Pain physician
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Review Meta Analysis
A systematic evaluation of prevalence and diagnostic accuracy of sacroiliac joint interventions.
The contributions of the sacroiliac joint to low back and lower extremity pain have been a subject of considerable debate and research. It is generally accepted that 10% to 25% of patients with persistent mechanical low back pain below L5 have pain secondary to sacroiliac joint pathology. However, no single historical, physical exam, or radiological feature can definitively establish a diagnosis of sacroiliac joint pain. Based on present knowledge, a proper diagnosis can only be made using controlled diagnostic blocks. The diagnosis and treatment of sacroiliac joint pain continue to be characterized by wide variability and a paucity of the literature. ⋯ Based on this systematic review, the evidence for the diagnostic accuracy of sacroiliac joint injections is good, the evidence for provocation maneuvers is fair, and evidence for imaging is limited.
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Review Meta Analysis
Effectiveness of therapeutic lumbar transforaminal epidural steroid injections in managing lumbar spinal pain.
Among the multiple interventions used in managing chronic spinal pain, lumbar epidural injections have been used extensively to treat lumbar radicular pain. Among caudal, interlaminar, and transforaminal, transforaminal epidural injections have gained rapid and widespread acceptance for the treatment of lumbar and lower extremity pain. The potential advantages of transforaminal over interlaminar and caudal, include targeted delivery of a steroid to the site of pathology, presumably onto an inflamed nerve root. However, there are only a few well-designed, randomized, controlled studies on the effectiveness of steroid injections. Consequently, multiple systematic reviews with diverse opinions have been published. ⋯ In summary, the evidence is good for radiculitis secondary to disc herniation with local anesthetics and steroids and fair with local anesthetic only; it is fair for radiculitis secondary to spinal stenosis with local anesthetic and steroids; and limited for axial pain and post surgery syndrome using local anesthetic with or without steroids.
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Review Meta Analysis
Effectiveness of thermal annular procedures in treating discogenic low back pain.
Persistent low back pain refractory to conservative treatment is a common problem that leads to widespread impairment, resulting in significant costs to society. The intervertebral disc is a major source of persistent low back pain. Technologies developed to treat this problem, including various surgical instrumentation and fusion techniques, have not reliably provided satisfactory results in terms of either pain relief or increased function. Thermal annular procedures (TAPs) were first developed in the late 1990s in an attempt to treat discogenic pain. The hope was that they would provide greater value than fusion in terms of efficacy, morbidity, and cost. Three technologies have been developed to apply heat to the annulus: intradiscal electrothermal therapy (IDET), discTRODE, and biacuplasty. Since nerve ingrowth and tissue regeneration in the annulus is felt to be the source of pain in discogenic low back pain, when describing the 3 above techniques we use the term "thermal annular procedures" rather than "thermal intradiscal procedures." We have specifically excluded studies treating the nucleus. TAPs have been the subject of significant controversy. Multiple reviews have been conducted resulting in varying conclusions. ⋯ In summary, the evidence is fair for IDET and poor for discTRODE and biacuplasty is being evaluated in 2 ongoing randomized controlled trials.
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Randomized Controlled Trial
Occipital nerve stimulation for chronic migraine: a randomized trial.
Chronic migraine (CM) and medication overuse headache (MOH) are disabling conditions that may be only partially managed with conservative treatments. Occipital nerve stimulation (ONS) is an innovative treatment for headache disorders. ⋯ According to the results obtained, ONS appears to be a safe and effective treatment for carefully selected CM and MOH patients.
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Comparative Study
Radiofrequency neurolysis versus local nerve infiltration in 42 patients with refractory chronic inguinal neuralgia.
Chronic inguinal neuralgia involving ilioinguinal and iliohypogastric nerves is a frequent complication of surgical procedures involving a lower abdominal incision such as hernia repair, appendicitis surgery, or cesarean sections. Chronic inguinal neuralgia is a very painful condition and diagnosis can be challenging as it is an overlooked impairment. Existing specific treatments are inefficient and often fail. ⋯ Radiofrequency neurolysis appears to be significantly more effective than local nerve infiltrations. It is a safe and effective treatment for chronic inguinal pain. Local steroid injection along with local injection of anesthetics should be used as a confirmation of ilioinguinal neuropathy before performing radiofrequency neurolysis.