Articles: back-pain.
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The objective of this study was to follow up patients considered for spinal cord stimulation and assess outcomes and patient selection factors associated with outcome. A retrospective study of patients considered for spinal cord stimulation was performed. This included three groups: A) those who did not have a temporary trial of stimulation, B) those who did not go on to have long-term stimulation after a trial, and C) those who did go on to have long-term stimulation after a trial. ⋯ We conclude that spinal cord stimulation is an efficacious therapy which is not associated with serious side effects. There is some reduction in therapeutic efficacy over time. Patients deteriorate without treatment.
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The acceptance of spinal manipulation as a reasonable method of treating certain patients with spinal pain over the past decade has led to a renewed interest and increased use of these techniques performed in conjunction with commonly used medications and procedures. Manual therapy is increasingly being used in conjunction with anesthetics, sedatives or analgesics as well as local, epidural and intra-articular injections. ⋯ Medicine-assisted spinal manipulation therapies have a relatively long history of clinical use and have been reported in the literature for over 70 years. However, evidence for the effectiveness of these protocols remains largely anecdotal, based on case series mimicking many other surgical and conservative approaches for the treatment of chronic pain syndromes of musculoskeletal origin. There is, however, sufficient theoretical basis and positive results from case series to warrant further controlled trials on these techniques.
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It was the purpose of this study to retrospectively test the safety and efficacy of the use of intraspinal analgesics in a diverse population of patients with chronic nonmalignant pain. This study was conducted in 39 patients, refractory to conventional therapies for intrathecal therapy. Twenty-two patients had neuropathic pain and 17 had nociceptive pain. ⋯ Other patient-reported side effects were not considered significant by the authors to be mentioned here. After more than 6 years of experience with spinal infusion of morphine, either alone or admixed with other spinal analgesics, in patients with pain of nonmalignant origin, we consider the technique to be helpful in selected patients not responding to oral treatment or when untoward side effects exist with oral treatment. The advantages, as regards to analgesic efficacy and quality of life, clearly outweigh the drawbacks of the long-term use of spinal morphine.
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Clinical outcome data was analyzed for 67 patients with contained disc herniation who underwent percutaneous disc decompression procedure using Coblation(R) technology, also referred to as Nucleoplasty after failing to respond to conservative management. Patients presented with clinical symptoms of discogenic low back pain and/or leg pain and were not considered candidates for open surgery. Follow-up data was collected up to 12 months. ⋯ Average pre-procedure pain level for all patients was reported as 6.8 while average pain level was 4.1 at the 12 month follow-up period. Statistically significant improvement was observed in 62%, 59%, and 60% of patients in sitting, standing, and walking ability at 12 months, respectively. The results of this analysis indicated that PDD using Coblation technology, also referred to as Nucleoplasty, is an effective procedure for patients presenting with discogenic back and/or leg pain who have failed conservative therapies and are not considered candidates for open surgical interventions.
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Bupivacaine is a local anesthetic agent of the amide class. This drug has been used in many clinical situations including intrathecal infusion. The literature regarding intrathecal bupivacaine is limited to small case studies, and anecdotal reports. This article examines a large patient group receiving bupivacaine with opioids over an extended period of time and analyzes efficacy and safety. The patients had pain related to failed back surgery syndrome or metastatic cancer to the spine. ⋯ Bupivacaine, when used in combination with opioids, is a helpful and safe method of treatment in a select population of patients who have not responded to intrathecal opioids alone.