Pain physician
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Bladder pain associated with interstitial cystitis and painful bladder syndrome (IC/PBS) is frequently excruciating and intractable. The use of onabotulinumtoxinA (BoNT-A) for relief of this type of bladder pain has not been well described. ⋯ Intravesical onabotulinumtoxinA injection appears to be a safe and effective therapeutic option for analgesia and increased bladder capacity for patients with IC/PBS. INSTITUTIONAL REVIEW: This study was approved by the Institutional Review Board of the Buddhist Tzu-chi General Hospital.
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Accumulating experimental and clinical evidence supports the hypothesis that complex regional pain syndrome type I (CRPS-I) may be a small fiber neuropathy. ⋯ The negative results indicate that CRPS-I may be associated with changes in the ultramicroscopic small fiber structure that cannot be visualized with commercially available techniques. Alternatively, functional rather than structural alterations of small fibers or pathological changes at a more proximal site such as the spinal cord or brain may be responsible for the syndrome.
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Review Meta Analysis
A systematic evaluation of prevalence and diagnostic accuracy of sacroiliac joint interventions.
The contributions of the sacroiliac joint to low back and lower extremity pain have been a subject of considerable debate and research. It is generally accepted that 10% to 25% of patients with persistent mechanical low back pain below L5 have pain secondary to sacroiliac joint pathology. However, no single historical, physical exam, or radiological feature can definitively establish a diagnosis of sacroiliac joint pain. Based on present knowledge, a proper diagnosis can only be made using controlled diagnostic blocks. The diagnosis and treatment of sacroiliac joint pain continue to be characterized by wide variability and a paucity of the literature. ⋯ Based on this systematic review, the evidence for the diagnostic accuracy of sacroiliac joint injections is good, the evidence for provocation maneuvers is fair, and evidence for imaging is limited.