Pain physician
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Randomized Controlled Trial Clinical Trial
Acute cardiovascular effects of epidural spinal cord stimulation.
Several animal studies support the contention that thoracic spinal cord stimulation (SCS) might decrease arterial blood pressure. ⋯ This study demonstrated that SCS at either the T1-T2 or T5-T6 region did not significantly alter MAP or HR compared to baseline (no SCS). However, during transcient stress (elevated sympathetic tone) induced by CPT, there was a significant increase in MAP and moderate decrease in HR during SCS at T5-T6 region, which is not consistent with previous data in the literature. Acute SCS did not result in adverse cardiovascular responses and proved to be safe.
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Clinical Trial
Transsacrococcygeal approach to ganglion impar block for management of chronic perineal pain: a prospective observational study.
The ganglion impar or ganglion of Walther is a solitary retroperitoneal structure at the level of sacrococcygeal junction. It provides the nociceptive and sympathetic supply to the perineal structures. Chronic Perineal Pain (CPP) has been effectively managed by ganglion impar block. In this study we analyze the feasibility, safety, and efficacy of ganglion impar block by transsacrococcygeal approach. ⋯ A transsacrococcygeal approach for a ganglion impar block is a technically feasible and safe technique. We recommend this technique for neurolysis or radiofrequency ablation of the ganglion impar and for diagnostic blocks, especially when the diagnosis and further plan of management is dependent on the response of the diagnostic block.
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Case Reports
Dural puncture and subdural injection: a complication of lumbar transforaminal epidural injections.
Two cases are presented in which the complication of dural puncture is documented in the context of a lumbar transforaminal epidural steroid injection. The hazard of dural puncture during transforaminal epidural injections, the anatomy of the dural and thecal sac, the potential for subdural injections, and relevant literature are reviewed. ⋯ Subdural and intrathecal spread of contrast is rarely seen with transforaminal injections and thus can be easily overlooked. Becoming familiar with the images presented in these cases may help alert the interventionalist of a dural puncture, and thus avoid injection of medications into the intrathecal and subdural spaces.
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Epidemiological studies have provided information on the prevalence and risk factors of low back pain (LBP) in white collar workers in industrialized countries. Little information has related individual, work ergonomic, and psychosocial factors to the incidence of LBP in low income countries. ⋯ High proportions of Greek office workers suffer from LBP which might affect the Greek economy. The incidence of LBP status is significantly associated with some anthropometric, ergonomic, and psychosocial factors.
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Complications reported from percutaneous disc decompression (PDD) include discitis, anaphylaxis (with chemonucleolysis), instability, increased back pain, and reherniation. To the best of our knowledge, there is no report of epidural fibrosis occurring with any of the many types of PDD. ⋯ This case is the first reported occurrence of epidural fibrosis following percutaneous lumbar disc decompression.