and lateral thigh pain and numbness. Most PFCN injuries are caused by intramuscular injections; however, this is the first reported case of a PFCN injury of hamstring pathology due to tendonitis caused by long-distance running. ⋯ After excluding the more common etiologies of buttock pain and sitting intolerance, practitioners should consider the rarer condition of the impingement of the PFCN in runners.
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Chronic opioid therapy may lead to high level tolerance development, hyperalgesia, and central sensitization, which further complicates long-term therapeutic management of chronic pain patients. In this case, we encounter a patient who was receiving over 15,000 morphine milligram equivalents through their intrathecal pain pump. Unfortunately, the intrathecal pump was inadvertently cut during a spinal surgery. It was deemed unsafe to delivery IV equivalent opioid therapy in this case; instead, the patient was admitted to the ICU and given a four-day ketamine infusion. ⋯ Ketamine may play an important role in attenuating not only tolerance but also acute withdrawal in a setting where rapid or instant weaning from high dose chronic opioid therapy is needed.
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Spinal cord stimulation (SCS) is a minimally invasive therapy that is increasingly used to treat refractory neuropathic pain. Although this technique has a low incidence of serious long-term adverse sequelae, the risk of complications such as inadvertent dural puncture remains. ⋯ The incorporation of the CLO view to guide epidural needle placement can decrease the odds of a PDPH during percutaneous SCS procedures. This study further provides real-world data supporting the potential enhanced accuracy of epidural needle placement in order to avoid unintentional puncture or trauma to deeper spinal anatomic structures.