Pain physician
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Observational Study
Influence of Handgrip Strength and Psoas Muscle Index on Analgesic Efficacy of Epidural Steroid Injection in Patients With Degenerative Lumbar Spinal Disease.
Handgrip strength (HGS) and psoas muscle index (PMI) are widely used protocols for screening or diagnosing sarcopenia by measuring muscle strength and mass. Epidural steroid injection (ESI) is a common intervention for the treatment of spinal pain; however, the influence of pre-procedural sarcopenic status on therapeutic effects after ESI has not been investigated. ⋯ In the present study, pre-procedural HGS was an independent predictor of analgesic efficacy after ESI in elderly patients with degenerative lumbar spinal disease. However, the PMI was not associated with pain relief after injection.
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Radiofrequency thermocoagulation (RFT) of the trigeminal ganglion is an excellent treatment option for medically intractable trigeminal neuralgia. However, this procedure can manifest abrupt changes in cardiovascular responses. With abrupt cardiovascular changes, a sudden trigeminocardiac reflex can occur during RFT of the trigeminal ganglion. ⋯ FO puncturing, electrical stimulation, and thermal heating demonstrated an abrupt increase in heart rate and mean arterial pressure. The incidence of sudden bradycardia during RFT of the trigeminal ganglion was 25%. Most cases of bradycardia were observed during FO puncturing.
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Hemifacial spasm (HFS) is mainly characterized by paroxysmal involuntary twitches of one side of the facial muscles. We developed an awake CT-guided percutaneous puncture of the stylomastoid foramen for radiofrequency ablation (RFA) therapy for the treatment of hemifacial spasm and successfully used it in our clinic. ⋯ There was no difference in the operation time or efficacy between the 2 approaches. The anterior mastoid approach is easier to perform and is recommended based on our experience.
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Legg-Calvé-Perthes disease (LCPD) and slipped capital femoral epiphysis (SCFE) can result in painful deformation of the hip joint with impaired range of motion and early development of secondary osteoarthritis. It has not been investigated whether having LCPD or SCFE is associated with increased use of pain or antidepressant drug prescriptions later in life. ⋯ During childhood, patients with LCPD or SCFE seem to suffer long-term pain and have an increased risk of requiring analgesic medication in adulthood, including opioids. It is important to assess the causes, type, and severity of pain to optimize pain management to counteract possible overuse in these patients. Seemingly, patients with LCPD do not have an increased risk for antidepressant drug therapy in adulthood whereas we did see an increased risk for that in patients with previous SCFE compared with the general population.
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Epidural injections are among the most commonly performed procedures for managing low back and lower extremity pain. Pinto et al and Chou et al previously performed systematic reviews and meta-analyses, which, along with a recent update from Oliveira et al showing the lack of effectiveness of epidural steroid injections in managing lumbar disc herniation, spinal stenosis, and radiculopathy. In contrast to these papers, multiple other systematic reviews and meta-analyses have supported the effectiveness and use of epidural injections utilizing fluoroscopically guided techniques. A major flaw in the review can be related to attributing active-controlled trials to placebo-controlled trials. The assumption that local anesthetics do not provide sustained benefit, despite extensive evidence that local anesthetics provide long-term relief, similar to a combination of local anesthetic with steroids is flawed. ⋯ A comparative systematic review and meta-analysis of the Cochrane Review of randomized controlled trials (RCTs) of epidural injections in managing chronic low back and lower extremity pain with sciatica or lumbar radiculopathy yielded different results. This review, based on the evidence derived from placebo-controlled trials and active-controlled trials showed Level I, or strong evidence, at one and 3 months and Level II at 6 and 12 months. This review once again emphasizes the importance of the allocation of studies to placebo-control and active-control groups, utilizing standards of practice with inclusion of only the studies performed under fluoroscopic guidance.