Pain practice : the official journal of World Institute of Pain
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Randomized Controlled Trial
The role of fluoroscopic interlaminar epidural injections in managing chronic pain of lumbar disc herniation or radiculitis: a randomized, double-blind trial.
There is continued debate on the effectiveness, indications, and medical necessity of epidural injections in managing pain and disability from lumbar disc herniation, despite extensive utilization. There is paucity of literature on interlaminar epidural injections in managing lumbar disc herniation or radiculitis in contemporary interventional pain management settings utilizing fluoroscopy. ⋯ Lumbar interlaminar epidural injections of local anesthetic with or without steroids might be effective in patients with disc herniation or radiculitis, with potential superiority of steroids compared with local anesthetic alone at 1 year follow-up.
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We describe the use of the antihypertensive, candesartan, with hydrochlorothiazide (ECARD Combination Tablets LD) as a preventive therapy that decreased the frequency of migraine accompanied by premonitory leg edema. Two women (aged 26 and 50 years) presented to hospital with an increasing frequency of migraine without aura accompanied by leg edema. ⋯ The use of ECARD to treat a series of migraines by controlling premonitory leg edema has not been reported. ECARD, combined with a low-dose diuretic, may have been helpful in these patients with the premonitory migraine symptom of leg edema.
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Randomized Controlled Trial
Randomized controlled trial on the efficacy of bilateral superficial cervical plexus block in thyroidectomy.
As thyroid surgery is being performed as an ambulatory procedure, recent studies concerning post thyroidectomy analgesia have focused on regional techniques such as bilateral superficial cervical plexus block (BSCPB) and bilateral combined superficial and deep cervical plexus block. But, data regarding the efficacy of BSCPB are controversial. Hence we compared the efficacy of BSCPB with 0.25% bupivacaine with and without clonidine in thyroidectomy, as preventative analgesia. ⋯ BSCPB with 0.25% bupivacaine with or without clonidine is effective in reducing both intraoperative and postoperative pain and analgesic requirements in thyroidectomy, and adding clonidine to bupivacaine reduces postoperative vomiting.
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Evaluate potential usefulness of a heated lidocaine/tetracaine topical patch for treatment for pain associated with myofascial trigger points (MTPs). ⋯ The heated lidocaine/tetracaine patch has potential utility as a noninvasive pharmacologic approach for managing MTP pain. Further studies are warranted.
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We are following with great interest the increasing generally favorable impressions of the long-term results of the MILD (minimally invasive lumbar decompression) procedure for treating spinal stenosis due to hypertrophied ligamentum flavum (LF). We are also influenced by the cautionary surgical observations and opinions of Tumialan et al and publications about the lack of efficacy or placebo effect. The impression indeed has been virtual safety of the MILD procedure, but Tumialan et al describe some major complications resulting from the procedure. An algorithm for clinical use is needed.