Pain practice : the official journal of World Institute of Pain
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Mechanical low back pain secondary to degenerative facet joint changes is a common reason for referral to pain clinics. When these changes cause encroachment into the intervertebral foramen, radicular pain may result. While pulsed radiofrequency of the dorsal root ganglion can be used in this setting, the anatomic deformity may make the transforaminal approach difficult. We report a case where a trans-facet approach was used successfully and describe the technique.
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Multicenter Study Clinical Trial
Patient-controlled analgesia in chronic pain patients: experience with a new device designed to be used with implanted programmable pumps.
Intrathecal drug delivery using implantable pumps is an effective method to control stable chronic pain. However, the appropriate alleviation of unpredictable pain fluctuations remains challenging. A possible solution is the use of patient-controlled analgesia (PCA) by means of a specific device--the personal therapy manager (PTM)--designed to be used with implanted programmable pumps. ⋯ Patient-controlled analgesia using a PTM with a programmable, implantable pump system is an effective therapy for the treatment of chronic pain and allows patients to feel that they have more control over unpredictable pain fluctuations.
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Case Reports
Cranial magnetic resonance imaging in spontaneous intracranial hypotension after epidural blood patch.
Spontaneous intracranial hypotension (SIH) is a syndrome characterized by orthostatic headache, nausea, vomiting, photophobia, and diplopia. Subdural effusion, diffuse dural enhancement, dilatation of epidural veins, and increased height of hypophysis are cranial magnetic resonance (MR) imaging findings in SIH. ⋯ We present the follow-up MR imaging findings in a case of SIH after a successful epidural blood patch treatment. We propose that cranial MR imaging as an objective test to evaluate the success of epidural blood patch treatment.
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Comment Letter Comparative Study
Tramadol and strong opioid: synergistic or additive opioid effect?
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We present a case report in which spinal cord stimulator trial lead became lodged in the posterior lumbar soft tissue. The lead could not be removed even with moderate force or with spine in the flexed position. Radiologic evaluation revealed that edge of metallic lead was wedged into the soft tissue. We were able to remove the lead only after placing the patient in an extreme tuck position (knee-to-chest); thus possibly avoiding surgical intervention.