Pain physician
-
Chronic headache is a significant medical and socioeconomic problem resulting in severe disability and impairment. The term "cervicogenic headache" was coined by Sjaastad in 1983, who also proposed criteria for its diagnosis. Cervicogenic headache as described by Sjaastad et al is characterized as recurrent, long lasting, severe unilateral headache arising from the neck. ⋯ Because of the numerous potential pain generators, neither uniform clinical findings, nor a pathophysiology has been defined for the entity known as cervicogenic headache. Sequential diagnostic injections may elucidate pain generators and differentiate it from other types of headaches. This review describes the epidemiological and clinical aspects of cervicogenic headache, pathophysiology, diagnostic strategies to differentiate it from other common headaches and describes various non-operative treatment strategies.
-
Caudal epidural administration of corticosteroids is one of the commonly used interventions in managing chronic low back pain. Reports of the effectiveness of all types of epidural steroids have varied from 18% to 90%. Sicard, a radiologist, was the first to describe injection of dilute solutions of cocaine through the sacral hiatus into the epidural space in 1901, to treat patients suffering from severe, intractable sciatic pain or lumbago. ⋯ The clinical effectiveness evaluations fill the literature with various types of reports including randomized clinical trials, prospective trials, retrospective studies, case reports, and meta-analyses. Evidence from all types of evaluations with regards to the clinical and cost-effectiveness of caudal epidural injections is encouraging. This review discusses various aspects of the role of caudal epidural injections in the management of chronic low back pain, including pathophysiology of low back pain, indications, clinical effectiveness and complications.