Pain physician
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Radiofrequency ablation (RFA) for the lumbar facet joints has demonstrated efficacy in the management of chronic low back pain. The traditional technique uses a conventional monopolar (CM) cannula placed parallel to the putative nerve to produce a thermal lesion resulting in pain relief of the facet joints. A new multi-tined (MT) cannula has come onto the market that allows targeting the putative nerve using a perpendicular to the nerve approach. ⋯ This study demonstrated that the outcomes in terms of pain, disability, quality of life, adverse events, and fluoroscopy exposure time were equivalent between the 2 cannulae. However, RFA using the MT cannula was faster to perform and involved less local anesthetic and radiation.
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Preoperative exposure to opioids has recently shown to be associated with poor outcomes after elective major surgery, but little is known as to how pretreatment opioid use affects results of interventional back pain management. ⋯ Pretreatment opioid use is associated with greater pain discomfort, impairment, and reduced functional ability, as well as poorer long-term effect of interventional back pain treatment at one-month follow-up. In our study, opioid users reported the same positive effects of facet joint nerve blocks immediately after the treatment and 2 hours after the treatment, but a significantly smaller effect at one-month follow-up. This could indicate that opioid use may diminish the effects of pain treatments by affecting relearning, behavioral changes, and central pain modulation. These findings may help providers understand the effect of pretreatment opioid use on patient care, and its implications on hospital and societal costs.
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Spinal cord stimulation (SCS) is an effective treatment for failed back surgery syndrome (FBSS). In patients with FBSS, opioids have often been initiated, even before SCS is trialed. ⋯ DP did not reduce the use of opioids in patients with FBSS. Opioid doses were lower and dose escalation less steep with continuous SCS therapy.
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Randomized Controlled Trial
The Effect of Erector Spinae Plane Block With and Without Addition of Magnesium on Relief of Pain from Post-herpetic Neuralgia.
The best tool for management of postherpetic neuralgia (PHN) is a matter of debate. The use of ultrasound-guided erector spinae plane block (ESPB) in patients with PHN may decrease pain severity and the need for analgesics. ⋯ ESPB with or without adding magnesium sulphate is an effective pain management tool for cases of PHN. It leads to a significant decrease in pain score and analgesic requirements.
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Observational Study
Clinical Observation of CT-Guided Intervertebral Foramen Puncture and Radiofrequency Thermocoagulation for the Treatment of Refractory PHN in the Superior Thoracic Segment.
Post-herpetic neuralgia (PHN) is a typical neuropathic pain. Conventional oral analgesics and nerve block therapy can only obtain temporary analgesia in many cases. This study summarized the clinical effect of CT-Guided intervertebral foramen puncture and radiofrequency thermocoagulation through the superior margin of costotransverse joint for the treatment of refractory PHN in the superior thoracic segment. ⋯ CT-Guided intervertebral foramen puncture and RFT through the superior margin of the costotransverse joint can effectively improve refractory PHN in the superior thoracic segment with good safety.