Pain physician
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Chronic pelvic pain can present in various pain syndromes. In particular, interventional procedure plays an important diagnostic and therapeutic role in 3 types of pelvic pain syndromes: pudendal neuralgia, piriformis syndrome, and "border nerve" syndrome (ilioinguinal, iliohypogastric, and genitofemoral nerve neuropathy). The objective of this review is to discuss the ultrasound-guided approach of the interventional procedures commonly used for these 3 specific chronic pelvic pain syndromes. ⋯ The ultrasound machine is portable and is more readily available to the pain specialist. It prevents patients and healthcare professionals from the exposure to radiation during the procedure. Because it allows the visualization of a wide variety of tissues, it potentially improves the accuracy of the needle placement, as exemplified by various interventional procedures in the pelvic regions aforementioned.
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Comparative Study
Influence of psychological variables on the diagnosis of facet joint involvement in chronic spinal pain.
Facet or zygapophysial joint pain is one of the common conditions responsible for chronic spinal pain. Controlled diagnostic blocks are considered the only means of reliable diagnosis of facet joint pain, due to the inability of physical examination, clinical symptoms, radiologic evaluation, and nerve conduction studies to provide a reliable diagnosis. The prevalence of facet joint pain has been established to be 15% to 45% of patients with low back pain, 39% to 67% of patients with neck pain, and 34% to 48% of patients with thoracic pain. However, using only a single block, false-positive rates of 27% to 63% in the cervical spine, 42% to 58% in the thoracic spine, and 17% to 50% in the lumbar spine have been reported. While there are multiple reasons for false-positive results, psychological variables may also contribute to false-positive results. A lack of influence of psychological factors on the validity of controlled diagnostic local anesthetic blocks of lumbar facet joints has been demonstrated. However, no such studies have been performed in the thoracic or cervical spine. ⋯ This study demonstrated that, based on patient psychopathology, there were no significant differences among the patients either in terms of prevalence or false-positive rates in the lumbar and thoracic regions. A higher prevalence and lower false-positive rates in the cervical region were established in patients with major depression.
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Occipital nerve stimulation is an emerging treatment modality for refractory headache disorders like migraine and cluster headache. Either percutaneous or surgical leads are implanted subcutaneously in the occipital region in an effort to stimulate the distal branches of the occipital nerves (C2-3). A number of complications of this technique have been reported, such as painful direct muscle stimulation and lead migration. ⋯ One patient underwent lead removal with reimplantation 1 month later; the other was managed with excision of a granuloma at the erosion site and prophylactic antibiotics. Both patients returned to excellent headache control. Lead erosion is a possible complication of occipital stimulation; strategies to reduce the risk of lead erosion are discussed, although further studies are needed to clarify the best surgical techniques.
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More than 50% of multiple sclerosis patients experience chronic pain syndrome. We set out to determine the specific type of chronic pain that was seen in our multiple sclerosis patients. ⋯ This study suggests that multiple sclerosis patients are at a higher risk of developing complex regional pain syndrome than the general population.