ABSTRACT
A spinal cord stimulator is an important long-term treatment modality for refractory chronic pain of multiple etiologies. Hardware-related complications remain known adverse events associated with this intervention. Understanding the risk factors for development of such complications is important for optimizing the efficacy and longevity of spinal cord stimulators. This case report highlights an uncommon case of implantable pulse generator site calcification that was discovered incidentally on spinal cord stimulator explant.
Subject(s)
Calcinosis , Chronic Pain , Pain, Intractable , Humans , Chronic Pain/etiology , Chronic Pain/therapy , Risk Factors , Spinal CordABSTRACT
Non-obstructive, chronic flank pain in urologic patients can be a challenging problem to manage. In this series, we examined the efficacy of celiac plexus blockade in providing pain relief and reducing opiate use in 14 adult urology patients with non-obstructive flank pain for > 1 year. Demographic, clinical, and procedural variables were collected from the medical record for retrospective analysis. Subjective improvement in pain occurred in 11 individuals (79%), and 5 (50%) were able to reduce their daily morphine equivalent dose (MED). Celiac plexus blockade is a viable option for symptomatic relief in urologic patients with non-obstructive chronic flank pain.
Subject(s)
Autonomic Nerve Block , Celiac Plexus , Chronic Pain/therapy , Flank Pain/therapy , Adult , Female , Humans , Male , Middle Aged , Retrospective Studies , Young AdultABSTRACT
Ventricular tachycardia (VT) storm, defined as recurrent VT requiring electrical cardioversion ≥3 times within 24 hours, is a rare presentation of long-QT syndrome. Pharmacologic autonomic modulation and/or left cardiac sympathetic denervation are established therapies in long-QT syndrome in adults but may not be effective or practical in the emergent treatment of VT storm. We present a novel case of a child with drug-refractory VT storm and prolonged QT requiring extracorporeal membrane oxygenation (ECMO) support. Continuous stellate ganglion blockade was remarkably effective in stabilizing his rhythm and should be considered in similar pediatric cases.
Subject(s)
Long QT Syndrome/therapy , Stellate Ganglion/surgery , Tachycardia, Ventricular/therapy , Catheterization , Child , Extracorporeal Membrane Oxygenation , Humans , Male , Treatment OutcomeABSTRACT
Restless legs syndrome can be a debilitating condition that affects a patient's ability to function and their quality of life. Neuromodulation may represent a potential option for nonpharmacological management of restless legs syndrome. We present 3 patients who have a chronic pain diagnosis and medically refractory restless legs syndrome that warranted neuromodulation. After neuromodulation, all 3 patients had improvement in their restless legs syndrome symptoms and were taking less pain medication, and 2 out of 3 had significantly improved functionality at short-term follow-up. This case series suggests that spinal cord stimulation may be a viable nonpharmacological treatment option for medically refractory restless legs syndrome.
Subject(s)
Chronic Pain/therapy , Restless Legs Syndrome/therapy , Spinal Cord Stimulation , Aged , Aged, 80 and over , Female , Humans , Male , Middle AgedABSTRACT
A 59-year-old man presented 7 months after coronary artery bypass with continued bilateral axillary pain. His symptoms progressed over a period of months to allodynia, edema, erythema, decreased range of motion, and skin changes consistent with complex regional pain syndrome type I. After failing multiple treatment options, the patient underwent a trial of spinal cord stimulation. Leads positioned in the posterior epidural space from the seventh cervical to the third thoracic vertebral levels resulted in complete paresthesia coverage of his truncal chronic regional pain syndrome (CRPS) and the stimulation was associated with almost complete resolution of CRPS. This case report suggests that spinal cord stimulation may provide effective treatment for truncal CRPS after coronary artery bypass graft surgery.
Subject(s)
Complex Regional Pain Syndromes/therapy , Spinal Cord Stimulation , Complex Regional Pain Syndromes/etiology , Coronary Artery Bypass/adverse effects , Epidural Space , Humans , Male , Middle Aged , Torso , Treatment OutcomeSubject(s)
Analgesia, Epidural/standards , Databases, Factual/standards , Drug Delivery Systems/standards , Drug Therapy, Computer-Assisted/standards , Injections, Spinal/standards , Internet/standards , Analgesia, Epidural/methods , Analgesics, Opioid/administration & dosage , Analgesics, Opioid/adverse effects , Databases, Factual/trends , Drug Delivery Systems/methods , Drug Delivery Systems/trends , Drug Therapy, Computer-Assisted/methods , Drug Therapy, Computer-Assisted/trends , Humans , Injections, Spinal/adverse effects , Internet/trends , Medical Order Entry Systems/standards , Medical Order Entry Systems/trendsABSTRACT
Baclofen is a common medication used as a muscle relaxant and antispasmodic. Baclofen-withdrawal syndrome has many symptoms such as sedation, somnolence, and weakness but can include psychological symptoms. We present a 62-year-old female whose oral baclofen was not continued at a skilled nursing facility after discharge following inpatient surgery that led to the development of altered mental status and respiratory insufficiency necessitating intensive care unit admission. Abrupt cessation of baclofen, no matter the mode of administration to the patient, can lead to baclofen-withdrawal syndrome.
