Pain physician
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Pulsed radiofrequency (PRF) treatment uses low energy, short pulsations to modulate tissue characteristics. PRF treatment has been effective as an interventional pain management technique to treat a variety of chronic neuropathic pain (neuralgia) disorders, but a comprehensive review of its biological mechanism has not been updated in a decade. ⋯ Herein describes a clinically relevant collated update describing the cellular and molecular mechanisms of action of PRF for pain management.
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Randomized Controlled Trial
Comparison of Efficacy and Safety of CT-Guided Radiofrequency Thermocoagulation Through Foramen Rotundum Versus Foramen Ovale for V2 Primary Trigeminal Neuralgia.
Primary trigeminal neuralgia (TN) is one of the most severe facial pain syndromes. TN affects patients' quality of life and, when severe, can lead to depression and increase social burden. ⋯ CT-guided RFT through the FR and FO are both an effective, minimally invasive treatments for V2 TN that can relieve pain effectively.
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Chronic low back pain is observed frequently after lumbar spinal surgery. Epidural fibrosis has been implicated in the etiology of persistent pain after back surgery. The incidence of epidural fibrosis increases as the number and extent of spinal surgery increases. Epidural fibrosis can be detected by conventional radiologic methods [e.g., lumbosacral magnetic resonance imaging (MRI) with gadolinium], but these methods are insufficient to reveal the presence of epidural adhesions. Imaging of the epidural cavity using an epiduroscope is one of the best methods for visualizing the spinal cavity without damaging anatomic structures. ⋯ We did not have a control group. Further studies are required to demonstrate the relevance of these 2 imaging techniques (epiduroscopy and MRI) in terms of detecting epidural fibrosis in patients with FBSS. CONCLUSIONS: Epiduroscopic imaging seems to be more sensitive than MRI in detecting grade I epidural fibrosis in patients with FBSS. Thus, the possibility of low-grade epidural fibrosis as a source of pain after back surgery, should be kept in mind in normally reported MRIs. Treatment should be planned accordingly.
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Meta Analysis
Pericranial Total Tenderness Score in Patients with Tension-type Headache and Migraine. A Systematic Review and Meta-analysis.
Increased pericranial tenderness is considered to be a typical characteristic of tension-type headache (TTH). Assessment of pericranial tenderness in TTH using the total tenderness score is recommended by the International Classification of Headache Disorders-3 (ICHD-3). However, to what extent pericranial tenderness differs between patients with TTH or migraine and healthy patients is unknown. ⋯ We found moderate quality evidence for higher tenderness in chronic TTH and migraine, and low quality evidence for higher tenderness in episodic TTH compared to healthy patients. Pericranial tenderness is a common finding in patients with headache and healthy patients. These findings apply for a critical evaluation of the total tenderness score in the current ICHD-3 classification of TTH.
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Randomized Controlled Trial
Dexamethasone Effectively Reduces the Incidence of Post-neurotomy Neuropathic Pain: A Randomized Controlled Pilot Study.
Radiofrequency neurotomy (RFN) of facet or sacroiliac joints is widely used for the treatment of chronic axial pain and can provide long-term pain relief in well-selected patients. The most common side effect is transient neuropathic pain at the paravertebral level of interest. Pain physicians commonly administer corticosteroid post-neurotomy to reduce the risk of post-neurotomy neuropathic pain, yet it remains unclear if this provides a true reduction in incidence. ⋯ A statistically significant reduction in post-neurotomy pain was observed in the steroid group. This protocol can be feasibly conducted in an effective and resource-efficient manner. Additional research is needed to increase the power of the study.