Pain practice : the official journal of World Institute of Pain
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Persistent low back pain after initially successful surgery that is not attributed to structural deficits is called failed back surgery syndrome (FBSS). When conservative and minimal invasive therapy fail, the recommended treatment is spinal cord stimulation (SCS). Because epidural fibrosis can be a contributing factor in the majority of FBSS patients, lumbosacral epiduroscopic lysis of adhesions may be considered as a less invasive alternative treatment option. We hypothesized that the use of epiduroscopic lysis of adhesions could reduce the need for SCS. ⋯ In this pilot study we observed a reduced need for SCS when lumbosacral epiduroscopic lysis of adhesions was used for patients with FBSS and magnetic resonance imaging-proven adhesions. These observations justify the evaluation of both treatment options in a prospective observational trial.
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In the past 2 decades, in developed countries, spine procedures (surgical and percutaneous) had the highest absolute increase in case volume trend. The optimal approach to prevent and treat postoperative pain is continuously evolving. This systematic literature review presents evidence on safety and efficacy of pharmacological and nonpharmacological therapies to prevent and treat postoperative pain after lumbar spine procedures. ⋯ Clinical evidence on perioperative pain management in patients undergoing spine procedures have significantly evolved after the review published in 2012. The aim of this systematic review was to report the latest evidence published. These include the preoperative use of dexamethasone, which was shown to be able to reduce pain at mobilization but not to reduce pain at rest or total morphine consumption; the use of gabapentinoids as part of a multimodal analgesic approach; and the safety and effectiveness of the intraoperative use of ketamine, dexketoprofen, and tramadol. Finally, electrical nerve stimulation is gaining interest and is potentially suitable for clinical needs.
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This study aimed to establish a practical method for assessing pain symptomatology and develop criteria for quantifying small fiber functions using laser speckle contrast analysis (LASCA). ⋯ Pain-related small fiber functions and symptomatology (two-in-one method) can be assessed via histamine- or capsaicin-evoked axon flare responses in as little as 15 minutes. The reduction of small fiber functions are characterized by decrease in flare size/intensity at 5 minutes after stimulation and prolongation/abolishment of the latency to reach 3-fold higher levels of baseline skin microcirculation. LASCA may be applied in the clinic to aid early diagnosis, monitor disease progression, and objectively assess treatment efficacy in patients with neuropathic pain.
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Until now, only reliability and validity of the English version of the modified Perceived Deficits Questionnaire (mPDQ) have been investigated. ⋯ This article presents the validity and test-retest reliability of the Dutch mPDQ. This measure could help clinicians who seek a reliable and user-friendly way to assess cognitive symptoms in chronic pain patients.
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Facet joint steroid injections are used to treat chronic low back pain. However, little is known about the systemic absorption and serum levels of steroids following intra-articular facet joint injections. The primary objective of this preliminary study was to investigate the pharmacokinetics of triamcinolone acetonide following fluoroscopically guided intra-articular lumbar facet joint injections in a cohort of patients with chronic low back pain. A secondary aim was to investigate the effects of triamcinolone on serum cortisol levels following lumbar facet joint injections. ⋯ The peak serum concentration of triamcinolone following intra-articular facet joint injections occurred within 24 hours. The median terminal elimination half-life was 213 hours, but baseline cortisol levels were suppressed for an average of 4.4 days. Clinically, the prolonged half-life and endocrine effects of triamcinolone could increase the risk for serious drug-drug interactions in patients taking medications that inhibit corticosteroid metabolism.