Articles: chronic-pain.
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Sjögren syndrome is a chronic autoimmune disease. This disease mainly involves salivary and lacrimal glands, although it may also involve the musculoskeletal, respiratory, gastrointestinal, renal, hepato-biliary, hematological, neurological, vascular, or both systems. Small vessel disease may appear in up to 30% of the cases. ⋯ In our pain unit, a percutaneous posterior spinal cord stimulator (SCS) was placed. SCS clinically reduced her pain by 90% and helped to improve her quality of life and significantly reduced her intake of analgesics. We conclude spinal cord stimulation may be a good alternative to conservative therapies in patients with vasculitis of Sjögren syndrome.
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Objectives To retrospectively analyze by indices of success, patients with chronic complex pain, including, axial low back pain, receiving dual spinal cord stimulation (SCS) systems. Methods Eighteen patients with dual spinal cord stimulators have been retrospectively and nonrandomly analyzed. The preponderance of patients in our study group had failed back surgery syndrome (FBSS). ⋯ Thirteen (81%) patients with dual lead SCS therapy were willing to repeat the SCS implant procedure. Complications occurred in 43.7%. Conclusions Dual spinal cord stimulation is appropriate and efficacious for treating complex pathology and complex pain that including pain of the low, axial back.
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The increased use of opioids in the treatment of chronic pain encourages the search for drugs with low abuse and tolerance potential but with potent analgesic activity. Opioid agonist-antagonists and partial agonists have less abuse potential than do mu opioid receptor agonists such as morphine, and have been used for many years for their analgesic affects. ⋯ Doctors are often hesitant to prescribe agonist-antagonists and partial agonists to opioid-tolerant patients, fearing that these drugs may precipitate withdrawal. Can drugs being used safely for addiction treatment also safely replace opioid agonists to provide analgesia in chronic pain patients who are opioid-tolerant?
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Availability of opiate substances through physicians and on the street has led to a rise in dependence and in addiction resulting in countless numbers of people hooked on these drugs. Long-term use of these agents results in reduction of endogenous supply of opiate replaced by these exogenous compounds. A technique known as Ultrarapid Detoxification (UROD) has been developed and appears more promising than conventional modalities. ⋯ Though techniques vary from center to center, safety should be paramount with the technique performed in an intensive care unit with trained professional anesthesiologists. Psychosocial issues should be evaluated by a trained addictionalist and most people will succeed from the UROD procedure without experiencing the horrible withdrawal syndrome. Patients must have realistic goals and be prepared to deal with psychosocial issues post-procedure.
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Epidural steroid injections are commonly used for chronic spinal pain. However, there is no conclusive evidence regarding their effectiveness, and debate continues as to their value in managing chronic spinal pain. ⋯ The evidence for effectiveness of epidural injections in managing chronic spinal pain ranged from limited to strong.