Pain medicine : the official journal of the American Academy of Pain Medicine
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Chronic cancer pain is often refractory and difficult to treat. Ketamine is a medication with evidence of efficacy in the treatment of chronic pain. ⋯ Despite limitations in the breadth and depth of data available, there is evidence that ketamine may be a viable option for treatment-refractory cancer pain.
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The purpose of the study was to systematically review the historical therapeutics for chronic pain care directed at the dorsal root ganglion (DRG) and to identify future trends and upcoming treatment strategies. ⋯ Despite a robust understanding of the DRG and its importance in acute nociception, as well as the development and maintenance of chronic pain, relatively poor evidence exists regarding current therapeutic strategies. Novel therapies like electrical and pharmacologic strategies are on the horizon, and more prospective study is required to better qualify the role of the DRG in chronic pain care.
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Randomized Controlled Trial
Improving needle visualization by novice residents during an in-plane ultrasound nerve block simulation using an in-plane multiangle needle guide.
Ultrasound-guided regional anesthesia with in-plane needle approaches can be challenging due to difficult needle visualization. We hypothesized that an in-plane, multiangle needle guide can help reduce the time it takes novice regional anesthesiologists to perform a simulated ultrasound-guided nerve-targeting procedure and enhance the visualization of the needle. ⋯ A needle guide can help reduce the time needed to complete a simulated nerve targeting procedure and enhance needle visualization for the novice sonographer in a phantom gel simulation. There was no significant reduction in the number of needle passes or in improvement of target approximation noted.
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The objective of this study was to evaluate the ability of artificial neural networks (ANNs) to predict, on the basis of clinical variables, the response of persons with fibromyalgia syndrome (FMS) to a standard, 4-week interdisciplinary pain program. ⋯ Properly trained ANNs can be a useful tool for optimal treatment selection at an early stage after diagnosis, thus contributing to minimize the lag until symptom amelioration and improving tertiary prevention in patients with FMS.
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Patients with lumbosacral spinal stenosis (LSS) do not always obtain satisfactory pain relief from transforaminal epidural steroid injection (TFESI) because perineural/epidural adhesions prevent the spread of injectate into the epidural space. Percutaneous adhesiolysis (PA) can eliminate the deleterious effects of adhesion. This study was to evaluate the effectiveness of PA among patients with LSS refractory to TFESI and to ascertain the prognostic factors determining PA efficacy. ⋯ PA may be a useful treatment in patients with LSS refractory to TFESI and reduce the surgical requirement. Previous surgery, spondylolisthesis, and foraminal stenosis may be associated with poor prognosis.