Pain physician
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Patients with chronic pain often experience co-occurring depression and in some cases suicidal ideation. It is critical to discover risk factors for suicide in this vulnerable patient population. ⋯ Results of this study are consistent with the prevailing literature on pain and suicide demonstrating a high prevalence of suicidal ideation in the chronic pain population. Novel predictive variables were also identified that will provide the basis for developing a risk stratification model that can be further tested prospectively in chronic pain patients.
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Observational Study
Cervical radiofrequency neurotomy reduces psychological features in individuals with chronic whiplash symptoms.
Individuals with chronic whiplash associated disorder (WAD) demonstrate various psychological features. It has previously been demonstrated that cervical radiofrequency neurotomy (cRFN) resolves psychological distress and anxiety. It is unknown if cRFN also improves or reduces a broader spectrum of psychological substrates now commonly identified in chronic whiplash, such as post-traumatic stress disorder (PTSD) and pain catastrophizing. ⋯ Effective pain relief would seem a crucial element in the management of psychological features associated with chronic WAD. IRB Approval: University of Calgary Conjoint Health Research Ethics Board ID#: E-22082.
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Cervical interlaminar epidural steroid injections (ESIs) are commonly performed as one part of a multi-modal analgesic regimen in the management of upper extremity radicular pain. Spinal epidural hematoma (SEH) is a rare complication with a reported incidence ranging from 1.38 in 10,000 to 1 in 190,000 epidurals. Current American Society of Regional Anesthesia (ASRA), American Society of Interventional Pain Physicians (ASIPP), and the International Spine Intervention Society (ISIS) recommendations are that non-steroidal anti-inflammatory drugs (NSAIDs) do not need to be withheld prior to epidural anesthesia. ⋯ Although the increased risk of bleeding for the alternative medications are minimal, they are nevertheless well documented. Additionally, their additive impairment on hemostasis has not been well characterized. Withholding NSAIDs, fluoxetine, fish oil, and vitamin E in the peri-procedural period is relatively low risk and should be considered for all patients with multiple risk factors for SEH.
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Observational Study
Anatomy of the infrapatellar branch in relation to skin incisions and as the basis to treat neuropathic pain by cryodenervation.
Neuropathic knee pain, particularly of the infrapatellar branch, is an important complication of knee replacement surgery, with an incidence as high as 70%. The increasing number of elderly patients requiring knee surgery, including total knee arthroplasty (TKA), has contributed to an increase in the number of patients with this pathology. Treatment includes neurectomy, infiltration therapy, and cryodenervation. Percutaneous cryodenervation of the infrapatellar branch is a promising option. ⋯ Based on our findings, the surgeon can localize the unbranched main nerve. Compared with the current practice, our approach should allow for a lower impact on tissues and should facilitate complete pain relief through a single cryodenervation. Furthermore, we propose that the lateral parapatellar skin incision is an acceptable alternative surgical approach in knee replacement surgery because it is associated with the lowest risk of damage to the infrapatellar branch.
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Mental nerve neuropathy (MNN), colloquially referred to as numb chin syndrome, is an uncommon neurologic condition that may arise secondary to multiple local and systemic etiologies, and may mimic other pain conditions affecting the mandible. Early recognition of mental nerve neuropathy in conjunction with accurate etiologic identification is crucial, as early pain management may prevent the transition from an acute to a chronic pain condition. In this article, we will describe the clinical courses of 2 patients who presented to the pain clinic with chronic painful numbness in the mental nerve sensory distribution following dental extraction. ⋯ The objective of our article is to help clinicians identify and properly manage early stage mental nerve neuropathy. Moreover, we aim to advance general medical knowledge of this important pain medicine topic. During the process of preparing this article we reviewed all existing pertinent medical literature related to MNN.