Pain physician
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Epidural injections have been used since 1901 in managing low back pain and sciatica. Spinal pain, disability, health, and economic impact continue to increase, despite numerous modalities of interventions available in managing chronic spinal pain. Thus far, systematic reviews performed to assess the efficacy of epidural injections in managing chronic spinal pain have yielded conflicting results. ⋯ This systematic review, with an assessment of the quality of manuscripts and outcome parameters, shows the efficacy of epidural injections in managing a multitude of chronic spinal conditions.
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Meta Analysis
High Frequency Repetitive Transcranial Magnetic Stimulation Therapy For Chronic Neuropathic Pain: A Meta-analysis.
Increasing evidence supports an analgesic effect of repetitive transcranial magnetic stimulation (rTMS) for neuropathic pain (NP). However, the optimal parameters of rTMS (stimulation frequency and treatment sessions) for achieving long-term analgesic effects remain unknown. This study analyzed the current findings in the literature. ⋯ HF-rTMS stimulation on primary motor cortex is effective in relieving pain in NP patients. Although 5 sessions of rTMS treatment produced a maximal analgesic effect and may be maintained for at least one month, further large-scale and well-controlled trials are needed to determine if this enhanced effect is specific to certain types of NP such as post-stroke related central NP.
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Radiofrequency thermocoagulation (RFT) has been widely used to manage trigeminal neuralgia (TN) refractory to oral medication. Careful selection of patients for managing TN with RFT can decrease morbidity and improve treatment efficacy. ⋯ IRB No. 1403-118-569.
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Laser ablation under an epiduroscopic view allows for the vaporization of a small amount of the nucleus pulposus, causing a reduction in intradiscal pressure and relief of radicular pain. Currently, Ho:YAG and Nd:YAG lasers are commonly used for spinal diseases. However, the use of the Nd:YAG laser for intra-spinal procedures can be limited because of thermal injury and low efficacy. ⋯ The 1414 nm Nd:YAG laser can be used effectively and safely under the guidance of a spinal epiduroscope in an in vivo porcine model and in a human cadaveric model. STUDY APPROVAL: Approval for the current study was granted by the Institutional Review Board of our institute (approval number: 1-2014-0049).
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The causes of subsequent vertebral fractures after kyphoplasty are debated. It is reported that most new vertebral fractures after kyphoplasty develop in adjacent vertebrae. ⋯ New VCFs after kyphoplasty occurred most often in nonadjacent vertebrae. VCFs after kyphoplasty were common in patients with low bone mineral density and in women, suggesting that osteoporosis is an underlying mechanism. INSTITUTIONAL REVIEW: This study was approved by the institutional review board.