Pain physician
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Randomized Controlled Trial
The Effect of Normal Saline Injection Volumes on the Optic Nerve Sheath Diameter during Thoracic Epidural Analgesia.
Saline or local anesthetic injection into the epidural space increases intracranial pressure (ICP), at least transiently. Measurement of the optic nerve sheath diameter (ONSD) using ocular ultrasonography is one of the noninvasive methods for ICP assessment. ⋯ Twenty milliliters of normal saline epidural injection resulted in a significant increase of ONSD, as compared to the 5 mL and 10 mL groups. Our results also indicate that an increase of ONSD occurs in accordance with the injected volume of normal saline.
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Randomized Controlled Trial
Three Needles Approach-A New Technique of Genicular Nerves Radiofrequency Ablation for Pain Relief in Advanced Chronic Knee Osteoarthritis: A Randomized Trial.
Ablation of the genicular nerves (GN) has emerged as a useful alternative therapeutic modality in chronic knee osteoarthritis (OA) specially for high-risk patients. However, in some cases due to the presence of other articular branches or anatomical variability, it may have a poor impact in relieving pain. Ablation of other or additional articular branches might have different outcomes. ⋯ Compared to the conventional single-needle GN ablation technique, the 3-needle approach appears to be a promising, safe, and more effective ablation technique for patients with chronic knee OA.
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Vitamin D deficiency has been linked to nonspecific low back pain (Ns-LBP); however, the role of inflammation as a possible mediator between vitamin D levels and Ns-LBP is not well understood. ⋯ Patients with Ns-LBP had lower vitamin D and higher inflammatory marker levels. This association between hypovitaminosis D and Ns-CLBP may be mediated by IL-6. Therefore, large-scale clinical trials are warranted to investigate the clinical efficacy of vitamin D supplementation for decreasing inflammation and relieving Ns-LBP.
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Randomized Controlled Trial
Comparison of Intravascular Injection Incidences and Technical Easiness Between Anteroposterior and Oblique Approaches During S1 Transforaminal Epidural Injection.
Transforaminal epidural injection (TFEI) is a useful intervention for radicular leg pain. Compared to TFEI in lumbar level, S1 TFEI is reported to have higher incidence rates of intravascular injection as well as technical difficulties. ⋯ Our study demonstrated reduced incidence rates of intravascular injection and reduced foramen passage time and radiation dosage with the use of OB view method during S1 TFEI.
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Headache is a very common condition that affects 5-9% of men and 12-25% of women in North America and Europe. Globally, the prevalence of active headaches among adults is 47%. The most common type of headache is tension headaches (38% of adults), followed by migraines (10%), and chronic headaches (3%). While the majority of headaches are benign, the disorder can severely negatively influence a patients' quality of life, which is directly reflected in societal costs. ⋯ Our review discusses several studies that suggest the efficacy of RFA in the treatment of headaches. Outcomes varied based on the difference in approaches regarding continuous radiofrequency versus pulsed radiofrequency, temperature, and duration of administration. The majority of the studies discussed in this review indicate a therapeutic benefit of RFA for headaches over a short-term period. Pain outcomes beyond one year are understudied and further studies are needed to determine the long-term effects of RFA for headaches.