Pain physician
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Persistent anterior knee pain, especially after surgery, can be very frustrating for the patient and the clinician. Injury to the infrapatellar branch of the saphenous nerve (IPS) is not uncommon after knee surgeries and trauma, yet the diagnosis and treatment of IPS neuralgia is not usually taught in pain training programs. In this case report, we describe the anatomy of the saphenous nerve and specifically the infrapatellar saphenous nerve branch; we also discuss the types of surgical trauma, the clinical presentation, the diagnostic modalities, the diagnostic injection technique, and the treatment options. ⋯ Because the clinical presentation may be vague, it has often been misdiagnosed and underdiagnosed. There is a documented vasomotor instability, but, unfortunately, sympathetic blocks will not address the underlying pathology, and therefore patients often will not respond to this modality, although the correct diagnosis can lead to rapid and gratifying resolution of the pathology. An entity unknown to the clinician is never diagnosed, and so it is important to familiarize pain physicians with IPS neuropathy so that they may be able to offer assistance when this painful condition arises.
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Case Reports Historical Article
Magnetic resonance imaging of the lumbar spine in a patient with a spinal cord stimulator.
The use of magnetic resonance imaging (MRI) is continuously escalating for the evaluation of patients with persistent pain following lumbar spine surgery (LSS). Spinal cord stimulation (SCS) therapy is being clinically applied much more commonly for the management of chronic pain following LSS. There is an increased probability that these 2 incompatible modalities may be accidentally used in the same patient. ⋯ This case demonstrates the lack of compatibility of lumbar MRI and the Precision SCS system as well as one of the possible patient adverse events that can occur when patients are exposed to MRI outside of the approved device labeling.
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Case Reports
Transversus abdominis plane neurolysis with phenol in abdominal wall cancer pain palliation.
Pain is commonly perceived by patients during cancer and its treatment. Although most patients respond to conservative management implemented according to the World Health Organization guidelines, a subset of patients with advanced disease develop intractable pain that may require additional interventions such as regional blocks and intrathecal therapy. Patients with terminal abdominal or pelvic cancer who have high tumor burdens are often offered a diagnostic visceral nerve block followed by neurolysis for pain palliation. ⋯ The patient tolerated the procedure well and demonstrated sustained analgesia for 45 days before dying of the disease. We also demonstrated that TAP block significantly reduces the total opioid requirement as demonstrated by the morphine equivalent daily dose score after the neurolytic procedure. This result supports our belief that TAP block with TAP neurolysis is an effective and inexpensive modality that can be used to palliate intractable abdominal wall pain in patients with terminal abdominal cancer.
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Randomized Controlled Trial Multicenter Study
Tapentadol immediate release versus oxycodone immediate release for treatment of acute low back pain.
Tapentadol has demonstrated analgesic efficacy across a range of pain conditions. ⋯ NCT00986180.
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Randomized Controlled Trial
Percutaneous epidural lysis of adhesions in chronic lumbar radicular pain: a randomized, double-blind, placebo-controlled trial.
Chronic radicular pain can occur after disc pathology and failed back surgery. An evidence-based effective therapeutic option is not available nor does a gold standard exist. ⋯ Based on the findings of our study as well as other studies, we believe the minimally invasive percutaneous adhesiolysis procedure should be the first choice treatment option for patients with chronic lumbosacral radicular pain who present with clinical history and findings similar to those of the patients enrolled in our study.