Pain medicine : the official journal of the American Academy of Pain Medicine
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Radiofrequency denervation of the zygapophysial (facet) joint is a frequently performed procedure for chronic low back pain. Several studies have shown considerable efficacy of the procedure, but none of the randomized controlled trials performed to date has used anatomically correct placement of radiofrequency cannula parallel to the target nerve. Three main techniques have been utilized for many years: North American, European, and Australian. Each has conceptual and technical limitations. This review analyzes these techniques and proposes a standardized technique of radiofrequency denervation of lumbar zygapophysial joints. ⋯ We believe that the technique using "tunnel vision" with anatomically appropriate cannula placement and use of a large-bore, curved needle with a 10-mm active tip may improve the results of radiofrequency denervation of lumbar zygapophysial joints. Providing a detailed description of an anatomically accurate technique should be of value to those seeking to perform this procedure in a valid manner.
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In this post hoc observational study, we investigated psychological predictors of outcome after radiofrequency and injection treatments, commonly performed in the management of chronic low back pain (CLBP). ⋯ Minimally invasive treatment for CLBP leads to significant pain reduction, including potential placebo effects. However, psychologically vulnerable patients, characterized by, among others, reduced life control, disturbed mood, negative self-efficacy, catastrophizing, high anxiety levels, inadequacy, and poor mental health, tend not to respond to this treatment. Patients characterized by a.o. reduced pain and interference levels, positive expectations, and reasonable physical and social functioning, react more favorably. From both a clinical and a financial perspective, psychosocial evaluation and selection of patients seems appropriate, before applying minimally invasive procedures for CLBP.
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This study was conducted to examine the psychometric properties of a Chinese translation of the Pain Catastrophizing Scale (HK-PCS). ⋯ This study has illustrated satisfactory psychometric properties of the HK-PCS. We provide evidence for the validity and reliability of the HK-PCS as an instrument for measuring pain catastrophizing in the Chinese patient with chronic pain.
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Case Reports
An N-of-1 trial as an aid to decision-making prior to implanting a permanent spinal cord stimulator.
Limited evidence supports the efficacy of spinal cord stimulation (SCS). Therefore, it is crucial to assess the usefulness of this invasive procedure before implanting permanent electrodes in each patient. An N-of-1 trial is an experiment in which a single participant undergoes periods of comparative treatments. We illustrate how an N-of-1 trial design may permit clinicians to conduct such an assessment in an individual patient. ⋯ We encourage clinicians to perform an N-of-1 trial in every patient before implanting permanent electrodes for SCS.
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1) To determine if the neuropathic pain scale (NPS) can be used to classify chronic pain patients (CPPs) as having primarily neuropathic vs non-neuropathic pain, and furthermore; 2) to determine what, if any, cut-off score can be used to reliably make this determination. ⋯ The NPS appears to be able to discriminate between neuropathic and non-neuropathic pain. A debate is currently raging as to whether diagnoses, such as fibromyalgia and complex regional pain syndrome 1, can be classified as neuropathic. Our NPS cut-off score results suggest that these diagnoses may have a neuropathic pain component. The reliability and validity of our NPS method will need to be tested further in other neuropathic pain models, such as diabetic peripheral neuropathic pain.