Pain practice : the official journal of World Institute of Pain
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This study aimed to: (1) determine prevalence of depression in patients referred to specialist pain services using the Structured Clinical Interview (SCID) diagnostic interview, (2) compare results on the Beck Depression Inventory II (BDI-II) with the SCID to determine the utility of the BDI-II as a screening tool in this population. Thirty-six participants were recruited, mainly women, with a mean age = 47.83 years (standard deviation = 12.85 years), who were heterogeneous with regard to their pain. All completed the BDI-II and SCID. ⋯ It has been suggested that the BDI overestimates incidence of depression in pain patients, but this study confirmed through diagnostic interview the very high incidence of depression in this population. It is therefore questionable whether there is value in screening referrals for depression. When using BDI-II for screening, audit or evaluation purposes with a pain clinic population, we suggest a cut-off of 22 or above.
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Postherpetic neuralgia (PHN) is a common cause of chronic pain in the elderly. Antidepressants, anticonvulsants, and opioids may reduce discomfort in many patients, while others have pain intractable to all forms of therapy. ⋯ Two cases are described in which an 80-year-old man and a 67-year-old woman with intractable PHN, lasting 2 and 10 years, respectively, were effectively treated with implantation of two octapolar leads in the lateral thoracic region. These cases suggest that peripheral nerve stimulation may offer an alternative treatment option for intractable pain associated with PHN especially in the elderly where treatment options are limited because of existing comorbidities.
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Anterior spine fusion by thoracotomy is indicated for the treatment of idiopathic scoliosis. Although epidural (EP) analgesia represents the most effective way to provide adequate analgesia after thoracotomy, scoliosis patients have substantial anatomic variations that make EP catheter placement more difficult and often contraindicated. ⋯ The procedure was guided by both ultrasound (US) and electrical stimulation of the Tuohy needle and catheter. The combination of US and nerve stimulation in this setting may be associated with easier, potentially safer, and more accurate insertion.
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To assess the putative predictors that may influence the pain experienced during ductal endoscopy of the breast. ⋯ Pain during ductal endoscopy of the breast is influenced by a host of factors: some immutable (such as history of lactation) and others variable (day of menstrual cycle). The latter (ie, avoidance of the luteal phase) may be targeted for the minimization of pain.