Pain practice : the official journal of World Institute of Pain
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The goal of interventional management of refractory pediatric complex regional pain syndrome is to facilitate early restoration of function to the affected extremity. These interventions are more complicated in children, as most do not tolerate these procedures without sedation. ⋯ Repeated interventional therapy for refractory, severe complex regional pain syndrome may not be feasible in children owing to the requirement for deep sedation or general anesthesia. A multidisciplinary apaproach of brief inpatient rehabilitation and continuous blockade via an indwelling pain catheter may provide a safer, more cost-effective means of restoring function in children with advanced disease.
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Celiac plexus neurolysis (CPN) is an effective but temporary management tool for pancreatic cancer pain (PCP). Clinical studies have shown the duration of benefit with initial CPN to be apaproximately 3 months. When pain recurs, CPN may be repeated, but the outcomes for repeat CPN are not well established. The objective of this study is to determine the success rate and duration of relief following repeat celiac plexus neurolysis (rCPN) for PCP. ⋯ rCPN does not provide as much pain relief as iCPN. Disease progression as detailed on imaging appears to be a major factor in the limitations of rCPN. Further prospective studies are warranted to confirm these results and investigate the utility of rCPN.
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The terms "opioid" and "narcotic" are often used interchangeably by healthcare providers. The purpose of this study was to compare understanding "narcotics" vs. "opioids." ⋯ While more women were more familiar with narcotic, many identified negative connotations with this term. Future research should explore how to improve patient understanding and attitudes regarding both the terms opioids and narcotics.
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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.