Pain medicine : the official journal of the American Academy of Pain Medicine
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Clinical observation has suggested the presence of ventral cervical extra-articular pain pathways in patients with C1-C2 joint pain. However, the existence of ventral innervation to the C1-C2 joint has not been documented. The objective of this study was to determine whether ventral innervation to the lateral C1-C2 joint exists, and to describe its relational anatomy. ⋯ In this study, two cervical prevertebral plexuses (superficial and deep) were identified that have not previously been described. Terminal branches of the plexuses entered the ventral joint capsule of the lateral C1-C2 joint and were seen approaching the dens. Findings provide and explanation for the clinical observation that electrical stimulation in the C2 ventral gutter can reproduce headache in patients with C1-C2 joint pain.
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The aim of this report is to determine the frequency of aberrant drug behaviors and their relationship to substance abuse disorders in a large primary sample of patients receiving opioids for chronic pain. ⋯ Patients who report four or more aberrant drug behaviors are associated with a current substance use disorder and illicit drug use, whereas subjects with up to three aberrant behaviors have a very low probability of a current substance abuse disorder. Four behaviors--oversedated oneself, felt intoxicated, early refills, increase dose on own--appear useful as screening questions to predict patients at greatest risk for a current substance use disorders.
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To evaluate the impact of an extended-release, once-daily morphine sulfate formulation on depressive symptoms and neurocognition in patients with chronic nonmalignant pain. ⋯ Achieving adequate pain control with once-daily morphine was associated with a reduction in pain and improvements in depressive symptoms and cognitive functioning in the short term.
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Advanced complex regional pain syndrome (CRPS) remains very difficult to treat. While subanesthetic low-dose ketamine has shown promise in early localized CRPS, its use in advanced CRPS has not been as effective. Since ketamine's analgesic potency and duration of effect in neuropathic pain are directly dose-dependant, we investigated the efficacy of ketamine in anesthetic dosage in refractory CRPS patients that had failed available standard therapies. ⋯ This open-label trial suggests benefit in pain reduction, associated CRPS symptoms, improved quality of life and ability to work following anesthetic ketamine in previously refractory CRPS patients. However, a randomized controlled trial will be necessary to prove its efficacy.
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Randomized Controlled Trial
Rationale, design, and baseline findings from a randomized trial of collaborative care for chronic musculoskeletal pain in primary care.
This article describes the rationale, design, and baseline findings from an ongoing study of collaborative care for chronic musculoskeletal pain and comorbid depression. ⋯ These baseline data support the rationale to develop a multifaceted approach to treat chronic pain in primary care that includes detection and treatment of psychiatric comorbidity.