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Treatment of chronic pain

Jitka Vanderpol, Leon Jonker
OBJECTIVE: Greater occipital nerve (GON) block is a treatment option applied for a variety of primary headache disorders. Although a patient's body position is known to have an impact on the effect of local anaesthetics, this has not before been investigated for patients undergoing GON block. Therefore, the clinical effectiveness of either a sitting or supine position was assessed. PATIENTS AND METHODS: This evaluative prospective study took place in a single neurology department in the UK...
December 3, 2018: Clinical Neurology and Neurosurgery
Rui V Duarte, Simon Thomson
OBJECTIVES: The aim of the current project was to evaluate the spinal cord stimulation (SCS) screening trial success rate threshold to obtain the same cost impact across two identical sets of patients following either a prolonged screening trial prior to implantation strategy or a full implant without a screening trial. MATERIALS AND METHODS: A cost impact analysis was carried out from a health care perspective and considered trial to implant rates reported in the literature...
December 10, 2018: Neuromodulation: Journal of the International Neuromodulation Society
Charlie C-T Hsu, Gigi Nc Kwan, Dalveer Singh, John A Rophael, Chris Anthony, Mieke L van Driel
BACKGROUND: Chronic limb-threatening ischaemia (CLTI) is a manifestation of peripheral arterial disease (PAD) that includes chronic ischaemic rest pain or ischaemic skin lesions, ulcers, or gangrene for longer than two weeks. The severity of the disease depends on the extent of arterial stenosis and the availability of collateral circulation. Treatment for CLTI aims to relieve ischaemic pain, heal ischaemic ulcers, prevent limb loss, improve quality of life, and prolong survival. CLTI due to occlusive disease in the infrapopliteal arterial circulation (below-knee circulation) can be treated via an endovascular technique by a balloon opening the narrowed vessel, so called angioplasty, with or without the additional deployment of a scaffold made of metal alloy or other material, so called stenting...
December 8, 2018: Cochrane Database of Systematic Reviews
Wuilker Knoner Campos, Marcelo Neves Linhares, Jamir Sarda, Adair Roberto Soares Santos, Júlio Licinio, João Quevedo, Kátia Lin, Roger Walz
OBJECTIVES: Previous studies demonstrated significant improvement in mean pain scores and quality of life (QOL) scales in patients with chronic pain who underwent spinal cord stimulation (SCS). However, the number of individuals who experience relevant improvements in QOL, termed the meaningful clinical improvement (MCI), is not known. The present study investigated changes in pain measurements based on MCI after SCS. MATERIALS AND METHODS: Thirty-four patients with chronic intractable pain completed scales of pain (visual analogue scale [VAS]), QOL (SF-36), and psychological dimensions during a 22-month follow-up period (mean)...
December 10, 2018: Neuromodulation: Journal of the International Neuromodulation Society
Ozkan Varan, Hamit Kucuk, Hakan Babaoglu, Nuh Atas, Reyhan Bilici Salman, Hasan Satis, Mehmet Akif Ozturk, Seminur Haznedaroglu, Berna Goker, Abdurrahman Tufan
BACKGROUND: Familial Mediterranean fever (FMF) patients suffer from chronic complications of disease such as AA amyloidosis, chronic arthritis, and spondylitis. Reduced quality of life (QoL) is a feature of chronic diseases but it is also impaired in patients with FMF. Despite the regular use of colchicine at a maximal dose, about 10% of patients do not respond well or resistant to colchicine (crFMF). IL-1 inhibitors have been shown to be effective in controlling attacks in crFMF patients...
December 10, 2018: Clinical Rheumatology
Shao-Cheng Liu, Ming-Chang Kao, Yun-Chen Huang, Wan-Fu Su
BACKGROUND: Management of chronic cluster headache (CCH) remains a challenging endeavor, and the optimal surgical approach for medically refractory CCH remains controversial. OBJECTIVE: To conduct a preliminary evaluation of the efficacy and safety of vidian neurectomy (VN) in patients with medically refractory CCH. METHODS: Between March 2013 and December 2015, 9 CCH patients, all of whom had failed to respond to conservative therapy, underwent VN with a precise nerve cut and maximal preservation of the sphenopalatine ganglion...
December 10, 2018: Neurosurgery
Tolga Ergonenc, Serbulent Gokhan Beyaz
AIM: Pulsed radiofrequency (PRF) therapy has become increasingly popular in the treatment of chronic shoulder pain due to its long duration of action and non-destructive method. The aim of the study was to reveal the effects of PRF therapy of the suprascapular nerve (SSN) under ultrasound guidance (UG) in patients with chronic shoulder pain on both shoulder pain and function. MATERIAL AND METHODS: This study included 74 patients diagnosed with at least one of the following: adhesive capsulitis, rotator cuff syndrome and impingement syndrome of shoulder...
December 8, 2018: Medical Ultrasonography
Philippe Donatien, Uma Anand, Yiangos Yiangou, Marco Sinisi, Michael Fox, Anthony MacQuillan, Tom Quick, Yuri E Korchev, Praveen Anand
Introduction: Granulocyte-macrophage colony-stimulating factor receptor (GM-CSFR) is highly expressed in peripheral macrophages and microglia, and is involved in arthritis and cancer pain in animal models. However, there is limited information on GM-CSFR expression in human central nervous system (CNS), peripheral nerves, or dorsal root ganglia (DRG), particularly in chronic pain conditions. Objectives: Immunohistochemistry was used to quantify GM-CSFR expression levels in human tissues, and functional sensory effects of GM-CSF were studied in cultured DRG neurons...
September 2018: Pain Reports (Baltimore, Md.)
Andreas Goebel, Austen Peter Moore, Anu Jacob
Introduction: Autoantibody-mediated autoimmunity directed against targets within the voltage-gated potassium channel complex (VGKCC autoantibodies) has been implicated in causing neuropathic pain. Methods: We report the case of a 76-year-old, United Kingdom male who was diagnosed with contactin-associated protein 2 (CASPR2) autoantibody-associated Morvan syndrome, a rare neurological condition. Results: He had previously worked in a swine abattoir; exposure to aerosol within swine abattoirs has been reported to elicit an immune response resulting in the production of these autoantibodies; however, unusually, his manifestations emerged with several years' latency...
September 2018: Pain Reports (Baltimore, Md.)
Lucie Lessard, Matthew J Bartow, James Lee, Julian Diaz-Abel, Oren E S Tessler
Background: Complex regional pain syndromes (CRPS) is a disease that is poorly understood. It is a chronic pain syndrome characterized by sympathetic disruptions as well as CNS sensitization. Botulinum Toxin-A has been shown to have efficacy in Raynaud's as well as other neuropathic pain disorders. Perhaps BTX-A warrants experimentation in the treatment of CRPS. Methods: Patients with CRPS refractory to 2 or more regional sympathetic nerve blocks in 2007 were included in the study...
October 2018: Plastic and Reconstructive Surgery. Global Open
Ryan A Hartley, Michael E Kordecki
Background and Purpose: Brachial plexus neuropraxia (BPN), or "burners" and "stingers", affect 50-65% of football players, with a high rate of recurrence and the potential, in rare cases, for catastrophic injury. Existing literature on rehabilitation of these athletes is limited. The purpose of this case report is to describe the successful and comprehensive rehabilitation of a subject with recurrent brachial plexus neuropraxia using range of motion exercises, cervical and periscapular strengthening, stabilization exercises, and activity modification...
December 2018: International Journal of Sports Physical Therapy
Andréia Cristina de Oliveira Silva, Daniela Aparecida Biasotto-Gonzalez, Fábio Henrique Monteiro Oliveira, Adriano Oliveira Andrade, Cid André Fidelis de Paula Gomes, Fernanda de Córdoba Lanza, César Ferreira Amorim, Fabiano Politti
Previous studies have reported that visceral disturbances can lead to increased musculoskeletal tension and pain in structures innervated from the corresponding spinal level through viscerosomatic reflexes. We designed a pilot randomised placebo-controlled study using placebo visceral manipulation as the control to evaluate the effect of osteopathic visceral manipulation (OVM) of the stomach and liver on pain, cervical mobility, and electromyographic activity of the upper trapezius (UT) muscle in individuals with nonspecific neck pain (NS-NP) and functional dyspepsia...
2018: Evidence-based Complementary and Alternative Medicine: ECAM
Michael Marsalli, Nicolás Moran, Jose I Laso
High-grade acromioclavicular (AC) injuries are frequent in the active population, and their treatment in the acute setting has reduced sequelae such as chronic pain, functional impairment, and inability to return to sports. Multiple techniques have been described to achieve reduction and fixation of the AC joint, but still there is no consensus. The objective of this Technical Note is to describe the reduction and internal fixation under arthroscopic assistance of the AC joint with the use of a double button implant plus high-strength tape in the acute setting...
November 2018: Arthroscopy Techniques
Johanna Blair de Haan, Nadia Hernandez, Sudipta Sen
Hidradenitis suppurativa (HS) is a chronic inflammatory disease of the terminal hair follicle of the apocrine gland-bearing skin, presenting with inflamed nodules, abscesses, and sinus tracts. Autoimmune, genetic, and infectious factors have been implicated in its pathogenesis. HS can be managed medically using topical and systemic antibiotics and with tumor necrosis factor antibody therapy in severe cases. Surgical treatment can range from local excision, deroofing or excision of sinus tracts, or wide radical excision of severe lesions...
2018: Local and Regional Anesthesia
Baogan Peng, Michael J DePalma
Cervical intervertebral disc has long been considered a common source of neck pain. However, the pain caused by the disc itself has not been clearly defined so far, and its diagnosis and treatment has always been controversial. Degenerative cervical disc has a rich supply of nerve fibers, is prone to inflammatory reactions, and is susceptible to pain that can be provoked by disc stimulation or distention, and can be eliminated by block. Overwhelming clinical evidence demonstrates that neck pain in patients with degenerative cervical radiculopathy or myelopathy can be subsided rapidly by anterior cervical surgery, further indicating that this neck pain stems from the pathology of cervical disc itself...
2018: Journal of Pain Research
Anand Prahalad Rao, Pooja Prakash Mallya, Shashi Ranjani, Jyothi Raghuram
Background: Chronic recurrent multifocal osteomyelitis (CRMO) is a rare auto-inflammatory disease of the bone. It tends to be multifocal and usually the symptoms tend to run for months and years before diagnosis is usually made. The objective of our study was to understand the clinical presentation and short-term response to treatment of CRMO patients. Materials and Methods: A retrospective analysis of patients diagnosed with CRMO between 2011 and 2016 was done...
November 2018: Indian Journal of Orthopaedics
Mustafa Abbas, Peter Siordet Scolding, Abubaker Ahmed Yosif, Roa Fath El Rahman, Melka O El-Amin, Mohamed Kamal Elbashir, Nora Groce, Ahmed Hassan Fahal
Mycetoma is a neglected tropical disease endemic in tropical and subtropical countries, particularly Sudan. The disease is characterised by the triad of painless subcutaneous mass, multiple sinuses and discharge that contain grains. It is a chronic, debilitating disease most commonly affecting the feet or hands and leads to substantial morbidity, loss of function and even amputation. It predominantly affects poor, rural populations and patients typically present late with advanced disease and complications...
December 10, 2018: PLoS Neglected Tropical Diseases
A V Shabunin, D V Matveev, M R Kuznetsov, E E Fedorov, A D Matveev
Presented in the review is the data concerning contemporary criteria for assessing the degree of chronic lower limb ischaemia and quality of the treatment performed. Problems regarding objectivization of the degree of an ischaemic lesion of an extremity and assessment of quality of conservative treatment still remain unresolved. Currently, in the world practice along with instrumental methods (assessment of the ankle-brachial index) subjective criteria are mainly employed: assessment of pain-free walking distance or maximum distance walked...
2018: Angiologii︠a︡ i Sosudistai︠a︡ Khirurgii︠a︡, Angiology and Vascular Surgery
Sarah Snell, Tia Hughes, Carolyn Fore, Roy Lukman, Brett Morgan
A significant portion of the world's population is impacted by chronic pain; in the United States, chronic pain costs billions annually in treatment and lost productivity. A needs assessment was conducted to evaluate the prevalence of chronic nonmalignant pain (CNMP) at a university occupational therapy clinic over a 3-month period; recommendations were made to improve pain management at the clinic and referring hospital system. Graded Chronic Pain Scale 2.0 results indicated the prevalence of CNMP was a significant problem...
January 2019: Journal of Christian Nursing: a Quarterly Publication of Nurses Christian Fellowship
Andrew H Gordon, Arthur Jason De Luigi
Platelet-rich plasma (PRP), as a regenerative treatment for partial ulnar collateral ligament (UCL) tears, is validated to lead to faster clinical recovery and return to play in adult athletes. However, studies examining such a role of PRP in younger pediatric and adolescent athletes are scarce. A 14-year-old adolescent throwing athlete, a right-handed pitcher, presented with chronic right medial elbow pain discovered to be secondary to a partial UCL tear, as identified on both ultrasound and magnetic resonance imaging...
December 2018: Current Sports Medicine Reports
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