Pain physician
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Observational Study
Computerized Characterization of Spinal Structures on MRI and Clinical Significance of 3D Reconstruction of Lumbosacral Intervertebral Foramen.
Segmentation of spinal structures is important in medical imaging analysis, which facilitates surgeons to plan a preoperative trajectory for the transforaminal approach. However, manual segmentation of spinal structures is time-consuming, and studies have not explored automatic segmentation of spinal structures at the L5/S1 level. ⋯ The 3D-UNet model developed in this study based on deep learning can effectively and simultaneously segment VBSs and IVDs at L5/S1 level formMR images, thereby enabling rapid and accurate 3D reconstruction of LIVF models. The method can be used to segment VBSs and IVDs of spinal structures on MR images within near-human expert performance; therefore, it is reliable for reconstructing LIVF for L5/S1 LTRFA.
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Since its adoption as a treatment for neuropathic pain in the 1960s, radiofrequency ablation (RFA) has continued to gain popularity for the management of various pain etiologies. Although RFA is considered to be a safe procedure, post-neurotomy neuritis (PNN), a neuropathic-type pain, is one of the most common side effects. Due to the increasing recognition of PNN, some providers have attempted to mitigate the risk of PNN by injecting local corticosteroids at the site of RFA following the procedure. Recent studies have generally concluded that corticosteroids do not protect against the development of PNN, however, they have been limited by their retrospective study designs and the low incidence of PNN. ⋯ Overall, our study is in agreement with prior studies that RFA is effective for the treatment of facet and osteoarthritic knee pain and that the incidence of PNN is likely small.
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Pain is essential for survival, but it is also a major clinical, social, and economic problem that demands adequate management. The latter involves timely and accurate assessment, so several efforts have been made to develop accurate and reliable pain assessment tools. Advances in objective pain assessment include a large body of work focused on determining whether autonomic-mediated peripheral responses can be used to predict pain intensity. However, there is still no clinically validated autonomic marker for objective pain assessment. ⋯ The measurement of autonomic responses elicited by experimentally induced pain is one crucial step toward the development of reliable pain assessment tools. Still, several issues need to be addressed before continuing to explore the use of autonomic parameters for the assessment of pain. It is also recommended that future research endeavors in capturing the singularity of the pain experience involve the measurement of both peripheral (end organs) and central (brain) autonomic responses to pain.
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Many self-report scales have been developed. Among them, are those clinically useful scales for quantifying chronic pain (such as the Numeric Rating Scale), which are useful for determining the effectiveness of treatment, and multifaceted and comprehensive pain assessment scales that are used to determine therapeutic strategies. The representative measure of the latter is the West Haven Yale Multidimensional Pain Inventory (WHY-MPI), which constitutes a system for classifying patients with chronic pain termed the multiaxial assessment of pain (MAP), proposed by Turk and Rudy. ⋯ The study findings support the applicability of the MPI-J as a clinical assessment scale in Japanese patients with chronic musculoskeletal pain.
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Multicenter Study Observational Study
Radiation Doses for Different Approaches of Fluoroscopy-Guided Epidural Injections: An Observational Clinical Study.
Although fluoroscopy-guided interventional therapies have declined in recent years, radiation exposure remains a critical issue for both patients and medical staff. Radiation exposure varies according to the physicians' experience, procedure time, patients' body mass index (BMI), imaging techniques, and the type of procedure performed. ⋯ Radiation dose levels and procedure times of 4 approaches of epidural injections were obtained from 3,711 procedures performed in a university hospital pain medicine clinic. BMI of patients was taken into account with the dose levels of injections given per BMI. Multicenter research with standardized techniques will assure more reliable reference levels, which will guide pain physicians to self-assess their own levels of radiation exposure.