Articles: treatment.
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Postherpetic neuralgia (PHN) remains a difficult pain problem for patients and physicians alike. This review describes the epidemiology and pathophysiology of PHN and discusses proposed mechanisms of pain generation and the various treatments currently available. Evidence is scant for the value of surgical and procedural interventions in general, although there are numerous small studies supporting the use of specific interventions such as nerve blocks, neurosurgical procedures and neuroaugmentation. ⋯ Interventions with low risk, such as TENS are appropriate. Although prevention of postherpetic neuralgia appears to be an appropriate strategy, there is little evidence to support the position that medical or interventional approaches (nerve blocks) will prevent PHN after a patient develops acute herpes zoster (HZ). Although antivirals are appropriate for acute HZ, and the use of neural blockade and sympathetic blockade may be helpful in reducing pain in selected patients with HZ, there is little evidence that these interventions will reduce the likelihood of developing PHN.
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Transforaminal epidural steroid injections are provided frequently for patients with lumbar radiculopathy, having demonstrated efficacy and safety. We present a patient who developed methicillin-resistant Staphylococcus aureus epidural abscess 11 days after a transforaminal epidural steroid injection. ⋯ Fortunately, the patient made a full recovery, and continues to do well one year later. The incidence, etiology and treatment of epidural injection-related infections are reviewed.
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Respiratory viral infections, also known as the common cold, are the most common infections in humans. Despite their benign nature, they are a major cause of morbidity and mortality on a worldwide basis. Several viruses have been associated with such illness, of which rhinovirus is the most common. ⋯ Therefore, antiviral treatment alone may not be able to prevent these events. The optimal use of such agents also requires earlier initiation; therefore, it is important to develop accurate and rapid diagnostic techniques for respiratory viruses. Before any reliable and effective treatment is available, symptomatic therapies may remain the only possible choice of management.
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The California Workers' Compensation system mandates the use of occupational medicine practice guidelines developed by the American College of Occupational and Environmental Medicine (ACOEM). These Guidelines cover the treatment of acute (less than three months' duration) injuries. The presence in the ACOEM Guidelines of references to procedures which may be of use after the three-month acute period creates ambiguity as to whether the ACOEM Guidelines are applicable after three months. ASIPP's "Evidence-Based Practice Guidelines for Interventional Techniques in the Management of Chronic Spinal Pain" are comprehensive, focusing on management of chronic spinal pain. ACOEM guidelines, mandated by the legislature, do not deal explicitly with chronic pain. Their application in managing chronic pain may result in denial of access to appropriate treatment. Thus, ASIPP guidelines may be supplemental to the ACOEM Guidelines. Evaluation of the two Guidelines may clarify which should be followed in the event of ambiguity or conflict. ⋯ The ASIPP Guidelines may be considered the applicable Guidelines for the treatment of work-related low back activity limitations persisting beyond three months.
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An update on recent developments in diagnosis and treatment of disseminated intravascular coagulation. ⋯ Whereas antithrombin and tifacogin failed to improve clinical outcome in severe sepsis, drotrecogin alpha (activated) increased the chances of survival of patients with severe sepsis with and without disseminated intravascular coagulation.