Pain practice : the official journal of World Institute of Pain
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Spontaneous cerebrospinal fluid leak is a well-documented cause of postural headache. We report a medically refractory headache due to multilevel thoracic cerebrospinal fluid leaks. ⋯ Treatment of multifocal cerebrospinal fluid leaks can be challenging, particularly when at least part of the underlying etiology is fixed structural bony pathology.
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To test the hypothesis that distal residual limbs (DRLs) have significant vasomotor abnormalities. ⋯ DRLs as measured by qIRT were significantly cooler than the corresponding area of the contralateral intact limbs. A better understanding of these findings may be important in elucidating the pathophysiology of relevant clinical features such as a potential sympathetic component of postamputation pain.
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There are currently 6 reviews on (pulsed) radiofrequency (RF) for the management of spinal pain. Two reviews on interventional pain management techniques in general also discuss RF. The outcomes of those reviews depend on the type of studies included and the opinion of the reviewers, which may result in different evidence levels. ⋯ Future research to confirm or deny the efficacy of (P)RF should be conducted in carefully selected patient populations. The tests used for patient inclusion in such a trial could potentially help the clinician in selecting patients for this type of treatment. The value of PRF treatment of the peripheral nerves also needs to be confirmed in well-designed trials.
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Sacroiliitis and sacroiliac (SI) joint dysfunction are frequent causes of the chronic lower back pain. Therapeutic solutions include intra-atricular injections with short-term pain relief and surgical fusion, which appears ineffective. Radiofrequency (RF) of the joint capsule or lateral branches has been previously reported with variable successes. ⋯ Opioid use decreased from median 30 to 20 mg morphine equivalent. Eighteen patients rated their improvement in pain scores using GPE as improved or much improved, while eight claimed minimal or no improvement. The majority of patients with chronic SI joint pain experienced a clinically relevant degree of pain relief and improved function following cooled RF of sacral lateral branches and DR of L5 at 3-4 months follow-up.
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Recent studies in Western populations have reported high patient burden of neuropathic pain. No data are currently available on the burden of neuropathic pain in Indian patients. Our study evaluated the burden of neuropathic pain in patients attending urban, private-sector, specialty clinics. ⋯ In Indian patients with access to urban, private-sector, specialty clinics neuropathic pain (particularly painful diabetic neuropathy) remains a significant medical condition with substantial negative impact on their quality of life.