Pain medicine case reports最新文献

{"title":"Accidental Subdural Injection of a Lidocaine With Epinephrine Test Dose Leading to Respiratory Arrest in a Parturient Patient: Case Report.","authors":"Aileen Haque, Roger Jacob, Steven Landau, Dipti Ghatol","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Background: </strong>A subdural injection is a rare complication of neuraxial anesthesia where medication is accidentally injected into the potential space between the dura mater and arachnoid mater of the spinal cord. Subdural blocks are typically underdiagnosed due to their variable presentation; failed early detection can lead to significant long-term consequences.</p><p><strong>Case report: </strong>This is a unique case of a 33-year-old parturient who presented for epidural placement during which a 3 mL subdural injection of preservative-free 1.5% lidocaine with 1:200,000 epinephrine test dose led to rapid clinical deterioration resulting in respiratory arrest.</p><p><strong>Conclusions: </strong>The objective of this case is to highlight atypical clinical features of an accidental subdural injection, detail the successful anesthetic management of a subdural injection, and emphasize the need for a high index of suspicion for subdural placement in patients receiving neuraxial anesthesia who develop an unexpected sensory or motor response following medication administration.</p>","PeriodicalId":520525,"journal":{"name":"Pain medicine case reports","volume":"10 6","pages":"559-562"},"PeriodicalIF":0.0,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148877177","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 Facet Interventions in a Patient with a Spinal Cord Stimulator for Chronic Headache and Neck Pain: A Case Report.","authors":"Monika Misak, Jonathan Saju, Kanchana Gattu, Seung J Lee, Lynn G Stansbury, Thelma Wright","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Background: </strong>Cervical spinal cord stimulation (SCS) has been used in selected patients with refractory headaches and neuropathic pain. However, overlapping conditions like cervicalgia, fibromyalgia, and inflammatory arthritis can result in persistent nonneuropathic pain that SCS may not adequately address.</p><p><strong>Case report: </strong>We present the case of a 40-year-old woman with a history of cervicalgia, fibromyalgia, chronic myofascial pain, and inflammatory polyarthritis who underwent a cervical SCS placement with 2 leads ending at C2 for chronic headaches and neck pain. While the SCS provided excellent headache relief, the axial neck and trapezius facet joint pain persisted despite device optimization, medication management, pain psychology, and physical therapy.</p><p><strong>Conclusions: </strong>Fluoroscopically guided cervical medial branch blocks provided immediate and clinically meaningful symptomatic relief through 1-month follow-up. This case highlights the potential role of cervical medial branch blocks in patients with persistent facet-mediated pain despite an otherwise successful SCS response.</p>","PeriodicalId":520525,"journal":{"name":"Pain medicine case reports","volume":"10 6","pages":"539-543"},"PeriodicalIF":0.0,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148877212","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":"Combined Subchondral, Intradiscal and Peridiscal BMAC Injections for Advanced Degenerative Discs and Endplates with Modic Changes: Retrospective Pilot Case Series.","authors":"Sudhir Diwan, Ana Flavia Vieira Leite, Annu Navani, Douglas P Beall, Shelby D Munoz, Michael E Schatman, Eva Manik, Robert Rapcan, Alan D Kaye","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Background: </strong>Degenerative disc disease (DDD) with cartilaginous endplate degeneration and Modic type 1 or 2 changes is increasingly recognized as a source of chronic vertebrogenic and discogenic low back pain. Because the intervertebral disc and vertebral endplates function as a biological and biomechanical unit, regenerative strategies targeting both structures may better address the disc-endplate complex.</p><p><strong>Case series: </strong>Thirteen consecutive patients with chronic refractory vertebrogenic and/or discogenic low back pain, MRI evidence of DDD with Modic type 1 or 2 changes, and failure of conservative management underwent combined intradiscal, peridiscal, and subchondral bone marrow aspirate concentrate (BMAC) injections under fluoroscopic guidance. Four patients had previously undergone basivertebral nerve radiofrequency ablation. The cohort included 6 men and 7 women with a mean age of 56.2 ± 17.5 years. Follow-up ranged from 4 to 15 months. Mean Visual Analog Scale scores decreased from 7.3 ± 2.0 at baseline to 2.1 ± 1.6 at latest follow-up, a mean reduction of 5.2 ± 1.8 points (72.7% ± 19.5%). All patients achieved at least 50% pain reduction and reported functional improvement. Twelve patients (92.3%) were satisfied or very satisfied, and all would recommend the procedure. No major procedure-related complications were observed.</p><p><strong>Conclusion: </strong>Combined intradiscal, peridiscal, and subchondral BMAC injections were associated with substantial pain reduction, functional improvement, high patient satisfaction, and no major complications in this small retrospective case series. Larger prospective controlled studies are needed to confirm these preliminary findings.</p>","PeriodicalId":520525,"journal":{"name":"Pain medicine case reports","volume":"10 6","pages":"569-583"},"PeriodicalIF":0.0,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148877242","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":"Thoracolumbar Fascia as an Overlooked Diagnosis of Chronic Back Pain: A Case Report of Successful Regenerative Treatments in an Athlete.","authors":"Tony Kwun Tung Ng, Jen-Li Pan, George C Chang Chien, Murray Taverner","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Background: </strong>Chronic nonspecific low back pain is common in elite athletes, often persisting and significantly affecting training and performance despite conventional therapy.</p><p><strong>Case report: </strong>This case report details the management of a 14-year-old triple jumper with a 16-onth history of chronic nonspecific low back pain. Magnetic resonance imaging was unremarkable, whereas dynamic ultrasound revealed abnormalities of the thoracolumbar fascia. The patient underwent a tiered regenerative injection strategy guided by biotensegrity principles. Initial ultrasound-guided dextrose hydrodissection was performed for adhesiolysis and analgesia, followed by leukocyte-poor platelet-rich plasma and platelet-poor plasma injections intended to promote tissue remodeling. The athlete reported an overall 85%-90% reduction in pain and returned to full training 4 weeks after the platelet-rich plasma/platelet-poor plasma treatment.</p><p><strong>Conclusions: </strong>This case illustrates that thoracolumbar fascia dysfunction may warrant consideration as a contributor to chronic nonspecific low back pain in young athletes. In our patient, a tiered regenerative approach resulted in substantial pain reduction and return to full training; however, controlled studies are needed to further establish efficacy of this approach or the causal treatment effect.</p>","PeriodicalId":520525,"journal":{"name":"Pain medicine case reports","volume":"10 6","pages":"529-534"},"PeriodicalIF":0.0,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148876954","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":"Radiofrequency Lesioning of Hypertrophied Ligamentum Flavum in Lumbar Spinal Stenosis - A Report of Two Cases.","authors":"Prasanna Vadhanan","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Background: </strong>Lumbar spinal stenosis is a debilitating condition commonly seen in older adults. Hypertrophy of the ligamentum flavum significantly contributes to the pathology. Although epidural injections are commonly used when conservative measures fail, they often provide only transient relief. Radiofrequency lesioning of fibrotic tissue can result in a reduction in size. We report radiofrequency lesioning of the ligamentum flavum and the outcomes.</p><p><strong>Case report: </strong>We present 2 patients with neurogenic claudication due to lumbar spinal stenosis and ligamentum flavum hypertrophy. They had disabling back pain and bilateral leg pain that was not adequately relieved by medications. Both underwent image-guided radiofrequency lesioning of the ligamentum flavum. The patients experienced clinically significant improvement in pain and functional scores at 4 weeks after treatment.</p><p><strong>Conclusions: </strong>Image-guided radiofrequency lesioning of hypertrophied ligamentum flavum may be a minimally invasive technique that provides symptomatic relief in patients with lumbar spinal stenosis who are poor surgical candidates.</p>","PeriodicalId":520525,"journal":{"name":"Pain medicine case reports","volume":"10 6","pages":"501-505"},"PeriodicalIF":0.0,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148876208","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":"Therapeutic Effect of Suzetrigine in the Management of Notalgia Paresthetica: A Case Report.","authors":"Brian Lee, Wendy Wang, Denny Cha, Jeffrey Lin","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Background: </strong>Notalgia paresthetica is a sensory neuropathy characterized by severe pruritus, pain, and hyperpigmented patches in the T2-T6 distribution. Despite multiple treatment options, there are no established guidelines to manage this challenging sensory neuropathy.</p><p><strong>Case report: </strong>A 64-year-old man presented to the pain clinic with persistent notalgia paresthetica for 5 years. He was unable to tolerate oral neuropathic agents, and insurance coverage for capsaicin cream and botulinum toxin injections was denied. He was treated with suzetrigine, a novel NaV1.8 channel inhibitor, for 1 month and experienced complete resolution of symptoms.</p><p><strong>Conclusions: </strong>The etiology of notalgia paresthetica has not been fully elucidated, but it is thought to involve irritation and aberrant firing of the thoracic spinal nerves.</p><p><p>This response to suzetrigine suggests that it may act as a peripheral nerve membrane stabilizer and may be a treatment option for this condition.</p>","PeriodicalId":520525,"journal":{"name":"Pain medicine case reports","volume":"10 6","pages":"491-495"},"PeriodicalIF":0.0,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148876767","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":"Managing Erythromelalgia-Associated Pain with Suzetrigine: A Case Report.","authors":"Don Hoang, Jennifer Hubbell, Thomas Verbeek","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Background: </strong>Erythromelalgia is a rare, debilitating chronic condition characterized by erythema, warmth, and recurrent burning pain typically in the feet. Despite numerous treatment options, management of erythromelalgia can be challenging. Sodium channel blockers are offered as treatment options for erythromelalgia; however, they are often nonselective, limiting their utility. Suzetrigine is a novel, selective Nav1.8 sodium channel inhibitor that appears to have promising antinociceptive potential.</p><p><strong>Case report: </strong>Our clinical vignette describes the case of a 23-year-old woman with worsening burning pain in her bilateral feet and ankles, diagnosed as erythromelalgia. Various interventions were trialed without adequate relief, including nonpharmacological management, aspirin, lumbar sympathetic block, and various systemic medications. Suzetrigine was ultimately tried with significant pain relief, making this the first described case of suzetrigine alleviating erythromelalgia-associated pain.</p><p><strong>Conclusions: </strong>Overall, our highlights suzetrigine's potentially wide applicability in various pain conditions, although additional clinical trials are still required to clarify the full extent.</p>","PeriodicalId":520525,"journal":{"name":"Pain medicine case reports","volume":"10 5","pages":"413-417"},"PeriodicalIF":0.0,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148672001","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":"Motor Strength Recovery Following Unilateral MILD® Procedure in a Patient With Severe Spinal Stenosis and Associated Foot Drop.","authors":"Shemar Crawford, Simran Prakash, Caroline Jones, Ali Mostoufi","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Background: </strong>Lumbar spinal stenosis (LSS) is a prevalent degenerative condition, particularly in individuals over 65, and is a leading cause of disability and spinal surgery in this population. The hallmark symptom is neurogenic claudication, but severe cases may present with focal motor deficits, such as foot drop. While open decompressive surgery remains the standard for patients with progressive neurological deficits, minimally invasive techniques, like the minimally invasive lumbar decompression (MILD®, Stryker Medical, Kalamazoo, MI) procedure, have emerged as alternatives, especially for patients with ligamentum flavum hypertrophy. However, the efficacy of MILD in cases with motor weakness remains underexplored.</p><p><strong>Case report: </strong>A 70-year-old woman with prediabetes, osteopenia, and depression presented with 9 months of frequent falls, progressive unsteady gait, and left ankle dorsiflexion weakness. Imaging revealed severe central canal stenosis at L2-L3 and L4-L5, with significant ligamentum flavum hypertrophy. Despite recommendations for open decompression, the patient declined surgery due to anesthesia concerns. She was managed conservatively with a walker and ankle-foot orthosis (AFO), but developed a heel pressure ulcer. Four months after symptom onset, she underwent a left-sided, image-guided MILD procedure at L4-L5. The procedure was completed without complications. At 2 weeks postprocedure, she discontinued AFO use, with marked improvement in ambulation and muscle strength. By 6 weeks, left ankle dorsiflexion had normalized, and at 12 weeks, she was nearly symptom free. At one-year follow-up, she maintained full motor recovery and did not require open surgery.</p><p><strong>Conclusions: </strong>Our case demonstrates that early use of the MILD procedure may facilitate rapid and durable motor recovery in selected patients with LSS and focal motor weakness due to ligamentum flavum hypertrophy. The MILD procedure offers a lower-risk alternative to open surgery, with significant improvements in function and quality of life. Larger studies are warranted to further validate its role in this patient population.</p>","PeriodicalId":520525,"journal":{"name":"Pain medicine case reports","volume":"10 5","pages":"423-427"},"PeriodicalIF":0.0,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148671986","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":"Platelet-Rich Plasma as Long-Term Therapy for Refractory Pain in an Atypical Case of Morton's Neuroma: A Case Report.","authors":"Muhamad Rafigi Hehsan","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Background: </strong>Morton's neuroma is a painful entrapment neuropathy typically affecting the third intermetatarsal space. Conventional therapies, including orthotics, corticosteroids, or surgery, often yield inconsistent outcomes.</p><p><strong>Case report: </strong>We describe a 26-year-old woman with chronic, persistent neuropathic pain due to an atypical Morton's neuroma located in the fourth intermetatarsal space. After failure of multiple conservative and infiltrative treatments, she received 2 injections of leukocyte-poor platelet-rich plasma (PRP). Pain severity (Visual Analog Scale) improved from 9/10 to 1/10, and the Foot Function Index improved by 75% at 12 months.</p><p><strong>Conclusions: </strong>PRP provided durable analgesia and functional recovery in this rare neuroma presentation, underscoring its regenerative and neuromodulatory potential. Our case highlights the effectiveness of PRP as a promising, minimally invasive alternative when conventional treatments fail.</p>","PeriodicalId":520525,"journal":{"name":"Pain medicine case reports","volume":"10 5","pages":"405-408"},"PeriodicalIF":0.0,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148671985","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":"Basivertebral Nerve Radiofrequency Ablation for Vertebral Osteomyelitis: A Technical Report.","authors":"Jimmy Wen, Allyson Kouche, Megan Kou, Yu-Tung Chen, Jose Silva, Sugamjot Badhan, Arsh Alam, Foad Elahi","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Background: </strong>Vertebral osteomyelitis (VO) frequently results in persistent vertebrogenic back pain (VBP) due to ongoing endplate inflammation and structural damage despite infection-directed therapy. The application of basivertebral nerve radiofrequency ablation (BVNRFA) for VBP resulting from vertebral infection has not been explored in the current literature.</p><p><strong>Case report: </strong>A 53-year-old man with poorly controlled diabetes and recurrent L3-L4 osteomyelitis underwent multiple hospitalizations for sepsis and progressive vertebral body destruction. Serial magnetic resonance imaging demonstrated chronic L3-L4 osteomyelitis with marrow edema, and 2 persistent enhancing fluid pockets, but no surgically drainable epidural abscess. Despite prolonged intravenous antibiotics and the absence of operative indications, severe axial lumbar pain continued with significant functional limitation. BVNRFA was performed to target nociceptive signaling originating from chronically diseased vertebral endplates. The intervention was tolerated without complications and resulted in meaningful improvement in axial pain and mobility.</p><p><strong>Conclusion: </strong>Our case illustrates a novel application of BVNRFA for VBP associated with chronic VO.</p>","PeriodicalId":520525,"journal":{"name":"Pain medicine case reports","volume":"10 5","pages":"453-457"},"PeriodicalIF":0.0,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148671909","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}