The Right to Pain Relief

2021 ◽  
Vol Publish Ahead of Print ◽  
Author(s):  
Mark D. Sullivan ◽  
Jane C. Ballantyne
Keyword(s):  
2017 ◽  
Vol 3 (20;3) ◽  
pp. E451-E454 ◽  
Author(s):  
Stephanie Jones

Pudendal neuralgia (PN) is a result of pudendal nerve entrapment or injury, also called “Alcock syndrome.” Pain that develops is often chronic, and at times debilitating. If conservative measures fail, invasive treatment modalities can be considered. The goal of this case report is to add to a small body of literature that a pulsed radiofrequency (PRF) ablation can be effectively used to treat PN and to show that high resolution MR neurography imaging can be used to detect pudendal neuropathy. Case Presentation: We present a case of a 51-year-old woman with 5 years of worsening right groin and vulva pain. Various medication trials only lead to limited improvement in pain. The first diagnostic right pudendal nerve block was done using 3 mL of 0.25% bupivacaine with 6mg of betamethasone using a transgluteal technique and a target of the right ischial spine; this procedure resulted in ~8 hours of > 50% pain relief. The patient was then referred for MR neurography of the lumbosacral plexus. This study revealed increased signal of the right pudendal nerve at the ischial spine and in the pudendal canal, findings consistent with the clinical picture of PN. Six weeks after the initial block, the patient underwent a second right transgluteal pudendal nerve block, utilizing 3 mL of 0.25% bupivacaine with 40 mg of triamcinolone acetonide; this procedure resulted in ~8 hours of 100% pain relief. Satisfied with these results the patient decided to undergo pudendal nerve PRF ablation for possible long-term relief. For this therapeutic procedure, a right transgluteal approach was again utilized. PRF ablation was performed for 240 seconds at 42° Celsius. Following this ablation the patient reported at least 6 weeks of significant (> 50%) pain relief. Discussion and Conclusion: In this paper we presented a case of successful treatment of PN with PRF ablation and detection of pudendal neuropathy on MR neurography. We believe that transgluteal PRF ablation for PN might be an effective, minimally invasive option for those patients that have failed conservative management. MR neurography employed in this case is not only helpful in confirming the diagnosis of PN but could also be useful in ruling out other causes of pelvic pain, such as genitofemoral neuropathy, endometriosis, adenomyosis, or pelvic mass lesion. To conclude, transgluteal PRF ablation can serve as a viable treatment option for mitigating symptoms of pudendal neuropathy and MR neurography is useful in confirming a clinically suspected diagnosis of PN. Key words: Pelvic pain, pudendal neuralgia, MR neurography, pulsed radiofrequency ablation, transgluteal technique, Alcock canal syndrome


2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Başak Akça ◽  
Aysun Ankay Yılbaş ◽  
Filiz Üzümcügil ◽  
Berkem Büyükakkuş ◽  
Elham Bahador Zırh ◽  
...  

Abstract Background Intraarticular injections are widely used to provide pain relief after arthroscopic procedures and minimize the use of opioids. Dexmedetomidine has been proven to potentiate pain relief and postpone the demand for the first analgesic drug when it is used intraarticularly following arthroscopic knee procedures. However, the effects of dexmedetomidine on articular structures have not yet been evaluated. Our aim was to determine the effects of intraarticular dexmedetomidine injection on articular structures such as cartilage and synovium. Design Animal study. Methods Twenty adult rats (Sprague-Dawley) were enrolled in the study. Following appropriate aseptic and anesthetic conditions, dexmedetomidine (100 mcg/ml) (0.25 ml) was injected into the right knee joint (the study group) and normal saline solution (0.25 ml) into the left knee joint (the control group) of the rats. Four rats were sacrificed from each group on days 1, 2, 7, 14, and 21, and knee joint samples were obtained. Histologists evaluated the articular and periarticular regions and the synovium using histological sections, and a five-point scale was used to grade the inflammatory changes in a blinded manner. Results The groups were found to be similar in terms of median congestion scores, edema and inflammation scores, subintimal fibrosis, neutrophil activation and cartilage structure at each of the time intervals. Conclusion In our placebo-controlled, in vivo trial, the intraarticular use of dexmedetomidine seemed to be safe with respect to the studied histopathological parameters. However, complementary studies investigating the histopathological effects, analgesic dosage and adverse effects of dexmedetomidine on damaged articular structure models are needed.


JMS SKIMS ◽  
2011 ◽  
Vol 14 (1) ◽  
pp. 1-3
Author(s):  
Javaid A Zargar ◽  
Abdul Qayoom Lone

The individuals rights in the United States, and the rise of democratic states, has created an environment in which individual pursuit of better health care, including pain relief, became explicit goals in the civilized world. The 'right to pain relief' has now multidimensional foundations in the developed world. Knowingly, acute pain is a universal phenomenon. All emergency and elective surgery, severe medical illness, trauma, childbirth, burns, natural calamities, war and torture, all contribute to its burden. In many countries political conflict, social dislocation, and inadequate availability of analgesics conspire to make the relief of acute pain sporadic at best. Effective and efficient pain control, however, is an ethical responsibility and moral obligation of a caring physician, whether working in the developed or developing world . JMS 2011;14(1):1-3


2008 ◽  
Vol 65 (6) ◽  
pp. 492-494
Author(s):  
Slobodan Culafic ◽  
Milan Spaic ◽  
Uros Zoranovic ◽  
Sidor Misovic

Introduction. Idiopathic obturator neuralgia is a rare chronic pain condition. It consists of pain radiating from the obturator nerve territory to the inner thigh. However, the symptomatic obturator neuralgia is commonly caused by the obturator canal bowel hernia that causes painful compressive neuropathy in more than 85% of the cases. Case report. A 61-year-old female who underwent right femoral amputation due to the occlusion of the aortofemoral vascular graft, complained of the pain characterized by its localization in the inguinal region and anterointernal side of the right inner thigh. Computer tomography and MRI findings excluded obturator canal herniation or lumbar plexopathy. A diagnosis of the obturator neuralgia was confirmed by an analgesic block of the obturator nerve. Thereafter, the neurolitic blockade of the right obturator nerve was done. The complete pain relief was achieved. Pain relief was complete in three-month follow-up period. Conclusion. Neurolitic blockade is an efficacious method in treating chronic pain caused by the idiopathic obturator neuralgia.


Chelovek RU ◽  
2020 ◽  
pp. 229-243
Author(s):  
Pavel Tishchenko ◽  

The idea of human design rests in the heart of European humanist project. The existential meaning of the idea of human design is analyzed. A piece of the work by J. Pico della Mirandola is interpreted as a prophecy expressing the fate of the New European era (by M. Heidegger). Several aspects could be distin-guished in this prophecy: the throwing of man into the world without his place, form and purpose, the right and demand to define both place and form and raison d 'être by reason. Historically, special exper-iments of solving the fundamental mystery are considered - what it means to be human from Descartes to modern transhumanistic projects of human self-construction? The meaning of the New Time era is de-fined through J. Pico 's proposed existential task. It is emphasized that at every historically special stage of subjugation of the nature of man, the dream of almighty condensed in the strange topos of about-being. Faced with the impossibility of defeating death, and without abandoning new projects of its sub-jugation, the modern era generates existential substitution. Suffering is put on the scene of death as the main representative of evil. The result is euthanasia technologies that view death not just as a lesser evil compared to suffering (pain), but as the most radical mean of achieving the new goal - radical pain relief. A thought experiment is being conducted to demonstrate the possibility of self-destruction of mankind motivated by the desire to solve the difficult problems of mankind in the way of its euthanasia.


2005 ◽  
Vol 23 (2) ◽  
pp. 83-85 ◽  
Author(s):  
Susmita Oomman ◽  
David Liu ◽  
Mike Cummings

A 39 year old woman, scheduled for elective caesarean section in her second pregnancy, developed thrombocytopenia. Therefore, at the time of surgery, spinal anaesthesia and non-steroidal analgesic drugs were avoided and she was given a standard general anaesthetic procedure including fentanyl 100μg and morphine 10mg. In the early postoperative period she received tramadol 100mg and a further 10mg of morphine. These drugs did not control her pain, but caused side effects - in particular nausea and retching. Acupuncture to LI4 and PC6 on the right side produced dramatic pain relief within minutes.


2012 ◽  
Vol 2012 ◽  
pp. 1-4 ◽  
Author(s):  
Edward C. Mader ◽  
Bruce J. Fisch ◽  
Nicole R. Villemarette-Pittman ◽  
Piotr W. Olejniczak ◽  
Michael E. Carey

Intractable epilepsy with painful partial motor seizures is a relatively rare and difficult disorder to treat. We evaluated the usefulness of botulinum toxin to reduce ictal pain. Two patients received two or four botulinum toxin (BTX) injections at one-to-two-month intervals. Patient 1 had painful seizures of the right arm and hand. Patient 2 had painful seizures involving the left foot and leg. Injections were discontinued after improved seizure control following resective surgery. Both patients received significant pain relief from the injections with analgesia lasting at least two months. Seizure severity was reduced, but seizure frequency and duration were unaffected. For these patients, BTX was effective in temporarily relieving pain associated with muscle contraction in simple partial motor seizures. Our findings do not support the hypothesis that modulation of motor end-organ feedback affects focal seizure generation. BTX is a safe and reversible treatment that should be considered as part of adjunctive therapy after failure to achieve control of painful partial motor seizures.


2016 ◽  
Vol 8 (12) ◽  
pp. e51-e51 ◽  
Author(s):  
Angelika Kosse ◽  
Jonathan Pishoi Nakhla ◽  
Reza Yassari ◽  
Apolonia Elisabeth Abramowicz ◽  
Allan Brook

A middle aged patient with multiple myeloma resulting in numerous pathological fractures underwent an L2, L3, and L5 vertebral cement augmentation for pain relief. After injection, the trocar at L2, the final level, could not be withdrawn despite several attempts of needle rotation, a second needle inserted to distract on, and rocking the needle on the pedicle. After a neurosurgical consultation, the patient was transferred to the operating room for open removal. As the needle protruded approximately 3 inches from the patient's back, the patient could not be positioned supine, and was anesthetized and intubated in the right semi-prone position prior to being placed prone on the operating room table. The needle was surgically exposed, cut off at the pedicular bone edge, and its free component was removed.


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