Pain physician
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The incidence of spinal infection seems to be increasing in recent years. Percutaneous endoscopic debridement and drainage (PEDD) has become an effective alternative to extensive open surgery. ⋯ PEDD using 4 different routes brought immediate pain relief and reduced disability in treating spinal infections, especially in elderly patients with comorbid underlying disorders.Key words: Percutaneous discectomy, psoas abscess, spinal epidural abscess, spondylodiscitis, surgical endoscopy.
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Failed back surgery syndrome (FBSS) is a cause of significant morbidity for up to 40% of patients following spine surgery, and is estimated to cost almost $20 billion. Treatment options for these patients currently include conventional medical management (CMM), repeat operation, or spinal cord stimulation (SCS). Much of the published data regarding cost effectiveness of SCS comprise smaller scale randomized controlled trials (RCTs) rather than large databases capturing practices throughout the US. SCS has been shown to have superior outcomes to CMM or repeat spinal operation in several landmark studies, yet there are few large studies examining its long-term economic impact. ⋯ We found that from 2000 to 2012, only 4.3% of patients across the United States with FBSS were treated with SCS. Long-term total annual costs for these patients were significantly reduced compared to patients with conventional management. Although implantation of an SCS system results in a short-term increase in costs at one year, the subsequent annual cumulative costs were significantly decreased long-term in the following 9 years after implantation. This study combines the largest group of FBSS patients studied to date along with the longest follow-up interval ever analyzed. Since SCS has repeatedly been shown to have superior efficacy to CMM in randomized clinical trials, the current study demonstrating improved long-term health economics at 1, 3, 6, and 9 years supports the long-term cost utility of SCS in the treatment of FBSS patients. Key words: Failed back surgery syndrome, spinal cord stimulation, back pain, leg pain, neuromodulation, FBSS, SCS.
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Meralgia paraesthetica (MP) is a condition originally described by Bernhardt in 1878 and was eventually named by Roth in 1895. It is caused by compression of the lateral femoral cutaneous nerve (LFCN) resulting in varying types of discomfort. Severity of the symptoms can range from mildly uncomfortable to painfully disabling. ⋯ In our patients, the MP syndrome was clearly related to the operation because symptoms appeared in the immediate post-operative period and were not present beforehand. LVR is a relatively new and evolving procedure with few reports of associated peri-operative complications. Key words: Meralgia paraesthetica, laparoscopy, rectopexy, lateral femoral cutaneous nerve.
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Comparative Study
Comparisons of Lesion Volumes and Shapes Produced by a Radiofrequency System with a Cooled, a Protruding, or a Monopolar Probe.
Radiofrequency (RF) ablation for denervation has been utilized for decades in chronic pain management. This relies on the proper targeting of the affected nerve which may be obtained by creating an ablation lesion with a shape and volume that optimizes targeting. Various systems designed to improve lesion size are available. These include cooling the active tip (cooled-RF) and protruding the RF electrode outside the active tip (PERF). ⋯ The results indicate that the lesion produced with a cooled-RF system (17 g, 4 mm tip) is significantly larger than that produced with either of the other systems trialed (18 g or 20 g, 10 mm active tip protruding electrode or 16 g, 18 g, or 20 g monopolar electrode). Interestingly, a 16 g, 10 mm active tip monopolar electrode produced a larger lesion than the one produced with the 18 g protruding electrode. Key words: Radiofrequency, ablation, lesion shape, lesion size, cooled-RF, protruding electrode RF, monopolar RF.
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Randomized Controlled Trial
Subcutaneous Injection of Triamcinolone and Lidocaine to Prevent Postherpetic Neuralgia.
Herpes zoster (HZ) is associated with inflammation of the peripheral nerves, which is considered to be an important cause of postherpetic neuralgia (PHN). Interventions aimed at reducing this inflammation could prevent PHN. One option is the epidural administration of corticosteroid and local anesthetic. However, several authors have reported a risk of arachnoiditis with epidural corticosteroids. Subcutaneous injection in an outpatient setting is a safer option. However, there is limited evidence of the effectiveness of this alternative for preventing PHN. ⋯ Subcutaneous injection, lidocaine, triamcinolone, postherpetic neuralgia, prevention.