Pain physician
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Trigeminal neuralgia is a very painful condition, and radiofrequency therapy is reserved for patients who are resistant or intolerant to pharmacologic therapy. Continuous radiofrequency (CRF) and pulsed radiofrequency (PRF) both have advantages and disadvantages. Recently, studies have found that PRF combined with low-temperature (< 65°C) CRF increases the efficacy of treatment, without leading to a significant increase in complications caused by nerve lesions. However, these reports have some limitations. ⋯ To our knowledge, this will be the first prospective, open-label, parallel, randomized controlled trial to compare the efficacy and safety of the application of high-voltage PRF, combined with and without low-temperature (60°C) CRF, for the patients who have failed to respond to pharmacologic treatments for primary trigeminal neuralgia. If proven effective, this will be an important, safe, minimally destructive alternative treatment modality for primary trigeminal neuralgia following an ineffective conservative treatment.
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Observational Study
Declining Utilization and Inflation-Adjusted Expenditures for Epidural Procedures in Chronic Spinal Pain in the Medicare Population.
Despite epidurals being one of the most common interventional pain procedures for managing chronic spinal pain in the United States, expenditure analysis lacks assessment in correlation with utilization patterns. ⋯ After adjusting for inflation, there was a decrease of expenditures for epidural procedures of 2%, or 0.2% annually, from 2009 to 2018. However, prior to inflation, the increases were noted at 14.6% and 1.5%. Inflation-adjusted costs per patient, per visit, and per procedure also declined. The proportion of Medicare patients per 100,000 receiving epidural procedures decreased 9.1%, or 1.1% annually. However, assessment of individual procedures showed higher costs for transforaminal epidural procedures compared to lumbar interlaminar and caudal epidural procedures.
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Comment Letter
Transforaminal Epidural Steroid Injections: A Systematic Review and Meta-Analysis of Efficacy and Safety.
Transforaminal epidural injections have been used since the late 1990s to treat lumbar radicular pain. They have been the subject of considerable attention, with varying conclusions from systematic reviews as to their efficacy. Transforaminal injections have been associated with rare but major complications. Further, the use of transforaminal injections has increased since the passage of the Affordable Care Act. Finally, with the SARS-CoV-2 pandemic, there has been heightened concern regarding the risk associated with steroid injections. ⋯ There is Level I evidence for the use of transforaminal injections for radicular pain from disc herniations.
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Observational Study
Visit Frequency and Outcomes for Patients Using Ongoing Chiropractic Care for Chronic Low-Back and Neck Pain: An Observational Longitudinal Study.
Chronic spinal pain is prevalent and long-lasting. Although provider-based nonpharmacologic therapies, such as chiropractic care, have been recommended, healthcare and coverage policies provide little guidance or evidence regarding long-term use of this care. ⋯ This 3-month window on chiropractic patients with CLBP and/or CNP revealed that they were improving, although slowly; may have reached maximum therapeutic improvement; and are possibly successfully managing their chronic pain using a variety of chiropractic visit frequencies. These results may inform payers when building coverage policies for ongoing chiropractic care for patients with chronic pain.
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Clinical Trial Observational Study
Long-Term Effectiveness and Tolerability of Pain Treatment with Tapentadol Prolonged Release.
The central analgesic tapentadol prolonged release (PR) has proven effective and generally well tolerated in a broad range of chronic pain conditions. Long-term data of its use are still scarce. ⋯ Sustained pain relief and quality of life for up to 72 treatment weeks under relatively stable dosing, as well as the good safety profile, indicate the usefulness of tapentadol PR for patients who suffer from severe chronic OA knee pain and LBP with limited risk for tolerance development.