Pain physician
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The clinical management of spinal hemangiomas and osteolytic metastases involving the upper cervical spine (C1-C3) is challenging. Symptoms vary from simple vertebral pain to progressive neurological deficits. Surgery and radiotherapy have been the treatment options for years. Surgery, however, can result in complications, such as hemorrhage, and may be counter-indicated when the treatment goal is primarily palliative due to multiple metastases, an unfavorable prognosis and/or a poor performance state. On the other hand, radiotherapy carries the risk of inducing secondary sarcomas or producing radionecrosis. Percutaneous vertebroplasty (PVP) was recently introduced as an alternative for treating patients in whom surgery and radiotherapy are counter-indicated. As of yet, there are few PVP case reports. ⋯ The safety and efficacy of CT-guided PVP using a translateral approach via the space between the carotid sheath and vertebral artery were demonstrated in patients with hemangioma or metastasis in the upper cervical spine. CT-guided PVP via a translateral approach should become a treatment option for such patients.
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Review Case Reports
Percutaneous osteoplasty for the treatment of a painful osteochondral lesion of the talus: a case report and literature review.
An osteochondral lesion of the talus (OLT) is a lesion involving the talar articular cartilage and its subchondral bone. OLT is a known cause of chronic ankle pain after ankle sprains in the active population. The lesion causes deep ankle pain associated with weight-bearing, impaired function, limited range of motion, stiffness, catching, locking, and swelling. ⋯ Postoperative fluoroscopy and computed tomography images showed bone cement filling of the defect. In the present case, arthroscopic and fluoroscopic guidance was used for aspiration of an OLT and for performing percutaneous osteoplasty with hydroxyapatite for one defect; this treatment decreased pain upon weight bearing and enabled a return to work without any restrictions one week after the procedure. The purpose of this report was to highlight the presence of OLT in chronic ankle pain and to review its management strategies.
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Millions of interventional pain procedures are performed each year in the United States. Interventional pain physicians commonly administer radiocontrast media (RCM) under fluoroscopy for these procedures. However, RCM can cause various types of hypersensitivity or allergic type reactions, in an acute or delayed fashion. Furthermore, some patients report a prior history of hypersensitivity reactions to RCM when presenting to the interventional pain clinic. Both scenarios present challenges to the interventional pain physician. ⋯ Although the mechanisms of various RCM allergic-type reactions are not entirely understood, the interventional pain physician should have a basic understanding of patient risk factors, prevention, diagnosis, and treatment of these reactions. The current review allowed for prevention and treatment strategies for managing patients with RCM hypersensitivity reactions.
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Facial pain occurring after traumatic injury of the facial branches of the trigeminal nerve is a medical condition that is often very difficult to treat. Patients are quite disabled by their symptoms and most therapies are ineffective in relieving this pain. Peripheral nerve stimulation has been used as a treatment to provide pain relief for this type of intractable atypical facial pain. ⋯ This surgical technique for placing peripheral nerve stimulators allows for a minimally invasive approach for the treatment of intractable posttraumatic trigeminal neuralgia with potentially less risk of facial nerve damage. This case confirms the need for further studies to be done in the future to prove the safety and effectiveness of this technique.
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Persistent postsurgical pain (PPSP) affects between 10% and 50% of surgical patients, the development of which is a complex and poorly understood process. To date, most studies on PPSP have focused on specific surgical procedures where individuals do not suffer from chronic pain before the surgical intervention. Individuals who have a chronic nerve injury are likely to have established peripheral and central sensitization which may increase the risk of developing PPSP. Concurrent analyses of the possible factors contributing to the development of PPSP following lumbar discectomy have not been examined. ⋯ We demonstrated that the occurrence of PPSP can be predicted using a small set of variables easily obtained at the preoperative visit. This a prediction rule that could further optimize perioperative pain treatment and reduce attendant complications by allowing the preoperative classification of surgical patients according to their risk of developing PPSP.