Vulvodynia--An Evidence-Based Literature Review and Proposed Treatment Algorithm.

OBJECTIVE: We searched the medical literature from the last 15 years (1998 to 2013) relating to the etiology, diagnosis, and treatment of vulvodynia. The evidence was reviewed supporting the therapeutic proposals currently in use and propose the incorporation of novel, minimally invasive, interventional therapies, within the context of a multidisciplinary approach. METHODS: This was a systematic review of all relevant studies with no language restrictions. Studies were identified through Medline/PubMed (1998 to March 2013), the Cochrane Library (2001 to 2013), and conference records and book chapters. The keywords used included "chronic pelvic pain," "vulvodynia," "vestibulodynia," and search terms "etiology," "diagnosis," and "treatment" were added. The levels of evidence were assessed using grading system for "Therapy/Prevention/Etiology/Harm" developed by the Centre for Evidence-Based Medicine (CEBM). The grading system assists in clinical decision-making, and we decided to use "The Grading of Recommendations Assessment, Development, and Evaluation (GRADE)." RESULTS: A total of 391 papers were assessed. Of these, 215 were analyzed and 175 were excluded, as they pertained to areas not directly related to the disease under review. CONCLUSION: The optimal therapy for vulvar pain syndrome remains elusive, with low percentages of therapeutic success, using either local or systemic pharmacological approaches. Surgery involving invasive and often irreversible therapeutic procedures has resulted in success for certain subtypes of vulvodynia. We present a multidisciplinary approach whereby pain treatment units may provide an intermediate level of care between standard medical and surgical treatments.

Subcutaneous botulinum toxin for chronic post-thoracotomy pain.

OBJECTIVE: Botulinum toxin is a neurotoxin that has been widely used in chronic pain for the treatment of multiple conditions with a component of localized muscle spasm. Recent studies suggest that botulinum toxin is effective in the treatment of neuropathic pain syndromes such as post-herpetic neuralgia. CASE REPORT: We report the case of a 67-year-old man who underwent atypical segmentectomy of a right lower lobe lung nodule. The patient was referred to our pain management department with a of 2-year history persistent pain along the thoracotomy scar having a predominantly neuropathic component, refractory to standard treatments. He was successfully treated with subcutaneous botulinum toxin type A. DISCUSSION: On the basics of our own experience and on the analysis of the reports published in the literature, fractioned subcutaneous injections of botulinum toxin may be useful for the treatment of various chronic localized pain conditions including chronic post-thoracotomy pain.

Intrathecal granuloma formation in a patient receiving long-term spinal infusion of tramadol.

OBJECTIVE: Intrathecal granuloma associated to the tip of subarachnoid catheters implanted in patients receiving long-term spinal infusion is a rare but potentially catastrophic complication. Its development seems to be related to the intrathecal administration of opioid drugs, although not all opioids induce granuloma formation with the same frequency. DESIGN: Morphine or hydromorphone-related granulomas have been reported extensively in the literature, but there are no data about any of the other opioids currently used in an off-label fashion when first-line drugs are contraindicated. SETTING AND PATIENTS: In this case, we report the first documented case of intrathecal granuloma formation in a patient receiving long-term spinal infusion of tramadol, and we put forward a hypothesis for its development. RESULTS AND CONCLUSIONS: Chronic intrathecal administration of high-dose tramadol could cause an inflammatory mass as it can be caused by similar, off-label infusions of morphine or hydromorphone. Additionally, tramadol stimulates the activity of natural killers and the proliferation of lymphocytes.

[Technical procedures for treating pain]. / Procedimientos técnicos en el tratamiento del dolor.

Nowadays, chronic pain treatment units are comprised by multidisciplinary work teams on which the contribution by each professional involved contributes to the team objective to handle and control pain. Out of all the forms of treatment and action plans developed for patients which deal with all the biological, psychological and social needs related to their experiences with chronic pain, in this article the authors concentrate exclusively on those technological and invasive procedures that are most frequently carried out by medical teams in chronic pain units. In this sense, nurses play an active participatory role in those procedures carried out, mainly in outpatient clinics where a patient is treated as an outpatient and nurses perform clinical services without the need of hospitalization.

Oral ketamine for the treatment of type I complex regional pain syndrome.

Ketamine has been shown to be effective in the treatment of neuropathic pain. We present a case of severe complex regional pain syndrome type 1 that was treated with oral ketamine. The response and tolerability of this preparation suggest that further study is warranted.

Subcutaneous and perineural botulinum toxin type a for neuropathic pain: a descriptive review.

OBJECTIVE: Botulinum toxin is a neurotoxin that has been widely used in chronic pain for the treatment of multiple conditions with a component of localized muscle spasm. Recent studies suggest that botulinum toxin is effective in the treatment of neuropathic pain syndromes such as postherpetic neuralgia or painful scars. METHODS: We searched the PubMed and OvidSP databases. We also included cross-referencing bibliographies from primary and review articles. DISCUSSION: In this descriptive review, we evaluate the usefulness, safety, and potential pathophysiological mechanism of botulinum toxin type A for treatment of painful disorders with neuropathic component such as postherpetic neuralgia, diabetic neuropathy, or trigeminal neuralgia. CONCLUSIONS: On the basis of the analysis of the reports published in the literature, it would seem that fractioned peripheral subcutaneous and perineural injections of botulinum toxin type A may be useful for the treatment of various chronic pain conditions with neuropathic component.

Can an intrathecal, catheter-tip-associated inflammatory mass reoccur?

OBJECTIVES: Intrathecal granuloma associated to the tip of catheters implanted in patients receiving long-term spinal infusion to alleviate chronic pain is a rare but potentially catastrophic complication. Its formation seems to be related to the intrathecal administration of opioid drugs, although not all opioids induce granuloma formation with the same frequency. METHODS: In this clinical report, we describe an intrathecal granuloma that reoccur twice in the same patient after its surgical removal. RESULTS AND DISCUSSION: This case report highlights the incomplete knowledge about the mechanism of granuloma formation and discuss the alternatives in the management of catheter-tip granulomas. This is the first case report of a patient in whom an intrathecal granuloma reoccurred twice after initial surgical removal. We also present and discuss a potential management strategy to avoid further surgery and resume intrathecal therapy early.

Estimulación medular como tratamiento de la neuralgia postherpética resistente a terapia convencional / Spinal cord stimulation as treatment for post-herpes neuralgia refractory to conventional therapy

No disponible

Procedimientos técnicos en el tratamiento del dolor / Technical procedures for treating pain

Actualmente las unidades de tratamiento de dolor crónico están constituidas por equipos multidisciplinares de trabajo, donde la acción de cada uno de los profesionales implicados contribuye finalmente al manejo y control del dolor. De todas las actividades desarrolladas con los pacientes atendiendo sus necesidades biopsicosociales implicadas en su experiencia de dolor, en el artículo se exponen, exclusivamente, los procedimientos tecnológicos e invasivos que con más frecuencia se realizan en las unidades de tratamiento de dolor. En este sentido la actividad enfermera tiene una participación activa en los procedimientos que se realizan, fundamentalmente en el hospital de día donde el paciente es tratado de forma ambulatoria(AU)

Nowadays, chronic pain treatment units are comprised by multidisciplinary work teams on which the contribution by each professional involved contributes to the team objective to handle and control pain. Out of all the forms of treatment and action plans developed for patients which deal with all the biological, psychological and social needs related to their experiences with chronic pain, in this article the authors concentrate exclusively on those technological and invasive procedures that are most frequently carried out by medical teams in chronic pain units. In this sense, nurses play an active participatory role in those procedures carried out, mainly in outpatient clinics where a patient is treated as an outpatient and nurses perform clinical services without the need of hospitalization(AU)

Mielitis transversa aguda: tratamiento del dolor / No disponible

No disponible