Pain Management Case Reports最新文献

{"title":"PARESTHESIA-FREE SPINAL CORD STIMULATION OF THE S1 SPINAL NERVE\u0000ROOT FOR REFRACTORY SURAL NEURALGIA: A CASE REPORT","authors":"Viet L Cai","doi":"10.36076/pmcr.2019/3/55","DOIUrl":"https://doi.org/10.36076/pmcr.2019/3/55","url":null,"abstract":"A 63-year-old man with a remote history of left ankle surgeries following traumatic injury, with resultant neuropathic pain secondary to sural nerve injury, was treated successfully with a left L5 DRG stimulator. He re-presents several years after a right Achilles tendon repair with resulting severe right posterolateral ankle pain. Based on the distribution of pain, a right sural nerve block was performed with > 75% relief of pain for 2 months. Cryoablations of the right sural nerve provided him with excellent pain relief for 5 months’ duration. For unclear reasons, the degree and duration of relief decreased with successive cryoablations. We then transitioned to right radiofrequency lesioning (pulsed RFL) L5 and S1 DRG with 90% relief of pain. During sensory stimulation, it was noted that the L5 DRG was discordant with his pain at the time of lesioning. For several years, the patient received serial S1 DRG RFLs, each with near complete relief lasting 4 to 8 months. Over this time period, the patient developed burning at the site of his implantable pulse generator (IPG) when the device was in the “on” mode only. The impression was that there was an electrical leak at the site where the lead inserts into the IPG. The decision was made to replace the existing IPG and add a lead over the S1 nerve root on the right, as close as possible to the DRG.","PeriodicalId":110696,"journal":{"name":"Pain Management Case Reports","volume":"19 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"127606008","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"SPINAL CORD STIMULATION IN BUERGER’S DISEASE – A CASE REPORT","authors":"O. Santos","doi":"10.36076/pmcr.2019/3/41","DOIUrl":"https://doi.org/10.36076/pmcr.2019/3/41","url":null,"abstract":"Buerger’s disease (BD) or thromboangeitis obliterants\u0000is a nonatherosclerotic segmental inflammation\u0000of the medium- and small-size arteries\u0000and vessels of the extremities. The pathogenesis\u0000of this process remains unclear. This disease is\u0000typically seen in male smokers under 45 years\u0000of age, and successful therapy is possible only\u0000with abstinence from tobacco. Methods to control\u0000ischemic pain include nonpharmacological and\u0000pharmacological options, such as prostanoids, or\u0000surgical intervention (sympathectomy or revascularization).\u0000This case report describes an unusual\u0000case of Buerger’s disease in a 60-year-old\u0000woman with a moderate smoking habit. Despite\u0000apparent tobacco abstinence and therapeutic\u0000optimization, there was no clinical improvement\u0000in this patient with pharmacological treatment.\u0000Attending to the imminent risk of amputation of\u0000her fingers, spinal cord stimulation (SCS) system\u0000implantation was the chosen therapeutic option.\u0000Transcutaneous oxygen pressure (TcPO2) was\u0000measured at different points in time after implantation\u0000and there was a significant increment of\u0000TcPO2 in both hands. In fact, the patient reported\u0000no pain after the first month of spinal stimulation;\u0000analgesics were progressively reduced and complete\u0000healing of ulcers was achieved. Furthermore,\u0000the patient reported a substantial improvement\u0000in her quality of life and total functional recovery\u0000in her hands mobilization after 6 months of treatment.\u0000The Brief Pain Inventory Scale and EuroQol-\u00005D scale were used to evaluate disease progression\u0000and its impact on quality of life. SCS system\u0000implantation is considered a safe procedure and\u0000cost-effective in the long term. The mechanisms\u0000behind these effects are still unknown, but SCS\u0000is a promising treatment option. More studies that\u0000include larger numbers of patients are needed.\u0000Key words: Buerger, tobacco, ischemia, amputation,\u0000electrical spinal cord stimulation, transcutaneous\u0000oxygen pressure","PeriodicalId":110696,"journal":{"name":"Pain Management Case Reports","volume":"13 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"125735615","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Adult Abdominal Migraine Presenting with Abdominal Myofascial\u0000Pain Syndrome: Case Report","authors":"Giraj G","doi":"10.36076/pmcr.2019/3/37","DOIUrl":"https://doi.org/10.36076/pmcr.2019/3/37","url":null,"abstract":"Background: Abdominal migraine in adults is\u0000poorly understood and often undiagnosed. It results\u0000in recurrent episodes of abdominal pain associated\u0000with nausea, vomiting, and retching. Abdominal\u0000myofascial pain syndrome is a common\u0000but unrecognized cause of chronic abdominal wall\u0000pain. Abdominal migraine can result in abdominal\u0000myofascial pain syndrome due to either trauma\u0000to the rectus abdominis muscle from excessive\u0000retching or due to viscerosomatic convergence\u0000from underlying esophageal-gastric inflammation.\u0000Objective: Our objective is to present a case\u0000report of undetected abdominal migraine in an\u0000adult patient presenting with abdominal myofascial\u0000pain syndrome and its diagnosis following\u0000successful management of abdominal myofascial\u0000pain syndrome.\u0000Study Design: This case report describes a patient\u0000presenting with 3 different types of abdominal\u0000pain to a pain medicine clinic.\u0000Setting: The patient was seen in a tertiary pain\u0000medicine clinic based in a university teaching\u0000hospital.\u0000Methods: This report describes the successful\u0000management of abdominal myofascial pain syndrome\u0000by trigger point treatment with depot steroids\u0000followed by pulsed radiofrequency treatment.\u0000Results: Successful management of abdominal\u0000myofascial pain syndrome resulted in subsequent\u0000diagnosis of abdominal migraine. There was\u0000improvement reported in pain intensity scores,\u0000quality of life, anxiety, and depression scores\u0000following the interventional management of abdominal\u0000myofascial pain syndrome as well as\u0000abdominal migraine.\u0000Limitations: This report represents a single\u0000patient presenting with a previously unreported\u0000combination of persistent abdominal pain.\u0000Conclusion: Abdominal migraine and abdominal\u0000myofascial pain syndrome are often unrecognized\u0000conditions that result in significant health care\u0000utilization. Undiagnosed abdominal migraine can\u0000result in abdominal myofascial pain syndrome and\u0000this can result in a delay in the correct diagnosis\u0000of abdominal migraine.\u0000Key words: Abdominal migraine, abdominal\u0000myofascial pain syndrome, chronic abdominal\u0000wall pain, trigger point treatment, viscerosomatic\u0000convergence","PeriodicalId":110696,"journal":{"name":"Pain Management Case Reports","volume":"43 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"115981332","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Management of Refractory Intracranial Hypotension Using\u0000Percutaneous Fibrin Sealant Patch – A Case Series and Review\u0000of the Literature","authors":"Kevin Wong","doi":"10.36076/pmcr.2018/3/13","DOIUrl":"https://doi.org/10.36076/pmcr.2018/3/13","url":null,"abstract":"Background: Intracranial hypotension (IH) among\u0000patients with persistent cerebrospinal fluid (CSF)\u0000leakage remains a challenging problem. The majority\u0000of these cases resolve spontaneously with\u0000conservative measures. The customary treatment\u0000for IH is epidural blood patch (EBP). In some\u0000cases, CSF leaks can persist for months or even\u0000years despite multiple trials of EBP. To date, there\u0000are only a limited number of published studies\u0000documenting the percutaneous injection of fibrin\u0000sealant for treatment of IH refractory to conservative\u0000measures and EBP.\u0000Objective: Our objective was to perform a literature\u0000review and retrospective case series regarding\u0000patients who underwent percutaneous injection of\u0000fibrin sealant for treatment of refractory IH at our\u0000institution.\u0000Study Design: This case series used a singlecentered\u0000retrospective observational study design\u0000and literature review.\u0000Setting: Patients in this case series were treated\u0000at a community-based tertiary care medical center.\u0000Methods: Five consecutive patients with the diagnosis\u0000of IH refractory to conservative measures\u0000and EBP who underwent percutaneous patching\u0000with fibrin sealant were identified at our institution\u0000between January 1, 2000 and January 1, 2016. A\u0000retrospective chart review was performed and data\u0000including demographics, characteristics, interventions,\u0000clinical outcomes, and complications were\u0000collected. A critical review of the current literature\u0000regarding the percutaneous use of fibrin sealant for\u0000treatment of IH was conducted.\u0000Results: Four of the 5 patients (80%) experienced\u0000no further symptoms of IH and no adverse events\u0000were noted. One patient (20%) ultimately required\u0000surgical duroplasty. Review of the current literature\u0000showed a total of 2 prospective case series,\u00004 retrospective case series, and 11 case reports.\u0000Our present case series and literature review demonstrated\u0000that fibrin sealants were well-tolerated by\u0000most patients and associated with low incidences\u0000of complications and recurrence.\u0000Limitations: This study is limited by the small retrospective\u0000case series of 5 patients.\u0000Conclusions: Percutaneous injection of fibrin sealant\u0000may be considered in refractory cases of IH\u0000when repeated trials of EBP have persistently failed.\u0000It appears to be a highly effective, safe, and easy-touse\u0000alternative therapy for patients with refractory IH\u0000in an ambulatory setting. Our review of the literature\u0000revealed only studies with low quality of evidence,\u0000including case series and case reports. There is a\u0000substantial need for high-quality studies and clinical\u0000evidence to corroborate the efficacy and safety of\u0000this percutaneous technique. However, this ideal is\u0000very challenging because of the relative rarity and\u0000heterogeneous etiologies of cases.\u0000Keywords: Fibrin sealant, intracranial hypotension,\u0000CSF leak, epidural blood patch, orthostatic\u0000headache, refractory, quality of life, percutaneous","PeriodicalId":110696,"journal":{"name":"Pain Management Case Reports","volume":"43 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"116283229","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Preoperative Surveillance Thoracic MRI for Thoracic Dorsal\u0000Column Stimulation: Case Series","authors":"A. Carayannopoulos","doi":"10.36076/pmcr.2019/3/1","DOIUrl":"https://doi.org/10.36076/pmcr.2019/3/1","url":null,"abstract":"Background: To date, there have been no\u0000guidelines, studies, or consensus statements\u0000regarding the use of advanced imaging studies\u0000as a preoperative screening tool prior to patients\u0000undergoing spinal cord stimulation (SCS).\u0000Objectives: The purpose of this case series is to\u0000highlight the importance of obtaining thoracic imaging\u0000studies as part of a thorough initial clinical\u0000assessment prior to percutaneously or surgically\u0000placing an SCS electrode.\u0000Methods: We undertook a 3-year retrospective\u0000review of patients undergoing evaluation for\u0000SCS therapy in an academic interventional pain\u0000management and neurosurgery practice. Patients\u0000with chronic neuropathic pain underwent a trial\u0000with percutaneous dorsal column stimulation,\u0000and if response to the trial was > 50% reduction\u0000in pain and improvement in function, the patient\u0000was implanted using either a percutaneous approach\u0000or placement of a paddle electrode with\u0000an internal pulse generator (IPG). All patients had\u0000advanced thoracic imaging performed (magnetic\u0000resonance imaging [MRI] if possible, or computed\u0000tomography [CT] if contraindicated) prior to percutaneous\u0000trial or paddle electrode implantation.\u0000Results: In 3 years, 88 patients underwent a trial\u0000of SCS, of which 75 patients (85%) were referred\u0000for implantation of a permanent percutaneous or\u0000paddle stimulator with IPG. Two patients (1.2%)\u0000treated by trial and implant were found to have\u0000a thoracic lesion on surveillance imaging, which\u0000contraindicated SCS implantation. One patient\u0000had thoracic imaging prior to undergoing the\u0000trial and one patient had thoracic surveillance\u0000imaging after the trial, but before surgical paddle\u0000placement.\u0000Limitations: The retrospective nature and lack of\u0000a control group in this case series are limitations\u0000of this study.\u0000Conclusion: This case series outlines the importance\u0000of considering advanced thoracic imaging\u0000studies for screening/surveillance purposes prior\u0000to SCS therapy. Placement of SCS electrodes\u0000in the thoracic epidural space without prior understanding\u0000of spinal anatomy potentially puts\u0000patients at unnecessary risk. In the cases presented,\u0000had patients undergone SCS trial and\u0000subsequent implant without screening imaging,\u0000thoracic lesions would have been missed, increasing\u0000the likelihood of diagnostic and therapeutic\u0000complications. Our incidental findings of lesions on\u0000MRI prior to SCS trial or implant support the use\u0000of a screening protocol for other centers providing\u0000thoracic SCS therapies.\u0000Key words: Thoracic, dorsal column stimulation,\u0000chronic pain, surveillance MRI, patient selection","PeriodicalId":110696,"journal":{"name":"Pain Management Case Reports","volume":"45 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"114212821","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Supraorbital Stimulation for the Treatment of Supraorbital\u0000Neuralgia: A Complication of Skin Erosion and Lead Extrusion","authors":"Dalia Elmofty","doi":"10.36076/pmcr.2018/2/235","DOIUrl":"https://doi.org/10.36076/pmcr.2018/2/235","url":null,"abstract":"","PeriodicalId":110696,"journal":{"name":"Pain Management Case Reports","volume":"6 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2018-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"125473067","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Quadratus Lumborum Block for Back Pain Related to Pancreatic\u0000Cancer – A Report of Two Cases","authors":"U. Hochberg","doi":"10.36076/pmcr.2018/2/197","DOIUrl":"https://doi.org/10.36076/pmcr.2018/2/197","url":null,"abstract":"Pancreatic cancer is often accompanied by\u0000severe pain. Patients typically experience upper\u0000abdominal and/or thoracolumbar back pain.\u0000For those cases failing to respond to standard\u0000medical management, as suggested by the World\u0000Health Organization, interventions designated at\u0000interruption of the sympathetic axis (such as neurolysis\u0000of the celiac plexus or splanchnic nerves)\u0000have been shown to be efficacious. Other than\u0000axial drug delivery, there are few interventional\u0000alternatives in patients with pancreatic cancerrelated\u0000pain.\u0000There is little knowledge regarding the therapeutic\u0000effects of treating peripheral somatic soft tissue\u0000among oncological patients. Here we report\u0000on 2 such patients, whose back pain improved\u0000following a quadratus lumborum block.\u0000Two patients diagnosed with pancreatic cancer\u0000presented with severe back pain. The pain pattern\u0000and patients’ physical exams were compatible\u0000with myofascial pain arising from the quadratus\u0000lumborum muscle, possibly irritated by the\u0000abdominal tumor. Advanced pain management,\u0000including long- and short-acting opioids and adjuvants,\u0000as well as celiac plexus neurolytic block,\u0000failed to provide satisfactory pain relief. Given the\u0000apparent muscular origin of the pain, a bilateral\u0000ultrasound-guided quadratus lumborum block\u0000was performed. Four weeks post procedure, the 2\u0000patients reported substantial pain relief supported\u0000by reduced consumption of pain medication and\u0000improved functional status. No adverse events or\u0000complications were observed in either case.\u0000In the patients described here, quadratus lumborum\u0000block proved to be safe and efficacious in\u0000alleviating back pain related to pancreatic cancer.\u0000In our opinion, clinicians should be aware of the\u0000possible contribution of a myofascial component\u0000to pain in pancreatic cancer and in cancer-related\u0000pain in general.\u0000Key words: Quadratus lumborum block, cancer\u0000pain, pancreatic cancer, pain control, myofascial\u0000pain syndrome, interventional pain management","PeriodicalId":110696,"journal":{"name":"Pain Management Case Reports","volume":"48 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2018-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"114692563","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Intra-Operative Complic atio n of Lumbar Kyphoplasty Instrumentatio n\u0000in Non-Osteoporotic Patients with Compression Fractures","authors":"Calvin R. Chen","doi":"10.36076/pmcr.2018/2/221","DOIUrl":"https://doi.org/10.36076/pmcr.2018/2/221","url":null,"abstract":"Background: Vertebral augmentation is a\u0000surgical procedure used to stabilize fractured\u0000vertebrae and reduce pain in patients with compression\u0000fractures. When intra-operative and\u0000post-operative complications do occur, they can\u0000have dire consequences. Some of the common\u0000risks associated with kyphoplasty are worsening\u0000of the fracture, infections, spinal cord compression,\u0000etc. Typically, we do not consider the risk\u0000of instrumentation failure.\u0000Objectives: In 2 cases, we describe patients\u0000who has undergone kyphoplasties with live\u0000fluoroscopic guidance. Both procedures used\u0000a unipedicular approach and the CareFusion\u0000system (Becton Dickinson, Franklin Lakes, NJ).\u0000The CareFusion AVAFlex curved augmentation\u0000needle was used, and intra-operatively the\u0000handle broke off at the neck making it difficult\u0000to remove the cannula and curved needle. To\u0000remove the system, an Arthrex Reamer (Arthrex\u0000Inc., Naples, NY).was used with Chuck Key (Arthrex\u0000Inc., Naples, NY).\u0000Study Design: Case report.\u0000Setting: Outpatient Interventional Pain Clinic.\u0000Methods: The vertebral body was accessed with\u0000an AVAFlex curved needle, a CareFusion AVAMax\u0000vertebral balloon, and Cement injection with\u0000polymethylmethacrylate, were used. The removal\u0000of the AVAFlex cannula was attempted with a gripping\u0000and pulling motion of the blue handle on the\u0000cannula, which resulted in the handle breaking at\u0000the most distal portion of the cannula. The cannula\u0000was then removed using the Arthrex Reamer with\u0000Chuck Key. The entire cannula was successfully\u0000removed from the vertebral body after cement had\u0000been delivered.\u0000Results: The density of bone tissue in a traumatic\u0000compression fracture of a nonosteoporotic individual\u0000will be higher and less porous when placing\u0000the needle and cannulas. Also, it is important to\u0000have an understanding of the different instruments\u0000that are available in the operative setting.\u0000Limitations: Small sample size.\u0000Conclusion: Instrumentation experience, understanding\u0000how to handle instrument failures, bone\u0000health of the patient, and the history of mechanism\u0000for compression fracture should all be considered\u0000when performing kyphoplasty.\u0000Key words: Kyphoplasty, vertebroplasty, compression\u0000fracture, instrumentation failure","PeriodicalId":110696,"journal":{"name":"Pain Management Case Reports","volume":"38 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2018-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"125616608","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cervicothoracic Epidural Blood Patch Provides Pain Relief after\u0000Failed Lumbar Epidural Blood Patch: A Case Report","authors":"Antepreet Dua","doi":"10.36076/pmcr.2018/2/205","DOIUrl":"https://doi.org/10.36076/pmcr.2018/2/205","url":null,"abstract":"Background: Spontaneous intracranial hypotension\u0000is an increasingly relevant cause of headaches\u0000as the breadth and depth of its diagnosis\u0000and management improves.\u0000Objectives: The objective of this case report is to\u0000describe a novel treatment for headaches caused\u0000by spontaneous intracranial hypotension without\u0000locating the cerebrospinal fluid (CSF) leak and to\u0000review the diagnostic and therapeutic options for\u0000spontaneous intracranial hypotension.\u0000Study Design: This is a report of a single case.\u0000Setting: The setting for this case report is a major\u0000academic center.\u0000Methods: After a review of the treatments and\u0000interventions that our patient had previously\u0000undergone, we decided to trial epidural blood\u0000patches for her chronic headaches.\u0000Results: Although the exact site of a CSF leak\u0000could not be identified despite exhaustive diagnostic\u0000interventions, cervicothoracic epidural\u0000blood patches provided excellent pain control for\u0000our patient’s severe headaches. The patient was\u0000completely free of headaches for 15 hours and\u0000reported well-controlled pain for approximately\u0000a month after her procedure as well as after 5\u0000subsequent monthly procedures.\u0000Limitations: As this is a report of a single case,\u0000more rigorous study in a larger patient population\u0000is needed to provide guidance.\u0000Conclusions: This case demonstrates that a\u0000nontargeted cervicothoracic epidural blood patch\u0000can be a treatment option for patients with spontaneous\u0000intracranial hypotension in which clinical\u0000suspicion is high despite nondiagnostic imaging.\u0000Key words: Spontaneous intracranial hypotension,\u0000cervicothoracic epidural blood patch,\u0000headache","PeriodicalId":110696,"journal":{"name":"Pain Management Case Reports","volume":"146 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2018-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"117046256","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Epidural Anesthesia to Effectively Manage Pain and Facilitate\u0000Rehabilitation in a Pediatric Case of Complex Regional Pain Syndrome","authors":"Goran Tubic","doi":"10.36076/pmcr.2018/2/209","DOIUrl":"https://doi.org/10.36076/pmcr.2018/2/209","url":null,"abstract":"There is a paucity of information related to treatment\u0000of pediatric CRPS. Treatment of CRPS\u0000in pediatric patients has been guided by adult\u0000recommendations, which consist of a multidisciplinary\u0000approach involving pharmacotherapy,\u0000physical therapy, and psychotherapy, as appropriate.\u0000Patients unable to tolerate physical therapy\u0000with traditional oral pharmacotherapy may require\u0000more invasive pain management techniques\u0000such as sympathetic blocks, epidural infusion of\u0000analgesics, or spinal cord stimulation to facilitate\u0000restoration of function.\u0000This case report describes the successful use\u0000of epidural infusion of fentanyl, clonidine, and\u0000bupivacaine through a tunneled epidural lumbar\u0000catheter for pain management in an 11-year-old\u0000girl who developed complex regional pain syndrome\u0000I (CRPS I) approximately 2 months after\u0000sustaining an injury to her right knee. Following\u0000short-lasting pain relief from 3 repeated blocks,\u0000she underwent an implant of a tunneled epidural\u0000catheter (TEC) and a 4-week infusion of fentanyl\u0000(2 mcg/mL), clonidine (1 mcg/mL), and bupivacaine\u0000(0.04%). At last follow-up, approximately\u00003.5 months after implant of the TEC, the patient’s\u0000pain and symptoms were completely resolved,\u0000her range of motion and function were completely\u0000restored, and her physical activity had returned to\u0000pre-injury levels.\u0000Key words: Complex regional pain syndrome\u0000(CRPS), tunneled epidural catheter, pediatric,\u0000continuous regional anesthesia, epidural analgesia,\u0000continuous epidural anesthesia, interventional\u0000pain management","PeriodicalId":110696,"journal":{"name":"Pain Management Case Reports","volume":"35 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2018-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"125802144","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}