The Clinical journal of pain
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This study evaluates the relationship between clinical symptoms and the function of the deep cervical flexor muscles in women with persistent neck pain. ⋯ This study shows a relationship between the levels of neck pain intensity and the function of the deep cervical flexor muscles in women with persistent neck pain but not in other clinical features, such as location or duration of the disorder. These findings may partially explain the heterogeneity in motor control impairments in patients with neck pain.
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Randomized Controlled Trial Multicenter Study Clinical Trial
Treatment expectation for pain coping skills training: relationship to osteoarthritis patients' baseline psychosocial characteristics.
This study examined predictors of treatment expectation among osteoarthritis (OA) patients in a multisite clinical trial of pain coping skills training (CST). ⋯ Although many OA patients will approach pain CST with positive expectations, others have lower expectations. This study suggests that a multidimensional assessment of OA patients with chronic pain can identify those who have higher expectations versus lower expectations. The results suggest that patients who are psychologically distressed are less optimistic about engaging in treatment and that these patients, in particular, may benefit from and need pretreatment motivational interviewing to enhance their uptake of pain coping skills.
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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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Randomized Controlled Trial
Ondansetron, a 5HT3-antagonist, does not alter dynamic mechanical allodynia or spontaneous ongoing pain in peripheral neuropathy.
The aim of this study was to examine whether the intensity of dynamic mechanical allodynia and spontaneous ongoing pain in patients with neuropathic pain associated with peripheral neuropathy was influenced by an intravenous infusion of the 5HT3-antagonist, ondansetron. ⋯ No influence from 8 mg of ondansetron could be shown on the intensity of brush-evoked or spontaneous ongoing pain in patients with peripheral neuropathy, indicating the lack of involvement of 5HT3-receptors in an earlier proposed spinobulbospinal loop with descending facilitation acting on spinal mechanisms related to dynamic mechanical allodynia.
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Review Case Reports
Bilateral cervicothoracic transforaminal blood patches for persistent headache from spontaneous intracranial hypotension: a case report and review.
Spontaneous intracranial hypotension (SIH) is an uncommon cause of headache that can be challenging to treat and can have serious clinical consequences. When symptoms persist despite conservative treatment, an interlaminar epidural blood patch is often performed, but may not be effective. ⋯ In this clinical report, we describe a case of spontaneous intracranial hypotension caused by a ventral dural tear at the cervicothoracic junction. Our patient suffered from recalcitrant postural headaches despite undergoing conventional interlaminar epidural blood patches. Bilateral transforaminal epidural blood patches were performed in order to deliver blood to the ventral epidural space at the site of the tear identified on magnetic resonance imaging. The transforaminal technique may be useful in patients who have failed conventional treatment, though a high degree of interventional experience and vigilance is required to safely perform this procedure.