Pain physician
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Chronic low back pain is observed frequently after lumbar spinal surgery. Epidural fibrosis has been implicated in the etiology of persistent pain after back surgery. The incidence of epidural fibrosis increases as the number and extent of spinal surgery increases. Epidural fibrosis can be detected by conventional radiologic methods [e.g., lumbosacral magnetic resonance imaging (MRI) with gadolinium], but these methods are insufficient to reveal the presence of epidural adhesions. Imaging of the epidural cavity using an epiduroscope is one of the best methods for visualizing the spinal cavity without damaging anatomic structures. ⋯ We did not have a control group. Further studies are required to demonstrate the relevance of these 2 imaging techniques (epiduroscopy and MRI) in terms of detecting epidural fibrosis in patients with FBSS. CONCLUSIONS: Epiduroscopic imaging seems to be more sensitive than MRI in detecting grade I epidural fibrosis in patients with FBSS. Thus, the possibility of low-grade epidural fibrosis as a source of pain after back surgery, should be kept in mind in normally reported MRIs. Treatment should be planned accordingly.
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Chronic pain is correlated with alterations in brain structure and function. The selection process for the ideal candidate for spinal cord stimulation (SCS) therapy is based on functional variables analysis and pain evaluation scores. In addition to the difficulties involved in the initial selection of patients and the predictive analysis of the trial phase, the large rate of explants is one of the most important concerns in the analysis of the suitability of implanted candidates. ⋯ These findings confirm a major role of the left putamen and the four pairs of brain regions in FBBS patients and suggest that a CDSS would be able to select patients susceptible to benefitting from SCS therapy adding imaging biomarkers.
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Degenerative lumbar spondylolisthesis (DLS) occurs mainly in geriatric patients. Some authors have reported satisfactory short-term outcomes following percutaneous endoscopic lumbar discectomy (PELD) for DLS; however, the long-term clinical outcomes remain unknown. In addition, it remains unclear whether PELD causes further progression of spondylolisthesis over a long period of time. ⋯ PELD maintained satisfactory clinical outcomes for the treatment of grade I and grade II DLS after a minimum 5-year follow-up; the operation did not cause further progression of spondylolisthesis. However, further large-scale multicenter studies are necessary.
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The role of psychological factors influencing chronic pain is well documented, although less is known about the implication and logistics of conducting behavioral and psychological assessments in clinical practice, specifically within pain management. ⋯ The utility and feasibility of psychological and behavioral health assessments appear to be a critical component of a pain management practice as there is substantial overlap with psychological comorbidities (e.g., depression and anxiety) and chronic pain. Positive affect, such as resilience, may act to confer some protection against the sequelae of chronic pain, and identifying such factors appears vital.
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Pulsed radiofrequency (PRF) on the dorsal root ganglion (DRG) is a common minimally invasive surgery for herpes zoster (HZ)-related pain, including acute zoster pain and postherpetic neuralgia (PHN); however, some patients still have no obvious pain relief, a high recurrence rate, and short-term recurrence. Radiofrequency thermocoagulation (RF-TC) has a higher temperature; however, it is still unknown whether the degree of complete damage will affect the recurrence rate and if there is any difference compared with the effect of PRF. ⋯ In the treatment of HZ-related pain, the use of PRF is significantly associated with a high short-term recurrence rate. However, compared with RF-TC, PRF results in milder numbness and less intraoperative pain. RF-TC may be a feasible procedure if patients can accept pain relief at the cost of long periods of numbness, whether RF-TC has the value of clinical promotion still needs to be further explored.