Pain medicine case reports最新文献

{"title":"Epidural Hematoma in an Elderly Patient With Multiple Comorbidities on Aspirin Following Spinal Cord Stimulator Trial: A Case Report.","authors":"Samer Hajmurad, Karim Jandali Rifai, Adryan Alexander Perez, Andrew Hall","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Background: </strong>Spinal cord stimulators (SCSs) are generally a safe and effective treatment for chronic pain conditions. Spinal epidural hematomas (SEHs) after SCS placement or removal, while rare, can be devastating. Aspirin use is not contraindicated in patients undergoing SCS procedures, but it increases bleeding risk. The American Society of Regional Anesthesia and Pain Medicine (ASRA) states that physicians must weigh the risks and benefits of aspirin use in each patient undergoing high-risk procedures, such as SCS trials. Thus, aspirin use, in conjunction with other risk factors for bleeding, must be recognized and assessed before neuraxial procedures.</p><p><strong>Case report: </strong>An 80-year-old woman who developed an SEH with neurological deficits after an SCS trial. Adding to the increased risk of bleeding due to her comorbidities, the patient did not disclose aspirin use. She therefore went for emergent neurosurgical intervention for the removal of SCS leads and epidural hematoma evacuation. Postoperatively, the patient regained bilateral lower extremity strength but remained with a mild deficit in sensation to light touch.</p><p><strong>Conclusions: </strong>Aspirin use, in conjunction with other risk factors associated with platelet dysfunction, can put patients at high risk for the development of epidural hematomas after neuraxial procedures, such as SCS trials. Physicians must continue to adhere to the ASRA guidelines.</p>","PeriodicalId":520525,"journal":{"name":"Pain medicine case reports","volume":"9 3","pages":"161-164"},"PeriodicalIF":0.0,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144556456","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":"Thoracic Spinal Cord Compression Precipitated by Epidural Steroid Injection Due to Undiagnosed Dural Arteriovenous Fistula - A Case Report.","authors":"Stephen N Dunay, John Wainwright, Ammar Siddiqui, Gurmeen Kaur","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Background: </strong>Spinal dural arteriovenous fistula is an abnormal connection between the arteries and veins surrounding the spinal cord. Symptoms may be vague contributing to its diagnostic difficulty. In some cases, patients may develop lower extremity weakness or sensory deficits, back or leg pain, and bowel or bladder dysfunction.</p><p><strong>Case report: </strong>We present a case of a female patient with chronic back pain who underwent routine and elective interlaminar epidural steroid injection and developed symptoms of thoracic cord compression due to a thoracic dural arteriovenous fistula that had not been previously identified on imaging.</p><p><strong>Conclusions: </strong>Our case emphasizes the importance of early recognition of symptoms of acute cord compression, as well as close review of magnetic resonance imaging in order to identify subtle changes that may indicate a rare anatomical anomaly that can cause significant disability.</p>","PeriodicalId":520525,"journal":{"name":"Pain medicine case reports","volume":"9 3","pages":"165-168"},"PeriodicalIF":0.0,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144556467","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":"Interventional Management of Facial Pain: A Retrospective Case Series.","authors":"Ramya Lakkaraju, Jason E Crowther, Pascal Scemama","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Background: </strong>Chronic facial pain is initially managed with conservative measures and medications but can also be treated with interventional procedures in refractory cases.</p><p><strong>Case report: </strong>We report a case series of 20 patients with atypical trigeminal neuralgia who had inadequate pain relief with medical management. Patients presented with pain in various distributions of the trigeminal nerve, with 75% having unilateral pain and 25% having bilateral pain. Approximately half (n = 9) of patients reported inciting events, including postsurgical, traumatic, or postinfectious etiologies; whereas, the remaining (n = 11) had no identifiable inciting etiology. Patients underwent infraorbital, supraorbital, supratrochlear, zygomaticotemporal, or trigeminal nerve blocks (NBs), based on pain distribution.</p><p><strong>Conclusions: </strong>Although patients varied on the amount of efficacy and length of response, on average, patients experienced an 80% improvement of their pain over a 3-month period. The findings suggest that interventional techniques, such as ultrasound-guided NBs, are an option for providing significant pain relief for patients with facial pain who are not adequately managed with medication or amenable to surgery, but they may require relatively frequent repeating of these procedures.</p>","PeriodicalId":520525,"journal":{"name":"Pain medicine case reports","volume":"9 3","pages":"179-182"},"PeriodicalIF":0.0,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144556457","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":"Penile Pain With Allodynia Following Spinal Cord Stimulation (SCS) Implant: A Case Report.","authors":"Laxmaiah Manchikanti, Mahendra Sanapati, Joshua A Hirsch","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Background: </strong>Spinal cord stimulation (SCS) is commonly utilized for managing chronic intractable pain associated with spinal conditions, complex regional pain syndrome (CRPS), neuropathic pain, and peripheral neuropathy. Although rare, complications such as dermatologic reactions and lead-related allergies have been reported. However, penile pain with allodynia has not been previously documented. We present a unique case of penile pain with allodynia following successful SCS implantation and initial pain relief.</p><p><strong>Case report: </strong>A 53-year-old man underwent implantation of a Boston Scientific spinal cord stimulator with leads positioned at the T8 level, covering the T9-T10 interspace. This followed a successful trial that resulted in 70% pain relief and functional improvement for chronic low back and lower extremity pain due to post-laminectomy syndrome. Following the permanent implant, the patient experienced approximately 40% relief over two months. Subsequently, the stimulator stopped providing effective relief, and he reported ongoing low back pain along with the new onset of penile pain. Despite multiple reprogramming attempts, he developed significant anxiety over his symptoms. Dermatological and urological evaluations were unremarkable. Pharmacologic interventions, including Gabapentin and Pregabalin, were ineffective. He also trialed THC and opioids without relief. The penile pain persisted regardless of whether the stimulator was active. After comprehensive discussions and shared decision-making, the stimulator was explanted. Post-surgery, the patient recovered well, and his penile discomfort resolved immediately.</p><p><strong>Conclusion: </strong>SCS can potentially lead to rare complications such as penile discomfort. In such cases, explantation of the device may be the only effective resolution.</p>","PeriodicalId":520525,"journal":{"name":"Pain medicine case reports","volume":"9 3","pages":"157-160"},"PeriodicalIF":0.0,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144556458","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":"A Case of Transverse Myelitis With an Intrathecal Pump: A Case Report.","authors":"Jimmy Wen, Shannon Dwyer, Burhaan Syed, Sugamjot Badhan, Ramy Khalil, Foad Elahi","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Background: </strong>Intrathecal pumps (ITP) are an effective tool for patients with intractable pain. We report a rare case of transverse myelitis as a late complication of ITP placement.</p><p><strong>Case report: </strong>A 60-year-old female patient reported bilateral progressive lower extremity weakness and loss of sensation 1.5 years postimplant of an ITP. She became unable to ambulate and developed urinary incontinence. Magnetic resonance imaging found hyperintense signaling from T6 to mid-T9 level. Lumbar puncture showed an elevated white blood cell count with lymphocyte predominance. The patient was given high-dose corticosteroids and plasmapheresis without improvement in symptoms. Following this treatment, the ITP was removed without complications and was sent for culture. Culture was positive for Parvimonas micra and treated with intravenous ampicillin/sulbactam. The patient was transferred to a tertiary medical center for further treatment.</p><p><strong>Conclusions: </strong>This case calls for early and prompt diagnosis and management of postimplant complications of an ITP.</p>","PeriodicalId":520525,"journal":{"name":"Pain medicine case reports","volume":"9 3","pages":"175-178"},"PeriodicalIF":0.0,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144556454","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":"Prospective Case Series Evaluating the Efficacy of Radiofrequency Ablation With Stryker Venom Technology in the Treatment of Lumbar Facet Joint Pain.","authors":"Emily A Panteli, Aaron K Calodney","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Background: </strong>Lumbar facet joint (FJ) arthropathy is a common source of low back pain (LBP). This study assesses the efficacy of radiofrequency ablation (RFA) using Stryker's MultiGen 2 RF Generator combined with the Venom 18G cannula and electrode system for treating FJ-mediated LBP.</p><p><strong>Case report: </strong>In this prospective, single-center case series, patients obtaining ≥ 80% improvement in pain after 2 medial branch blocks underwent RFA. Follow-ups were 1-, 3-, 6-, and 12-month post-RFA. Outcomes were the Visual Analog Scale (VAS), Oswestry Disability Index (ODI), Roland-Morris Disability Questionnaire (RMDQ), medications consumed, and adverse events (AEs). Nineteen patients were treated with RFA. Mean VAS, ODI, and RMDQ scores significantly decreased one-month postprocedure, and improvements were sustained to 12 months post-RFA. Patients' analgesic consumption remained stable. No procedure- or device-related AEs occurred.</p><p><strong>Conclusions: </strong>This study highlights the effectiveness of RFA for treating FJ-mediated LBP. Significant improvements were observed rapidly and were sustained for the entire study.</p>","PeriodicalId":520525,"journal":{"name":"Pain medicine case reports","volume":"9 3","pages":"169-174"},"PeriodicalIF":0.0,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144556459","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":"Cervical Spinal Cord Stimulator Malfunction Secondary to Lead Fracture.","authors":"Laxmaiah Manchikanti, Mahendra Sanapati, Joshua A Hirsch","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Background: </strong>Spinal cord stimulation (SCS) is commonly used in the cervical spine to manage chronic intractable pain. However, complications can include lead displacement, lead migration, and lead fracture. CASE REPORT 1: The first case is of a 67-year-old woman who underwent spinal cord stimulator implantation in 2009 for the treatment of complex regional pain syndrome (CRPS). The device used was a Medtronic Restore system with an Octad 1×8 single lead array, and the battery was replaced in 2021. In December 2023, the patient began experiencing new-onset symptoms including dizziness, headaches, and balance disturbances. Due to these emerging neurological symptoms and the necessity for magnetic resonance imaging (MRI), the SCS system was explanted. CASE REPORT 2: The second case is of a 78-year-old woman who underwent spinal cord stimulator implantation in 2011 for the treatment of CRPS. The system used was a Medtronic RestoreUltra with an Octad 1×8 dual lead array. In 2020, the battery was replaced with a Medtronic Intellis pulse generator due to end-of-life. In 2021, following a motor vehicle accident, the patient began experiencing electric shock-like sensations whenever the spinal cord stimulator was activated. A system interrogation was performed in 2022, which failed to resolve the issue. Due to the persistent uncomfortable sensations and lack of therapeutic benefit, she requested removal of the system, which was explanted in May 2025. Post-explantation imaging revealed that the distal electrode of one lead remained in the cervical spine.</p><p><strong>Conclusion: </strong>These two case reports highlight unusual presentations of cervical spinal cord stimulator lead fracture with or without loss of stimulation effectiveness. However, in the first case, despite the continued functionality of the device, the patient developed unexplained neurological symptoms and required MRI imaging. These symptoms improved following device removal, even though a portion of the electrode remained in place. In the second case, stimulation produced uncomfortable electrical sensation requiring electrical stimulation. During the surgical procedure, post-explantation imaging revealed that the top electrode remained in the cervical spine, which in both cases was not identified until after explantation.</p>","PeriodicalId":520525,"journal":{"name":"Pain medicine case reports","volume":"9 3","pages":"151-156"},"PeriodicalIF":0.0,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144556455","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":"Nanotechnology Pain Patch Relieves Chronic Back Pain: A Case Report.","authors":"Danielle Levin, Sarah Levin, Abhin Shah, Martin Acquadro","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Background: </strong>Low back pain is a debilitating symptom that may develop into a refractory chronic condition, resistant to physical, medical, psychological, and/or interventional therapy options. We would like to share the first report of a nanotechnology pain patch providing > 90% chronic back pain relief for 3 months.</p><p><strong>Case report: </strong>A 75-year-old man with chronic low back pain secondary to L2-L3 disc herniation suffered from pain for > 35 years. He found physical therapy, baclofen, low-dose opioids, and lumbar epidural steroid injection ineffective. A trial of a nanotechnology pain patch (nCAP Signal Relief Patch) worn daily provided the patient with consistent 90% to 100% back pain relief and enabled the patient to have significant functional improvement.</p><p><strong>Conclusions: </strong>This case report demonstrates that the nCAP Signal Relief Patch could be a simple, safe, noninvasive, and effective treatment option for those affected by chronic low back pain.</p>","PeriodicalId":520525,"journal":{"name":"Pain medicine case reports","volume":"9 2","pages":"115-118"},"PeriodicalIF":0.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144040733","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":"Bridging Antiplatelet Therapy With Cangrelor in Spinal Cord Stimulator Trial and Implant for Patient With Refractory Angina: A Case Report.","authors":"Marshall Yuan, Angie Kuang, David Hao","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Background: </strong>Antiplatelet medications increase the risk of neuraxial bleeding during spinal cord stimulator (SCS) trials and implants, necessitating adequate discontinuation. However, interrupting antiplatelet therapy is undesirable in patients at high risk for thromboembolism. Cangrelor, a novel nonthienopyridine adenosine triphosphate analog, has a rapid onset and offset that can be used to bridge antiplatelet therapy prior to procedures involving neuraxial access, minimizing the risk of subtherapeutic anticoagulation.</p><p><strong>Case report: </strong>We present the case of a 44-year-old man with an extensive cardiac history who underwent neuromodulation for refractory angina. The patient was transitioned from prasugrel to cangrelor, with cangrelor being discontinued 3 hours prior to the tunneled SCS trial and subsequent implant. He showed no signs of any complications, including neurological issues, related to bleeding.</p><p><strong>Conclusions: </strong>This case illustrates the successful use of cangrelor as an antiplatelet bridge prior to a neuraxial procedure.</p>","PeriodicalId":520525,"journal":{"name":"Pain medicine case reports","volume":"9 2","pages":"147-150"},"PeriodicalIF":0.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144052765","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":"Peripheral Nerve Stimulation for Acute Vertebral Compression Fracture Pain: A Case Report.","authors":"Tony K George, Alfred J Tria","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Background: </strong>Vertebral compression fracture (VCF) pain can be debilitating, affecting daily activities and quality of life. This case presentation shows the utility of peripheral nerve stimulation (PNS) for acute pain relief in the setting of an acute VCF.</p><p><strong>Case report: </strong>This case is of an 84-year-old woman with osteoporosis and an acute T9 compression fracture reporting significant pain relief with 60-day PNS when medications and modalities failed to relieve pain. PNS is utilized for acute and chronic nerve pain with an expanding role for acute postoperative pain and chronic nociceptive, nociplastic, and neuropathic pain. This case report highlights the expanding role of PNS for managing acute pain.</p><p><strong>Conclusions: </strong>This novel approach to addressing acute insufficiency fracture pain highlights a promising alternative to inadequately relieved acute pain with conventional medication management or augmentation limitations due to patient comorbidities.</p>","PeriodicalId":520525,"journal":{"name":"Pain medicine case reports","volume":"9 2","pages":"127-130"},"PeriodicalIF":0.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144063898","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}