Pain medicine : the official journal of the American Academy of Pain Medicine
-
Case Reports
Unintended epidural placement of a thoracic paravertebral catheter in a patient with severe chest trauma.
Severe pain can lead to ventilatory compromise in patients with multiple rib fractures. Regional anesthetic techniques, including continuous thoracic paravertebral and thoracic epidural blocks, can be useful in reducing this pain and subsequent morbidity due to respiratory compromise. Thoracic paravertebral block can result in significant complications. Presumed epidural spread of injected medication has been described with thoracic paravertebral block. High-quality radiographic images of an attempted placement of a thoracic paravertebral catheter in the epidural space have not been reported. We present these images to highlight the occurrence of this complication. ⋯ In the setting of severe chest trauma, the potential risk of unintended placement of an intended thoracic paravertebral catheter in the epidural space is graphically illustrated as a potential risk of this procedure.
-
Although fibromyalgia (FM) is traditionally a non-inflammatory condition, emerging data also suggest that FM has an immunologic component. Previous studies have reported that peripheral blood concentrations of two chemokines (i.e., interleukin-8 [IL-8] and monocyte chemotactic protein-1 [MCP-1]) were elevated in FM patients compared with normal controls. We sought to determine the longitudinal relationships of changes in the levels (picogram/mL) of IL-8 and MCP-1 with changes in the severity of FM-related pain. ⋯ Although preliminary, our findings raise the hypothesis that IL-8 and MCP-1 may be involved in the pathogenesis of FM. If replicated in a larger study, IL-8 and MCP-1 may assist in determining prognosis and in monitoring of treatment response.
-
To investigate the prevalence and the type of mental comorbidity in a population-based sample of subjects with non-specific chronic back pain. ⋯ The consistent diagnoses of anxiety, fear, and avoidance in these subjects indicate that also primary care health professionals should consider anxiety disorders in patients with chronic pain, in addition to the affective disorders that are most frequently self-reported in pain patients.
-
An extensive neuroimaging literature on chronic pain demonstrates increased cerebral blood flow and metabolism consistent with increased neuronal activity in the structures comprising the "pain matrix"; furthermore, some of these regions have been shown to encode pain intensity. It is the objective of this study to demonstrate the feasibility of using quantitative electroencephalography (EEG) source localization to reflect and to quantify activity in the pain matrix. ⋯ The areas that were activated in the high pain state localized to the same regions reported by other neuroimaging methods and with frequency specificity. The frequency and regionally specific activation may indicate distinctive patterns of pathophysiology underlying the pain matrix. Although in a small number of patients, this work suggests that QEEG may be a useful tool in the exploration and quantification of the pain matrix in a clinical setting.
-
This study aimed to examine the effectiveness of a structured educational nursing intervention on pain assessment and management in older hospitalized people. ⋯ The comprehensive intervention enabled change in practice and improvements in pain intensity, and the assessment and management of pain. Future research is needed on implementing the intervention with a multidisciplinary team of health professionals in a subacute environment.