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1.
BMJ Case Rep ; 14(10)2021 Oct 28.
Artigo em Inglês | MEDLINE | ID: mdl-34711627

RESUMO

A 36-year-old man with schizophrenia, on two times per day clozapine, presented with a 2-year history of diffuse intermittent body pain.Per chart review-and on presentation-his physical examination had been consistently unremarkable, without point-tenderness elicited at any major muscle groups or focal neurological deficits. Workup for myopathy, neuropathy and supratherapeutic clozapine levels had similarly been unrevealing.Given that prior interventions had been unsuccessful in alleviating these symptoms, we queried whether clozapine might have been contributory. As a result, we adopted a previously described strategy of scheduling the bulk of patients' medication during non-waking hours.At 1-month follow-up, the patient reported about a 50% improvement in his symptoms. At 6-month follow-up, this improvement in symptoms had been sustained.Our findings add to the limited anecdotal reports of this side effect whose true prevalence remains unknown. Timely recognition has the potential to promote adherence to therapy among patients in the maintenance phase.


Assuntos
Antipsicóticos , Clozapina , Dor Intratável , Esquizofrenia , Adulto , Antipsicóticos/efeitos adversos , Clozapina/efeitos adversos , Humanos , Masculino , Dor Intratável/tratamento farmacológico , Esquizofrenia/tratamento farmacológico
2.
Pain Physician ; 24(6): E761-E769, 2021 09.
Artigo em Inglês | MEDLINE | ID: mdl-34554694

RESUMO

BACKGROUND: While the efficacy of pulsed radiofrequency (PRF) for shoulder pain has been demonstrated, its efficacy on the saphenous nerves for knee osteoarthritis (OA)-associated pain has only been reported in observational studies. OBJECTIVES: The aim of this study was to compare saphenous nerve PRF to placebo for knee OA-associated pain. STUDY DESIGN: Patients, practitioners, and outcome assessor-blinded randomized placebo-controlled trial. SETTING: Pain management clinics at 2 hospitals in Japan. METHODS: Patients were randomly allocated to the PRF (n = 37) or placebo group (n = 33). Patients aged 40-85 years with refractory anteromedial knee pain. PRF in the saphenous nerve under ultrasound guidance. The placebo group underwent the same procedure, but with motor stimulation. The primary endpoint was the average pain intensity measured using the visual analog scale (VAS) at the 12-week post-treatment visit; secondary outcomes included the average VAS at 1 and 4 weeks, and pain intensities at rest, in flexion, at standing, and at walking. Other secondary outcomes were knee pain, symptoms, activities of daily living, knee-related quality of life, mobility, range of motion, and adverse events. RESULTS: In the PRF group, the mean VAS score was 52.41 ± 26.17 at 12 weeks, while in the sham group, the mean VAS score was 63.06 ± 27.12 (P < 0.05). There were no significant differences between the groups in any of the secondary outcomes. LIMITATIONS: Patients with comorbidities were excluded from this study. The follow-up time was limited to 12 weeks. CONCLUSIONS: Ultrasound-guided saphenous nerve PRF proved to be effective for at least 12 weeks in patients with knee OA and showed no adverse events.


Assuntos
Osteoartrite do Joelho , Dor Intratável , Tratamento por Radiofrequência Pulsada , Atividades Cotidianas , Método Duplo-Cego , Humanos , Osteoartrite do Joelho/terapia , Qualidade de Vida , Resultado do Tratamento , Ultrassonografia de Intervenção
3.
Pain Physician ; 24(6): 479-488, 2021 09.
Artigo em Inglês | MEDLINE | ID: mdl-34554696

RESUMO

BACKGROUND: Failed Back Surgery Syndrome (FBSS) causes disability and lowers health-related quality of life (HRQoL) for patients. Many patients become refractory to Conventional Medical Management (CMM) and Spinal Cord Stimulation (SCS) is advised. However, comparative effectiveness research of both clinical approaches still lacks further evidence. OBJECTIVES: This study describes Comparative Effectiveness Research of CMM versus SCS to provide real world evidence regarding the appropriate means for FBSS management, in terms of Patient-Reported Outcomes Measures. STUDY DESIGN: Naturalistic, pragmatic, prospective observational multicenter SEFUDOCE-study. SETTING: FBSS patients attending clinical programmed visits in Pain Unit at Hospital Universitario de La Princesa and at Hospital General Universitario de Alicante (Spain). METHODS: Study evaluates the impact on pain, functional limitation, and HRQoL of CMM versus SCS in the management of FBSS. Patients completed Pain Detect Questionnaire, Oswestry Disability Index, EQ-5D-3L, Medical Outcomes Study Sleep Scale, and Hospital Anxiety and Depression Scale at baseline and at 3, 6, 12, 18 and 24 months. Longitudinal data were analysed with repeated-measures one-way analysis of variance adjusting by confounders. RESULTS: Eighty-five adults patients with FBSS receiving treatment according to current clinical practice were assessed. After 24 months, the PainDETECT Questionnnaire showed that CMM patients maintained similar scores, while SCS patients reduced their overall score (current pain: 6 CMM versus 4.21 SCS, P = 0.0091; intensity strongest pain: 7.77 CMM versus 6.07 SCS, P = 0.0103; average pain: 6.46 CMM versus 4.75 SCS, P = 0.0012). For the Oswestry Disability Index, the Medical Outcomes Study Sleep Scale, and the Hospital Anxiety and Depression Scale no significant inter-group differences were found. EQ-5D utility improved in SCS patients from baseline (baseline: 0.32 CMM versus 0.22 SCS; 24-month: 0.37 CMM versus 0.63 SCS, P = 0.026). Twenty-four month follow-up showed unlikely presence of neuropathic pain and moderate disability in SCS patients, whereas the CMM patients maintained baseline health state. LIMITATIONS: Given the nature of the intervention, conducting a blinded study was not considered practically feasible. A larger sample could also overcome having younger patients in the SCS arm. CONCLUSIONS: SCS may improve the HRQoL and functionality of FBSS patients with refractory pain in the long-term compared to CMM alone.


Assuntos
Síndrome Pós-Laminectomia , Neuralgia , Dor Intratável , Estimulação da Medula Espinal , Adulto , Síndrome Pós-Laminectomia/terapia , Humanos , Qualidade de Vida , Medula Espinal , Resultado do Tratamento
4.
Int J Hyperthermia ; 38(2): 46-55, 2021 09.
Artigo em Inglês | MEDLINE | ID: mdl-34420438

RESUMO

OBJECTIVE: To elucidate the efficacy and safety of MRgFUS in the treatment for refractory pain derived from medial knee OA. METHODS: Twenty patients with medial knee OA eligible for total knee arthroplasty were included in this prospective, non-controlled study (UMIN000010193). MRgFUS treatment was provided at the site of most severe tenderness around the medial femorotibial joint of each patient under real-time monitoring of temperature. The goal temperature of the targeted bone surface was 55 °C. Numerical rating scale (NRS) worst pain scores, Western Ontario and McMaster Universities osteoarthritis index (WOMAC) scores, EuroQol 5 dimensions index (EQ-5D) scores and pressure pain threshold (PPT) were evaluated before treatment (baseline) and at 1 week and 1, 3, 6, and 12 months post-treatment, respectively. Complications and adverse events were also assessed clinically and radiographically. RESULTS: Treatment response (a 50% or greater decrease in NRS score) was seen in 14 patients (14/19, 73.7%) at 12 months post-treatment. Mean NRS score rapidly decreased at 1 month after treatment and continued to decline through the following 12 months. At final follow-up, mean NRS score was 3.2 ± 1.9, significantly lower than at baseline (p = 0.0013). Mean WOMAC and EQ-5D scores also improved significantly from 1 month after treatment. Fifteen patients showed significant sustained increases in PPTs at the sites of most severe tenderness. No serious adverse events were observed during and after treatment. CONCLUSIONS: MRgFUS treatments were effective not only for managing refractory pain, but also for improving physical functions without adverse events in elderly patients with medial knee OA.


Assuntos
Dor Crônica , Osteoartrite do Joelho , Dor Intratável , Idoso , Humanos , Espectroscopia de Ressonância Magnética , Osteoartrite do Joelho/diagnóstico por imagem , Osteoartrite do Joelho/cirurgia , Estudos Prospectivos
5.
6.
Rev Med Liege ; 76(7-8): 614-619, 2021 Jul.
Artigo em Francês | MEDLINE | ID: mdl-34357714

RESUMO

Intracerebroventricular (ICV) infusion of morphine is a well-known technique to relieve intractable neoplasic pain when conventional analgesic strategies reach their limits. Through this case report, we present indications, assets, and drawbacks of this procedure in such conditions. We also describe the adaptation of the systemic analgesic treatment to allow discharge from the hospital to home settings. Thanks to the ICV infusion of a mixture of morphine, bupivacaine and clonidine, the patient was weaned from oral opioid medications and reached an acceptable level of comfort. This allowed him to be discharged from the hospital to go back home with a specific setting of mobile palliative care structure. The patient's family followed training about the device to prevent any technical trouble and to react in case of unwanted events.


Assuntos
Clonidina , Dor Intratável , Analgésicos Opioides/uso terapêutico , Bupivacaína/uso terapêutico , Clonidina/uso terapêutico , Humanos , Infusões Intraventriculares , Masculino , Morfina/uso terapêutico , Dor Intratável/tratamento farmacológico , Dor Pós-Operatória , Cuidados Paliativos
7.
Medicine (Baltimore) ; 100(29): e26684, 2021 Jul 23.
Artigo em Inglês | MEDLINE | ID: mdl-34398039

RESUMO

RATIONALE: Chronic ulcerative colitis is an autoimmune disease in which epithelial injury continuously occurs in the colonic mucosa. While mesalazine (5-aminosalicylic acid) is used to treat ulcerative colitis, it can also cause liver failure, headaches, and abdominal pain; therefore, an alternative treatment is required. The purpose of this study was to evaluate the effectiveness of 80 stellate ganglion blocks in reducing pain and other symptoms in a patient with chronic ulcerative colitis. PATIENT CONCERNS: A 54-year-old female patient with a history of ulcerative colitis was concerned with worsening symptoms, such as abdominal discomfort and bloody-mucous stools, over the past 3 years. DIAGNOSES: Oozing mucosal bleeding and a small amount of exudate were observed on colonoscopy; a diagnosis of ulcerative colitis was made upon histologic examination. INTERVENTIONS AND OUTCOMES: A total of 80 stellate ganglion blocks were administered, after which the patient's symptom and pain level was decreased from 6 to 4 points on the numeric rating scale (11-point, 0 = no pain, 10 = worst pain imaginable). Improved clinical signs were observed on colonoscopy at a follow-up assessment. LESSONS: The stellate ganglion block may be effective for the reduction of pain and other symptoms in patients with chronic ulcerative colitis.


Assuntos
Bloqueio Nervoso Autônomo , Colite Ulcerativa , Dor Intratável/prevenção & controle , Gânglio Estrelado , Feminino , Humanos , Pessoa de Meia-Idade , Medição da Dor
8.
Am J Obstet Gynecol ; 225(5): 568.e1-568.e11, 2021 11.
Artigo em Inglês | MEDLINE | ID: mdl-34464585

RESUMO

BACKGROUND: Chronic pelvic pain is a debilitating problem that afflicts 15% to 20% of women in the United States. Although more than 200,000 hysterectomies are performed annually for the treatment of chronic pelvic pain, previous studies indicate that 1 in 4 women undergo the discomfort and morbidity of hysterectomy without the relief of pain. The factors that predict treatment failure remain poorly characterized. OBJECTIVE: To describe the incidence of persistent pelvic pain 6 months following hysterectomy in women with chronic pelvic pain and determine whether a simple, self-reported measure of central sensitization is associated with a greater risk of persistent pelvic pain following hysterectomy. STUDY DESIGN: We conducted a prospective, observational cohort study of women undergoing hysterectomy at an academic tertiary care center for a benign indication. Patients with preoperative chronic pelvic pain, defined as average pelvic pain ≥3 on a 0 to 10 numeric rating scale for >3 months before hysterectomy, were included in this analysis. The patients completed validated assessments of pain, anxiety, depression, and centralized pain (using the 2011 Fibromyalgia Survey Criteria, 0-31 points) preoperatively and 6 months after hysterectomy. The demographic information, surgical history, intraoperative findings, and surgical pathology were abstracted from the electronic medical records. Multivariate logistic regression was used to identify the independent predictors of persistent pelvic pain 6 months following hysterectomy, defined as <50% improvement in pelvic pain severity. RESULTS: Among 176 participants with pelvic pain before hysterectomy, 126 (71.6%) were retained at 6 months, and 15 (11.9%) reported persistent pelvic pain. There was no difference in age (P=.46), race (P=.55), average pain severity during menses (P=.68), average overall pelvic pain (P=.10), or pain duration (P=.80) in those with and without persistent pelvic pain. Whereas intraoperative findings of endometriosis (P=.05) and uterine fibroids (P=.03) were associated with a higher incidence of persistent pain on univariate analysis, the surgical route (P=.46), pelvic adhesions (0.51), uterine weight (P=.66), and adenomyosis on histopathology (P=.27) were not related to the risk of persistent pain. Higher preoperative centralized pain scores (P=.01) but not depression (P=.64) or anxiety (P=.45) were more common in women with persistent pelvic pain. Multivariate logistic regression adjusting for age, preoperative pain severity, anxiety, depression, and operative findings of endometriosis and fibroids indicated that every 1-point increase in centralized pain before hysterectomy was associated with a 27% increase in the odds of persistent pelvic pain (odds ratio, 1.27; 95% confidence interval, 1.03-1.57) 6 months after surgery. CONCLUSION: Although the majority of women with chronic pelvic pain report considerable improvement in pain following hysterectomy, higher degrees of centralized pain before hysterectomy is a robust predictor of persistent pelvic pain.


Assuntos
Dor Crônica/cirurgia , Histerectomia , Dor Intratável/epidemiologia , Dor Pélvica/cirurgia , Adulto , Ansiedade/complicações , Dor Crônica/epidemiologia , Estudos de Coortes , Feminino , Humanos , Incidência , Pessoa de Meia-Idade , Medição da Dor , Dor Pélvica/epidemiologia , Período Pós-Operatório
9.
Neuromodulation ; 24(6): 1115-1120, 2021 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-34313358

RESUMO

INTRODUCTION: Subcutaneous trigeminal nerve field stimulation (sTNFS) is a neuromodulatory treatment for neuropathic trigeminal pain with the ability to reduce the intensity and frequency of pain attacks. However, hardware issues including lead migration, skin erosion, infection, so-called pocket pain at the site of the implanted neurostimulator are reported. Implantable wireless neurostimulation technology promises not only an even less invasive sTNFS treatment and thinner and more flexible electrodes better suited for facial implants, but also provides further advantages such as lack of an implantable neurostimulator and 3T magnetic resonance imaging compatibility. MATERIAL AND METHODS: All patients who had received trial stimulation with a partially implantable sTNFS system were analyzed for ICHD-3 (3rd edition of the International Classification of Headache Disorders) diagnosis, success of trial stimulation, pre- and postoperative pain intensity, frequency of attacks, complications, and side-effects of sTNFS. RESULTS: All patients (N = 3) responded to sTNFS (≥50% pain reduction) during the trial period. According to ICHD-3, N = 2 of the patients were classified with trigeminal neuralgia (TN) with concomitant persistent facial pain and N = 1 patient with multiple sclerosis associated TN. The time of the test period was 44 ± 31.24 days (mean ± SD). The average daily duration of stimulation per patient amounted 2.5 ± 2.2 hours (range 1-5). The pain intensity (defined on a visual analog scale) was reduced by 80% ± 17% (mean ± SD). Reduction or cessation in pain medication was observed in all patients. No surgical complications occurred in the long-term follow-up period of 18.84 ± 6 (mean ± SD) months. CONCLUSION: The partially implantable sTNFS device seems to be safe, effective, and reliable. Compared to conventional devices, the equipment is not limited to the length of trial stimulation. Furthermore, the daily stimulation duration was much shorter compared to previous reports.


Assuntos
Terapia por Estimulação Elétrica , Dor Intratável , Terapia por Estimulação Elétrica/efeitos adversos , Eletrodos Implantados , Humanos , Dor Intratável/terapia , Resultado do Tratamento , Nervo Trigêmeo
10.
J Pain Palliat Care Pharmacother ; 35(3): 167-174, 2021 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-34264774

RESUMO

End of life (EoL) and refractory symptom management is a growing clinical topic and there is minimal literature to support effective treatment strategies, especially in individuals with a substance use disorder or opioids and/or benzodiazepine tolerance. We report the successful use of phenobarbital for proportionate EoL sedation in a 57-year-old man with opioid use disorder (heroin) and metastatic urothelial carcinoma presenting to an acute care hospital with intractable back pain related to bone metastases. During his hospitalization, his daily opioid requirement exceeded 1 gram of morphine equivalent daily dose (MEDD) with suboptimal pain control. The patient's clinical course was complicated by active heroin withdrawal, psychosocial suffering, and disease progression. Despite use of high-dose opioids and benzodiazepines, pain and anxiety were poorly controlled. After an acute medical decompensation, a goals of care discussion was held with his family and a determination with informed consent was made to change patient status to do not attempt resuscitation and proportionate sedation with phenobarbital was initiated to target refractory pain and agitation. Phenobarbital was continued for approximately 15 hours before patient peacefully died. Findings from this case report demonstrate the successful use of phenobarbital in opioid use disorder and benzodiazepine tolerance with intractable pain.


Assuntos
Carcinoma de Células de Transição , Dor Intratável , Neoplasias da Bexiga Urinária , Analgésicos Opioides , Morte , Humanos , Masculino , Pessoa de Meia-Idade , Dor Intratável/tratamento farmacológico , Dor Intratável/etiologia , Fenobarbital
11.
Acta Neurochir Suppl ; 128: 133-144, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34191070

RESUMO

Surgical or chemical hypophysectomy has historically shown good effectiveness in management of intractable pain but has often been accompanied by serious complications. In contrast, high-dose irradiation of the pituitary gland and stalk provides comparable analgesic effects and is associated with minimal morbidity. Although its physiological mechanism remains elusive, pituitary radiosurgery using the Gamma Knife has demonstrated high clinical efficacy and safety in cases of both cancer pain and noncancer pain. According to the available data, this treatment provides at least a temporary analgesic effect in >80% of patients, usually within hours to days after the procedure. Although the pain relief is most prominent and durable in cases of metastatic bone disease, it is not limited to that pathological condition or to cases of hormone-dependent cancers. Nevertheless, the low-quality studies reported to date cannot support any meaningful clinical recommendations on use of pituitary radiosurgery. Therefore, additional well-elaborated clinical and basic investigations, preferably performed in a multi-institutional and prospective fashion, are clearly needed and may bolster further developments of this highly promising treatment modality.


Assuntos
Dor Intratável , Radiocirurgia , Feminino , Humanos , Dor Intratável/cirurgia , Hipófise , Estudos Prospectivos , Tóquio , Resultado do Tratamento , Universidades
12.
Rev Esp Anestesiol Reanim (Engl Ed) ; 68(5): 293-296, 2021 05.
Artigo em Inglês | MEDLINE | ID: mdl-34140126

RESUMO

Erythromelalgia (EM) is a rare autosomal dominant neuropathy characterized by the combination of severe burning pain and erythematous warm extremities. Chronic pain control is most often unsuccessful and a completely effective therapy is yet to be identified. Recent studies have reported significant improvements in pain management using a combination of amitriptyline and ketamine in a topical formulation. We describe a 1-year follow-up pain control success case of a male patient with EM, proposed for topical use of a 2% Amitriptyline and 0.5% Ketamine gel.


Assuntos
Eritromelalgia , Ketamina , Dor Intratável , Amitriptilina/uso terapêutico , Analgésicos/uso terapêutico , Combinação de Medicamentos , Eritromelalgia/tratamento farmacológico , Humanos , Ketamina/uso terapêutico , Masculino , Manejo da Dor
13.
Support Care Cancer ; 29(12): 7611-7616, 2021 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-34131845

RESUMO

PURPOSE: Morphine infusion through Intrathecal Drug Delivery System (IDDS) is widely used to relieve refractory cancer pain. However, continuous escalation of morphine dose caused by opioid tolerance and/or progress of cancer was commonly observed. Combining morphine with medications of different analgesic mechanisms is applied to blunt the rate of morphine increase. The purpose of this study was to determine the analgesic efficacy and safety of combining gabapentin with morphine after IDDS implantation. METHODS: This study compared patients that received IDDS implantation from January 1, 2017 to November 10, 2018 in our institute. Key outcomes included change in mean pain score, dose of morphine used in patients, percentage of patients with 30% and 50% reduction in mean pain score, Patient Global Impression of Change scores, breakthrough pain characters and side effects. RESULTS: 34 patients in the combination group (morphine + gabapentin) and 40 patients in the monotherapy group(morphine)were analyzed. The results showed that both therapy groups achieved similar analgesic efficacy, demonstrated by Numerical rating scale (2.42 ± 0.88 vs 2.57 ± 0.85; Combination vs Monotherapy), PGIC and responder status. Mean daily dose of morphine was significantly lower in combination group compared to monotherapy group (3.54 ± 1.29 mg vs 4.64 ± 1.28 mg, P = 0.007). More patients experienced dizziness and somnolence after receiving combination therapy compared to morphine-alone treatment although no statistical significance was found (P = 0.49). CONCLUSION: Addition of gabapentin achieved similar analgesic efficacy with lower dose of morphine compared to morphine alone accompanying with higher incidence of dizziness and somnolence.


Assuntos
Dor do Câncer , Gabapentina , Morfina , Dor Intratável , Analgésicos , Analgésicos Opioides , Dor do Câncer/tratamento farmacológico , Tolerância a Medicamentos , Gabapentina/efeitos adversos , Gabapentina/uso terapêutico , Humanos , Morfina/efeitos adversos , Morfina/uso terapêutico , Neoplasias/complicações
14.
World Neurosurg ; 151: 225-234.e6, 2021 07.
Artigo em Inglês | MEDLINE | ID: mdl-33905910

RESUMO

Pain is a common occurrence in patients with cancer, which, in some cases, is not adequately controlled with medical analgesia. Thalamotomy is a treatment option in such circumstances, but synthesis of historical evidence and thalamic stratified data are lacking. We therefore sought to systematically review evidence supporting radiofrequency thalamotomy for intractable cancer pain. This review was performed using multiple electronic databases and a (PICO) patient/problem, intervention, comparison, outcome search with the terms "radiofrequency thalamotomy" and "cancer pain." Of 22 full-text studies assessed for eligibility, 14 were included for review. Articles were excluded in which radiofrequency ablation was not used, chronic implantation was used, or the study did not include patients with cancer pain. Thirteen case series and 1 case report were included. Thalamic targets included ventral posterior, central lateral, dorsomedial, centromedian, centromedian/parafascicular, centromedian and anterior pulvinar, pulvinar, limitans, suprageniculate and posterior nuclei. Patient characteristics, operative methods, lesioning parameters, patient follow-up, and outcomes were variably reported across the studies. Where relevant outcome data were available, 97% of patients experienced initial pain relief and 79% experienced significant lasting relief. Adverse events were typically transient. We conclude that radiofrequency thalamotomy for cancer pain is well tolerated and can produce significant relief from intractable cancer pain. No superiority of thalamic target could be determined.


Assuntos
Dor do Câncer/cirurgia , Neoplasias/cirurgia , Dor Intratável/cirurgia , Radiocirurgia , Humanos , Imageamento Tridimensional/métodos , Psicocirurgia/métodos , Radiocirurgia/métodos
15.
BMC Neurol ; 21(1): 147, 2021 Apr 05.
Artigo em Inglês | MEDLINE | ID: mdl-33820539

RESUMO

BACKGROUND: Until recently, it is generally considered safe to perform magnetic resonance imaging (MRI) in patients with an intrathecal drug administration system (ITDAS) device. In this study, we presented a case of morphine overdose due to ITDAS malfunction during MRI evaluation for the diagnosis of stroke. CASE PRESENTATION: A 58-year-old woman was referred to the emergency department for left-sided hemiparesis and dysarthria. She had undergone ITDAS implantation 4 years ago because of intractable back pain. Her brain MRI examination did not show any abnormalities except an old hemorrhagic infarction in the right basal ganglia. After MRI was performed, her symptoms completely resolved. Approximately 3 h after the MRI scan, the patient showed progressive stuporous consciousness and decreased respiration with decreased peripheral oxygen saturation of 80%. Initial arterial blood gas analysis revealed respiratory acidosis with hypoxia and hypercapnia. We suspected the opioid overdose for her unconciousness, small and sluggish pupils, and slow respiration. The patient regained consciousness within 3 min after the administration of naloxone with severe anxiety and irritability, without any respiratory symptoms or focal neurological deficits. In the pump interrogation and actual reservoir checks performed 6 h after the MRI scan, there was no significant difference between the expected reservoir volume and actual reservoir volume. Follow-up MRI performed to rule out posterior circulation infarction showed no structural lesions. The patient was eventually discharged without further neurologic or functional deterioration, with diagnosis of transient ischemia attack for initial symptoms of focal neurologic deficits. CONCLUSION: Although both ex vivo and in vivo studies have provided evidence that ITDAS devices are MRI-compatible, the pump is made of titanium and has ferromagnetic components. Since misdiagnosis of overinfusion could lead to mortality, early awareness of overinfusion of the intrathecal drug is needed to all clinicians in case of performing MRI in ITDAS implanted patients.


Assuntos
Morfina/efeitos adversos , Naloxona/administração & dosagem , Acidente Vascular Cerebral/diagnóstico , Feminino , Humanos , Imageamento por Ressonância Magnética , Pessoa de Meia-Idade , Morfina/administração & dosagem , Dor Intratável/tratamento farmacológico
16.
Dermatol Online J ; 27(3)2021 Mar 15.
Artigo em Inglês | MEDLINE | ID: mdl-33865284

RESUMO

Report _Case Presentation X Photo Vignette _Letter Authors declare that the contents of this article are their own original unpublished findings. Title: Cutaneous calciphylaxis of the glans penis presenting as a gangrenous ulceration Authors: Marie Danset, Cécile Lesort, Denis Jullien, Jean Kanitakis Affiliations: Dermatology Department, Edouard Herriot Hospital, Hospices Civils de Lyon, Claude Bernard Lyon I University, Lyon, France Corresponding Author: Jean Kanitakis, Department of Dermatology, Edouard Herriot Hospital Group, 69437 Lyon Cedex 03, France, Tel: 33-472110301, Email: jean.kanitakis@univ-lyon1.fr Abstract: Calciphylaxis is a rare microvascular disorder causing necrotic skin ulcers. It is characterized by deposits of calcium within vascular walls but its precise pathogenesis remains poorly understood. A major risk factor is end-stage renal disease on dialysis. We report a 67-year-old man with calciphylaxis revealed by an unusual necrotic ulcer of the glans penis. The patient also presented with bilateral panniculitis of the thighs and a calf ulcer. All those lesions were painful, highlighting the value of pain as a diagnostic clue. Penile involvement of calciphylaxis is rare and biopsy is often avoided in this area. However, rapid diagnosis of calciphylaxis is important because early treatment has a better chance of being successful. Our patient's condition deteriorated rapidly with development of bilateral retinal artery occlusion and he died shortly thereafter. This case further highlights the fact that calciphylaxis is a systemic vascular disease with an ominous prognosis.


Assuntos
Calciofilaxia/patologia , Doenças do Pênis/patologia , Pênis/patologia , Idoso , Calciofilaxia/complicações , Evolução Fatal , Gangrena/etiologia , Gangrena/patologia , Humanos , Masculino , Dor Intratável/etiologia , Doenças do Pênis/complicações , Oclusão da Artéria Retiniana/etiologia , Sepse/etiologia , Úlcera Cutânea/etiologia , Úlcera Cutânea/patologia
17.
A A Pract ; 15(3): e01416, 2021 Mar 08.
Artigo em Inglês | MEDLINE | ID: mdl-33684093

RESUMO

A 78-year-old man with uncontrolled diabetes, heart failure, and hemodialysis-dependent end-stage renal disease presented with intractable penile pain secondary to calciphylaxis and necrosis of his glans penis. Given pain refractory to pharmacologic management and refusal of surgery, treatment entailed an ultrasound-guided dorsal penile nerve block with 5 mL of aqueous 4% phenol bilaterally. The patient reported immediate relief and died pain-free 3 months later. While phenol nerve blocks are increasingly uncommon due to local tissue toxicity, the precision of ultrasound leverages phenol's denaturing and axonal demyelinating properties to facilitate long-term targeted neurolysis to palliate chronic nonmalignant pain.


Assuntos
Calciofilaxia , Bloqueio Nervoso , Dor Intratável , Idoso , Calciofilaxia/tratamento farmacológico , Humanos , Masculino , Pênis/diagnóstico por imagem , Fenol , Ultrassonografia de Intervenção
19.
Curr Sports Med Rep ; 20(3): 164-168, 2021 Mar 01.
Artigo em Inglês | MEDLINE | ID: mdl-33655998

RESUMO

ABSTRACT: Slipping rib syndrome is pain created at the lower, anterior border of the rib cage when performing upper-extremity activities, coughing, laughing, or leaning over. Defects in the costal cartilage of ribs 8 to 10 result in increased movement of the ribs, impinging soft tissue and intercostal nerves. Advancements have been made in the diagnosis of slipping rib syndrome by dynamic ultrasound. Ultrasound can identify abnormalities in the rib and cartilage anatomy, as well as soft tissue swelling. Although the mainstays of treatment continue to be reassurance, nonsteroidal anti-inflammatory drugs, physical therapy, intercostal nerve injections, osteopathic manipulative treatment, surgery for refractory pain, and botulinum toxin injections have been attempted, and there may be a role for prolotherapy in treatment. Surgical techniques are being examined secondary to recurrence of pain following resection. The hooking maneuver and surgery remain important for identification and treatment, respectively.


Assuntos
Costelas/diagnóstico por imagem , Costelas/fisiopatologia , Doenças Torácicas/diagnóstico por imagem , Dor no Peito/diagnóstico por imagem , Dor no Peito/etiologia , Dor no Peito/cirurgia , Dor no Peito/terapia , Tratamento Conservador , Humanos , Dor Intratável/diagnóstico por imagem , Dor Intratável/etiologia , Dor Intratável/cirurgia , Dor Intratável/terapia , Recidiva , Síndrome , Doenças Torácicas/etiologia , Doenças Torácicas/terapia , Ultrassonografia
20.
F1000Res ; 10: 42, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33732434

RESUMO

Background:  Cancer is the second leading cause of death globally. Up to 86% of advanced cancer patients experience significant pain, while 10-20% live in chronic pain. Besides, increasing prescription of opioids resulted in 33,000 deaths in the US in 2015. Both reduce patients' functional status and quality of life. While cancer survival rates are increasing, therapeutic options for chronic opioid refractory pain are still limited. Esketamine is the s-enantiomer of ketamine, with superior analgesic effect and less psychotomimetic side effects. Intranasal esketamine was approved by the FDA for treatment-resistant depression. However, its use in chronic cancer pain has never been tested. Therefore, we propose a phase II, randomized, placebo-controlled trial to evaluate the efficacy and safety of intranasal esketamine in chronic opioid refractory cancer pain. Methods and analysis: We will recruit 120 subjects with chronic opioid refractory pain, defined as pain lasting more than 3 months despite optimal therapy with high dose opioids (>60 mg morphine equivalent dose/day) and optimal adjuvant therapy. Subjects will be randomized into two groups: intranasal esketamine (56mg) and placebo. Treatment will be administered twice a week for four consecutive weeks. The primary outcome is defined as reduction in the Numeric Pain Rating Scale (NPRS) after first application. Secondary outcomes include NPRS reduction after four weeks, the number of daily morphine rescue doses, functional status and satisfaction, and depression. Conclusion: This study may extend therapeutic options in patients with chronic pain, thus improving their quality of life and reducing opioid use. Trial registration: Clinical Trials.gov, NCT04666623. Registered on 14 December 2020.


Assuntos
Dor Crônica , Ketamina , Dor Intratável , Analgésicos Opioides/uso terapêutico , Dor Crônica/tratamento farmacológico , Método Duplo-Cego , Humanos , Ketamina/uso terapêutico , Qualidade de Vida , Resultado do Tratamento
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