Pain physician
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Intrathecal delivery of baclofen (ITB) is effective at controlling spasticity. However, it requires the placement of a catheter into the intrathecal space, and a pump with a reservoir for the medication. The process of placing the catheter and pump are prone to complications. ⋯ Complication rates after placement of intrathecal pump/catheters have increased in the pediatric population between 1997 and 2006 mainly due to an increase in mechanical complications.
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In 2000 the intradiscal electrothermal therapy (IDET) procedure for the treatment of discogenic pain was introduced. The technique involves the positioning of an intradiscal catheter with a temperature-controlled thermal resistive heating coil at the inner posterior annulus. The therapeutic mechanism of IDET combines the thermo-coagulation of native nociceptors and in-grown nonmyelinated nerve fibers with collagen shrinkage, stabilizing annular fissures. Thermal nerve root injuries were described with IDET. The temperature in relation to the distance from the catheter tip was investigated. The intradiscal temperature distribution during treatment with IDET was also described. ⋯ This study shows that temperatures generated within the spinal canal during IDET do not appear to be high enough to cause nerve damage.
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The epidural lysis of adhesions (ELOA) procedure supposedly has a biomechanical component in addition to the targeted injection of medications into the epidural space. It is assumed that the catheters used for the ELOA procedure can release epidural scars and adhesions. ⋯ According to our findings and arguments, the ELOA procedure is predominantly a method for the highly targeted application of epidural medications and possibly also has a lavage effect. A mechanical lysis of scars or adhesions appears unlikely.
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Case Reports
Autologous adipose tissue-derived stem cells induce persistent bone-like tissue in osteonecrotic femoral heads.
Osteonecrosis, also known as avascular necrosis, of the femoral head is a debilitating disorder that commonly affects 30- to 50-year-old individuals. Currently, definitive treatment is limited to total hip replacement. However, recent studies have demonstrated bone regeneration in the femoral head after the infusion of bone marrow-derived mesenchymal stem cells. In addition, local injection of adipose tissue-derived stem cells has been shown to regenerate medullary bone-like tissue 3 months after treatment. However, there have been no long-term follow-up studies on humans treated with adipose tissue-derived stem cells for osteonecrosis. ⋯ These 2 cases demonstrate the presence of sustained, regenerated medullary bone-like tissue in 2 severely necrotic femoral heads and suggest that this rather simple, minimally invasive percutaneous procedure may hold great promise as a therapy for patients with femoral head osteonecrosis.
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Facial pain is a complex disease with a number of possible etiologies. Trigeminal neuropathic pain (TNP) is defined as pain caused by a lesion or disease of the trigeminal branch of the peripheral nervous system resulting in chronic facial pain over the distribution of the injured nerve. First line treatment of TNP includes management with anticonvulsant medication (carbamazepine, phenytoin, gabapentin, etc.), baclofen, and analgesics. ⋯ The patients in this case series continue to have significant symptomatic relief, demonstrating PNS as an effective treatment option for intractable TNP. Though there are no randomized trials, peripheral neuromodulation has been shown to be an effective means of treating TNP refractory to medical management in a growing number of case series. PNS is a safe procedure that can be performed even on patients that are not optimal surgical candidates and should be considered for patients suffering from TNP that have failed medical management.