Pain physician
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Meta Analysis
Comparison of Different Operative Approaches for Lumbar Disc Herniation: A Network Meta-Analysis and Systematic Review.
New approaches and technologies can be beneficial for patients but also bring corresponding complications. Traditional pairwise meta-analyses cannot be used to comprehensively rank all surgical approaches. ⋯ Compared with other approaches used to treat LDH, PED had the best safety and efficacy in general, and TD had the lowest reoperation rate. Finally, we recommended PED for LDH.
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Although being controversial, pregabalin (PGB) is proposed during a short perioperative period to improve pain relief.Comparisons between chronic and short-term users during lumbar spine surgery are lacking. ⋯ Patients chronically treated with PGB required less opioid when compared with a short perioperative administration before spinal surgery. Further prospective studies are required to confirm these results in spinal surgeries.
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Observational Study
CT-guided Chemical Lumbar Sympathectomy in the Treatment of Cold Hypersensitivity in the Hands and Feet.
Cold hypersensitivity in the hands and feet is a common clinical symptom in Asian women. Currently, treatment of cold hypersensitivity in the hands and feet is still limited to traditional Chinese medicine, mainly herbal medicine. However, many patients with cold hypersensitivity in the hands and feet in China are not satisfied with the therapeutic effect of herbal medicine, and took medication for a longer time. Chemical lumbar sympathectomy is widely used in the treatment of plantar hyperhidrosis, diabetic foot, recalcitrant erythromelalgia, and other diseases. ⋯ Chemical lumbar sympathectomy is a valid treatment option for cold hypersensitivity in hands and feet, and computed tomography-guided percutaneous puncture chemical lumbar sympathectomy has the advantages of high success rate, less invasion, less complications, and repeatablity.
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Complex regional pain syndrome is a rare, neuropathic disorder that affects fewer than 200,000 individuals in the United States annually. Current treatments often focus on pain management and fall short of relieving symptoms of pain and dystonia in patients. ⋯ There is a need for additional prospective and interventional studies addressing the use of low-dose naltrexone in the treatment of complex regional pain syndrome symptoms.
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Selective nerve root block (SNRB) has been used to facilitate the diagnostic process when radiologic abnormalities are not correlated with clinical symptomatology in patients with cervical radiculopathy. Meanwhile, minimally invasive posterior percutaneous endoscopic cervical foraminotomy and discectomy (PPECFD) has been widely used to treat cervical radiculopathy because of its advantages. However, combination of these 2 procedures in the treatment of cervical radiculopathy with diagnostic uncertainty has not been reported. ⋯ Diagnostic SNRB may be a helpful tool to identify the origin of cervical radicular pain for patients with diagnostic uncertainty. With the guidance of SNRB, PPECFD is likely to be an effective and safe option for the treatment of cervical radiculopathy with diagnostic uncertainty.