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      Lumbar foraminal neuropathy: an update on non-surgical management

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          Abstract

          Lumbar foraminal pathology causing entrapment of neurovascular contents and radicular symptoms are commonly associated with foraminal stenosis. Foraminal neuropathy can also be derived from inflammation of the neighboring lateral recess or extraforaminal spaces. Conservative and interventional therapies have been used for the treatment of foraminal inflammation, fibrotic adhesion, and pain. This update reviews the anatomy, pathophysiology, clinical presentation, diagnosis, and current treatment options of foraminal neuropathy.

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          Opioid-induced hyperalgesia: a qualitative systematic review.

          Martin S Angst, J David Clark (2006)
          Opioids are the cornerstone therapy for the treatment of moderate to severe pain. Although common concerns regarding the use of opioids include the potential for detrimental side effects, physical dependence, and addiction, accumulating evidence suggests that opioids may yet cause another problem, often referred to as opioid-induced hyperalgesia. Somewhat paradoxically, opioid therapy aiming at alleviating pain may render patients more sensitive to pain and potentially may aggravate their preexisting pain. This review provides a comprehensive summary of basic and clinical research concerning opioid-induced hyperalgesia, suggests a framework for organizing pertinent information, delineates the status quo of our knowledge, identifies potential clinical implications, and discusses future research directions.
          Article 0 comments Cited 149 times – based on 0 reviews     Review now
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            Electrical inhibition of pain by stimulation of the dorsal columns: preliminary clinical report.

            C Shealy, J T Mortimer, J B Reswick (2015)
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              Ketamine for chronic pain: risks and benefits.

              Marieke Niesters, Christian Martini, Albert Dahan (2014)
              The anaesthetic ketamine is used to treat various chronic pain syndromes, especially those that have a neuropathic component. Low dose ketamine produces strong analgesia in neuropathic pain states, presumably by inhibition of the N-methyl-D-aspartate receptor although other mechanisms are possibly involved, including enhancement of descending inhibition and anti-inflammatory effects at central sites. Current data on short term infusions indicate that ketamine produces potent analgesia during administration only, while three studies on the effect of prolonged infusion (4-14 days) show long-term analgesic effects up to 3 months following infusion. The side effects of ketamine noted in clinical studies include psychedelic symptoms (hallucinations, memory defects, panic attacks), nausea/vomiting, somnolence, cardiovascular stimulation and, in a minority of patients, hepatoxicity. The recreational use of ketamine is increasing and comes with a variety of additional risks ranging from bladder and renal complications to persistent psychotypical behaviour and memory defects. Blind extrapolation of these risks to clinical patients is difficult because of the variable, high and recurrent exposure to the drug in ketamine abusers and the high frequency of abuse of other illicit substances in this population. In clinical settings, ketamine is well tolerated, especially when benzodiazepines are used to tame the psychotropic side effects. Irrespective, close monitoring of patients receiving ketamine is mandatory, particularly aimed at CNS, haemodynamic, renal and hepatic symptoms as well as abuse. Further research is required to assess whether the benefits outweigh the risks and costs. Until definite proof is obtained ketamine administration should be restricted to patients with therapy-resistant severe neuropathic pain.
              Article 0 comments Cited 135 times – based on 0 reviews     Review now
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                Author and article information

                Journal
                Journal ID (nlm-ta): Korean J Pain
                Journal ID (iso-abbrev): Korean J Pain
                Title: The Korean Journal of Pain
                Publisher: The Korean Pain Society
                ISSN (Print): 2005-9159
                ISSN (Electronic): 2093-0569
                Publication date (Print): July 2019
                Publication date (Electronic): 01 July 2019
                Volume: 32
                Issue: 3
                Pages: 147-159
                Affiliations
                New Jersey Pain Medicine for the Difficult and Failed Pain, Robert Wood Johnson University Hospital Rahway, Rahway, NJ, USA
                Author notes
                Correspondence to: Young Kook Choi, New Jersey Pain Medicine for the Difficult and Failed Pain, Robert Wood Johnson University Hospital Rahway, 865 Stone Street, Rahway, NJ 07065, USA, Tel: +1-732-754-0369, Fax: +1-855-492-5768, E-mail: choiyomd@ 123456hotmail.com , ORCID: https://orcid.org/0000-0002-9572-011X
                Article
                Publisher ID: kjp-32-147
                DOI: 10.3344/kjp.2019.32.3.147
                PMC ID: 6615450
                PubMed ID: 31257823
                SO-VID: a29b7d7f-92b7-4157-924b-5959b62c2b8f
                Copyright © © The Korean Pain Society, 2019
                License:

                This is an open-access article distributed under the terms of the Creative Commons Attribution Non-Commercial License ( http://creativecommons.org/licenses/by-nc/4.0/), which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                Date received : 10 May 2019
                Date revision received : 11 June 2019
                Date accepted : 11 June 2019
                Categories
                Subject: Review Article

                ScienceOpen disciplines: Anesthesiology & Pain management
                Keywords: constriction, pathologic,decompression,electric stimulation,fibrosis,foraminotomy,ganglia, spinal,inflammation,lumbosacral region,pain management,radiculopathy,spinal nerve roots
                Data availability:
                ScienceOpen disciplines: Anesthesiology & Pain management
                Keywords: constriction, pathologic, decompression, electric stimulation, fibrosis, foraminotomy, ganglia, spinal, inflammation, lumbosacral region, pain management, radiculopathy, spinal nerve roots

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