Pain physician
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Amputees commonly feel an intermittent tingling, piercing, or burning sensation in the region of the missing portion of the amputated limb, a phenomenon known as phantom limb pain. Current treatment modalities include medications, mirror therapy, transcutaneous electrical nerve stimulation, and more recently neuromodulation through spinal cord stimulation and dorsal root ganglion (DRG) stimulation. ⋯ The cumulative evidence at present suggests DRG stimulation may be a potentially effective treatment for phantom limb pain, however, a powered prospective randomized controlled trial is needed to assess the long-term benefits of this treatment modality. Given the increasing population of military veterans who are living with limb amputations, finding a modality for adequate long-term pain control is crucial.
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Randomized Controlled Trial
Immunosuppressive Effect of Intrathecal Morphine, Dexmedetomidine, or Both in Combination with Bupivacaine on Patients Undergoing Major Abdominal Cancer Surgery.
An impaired immune system in the perioperative period has important clinical implications in patients with cancer. Despite the immunosuppressive properties of opioid therapy, it is still commonly utilized in the intrathecal or epidural space for the treatment of postoperative pain. Also, intrathecal dexmedetomidine has extended analgesic efficacy in postoperative pain; it can significantly affect immune function in perioperative patients. ⋯ Intrathecal dexmedetomidine has the least immunosuppressive effect than morphine and morphine-dexmedetomidine, in combination with bupivacaine.
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Multicenter Study Observational Study
Meckel's Cave Size Measured by Magnetic Resonance Imaging in the Prognosis of Percutaneous Balloon Compression for Trigeminal Neuralgia.
Percutaneous balloon compression (PBC) is a safe and effective method to treat trigeminal neuralgia. Despite it is known that intraoperative balloon volume is crucial in the prognosis of PBC patients and correlates with Meckel's cave (MC) size, it is a lack of objective and valid criteria for intraoperative balloon volume of PBC. ⋯ The equation [balloon volume (cm3) = 0.110 cm3 + 1.274*MC size] yields an appropriate value at which the patient has a low recurrence rate and a low degree of facial numbness. Preoperative measurement of MC size can be used to guide the intraoperative balloon volume and to predict the patient's prognosis.
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Randomized Controlled Trial
Radiofrequency Denervation on Lumbar Facet Joint Pain in the Elderly: A Randomized Controlled Prospective Trial.
Lumbar facet joint (LFJ) pain is the most common cause of low back pain in the elderly. Denervation of the medial branch of the spinal dorsal ramus can theoretically achieve long-term pain relief. Yet there is little evidence of high-level prospective randomized controlled research. ⋯ Radiofrequency denervation can effectively reduce LFJ pain and improve movement disorder. The effect is good until 6 months later.
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The diagnosis and treatment of neuropathic pain is often clinically challenging, with many patients requiring treatments beyond oral medications. To improve our percutaneous treatments, we established a clinical pathway that utilized ultrasound (US) guidance for steroid injection and alcohol ablation for patients with painful neuropathy. ⋯ US-guided percutaneous treatments for neuropathic pain present a growing opportunity for interprofessional collaboration between neurosurgery, clinicians who treat chronic pain, and sonologists. US can provide valuable diagnostic information and guide accurate percutaneous treatments in skilled hands. Further studies are warranted to determine whether a US-guided treatment pathway can prevent unnecessary open surgical management.