Pain physician
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Our intent is to report a case of intercostal neuralgia occuring as a complication of splanchnic radiofreqency ablation (RFA), due to a breach in the integrity of the insulating sheath of the RFA needle. A 48-year-old man presented to our pain clinic with upper abdominal pain due to chronic pancreatitis, recalcitrant to medical management. We decided to perform bilateral splanchnic nerve RFA in this patient. ⋯ Convinced of correct needle placement, we examined the RFA needles which had been used for ablation in this patient. One of the needles was discovered to have a fine breach in its insulating sheath, at a distance of approximately 30 mm from the active tip. It is of utmost importance for all interventional pain physicians to perform a thorough pre-use check of the equipment prior to any RFA procedure, with special emphasis on ensuring the integrity of the insulating sheath of the needles which are to be used, in order to prevent injury of non target nerves.
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Review Meta Analysis
High Prevalence of Neuropathic Pain Component in Patients with Low Back Pain: Evidence from Meta-Analysis.
Low back pain (LBP) is a complex syndrome which includes a nociceptive (NcP) component, a neuropathic (NeP) component, or a mixture of components (mixed pain). The NeP component (NePC) in LBP is defined as the presence of NeP with or without an NcP. ⋯ Neuropathic pain, nociceptive pain, low back pain, symptom-based questionnaire, chronicity.
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Randomized Controlled Trial
Subcutaneous Injection of Triamcinolone and Lidocaine to Prevent Postherpetic Neuralgia.
Herpes zoster (HZ) is associated with inflammation of the peripheral nerves, which is considered to be an important cause of postherpetic neuralgia (PHN). Interventions aimed at reducing this inflammation could prevent PHN. One option is the epidural administration of corticosteroid and local anesthetic. However, several authors have reported a risk of arachnoiditis with epidural corticosteroids. Subcutaneous injection in an outpatient setting is a safer option. However, there is limited evidence of the effectiveness of this alternative for preventing PHN. ⋯ Subcutaneous injection, lidocaine, triamcinolone, postherpetic neuralgia, prevention.
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Refractive surgery is a common procedure, but may be associated with severe post-operative pain. ⋯ Photorefractive keratectomy, in situ keratomileusis, pain, analgesia, opioid, codeine, review.
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Review Case Reports
Percutaneous Vertebroplasty for Primary Non-Hodgkin's Lymphoma of the Thoracic Spine: Case Report and Review of the Literature.
Primary non-Hodgkin's lymphoma of the vertebra is rare in the spine of the elderly. The clinical presentation and radiological features are unspecific, which make it more difficult for diagnosis. We report a case of a 79-year-old woman complaining of serious backache without any injury. ⋯ The patient was diagnosed with primary bone lymphoma finally. Due to the previous condition of the patient, R-miniCHOP chemotherapy was applied following the surgery in the department of hematology. Until the 9 months follow-up, the clinical result was still satisfactory.