Pain physician
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Randomized Controlled Trial
Effect of Adding Calcitonin to Translaminar Epidural Steroid in Degenerative Lumbar Spinal Canal Stenosis.
Spinal canal stenosis is one of the most common causes of low back pain and disability. Its management varies from surgical to conservative, and the indications for ideal management are not clearly defined. ⋯ Adding calcitonin to epidural steroid and local anesthetic injection seems to be more effective than epidural steroid and local anesthesia alone in management of spinal canal stenosis regarding increased walking distance, better Oswestry scale, diminished pain intensity and perception of paresthesia, and less analgesic consumption, all the above mentioned benefits continued up to one year. So, epidural calcitonin may be considered as a new therapeutic modality in the management of pain in spinal canal stenosis.
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The following case series describes the treatment of neuropathic pain in post-surgical scars, using adipocytes and adipose-derived stem/progenitor cells (ASCs). Two cases are described in which patients underwent lipofilling to treat painful scars after cosmetic surgery. ⋯ We found a notable long-lasting reduction in the NRS values after the "modified" lipofilling treatment. The results are promising and reinforce earlier data on the positive effect of lipofilling and pain in scars.
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Case Reports
Serratus Plane Block for Persistent Pain after Partial Mastectomy and Axillary Node Dissection.
Persistent pain after breast cancer surgery (PPBCS) is defined as chronic neuropathic pain that persists for more than 3 months after surgery. The pain can be sufficiently severe to cause long-term disabilities and interfere with sleep and daily life. Serratus plane block (SPB) is a novel, ultrasound-guided regional anesthetic technique that is suggested to achieve complete anesthesia of the anterolateral chest wall. ⋯ With her improved pain control, she was able to perform physical therapy and subsequently experienced marked improvement in her functional status and ability to perform daily activities. She has not required any interventional pain management since the last SPB performed 11 months ago. SPB represents one of the treatment modalities for PPBCS and is an advantageous technique because it can be performed more safely and easily than neuraxial approaches.
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Zygapophysial joint arthrosis is a pathology related with axial lumbar pain. The most accepted treatment, after failure of medical management, is the thermal denervation of the medial branch. Nonetheless, the placement of the heat probe remains a challenge to surgeons, even when using the fluoroscope. Using a variation of Shealy's and Bogduk's original techniques, which includes ablation of the medial branch and the nerves present in the joint capsule, we hypothesize that we can obtain similar outcomes to those found in the literature. ⋯ Thermal therapy for zygapophysial joint arthrosis constitutes a safe and effective technique. The one year follow-up data presented here show that the ablation of the medial branch and nerves present in the joint capsule leads to satisfactory results in a high percentage of patients.
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Case Reports
Combined Spinal Cord Stimulation and Peripheral Nerve Stimulation for Brachial Plexopathy: A Case Report.
Brachial plexopathy usually results from an iatrogenic brachial plexus injury and can sometimes cause severe chronic pain and disability. There are a number of possible treatments for this condition, including medication, physical therapy, nerve blocks, and neuromodulation, but they are not always successful. Recently, combined spinal cord stimulation (SCS) and peripheral nerve stimulation (PNS) have been tried for various chronic pain diseases because of their different mechanisms of action. ⋯ After combined PNS and SCS, his background pain disappeared, although a breakthrough pain (NRS 3 - 4/10) was caused intermittently by light touch. Furthermore, the patient's need for analgesics decreased, and he was satisfied with the outcome of this combined treatment. We concluded that combined SCS and PNS is a very useful treatment modality, which can stimulate the target nerve both directly and indirectly, and hence, relieve pain from brachial plexopathy.