Pain practice : the official journal of World Institute of Pain
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The aim of the study was to define risk factors related to pain in adult end-stage renal disease (ESRD) patients on chronic intermittent hemodialysis (HD) by developing a systematic review of published data. ⋯ Multiple factors for various types of pain in very heterogeneous populations and heterogeneous settings were analyzed in the literature. The results turned out to be inconsistent between the studies. Future large-scale studies are required, taking into the account limitations of the current evidence base.
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Case Reports
Four Extremity Neurostimulation Using Two Cervical octapolar leads and high-frequency of 10-kHz.
A few published reports describe successful clinical use of low-frequency spinal cord stimulation (SCS) in the cervical spine resulting in bilateral upper and lower extremity pain relief. A major side-effect when using this modality of SCS is the uneven intensity of paresthesias, which are frequently excessive in upper extremities while attempting to achieve optimal paresthesia coverage in all 4 extremities. ⋯ Here we describe a successful case of high-frequency SCS at 10 kHz where profound control of neuropathic pain of all 4 extremities was achieved without the complication of paresthesias. Discussed are future implications of such therapy.
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Few studies have considered the effect of Weinberger et al.'s personality types on the management of pain. The aims of this study were to (1) identify whether the relationships between pain intensity, cognitive factors, and disability at 3 and 6 months postbaseline differ as a result of personality type; and (2) identify whether personality type affects the likelihood of achieving a minimal clinically important change in pain intensity or disability at 3 and 6 months. ⋯ The high proportion of defensive high-anxious individuals highlights the need for psychologically based interventions to be delivered earlier in the care process. Stratifying the population, based on personality type, may allow for more targeted interventions, which could be more cost effective and reduce the number of patients remaining in the care system.
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Clinical Trial
Stimulation of the L2-L3 Dorsal Root Ganglia Induces Effective Pain Relief in the Low Back.
Chronic low back pain affects millions of people worldwide and can arise through a variety of clinical origins. In the case of failed back surgery syndrome (FBSS), previous surgical procedures can contribute to low back pain that is often unresponsive to intervention. Although spinal cord stimulation (SCS) can be an effective treatment modality, it does not provide sufficient pain relief for some intractable cases. Recently, alternative neuromodulation options have been developed, including dorsal root ganglion (DRG) stimulation. The objective of this report is to further investigate these clinical observations. ⋯ For the studied population, DRG stimulation at the L2-L3 levels was effective at relieving low back pain. These reductions in pain were associated with improvements in quality of life. Thus, DRG stimulation at these levels may be effective for low back pain by recruiting both segmental and nonsegmental neural pathways that are not otherwise accessible via traditional SCS.