Pain physician
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Clinical Trial Observational Study
Long-Term Effectiveness and Tolerability of Pain Treatment with Tapentadol Prolonged Release.
The central analgesic tapentadol prolonged release (PR) has proven effective and generally well tolerated in a broad range of chronic pain conditions. Long-term data of its use are still scarce. ⋯ Sustained pain relief and quality of life for up to 72 treatment weeks under relatively stable dosing, as well as the good safety profile, indicate the usefulness of tapentadol PR for patients who suffer from severe chronic OA knee pain and LBP with limited risk for tolerance development.
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For palliative percutaneous vertebroplasty (PVP) for vertebral metastases, local bone destruction progression (LBDP) commonly occurs in the previously treated vertebrae. There were no studies regarding LBDP and its risk factors in previous reports, and there was no uniform evaluation method for the distribution of bone cement in the vertebrae. ⋯ The cement dose, complete filling of cement, Saliou score, and filling rate were factors negatively related to LBDP occurring in less than 6 months. Patients with lower filling rates are maybe more likely to have early LBDP compared with those with higher filling rates.
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The use of opioids for the treatment of pain is a risk versus benefit analysis and metabolic disease is an often overlooked variable in the equation and may lead to increased risk of comorbidities of cardiovascular and cerebrovascular disease and diabetes. ⋯ Although all Americans should be alarmed at the lipid levels reported in this study, specific combinations of heightened lipid laboratory values among prescription opioid users accelerate the trajectories toward comorbidities-heart disease, cerebrovascular disease, and diabetes-leading to diminished quality of life. Therefore pain management and comprehensive drug recovery programs should include nutritional counseling and physical activity as part of their overall treatment plan.
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Multicenter Study Comparative Study
Comparison of Percutaneous Transforaminal Endoscopic Discectomy and Microendoscopic Discectomy for the Surgical Management of Symptomatic Lumbar Disc Herniation: A Multicenter Retrospective Cohort Study with a Minimum of 2 Years' Follow-Up.
Percutaneous transforaminal endoscopic discectomy (PTED) and microendoscopic discectomy (MED) are alternative minimally invasive procedures for the treatment of symptomatic lumbar disc herniation (LDH). However, insufficient literature exists to highlight the differences between the procedures. ⋯ Both PTED and MED present to be an acceptable long-term efficacy for the treatment of LDH. Although PTED is associated with longer intraoperative fluoroscopy and a little more cost, it should still be considered superior to MED considering the benefits of lesser invasion, shorter hospital stays, quicker pain relief, and functional recovery.
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Epidural injections have been extensively used since their description in 1901, and steroids since their first utilization in 1952. Multiple randomized controlled trials and systematic reviews have reached discordant conclusions regarding the effectiveness of sodium chloride solution and steroids in managing spinal pain. True placebo-controlled trials with the injection of an inactive substance to unrelated structures have been nonexistent. Consequently, the discussions continue to escalate, seemingly without proper discourse. In this review, we sought to assess the true placebo nature of saline and the effectiveness of steroids. ⋯ The findings of this systematic review and meta-analysis show that epidurally administered sodium chloride solution and sodium chloride solution with steroids may be effective in managing low back and lower extremity pain. Consequently, the findings of this review provide information that epidurally administered sodium chloride solution is not a true placebo.