Pain practice : the official journal of World Institute of Pain
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Review Case Reports
The delayed appearance of neurological signs in intrathecal granuloma warrants imaging surveillance: a case series and review of the literature.
Intrathecal pump therapy (ITP) has become a mainstay of treatment for the chronic, refractory nonmalignant pain patient. Increasingly, ITP therapy is being instituted for the failed back pain population. Inflammatory mass or granuloma is a complication that is considered "rare" or "uncommon." In this patient population, the symptoms of granuloma can often mimic the symptoms for which the patient is being treated. ⋯ The cases presented illustrate the need for broader education of inflammatory mass among nonpain specialists. Etiology, diagnosis and treatment guidelines of inflammatory mass are reviewed. The literature reviewed highlights the number of patients who present with paralysis as well as the need for regular screening of ITP patients.
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To examine the real-world role of tricyclic antidepressants (TCAs) in fibromyalgia (FM) treatment. ⋯ Research covering 1999 to 2005 using the same methods found that 15.9% of patients with FM used TCAs during the year before FM diagnosis and 20.7% used TCAs during the year after. These findings suggest that TCA use among the patients with FM is uncommon and may be declining in real-world practice.
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Editorial Comment
Epiduroscopy: the missing link connecting diagnosis and treatment?
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Randomized Controlled Trial
The long-term outcome of transcutaneous electrical nerve stimulation in the treatment for patients with chronic pain: a randomized, placebo-controlled trial.
Transcutaneous electrical nerve stimulation (TENS) is an easy to use analgesic intervention. However, long-term randomized placebo-controlled studies with treatment periods of more than 3 months have not been executed to date. The aim of our study is to explore the long-term (1 year) time course of the treatment effects of TENS compared to placebo (sham TENS). ⋯ Transcutaneous electrical nerve stimulation and sham TENS show similar effects in patients with chronic pain over a period of 1 year. We found support for a long sustained placebo effect.
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Chronic pain (CP) poses a diverse and substantial burden for employees, employers, and society. The deleterious consequences of CP in the workplace are frequently underestimated. ⋯ The body of evidence identified from the systematic review indicates that CP has a substantial negative impact on work-related outcomes, supporting the importance of interventions to reduce the burden of CP. Well-designed prospective studies specifically assessing the direct consequences of CP on employment are needed to confirm these findings.