Pain physician
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Lumbar disc herniation (LDH) occurs when the central disc material, primarily the nucleus pulposus, is displaced beyond the outer annulus, compressing the spinal nerve roots. LDH symptoms, including radicular leg pain, radiculopathy, and low back pain, are associated with considerable disease burden and the significant utilization of health care resources. ⋯ The lack of sustained benefits associated with ESIs and the risks associated with surgery underscore the unmet need for novel, minimally invasive interventional therapies able to address the underlying nerve root compression in LDH.
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Yoga has been recognized for its many mental and physical health benefits. A growing body of literature supports yoga's indication in chronic low back pain (CLBP) management. CLBP is a major public health concern, given its high rates of associated disabilities and large healthcare costs. A biopsychosocial approach has been deemed the most effective and appropriate management strategy for this condition. When alternative and comprehensive approaches for managing the complexity of CLBP are considered, yoga poses a safe, accessible adjunctive treatment option. ⋯ Overall, the current management strategies for CLBP do not encompass an effective biopsychosocial approach, and an intervention such as yoga is a promising adjunctive treatment for the condition.
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Multicenter Study
Short-Term Trigeminal Ganglion Stimulation in Patients with Multi-Branch Trigeminal Herpetic Neuralgia: A Pilot Study.
Trigeminal herpetic neuralgia (THN) presents with severe pain hyperalgesia and is a high-risk factor for postherpetic neuralgia (PHN). The current clinical treatments for THN are unsatisfactory, and new treatments are desperately required. ⋯ Short-term trigeminal ganglion stimulation can be used safely and effectively to treat patients with multi-branch THN and significantly reduce the occurrence of PHN.
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Review
Older and Better: A Narrative Review of Successful Aging and Adaptation to Pain in Late Life.
"Invariably, the self-assessed QoL was far better than I, as a physician, would have anticipated from the diseases and disabilities that you reported." -Ben Eiseman, MD, based on a survey of his octogenarian Yale University classmates. ⋯ Chronic pain is common in the elderly and is not adequately treated. Data indicate that older persons can benefit from guidance toward distinct attitudes and actions they can employ to cope with persistent pain. Epidemiologic and aging literature describe attitudes and behaviors that facilitate health and wellbeing during aging. Data from gerontology and from research on chronic pain in elderly patients converge upon factors that are common to better adaptation to both aging and late-life pain. I describe these common factors, which I categorize as treatment-factors, traits, attitudes, and actions. Two cases are presented to demonstrate these concepts.
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Randomized Controlled Trial
Percutaneous Intradiscal Radiofrequency Thermocoagulation Combined with Sinuvertebral Nerve Ablation for the Treatment of Discogenic Low Back Pain.
Percutaneous intervertebral radiofrequency thermocoagulation (PIRFT) and sinuvertebral nerve ablation (SVNA) are commonly used clinical treatments for discogenic low back pain (DLBP). However, they have been reported to have low efficacy rates of approximately 16.5%-26.5%, especially in the medium to long term. ⋯ In DLBP, the sinuvertebral nerve (SVN) is the main nerve involved in the lumbar disc pain signaling pathway, and compared with PIRFT and SVNA alone, combined PIRFT and SVNA treatment may provide more satisfactory pain relief and functional improvement at an early stage.