The Clinical journal of pain
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Comparative Study
Neuropathic Pain Components Are Common in Patients With Painful Cervical Radiculopathy, but Not in Patients With Nonspecific Neck-Arm Pain.
The aim of this study was to investigate, using quantitative sensory testing (QST) parameters and the painDETECT (PD-Q) screening questionnaire, the presence of neuropathic pain (NeP) in patients with unilateral painful cervical radiculopathy (CxRAD) and in patients with unilateral nonspecific neck-arm pain associated with heightened nerve mechanosensitivity (NSNAP). ⋯ QST data suggest that NeP is likely to be observed in patients with painful CxRAD, but not in patients with NSNAP.
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To investigate the relation between localized pressure pain sensitivity and the amplitude and specificity of semispinalis cervicis muscle activity in patients with chronic neck pain. ⋯ In contrast to asymptomatic individuals, the semispinalis cervicis muscle displays reduced and less-defined EMG activity during a multidirectional isometric contraction in patients with chronic neck pain. The altered behavior of the semispinalis cervicis is weakly associated to pressure pain sensitivity.
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Case Reports
Percutaneous Trigeminal Rhizotomy for Facial Pain Secondary to Head and Neck Malignancy.
Nearly 80% of patients with head and neck cancers experience facial pain related to their tumor or treatment. The majority obtain pain relief with appropriate medical treatment. Occasionally some remain refractory to all analgesics or cannot tolerate the accompanying side effects. They may benefit from surgical intervention. ⋯ Percutaneous trigeminal rhizotomy is a surgical option for managing nociceptive pain secondary to a head and neck malignancy. This technique, last reported in the literature almost 30 years ago, must not be forgotten by the next generation of oncologists, pain specialists, and neurosurgeons.
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Slipping rib syndrome (SRS) is a musculoskeletal cause of severe and recurrent thoracic or abdominal pain. The etiology of SRS is unknown, it seems to arise from costal hypermobility with a tendency of one of the ribs (usually from 8th to 10th but also 11th and 12th have been described) to slip under the superior adjacent rib. Its prevalence is underestimated because SRS is mainly a clinical diagnosis, frequently missed. The critical aspect of the diagnosis is knowledge of the condition itself, which, when lacking, often results in the patient being referred to many different specialists and exposed to unnecessary and costly investigations. The management of the condition includes conservative techniques such as manipulation, localized anesthetic, and steroid or anesthetic nerve block. However, where conservative therapy fails, surgical treatment, with excision of the rib, may be performed. ⋯ To our knowledge botulinum toxin has never been proposed before for the treatment of SRS. We believe that it should be considered as a therapeutic option, especially where other medical treatments have failed or as an intermediate step before surgical intervention.