Failed back surgery syndrome refers to persistent back pain following back surgery. The optimal course of treatment for this syndrome varies according to the patient and the etiology of the pain. This study describes the application of a treatment algorithm for failed back surgery syndrome, focusing on the use of epiduroscopy, a novel technique that is useful for diagnosis and treatment of this syndrome. Diagnoses and treatment success after one year of follow-up are reported.
Recibido el 2 de diciembre de 2013; aceptado el 12 de noviembre de 2014 Disponible en Internet el 29 de diciembre de 2014 PALABRAS CLAVE Neuralgia del pudendo; Dolor perineal; Tratamiento del dolor Resumen Objetivo: Presentar un algoritmo de manejo del dolor perineal crónico severo con sospecha de neuralgia del trigémino. Casos: Se presentan 3 casos clínicos con etiología y evolución clínica diversa. Discusión: Análisis de los criterios diagnósticos y tratamientos vigentes. Evaluación de los casos a la luz del algoritmo de diagnóstico y tratamiento propuesto. ß 2013 SEGO. Publicado por Elsevier España, S.L.U. Todos los derechos reservados. KEYWORDS Pudendal neuralgia; Chronic pelvic pain; Pain management Pudendal neuralgia: Algorithm for diagnostic and therapeutic management in a pain unit Abstract Objective: To describe a new algorithm for the management of severe chronic perineal pain/ pudendal neuralgia.Cases: We report 3 clinical cases with different etiologies and outcomes. Discussion: We analyze the diagnostic criteria and treatments and evaluate the rational management of these patients according to the algorithm.
Background: Tapentadol is a new oral analgesic with a dual mode of action as a mu-opioid receptor agonist and as norepinephrine reuptake inhibitor. The cost of treatment can be argued as a problem for prescribing it.Objective: The aim of this study was to compare the cost-effectiveness of tapentadol to that of associations of other opioids with pregabalin.Patients and methods: 21 patients suffering chronic pain under treatment with opioids and pregabalin for more than 3 months and pain poorly controlled (VAS > 4) were proposed to change to tapentadol in a progressive manner: First changing the opioid to tapentadol and then removing pregabalin. Pain (VAS), daily cost of treatments and adverse effects incidence were registered.Results: Four patients returned to prior treatment because of higher incidence of adverse effects. In the group of 17 patients who completed the change of treatment pain improved from 5.7 (VAS) to 3.4 (VAS) (p < 0.001), and the cost of treatment from 4.57 €/day to 3.78 €/day (p < 0.05).Conclusion: Tapentadol treatment may be cost-effective when compared with associations of other opioids and pregabalin in patients suffering moderate to severe chronic pain. More extensive studies must be done in this sense.
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