Pain practice : the official journal of World Institute of Pain
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Peripheral artery diseases (PAD) and Raynaud's syndrome are associated with substantial morbidity. PAD, through the restriction of blood flow to the extremities, may lead to critical limb ischemia with symptoms of pain at rest which may eventually progress to severe limb ischemia with gangrene. This serious and painful clinical condition requires extensive medical care, is limb-threatening and, in case of delayed or unsuccessful treatment, is associated with a high mortality rate. In Raynaud's syndrome, the blood supply to certain parts of the body, usually the fingers and toes and less frequently the nose or ears, is restricted because of vasculopathy of the smaller vessels at acral sites. Under certain circumstances, with cold as the most well-known provoking factor, blood flow restriction occurs, leading to demarcated color changes and symptoms such as pain, paresthesia, and numbness. In severe cases of Raynaud syndrome tissue ischemia may lead to necrosis and the need for amputation of the affected area. ⋯ In both PAD and Raynaud's syndrome, additional RCTs are needed to substantiate interventional (pain) management and bolster the evidence base for sympathectomy and SCS as treatment options.
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It is not uncommon for patients to experience postoperative neurologic deficit, thoracic radiculopathy, abdominal pain, or lower extremity paresthesia after the implantation of thoracic spinal cord stimulator (SCS) paddle leads. Smaller thoracic canal diameters have previously been associated with postoperative neurologic deficits. ⋯ A smaller thoracic canal diameter is associated with postoperative thoracic radiculopathy and abdominal pain. We believe that surgical planning to create adequate space for SCS leads is critical in preventing postoperative neurologic complaints of deficit, thoracic radiculopathy, and abdominal pain.