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Chronic intractible pain

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https://www.readbyqxmd.com/read/29913768/chronic-non-cancer-pain-and-the-long-term-efficacy-and-safety-of-opioids-some-blind-men-and-an-elephant
#1
C Peter, N Watson
Background The use of opioids for chronic non-cancer pain (CNCP) remains very controversial. There are a number of randomized controlled trials (RCTs) showing efficacy and safety in the short-term, but long-term data are limited. Methods This article contains 10 case reports (followed to 2011) that were selected from a survey of 84 patients with intractable CNCP treated with opioids and followed every 3 months now for a median of 10 years. The previous published survey of this group reported outcomes of pain severity, adverse effects, pain relief, satisfaction, mood, problematic opioid use, tolerance, physical dependency, functional status, health-related quality of life (HRQL), immune status and sexual function...
December 29, 2017: Scandinavian Journal of Pain
https://www.readbyqxmd.com/read/29889356/spinal-cord-stimulation-scs-trial-outcomes-after-conversion-to-a-multiple-waveform-scs-system
#2
Nameer Haider, Dwight Ligham, Brett Quave, Kirk E Harum, Eduardo A Garcia, Christopher A Gilmore, Nathan Miller, Gregory A Moore, Amarpreet Bains, Kristen Lechleiter, Roshini Jain
OBJECTIVE: Spinal cord stimulation (SCS) for chronic intractable pain is typically delivered in pulses, classically programmed between approximately 20 and 100 Hz. Though some recent studies suggest that better pain relief is obtained, with only 10 kHz stimulation, other studies show that single-therapy trials do not always lead to permanent implantation. We evaluated SCS outcomes in subjects given trials with multiple waveforms who did not experience satisfactory trial relief with 10 kHz stimulation only...
June 11, 2018: Neuromodulation: Journal of the International Neuromodulation Society
https://www.readbyqxmd.com/read/29888265/hydrogen-rich-saline-activated-autophagy-via-hif-1-%C3%AE-pathways-in-neuropathic-pain-model
#3
Huixing Wang, Xiaodong Huo, Hongguang Chen, Bo Li, Jingzhi Liu, Wenting Ma, Xiaojuan Wang, Keliang Xie, Yonghao Yu, Kemei Shi
Background: Neuropathic pain is a chronic and intractable pain, with very few effective analgesics. It involves an impaired cell autophagy process. Hydrogen-rich saline (HRS) reportedly reduces allodynia and hyperalgesia in a neuropathic pain model; however, it is unknown whether these effects involve autophagy induction. Methods: We investigated the relationship between HRS and cell autophagy in a neuropathic pain model generated by chronic constriction injury (CCI) in Sprague-Dawley rats...
2018: BioMed Research International
https://www.readbyqxmd.com/read/29858746/long-term-quality-of-life-improvement-for-chronic-intractable-back-and-leg-pain-patients-using-spinal-cord-stimulation-12-month-results-from-the-senza-rct
#4
Kasra Amirdelfan, Cong Yu, Matthew W Doust, Bradford E Gliner, Donna M Morgan, Leonardo Kapural, Ricardo Vallejo, B Todd Sitzman, Thomas L Yearwood, Richard Bundschu, Thomas Yang, Ramsin Benyamin, Abram H Burgher, Elizabeth S Brooks, Ashley A Powell, Jeyakumar Subbaroyan
PURPOSE: Chronic axial low-back pain is a debilitating disorder that impacts all aspects of an afflicted individual's life. Effective, durable treatments have historically been elusive. Interventional therapies, such as spinal cord stimulation (SCS), have shown limited efficacy at best. Recently, a novel treatment, 10 kHz SCS, has demonstrated superior pain relief compared with traditional SCS in a randomized controlled trial (RCT). In this manuscript, we report on the long-term improvements in quality of life (QoL) outcomes for subjects enrolled in this study...
June 1, 2018: Quality of Life Research
https://www.readbyqxmd.com/read/29794496/neuromodulation-in-pediatrics-case-series
#5
Eugene Kim, Sean Gamble, Adina Schwartz, Giovanni Cucchiaro
OBJECTIVES: Neuromodulation, particularly intrathecal drug delivery systems and spinal cord stimulators, can be a valuable tool when treating chronic pain in adults. However, there is a paucity of literature regarding its use in pediatrics. MATERIALS: and Methods: We present a series of 14 children and adolescents with intractable pain who received a spinal cord stimulator or a pump for the intrathecal delivery of medications between 2010 and 2016 at our institution...
May 22, 2018: Clinical Journal of Pain
https://www.readbyqxmd.com/read/29775161/surgical-treatment-of-middle-cluneal-nerve-entrapment-neuropathy-technical-note
#6
Juntaro Matsumoto, Toyohiko Isu, Kyongsong Kim, Naotaka Iwamoto, Daijiro Morimoto, Masanori Isobe
OBJECTIVE The etiology of low-back pain (LBP) is heterogeneous and is unknown in some patients with chronic pain. Superior cluneal nerve entrapment has been proposed as a causative factor, and some patients suffer severe symptoms. The middle cluneal nerve (MCN) is also implicated in the elicitation of LBP, and its clinical course and etiology remain unclear. The authors report the preliminary outcomes of a less invasive microsurgical release procedure to address MCN entrapment (MCN-E). METHODS The authors enrolled 11 patients (13 sites) with intractable LBP judged to be due to MCN-E...
May 18, 2018: Journal of Neurosurgery. Spine
https://www.readbyqxmd.com/read/29763654/obturator-neuromodulation-with-laparoscopic-placement-of-an-obturator-lead-for-the-treatment-of-intractable-opioid-dependent-chronic-pelvic-pain-due-to-obturator-neuralgia
#7
Richard P Marvel
Chronic pelvic pain(CPP) is a common condition in women that can have a devastating effect on quality of life. Some of the most severe forms of CPP are related to peripheral nerve injuries causing persistent neuropathic pain. This is a case of a young woman with severe opioid dependent chronic pelvic and right groin pain due to obturator neuralgia. She had failed a multitude of treatments including multiple medications, manual physical therapy, nerve blocks, surgical neurolysis and spinal cord stimulation without significant benefit...
May 12, 2018: Journal of Minimally Invasive Gynecology
https://www.readbyqxmd.com/read/29761638/ultra-sound-guided-neurolysis-of-six-genicular-nerves-of-knee-for-intractable-pain-from-knee-osteoarthritis-a-case-series
#8
Arif Ahmed, Divesh Arora
INTRODUCTION: Among the elderly populations, the chronic osteoarthritis of knee joint is one of the leading cause of disability and causes considerable pain, joint stiffness and functional limitations. Although knee replacement is a good option for the grade IV osteoarthritis, but many patients failed to undergo surgery due to co-morbidities or other reasons. METHODS: Four patient with severe pain from grade III and IV osteoarthritis of knee joint had underwent ultrasound guided alcohol neurolysis of the six genicular nerves of knee joint after a positive genicular nerve block with local anesthetics...
May 14, 2018: Pain Practice: the Official Journal of World Institute of Pain
https://www.readbyqxmd.com/read/29729250/application-of-optogenetics-in-the-study-of-pain-modulation
#9
REVIEW
Yu-Feng Xie, Jing Wang, Robert P Bonin
Intractable pain is the single most common cause of disability, affecting more than 20% of the population world-wide. There is accordingly a global effort to decipher how changes in the activity of nociceptive sensory afferents and dorsal horn cell populations contribute to the onset and maintenance of chronic pain. Through the application of advances in genetic techniques, there has been a surge in the success of efforts along this front. In particular, the past several years have brought rapid progress in the adaptation of optogenetic approaches to study and manipulate the activity of sensory afferents and spinal cord neurons in freely behaving animals...
May 2, 2018: Experimental Neurology
https://www.readbyqxmd.com/read/29726593/surgical-management-of-neck-pain-and-headache-associated-with-pediatric-hashimoto-s-thyroiditis
#10
Paul Krakovitz, Christine Cairns, Bahareh Michelle Schweiger, Brian Burkey
OBJECTIVES/HYPOTHESIS: Case reports of a painful variant of Hashimoto's thyroiditis exist in the literature; however, these cases have only been documented in adult patients and there are no standard treatment guidelines. The aim of this study was to describe an alternative management for Hashimoto's thyroiditis associated with medically intractable head and neck pain in the pediatric population. STUDY DESIGN: Case series with chart review. METHODS: The study was conducted in the Section of Pediatric Otolaryngology at the Cleveland Clinic...
May 4, 2018: Laryngoscope
https://www.readbyqxmd.com/read/29701900/single-s1-dorsal-root-ganglia-stimulation-for-intractable-complex-regional-pain-syndrome-foot-pain-after-lumbar-spine-surgery-a-case-series
#11
Ioannis M Skaribas, Christian Peccora, Elena Skaribas
INTRODUCTION: Intractable complex regional pain syndrome (CRPS)-related chronic foot pain, is a common therapeutic challenge for interventional pain management physicians and patients alike. Dorsal root ganglia (DRG) stimulation is a very target specific dorsal column stimulation technique with very promising clinical outcomes. Patients with CRPS foot pain and previous back surgery can benefit from DRG stimulation but also run a significant risk of epidural trauma from the DRG sheath advancement...
April 27, 2018: Neuromodulation: Journal of the International Neuromodulation Society
https://www.readbyqxmd.com/read/29692890/management-of-a-postbulbar-duodenal-ulcer-and-stricture-causing-gastric-outlet-obstruction-a-case-report
#12
Maxwell D Mirande, Raul A Mirande
Introduction: Peptic ulcer disease has significantly decreased over the past several decades making the need for definitive surgical intervention an infrequent occurrence. Presentation of Case: A 44-year-old Caucasian female was sent to the emergency department by her primary care physician for right upper quadrant abdominal pain which had been intermittent for the past two months but acutely worsened over the last five days. During this time, she was unable to tolerate oral intake with intractable nausea and vomiting...
May 2018: Annals of Medicine and Surgery
https://www.readbyqxmd.com/read/29682021/coccygectomy-for-coccygodynia-a-single-center-experience-over-5-years
#13
Arif Hussain Sarmast, Altaf Rehman Kirmani, Abdul Rashid Bhat
Introduction: Coccygodynia refers to a pathological condition in which pain occurs in the coccyx or its immediate vicinity. The pain is usually provoked by sitting or rising from sitting. Several studies have reported good or excellent results after coccygectomy especially in patients who are refractory to conservative treatment. Aims and Objectives: This study aims to evaluate the role and effectiveness of coccygectomy in chronic refractory coccygodynia. Materials and Methods: Between January 2011 and January 2015, 16 consecutive patients (4 males and 12 females) who underwent surgical coccygectomy were enrolled prospectively in the study...
April 2018: Asian Journal of Neurosurgery
https://www.readbyqxmd.com/read/29673066/total-pancreaticoduodenectomy-with-autologous-islet-transplantation-14-years-after-liver-contained-composite-visceral-transplantation
#14
Ahmed Nassar, Cristiano Quintini, Guilherme Costa, Elizabeth Lennon, Rita Bottino, Betul Hatipoglu, Koji Hashimoto, Masato Fujiki, Fouad Kandeel, R Matthew Walsh, Kareem Abu-Elmagd
Chronic pancreatitis (CP) is a severely disabling disorder with potential detrimental effects on quality of life, gut function, and glucose homeostasis. Disease progression often results in irreversible morphological and functional abnormalities with development of chronic pain, mechanical obstruction, and pancreatic insufficiency. Along with comprehensive medical management, the concept of total pancreatectomy and islet autotransplantation (TP-AIT) was introduced 40 years ago for patients with intractable pain and preserved beta-cell function...
April 19, 2018: American Journal of Transplantation
https://www.readbyqxmd.com/read/29671870/wireless-high-frequency-dorsal-root-ganglion-stimulation-for-chronic-low-back-pain-a-pilot-study
#15
B Billet, K Hanssens, O De Coster, W Nagels, R L Weiner, R Wynendaele, N Vanquathem
OBJECTIVE: Evaluation of the efficacy of a wireless high-frequency stimulator placed over selected DRG of exiting nerve roots for the treatment of chronic low back pain. DESIGN: Feasibility. SUBJECTS: Six subjects with chronic, intractable back pain refractory to standard medical treatment. METHODS: Four stimulators (Freedom-4A) provided by Stimwave Technologies, were implanted over the DRG exiting nerve roots, bilaterally at both the T9 and L2 vertebral levels...
April 19, 2018: Acta Anaesthesiologica Scandinavica
https://www.readbyqxmd.com/read/29668612/treatment-by-ultrasound-guided-local-infiltration-in-adhesion-related-abdominal-pain-and-intractable-hiccups-a-case-report
#16
Dan Zhu, Zhi-Yong Gu, Chia-Shiang Lin, Fa-Chuan Nie, Jian Cui
RATIONALE: Abdominal pain and hiccups secondary to intra-abdominal adhesion are surgical complications that are often treated by painkillers and secondary surgeries with an unsatisfactory therapeutic effect. This study presents a new treatment method that uses ultrasound-guided local infiltration in peritoneal and abdominal wall adhesions in patients with hiccups and abdominal pain. PATIENT CONCERNS: A 62-year-old patient presented to our hospital with a history of intractable hiccups and abdominal pain for 30 years...
April 2018: Medicine (Baltimore)
https://www.readbyqxmd.com/read/29661045/recent-approaches-for-targeted-drug-delivery-in-rheumatoid-arthritis-diagnosis-and-treatment
#17
Sana Pirmardvand Chegini, Jaleh Varshosaz, Somayeh Taymouri
Rheumatoid arthritis (RA) is a chronic inflammatory disease with complex pathology characterized by inflammation of joints, devastation of the synovium, pannus formation, bones and cartilage destruction and often is associated with persistent arthritic pain, swelling, stiffness and work disability. In conventional RA therapy, because of short biological half-life, poor bioavailability, high and frequent dosing is required. Thereby, these anti-RA medications, which unable to selectively target affected zone, may cause severe side effects in extra-articular tissues...
April 16, 2018: Artificial Cells, Nanomedicine, and Biotechnology
https://www.readbyqxmd.com/read/29652011/quest-for-haller-cells-a-digital-orthopantomography-study
#18
Kavitaa Nedunchezhian, Nalini Aswath, A Amudhan
Aims: Haller Cells refer to the ethmoidal pneumatization and are the extensions of anterior ethmoid sinus into the floor of the orbit and superior aspect of the maxillary sinus, basically an anatomic variation. They may be associated with orofacial pain, sinusitis, nasal obstruction, impaired nasal breathing, headache, chronic cough, and mucocele. The aim of the present study was to identify, determine the prevalence and characteristics of Haller's cells on Digital orthopantomographs in patient's reporting to a dental institution in Chennai...
March 2018: Indian Journal of Dental Research: Official Publication of Indian Society for Dental Research
https://www.readbyqxmd.com/read/29594982/penile-calciphylaxis-in-a-patient-on-combined-peritoneal-dialysis-and-hemodialysis
#19
Takahiro Kasai, Naoki Washida, Hirokazu Muraoka, Kentarou Fujii, Kiyotaka Uchiyama, Keisuke Shinozuka, Kohkichi Morimoto, Hirobumi Tokuyama, Shu Wakino, Hiroshi Itoh
Calciphylaxis presents with painful purpura and intractable skin ulcers on the trunk and particularly the distal extremities, and it mainly occurs in patients on chronic dialysis. A 66-year-old man with renal failure due to diabetic nephropathy was on peritoneal dialysis alone for 1 year, followed by peritoneal dialysis combined with hemodialysis for 3 years. He developed calciphylaxis of the penis, which was diagnosed from the skin biopsy findings and clinical observation. To treat this condition, PD was stopped and HD was performed three times a week...
March 28, 2018: CEN Case Reports
https://www.readbyqxmd.com/read/29587798/inhibition-of-peripheral-macrophages-by-nicotinic-acetylcholine-receptor-agonists-suppresses-spinal-microglial-activation-and-neuropathic-pain-in-mice-with-peripheral-nerve-injury
#20
Norikazu Kiguchi, Daichi Kobayashi, Fumihiro Saika, Shinsuke Matsuzaki, Shiroh Kishioka
BACKGROUND: Neuro-immune interaction underlies chronic neuroinflammation and aberrant sensory processing resulting in neuropathic pain. Despite the pathological significance of both neuroinflammation-driven peripheral sensitization and spinal sensitization, the functional relationship between these two distinct events has not been understood. METHODS: In this study, we determined whether inhibition of inflammatory macrophages by administration of α4β2 nicotinic acetylcholine receptor (nAChR) agonists improves neuropathic pain and affects microglial activation in the spinal dorsal horn (SDH) in mice following partial sciatic nerve ligation (PSL)...
March 27, 2018: Journal of Neuroinflammation
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