Chronic pain management

The aim of the present study was to comparing the effectiveness of mindfulness based cognitive training MBCT adapted for Iran's culture and cognitive-behavioral training CBT on chronic pain in employees. In this research, using experimental method, 54 employees were selected and randomly assigned into the 2 experimental groups and control 18 per a group), and were assessed in pre-test, post-test and follow up by the West Haven-Yale Multidimensional Pain Inventory (Ira et al, 1995). First experimental group received 8 sessions of MBCT, while second experimental group received 8 sessions of cognitive-behavioral training CBT, each session took 120 minutes. The results of the within and between subjects from analysis of repeated measures revealed that training have a significant effect on reduction in chronic pain (P  0.01).

Incisional pain is particularly troublesome after hysterectomy. A method called transversus abdominis plane block (TAPB) has shown promise in managing postoperative pain. In this study, we evaluated the analgesic efficacy of ultrasound-guided TAPB after hysterectomy at different time points and at each time point separately for 48 hours.

tBackground: Although the effectiveness of low-dose radiotherapy for chronic degenerative and inflam-matory diseases has been documented in previous studies, patient-reported clinical outcomes are rarelyavailable.Objective: This study aimed to determine the effect of low-dose radiotherapy on patients with painfulplantar fasciitis.Method: From 2002 to 2008, 200 patients older than 65 years of age with painful plantar fasciitis weretreated in our hospital. Records from 171 of these patients were available for analysis. All patients weretreated with an identical dose of 3 Gy using identical equipment and techniques. Response was evaluatedwith patient-reported questionnaires and clinical visits.Results: Minimum-term follow-up was 18 months, with mean follow-up at 54 months. Three monthsafter receiving low-dose radiotherapy, 67.3% of patients had no or mild pain, and 57.9% had no or discretemobility restriction. At a mean of 54 months, 61.4% of patients had no or mild pain and 64.9% of patientshad no or discrete mobility restriction; 60.8% of patients reported improved quality of life.Conclusion: Low-dose radiotherapy is effective in most patients with painful plantar fasciitis. Due tominimal side effects and low costs, it represents an excellent treatment option compared to conventionaltherapies or surgery.

Vasquez A. Neuroinflammation in fibromyalgia and CRPS is multifactorial. Nature Reviews Rheumatology 2016; March 3: doi:10.1038/nrrheum.2016.25. http://www.nature.com/nrrheum/journal/vaop/ncurrent/full/nrrheum.2016.25.html. Basically what I do in this Correspondence is refute the idea that these "chronic pain" and neuroinflammatory / central sensitization conditions are "idiopathic" and are --rather and importantly-- multifactorial. The distinction is of massive importance, because if we view these conditions as multifactorial we can then begin to dismantle these conditions by addressing the components. Based on my previous work starting in 2004 on migraine (textbook: "Integrative Orthopedics") and 2008 on fibromyalgia (CME monograph: "Musculoskeletal Pain"), I show --working within the constraints of fewer than 500 words-- that these conditions are triggered and perpetuated by 1) dysbiosis, 2) mitochondrial dysfunction, and 3) nutrient deficiencies, especially vitamin D. Logical treatment thereby follows, as already proven safe and effective by respective clinical trials. My current textbooks that cover this information are: Inflammation Mastery, 4th Edition (2016); see hyperlinks: http://www.ichnfm.org/#!blank/an1g3 (please note the discount available via http://www.ichnfm.org/#!store---membership/wq28b)
-- Nondiscount/retail Inflammation Mastery 4th Edition: http://amazon.com/author/alexvasquez
-- Pain Revolution for Migraine and Fibromyalgia: http://www.amazon.com/dp/1522951008
-- Fibromyalgia Solution: http://www.amazon.com/dp/B01AS1ZKPA
-- See also: Migraine and Headache Revolution: http://www.amazon.com/dp/B01AS15XZW
-- See also: Mitochondrial Medicine Arrives to Prime Time in Clinical Care. Altern Ther Health Med 2014 https://www.academia.edu/5636450/
-- See also: Mitochondrial Dysfunction and the Emerging Mitochondrial Medicine. Integrative Medicine 2013 https://www.academia.edu/17119323/
-- See also: Translating Microbiome (Microbiota) and Dysbiosis Research into Clinical Practice: The 20-Year Development of a Structured Approach that Gives Actionable Form to Intellectual Concepts. Int J Hum Nutr Funct Med 2015 https://www.academia.edu/12870819/
-- See also: The clinical importance of vitamin D (cholecalciferol): a paradigm shift with implications for all healthcare providers. Altern Ther Health Med. 2004 https://www.academia.edu/18078062/

Pain associated with cancer is often difficult to treat, even more so when tumors involve peripheral nerves. Therapy is complex and often requires a multimodal approach that can include medications, radiation, and interventional techniques. These components are utilized with variable success, but are also limited by known complications or adverse effects. We present the case of a 53-year-old woman with a metastatic axillary tumor that involved her brachial plexus. Attempts to control her pain with medication were unsuccessful despite escalation and use of adjunct agents. She was not deemed to be a surgical candidate due to the size and location of the tumor. Radiation was discussed but, obviously, would not work immediately. Our team decided to employ a brachial plexus catheter for continuous nerve block, which provided almost complete relief of pain. Since her pain was deemed to be of peripheral etiology, pulsed radiofrequency ablation of her brachial plexus was used for more long-term pain relief. The patient responded very well with minimal pain issues and no apparent complications. On follow-up, the patient had good relief for almost 2 months. Pulsed radiofrequency is a poorly understood technology that has increasing evidence for certain pain conditions; however, for cancer and peripheral nerves the evidence is slim to none. Our case presents a successful use for pain management of a brachial plexopathy due to a tumor. We propose that pulsed radiofrequency may present a non-neurodestructive pain management technique for tumors involving peripheral nerves, though more data is definitely needed.

Eagle's syndrome is a rare condition characterized by foreign body sensation in the throat, cervical pain, and dysphagia. It is commonly due to a pathological longer styloid process or ossification of the stylohyoid ligament. There are two classical therapeutic approaches: a conservative management, with a combination of Non-Steroidal Anti-Inflammatory Drugs (NSAIDs), anticonvulsants and antidepressants along with local injections of local anaesthetics/corticosteroids, or a surgical treatment i.e. the removal of the styloid process and stylohyoid ligament. We reported the case of a 52-years old woman presented with pain localized at the right side of the neck, back of the throat, tonsillar fossa, base of the tongue, soft palate and inferior part of the occipital bone together with sensation of foreign body in the throat. These symptoms started at the age of 29 after drinking some water with a pain intensity evaluated by numeric rating scale (NRS) of 10. Both pharmacological and surgical treatment didn't produce substantial relief. In 2017 the patient came to our attention and a 10KHz Spinal Cord Stimulator (SCS) was positioned between C2 and C7 with a significant pain relief (NRS4) and a complete relief from foreign body sensation in the throat. This is, to our knowledge, the first case of Eagle's syndrome treated with SCS. This case is here reported along with a short review of Eagle's syndrome and a description of mechanisms and potential applications of SCS.

Background.—Clinical presentation of spontaneous intracranial hypotension headache (SIHH) has similarities with
postdural puncture headache (PDPH). Recommended treatment for both conditions is an epidural blood patch. Successful
outcomes following greater occipital nerve blocks have been reported in the management of PDPH. We present the first
report of greater occipital nerve treatment in SIHH.
Methods.—A 40-year-old male presented with a 2-year history of daily postural headaches having a significant impact
on quality of life. Magnetic resonance imaging revealed bilateral convexity subdural collections. Post gadolinium scan
revealed pachymeningeal enhancement with reduced pontomesencephalic angle below 50 degrees. The patient was offered
an epidural blood patch and greater occipital nerve block with corticosteroids. The patient chose occipital nerve block.
Result.—The patient reported significant short-term benefit lasting 4 months. Thereafter, the patient underwent pulsed
radiofrequency treatment to bilateral greater occipital nerves. He reported significant benefit lasting 10 months.
Conclusion.—Greater occipital nerve treatment may have a role in management of SIHH.

Somatosensory rehabilitation is presented by means of its paradigm which is: Look for hypoesthesia, because, by decreasing hypoesthesia neuropathic pain decreases. Occupational therapists are going to observe cutaneous sense disorders if, and only if they know beforehand that they can offer a new treatment to the patients they are taking care of.
Somatosensory rehabilitation and it’s effects are presented: by means of the Mc Gill pain questionnaire which allows the assessment of the patients pain symptoms and by means of the pharmacological treatment indicator: The number needed to treat (NNT). The important and strong correlation (Cov=15.7) between the decrease of hypoesthesia and the decrease of neuropathic pain is demonstrated. The rehabilitation of hyposensitivity based on the neuroplasticity of the somatosensory system is described. The second part of the article tells about the assessment of patients with chronic neuropathic pain: Clinical reasoning of a beginning reeducator, the mapping of the zones of hypoesthesia or when it occurs, that are hypertensive to touch and especially the therapeutic strategy which will be chosen according to the status of the skin. As a conclusion, the ways to learn more about it are enumerated.