The Clinical journal of pain
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Randomized Controlled Trial
Predicting Prognostic Factors in a Randomized Controlled Trial of Acupuncture Versus Topiramate Treatment in Patients With Chronic Migraine.
This study aimed to identify predictive factors of outcome in patients with chronic migraine (CM) treated with acupuncture or topiramate in a randomized controlled trial. ⋯ Some variables can predict outcome in acupuncture or topiramate treatment of CM patients. Identifying predictors of prognosis of both treatments for CM may help improve outcomes in future work.
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Previous studies indicate that genetic variants in genes encoding proteins like matrix metalloproteinase (MMP) enzymes may affect degeneration of the intervertebral disk. One such genetic variant is a single nucleotide polymorphism insertion in the promoter region of the MMP1 gene, that is, the MMP1 rs1799750 2G allele, which increases the MMP1 expression in vitro. In this study, we examined whether the MMP1 rs1799750 2G allele might be associated with disk degeneration and clinical outcome after lumbar disk herniation. ⋯ Our findings suggest that the MMP1 rs1799750 2G/2G genotype may contribute to low back pain, sciatica, and disability after lumbar disk herniation.
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Case Reports
Ritodrine for Intractable Uterine Pain Due to Extrapelvic Malignant Tumor Metastases: A Case Report.
Effective pain management is an essential component of cancer treatment as approximately 75% of all cancer patients experience excruciating nociceptive pain even at maximum safe doses of nonsteroidal anti-inflammatory drugs and/or opioids. We report a case where ritodrine hydrochloride effectively controlled refractory pain due to uterine metastases from thymic carcinoma. ⋯ Ritodrine relieved the pain caused by uterine contraction due to metastases and enhanced the quality of life.
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Case Reports
Placement of an Intrathecal Catheter Through a Bony Fusion Mass Using 3D Image Guidance: A Case Report.
We describe the 3-dimensional (3D) image-guided placement technique for a lumbar intrathecal catheter through a dorsal fusion mass. This is the first time this technique has been reported. A patient with 6 prior spine surgeries and chronic pain syndrome presented with a challenging large dorsal fusion mass. The use of 3D cone beam computed tomography-based image guidance proved advantageous for the placement of an intrathecal drug delivery system (IDDS). ⋯ This is the first case report using 3D cone beam computed tomography-based image guidance for the placement of an intrathecal catheter through a bony fusion mass. This technique appears to be a viable option for IDDS implantation in patients with difficult anatomy.
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Epidemiologic studies in the non-human immunodeficiency virus (HIV) positive population have shown greater health care utilization among persons with chronic non-cancer pain on opioid therapy. However, we are not aware of any similar data in the HIV positive population. ⋯ In our study HIV positive individuals with chronic pain were more likely to be seen in the ER and be hospitalized if they were on opioids. However, after controlling for other variables, the association with opioids no longer remained significant.