Pain physician
-
The high prevalence of chronic persistent neck pain not only leads to disability but also has a significant economic, societal, and health impact. Among multiple modalities of treatments prescribed in the management of neck and upper extremity pain, surgical, interventional and conservative modalities have been described. Cervical epidural injections are also common modalities of treatments provided in managing neck and upper extremity pain. They are administered by either an interlaminar approach or transforaminal approach. ⋯ This systematic review with qualitative best evidence synthesis shows Level II evidence for the efficacy of cervical interlaminar epidural injections with local anesthetic with or without steroids, based on at least one high-quality relevant randomized control trial in each category for disc herniation, discogenic pain without facet joint pain, central spinal stenosis, and post surgery syndrome.
-
Case Reports
Pain relief with percutaneous trochanteroplasty in a patient with bilateral trochanteric myelomatous lytic lesions.
Multiple myeloma is a hematologic malignancy associated with destructive bone loss. Lytic lesions, a hallmark of this cancer, can result in significant morbidity because of associated pain and structural osseous compromise. Osteoplasty has demonstrated efficacy in the treatment of myelomatous pain within the axial skeleton; however, there is limited evidence supporting the utility of osteoplasty to treat extra-spinal lesions. ⋯ The intended goals of this novel procedure were to determine the cause of the suspected lytic lesions, provide pain relief, and offer structural stability by safely implanting bone cement as part of a fracture prevention strategy. At 12 month follow-up, the patient's pain improved by 70% and she no longer required the use of pain medication. The patient also displayed a significant improvement in her day-to-day functioning and quality of life.
-
We previously published on the pressure effect using a rheumatoid animal model (Pain Physician in 2013 and 2014). However, we do not know how long the pressure effect lasts after exposure to high pressure. ⋯ The 3 hours of 1.5 ATA pressure effect lasted for more than a day. Longer pressure exposure time appears to yield a greater therapeutic effect in an RA animal model up to a given study period. Continuous application of high pressure might be beneficial for achievement of a better therapeutic effect in clinical application.