Purpose of ReviewThe purpose of this review is to summarize the up-to-date pain management options and recommendations for the challenging disease, endometriosis. Recent Findings The mainstays of endometriosis advances of both surgical and medical management continue to evolve. Experimental pharmaceuticals include Gestirone, and aromatase inhibitors have shown promise but are still under scrutiny. Surgical techniques include laparoscopic uterosacral nerve ablation/resection and presacral neurectomy. Summary No studies have directly compared medical versus surgical management, and as such, no one treatment modality can be recommend as superior to the other. Patients may initially be given a medical diagnosis and treated with nonsteroidal antiinflammatory drugs, neurolepitcs, OCP, GNRH agonists/antagonists, and Danazol. Assessing the success of these regimens has proved difficult. Surgical management relies on various methods including excision/ablation of the lesions, nerve ablation, neurectomy, hysterectomy, and oophorectomy. KeywordsEndometriosis . Endometriosis pain management . Surgical management endometriosis . Medical management endometriosis . Endometriosis adjuvants . Endometriosis experimental treatments This article is part of the Topical Collection on Other Pain * Daniel Carlyle

During the routine dissection of upper limbs of a Caucasian male cadaver, variations were observed in the brachial plexus. In the right extremity, the lateral cord was piercing the coracobrachialis muscle. The musculocutaneous nerve and lateral root of the median nerve were observed to be branching inferior to the lower attachment of coracobrachialis muscle. The left extremity exhibited the passage of the median nerve through the flat tendon of the coracobrachialis muscle near its distal insertion into the medial surface of the body of humerus. A variation in the course and branching of the nerve might lead to variant or dual innervation of a muscle and, if inappropriately compressed, could result in a distal neuropathy. Identification of these variants of brachial plexus plays an especially important role in both clinical diagnosis and surgical practice.

In the course of routine dissection of the upper limbs of a Caucasian male cadaver, bilateral variations were observed in the brachial plexus. In the right extremity, the lateral cord was found to be piercing the coracobrachialis muscle. The musculocutaneous nerve and lateral root of the median nerve were observed to be branching inferior to the lower attachment of coracobrachialis muscle. The left extremity exhibited passage of the median nerve through the flat tendon of the coracobrachialis muscle near its distal insertion into the medial surface of the body of the humerus. A variation in the course and branching of a nerve might lead to variant or dual innervation of a muscle and if inappropriately compressed, could result in a distal neuropathy. Identification of these variants of brachial plexus plays an especially important role in both the clinical diagnosis of musculoskeletal pathology and surgical practice.

Epidural blood patches are routine procedures interventional pain physicians perform for postdural puncture headaches (PDPH), whether it be due to the inadvertent wet tap from an epidural or a diagnostic lumbar puncture. Typically, these patients are relatively healthy and an epidural is relatively straightforward. However, there are cases complicated by a neurologic history such as benign intracranial hypertension. Here, we present a case of a patient with benign intracranial hypertension (BIH) that suffered a postdural puncture headache after a diagnostic lumbar puncture, with no documented opening pressure, continued on acetazolamide. There have only been a small number of documented cases of BIH complicated by PDPH. We discuss the medical management of BIH, how it can exacerbate a postdural puncture headache, our definitive management with an epidural blood patch, and our concerns of rebound intracranial hypertension. We demonstrate that treatment of PDPH in BIH is best managed with image-guided blood patches, with smaller volume of autologous blood, and at a slower rate.

In the course of routine dissection of the upper limbs of a Caucasian male cadaver, bilateral variations were observed in the brachial plexus. In the right extremity, the lateral cord was found to be piercing the coracobrachialis muscle. The musculocutaneous nerve and lateral root of the median nerve were observed to be branching inferior to the lower attachment of coracobrachialis muscle. The left extremity exhibited passage of the median nerve through the flat tendon of the coracobrachialis muscle near its distal insertion into the medial surface of the body of the humerus. A variation in the course and branching of a nerve might lead to variant or dual innervation of a muscle and if inappropriately compressed, could result in a distal neuropathy. Identification of these variants of brachial plexus plays an especially important role in both the clinical diagnosis of musculoskeletal pathology and surgical practice.