Pain practice : the official journal of World Institute of Pain
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Case Reports Observational Study
Directional preference following epidural steroid injection in three patients with acute cervical radiculopathy.
Cervical radiculopathy is typically characterized by neurologic symptoms that are traced to disturbances of discrete spinal nerve root(s) due to inflammatory or mechanical etiologies. Here we present three patients diagnosed with cervical radiculopathy, whose directional preference only surfaced after either a cervical transforaminal or intralaminar nerve root epidural steroid injection. This retrospective observational case series describes three men who presented with cervical radiculopathy with 7-9/10 neck pain, neck disability index (NDI) ranging between 44% and 90%, and an irreducible derangement upon McKenzie mechanical diagnosis and therapy (MMDT) evaluation. ⋯ They were all discharged with stable 0-3/10 pain severity after four physical therapy sessions and NDI scores of 0%. These cases suggest an interplay between inflammatory and mechanical contributors to spine-mediated pain and the treatment challenge this presents. Dissecting the components of spine pain can be challenging; however, delivery of skilled multidisciplinary care in an algorithmic fashion may be beneficial and provide the future framework for the management of cervical radiculopathy and other spine-related conditions.
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We are following with great interest the increasing generally favorable impressions of the long-term results of the MILD (minimally invasive lumbar decompression) procedure for treating spinal stenosis due to hypertrophied ligamentum flavum (LF). We are also influenced by the cautionary surgical observations and opinions of Tumialan et al and publications about the lack of efficacy or placebo effect. The impression indeed has been virtual safety of the MILD procedure, but Tumialan et al describe some major complications resulting from the procedure. An algorithm for clinical use is needed.
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The treatment for pain in emergency medicine is a matter of increasing interest. Available data indicate that in both normal conditions and during major-emergencies, the majority of healthcare providers are culturally and professionally unprepared to adequately treat acute pain conditions. In case of natural disasters, opioid drugs are often unavailable. ⋯ Pain inadequately treated may modify the characteristics of the pain itself. Pain is no longer considered just a symptom, but itself becomes an autonomous pathology heavily influencing the social life and psycho-social aspects of a person. In the disastrous situation following an earthquake, an inadequate treatment of pain was the major violation of the psycho-physical integrity of individuals and a severe violation of their rights, as human beings and patients.
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Case Reports
Ultrasound-Guided Continuous Superficial Peroneal Nerve Block below the Knee for the Treatment of Nerve Injury.
(CRPS) describes a constellation of symptoms including pain, trophic changes, hyperesthesia, allodynia, and dysregulation of local blood flow often following trauma. It is often confined to the extremities. Treatment of this disorder consists of a variety of modalities including systemic pharmacotherapy, local anesthetic injections or infusions, psychological nonpharmacotherapy, physical rehabilitation, and surgical intervention. ⋯ Despite the array of available therapies, it can still be difficult to manage. We report a case of a 19-year-old patient diagnosed by her surgeon as having CRPS Type II, secondary to foot trauma, which was treated with a continuous infusion of local anesthetic at the superficial peroneal nerve (SPN). While placement of peripheral nerve block catheters to augment chronic pain therapy is not novel, the application of a perineural catheter at the SPN has not been previously described.
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To examine how the severity of postoperative pain affects patient's health-related quality of life (HRQoL) at 1 week following surgery and to compare two generic validated HRQoL instruments. ⋯ A proportion of patients continue to experience severe pain at 7 days postoperatively, even after minor surgery. HRQoL is strongly associated with the level of pain and provides additional data on the impact of postsurgery pain on patient's function and well-being. Additional studies are needed to elucidate the interaction between pain severity and HRQoL during the peri-operative period.