Pain practice : the official journal of World Institute of Pain
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Persistent occipital neuralgia can produce severe headaches that are difficult to control by conservative or surgical approaches. We retrospectively describe a series of six patients with severe occipital neuralgia who received conservative and interventional therapies, including oral antidepressants, membrane stabilizers, opioids, and traditional occipital nerve blocks without significant relief. This group then underwent occipital nerve blocks using the botulinum toxin type A (BoNT-A) BOTOX Type A (Allergan, Inc., Irvine, CA, U. ⋯ Following block resolution, the average pain scores and PDI returned to similar levels as before BoNT-A block. In conclusion, BoNT-A occipital nerve blocks provided a much longer duration of analgesia than diagnostic local anesthetics. The functional capacity improvement measured by PDI was profound enough in the majority of the patients to allow patients to resume their regular daily activities for a period of time.
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Comparative Study Clinical Trial
Effervescent morphine results in faster relief of breakthrough pain in patients compared to immediate release morphine sulfate tablet.
Morphine tablets have been formulated to produce an easily ingested effervescent solution when placed in water. It was hypothesized that an aqueous solution would result in fast gastrointestinal transit with a more rapid onset of action compared to immediate release morphine sulfate (IRMS), which would be especially beneficial in treating breakthrough pain (BTP). In an open-label safety and efficacy study, effervescent morphine was given to 76 chronic cancer pain patients for treatment of BTP evaluating time until pain relief, global satisfaction and side effects. ⋯ The dose for treatment of BTP was determined by individual titration and not predicted by the dose taken with the basic pain medication. Compared to IRMS, overall satisfaction for effervescent morphine was rated "superior" by 16.7%, and "better" by 63.2% of patients. Effervescent morphine offers an alternative for management of breakthrough cancer pain compared with the commonly used IRMS.
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Case Reports
Spinal cord stimulator relieves neuropathic pain in a patient with radiation-induced transverse myelitis.
We present a patient with intractable neuropathic pain because of radiation-induced transverse myelitis unresponsive to medical treatment. After a successful trial of spinal cord stimulation, a permanent stimulator was implanted. Improvement was noted in verbal pain score, medication usage and function. Spinal cord stimulation may offer a therapeutic option for patients with neuropathic pain resulting from transverse myelitis and should be considered when other treatments fail.
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Case Reports
Nerve stimulator-guided repetitive paravertebral block for thoracic myofascial pain syndrome.
Myofascial pain syndrome (MPS) may persist for many years and is often refractory to traditional therapeutic approaches including pharmacotherapy, focal tenderness infiltration by local anesthetic and corticosteroids, physical therapy and behavioral modification. This report describes three cases of MPS following coronary artery bypass graft, inadequate positioning during abdominal hysterectomy, and excessive physical effort refractory to conventional therapeutic approaches. Three patients were successfully treated with repeated nerve stimulator-guided paravertebral block using a mixture of bupivacaine and clonidine. ⋯ If the pain returned, a second paravertebral block was performed. The three patients were pain-free over a follow-up period up to 2 years. Our report suggests that nerve stimulator-guided paravertebral blockade could be a useful treatment for MPS refractory to traditional therapeutic approaches.
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Groin and thigh pain are frequently the major symptoms of hip joint pathology. The hip joint is innervated by articular branches of the obturator, femoral, superior gluteal, and sciatic nerves. The nerve responsible for hip joint pain can be determined by a diagnostic nerve block. ⋯ We report on two patients with groin and thigh pain related to hip joint pathology treated with a novel technique for hip pain relief, pulsed radiofrequency treatment (PRF) of articular branches of the obturator and femoral nerves. At the time this case was written, both patients demonstrated at least 50% pain relief 3 to 4 months after the intervention along with improved function (increased ambulation and ability to participate in physical therapy). Our clinical observation suggests that PRF of articular branches of the hip joint may be an alternative treatment for patients with intractable hip pain.