Pain physician
-
Randomized Controlled Trial Comparative Study
A comparative effectiveness evaluation of percutaneous adhesiolysis and epidural steroid injections in managing lumbar post surgery syndrome: a randomized, equivalence controlled trial.
Speculated causes of post lumbar surgery syndrome include epidural fibrosis, acquired stenosis, and facet joint pain among other causes. Even though fluoroscopically directed caudal epidural injections and facet joint interventions are effective in some patients, others continue to suffer with chronic persistent pain. Percutaneous adhesiolysis with target delivery of medications has been demonstrated to be effective in these patients. However, the evidence for percutaneous adhesiolysis in managing post surgery syndrome has been questioned, coupled with a paucity of controlled trials. ⋯ Percutaneous adhesiolysis in chronic function-limiting, recalcitrant low back pain in post lumbar surgery syndrome demonstrated effectiveness in 73% of the patients.
-
Case Reports
Sacral nerve stimulation as a treatment modality for intractable neuropathic testicular pain.
Chronic testicular pain, or "chronic orchalgia," is defined as testicular pain 3 months or longer in duration that significantly interferes with the daily activities of the patient. For patients failing to respond to conservative treatment, microsurgical denervation of the spermatic cord, epididymectomy, and vasovasostomy have all shown a degree of relief. However, these are all invasive procedures and no treatment has proven efficacy when these options fail. ⋯ The above case demonstrates the potential benefit of sacral nerve stimulation with neuropathic intractable testicular pain in a patient that failed conservative treatment. In this case, the patient had exhausted medical and surgical management, including advanced interventional pain options. We were unable to find any previous published cases of neurostimulation used as a modality of treatment for testicular pain, and further studies are needed to gain a better understanding of the efficacy in this setting.
-
Relief of regional, non-appendicular pain, particularly low back pain, through spinal cord stimulation (SCS) has proven challenging. Recently, peripheral nerve stimulation (PNS), also known as peripheral nerve field stimulation (PNFS) depending on the stimulation area, has demonstrated efficacy for the treatment of well-localized, small areas of pain involving the abdomen, inguinal region, pelvis, face, occipital area, and low back. More widespread application of peripheral nerve stimulation has been limited by its narrow field of coverage in a larger group of patients with diffuse or poorly localized pain. ⋯ The use of the PNSCT technique allows for significant analgesia for large painful areas that have been poorly captured using traditional SCS techniques and not considered as an option with the current application of peripheral nerve stimulation.
-
Cryotechnology is a modality of renewed interest in pain management. It is safe and effective when used to treat neuropathies of sensory and mixed nerves. Cryoablation, in general, is devoid of the risk of neuroma formation and can provide several weeks to months of adequate pain relief. ⋯ It allowed a smaller gauge introducer and cryoablation probe to be used since there was better visualization of the target area. Ultrasound helped identify important vascular structures, allowing safe introduction of the introducer and cryoablation probe. The patient remains pain free at 2-month follow-up.