Pain physician
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Peripheral neuropathic pain (PNP) is a complex, subjective experience affecting both physical and psychological aspects of functioning. Assessing patient-reported outcomes (PROs) beyond pain relief is important and aligns with the recommendations of IMMPACT (Initiative on Methods, Measurement, and Pain Assessment in Clinical Trials). Moreover, PRO data are key to clinical decision-making when evaluating treatment options. However, direct comparisons between such options are scarce. High-concentration capsaicin 179 mg (8% w/w) cutaneous patch (HCCP) is applied to the skin at minimum intervals of 90 days under physician supervision; alternative recommended treatments for PNP are mostly orally administered on a daily basis. The ELEVATE study directly compared HCCP with pregabalin and found noninferior efficacy of HCCP to pregabalin in relieving pain after 8 weeks, with a significantly faster onset of action and fewer systemic side effects. ⋯ NCT01713426.
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The American Society of Regional Anesthesia currently recommends ceasing antithrombotic medications for all spinal epidural steroid injections, however there is a paucity of data on the true risk of spinal epidurals via various approaches versus the risk of cessation of an agent as it relates to the underlying medical condition. ⋯ We conclude that caudal epidural steroid injections can be performed safely in patients while taking antithrombotic medications. Catastrophic events have been observed in patients who have discontinued antithrombotic agents preceding procedures. Thus, discontinuing antithrombotic medications may pose a greater risk than benefit for patients on an antithrombotic medication who have painful lumbar radiculopathy.
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Adult degenerative (de novo) scoliosis (ADS) usually occurs due to degenerative changes and is accompanied by progressive low-back pain and/or symptomatic lumbar stenosis. Interlaminar decompression is considered an effective treatment of lumbar stenosis, but some surgical contraindications to traditional open surgery limit its application in elderly patients with many disorders. A 10-mm endoscope has been used in the treatment of stenosis in individuals with ADS and its safety and efficacy should be assessed. ⋯ Minimally invasive decompression with a 10-mm endoscope was suggested to be a safe and effective method, as expected, for the treatment of lumbar stenosis in ADS patients.
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Meta Analysis Comparative Study
Comparison of Clinical Outcomes and Complications Between Percutaneous Endoscopic and Minimally Invasive Transforaminal Lumbar Interbody Fusion for Degenerative Lumbar Disease: A Systematic Review and Meta-Analysis.
Percutaneous endoscopic transforaminal lumbar interbody fusion (PE-TLIF) has been increasingly used to treat degenerative lumbar disease in recent years. However, there are still controversies about whether PE-TLIF is superior to minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF). ⋯ The present meta-analysis indicates that medium to long-term clinical outcomes and complication rates of PE-TLIF were similar to MIS-TLIF for the treatment of degenerative lumbar disease. However, PE-TLIF shows advantages in less surgical trauma, faster recovery, and early postoperative relief of back pain.