Pain physician
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Randomized Controlled Trial Observational Study
Comparison of Effect and Contrast Spreading in Transforaminal Epidural Injection Using the Retrodiscal Versus Subpedicular Approach: A Prospective, Randomized Trial.
Lumbar transforaminal epidural injection (TFEI) effectively decreases low back pain and radicular pain in herniated intervertebral disc (HIVD) and spinal stenosis (SS). The precise delivery of drugs to the target is important for pain control and minimizing complications. ⋯ The RD approach for TFEI showed a better contrast spreading pattern than the SP approach, especially in patients with severe central and foraminal spinal stenosis. The RD approach might be more beneficial for patients with severe central and foraminal spinal stenosis in the short-term follow-up.
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Randomized Controlled Trial
The Effect of Tramadol Versus Sufentanil on Controlling Postoperative Pain for Men Who Smoke and Do Not Smoke: A Randomized Clinical Trial.
Smoking behavior alters the analgesic threshold, which challenges postoperative pain management for patients who smoke. ⋯ Our data suggest that tramadol has a better analgesic effect than sufentanil in relieving postoperative pain in patients who smoke.
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Observational Study
High-order Brain Networks Abnormalities in Osteonecrosis of the Femoral Head Patients: An Independent Component Analysis of Resting-state fMRI.
Patients with osteonecrosis of the femoral head commonly present with sensorimotor anomalies. With independent component analysis, it is possible to explore the intrinsic alternations in highly specific functional networks. We used independent component analysis to examine the intrinsic changes and interactive connectivity between related functional resting-state networks. ⋯ This study investigated the alterations in resting-state network functional connectivity in osteonecrosis of the femoral head patients. Examining the large-scale functional reorganization in osteonecrosis of the femoral head patients may be helpful for us to understand the pathological mechanisms underlying dysfunction and shed light on potential behavioral treatments for osteonecrosis of the femoral head based on functional magnetic resonance imaging in clinical practice. Understanding the mechanisms of the disease may shed light on potential behavioral treatments for patients with osteonecrosis of the femoral head based on functional magnetic resonance imaging findings.
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Observational Study
Healthcare Utilization and Costs Associated with New-Onset Pain in a Medicare Population.
Chronic pain is a common and growing problem in the United States with variable strategies for its treatment. Surgical interventions are necessary in some cases but not required for all patients with new-onset pain. For some patients, interventional pain management (IPM) techniques can treat chronic pain without the cost or risk associated with surgical intervention. ⋯ By shifting patients from higher-cost and more invasive surgical procedures, IPM's multidisciplinary approach to pain treatment can reduce surgical utilization and costs for certain chronic pain patients. This shift away from more expensive surgical treatments fits well with Medicare's move toward value-based care, driven by a focus on patient outcomes including health care utilization and costs.
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Approximately 700,000 individuals experience osteoporotic vertebral compression fractures (OVCF) every year in the United States. Chronic complications from patients and increasing economic burdens continue to be major problems with OVCFs. Multiple treatment options for OVCF are available, including conservative management, surgical intervention, and minimally invasive vertebral augmentation. Prior studies have investigated the utility of vertebral augmentation techniques such as percutaneous vertebroplasty (PVP), balloon vertebroplasty (BVP), and vertebral augmentation with the KivaTM implant on patient mortality with favorable results. The optimal time from OVCF occurrence to vertebral augmentation continues to be a topic of investigation. ⋯ Early intervention (< 12 weeks) with vertebral augmentation in patients with OVCF is associated with improved pain scores when compared to later intervention (> 12 weeks). Very early intervention (< 6 weeks) confers a greater advantage when compared to later intervention (> 12 weeks).