RESUMO
BACKGROUND: Osteoporotic vertebral compression fracture (OVCF) is a common complication of osteoporosis in the aging population. Refractory chronic pain may develop, and few effective treatment options exist. METHODS: We retrospectively analyzed 52 cases in which gray ramus communicans nerve block was used for painful OVCF after failure of conservative analgesic therapy. All were office-based, fluoroscopically guided procedures; a combination of 2% lidocaine and 2% sterile triamcinolone diacetate (Aristocort) was injected on the gray ramus tract of the somatic nerve root corresponding with radiographically documented OVCF. Patient-reported and physician-reported pain scores, analgesic medication use, and overall patient satisfaction were measured. The average follow-up period was 9 months. RESULTS: A 1-point improvement in pain scores was reported by 92% of patients and 88% of physicians; a 4-point improvement was reported by 63% and 58%, respectively. No patients reported increased pain scores; physicians reported increases in two cases. Decreased analgesic requirement was documented in 42%. Patient satisfaction was "high" in 50% and "medium" in 25%. No procedural complications occurred. CONCLUSION: Prompt and sustained improvements in all parameters, especially pain scores, support widespread clinical application of this safe effective and cost-effective therapy.
Assuntos
Anestésicos Locais , Anti-Inflamatórios , Fluoroscopia/métodos , Fraturas Espontâneas/etiologia , Fraturas Espontâneas/terapia , Disco Intervertebral/inervação , Lidocaína , Bloqueio Nervoso/métodos , Osteoporose/complicações , Manejo da Dor , Dor/etiologia , Radiografia Intervencionista/métodos , Fraturas da Coluna Vertebral/etiologia , Fraturas da Coluna Vertebral/terapia , Triancinolona , Idoso , Idoso de 80 Anos ou mais , Combinação de Medicamentos , Feminino , Fluoroscopia/psicologia , Fraturas Espontâneas/diagnóstico por imagem , Fraturas Espontâneas/psicologia , Humanos , Masculino , Pessoa de Meia-Idade , Bloqueio Nervoso/psicologia , Osteoporose/psicologia , Dor/diagnóstico , Medição da Dor , Satisfação do Paciente , Radiografia Intervencionista/psicologia , Estudos Retrospectivos , Fraturas da Coluna Vertebral/diagnóstico por imagem , Fraturas da Coluna Vertebral/psicologia , Resultado do TratamentoRESUMO
This report describes a case of pseudocyesis in a male patient and reviews the literature in pseudocyesis in the male and female. Pseudocyesis is a rare psychiatric syndrome with only about 100 cases reported in females and three in males in the past 45 years. The authors suggest that somatic factors may play a role in the genesis of some cases of pseudocyesis by stimulating pregnancy wishes and interacting with these wishes to set up a psychophysiological interaction leading to the clinical syndrome of pseudocyesis.
