Pain physician
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Randomized Controlled Trial
Comparison of Caudal Versus Transforaminal Epidural Steroid Injection in Post Lumbar Surgery Syndrome After Single-level Discectomy: A Prospective, Randomized Trial.
Epidural fibrosis (EF) is one of the leading causes of post lumbar surgery syndrome (PLSS). Although there are studies in the literature suggesting that lumbar epidural steroid injections are an effective method in the pain management of PLSS caused by EF, no study is available comparing the effectiveness and safety of caudal and transforaminal approaches. ⋯ Both CESI and TFESI are effective and safe methods in the treatment of PLSS caused by EF following lumbar discectomy. These methods can reduce pain and disability. Although both methods have similar treatment success rates, TFESI seems to be a more effective treatment method in reducing disability at 3-week follow-up.
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Observational Study
The Ultrasound-guided Anteromedial Joint Line Approach: A Targeted Corticosteroid Injection Technique for Patients With Medial Knee Pain.
Medial knee pain is a common complaint in the adult population. When conservative measures fail, intraarticular knee corticosteroid injections are often offered through the superolateral approach into the suprapatellar recess to provide short-term relief. However, some patients fail to respond and require alternative approaches. The anteromedial joint line (AMJL) approach, which targets the medial compartment, may be more effective when pain-generating pathologies such as synovitis are located in the medial compartment. To date, there have been no dedicated studies evaluating ultrasound-guided (USg) corticosteroid injections through the AMJL approach to reduce medial knee pain. ⋯ USg AMJL injection is a safe and effective procedure for targeting medial knee pain, particularly in the settings of obesity and prior failed superolateral and suprapatellar knee injections. Further investigation is required to assess long-term clinical outcomes of this injection approach.
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Pain costs more than $600 billion annually and affects more than 100 million Americans, but is still a poorly understood problem and one for which there is very often limited effective treatment. Electronic health records (EHRs) are the only databases with a high volume of granular pain information that allows for documentation of detailed clinical notes on a patient's subjective experience. ⋯ Our customized NLP model demonstrated good and successful performance in extracting granular pain information from clinical notes in electronic health records.
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Percutaneous endoscopic lumbar discectomy (PELD) has become a mature and mainstream minimally invasive surgical technique for treating lumbar disc herniation (LDH). During PELD, various spinal structures, such as ligamentum flavum, dural sac, nerve root, posterior longitudinal ligament, annulus fibrosus, and endplate, were exposed, removed, and decompressed. When we used different endoscopic instruments to touch, remove, and excise different spinal structures, the patient will experience varying degrees of low back pain (LBP). To the best of our knowledge, the differences of the LBP have not been investigated in detail. ⋯ During PELD, varied LBP will generate when different spinal tissues are manipulated by different endoscopic instruments, the most severe LBP always came from the posterior longitudinal ligament and nerve root /dural sac. Moreover, compared to incision and thermal stimulus, traction could provoke more severe LBP.
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Chronic low back pain secondary to facet joint pathology is prevalent in 27% to 40% of selected populations using controlled comparative local anesthetic blocks. Lumbar facet joint nerve blocks and radiofrequency neurotomy are the most common interventional procedures for lower back pain. Nonetheless, questions remain regarding the effectiveness of each modality. Moreover, there is no agreement in reference to superiority or inferiority of lumbar facet joint nerve blocks when compared with radiofrequency neurotomy. Centers for Medicare and Medicaid Services (CMS) and almost all payers prefer radiofrequency ablation. Both procedures have been extensively studied with randomized controlled trials, systematic reviews, and cost utility analysis. ⋯ This study shows similar outcomes of therapeutic lumbar facet joint nerve blocks when compared with radiofrequency neurotomy as indicated by significant pain relief and cost utility.