Pain practice : the official journal of World Institute of Pain
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Review Meta Analysis
Targeted muscle reinnervation in managing post-amputation related pain: A systematic review and meta-analysis.
Limb amputation can cause residual limb pain (RLP) and/or phantom limb pain (PLP). Although targeted muscle reinnervation (TMR) was initially introduced to facilitate the control of prosthetic limbs, it has been noted that these patients experience less pain and improved prosthetic functional outcomes. As a result, the use of TMR in managing neuroma-related RLP is increasing. The aim of this review is to assess the quality and strength of the evidence supporting the effectiveness of TMR in managing amputation-related pain. ⋯ There is limited evidence of good quality favoring TMR in reducing postamputation PLP and RLP pain compared with standard care. Randomized clinical trials are encouraged to compare the efficacy of different surgical techniques.
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Spinal cord stimulation is an important therapy option for the treatment of chronic neuropathic pain of spinal or peripheral etiology. As with any implantable device, complications may arise. These must be promptly identified and managed to maintain patients in successful therapy. ⋯ Lead migration is one of the most common complications of spinal cord stimulation, and left untreated can lead to loss of therapy and possible device explant. A strategy for correcting this issue is needed, and we present an unusual case to consider when faced with a loss of therapy from lead migration.
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Spinal cord stimulation (SCS) is conventionally placed at either cervical or thoracic spinal regions to treat chronic pain. However, for patients with multiarea pain, concomitant cervical and thoracic SCS (ctSCS) may be necessary to provide sufficient coverage. It remains unknown whether ctSCS is effective and safe. Thus, we aimed to survey the existing literature and assess the efficacy and safety of ctSCS. ⋯ Despite the limited evidence available, ctSCS seems to be effective and generally well tolerated. The dearth of relevant primary literature illustrates a knowledge gap, and future studies are needed to better clarify the efficacy and safety profile of this SCS variant.
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Posterior femoral cutaneous nerve (PFCN) neuropathy is an uncommon, potentially under-recognized cause of low back, buttock, perineal, and posterior and lateral thigh pain and numbness. Most PFCN injuries are caused by intramuscular injections; however, this is the first reported case of a PFCN injury of hamstring pathology due to tendonitis caused by long-distance running. ⋯ After excluding the more common etiologies of buttock pain and sitting intolerance, practitioners should consider the rarer condition of the impingement of the PFCN in runners.