Pain physician
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Observational Study
Treatment of Osteoporotic Vertebral Compression Fractures: Applicability of Appropriateness Criteria in Clinical Practice.
Appropriate treatment choice for osteoporotic vertebral compression fractures (OVCF) is challenging due to patient heterogeneity. Using the RAND/UCLA method, an international multidisciplinary expert panel established patient-specific criteria for the choice between non-surgical management (NSM), vertebroplasty (VP), and balloon kyphoplasty (BKP). ⋯ This international, multi-specialty utilization review showed excellent applicability of, and good adherence with RAND/UCLA-based recommendations on treatment choice in OVCF.
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Observational Study
Clinical Outcome Following Radiofrequency Denervation for Refractory Sacroiliac Joint Dysfunction Using the Simplicity III Probe: A 12-Month Retrospective Evaluation.
Sacroiliac joint syndrome (SIJ) is diagnosed in 10% to 25% of cases of lower back pain. The response to traditional radiofrequency (RF) denervation of the SIJ has being inconsistent. The Simplicity III RF probe (Neruotherm. Inc.) offers a novel treatment option. ⋯ By creating a consistent radiofrequency lesion between the sacral foramen and the SIJ will reliably capture the innervation to the SIJ with significant long-term clinical improvement. This technique should be considered earlier in the treatment algorithm of individuals suffering from SIJ symptoms.
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Controlled Clinical Trial
Tetra-ataxiometric Posturography in Patients with Migrainous Vertigo.
Migraine is a common disorder characterized by headache attacks frequently accompanied by vestibular symptoms like dizziness, vertigo, and balance disorders. Clinical studies support a strong link between migraine and vertigo rather than between other headache types and vertigo or nonvertiginous dizziness. There is a lack of consensus regarding the pathophysiology of migrainous vertigo. Activation of central vestibular processing during migraine attacks and vasospasm-induced ischemia of the labyrinth are reported as the probable responsible mechanisms. Because vestibular examination alone does not provide enough information for diagnosis of migrainous vertigo, posturography systems which provide objective assessment of somatosensory, vestibular, and visual information would be very helpful to show concomitant involvement of the vestibular and somato-sensorial systems. There are few posturographic studies on patients with migraine but it seems that how balance is affected in patients with migraine and/or migrainous vertigo is still not clear. We want to investigate balance function in migraineurs with and without vertigo with a tetra-ataxiometric posturography system and our study is the first study in which tetra-ataxiometric static posturography was used to evaluate postural abnormalities in a well-defined population of patients with migrainous vertigo. ⋯ In this first study of tetra-ataxiometric static posturography evaluating postural abnormalities in a well-defined population of patients with migrainous vertigo, the central part of the vestibular apparatus would be responsible of postural abnormalities in patients with migraine and migrainous vertigo.
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Low back pain (LBP), one of the most prominent problems worldwide, lacks effective disease-modifying medical therapy. Intervertebral disc degeneration (IVDD) is a major cause of LBP, and proinflammatory cytokines are the key factors involved in the development of IVDD-induced back pain. Sirtuin 1 (SIRT1) is implicated in the molecular control of aging and immune responses in various diseases; however, its effect on IVDD is not clearly understood. ⋯ Our results indicated that SIRT1 exerted anti-inflammatory effects againstIL-1β-mediated degeneration of NP cells through the TLR2/SIRT1/NF-κB pathway, suggesting that it could be used as a potential candidate for treating IVDD-mediated back pain.
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Chronic intractable shoulder pain (CISP) is defined as shoulder pain which is present for longer than 6 months and does not respond to standard treatments like medication, physical therapy, rehabilitation, selective nerve blocks and local infiltrations, or orthopedic procedures. The etiology of CISP may be very diverse, varying from many orthopedic conditions to non-orthopedic conditions. The fact that the suprascapular nerve is one of the most important nerves supplying the shoulder region makes this nerve an interesting target in treating patients suffering shoulder pain. ⋯ Permanent neurostimulation of the suprascapular nerve and its end branches may be a new interesting target in treating patients suffering shoulder pain due to various etiologies. In our patient the follow-up period is 9 months with an excellent result in pain relief, we observed no complications thus far, especially no dislocation or breakage of the lead. In this report, literature on this subject is reviewed, and our technique is well documented with additional anatomical illustrations.