Pain physician
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Observational Study
Predictive Factors of Chronic Post-Surgical Pain at 6 Months Following Knee Replacement: Influence of Postoperative Pain Trajectory and Genetics.
The frequency of chronic postsurgical pain (CPSP) after knee replacement remains high, but might be decreased by improvements to prevention. ⋯ Our findings suggest that several preoperative and postoperative characteristics could be used to facilitate the identification of patients at high risk of CPSP after knee surgery. All therapeutic strategies decreasing APOP, such as anxiety management or performing knee replacement before the pain has a serious effect on ability to walk, may help to decrease the risk of CPSP. Further prospective studies testing specific management practices, including a training program before surgery, are required.
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The quadratus femoris (QF) muscle is a possible source of lower buttock pain as evidenced by what is known about the pathophysiology of ischiofemoral impingement syndrome. However, there are few reports about the interventional management of the QF muscle as a pain generator. ⋯ Ultrasound-guided QF muscle injection with local anesthetic helps alleviate pain in patients with lower buttock pain attributed to the QF muscle, and leads to high levels of satisfaction for patients. A randomized placebo-controlled trial should be considered in the future.
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Painful vertebral compression fractures (VCF) caused by osteoporosis are a common health problem in the elderly population. If conservative treatments are unsuccessful, surgical treatments like vertebroplasty or kyphoplasty are recommended. But the use of Polymethylmethacrylat (PMMA) bone cement for augmentation surgery is associated with risks. ⋯ The study results demonstrate that the clinical outcome of VAS and ODI of using the silicon polymer VK100 is comparable or slightly better than using PMMA. VK 100 shows a trend to minor additional fractures during the follow-up. However, height restoration is not satisfactory in comparison to PMMA, although vertebral height stayed more or less constant in the VK group. To address the augmentation success further, it would be necessary to study a larger patient group over a longer study period and to assess additional parameters such as bone density and injected amount of filling material.
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Most cases of complex regional pain syndrome (CRPS) occur after some inciting injury. There are a few cases of CRPS after an operation for disc disease. CRPS from a mild herniated intervertebral disc (HIVD) without surgical intervention is even rarer than CRPS after an operation for disc disease. ⋯ It has a clear causal relationship between HIVD and CRPS and definitively fits in the newly revised IASP criteria. In conclusion, mild HIVD can cause CRPS without any trauma. And percutaneous nucleoplasty can be considered as a treatment option.
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Review Meta Analysis
Particulate vs Non-Particulate Steroids for Transforaminal Epidural Steroid Injections: Systematic Review and Meta-analysis of the Current Literature.
The efficacy of particulate and non-particulate steroids in patients receiving epidural steroid injections remains unclear. ⋯ As the use of particulate steroids seems to be associated with slightly better VAS scores only, clinicians need to weigh their clinical relevance in the light of complications and recent FDA recommendations on the use of particulate steroids.