Articles: chronic-pain.
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This case report identifies a patient with complex regional pain syndrome Type 2 (causalgia) with sympathetically maintained pain in a distal extremity associated with an anterior sacroiliac fusion with local bone graft. ⋯ Complex regional pain syndrome Type 2 with sympathetically maintained pain is a condition that can result in serious disability and can be associated with spinal procedures and sacroiliac arthrodesis. Early intervention is recommended to provide long-term resolution of the condition.
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Introduction. Intrathecal octreotide has been considered an alternative to opioids in chronic infusion for pain. Octreotide is an analog of the growth hormone sandostatin. Previous work has shown the drug to be efficacious in cancer patients who had failed intrathecal opioids. ⋯ The Saint Francis Hospital IRB and FDA approved the ongoing use of intrathecal octreotide for research. Conclusions. Intrathecal octreotide, at doses as high as 20 µg/hr, appeared to be as safe as saline when given as a continuous intrathecal infusion. Further work is needed on dose-range analysis and efficacy.
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Clay shoveler's fracture is a repetitive stress injury that affects the spinous process of the lower cervical and upper thoracic spine. In sports, deceleration forces caused by the pull of the trapezius, rhomboids, and the ligamentum nuchae on the neck probably exert repetitive traction on their attachment sites to the narrow spinous processes. The condition is known in manual laborers, but it is rare in athletes, as in this case of a volleyball player. Early recognition and treatment with rest, analgesics, and physical therapy are important to prevent debilitating chronic back pain.
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The ganglion impar, a single structure usually found at the anterior aspect of the sacrococcygeal joint, is the lowest ganglion of the paravertebral sympathetic chain. Its blockade is indicated in visceral pain syndromes and/or sympathetic pain syndromes of the perineal region. Several approaches to this block have been described, mainly through the anococcygeal or sacrococcygeal ligaments. ⋯ After therapy the VAS decreased by an average of 50% in the whole group. There were no adverse events. Our result show that this proposed modified approach to the block and use of radiofrequency for the ganglion impar is useful for the treatment of perineal noncancer-related pain.
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With the continuous development of technological advances for diagnosis and treatment comes the increased need for anesthesia outside of the operating room. Children, because of their inability to cooperate with lengthy imaging procedures or painful treatments, form the largest group needing non operating room anesthesia (NORA). As the distinction between deep sedation and general anesthesia becomes less clear, it has become increasingly common for institutions to dedicate resources for pediatric NORA (as opposed to sedation services) to improve predictability, comfort, and safety. ⋯ NORA is a specific microsystem environment that must integrate operating room systems with those of other departments and specialties. Often the children that require these procedures have chronic illnesses and return at frequent intervals with complex medical, psychological, and behavioral issues. Special knowledge, training, and support infrastructure are required to provide optimal care for these expanding services.