Pain physician
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Although chronic pain is generally treated with pharmacological and surgical interventions, many patients still fail to reach adequate pain relief through these methods. Patients and providers have looked to complementary and alternative strategies for managing chronic pain due to these methods' feasibility and cost-effectiveness and patients' preferences for them. Some promising interventions for chronic pain include resistance training, fasting therapy, sauna therapy, and cryotherapy. ⋯ The experimental evidence that confirms the pain-alleviating properties of these therapeutic modalities is scarce and warrants further investigation. However, a substantial amount of work supports the use of these modalities in the multimodal and multidisciplinary managements of chronic pain disorders. Future work should continue to elucidate the relationships between chronic pain disorders and resistance training, fasting therapy, sauna therapy, and cryotherapy so that guidelines can be developed.
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Randomized Controlled Trial
Fluoroscopy-guided Intradiscal Radiopaque Gelified Ethanol Injection Using an Anteroposterior View Compared to an Oblique View: A Randomized Controlled Trial.
This study introduces a new fluoroscopy-guided intradiscal radiopaque gelified ethanol injection technique using the antero-posterior view and compare it to conventional oblique view. Intradiscal procedures, are minimally invasive techniques that aim to reduce pain associated with lumbar disc herniation by modifying the disc material and decreasing pressure on surrounding nerves. ⋯ An anteroposterior view radiopaque gelified ethanol injection is a promising alternative to the conventional oblique view technique for radicular leg pain management. This novel approach offers a safer and more efficient treatment option, reducing radiation exposure and procedure time without compromising clinical outcomes. Its potential to minimize patient discomfort and enhance overall management of radicular leg pain warrants further investigation and widespread adoption.
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Paresthesia-based spinal cord stimulation (SCS) depends upon dorsal column (DC) fiber activation to engage pain-relieving neural mechanisms. However, the mechanisms for 10-kHz paresthesia-free SCS have not been fully elucidated. Preclinical work has shown selective drive of inhibitory dorsal horn neurons, while other hypotheses suggest that DC fibers may be activated. To provide clinical data for guiding mechanism work, we analyzed paresthesia perception thresholds (PPT) over a range of low to high kHz frequency and compared those values to the stimulation parameters from the therapeutic 10-kHz SCS programs used by patients. ⋯ Therapeutic 10-kHz SCS uses stimulation amplitudes far lower than the PPT, providing evidence that therapeutic 10-kHz SCS does not activate dorsal column axons. Additionally, the PPT decreases with increasing kHz frequency, suggesting that a presumed asynchronous pattern of activation from kHz stimulation does not raise the threshold at which sensation occurs.
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Opioids, which are widely used during surgery in perioperative settings, may cause hyperalgesia, especially when the opioid employed is remifentanil. Opioid-induced hyperalgesia may increase the length of a patient's hospital stay and negatively affect enhanced recovery after surgery and the patient's prognosis. Currently, there is no consensus on treatment strategies for remifentanil-induced postoperative hyperalgesia (RIPH). ⋯ Our results demonstrated that the upregulation of LCN2 in the ACC plays a crucial role in the occurrence of RIPH, suggesting that LCN2 potentially be a therapeutic target for alleviating RIPH.