Pain practice : the official journal of World Institute of Pain
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Randomized Controlled Trial
Effects of Intra-Operative Ketamine Administration on Postoperative Catheter-Related Bladder Discomfort: A Double-Blind Clinical Trial.
Urinary catheterization during surgery frequently leads to unfavorable signs and symptoms (ie urgency, discomfort, frequency) during recovery. These signs and symptoms are collectively called catheter-related bladder discomfort (CRBD). We hypothesized that preemptive IV ketamine administration prior to intra-operative catheterization would reduce the incidence of CRBD in the postoperative period when compared to placebo. ⋯ Preemptive administration of IV ketamine (0.5 mg/kg) can reduce incidence and severity of CRBD in the early postoperative period.
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Myofascial pain syndrome (MPS) is a musculoskeletal condition characterized by regional pain and muscle tenderness associated with the presence of myofascial trigger points (MTrPs). The last decade has seen an exponential increase in the use of botulinum toxin (BTX) to treat MPS. To understand the medical evidence substantiating the role of therapeutic BTX injections and to provide useful information for the medical practitioner, we applied the principles of evidence-based medicine to the treatment for cervico-thoracic MPS. ⋯ This was due to appropriate identification of diagnostic criteria, excellent study design and objective endpoints. The 6 other identified studies had significant failings due to deficiencies in 1 or more major criteria. We conclude that higher quality, rigorously standardized studies are needed to more appropriately investigate this promising treatment modality.
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With the advent of newer treatment modalities, survival rate among breast cancer patients has improved substantially over the last few years. Hence, the concern has also shifted to the impact of treatment, side effects, and the morbidities arising from disease management. Among them is the development of phantom breast pain (PBP) and sensation (PBS) after mastectomy. ⋯ The prevalence of PBP and PBS was very low and of minor clinical significance. There was higher prevalence of depression, sleep disturbances, and anxiolytic intake among the patients with PBP and PBS, but it did not result in any significant impact on the patients daily activities.
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Chronic postsurgical pain (CPSP) is a common complication of surgery with high impact on quality of life. Peripheral and central sensitization caused by enhanced and prolonged afferent nociceptive input are considered important mechanisms for the development of CPSP. This case-control study investigated whether epidural analgesia is associated with a reduced incidence of CPSP after open abdominal surgery. ⋯ Chronic postsurgical pain occurs in a significant number of patients 6 months after open abdominal surgery. Postoperative epidural analgesia is associated with a reduced incidence of CPSP after abdominal surgery.
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Case Reports
Neuropathic Pain with Features of Complex Regional Syndrome in the Upper Extremity after Herpes Zoster.
We report a case of a 73-year-old female who developed unbearable neuropathic pain after a herpes zoster episode. The pain persisted and could not be controlled despite multimodal analgesia. In addition to postherpetic neuralgia, myelitis and complex regional pain syndrome were diagnosed during the evolution of neuropathic pain. This complex neuropathic pain was resolved after sympathetic ganglion block.