Pain physician
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Chronic low back pain is a major social, economic, and healthcare issue in the United States. Various techniques are utilized in managing discogenic pain, with or without disc herniation. Percutaneous techniques are rapidly replacing traditional open surgery in operations requiring discectomy, decompression, and fusion. ⋯ The most often stated goal of central nuclear decompression is to lower the pressure in the nucleus and to allow room for the herniated fragment to implode inward. Provocative discography prior to percutaneous lumbar disc decompression is recommended. Percutaneous disc decompression may result in a small number of complications but occasionally, these could be serious.
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Comparative Study Controlled Clinical Trial
Quality assurance for interventional pain management procedures.
Over the last decade various guidelines for quality assurance in pain medicine have been published for cancer pain, acute postoperative pain and other pain conditions. However, quality assurance for interventional pain management procedures has yet to be addressed. An interventional pain program should at least evaluate 1) efficacy of pain relief; 2) complication rate; and 3) patient satisfaction. ⋯ The results of the current study indicate that quality assurance of interventional pain management procedures in terms of immediate pain relief following the procedure, low complication rate, and high patient satisfaction can be achieved through application of a quality assurance program.
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Comparative Study
A novel approach to transnasal sphenopalatine ganglion injection.
Sphenopalatine ganglion block is used to treat headache and facial pain. There are transnasal, transoral and lateral approaches to establish the blockade. The transnasal application of topical anesthetic is the simplest and most common technique among the three. However, the diffusion of topical anesthetic to the ganglion is unpredictable and the blockade is not durable. ⋯ This method preserves the technical simplicity of the original transnasal approach and includes the predictability and durability of the blockade from needle injection.
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Comparative Study Controlled Clinical Trial
Evaluation of therapeutic thoracic medial branch block effectiveness in chronic thoracic pain: a prospective outcome study with minimum 1-year follow up.
The prevalence of persistent upper back and mid back pain due to involvement of thoracic facet joints has been described in controlled studies as varying from 43% to 48% based on IASP criteria. Therapeutic intraventions utilized in managing chronic neck pain and low back pain of facet joint origin include intraarticular injections, medial branch nerve blocks, and neurolysis of medial branch nerves by means of radiofrequency. These interventions have not been evaluated in managing chronic thoracic pain of facet joint origin. ⋯ Therapeutic thoracic medial branch blocks were an effective modality of treatment in managing chronic thoracic pain secondary to facet joint involvement confirmed by controlled, comparative local anesthetic blocks.
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Comparative Study Controlled Clinical Trial
Treatment of painful advanced internal lumbar disc derangement with intradiscal injection of hypertonic dextrose.
Degenerative discs are thought to produce nerve root pain either mechanically or chemically. Particularly in the case of advanced degenerative disc disease, this clinical entity has often proven to be symptomatically resistant to peridural steroids, Intra-discal Electrothermoplasty (IDET) and direct surgical intervention. Exposure of irritated nerves to hypertonic dextrose is thought to have chemoneuromodulatory potential. Sustained pain reduction has been demonstrated in a pilot study involving injection of a combination of dextrose, glucosamine, chondroitin and dimethylsulfoxide into degenerative discs of patients with chronic low back pain of discogenic origin. ⋯ The results suggest that intradiscal injection of hypertonic dextrose may have a place in the management of pain arising from advanced lumbar degenerative disc disease.