Pain physician
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Observational Study
Assessment of neuropathic pain in patients with cancer: the interobserver reliability. An observational study in daily practice.
Neuropathic pain (NeP) is a burdensome problem in all stages of cancer. Although clinical judgment is accepted as a surrogate for an objective gold standard in diagnosing NeP, no publications were found about its reliability. ⋯ A substantial level of agreement was found for the diagnosis of pure NeP and a moderate level of agreement for the diagnosis of the NeP component was found, both with a PA = 70%. There was only a fair agreement between the physicians regarding the grading system. However, there was a substantial level of (interrater) agreement for the diagnosis of an NeP component and the outcome of the grading system. The findings in this study also suggest that a better standardization of the clinical assessment and classification of pain in patients with cancer with respect to the identification of neuropathic pain is necessary.
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Review Meta Analysis
Antioxidant therapy for pain relief in patients with chronic pancreatitis: systematic review and meta-analysis.
Currently, there is no specific therapy for chronic pancreatitis (CP). The treatment of micronutrient antioxidant therapy for painful CP has been sporadically used for more than 30 years, however, its efficacy are still poorly understood. ⋯ Combined antioxidant therapy seems to be a safe and effective therapy for pain relief in CP patients. Measures of total antioxidant status may not help to monitor the efficacy of antioxidant therapy for patients with CP.
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Pudendal nerve entrapment (PNE) is an uncommon cause of chronic pain. Pudendal nerve entrapment typically occurs when the pudendal nerve is fused to nearby anatomical structures or trapped between the sacrotuberous and sacrospinalis ligaments. Pudendal nerve entrapment can be caused by excessive bicycling, pregnancy, anatomic abnormalities, scarring due to surgery, or as a sequela of radiation therapy. ⋯ He was ultimately diagnosed as having a right sided pudendal entrapment neuropathy. His pain was refractory to all conventional treatment modalities; therefore we decided to pursue neuromodulation via a dorsal column spinal cord stimulator implant. Below, we describe the decision making process for the diagnosis and treatment of his pudendal neuropathy.
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Given that there are gender differences in pain perception, it is likely that there are differences in pain responses between men and women with lumbar spinal stenosis (LSS). Furthermore, these differences may lead to different degrees of impairment in both daily activities and quality of life between men and women. ⋯ Women showed increased low back pain and leg pain due to degenerative LSS compared to men. The current study demonstrates that this difference in symptom severity may be partly mediated by pain sensitivity.
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Comparative Study
Percutaneous endoscopic lumbar discectomy for L5-S1 disc herniation: transforaminal versus interlaminar approach.
Percutaneous endoscopic lumbar discectomy (PELD) is a minimally invasive spinal technique. The unique anatomic features of the L5-S1 space include a large facet joint, narrow foramen, small disc space, and a wide interlaminar space. PELD can be performed via 2 routes, transforaminal (TF-PELD) or interlaminar (IL-PELD). However, it is questionable that the decision of the endoscopic route for L5-S1 discs only depends on the surgeon's preference and anatomic relation between iliac bone and disc space. Thus far, no study has compared TF-PELD with IL-PELD for L5-S1 disc herniation. ⋯ This study demonstrated that TF-PELD is preferred for shoulder type, centrally located, and recurrent disc herniation, while IL-PELD is preferred for axillary type and migrated discs, especially those of a high grade.