Pain physician
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Trigeminal neuralgia is a very painful condition, and radiofrequency therapy is reserved for patients who are resistant or intolerant to pharmacologic therapy. Continuous radiofrequency (CRF) and pulsed radiofrequency (PRF) both have advantages and disadvantages. Recently, studies have found that PRF combined with low-temperature (< 65°C) CRF increases the efficacy of treatment, without leading to a significant increase in complications caused by nerve lesions. However, these reports have some limitations. ⋯ To our knowledge, this will be the first prospective, open-label, parallel, randomized controlled trial to compare the efficacy and safety of the application of high-voltage PRF, combined with and without low-temperature (60°C) CRF, for the patients who have failed to respond to pharmacologic treatments for primary trigeminal neuralgia. If proven effective, this will be an important, safe, minimally destructive alternative treatment modality for primary trigeminal neuralgia following an ineffective conservative treatment.
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Diabetic peripheral neuropathy (DPN) is a most common devitalizing complication of diabetes mellitus, which is primarily characterized by sensory loss, paresthesia, prickling, pain, or allodynia. ⋯ Nortriptyline reported the advantage relative to other drugs in achieving 30% and 50% pain reduction from the baseline. Gabapentin reported a significance of 50% pain reduction relative to placebo.
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Randomized Controlled Trial
Effectiveness of Repetitive Transcranial Magnetic Stimulation in Patients With Failed Back Surgery Syndrome: A Double-Blind Randomized Placebo-Controlled Study.
Failed back surgery syndrome (FBSS) is the term of persistent back and/or leg pain after lumbar surgery. Repetitive transcranial magnetic stimulation (r-TMS) is a technique that allows noninvasive and relatively painless stimulation of cerebral cortex. It can reduce the experience of chronic pain by producing the small electrical currents in the cortex via magnetic field. ⋯ r-TMS might be an effective alternative treatment in patients with FBSS, further studies with larger groups are needed.
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Comment Letter
Transforaminal Epidural Steroid Injections: A Systematic Review and Meta-Analysis of Efficacy and Safety.
Transforaminal epidural injections have been used since the late 1990s to treat lumbar radicular pain. They have been the subject of considerable attention, with varying conclusions from systematic reviews as to their efficacy. Transforaminal injections have been associated with rare but major complications. Further, the use of transforaminal injections has increased since the passage of the Affordable Care Act. Finally, with the SARS-CoV-2 pandemic, there has been heightened concern regarding the risk associated with steroid injections. ⋯ There is Level I evidence for the use of transforaminal injections for radicular pain from disc herniations.
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Review Meta Analysis
Corticosteroids: Review of the History, the Effectiveness, and Adverse Effects in the Treatment of Joint Pain.
Corticosteroids have been used for the past 70 years in the treatment of various musculoskeletal conditions. This includes its use for joint pain such as rheumatoid arthritis and osteoarthritis. ⋯ The current evidence would suggest that the use of corticosteroids provides moderate evidence for short-term pain reduction and improvement in function. There are multiple potential adverse effects, such as toxic damage to articular cartilage, as well as numerous systemic side effects, including a reduction in immune function and an increased risk of infection, of which physicians need to be aware.