Pain physician
-
Randomized Controlled Trial
Efficacy of pulsed radiofrequency in the treatment of thoracic postherpetic neuralgia from the angulus costae: a randomized, double-blinded, controlled trial.
Postherpetic neuralgia (PHN) is often refractory to existing treatments. Pulsed radiofrequency (PRF) is known to be effective for treating neuropathic pain. In common, the targets of PRF treatment were the segmental dorsal root ganglion (DRG) neurons responsible for the pain. A potential complication that can occasionally occur with PRF treatment is damage to the adjacent tissue and organ. The effectiveness of the angulus costae as a puncture site for PRF has not been tested in thoracic PHN treatment. ⋯ NO ISRCTN25588650.
-
Reports of chronic pain and associated opioid use, abuse, and fatalities continue to increase at an alarming rate, not only in the United States but also across the globe. In light of the many resultant fatalities, multiple authors and authorities have cautioned against the excessive use of opioids. Consequently, the Food and Drug Administration, Drug Enforcement Administration, and multiple state authorities have been proposing and implementing a plethora of regulations to curb opioid overuse and abuse. In the majority of cases, pain physicians have been portrayed as the perpetrators responsible for escalating use and abuse and resultant fatalities. ⋯ This study shows an overwhelming majority of patients were initiated and maintained with opioids in managing chronic noncancer pain. They were frequently on high doses over a long period of time with multiple drug combinations prescribed by primary care physicians.
-
Although headache is the most common complication of dural puncture, knowledge gaps remain about patient-related risks. Data are lacking on the role, if any, of tobacco smoking, race, anxiety, depression, and Post Traumatic Stress Disorder (PTSD) in conferring risk for post-dural puncture headache (PDPH). ⋯ Most notably, smokers had a considerably reduced rate of PDPH in comparison with non-smokers. This information could be a useful addition to the clinical assessment of relative risk for PDPH. Further research into the mechanisms by which tobacco smoking may inhibit PDPH, such as nicotine stimulation of dopamine neurotransmission or alterations in coagulation, appears warranted.
-
While the use of opioids for chronic non-cancer pain (CNCP) has increased dramatically in the past 2 decades, concern exists about the safety of opioids, particularly with the extensive use among individuals with CNCP. ⋯ This study found no association between use of opioids and risk of T2D among non-cancer adults.
-
Review Case Reports
Cooled sacroiliac radiofrequency denervation for the treatment of pain secondary to tumor infiltration: a case-based focused literature review.
The sacroiliac (SI) joint is a common cause of low back pain, for which radiofrequency (RF) denervation has been shown to provide long-term relief. However, controversy exists surrounding the innervation, which treatment paradigm to utilize, and how best to select patients who might benefit. ⋯ This is the first report of cooled SI joint RF ablation to treat cancer pain. Our patient's positive response to the procedure suggests the possibility that the lateral branches innervate not only the posterior ligaments, but also the bony articulation. The decision to proceed with RF ablation on the same day as a prognostic lateral branch block was based on our patient's terminal condition, and the fact that cooled RF does not require sensory stimulation to ensure proximity to the target nerves. Because of her transitional anatomy, we elected to target L4.