Pain practice : the official journal of World Institute of Pain
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Transforaminal epidural steroid injections (TFESIs) are often used to treat lumbar foraminal stenosis. Injectate pressure (of contrast) was monitored during fluoroscopically guided TFESI to assess the effect on short-term pain reduction. ⋯ In this setting, relative injectate pressures had no significant effect on immediate outcomes of TFESI.
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Patient satisfaction is tied to outcome, but there is scant literature on the relationship of patient perceived outcome and attributes of the pain clinic visit, including the patient interaction with the pain management specialist. The primary purpose of this study is to identify attributes of the patient-provider interaction most strongly associated with patient perceived outcome of their clinic visit. The secondary aim is to correlate patient perceived outcome with patient self-rated overall health. ⋯ Our results suggest that pain physicians may positively impact patient perceived outcomes of clinic visits by explaining the patient's condition and treatment, providing instructions, and taking the time to understand the patient and their values.
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In addition to the influence of tissue damage, the intensity of pain is also related to individual cognitive factors. The Pain Catastrophizing Scale (PCS) is used to measure individual tendency toward pain by inquiring about a subject's cognitive characteristics. Building on the knowledge that the venipuncture process causes severe pain and anxiety in some patients, the objective of this study was to investigate the relationship between the PCS score and venipuncture pain. ⋯ There was a positive correlation between venipuncture pain and PCS score. Consequently, the venipuncture pain score could be useful in informing practitioners about a patient's pain considerations.
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Transforaminal epidural steroid injections (TFESI) are commonly performed for the treatment of lumbar herniated nucleus pulposus and lumbosacral radiculopathy. Although rare, documented complications including spinal cord infarction, paraparesis, epidural abscess, paraplegia, and epidural hematoma have been reported. Here, we present a case of perineural hematoma affecting the L4 nerve root resulting in progressive acute-on-chronic lumbar radiculopathy following TFESI. ⋯ Although extremely rare, perineural or foraminal hematomas may occur as a serious complication of TFESI, even in the setting of a standardized procedure. Hematoma may cause worsening of symptoms in the acute and subacute phase following TFESI. Further investigation into the etiologies of such injuries is warranted and must be added to the considerations of pain physicians performing these procedures.
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Neuropathic pain is a serious chronic condition strongly affecting quality of life, which can be relieved but cannot be cured. Apart from symptomatic management, treatment should focus on the underlying disorder. The estimated prevalence is at least 1% to 5% of the general population. ⋯ Ancillary investigations may include EMG and computerized tomography/magnetic resonance imaging scans, depending on the localization of the suspected lesion. A limited number of agents, primarily directed at symptom control, are currently approved for use in neuropathic pain. A mechanism-based approach to pharmacological intervention supports the use of polypharmacy in neuropathic pain.