Articles: chronic-pain.
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Direct central nervous system (CNS) analgesic delivery is a useful option when more traditional means of dealing with chronic pain fail. Solutions containing local anesthetic have been effective in certain disease states, particularly in patients suffering from intractable head and neck pain. This review discusses historical aspects of CNS drug delivery and the role of intrathecal bupivacaine-containing solutions in refractory head and neck pain patients.
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Review Case Reports
Spinal cord stimulation as a method of reducing opioids in severe chronic pain: a case report and review of the literature.
Opioid addiction and abuse are growing problems in the United States, particularly in Appalachian areas, which has led to a major social health problem costing millions of dollars in lost wages, medical care and lost productivity. In some patients with chronic moderate to severe pain, opioids are indicated and can be successfully used with proper monitoring. In this report, we present a case where the use of spinal cord stimulation (SCS) led to an elimination of opioids, a return to work, and to productive function. We also review the literature on the use of SCS to reduce opioid use and improve function based on objective criteria.
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Though it is our ethical imperative to minimize discomfort, physicians often struggle to manage pain effectively, mainly due to time constraints, lack of training, and fear of litigation regarding over-prescribing of controlled substances. In addition, physicians also now must face potential litigation for under treatment of persistent pain. This dilemma often leaves the physician with a sense of insecurity and stress. ⋯ In the elderly, since abuse potential is less likely and disease documentation is often more readily apparent, we feel relatively comfortable in initiating careful prescribing of opioid therapy early on. As we become more adept at our approach toward pain management issues, we will attempt some assessment of outcomes by observing changes in several parameters, including numbers of opioid prescriptions and comparative adequacy of pain control over time. National and local pain/addiction information and referral resources are available as follows: http:// www.nationalsubstanceabuseindex .org and http://www.wvupc. org/charleston/painlist.
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Objectives. Medically refractory cervical dystonia has recently been treated using deep brain stimulation (DBS), targeting the subthalamic nucleus (STN). There has been limited literature regarding short-term outcomes and no literature regarding long-term outcomes for refractory cervical dystonia following DBS of the STN. Materials and Methods. Two patients with medically refractory cervical dystonia underwent STN DBS. ⋯ The STN and SNr were easily identified as having activity similar to off-state Parkinson's patients. Conclusions. DBS therapy for cervical dystonia utilizing the STN as the surgical target may be novel and may be an alternative target to the globus pallidus internus as supported by this first long-term outcome report. Further studies need to be performed to confirm these conclusions.
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Factors Influencing Depression Endpoints Research (FINDER) is a 6-month, prospective, observational study carried out in 12 European countries aimed at investigating health-related quality of life (HRQoL) in outpatients receiving treatment for a first or new depressive episode. The Italian HRQoL data at 6 months is described in this report, and the factors associated with HRQoL changes were determined. ⋯ After starting AD treatment, HRQoL improvements at 3 and 6 months were observed. However, several factors can negatively influence HRQoL, such as the presence of somatic and painful symptoms, the presence of any chronic medical condition or previous psychiatric illness.