Pain practice : the official journal of World Institute of Pain
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Case Reports
Acute Rhabdomyolysis in a Patient with Long-Term Exposure to Intrathecal Ziconotide: A Case Report.
Ziconotide is an intrathecally administered nonopioid analgesic for the treatment of severe chronic pain. Previous reports have noted rhabdomyolysis in patients receiving ziconotide during the initial single-shot trial or due to concurrent medical problems. We present a case of an acute rhabdomyolysis following an intrathecal bolus injection of ziconotide on a patient who had long-term exposure to the drug. ⋯ The clinical scenario described is a case of acute rhabdomyolysis from an intrathecal bolus injection of ziconotide in a patient with prior long-term exposure to the drug. The decrease in CK levels coincided well with the average half-life of ziconotide; however, the rhabdomyolysis may have been potentiated by hypokalemia.
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Randomized Controlled Trial
Single Paravertebral Injection for Acute Thoracic Herpes Zoster: A Randomized Controlled Trial.
The aim of this study was to evaluate the efficacy of single thoracic paravertebral injection in acute thoracic herpes zoster (HZ) pain, eruptive duration, and the incidence of postherpetic neuralgia (PHN). ⋯ Early single paravertebral blockade in the course of acute thoracic HZ seems to be a safe and effective adjuvant treatment modality.
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Randomized Controlled Trial
Can We "Predict" Long-Term Outcome for Ambulatory Transcutaneous Electrical Nerve Stimulation in Patients with Chronic Pain?
Evidence for effectiveness of transcutaneous electrical nerve stimulation (TENS) is still inconclusive. As heterogeneity of chronic pain patients might be an important factor for this lack of efficacy, identifying factors for a successful long-term outcome is of great importance. ⋯ The results showed that factors associated with a successful outcome in the long term are dependent on definition of successful outcome.
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Observational Study
Effectiveness of opioid analgesics in chronic noncancer pain.
There is general agreement about the need to perform a screening test to assess the risk of opioid misuse prior to starting a long-term opioid treatment for chronic noncancer pain. The evidence supporting the effectiveness of opioid long-term treatment is weak, and no predictors of its usefulness have been assessed. ⋯ The results indicate that pain relief significantly improved over a 6-month period of opioid treatment, together with quality of life. The outcome was better in patients with a pretreatment low risk of opioid misuse, low scores in the Cynicism scale of MMPI-2, and no aberrant drug behaviors at follow-up. Therefore, a psychological screening and support is crucial for a good outcome of opioid therapy for chronic noncancer pain patients.
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The objective of this study was to determine the long-term efficacy of percutaneous glycerol rhizolysis of the trigeminal ganglion for treating patients with trigeminal neuralgia and search for predictors associated with (long-term) benefit to improve patient selection. ⋯ The present study demonstrates that involvement of the third branch is a negative predictor for long-term outcome in percutaneous glycerol rhizolysis of the trigeminal ganglion in patients with classical trigeminal neuralgia. However, in the absence of third-branch involvement, glycerol rhizolysis yields excellent long-term results when initial positive effect is obtained.