Pain physician
-
Review Meta Analysis
A systematic review and meta-analysis of randomized controlled trials of unilateral versus bilateral kyphoplasty for osteoporotic vertebral compression fractures.
Kyphoplasty reduces the pain caused by osteoporotic vertebral compression fracture (OVCF). Although the procedure is typically carried out using a bilateral approach, it is now increasingly performed using a unilateral approach because of the concern for long-term adverse effects. However, little evidence is available to demonstrate superior safety of the unilateral approach. ⋯ Both unilateral and bilateral kyphoplasty are effective in alleviating the back pain caused by OVCF. Two approaches have the same degree of safety. More RCTs are needed to examine the efficacy and adverse reactions of the 2 approaches.
-
Review
Central sensitization in urogynecological chronic pelvic pain: a systematic literature review.
Chronic pelvic pain (CPP) is a complex pain syndrome. Since its pathogenesis is still poorly understood and structural alterations in pain related brain regions may be present, there is a greater acceptance that sensitization of the central nervous system (CNS) plays an important role in the development and maintenance of chronicity. ⋯ Although the majority of the literature provides evidence for the presence of CS in urogynecological CPP with changes in brain morphology/function and sensory function, it is unclear whether these changes in central pain processing are secondary or primary to CPP, especially since evidence regarding the function of endogenous pain inhibition and the role of psychosocial pain facilitation is scarce. Further studies with good methodological quality are needed in order to clarify exact mechanisms.
-
Lumbar sympathetic blocks and chemical sympathectomies are used for the pain treatment of peripheral arterial occlusive disease or sympathetically maintained pain syndrome after nerve injury or complex regional pain syndrome (CRPS). A 30-year-old patient was referred to the pain department with all the clinical signs and symptoms of a CRPS of the right foot one and a half years after being surgically treated for rupture of the achilles tendon. An inpatient admission was necessary due to insufficient pain reduction upon the current treatment, strong allodynia in the medial distal right lower leg and decreased load-bearing capacity of the right foot. ⋯ This was a long-lasting lesion of the lateral femoral cutaneous nerve following a CT-guided chemical sympathectomy with a low-volume ethanol 96% application - a complication which has not been described in literature until now. This is probably caused by broad dissemination of the neurolytic agent along the psoas muscle despite a correct needle position and spread of contrast agent. The development of this nerve injury even after injection of a small volume of ethanol (2 mL) may be delayed.