Pain practice : the official journal of World Institute of Pain
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Case Reports
Yoga spinal flexion positions and vertebral compression fracture in osteopenia or osteoporosis of spine: case series.
The objective of this report is to raise awareness of the effect of strenuous yoga flexion exercises on osteopenic or osteoporotic spines. We previously described subjects with known osteoporosis in whom vertebral compression fractures (VCFs) developed after spinal flexion exercise (SFE) and recommended that SFEs not be prescribed in patients with spinal osteoporosis. ⋯ The development of pain and complications with some flexion yoga positions in the patients with osteopenia leads to concern that fracture risk would increase even further in osteoporosis. Although exercise has been shown to be effective for improving bone mineral density and decreasing fracture risk, our subjects had development of VCFs and neck and back pain with yoga exercises. This finding suggests that factors other than bone mass should be considered for exercise counseling in patients with bone loss. The increased torque pressure applied to vertebral bodies during SFEs may be a risk. Exercise is effective and important for treatment of osteopenia and osteoporosis and should be prescribed for patients with vertebral bone loss. Some yoga positions can contribute to extreme strain on spines with bone loss. Assessment of fracture risk in older persons performing SFEs and other high-impact exercises is an important clinical consideration.
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Review Case Reports
Neuromodulation of pelvic visceral pain: review of the literature and case series of potential novel targets for treatment.
Chronic pelvic pain (CPP) is complex and often resistant to treatment. While the exact pathophysiology is unknown, the pain states resultant from conditions such as interstitial cystitis and the like yield patients with a presentation that bears a striking similarity to neuropathic syndromes that are known to respond to neuromodulation. While there has been past success using the sacral region as a target for spinal cord stimulation (SCS) to treat these patients, there remains to be a consensus on the optimal location for lead placement. In this article, the authors discuss the potential etiology of CPP, examine the current literature on lead placement for SCS as a method of treatment, as well as present several cases where novel lead placement was successfully employed.
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The majority of patients with breast cancer receiving chemotherapy report multiple symptoms. Compelling evidence has shown that subgroups of patients can be clustered by the severity of symptoms. Recent studies demonstrate that chemotherapy with such substances as paclitaxel can cause neuropathic pain (CINP) and consequently neural damage. ⋯ the present study examined the relationship between symptom clusters and CINP among 40 patients with breast cancer. The study was based on 2 sessions conducted before and during paclitaxel treatment. In each session, neuropathic pain was assessed by the DN4 Questionnaire. In the second session, the Lee Fatigue Scale, the General Sleep Disturbance Scale, and the Center for Epidemiological Studies-Depression Scale were also administered, and the worst pain intensity was assessed. Using cluster analysis, 2 symptom clusters were identified on the basis of the severity of the 4 symptoms scores. Patients in the High Cluster (37%) experienced a high level of all symptoms, whereas patients in the Low Cluster (63%) experienced a low level of all symptoms. Twenty patients (50%) were diagnosed with CINP. A subgroup of patients (23%) from the High Cluster was identified as having CINP; 35% were in the Low Cluster and free of CINP. In conclusion, there appears to be a specific subgroup of patients with hypersensitive cancer who need greater attention to symptom management. Early detection of symptoms, together with careful dose selection and assessment of early stages in the development of neuropathic pain, are essential for preventing the simultaneous occurrence of severe multiple symptoms and CINP.
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Editorial Comment
Pelvic pain: mechanistically enigmatic, therapeutically challenging.
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Randomized Controlled Trial Multicenter Study
Sustained safety and efficacy of once-daily hydromorphone extended-release (OROS® hydromorphone ER) compared with twice-daily oxycodone controlled-release over 52 weeks in patients with moderate to severe chronic noncancer pain.
Once-daily hydromorphone extended-release (OROS(®) hydromorphone ER) and oxycodone controlled-release (CR) are semisynthetic, ER opioid analgesics with established efficacy. An open-label, randomized, 24-week, parallel group, flexible-dose study demonstrated noninferiority of OROS hydromorphone ER vs. twice-daily oxycodone CR in patients with chronic noncancer pain. In total, 112 patients were enrolled in a 28-week, open-label extension study; 60 patients received OROS hydromorphone ER and 52 received oxycodone CR. ⋯ At Week 52, global assessment of efficacy was rated as "very good" or "good" by the majority of patients (OROS hydromorphone ER, 91.7%; oxycodone CR, 86.5%). More patients in the OROS hydromorphone ER group (35.0% vs. 21.2%) assessed mode of drug intake as "very convenient." The majority of patients receiving OROS hydromorphone ER (88.3%) and oxycodone CR (88.5%) rated tolerability as "good" or "very good" at Week 52; few patients discontinued treatment because of an adverse event (1.6% vs. 0.4%, respectively). The effectiveness of OROS hydromorphone ER and oxycodone CR was maintained through 1 year.