Articles: chronic.
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Multidisciplinary treatment of patients with chronic pain in pain centers was studied. The conditions of all multidisciplinary pain centers in the German federal state of Northrhine-Westphalia (NRW), an area of about 17 million inhabitants, were investigated. ⋯ There is an existing network of multidisciplinary pain centers in Northrhine-Westphalia. If we consider the estimated number of 850,000 patients with chronic pain in this area, the low number of yearly treated patients (120,000) indicates, that the capacity of multidisciplinary pain centers is inadequate for the demand of multidisciplinary treatment of patients with chronic pain in Northrhine-Westphalia.
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This prospective study was designed to determine the prevalence of lumbar facet joint pain in a consecutive series of patients with chronic low back pain treated at an interventional, multidisciplinary private pain management practice utilizing double diagnostic blocks, to determine the prevalence of false positive rate of uncontrolled facet joint blocks, and to determine the relationship of clinical features of responders and non-responders to double diagnostic blocks. One hundred and twenty patients with low back pain with or without lower extremity pain were selected. The procedure consisted of diagnostic blocks using lidocaine and bupivacaine on separate occasions, usually two weeks apart. ⋯ However, history of previous surgery showed a negative correlation as only 29% of the patients after previous surgery were positive in contrast to 51% of the nonsurgical population. The results of this study echo previous concerns of reliability of uncontrolled single blocks, history, and clinical features. This study demonstrated that the facet joint is a source of pain in 45% of the patients suffering with chronic low back pain in an interventional pain management setting in a private practice.
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Post lumbar laminectomy syndrome with its resultant chronic low back pain is estimated to occur in 20% to 50% of the patients. Among various procedures available, lysis of epidural adhesions is considered as one of the effective therapeutic modalities of management in these patients, and may be performed either non-endoscopically or endoscopically. This retrospective evaluation included 120 post lumbar laminectomy patients who underwent either non-endoscopic adhesiolysis (Group I) or endoscopic adhesiolysis (Group II) with 60 consecutive patients in each group. ⋯ Cost effectiveness analysis showed Group I patients experiencing significant relief at a cost of $40 per week, with one year quality of life improvement for $2,080, whereas it was $135 per week improvement in Group II with a one year quality of life improvement at a cost of $7,020 with significant difference noted in cost effectiveness. In conclusion, non-endoscopic epidural adhesiolysis and administration of corticosteroids and hypertonic saline is a safe and cost effective procedure for relieving chronic intractable pain in post lumbar laminectomy patients who failed to respond to other modalities of treatment. Similarly, endoscopic adhesiolysis with the administration of corticosteroids is also a safe and possibly cost-effective technique for relief of chronic intractable pain failing to respond to other modalities of treatments.
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Chronic neck pain, headache, and arm pain are some of the most common patient complaints confronting today's health care provider. Chronic neck pain is reported to be a frequency symptom in 34% of the general population with 14% of the general population reporting neck pain that lasted for more than 6 months. The magnitude of the problem is demonstrated by increase of cervical spine surgery by 45% and cervical fusion by 70% over a ten year period from 1979 through 1988. ⋯ Neural blockade in the cervical spine, though introduced in 1912, lagged behind that of the lumbar spine. At the present time, neural blockade is an extremely popular tool for diagnostic purposes in evaluation of neck pain, even though it has not developed a definitive role in the management of chronic neck pain and associated syndromes. The object of this review is to focus on various aspects of neural blockade in the management of chronic neck pain and associated syndromes including its rationale, clinical effectiveness, indications, and complications.
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In patients with renal or hepatic failure, the pharmacokinetics of opioids may be affected in several ways, leading to the necessity to correct the dose. The liver is the major site for biotransformation of most opioids. The major metabolic pathway is oxidation. ⋯ On the other hand, the analgesic activity of codeine and tilidine depends on transformation into the active metabolites, morphine and nortilidine. In the case of reduced metabolism in chronic liver disease, the analgesic action of these drugs may be compromised. Lastly, the disposition of a few opioids, such as fentanyl, sufentanil, and remifentanil, appears to be unaffected in liver disease.