Pain physician
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Chronic persistent neck pain with or without upper extremity pain is common in the general adult population with a prevalence of 48% for women and 38% for men, with persistent complaints in 22% of women and 16% of men. Multiple modalities of treatment are exploding in managing chronic neck pain along with increasing prevalence. However, there is a paucity of evidence for all modalities of treatments in managing chronic neck pain. Controlled studies have supported the existence of cervical facet or zygapophysial joint pain in 36% to 60% in heterogenous population of these patients. However, these studies also have shown false-positive results in 27% to 63% of patients with a single diagnostic block. ⋯ Diagnostic cervical facet joint nerve blocks are safe, valid, and reliable. The strength of evidence for diagnostic facet joint nerve blocks is good with the utilization of controlled diagnostic blocks with at least 75% pain relief as the criterion standard; however, the evidence is limited for single blocks or dual blocks for relief of 50% to 74% and single blocks with at least 75% pain relief.
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Randomized Controlled Trial
The effect of Helicobacter pylori eradication on migraine: a randomized, double blind, controlled trial.
Recent studies have shown a positive correlation between Helicobacter pylori (H. pylori)infection and migraine headache. ⋯ H. pylori eradication may have a beneficial role on migraine headache. This shows the significance of H. pylori treatment in the management of migraine headache among Iranian patients.
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Randomized Controlled Trial
Effect of early stellate ganglion blockade for facial pain from acute herpes zoster and incidence of postherpetic neuralgia.
The incidence of postherpetic neuralgia (PHN) has been reported to be 25% among those over the age of 50 years treated with antiviral medication. The role of sympathetic block in its prevention remains questionable. ⋯ Early stellate ganglion blockade, in combination with an antiviral agent, is a very effective treatment modality; it dramatically decreases the intensity of acute pain and shortens its duration and reduces the incidence of postherpetic neuralgia.
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Therapy with glucocorticoids often results in bone loss and glucocorticoid-induced osteoporosis. However, the relationship between epidural steroid injection (ESI), bone mineral density (BMD), and vertebral fracture remains to be determined. ⋯ Older age and lower BMD were associated with osteoporotic fracture in postmenopausal women treated for low back pain with ESI. The ESIs were not associated with low BMD or fracture.
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This survey was undertaken to explore the variation in the functional constitution of pain clinics in Europe. In addition, we also explored the amount of training which doctors practicing pain medicine typically receive. Approximate hospital charges for common pain interventions and the source of funding were also surveyed. ⋯ Two thirds of the respondents reported the cost of 4-joint radiofrequency lumbar denervation to be less than €1,500 ($1,935). Good practice should ensure an adequate duration of training, and development of a pain faculty to ensure standards of assessments across the continent. A more detailed, large scale survey is perhaps required to map the availability of chronic pain services and understand the health economics in pain medicine across Europe.