Pain practice : the official journal of World Institute of Pain
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Injury to the ilioinguinal nerve commonly follows during lower abdominal and pelvic surgery, especially with inguinal hernia repair, appendectomy, and hysterectomy. Other potential causes include low abdominal blunt trauma, iliac crest bone graft, psoas abscess, Pott's disease, and prolonged wearing of abdominally constrictive clothing. The actual incidence of ilioinguinal neuralgia is uncertain, as reported percentage ranges between 12% and 62%. ⋯ We present three cases of successful pain control of ilioinguinal neuralgia with peripheral nerve stimulation. These cases demonstrate the potential benefits of neurostimulation including durable effective pain relief and decreased use of medication. Putative mechanisms of effect(s) and caveats for continued research to inform prudent employment of this technique are presented.
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Case Reports
Thoracic spinal cord stimulation for post-ablation cardiac pain in a patient with permanent pacemaker.
Spinal cord stimulation (SCS) is increasingly utilized for inoperable, intractable chest pain because of ischemia. Because patients with ischemic heart disease commonly have permanent cardiac pacemakers (PPM) or automated implantable cardio-defibrillators (AICD), concurrent use of SCS and PPM or AICD may grow. Interference between SCS and PPM or AICD devices is potentially dangerous and has been previously reported. ⋯ Others have reported SCS implantation in patients with PPM. This is the first report to describe safe and effective use of an Advanced Bionics SCS in a patient with a Guidant PPM. In addition, we speculate that this patient's cardiac pain may have been other than ischemic in origin. As such, this case may represent a unique clinical scenario. Despite many cases series and case reports demonstrating safety of concurrent SCS and PPM or AICD, the complexity of these technologies requires continued demonstration of device compatibility in novel contexts.
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Case Reports
Peripheral neurostimulation in supraorbital neuralgia refractory to conventional therapy.
Supraorbital neuralgia has been identified as an infrequent cause of headache that may prove very difficult to control pharmacologically. Peripheral nerve stimulation using electrodes to stimulate the nerve segmentally responsible for the zone of pain may constitute a management alternative in such cases. We present the case of a patient with headache because of posttraumatic supraorbital neuralgia, refractory to medical treatment, with good analgesic control after peripheral nerve stimulation. Peripheral nerve stimulation may be considered a safe, reversible treatment for patients with headache secondary to supraorbital neuralgia who respond poorly to pharmacological treatment, thus avoiding irreversible alternatives such as surgery.
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Median arcuate ligament syndrome, which presents with intractable visceral pain, is difficult to both diagnose and treat. This case report describes the first use of an intrathecal morphine pump as an effective therapeutic intervention. ⋯ The use of an intrathecal narcotic pump should be considered for treatment of patients with intractable visceral pain secondary to median arcuate ligament syndrome.
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Multicenter Study
Treatment of 94 outpatients with chronic discogenic low back pain with the DRX9000: a retrospective chart review.
This study's goal was a retrospective chart audit of 100 outpatients with discogenic low back pain (LBP) lasting more than 12 weeks treated with a 2-month course of motorized spinal decompression via the DRX9000 (Axiom Worldwide, Tampa, FL, U.S.A.). ⋯ This retrospective chart audit provides preliminary data that chronic LBP may improve with DRX9000 spinal decompression. Randomized double-blind trials are needed to measure the efficacy of such systems.