Pain medicine : the official journal of the American Academy of Pain Medicine
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While acute musculoskeletal pain is a frequent complaint in emergency care, its management is often neglected, placing patients at risk for insufficient pain relief. Our aim is to investigate how often pain management is provided in the prehospital phase and emergency department (ED) and how this affects pain relief. A secondary goal is to identify prognostic factors for clinically relevant pain relief. ⋯ There is still room for improvement of musculoskeletal pain management in the chain of emergency care. A high percentage of patients were discharged with unacceptable pain levels. The use of multimodal pain management or the implementation of a pain management protocol might be useful methods to optimize pain relief. Additional research in these areas is needed.
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Metastatic bone pain is characteristic of cancer pain and is a form of refractory cancer pain, as the pain includes not only nociceptive but also neuropathic pain. Although some drugs are effective in the management of painful bone metastases, pain while moving is one of the most refractory forms of pain. Although pulsed radiofrequency (RF) dramatically reduces neuropathic pain, chronic pain, and vertebral metastatic pain, the number of cases reported in these studies was very small (five or less). ⋯ DRG pulsed RF procedure provided sound pain relief for patients with intractable vertebral metastatic pain. Metastatic bone pain is characteristic of cancer pain and is a form of refractory cancer pain, as the pain includes not only nociceptive but also neuropathic pain. Although some drugs are effective in the management of painful bone metastases, pain while moving is one of the most refractory forms of pain. DRG pulsed RF procedure provided sound pain relief for patients with intractable vertebral metastatic pain.
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Cognitive-behavioral models highlight the role of learning and memory biases in the development and maintenance of chronic pain. However, the extent to which a memory bias is a consequence of the clinical state of being a chronic pain subject is unknown. This article presents a study which delineates the influence of chronic and acute pain on autobiographical memory retrieval. ⋯ The present data demonstrate that current pain but not chronic pain per se can exert specific influences on remembering in participants with chronic pain. This memory bias could be a predisposition for the development of chronic pain but could also be a pain-maintaining consequence of painful experiences. This should be addressed in longitudinal studies.
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Letter Case Reports
Extradural thoracic spinal lesion presenting as low back and leg pain.