Articles: chronic-pain.
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The intervertebral disc is the focal point of pathology for most low back pain. Contained disc herniation is a common cause of low back pain and, when unresponsive to conservative measures, is often treatable by disc decompression. To evaluate the safety and efficacy of percutaneous disc decompression using Coblation (Nucleoplasty) in the treatment of back and/or leg pain associated with contained disc herniation, a prospective, nonrandomized cohort analysis was conducted in an interventional pain management practice. ⋯ Additionally, significant improvement was reported by 54%, 44%, and 49% of patients in sitting, standing and walking abilities, respectively, at 12 months. There were no instances of complications. These results indicate that disc decompression using Coblation (Nucleoplasty) is a safe and efficacious procedure for reducing discogenic low back pain with or without leg pain.
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Spinal Cord Stimulation (SCS) is a treatment option for chronic pain patients. The most common indication for SCS is the failed back syndrome with leg pain. In the last decade, advances in our understanding of appropriate stimulation programming, lead placement and the physiology of SCS, have led to changes in multi-site stimulation, and stimulation with differing programs. In the past, low back, axial neuropathic type pain was not responsive to SCS. With dual electrode arrays, and dual stimulation with alternating programs of stimulation, steering of stimulation paresthesia, and versatile programmable stimulation parameters, SCS has become a more versatile form of analgesia. ⋯ SCS is the most effective treatment for limb pain not amenable to surgical decompression. The success of SCS in this chronic pain group is 80% successful in treatment of leg pain, and much less effective in treatment of axial pain.
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This study sought to determine the efficacy of fluoroscopic caudal epidural steroid injections as a conservative treatment in patients with presumably chronic lumbar discogenic pain. ⋯ At greater than two year follow-up, the efficacy of fluoroscopically guided caudal epidural steroid injections in patients with chronic lumbar discogenic pain is poor. Patient satisfaction exceeds the reported rate of efficacy. Patients responding to injection have significantly lower pre-injection pain scores.
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Drug abuse with illicit drugs and licit drugs has been increasing steadily over the past decade. A recent National Household Survey on Drug Abuse found statistically significant increases between 2000 and 2001 in the use of multiple drugs, including marijuana, cocaine, and non-medical use of pain relievers and tranquilizers. Prescription controlled substance abuse is a major issue in chronic pain management. ⋯ Only one patient tested positive for a combined use of both marijuana and cocaine. This study showed that, in an interventional pain management setting, there is significant use of illicit drugs (16%) with 13% use of marijuana and 3% use of cocaine in patients who are considered as non-abusers of prescription controlled substances and those who are adherent to controlled substance agreements. However, if cocaine is considered as a hardcore drug in contrast to marijuana, abuse of hardcore illicit drugs is only 3%.
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It is widely believed that the extent of a patient's subjective complaints are often based on developmental, psychological, social, and cultural factors rather than structural or physical pathology. In patients presenting with chronic low back pain, underlying behavioral problems may not be immediately apparent. These behavioral or non-physiological issues may be secondary to a deliberate deception or may be associated with psychological distress. ⋯ Results showed that 27 patients (22%) presented with non-physiological symptoms, 34 patients (28%) with non-physiological signs, and 19 patients (16%) with combined presence of non-physiological signs and symptoms. Overall there was significant correlation of non-physiological signs with depression, anxiety, and somatization, both by diagnosis of depression, diagnosis of anxiety and elevated scores. However, correlation was present for non-physiological symptoms only with elevated scores of anxiety and somatization.