Pain physician
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Chronic pelvic pain (CPP) represents a group of poorly understood disorders that are often refractory to conventional treatment. Referral to pain management typically occurs later in the continuum of care; as such, many of the injections and nerve blocks commonly prescribed for such patients are potentially limited in efficacy. While neuromodulation is conventionally considered the next algorithmic step in the treatment of chronic pain after injections fail, there is a common perception that neuromodulation is largely ineffective for CPP conditions. However, there is evidence that suggests neuromodulation may in fact be a viable treatment option for this particular patient population when utilized properly. ⋯ Chronic pelvic pain, neuromodulation, spinal cord stimulation, CRPS, complex regional pain syndrome, neuropathic pain.
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Comparative Study
Detection of Intravascular Injection During Cervical Transforaminal Epidural Injection: A Comparison of Digital Subtraction Angiography and Real Time Fluoroscopy.
Transforaminal epidural injection (TFEI) with local anesthetics and steroids are effective in treating spinal radicular pain. However, inadvertent intravascular injection can lead to severe neurologic complications. To reduce complications of intravascular injection, use of imaging modality, such as real-time fluoroscopy (RTF) or digital subtraction angiography (DSA), has been recommended. DSA is an imaging technique that can clearly visualize the blood vessels from surrounding bones or dense soft tissues by subtracting the pre-contrast image from the image after injecting contrast medium. ⋯ Analgesia, bleeding, clinical trials, complications, diagnostic equipment, epidural, radiculopathy, spine.
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Though transforaminal endoscopic discectomy has achieved a satisfactory clinical outcome in the treatment of paracentral disc herniation, it has a high failure rate for treating central disc herniation. ⋯ Central disc herniation, rod adjustment technique, transforaminal endoscopy, minimal invasion, complication.
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The intervertebral disc has been implicated as a major cause of chronic spinal pain based on clinical, basic science, and epidemiological research. There is, however, a lack of consensus regarding the diagnosis and treatment of intervertebral disc disorders. Based on controlled evaluations, lumbar intervertebral discs have been shown to be the source of chronic back pain without disc herniation in 26% to 39% of patients, and in 16% to 53% of patients with pain in the cervical spine. Lumbar, cervical, and thoracic provocation discography, which includes disc stimulation and morphological evaluation, is often used to distinguish a painful disc from other potential sources of pain. Despite the extensive literature on point, intense debate continues about lumbar discography as a diagnostic tool. ⋯ Lumbar intervertebral disc, cervical intervertebral disc, thoracic intervertebral disc, discography, provocation discography, analgesic discography, diagnostic accuracy, prevalence.
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Until now, few studies had investigated the neuropathic pain component in patients with a rotator cuff tear (RCT). ⋯ Shoulder, rotator cuff tear, arthroscopic rotator cuff repair, neuropathic pain.