The Clinical journal of pain
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Comparative Study Clinical Trial
Comparison of the effectiveness of interlaminar and bilateral transforaminal epidural steroid injections in treatment of patients with lumbosacral disc herniation and spinal stenosis.
The purpose of this study is to compare the effectiveness of interlaminar (IL) and bilateral transforaminal (TF) epidural steroid injections (ESIs) for pain reduction in patients with axial back pain resulting from herniated intervertebral disc (HIVD) and spinal stenosis (SS). ⋯ Bilateral TF epidural injection allowed the higher concentration of injectates to be delivered into ventral epidural space bilaterally. The IL approach can be more affected by tissue fibrosis, scarring, or hypertrophy, which is more prominently featured in SS than in HIVD; these prevent the injectate delivered via the posterior route from spreading to the ventral epidural space. Consequently, in patients with SS, bilateral TF produces better results than IL.
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To explore relationships between beliefs and worries held by parents of adolescents with chronic, nondisease specific, musculoskeletal pain and (1) parental pain promoting behaviors, (2) the adolescent's pain-related disability, (3) family functioning, and (4) parenting stress. ⋯ These findings provide insight into the complex interrelationships that exist among parents' beliefs and worries about adolescent pain, parental pain promoting behavior, adolescent disability, family functioning, and parenting stress that may have implications for treatment decisions made on the adolescent's behalf.
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Case Reports
Obstructed catheter connection pin discovered during intrathecal baclofen pump exchange.
We report a case of catheter obstruction due to complete narrowing of the lumen of a connecting pin, and catheter disconnection in a patient undergoing intrathecal Baclofen pump exchange. The patient underwent intrathecal baclofen pump implantation for treatment of lower extremity spasticity and hypertonia secondary to congenital tetraplegia. Intrathecal baclofen dose escalation occurred over the course of treatment (73 mo) from 80 to 708 mcg/d representing a 189% increase in dose. ⋯ Upon further examination, the lumen of the connection pin positioned between the pump catheter and intrathecal catheter was completely obstructed. Postsurgically, the patient's intrathecal baclofen dose was substantially reduced from 708 to 527 mcg/d (25.6% reduction) to control hypotonicity and to reestablish an Ashworth score of 2. We discuss intrathecal baclofen therapy and a unique complication associated with a catheter connecting pin.
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To investigate the expression of capsaicin receptor [transient receptor potential vanilloid type-1 (TRPV1)] in the peritoneum of women with chronic pelvic pain (CPP). ⋯ TRPV1 may play an important role in the maintenance and perpetuation of symptoms in women with CPP. In view of the immunoreactivity detected for TRPV1, the endometriotic lesion may have the ability to interfere with nociception or with the inflammatory peritoneal environment in women with CPP. Further studies are needed to elucidate the participation of TRPV1 in CPP and its association with endometriosis.
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It is currently unknown whether specific determinants are predictive for developing delayed onset muscle soreness (DOMS) after heavy work-related activities. The aim of this study was to analyze whether personal characteristics and performance measures are predictive for onset, intensity, and duration of DOMS after performing work-related activities during a Functional Capacity Evaluation in healthy participants. ⋯ The results demonstrate that the intensity and duration of self-reported DOMS can only minimally be predicted from the candidate predictors used in this study.