Pain physician
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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.
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Cervical interlaminar epidural injection (CILEI) is commonly used to treat acute or chronic pain that affects the head, neck, and upper extremities. Thus far, studies on CILEI have focused on determining the optimal volume of contrast medium or analyzing the spread of contrast medium during a CILEI. To our knowledge, few studies have attempted to assess the correlation between epidurogram patterns and clinical outcomes of CILEI. ⋯ If the duration of symptoms is lengthy, central stenosis is severe, or contrast medium spread is limitedly solely within the central canal and does not reach the dorsal root ganglion any further, the outcome after a CILEI is likely to be poor. Therefore, efforts should be made to spread injectate around the dorsal root ganglion at the target level.
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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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Review Case Reports
Painful Diabetic Neuropathy - Spinal Cord Stimulation, Peripheral Nerve Stimulation, Transcutaneous Electrical Nerve Stimulation, and Scrambler Therapy: A Narrative Review.
First-line medications for the treatment of painful diabetic neuropathy (PDN) are associated with a substantial rate of discontinuation due to adverse effects or insufficient efficacy. Neuromodulation techniques have been used for PDN, but a comprehensive review of the literature that incorporates several distinct device categories has yet to be undertaken. ⋯ The evidence for neuromodulation devices for the treatment of PDN mostly comprises open-label prospective trials or case reports. SCS has the most volume of evidence for efficacy. Studies regarding TENS show mixed results, possibly due to numerous device varieties. PNS and ST may hold promise based on their proposed mechanisms of action, but prospective controlled trials are needed.