Pain practice : the official journal of World Institute of Pain
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Cervical radicular pain is defined as pain perceived as arising in the arm caused by irritation of a cervical spinal nerve or its roots. Approximately 1 person in 1,000 suffers from cervical radicular pain. In the absence of a gold standard, the diagnosis is based on a combination of history, clinical examination, and (potentially) complementary examination. ⋯ When its effect is insufficient or of short duration, conventional radiofrequency treatment is recommended (2B+). In selected patients with cervical radicular pain, refractory to other treatment options, spinal cord stimulation may be considered. This treatment should be performed in specialized centers, preferentially study related.
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Complex regional pain syndrome is a condition that usually affects the upper or lower extremities. The cause is not clearly understood. We report a case of a severe form of a rapidly progressive complex regional pain syndrome type I developing after a right shoulder injury managed with spinal cord stimulation (SCS). ⋯ Due to the need for frequent recharging, the system was removed. During explantation of the surgical paddle lead, it was noted by the neurosurgeon that the contacts of the paddle lead were detached from the lead. After successful implantation of another SCS system, the patient was able to reduce her medications and is now able to ambulate with the use of a left elbow crutch.
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Occipital nerve stimulation is a modality reserved for refractory headache disorders. Leads (wires) are inserted subcutaneously in the occipital region to stimulate the distal C1-3 nerves; lead migration may result from repeated mechanical forces on the lead associated with patient movement. The primary aim of this study was to determine implantation pathways associated with the least pathway length change secondary to body movement in an in vitro model of an occipital stimulator system. ⋯ Internal pulse generators in sites other than the buttock, including infraclavicular or low abdomen, may be associated with lower lead migration risk. There are many considerations when selecting insertion sites and lead pathways for occipital nerve stimulation. Implanters and patients may consider these results when contemplating surgical approaches to this challenging form of peripheral nerve stimulation.
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Comparative Study
The vertebral artery is unlikely to be the sole source of vascular complications occurring during stellate ganglion block.
Stellate ganglion block (SGB) is commonly performed for upper extremity complex regional pain syndrome and other conditions. Known complications of stellate block include Horner's syndrome, hoarseness, hematoma formation, airway compromise, immediate seizure (presumably from vertebral artery injection), and death. A previous arterial anatomy study demonstrated other vessels, eg, the ascending and deep cervical arteries, reinforcing the blood supply of the spinal cord and brain stem. The potential role of these vessels in the pathogenesis of seizures or hematoma during SGB has not been studied. ⋯ Arterial vessels other than the vertebral artery that also supply the anterior spinal cord and brain stem pass directly anterior to the transverse processes at the most common sites of the SGB. It is anatomically possible, therefore, that accidental injection or induced spasm of these vessels and not the vertebral arteries is responsible for some cases of seizure, hematoma, or other vascular complications during SGB.
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Treatment of functional anorectal pain disorders remains a challenge. The purpose of this study is to describe a single center experience with sacral neuromodulation for the treatment of chronic functional anorectal pain. ⋯ This study showed that sacral neuromodulation can be a successful treatment for functional anorectal pain not responding to other treatments. Improvement obtained during test stimulation is a good predictor (diagnostic) for sustained success of permanent sacral neuromodulation.