Pain physician
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The pathological entities commonly associated with lumbosacral pain are the intervertebral discs, facet joints or surrounding muscle. However, in the absence of diagnostic confirmation of the aforementioned structures, the diagnosis may become confusing and intractable. Sacroiliac fascial lipocele (SFL), namely, pannicular hernia, could be a neglected cause. ⋯ It is important to distinguish SFL some cases with lumbosacral back pain. Detailed physical examination, superficial ultrasonography and diagnostic nerve block are extremely valuable for acquiring a precise diagnosis. Overall, when considering the clinical outcome of such cases and the foregoing benefits, percutaneous endoscopic treatment could be an efficacious alternative treatment for SFL-related lumboscral back pain.
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Randomized Controlled Trial Comparative Study
Piriformis syndrome: comparison of the effectiveness of local anesthetic and corticosteroid injections: a double-blinded, randomized controlled study.
Piriformis syndrome (PS), which is characterized by pain radiating to the gluteal region and posterior leg, is accepted as one of the causes of sciatalgia. Although the importance of local piriformis muscle injections whenever PS is clinically suspected has been shown in many studies, there are not enough studies considering the clinical efficacy of these injections. ⋯ LA injections for the PS were found to be clinically effective. However, addition of CS to LA did not give an additional benefit. This gives us the idea that PS is mostly muscular in origin and responds well to both LA and LA+CS injections.
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Cervicogenic headache is a secondary headache that has a source in the upper cervical spine. There is a small but growing body of evidence to establish effectiveness of radiofrequency (RF) neurotomy, and the pulsed RF (PRF) procedure for management of cervicogenic headache. ⋯ There is limited evidence to support RF ablation for management of CHA as there are no high quality RCTs and/ or multiple consistent non-RCTs without methodological flaws. There is poor evidence to support PRF for CHA as there are no high quality RCTs or Non-RCTs.
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Randomized Controlled Trial
Ultrasound-guided greater occipital nerve block: an efficient technique in chronic refractory migraine without aura?
The effectiveness of greater occipital nerve block (GONB) in patients with primary headache syndromes is controversial. Few studies have been evaluated the usefulness of GONB in patients with migraine without aura (MWOA). ⋯ Ultrasound guided GONB with 1.5 mL of 0.5% bupivacaine for the treatment of migraine patients is a safe, simple, and effective technique without severe adverse effects. To increase the effectiveness of the injection, and to implement the isolated GONB, ultrasonography guidance could be suggested.
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Randomized Controlled Trial
Perioperative lidocaine infusion reduces the incidence of post-mastectomy chronic pain: a double-blind, placebo-controlled randomized trial.
Chronic post-surgical pain (CPSP) is a not uncommon complication after mastectomy, with a reported incidence between 20% and 68%. Careful dissection, the use of minimally invasive surgical techniques, and attempts to reduce the associated inflammatory and hyperalgesic responses are suggested methods to prevent CPSP. ⋯ Perioperative lidocaine administration was associated with a decreased incidence of CPSP, while breast implant placement and radiotherapy were associated with an increased incidence. These findings suggest a protective effect of lidocaine on CPSP development in mastectomy patients.