It's been a day of music and a kind of leisure. It seems appropriate to top the hours off with a bit of light housekeeping: Here are a few of the research article abstracts that are piling up around here. [I would say that the waste of redundant hard copies gather dust in the corners... but I can't fool you. You know that Computer Turrets don't have corners!]
There is nothing earth-shattering, just the train-train quotidien of progress. So long as we have that dull, repetitive noise as a lazy day soundtrack, we're okay.
For today's lazy day, that's fine. Come tomorrow? Maybe we can step it up a bit, eh, you scientist types?
Tease a little more information from those short fibers (Destined for Ganglia!)!
Add the Ketamine to the Propofol, whaddaya get? Ketofol!
[Will my insurance cover Deep Brain Stimulation, do you think? The At Home version? I've had about enough of this tw-tw-twitching... Shouldn't be that hard to sink a few carelessly modified TENS leads into the old gray matter, then hook those babies to the ramped-up three-phase step-down transformers that Fred mounted between the two utility poles in back of the barn... Don't worry, we'll carefully document our results and protocols. The ABSTRACT ought to be ready to go by the weekend, pending publication in the October DIY CRPS Revue.]
Efficacy of Outpatient Ketamine Infusions in Refractory Chronic Pain Syndromes: A 5-Year Retrospective Analysis
Patil, S. and Anitescu, M.
(2011), Pain Medicine. doi: 10.1111/j.1526-4637.2011.01241.x
Objective. We evaluated whether outpatient intravenous ketamine infusions were satisfactory for pain relief in patients suffering from various chronic intractable pain syndromes.
Design. Retrospective chart review.
Setting and Patients. Following Institutional Review Board approval, we retrospectively analyzed our database for all ketamine infusions administered over 5 years from 2004 to 2009.
Outcome Measures. Data reviewed included doses of intravenous ketamine, infusion duration, pain scores on visual analog scale (VAS) pre- and post-procedure, long-term pain relief, previous interventions, and side effects. All patients were pretreated with midazolam and ondansetron.
Results. We identified 49 patients undergoing 369 outpatient ketamine infusions through retrospective analysis. We excluded 36 infusions because of missing data. Among our patients, 18 (37%) had a diagnosis of complex regional pain syndrome (CRPS). Of the remaining 31 (63%) patients, eight had refractory headaches and seven had severe back pain. All patients reported significant reduction in VAS score of 5.9 (standard error [SE] 0.35). For patients with CRPS, reduction in VAS score was 7.2 (SE 0.51, P < 0.001); for the others, the reduction was 5.1 (SE 0.40, P < 0.001). The difference of 2.1 between groups was statistically significant (SE 0.64, P = 0.002). In 29 patients, we recorded the duration of pain relief. Using the Bernoulli model, we found (90% confidence interval) that the probability of lasting pain relief in patients with refractory pain states was 59–85% (23–51% relief over 3 weeks).
Rheumatology (2011) 50 (10):1739-1750.
doi: 10.1093/rheumatology/ker202
Contact: Dr. Martin Tegenthoff
martin.tegenthoff@rub.de
49-234-302-6810
Ruhr-University Bochum
The rest of this press release can be read HERE.
This is the ABSTRACT for the much-hyped research itself:
Bilateral somatosensory cortex disinhibition in complex regional pain syndrome, type 1
There is nothing earth-shattering, just the train-train quotidien of progress. So long as we have that dull, repetitive noise as a lazy day soundtrack, we're okay.
For today's lazy day, that's fine. Come tomorrow? Maybe we can step it up a bit, eh, you scientist types?
Tease a little more information from those short fibers (Destined for Ganglia!)!
Add the Ketamine to the Propofol, whaddaya get? Ketofol!
[Will my insurance cover Deep Brain Stimulation, do you think? The At Home version? I've had about enough of this tw-tw-twitching... Shouldn't be that hard to sink a few carelessly modified TENS leads into the old gray matter, then hook those babies to the ramped-up three-phase step-down transformers that Fred mounted between the two utility poles in back of the barn... Don't worry, we'll carefully document our results and protocols. The ABSTRACT ought to be ready to go by the weekend, pending publication in the October DIY CRPS Revue.]
Patil, S. and Anitescu, M.
(2011), Pain Medicine. doi: 10.1111/j.1526-4637.2011.01241.x
Objective. We evaluated whether outpatient intravenous ketamine infusions were satisfactory for pain relief in patients suffering from various chronic intractable pain syndromes.
Design. Retrospective chart review.
Setting and Patients. Following Institutional Review Board approval, we retrospectively analyzed our database for all ketamine infusions administered over 5 years from 2004 to 2009.
Outcome Measures. Data reviewed included doses of intravenous ketamine, infusion duration, pain scores on visual analog scale (VAS) pre- and post-procedure, long-term pain relief, previous interventions, and side effects. All patients were pretreated with midazolam and ondansetron.
Results. We identified 49 patients undergoing 369 outpatient ketamine infusions through retrospective analysis. We excluded 36 infusions because of missing data. Among our patients, 18 (37%) had a diagnosis of complex regional pain syndrome (CRPS). Of the remaining 31 (63%) patients, eight had refractory headaches and seven had severe back pain. All patients reported significant reduction in VAS score of 5.9 (standard error [SE] 0.35). For patients with CRPS, reduction in VAS score was 7.2 (SE 0.51, P < 0.001); for the others, the reduction was 5.1 (SE 0.40, P < 0.001). The difference of 2.1 between groups was statistically significant (SE 0.64, P = 0.002). In 29 patients, we recorded the duration of pain relief. Using the Bernoulli model, we found (90% confidence interval) that the probability of lasting pain relief in patients with refractory pain states was 59–85% (23–51% relief over 3 weeks).
Conclusions. We conclude that in patients with severe refractory pain of multiple etiologies, subanesthetic ketamine infusions may improve VAS scores. In half of our patients, relief lasted for up to 3 weeks with minimal side effects.
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Complex regional pain syndrome with associated chest wall dystonia: a case report
Journal of Brachial Plexus and Peripheral Nerve Injury 2011, 6:6
doi:10.1186/1749-7221-6-6
Published: 26 September 2011Patients with complex regional pain syndrome (CRPS) often suffer from an array of associated movement disorders, including dystonia of an affected limb. We present a case of a patient with long standing CRPS after a brachial plexus injury, who after displaying several features of the movement disorder previously, developed painful dystonia of chest wall musculature. Detailed neurologic examination found palpable sustained contractions of the pectoral and intercostal muscles in addition to surface allodynia. Needle electromyography of the intercostal and paraspinal muscles supported the diagnosis of dystonia. In addition, pulmonary function testing showed both restrictive and obstructive features in the absence of a clear cardiopulmonary etiology. Treatment was initiated with intrathecal baclofen and the patient had symptomatic relief and improvement of dystonia. This case illustrates a novel form of the movement disorder associated with CRPS with response to intrathecal baclofen treatment.
Provisional PDF of the complete article is available HERE.
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doi: 10.1093/rheumatology/ker202
Complex regional pain syndrome (CRPS) is a highly painful, limb-confined condition, which arises usually after trauma. It is associated with a particularly poor quality of life, and large health-care and societal costs. The causes of CRPS remain unknown. The condition's distinct combination of abnormalities includes limb-confined inflammation and tissue hypoxia, sympathetic dysregulation, small fibre damage, serum autoantibodies, central sensitization and cortical reorganization. These features place CRPS at a crossroads of interests of several disciplines including rheumatology, pain medicine and neurology. Significant scientific and clinical advances over the past 10 years hold promise both for an improved understanding of the causes of CRPS, and for more effective treatments. This review summarizes current concepts of our understanding of CRPS in adults. Based on the results from systematic reviews, treatment approaches are discussed within the context of these concepts. The treatment of CRPS is multidisciplinary and aims to educate about the condition, sustain or restore limb function, reduce pain and provide psychological intervention. Results from recent randomized controlled trials suggest that it is possible that some patients whose condition was considered refractory in the past can now be effectively treated, but confirmatory trials are required. The review concludes with a discussion of the need for additional research.
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The 'disinhibited' brain
New findings on CRPS -- a disease characterized by severe pain
The Complex Regional Pain Syndrome (CRPS), also known as Morbus Sudeck, is characterised by "disinhibition" of various sensory and motor areas in the brain. A multidisciplinary Bochum-based research group, led by Prof. Dr. Martin Tegenthoff (Bergmannsheil Neurology Department) and Prof. Dr. Christoph Maier (Bergmannsheil Department of Pain Therapy), has now demonstrated for the first time that with unilateral CRPS excitability increases not only in the brain area processing the sense of touch of the affected hand. In addition, the brain region representing the healthy hand is simultaneously "disinhibited". The group has been performing research on and treatment of CRPS for a number of years. The researchers are reporting the new findings in the renowned journal Neurology. The study was supported by the Research Funds of the Deutsche Gesetzliche Unfallversicherung (DGUV).Contact: Dr. Martin Tegenthoff
martin.tegenthoff@rub.de
49-234-302-6810
Ruhr-University Bochum
The rest of this press release can be read HERE.
This is the ABSTRACT for the much-hyped research itself:
Neurology September 13, 2011 vol. 77 no. 11 1096-1101
- M. Lenz,
- O. Höffken, MD,
- P. Stude, MD,
- S. Lissek, PhD,
- P. Schwenkreis, MD,
- A. Reinersmann,
- J. Frettlöh, PhD,
- H. Richter,
- M. Tegenthoff, MD and
- C. Maier, MD
Objective: In a previous study, we found bilateral disinhibition in the motor cortex of patients with complex regional pain syndrome (CRPS). This finding suggests a complex dysfunction of central motor-sensory circuits. The aim of our present study was to assess possible bilateral excitability changes in the somatosensory system of patients with CRPS.
Data Supplement: Three tables; Three Microsoft Excel documents
Methods: We measured paired-pulse suppression of somatosensory evoked potentials in 21 patients with unilateral CRPS I involving the hand. Eleven patients with upper limb pain of non-neuropathic origin and 21 healthy subjects served as controls. Innocuous paired-pulse stimulation of the median nerve was either performed at the affected and the unaffected hand, or at the dominant hand of healthy controls, respectively.
Results: We found a significant reduction of paired-pulse suppression in both sides of patients with CRPS, compared with control patients and healthy control subjects.
Conclusion: These findings resemble our findings in the motor system and strongly support the hypothesis of a bilateral complex impairment of central motor-sensory circuits in CRPS I.
Data Supplement: Three tables; Three Microsoft Excel documents
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