The Clinical journal of pain
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Randomized Controlled Trial
Preemptive low-dose epidural ketamine for preventing chronic postthoracotomy pain: a prospective, double-blinded, randomized, clinical trial.
Chronic postthoracotomy pain is the most common long-term complication that occurs after a thoracotomy with a reported incidence of up to 80%. Although thoracic epidural analgesia is a widely used method for managing acute postthoracotomy pain, its effects seems questionable. The objective of this prospective, double-blinded, randomized, controlled trial was to assess the effect of preemptive low-dose epidural ketamine in addition to preemptive thoracic epidural analgesia on the incidence of chronic postthoracotomy pain. ⋯ The addition of preemptive low-dose epidural ketamine (1.2 mg/h) to preemptive thoracic epidural analgesia did not have any beneficial effects in preventing chronic postthoracotomy pain.
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We report a case of a 59-year-old female with severe TN who experienced satisfactory symptom relief from a single-shot trial of intrathecal ziconotide. ⋯ Ziconotide should be considered for treatment of TN, although further investigation is recommended.
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Clinical Trial
Is interfascial block with ultrasound-guided puncture useful in treatment of myofascial pain of the trapezius muscle?
Ultrasound-guided puncture is indispensable for the injection of local anesthetic in the interfascial space, the space between 2 muscle fasciae. Interfascial infiltration or block may be useful in treating myofascial pain in the trapezius muscle. ⋯ The anatomical, histological, and ultrasound findings in the cadaver study confirmed the diffusion of the solution in the interfascial space. Study in patients confirms that the interfascial block in the back musculature can be as effective as in the abdominal musculature. The presence of nerve structures in this space, confirmed by the histological study, seems to explain the pain relief reported by the patients with this interfascial technique.
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Measuring outcomes across multiple domains is essential for an adequate understanding of chronic pain and the effects of pain treatment. Pain interference reflects the negative effects of pain on functioning, and is recognized as a critical outcome domain. The Pain Disability Assessment Scale (PDAS) contains items that assess the negative effects of pain on broad spectrum pain interference domains. The purpose of this study was to examine the factor structure, reliability, and validity of the PDAS. ⋯ The PDAS may be useful when researchers or clinicians require a multidimensional measure of the effects of pain on a patient's life.
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The main objective of this study was to investigate different psychometric properties of the Swedish version of the Depression, Anxiety, and Positive Outlook Scale (DAPOS) in patients with chronic musculoskeletal pain in an orthopedic setting. ⋯ To be able to rely on an instrument with as few items as DAPOS, the cross-validation of its constructs for sex and diagnostic groups is a valuable information, particularly when investigated in patients with musculoskeletal pain. Based on these results, we recommend that DAPOS could replace longer and more time-consuming screening tests in clinical settings.