Pain physician
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Chronic axial spinal pain is one of the major causes of disability. Literature shows that spending on low back and neck pain and musculoskeletal disorders continues to escalate, not only with disability, but also with increasing costs, accounting for the highest amount of various disease categories. Based on the current literature utilizing controlled diagnostic blocks, facet joints, nerve root dura, and sacroiliac joints have been shown as potential sources of spinal pain. Therapeutic facet joint interventional modalities of axial spinal pain include radiofrequency neurotomy, therapeutic facet joint nerve blocks, and therapeutic intraarticular injections. ⋯ Based on the present systematic review and meta-analysis with 9 RCTs and 12 non-randomized studies, the evidence is Level II with moderate to strong recommendation for therapeutic facet joint nerve blocks in managing spinal facet joint pain.
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Randomized Controlled Trial
Comparison of Selective Nerve Root Pulsed Radiofrequency Vs Paramedian Interlaminar Epidural Steroid Injection for the Treatment of Painful Cervical Radiculopathy.
Although there are studies evaluating ultrasound-guided selective nerve root pulsed radiofrequency (ULSD-SNRPRF) and fluoroscopy-guided paramedian cervical interlaminar epidural steroid injection (FL-CIESI) for the treatment of chronic cervical radicular pain, no study has compared the efficacy of these 2 methods. ⋯ Pain relief, functional improvement, and safety were similar between groups. ULSD-SNRPRF and paramedian FL-CIESI are 2 different effective techniques for chronic cervical radicular pain. The choice of method should depend on various factors, such as patient preference, operator experience, and availability of resources. An advantage of ULSD over fluoroscopy is that patients and physicians are not exposed to radiation.
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Randomized Controlled Trial
Stellate Ganglion Destruction With Alcohol Versus Thermal Ablation for Chronic Post-Mastectomy Pain: A Randomized Trial.
Post-mastectomy pain syndrome (PMPS) is a persistent post-surgical neuropathic pain. Stellate ganglion (SG) block is used for diagnosis, prognosis, and treatment of pain syndrome. ⋯ US-guided SG destruction with alcohol was more effective than thermal radiofrequency for managing acute postoperative pain by decreasing pain score, oxycodone, and pregabalin consumption, which were consumed before the block.
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Observational Study
Comparison of Radiation Doses of Contralateral Oblique and Lateral View for Fluoroscopy-Guided Lumbar Interlaminar Epidural Steroid Injection.
Despite newly developing technologies and techniques, the use of fluoroscopic guidance in spinal interventional treatments remains popular. Therefore, it is essential to set reference standards and techniques for reducing radiation exposure in fluoroscopy-guided procedures. ⋯ Although there was no difference in terms of radiation dose and duration of procedure between lumbar ILESI conducting using the CLO or lateral view fluoroscopy imaging, there was a significant difference in terms of complications. Therefore, conducting lumbar ILESI using a CLO view minimizes the complication rate.
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Since electronic cigarettes (E-Cigs) were introduced to the United States (US) in 2007 its use has increased. Like other tobacco products, E-Cigs too pose health risks. Studies have shown a correlation between pain and tobacco use, with the association being bidirectional. However, there is limited data on the effect of E-Cig use on chronic pain, as well as its association with opioid use. ⋯ In this study of chronic pain patients, cigarette smoking and E-Cig use was similar to the reported use in the general adult population in the US. The study showed a strong correlation between tobacco use, especially cigarettes and E-Cigs, and opioid use. As the use of E-Cigs becomes more mainstream, the association between E-Cig use, chronic pain, and opioid use should be monitored.