Pain physician
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For many headache types, occipital peripheral nerve stimulation (ONS) provides significant relief of chronic, frequent, and severe headaches. Though rarely reported, ONS may cause painful muscle spasms that make stimulator use impractical. The classic description of the technique advocates placement of the leads transversely at the level of the arch of C1 or at C1-2. At that level, the greater occipital nerve (GON) infrequently pierces the superficial fascia of the neck muscles to become superficial. However, important anatomic variability exists. ⋯ Stimulation parameters vary, thus posting parameters may be misleading as muscle spasms occurred despite multiple reprogramming attempts and were a function of lead position, not program settings.
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Case Reports
Herpes zoster radiculopathy treated with fluoroscopically-guided selective nerve root injection.
Varicella-zoster virus, a member of the herpes virus family, is a neurotrophic virus that primarily affects afferent sensory neurons. Reactivation of latent virus within the dorsal root ganglion and axoplasmic transport to epithelial nerve terminals causes the segmental cutaneous rash and neuralgic pain characteristic of herpes zoster. ⋯ Cases of herpes zoster-induced radiculopathy may become more frequent, as evidenced by the increasing number of cases of herpes zoster in the United States noted epidemiologically.
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Pain is a common problem in older age and strongly interacts with neuropsychiatric disorders. In this paper we studied the prevalence of pain and the connection between pain and neuropsychiatric comorbidities among older nursing home residents. ⋯ It is important when assessing pain to consider the patient's neuropsychiatric status and especially communication abilities. The information above helps understand the variances in pain parameters in neuropsychiatric patients and may ultimately lead to better pain management in these difficult patients.
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Antidepressants are prescribed in a wide range of doses to treat both depression and chronic pain, with optimal psychopharmacology individualized for each patient. In the past decade more antidepressants from different chemical classes have become available and are being used for the treatment of both chronic pain and depression. ⋯ The data suggest that in the context of multimodal treatment for chronic pain, antidepressant therapy at both low and therapeutic doses demonstrates similar response rates. Tricyclic antidepressants (TCAs), which include secondary and tertiary amines, as well as SSRI/SNRIs and atypicals, all appear to show similar favorable response rates.
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Case Reports
Chronic regional pain syndrome after subtalar arthrodesis is not prevented by early hyperbaric oxygen.
Subtalar arthrodesis was performed on a 48-year-old, non-insulin-dependent diabetic with a history of chronic ankle instability and lateral ankle pain. In the early post-operative period he presented as an emergency with an infection at the operative site. This was treated with 2 returns to the operating theatre for washout and debridement. ⋯ Symptoms and signs at this time were compatible with a diagnosis of chronic regional pain syndrome (CRPS). There is published evidence to suggest that HBO therapy may be a useful modality in the treatment of established CRPS. Here, we seek to publicize a case in which early treatment with HBO for another indication did not prevent the simultaneous development of CRPS Type 1.