Pain practice : the official journal of World Institute of Pain
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We present a case of a young woman diagnosed with complex regional pain syndrome (CRPS) who underwent spinal cord stimulator (SCS) implantation. She had 2 successful pregnancies following implantation. ⋯ Both an SCS and many medications used for pain management in CRPS could cause harm to both mother and fetus in pregnancy. Further research must be done to determine the safety and efficacy of SCS use in pregnancy.
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Suprascapular nerve (SSN) block is a useful tool for pain control of different chronic shoulder pain syndromes. If the short-term effect of nerve block using local anesthetics is not sufficient, pulsed radiofrequency (PRF) neuromodulation of the SSN may provide long-term pain relief. ⋯ PRF of the SSN under ultrasonography guidance is a safe and effective treatment modality for management of chronic shoulder pain. The effect of a combination of PRF and a short-acting corticosteroid lasts up to 24 weeks, thereby assisting patients in undergoing relatively painless physiotherapy.
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Interdisciplinary pain rehabilitation programs are an evidence-based biopsychosocial treatment approach for chronic pain. The purpose of the current study is to assess outcomes for a 10-week interdisciplinary, acceptance and commitment therapy (ACT)-based, outpatient treatment model and to evaluate the relationship between psychological process variables (ie, pain catastrophizing, pain acceptance, pain self-efficacy) and treatment outcomes. ⋯ This study supports a 10-week, ACT-based treatment model for interdisciplinary chronic pain rehabilitation. In addition, pain catastrophizing, pain acceptance, and pain self-efficacy were each found to be mechanisms by which individuals achieve successful treatment outcomes. This research provides further support for interdisciplinary rehabilitation approaches for chronic pain.
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Ketamine, a potent analgesic and N-methyl-D-aspartate-(NMDA)-receptor antagonist, improves analgesic outcomes in patients with complex regional pain syndrome (CRPS). The NMDA receptor has also been implicated in opioid withdrawal. The use of ketamine to assist with a rapid opioid taper in the setting of CRPS has not been previously described. ⋯ CRPS may involve catecholamine hypersensitivity and central sensitization and can be notoriously challenging to treat by itself even outside of the context of an opioid taper. The patient we describe here received one additional 5-day infusion at 6 months and remained opioid-free while experiencing a major improvement in function and lifestyle that he still maintains. This was possible through a combination of aggressive inpatient management with ketamine as the centerpiece, followed by consistent outpatient CBT to maintain results without the need for a return to opioids. This combination has previously not been described in the setting of a rapid opioid taper and this patient's underlying CRPS made it all the more remarkable.
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Experimental and clinical studies have shown that tonic spinal cord stimulation (SCS) releases gamma-aminobutyric acid (GABA) in the spinal dorsal horn. Recently, it was suggested that burst SCS does not act via spinal GABAergic mechanisms. Therefore, we studied spinal GABA release during burst and tonic SCS, both anatomically and pharmacologically, in a well-established chronic neuropathic pain model. ⋯ In conclusion, our anatomical and pharmacological data demonstrate that, in this well-established chronic neuropathic animal model, the analgesic effects of both burst SCS and tonic SCS are mediated via spinal GABAergic mechanisms.