Posterior neck pain is a common complaint of patients in the pain clinic. The atlas (C1) burst fracture is known to be a cause of posterior neck pain and instability. Although the atlas burst fracture and instability can be discovered by plain X-rays which show lateral mass displacement or widening of the atlantodental interval, assessment of an atlas burst fracture can be difficult if there is no instability in the imaging study. Here we report a case of a 46-year-old female patient who had complained of sustained posterior neck pain for 6 months. Plain X-rays showed only disc space narrowing at C4/5 and C5/6, without any cervical instability. However, an unrecognized C1 lateral mass fracture was detected by CT and MRI. The patient's pain was then successfully treated after atlantoaxial joint injection with a C2 DRG block.
Atlanto-Axial Joint ; Cervical Atlas ; Diagnosis-Related Groups ; Displacement (Psychology) ; Female ; Humans ; Middle Aged ; Neck Pain ; Pain Clinics ; Spinal Fractures

BACKGROUND: Elderly patients visiting pain clinic may be at greater risk of misunderstanding the explanation because of age-related cognitive decline. Video instruction may provide a consistent from of teaching in a visual and realistic manner. We evaluated the effect of educational video on the patient understanding and satisfaction in a group of geriatric patients visiting pain clinic. METHODS: Ninety two patients aged more than 60 years old who were scheduled for transforaminal epidural block were recruited. After exposure to either video or paper instruction process, each patient was asked 5-item comprehension questions, overall satisfaction and preference question. During follow-up period, number of outpatient referral-line call for further explanation was counted. RESULTS: We observed significantly better comprehension in the video education compared with paper instruction (P < 0.001). Patient satisfaction was also higher in the video group (P = 0.015), and patients visiting pain clinic were more preferred video instruction (P < 0.001). Proportion of referral-line call for further explanation were similar (P = 0.302). CONCLUSIONS: Video approach to instruction process before consent improves treatment comprehension in geriatric patient visiting pain clinic.
Aged ; Comprehension ; Follow-Up Studies ; Humans ; Outpatients ; Pain Clinics ; Patient Satisfaction

BACKGROUND: Prevalence of chronic pain and its association with demographic characteristics have been reported by different studies from different geographical regions in the world. However, data from many Middle East countries including Iran (especially southern Iran) are scare. The aim of the present study was to demonstrate the prevalence of chronic pain and its association with demographic, psychological and socioeconomic factors in an Iranian population. METHODS: In this population-based survey, the target population was comprised of subjects aged 20 to 85 years residing in Jahrom, southern Iran during 2009-2011. All eligible subjects were invited to participate in the study. Before a detailed questionnaire was given; face to face interviews were done for each individual. RESULTS: There were 719 men and 874 women with an average age of 40.5 years at the onset of the study. Among the study population, 38.9% (620/1,593) complained of chronic pain, of whom 40.8% (253/620) were men and 59.2% (367/620) were women. Foot and joint pain were observed in 31.9%. Hip and spine pain, migraine and tension headaches, heart pain, and abdomen pain were observed in 21.5%, 15.5%, 9.5%, and 8.0% of chronic pain cases, respectively. There was a significant association among the covariables age, sex, overweight, educational level, income, and type of employment with chronic pain as the dependent variable (P < 0.0001). CONCLUSIONS: Our findings show the prevalence of chronic pain and its association with demographic, psychological and socioeconomic factors. Individuals with low incomes and less education became accustomed to pain due to a lack of knowledge.
Abdomen ; Aged ; Aging ; Arthralgia ; Chronic Pain ; Employment ; Female ; Foot ; Health Services Needs and Demand ; Heart ; Hip ; Humans ; Iran ; Male ; Middle East ; Migraine Disorders ; Overweight ; Prevalence ; Surveys and Questionnaires ; Socioeconomic Factors ; Spine ; Tension-Type Headache

BACKGROUND: Vitamin E is widely known to be one of the reactive oxygen species (ROS) scavengers and a drug that can easily be obtained, and it has been shown to attenuate the pain responses induced by various causes in animal pain models. Thus, this experiment was conducted to assess the antinociceptive effects of vitamin E by comparing intraperitoneal and intrathecal injections in rats subjected to the formalin test. METHODS: After the intraperitoneal and intrathecal injections of vitamin E were carried out, respectively (IP: 500 mg/kg, 1 g/kg, and 2 g/kg, IT: 3 mg/kg, 10 mg/kg, and 30 mg/kg), the formalin test was perfumed. As soon as 5% formalin was injected into left hind paw, the number of flinches induced by pain was measured at 5-minute intervals for 1 hour. RESULTS: Formalin injected into the left hind paw induced biphasic nociceptive behavior in all animals. Intraperitoneal injection of vitamin E diminished the nociceptive behavior in a dose-dependent manner during the early and late phase. Intrathecal vitamin E diminished nociceptive behavior dose dependently during the late phase but showed no significant difference in the early phase. CONCLUSIONS: Vitamin E attenuated acute nociception when it was injected systemically, while both systemic and intrathecal injection produced analgesia in a rat model of formalin-induced hyperalgesia.
Analgesia ; Animals ; Formaldehyde ; Hyperalgesia ; Injections, Intraperitoneal ; Injections, Spinal ; Nociception ; Pain Measurement ; Rats ; Reactive Oxygen Species ; Vitamin E ; Vitamins

BACKGROUND: Milnacipran is a balanced serotonin norepinephrine reuptake inhibitor with minimal side effects and broad safety margin. It acts primarily on the descending inhibitory pain pathway in brain and spinal cord. In many animal studies, intrathecal administration of milnacipran is effective in neuropathic pain management. However, there is no study for the neurological safety of milnacipran when it is administered neuraxially. This study examined the neurotoxicity of epidural milnacipran by observing behavioral and sensory-motor changes with histopathological examinations of spinal cords in rats. METHODS: Sixty rats were divided into 3 groups, with each group receiving epidural administration of either 0.3 ml (3 mg) of milnacipran (group M, n = 20), 0.3 ml of 40% alcohol (group A, n = 20), or 0.3 ml of normal saline (group S, n = 20). RESULTS: There were no abnormal changes in the behavioral, sensory-motor, or histopathological findings in all rats of groups M and S over a 3-week observation period, whereas all rats in group A had abnormal changes. CONCLUSIONS: Based on these findings, the direct epidural administration of milnacipran in rats did not present any evidence of neurotoxicity in behavioral, sensory-motor and histopathological evaluations.
Animals ; Brain ; Cyclopropanes ; Injections, Epidural ; Neuralgia ; Norepinephrine ; Rats ; Serotonin ; Spinal Cord

BACKGROUND: It has been reported that curcumin, the main active compound of Curcuma longa, also known as turmeric, exhibits antinociceptive properties. The aim of this study was to examine the participation of ATP-sensitive potassium channels (KATP channels) and, in particular, that of the L-arginine-nitric oxide-cyclic GMP-KATP channel pathway, in the antinociceptive effect of curcumin. METHODS: Pain was induced by the intraplantar injection of 1% formalin in the right hind paw of Wistar rats. Formalin-induced flinching behavior was interpreted as an expression of nociception. The antinociceptive effect of oral curcumin was explored in the presence and absence of local pretreatment with L-NAME, an inhibitor of nitric oxide synthase, ODQ, an inhibitor of soluble guanylyl cyclase, and glibenclamide, a blocker of KATP channels. RESULTS: Oral curcumin produced a dose-dependent antinociceptive effect in the 1% formalin test. Curcumin-induced antinociception was not altered by local L-NAME or ODQ, but was significantly impaired by glibenclamide. CONCLUSIONS: Our results confirm that curcumin is an effective antinociceptive agent. Curcumin-induced antinociception appears to involve the participation of KATP channels at the peripheral level, as local injection of glibenclamide prevented its effect. Activation of KATP channels, however, does not occur by activation of the L-arginine-nitric oxide-cGMP-KATP channel pathway.
Curcuma ; Curcumin ; Formaldehyde ; Glyburide ; Guanylate Cyclase ; KATP Channels ; NG-Nitroarginine Methyl Ester ; Nitric Oxide Synthase ; Nociception ; Pain Measurement ; Potassium Channels ; Rats, Wistar ; Receptors, Cytoplasmic and Nuclear

BACKGROUND: It has been demonstrated that the expression of tumor necrosis factor-alpha (TNF-alpha) and apoptotic cell death in the dorsal root ganglion (DRG) following spinal nerve constriction injury play a role in the initiation and continuation of hyperalgesia and allodynia. The present study was designed to investigate the effects of ethyl pyruvate (EP) on mechanical and cold allodynia, TNF-alpha expression, and apoptosis in DRG after spinal nerve ligation injury. METHODS: Rats were divided into 3 groups: control, pre-EP, and post-EP. EP (50 mg/kg) was intraperitoneally injected 30 minutes before (pre-EP) or after (post-EP) surgery. Behavioral tests to determine mechanical and cold allodynia were conducted before surgery and 4 and 7 days after surgery. Seven days after surgery, TNF-alpha protein levels in DRG were evaluated by enzyme-linked immunosorbent assay, and DRG apoptosis was determined by immunohistochemical detection of activated caspase-3. RESULTS: Treatment with EP significantly reduced mechanical and cold allodynia following spinal nerve ligation injury. TNF-alpha protein levels in the pre-EP (4.7 +/- 1.2 pg/200 microg; P < 0.001) and post-EP (6.4 +/- 1.8 pg/200 microg; P < 0.001) groups were 2-3 times lower than the control group (14.4 +/- 1.2 pg/200 microg). The percentages of neurons and satellite cells that co-localized with caspase-3 were also significantly lower in the pre-EP and post-EP groups than the control group. CONCLUSIONS: These results demonstrate that EP has a strong anti-allodynic effect that acts through the inhibition of TNF-alpha expression and apoptosis in DRG after spinal nerve ligation injury.
Animals ; Apoptosis ; Caspase 3 ; Cell Death ; Cold Temperature ; Constriction ; Diagnosis-Related Groups ; Enzyme-Linked Immunosorbent Assay ; Ganglia, Spinal ; Hyperalgesia ; Ligation ; Neurons ; Pyruvates ; Pyruvic Acid ; Rats ; Spinal Nerve Roots ; Spinal Nerves ; Tumor Necrosis Factor-alpha

No abstract available.

Pulsed radiofrequency (PRF) treatment of nervous tissue has been proposed as a less neurodestructive technique alternative to continuous RF heat lesioning. Recently, clinical reports using PRF have shown favorable effects in the treatment of a variety of focal pain areas, even in non-nervous tissues; however, the mechanism of effect underlying this treatment to non-nervous tissue remains unclear. We report the case of a 67-year-old male who presented with pain reliving point in the posterior neck. The patient had pain in the posterior neck for 3 years. The pain subsided with pressure applied to a point in the posterior neck. There were no specific abnormal findings on laboratory testing and radiologic examinations. After PRF treatment to the pain-relieving point, he had pain relief which lasted more than 5 months.
Aged ; Hot Temperature ; Humans ; Male ; Neck ; Pulsed Radiofrequency Treatment

Although postherpetic neuralgia (PHN) is a common chronic pain syndrome, the pathophysiology of this disorder is not well known and management is often very difficult. N-Methyl-D-Aspartate (NMDA) receptor antagonists are known to be effective in PHN, and magnesium, a physiological blocker of NMDA receptors, is widely used to treat various chronic pain disorders. Here, we present a case of the PHN refractory to conventional treatment, which was treated successfully with transforaminal epidural injection of magnesium sulphate at the affected dermatome.
Chronic Pain ; Injections, Epidural ; Magnesium ; N-Methylaspartate ; Neuralgia, Postherpetic ; Receptors, N-Methyl-D-Aspartate