Pain practice : the official journal of World Institute of Pain
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Paravertebral block is commonly used in the treatment for acute and chronic pain. The duration of paravertebral block could theoretically be prolonged with neurolytic agents. We report two cases of ultrasound-guided neurolytic paravertebral blocks in patients suffering from intense cancer-related thoracic pain. ⋯ The two patients had great pain relief. Neurolytic paravertebral block can be a useful technique in patients with intractable cancer pain. Because of the risk of complication, it is recommended that this technique should be limited to relief of intractable pain in cancer patients with a poor prognosis.
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Chronic pain conditions are highly prevalent, with somatoform pain disorder accounting for a large proportion. However, the psychological forms of treatment currently used achieve only small to medium effect sizes. This retrospective study investigated the effectiveness of a 5-week multimodal pain program for patients with somatoform pain disorder. ⋯ The lowest effect sizes were found for improvement of pain-related disabilities (PDI: d = 0.42) and sensory items of the Pain Perception Scale (SES-S: d = 0.50). Despite high chronification of pain condition, with average pain duration of greater than 8 years, the multimodal treatment program showed medium to large effect sizes on the outcome of patients with somatoform pain disorder. Compared with previous data with small to moderate effect sizes, a multimodal program seems to be more effective than other interventions to address somatoform pain disorder.
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Growth in the number of patients with pain conditions, and the subsequent rise in prescription opioid use for treatment, has been accompanied by an increase in diagnosed opioid abuse. Understanding what drives the incremental healthcare costs of members diagnosed with prescription opioid abuse may assist in developing better screening techniques for abuse. ⋯ Costs of members diagnosed with prescription opioid abuse are driven by higher pain and psychiatric comorbidities relative to nonabuse controls.
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Transforaminal epidural steroid injections (TFESIs) are often used to treat lumbar foraminal stenosis. Injectate pressure (of contrast) was monitored during fluoroscopically guided TFESI to assess the effect on short-term pain reduction. ⋯ In this setting, relative injectate pressures had no significant effect on immediate outcomes of TFESI.