Pain physician
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Randomized Controlled Trial Controlled Clinical Trial
Verification of Sphenopalatine Ganglion Block Success Using Transcranial Doppler in Management of Patients with Postdural.
Sphenopalatine ganglion block (SPGB) is traditionally advised in the management of head and neck pain. Since SPGB is a minimally invasive, repeatable, and simple technique, SPGB should be tried first in the management of postdural puncture headaches (PDPH). Verification of the block's success in diagnostic, prognostic, and therapeutic nerve blocks, is of paramount importance in pain management. ⋯ Performing SPGB without standardized equipment may limit the results of the current studyCONCLUSIONS: SPGB should be considered as a first treatment modality for PDPH. Moreover, the results indicate that TCD is a successful objective tool in assessing a transnasal sphenopalatine ganglion block.
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Randomized Controlled Trial
Long-term Efficacy of Percutaneous Epidural Neurolysis of Adhesions in Chronic Lumbar Radicular Pain: 10 Year Follow-up of a Randomized Controlled Trial.
No long-term follow-up data exist in any treatment for chronic radicular pain occurring with disc pathology and after failed back surgery. A previous randomized controlled trial (RCT) has proven efficacy in short-term follow-up as an evidence-based effective therapeutic option. ⋯ This is the first 10 year follow-up report of a placebo-controlled RCT showing efficacy of the minimally invasive percutaneous adhesiolysis procedure for patients with chronic lumbosacral radicular pain. No alternative evidence-based treatment modality with 10 year follow-up is available to be recommended. This procedure should be considered as the first treatment option for patients with chronic lumbosacral radicular pain.
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Pancreatic cancer (PC) is one of the most lethal cancers and is the eleventh most common cancer worldwide. This disease is characterized by an often-fatal evolution and a high burden of symptoms, particularly pain. Several studies have demonstrated that pancreatic cancer patients have a high prevalence of pain, with up to 82% of patients reporting pain, often requiring systemic strong opioids as mainstay treatment. This comprehensive review of pancreatic cancer related pain (PCRP), focuses on current mechanisms that lead to pain including regional invasion processes, as well as the local secretion of factors that sensitize nociceptive nerves. ⋯ This review analyzes both past and current literature with a critical analysis of findings and respective recommendations. Most studies of IDDS in PCRP evaluate outcomes on pain using one-dimensional pain scales, such as VAS. Other relevant results, such as performance status or quality of life, are not frequently reported. Burden of disease variables, such as cancer stage, location, and comorbidities, like depression and systemic analgesia co-prescription, are usually not presented in these studies. In the same way, most studies do not precisely inform IDDS titration and IT medication. These factors make integration of IDDS in PC studies difficult. Future studies regarding impact of IDDS on pain control on quality of life, in this particular population, may help clinicians in deciding the optimal time and approach for IDDS. The studies should report data on particular disease, comorbidities, and treatment regimens.
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Randomized Controlled Trial Observational Study
Conservative Treatment for Giant Lumbar Disc Herniation: Clinical Study in 409 Cases.
There have been several recent reports of lumbar disc herniation (LDH) resorption; however, large sample studies are lacking, and the mechanism(s) underlying this phenomenon is unclear. ⋯ Patients with giant LDH are less likely to develop progressive nerve injury and cauda equina syndrome if their clinical symptoms improve after treatment. As long as there is no progressive nerve injury or cauda equina syndrome, conservative treatment is preferred for giant disc herniation. Resorption is more likely with greater disc protrusions in the spinal canal. A ring enhancement bull's eye sign) around a protruding disc on enhanced magnetic resonance imaging is an important indicator of straightforward resorption.
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We previously reported on a combined technique and initial data of hip denervation using an anterior approach and cooled radiofrequency. ⋯ Improvements in pain scores and longevity of pain relief from chronic hip pain using a simple, anterior approach to radiofrequency denervation of the lateral obturator and lateral femoral nerves justifies further randomized prospective trials. Repeated CRFAs demonstrated consistency in pain relief and absolute safety of repeated denervation.