Pain physician
-
Case Reports Meta Analysis
Infections Following Interventional Spine Procedures: A Systematic Review.
Interventional spine procedures, such as discography, epidural steroid injections (ESIs), facet joint procedures, and intradiscal therapies, are commonly used to treat pain and improve function in patients with spine conditions. Although infections are known to occur following these procedures, there is a lack of comprehensive studies on this topic in recent years. ⋯ Based on our systematic review, the risk of infections following interventional spine procedures appears to be low overall. More studies focusing on infectious complications with larger sample sizes are needed, particularly for intradiscal therapies, in which the microbiome may be an underlying cause of disc infection. To achieve a true incidence of the risk of infections with these procedures, large prospective registries that collect complication rates are necessary.
-
Over the last decade, several authors have reported that percutaneous peripheral nerve stimulation (PNS) can be used to assist in verifying the position of the procedure needle tip in relation to nerve structures, and that the combined technique using both ultrasound (US) guidance and PNS may serve as a reliable method for confirmation of the correct position of the procedure needle tip. It has also been reported that, when combined with US guidance, PNS may increase the success rate of pain management interventions. ⋯ Our illustrated step-by-step technical protocol can be effectively and safely utilized as a reliable method of training, by which physicians with little to moderate US experience can improve their skills in accurately identifying the genicular nerves while performing US-guided examinations with the intent of executing a peripheral nerve block.
-
Clinicians frequently order urine drug testing (UDT) for patients on chronic opioid therapy (COT), yet often have difficulty interpreting test results accurately. ⋯ Interpretations were well received by clinicians but did not significantly improve laboratory-clinician interpretation concordance, interpretation documentation frequency, or opioid-prescribing behavior.
-
Although conventional pain relief therapeutics have centered around mu-opioid agonists, these drugs are limited by adverse side effects, including respiratory depression and addiction potential. The ongoing opioid epidemic has galvanized research into novel analgesic therapies with more favorable profiles. New pharmacologic agents have been developed to target neuronal pathways involved in pain sensation. Certain receptors have been recognized to mediate nociceptive transmission, central sensitization, and the development of chronic pain states. ⋯ We provide an overview of potential analgesic therapies in various stages of development, which may become clinically relevant in the near future. Some drugs such as TRPV1 agonists, anti-IL-6, and anti-nerve growth factor antibodies have demonstrated analgesic effect in specific clinical pain states.
-
Randomized Controlled Trial
Efficacy and Safety of Radiofrequency Thermocoagulation with Different Puncture Methods for Treatment of V1 Trigeminal Neuralgia: A Prospective Study.
Radiofrequency thermocoagulation through the supraorbital foramen with a different puncture method is a new approach for the treatment of ophthalmic division trigeminal neuralgia. ⋯ The transverse puncture method during radiofrequency thermocoagulation through the supraorbital foramen had better efficacy and fewer complications in comparison with the vertical puncture method when treating ophthalmic division trigeminal neuralgia.