Pain physician
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Review Meta Analysis
Ozone therapy as a treatment for low back pain secondary to herniated disc: a systematic review and meta-analysis of randomized controlled trials.
Low back pain (LBP) is one of the most common and important health problems affecting the population worldwide and remains mostly unsolved. Ozone therapy has emerged as an additional treatment method. Questions persist concerning its clinical efficacy. ⋯ Ozone therapy appears to yield positive results and low morbidity rates when applied percutaneously for the treatment of chronic low back pain.
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Two studies, each consisting of large sample sets, were recently published on radiation exposure in percutaneous spinal cord stimulation (SCS) trialing procedures. A more rigorous use of statistical methods in the second study more accurately defined benchmark reference levels. Principally, one physician implanter-considered an advanced interventional pain physician-performed all such procedures to nullify inter-physician variability. However, the literature is sparse in articles comparing exposure levels of radiation in pain procedures conducted by novice and advanced interventionally trained physicians, and inferential statistical analysis is seldom included in radiation exposure studies. ⋯ Radiation exposure levels in SCS trialing procedures remain negligible. While no differences in fluoroscopy times for such procedures were detected based on physician experience, the expert implanter demonstrated the ability to use less fluoroscopy time than that of the benchmark reference level.
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A substantial number of patients with persistent lumbar radicular pain are treated with a multimodal spectrum of conservative therapies without lasting effect. The duration of pain is certainly a risk factor for chronification. There is evidence that guided periradicular infiltrations are a valid option in the treatment of radiculopathies. Usually a combination of local anesthetic and/or corticosteroid is injected. Tramadol is being used for perioperative analgesia and has been shown to provide effective, long-lasting pain relief after epidural administration. ⋯ Fast and lasting pain relief is the key to optimize rehabilitation for patients with radicular pain. There is a physiological rationale that the opioid receptors at the spinal level could be used to optimize the analgetic effect of guided periradicular injections. In our case series, serial CT-guided selective nerve root infiltrations with the supplement of tramadol were found to be highly effective in the treatment of persistant radiculopathies. Randomized controlled trials will be necessary to clarify the possible benefit of the supplement of an opioid.