Pain physician
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Since its adoption as a treatment for neuropathic pain in the 1960s, radiofrequency ablation (RFA) has continued to gain popularity for the management of various pain etiologies. Although RFA is considered to be a safe procedure, post-neurotomy neuritis (PNN), a neuropathic-type pain, is one of the most common side effects. Due to the increasing recognition of PNN, some providers have attempted to mitigate the risk of PNN by injecting local corticosteroids at the site of RFA following the procedure. Recent studies have generally concluded that corticosteroids do not protect against the development of PNN, however, they have been limited by their retrospective study designs and the low incidence of PNN. ⋯ Overall, our study is in agreement with prior studies that RFA is effective for the treatment of facet and osteoarthritic knee pain and that the incidence of PNN is likely small.
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Novel externally powered spinal cord stimulation technology can be fully implanted when trialing the effectiveness of the therapy, since no percutaneous leads are needed, and the trial period lasted 30 days. Multiple tests of different stimulation modalities and parameters are possible, thus improving the chances that the therapy will lead to effective pain reduction. ⋯ The study demonstrates that spinal cord stimulation with multiple stimulation patterns demonstrates clinical and functional efficacy when using an externally powered stimulation system.
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Cervical facet joint pain is often managed with either cervical radiofrequency neurotomy, cervical medial branch blocks, or cervical intraarticular injections. However, the effectiveness of each modality continues to be debated. Further, there is no agreement in reference to superiority or inferiority of facet joint nerve blocks compared to radiofrequency neurotomy, even though cervical facet joint radiofrequency neurotomy has been preferred by many and in fact, has been mandated by the Centers for Medicare and Medicaid Services (CMS), except when radiofrequency cannot be confirmed. Each procedure has advantages and disadvantages in reference to clinical utility, outcomes, cost utility, and side effect profile. However, comparative analysis has not been performed thus far in the literature in a clinical setting. ⋯ In this study, outcomes of cervical therapeutic medial branch blocks compared to radiofrequency neurotomy demonstrated significantly better outcomes with significant pain relief with similar costs for both treatments over a period of one year.
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Lumpectomy is important for preventing malignant changes in benign tumors and diagnosing malignant tumors. Intercostal nerve blocks (ICNBs) are useful for breast lumpectomy as either the primary anesthetic or as an adjuvant anesthetic procedure. To our knowledge, no studies have evaluated the association between Horner syndrome and ICNB. ⋯ Horner's syndrome, intercostal nerve block, breast lumpectomy, enhanced recovery.
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Clinical Trial
Treatment of Femoral Head Osteonecrosis with Ozone Therapy: Pilot Trial of a New Therapeutic Approach.
Osteonecrosis of the femoral head (ONFH) is a progressive and painful disorder due to impaired blood supply to the femoral head, yet little is known about the effect of ozone therapy in femoral head necrosis. ⋯ Ozone therapy was associated with significant pain relief, improvement in hip function, and bone marrow edema resolution that may delay the need for THA in patients affected by ONFH.Institutional Review Board (IRB) approval number: HK2018-10-28.Clinical trials registration number: ChiCTR1900023449.