The Clinical journal of pain
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The outcome of complex regional pain syndrome (CRPS) is relatively unknown. High disease resolution rates have been reported, but also long-lasting impairments in many patients. This study aims to assess CRPS outcome in a population-based cohort of CRPS patients. ⋯ Severe CRPS outcome is rare, but a majority of patients has persistent impairments at 2 or more years since onset.
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To improve opioid repsonse in patients with movement-related pain by using opioid switching adding a burst of ketamine. ⋯ The development of breakthrough pain due to movement (incident pain), associated with bone metastases is so rapid that no medication as needed has such a short onset to parallel this temporal pattern of pain firing. Experimental studies have shown that bone metastases are characterized by a specific pattern of spinal hyperexcitation requiring higher doses of opioids. Optimization of basal opioid regimen may improve mobilization. However, adverse effects may more likely occur. The role of opioid switching and burst ketamine to further improve the opioid response has never been assessed in this context. Further studies in animals could confirm these preliminary data, with specific design to parallel this clinical context.
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Randomized Controlled Trial
Plasma vitamin C is lower in postherpetic neuralgia patients and administration of vitamin C reduces spontaneous pain but not brush-evoked pain.
Plasma vitamin C concentrations have been suggested to be related to pain modulation in postherpetic neuralgia (PHN), an intractable neuropathic pain syndrome. In this study, we first compared plasma concentrations of vitamin C between healthy volunteers and PHN patients and then designed a symptom-based and mechanism-based approach to assess the analgesic effect of intravenous vitamin C on spontaneous and brush-evoked pain. ⋯ Plasma vitamin C status plays a role in PHN, and intravenous ascorbate helps relieve spontaneous pain in PHN.
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Clinical Trial
CT-guided blocks and neuroablation of the ganglion impar (Walther) in perineal pain: anatomy, technique, safety, and efficacy.
An alternate approach to the ganglion impar was chosen to minimize the risk of adverse events. Efficacy of the procedure was evaluated. ⋯ CT-guided block and neuroablation of the ganglion impar (Walther) results in a significant reduction of pain scores and carries virtually no hazards.