Pain physician
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Previous studies have reported a high incidence of re-collapse of the augmented vertebrae after percutaneous vertebral augmentation (PVA) for osteoporotic vertebral compression fractures (OVCFs) with intravertebral vacuum cleft (IVC) during long-term follow-up. Previous IVC might be considered an important predisposing factor for re-collapse, but the prior studies could not find a significant correlation. ⋯ PVA treatment was initially effective in all patients with OVCFs. However, significant re-collapse of the augmented vertebrae with IVCs, especially those with inferior endplate IVCs, was found with long-term follow-up. Key words: Intravertebral vacuum cleft, percutaneous vertebral augmentation, osteoporotic vertebral compression fractures, affected vertebrae, augmented vertebrae.
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Review Meta Analysis
The Effect of Early Use of Supplemental Therapy on Preventing Postherpetic Neuralgia: A Systematic Review and Meta-analysis.
Postherpetic neuralgia (PHN) is the most common and refractory complication of herpes zoster (HZ). Aggressive treatment of acute pain in HZ has the potential to prevent the development of PHN, but the preventive efficacy of supplemental therapy commonly used in clinical practice is controversial. ⋯ This meta-analysis demonstrates that the early use of supplemental therapy can significantly reduce the incidence of PHN. The subgroup analysis shows that supplemental interventional procedures have a beneficial effect on preventing PHN, while supplemental systemic adjunct treatments do not. The early use of interventional procedures for acute pain may be a preferred choice for patients without contraindication, but evidence is moderate. More data from high-quality RCTs will be needed to confirm these results.Key words: Postherpetic neuralgia, systemic treatment, local anesthesia, analgesia, meta-analysis.
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Randomized Controlled Trial Comparative Study
Posture Influences the Extent of Spread of Contrast Medium During Thoracic Epidurography: A Prospective Randomized Trial.
Various factors influencing the distribution of sensory blockade in epidural anesthesia have been identified; however, reports on the effects of gravity and different postures in thoracic epidural anesthesia have been rare. Medications may be injected with the lateral decubitus or the neutral position; however, it is unclear whether the distribution range of medication is similar or significantly different between these 2 postures. ⋯ Group L demonstrated a more extensive distribution of contrast medium for both the cranial and caudad directions compared to group P.Key words: Epidural, thoracic, contrast medium, injections.
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Review
A Practical Guide for Treatment of Pain in Patients with Systemic Mast Cell Activation Disease.
Systemic mast cell activation disease (MCAD, a subclass of mastocytosis), which has a prevalence of around 17% (at least in the German population), is characterized by accumulation of genetically altered dysfunctional mast cells with abnormal release of these cells' mediators. Since mast cells affect functions in potentially every organ system, often without causing abnormalities in routine laboratory or radiologic testing, this disease has to be considered routinely in the differential diagnosis of patients with chronic multisystem polymorbidity of a generally inflammatory and allergic theme. Pain in its different manifestations is a common symptom in MCAD found in more than three-quarters of the MCAD patients. ⋯ Due to the high prevalence of MCAD, many physicians are often faced with the issue of pain management in MCAD patients. Hence, our practical guide should contribute to the improvement of patient care. Key words: Pain therapy, mast cell activation disease, mast cell activation syndrome, systemic mastocytosis, mast cell.
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Individuals with chronic whiplash associated disorders (WAD) present persistent pain in the absence of structural pathology. In these people, altered central pain processing and central sensitization are observed. The role of personal factors, such as gender and age, on pain processing mechanisms in chronic WAD, however, is still unclear. ⋯ Some alterations of altered pain processing are present in chronic WAD patients, however not in response to exercise. No gender and age differences in pain measurements were observed in people with chronic WAD.Key words: Neck pain, whiplash associated disorders, chronic pain, personal factors, age, gender, central sensitization, exercise induced hyperalgesia, pressure pain thresholds, self reported pain.