Pain physician
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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.
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Cervical epidural steroid injections have long been utilized to treat intraspinal inflammation causing cervicalgia and/or cervical radiculopathy, and much has been written about safety and efficacy. There are published opinions, without evidence basis, that these injections should not be performed above C7-T1 for fear of dural puncture, spinal cord injury, and other complications that might occur more frequently at higher spinal levels. However, many experienced interventional pain physicians believe that epidural injections targeted to the level of spinal inflammation may be more effective. Although medication injected at the lowest cervical level C7-T1 may ascend to higher spinal levels, it often does not since inflammation and swelling at the cervical level of pathology may increase epidural pressure causing the injectate to move caudally down the path of least resistance. ⋯ Our article supports the contention that interlaminar cervical epidural injections above C7-T1 are safe. Complication rates were not increased with cervical injections cephalad to C7-T1.
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Endoscopic rhizotomy (ER) of the medial branch has been recently developed for the treatment of lumbar facet joint pain (LFJP). However, there are no studies comparing the pain-free duration after ER and radiofrequency (RF). ⋯ Both ER and RF can improve the pain and physical function in patients with LFJP. ER is associated with a longer operative duration and medical expenses; however, it provides more sustained efficacy than RF. The surgical choice should depend on the patients' specific conditions.
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Clinical Trial
Treatment of Femoral Head Osteonecrosis with Ozone Therapy: Pilot Trial of a New Therapeutic Approach.
Osteonecrosis of the femoral head (ONFH) is a progressive and painful disorder due to impaired blood supply to the femoral head, yet little is known about the effect of ozone therapy in femoral head necrosis. ⋯ Ozone therapy was associated with significant pain relief, improvement in hip function, and bone marrow edema resolution that may delay the need for THA in patients affected by ONFH.Institutional Review Board (IRB) approval number: HK2018-10-28.Clinical trials registration number: ChiCTR1900023449.