Pain physician
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There has been no previous prospective examination of the homogeneity of chronic non-cancer pain (CNCP) patients in risk factors for non-adherent opioid use. ⋯ Clusters of CNCP patients with distinct risk profiles for non-adherence exist. Each group was identified by at least one risk factor but the likelihood of non-adherent opioid use was higher in groups with particular clusters of multiple risk factors. Not all those with risk factors display non-adherence, emphasising the need for strategies to reduce risk for those patients displaying particular clusters of risks.
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This a unique case of severe scapular pain following unintentional epidural space air injection during epidural steroid injection. A 70-year-old woman presented for a fluoroscopically guided C7-T1 interlaminar epidural steroid injection. Three injection attempts were made using the loss of resistance with air technique. ⋯ The authors theorize that unintentional prefilling of the epidural space with air prior to the injection of the subsequent steroid mixture added sufficient pressure to the epidural space to cause right-sided C4 nerve root stretching/entrapment and ensuing radicular pain to the right scapular border. The subsequent intravenous diazepam provided cervical muscle relaxation and facilitated foramina passage of air out of the spinal canal. This case demonstrates that under certain conditions entry of air into cervical epidural space can lead to unexpected, albeit temporary, neurological symptoms.
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Meralgia paresthetica (MP) is a neurologic disorder of the lateral femoral cutaneous nerve (LFCN), which is characterized by a localized area of paresthesia and numbness on the anterolateral aspect of the thigh. In most patients with MP, symptoms can be successfully managed with conservative treatment. However, in a small group of MP patients who are refractory to medical treatment, more aggressive low-risk treatment should be considered. ⋯ PRF neuromodulation of the LFCN provides immediate and long-lasting pain relief without complications. Therefore, PRF of the LCFN can be used as an alternative treatment in patients with MP who are refractory to conservative medical treatment.
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A 75-year-old man, who was healthy, visited the hospital because of shooting pain and numbness in both lower limbs (right > left). The patient had an L4/5 moderate right foraminal stenosis and right subarticular disc protrusion and received a lumbar epidural block. ⋯ The patient expired 4 months later with respiratory failure due to motor neuron disease. This case suggests that any abnormal neurological symptoms that occur after an epidural block should be examined thoroughly via testing and consultations to identify the cause of the symptoms.
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The following case series describes the treatment of neuropathic pain in post-surgical scars, using adipocytes and adipose-derived stem/progenitor cells (ASCs). Two cases are described in which patients underwent lipofilling to treat painful scars after cosmetic surgery. ⋯ We found a notable long-lasting reduction in the NRS values after the "modified" lipofilling treatment. The results are promising and reinforce earlier data on the positive effect of lipofilling and pain in scars.