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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Randomized Controlled Trial
Comparison of Different Treatment Regimens of Extracorporeal Shockwave Therapy in Chronic Low-back Pain: A Randomized Controlled Trial.
Extracorporeal shockwave therapy (ESWT) has shown its efficacy in treating chronic pain. Previous evidence has proven that ESWT in patients with chronic low-back pain (CLBP) results in significant reductions in pain. However, the optimal regimen for conducting ESWT in these patients remains unknown. ⋯ Low-intensity ESWT treatment with more sessions is more effective in relieving pain and improving disability in the short-term than medium-intensity treatment with fewer sessions under the same total energy dose.
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Randomized Controlled Trial
Transforaminal Versus Interlaminar Approach of Full-Endoscopic Lumbar Discectomy Under Local Anesthesia for L5/S1 Disc Herniation: A Randomized Controlled Trial.
Local anesthesia is feasible for both transforaminal and interlaminar approaches in percutaneous endoscopic lumbar discectomy (PELD). However, the optimal approach for PELD has not yet been established at the L5/S1 segment under local anesthesia with 1% lidocaine. ⋯ Both TELD and IELD can provide good clinical outcomes for L5/S1 DH under local anesthesia with 1% lidocaine. TELD was superior to IELD in terms of surgical-related experience and complications.
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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.