Pain practice : the official journal of World Institute of Pain
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Multicenter Study
Subcutaneous target stimulation (STS) in chronic noncancer pain: a nationwide retrospective study.
Stimulation of primary afferent neurons offers a new approach for the control of localized chronic pain. We describe the results with a new neurostimulation technique, subcutaneous target stimulation (STS), for the treatment of chronic focal noncancer pain. STS applies permanent electrical stimulation directly at the painful area via a percutaneous-placed subcutaneous lead. ⋯ The retrospective data analysis revealed that STS effectively provided pain relief in patients suffering from refractory focal chronic noncancer pain and that STS is an alternative treatment option. Prospective controlled studies are required to confirm these retrospective findings. This article presents a new minimally invasive technique for therapy-resistant focal pain.
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Randomized Controlled Trial Comparative Study
Effect of intravenous lidocaine on manifestations of fibromyalgia.
The objective of our study was to evaluate the effect of intravenous lidocaine on the manifestations of fibromyalgia. ⋯ The addition of 240 mg intravenous lidocaine (once a week) to 25 mg amitriptyline for 4 weeks did not modify pain intensity or manifestations in patients with fibromyalgia compared with amitriptyline alone.
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Case Reports
Peripheral nerve field stimulation for intractable post-thoracotomy scar pain not relieved by conventional treatment.
Peripheral nerve field stimulation (PNFS) is being applied in individual cases where conventional treatments have failed to control pain localized to limited dermatomal distribution. We applied PNFS for unrelieved post-thoracotomy scar pain. Although spinal cord stimulation may have resulted in good coverage in the same dermatomal distribution, we chose the more peripheral approach to minimize the risk of complications, avoiding the potential neurologic sequelae associated with stimulation of the spinal cord. In summary, PNFS was effective in relieving post-thoractomy pain refractory to conventional pain management suggesting great potential of PNFS as a treatment option for chronic surgical-scar pain.
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Trigeminal neuralgia (TN) is a chronic condition affecting the fifth cranial nerve and resulting in sporadic intense burning and shock-like pain lasting for seconds to minutes that can be incapacitating to patients. Atypical TN includes additional features such as continuous pain and sensory disturbances in the area innervated by one or more branches of the trigeminal nerve. Documented cases of TN have dated back to the 18th century. ⋯ Cases refractory to medical management can be treated with surgical microdecompression or minimally invasive procedures such as radiofrequency (RF) treatment. Pulsed RF (PRF) is a method gaining interest as it is delivered in pulses, allowing adequate time for dissipation of heat and energy resulting in less damage to surrounding structures. This case report describes the successful treatment of atypical V2 TN refractive to medical management requiring PRF treatment, a sphenopalatine block series, and low-dose methadone.
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Approximately 5% of the patients referred to outpatient pain clinics suffer thoracic pain. Thoracic pain in this article is limited to thoracic radicular pain and pain originating from the thoracic facet joints. Thoracic radicular pain is characterized by radiating pain in the localized area of a nervus intercostalis. ⋯ However, extensive skills are required to perform this procedure above the level of Th7. This treatment should take place in specialized centers. For thoracic facet pain, radiofrequency treatment of the ramus medialis of the thoracic rami dorsales is recommended (2 C+).