Pain physician
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Pain following thoracotomy is of moderate to severe nature. Management of thoracotomy pain is a challenging task. Post thoracotomy pain has acute effects in the post operative period by affecting respiratory mechanics, which increases the morbidity. ⋯ The patient had significant pain relief following a single bolus of the drug. The infusion was started thereafter, which provided excellent analgesia and facilitated an uneventful recovery. Here, we describe the successful management of thoracotomy pain using the serratus anterior plane block.
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Although pharmacological therapy is the primary treatment modality for trigeminal neuralgia associated pain, ineffective analgesia and dose limiting side effects often prompt patients to seek alternative pharmacological solutions such as interventional nerve blockade. Blockade of the Gasserian ganglion or its branches is an effective analgesic procedure for trigeminal neuralgia, traditionally performed using fluoroscopy or CT imaging. Ultrasonography allows point of care and real time visualization of needle placement within the surrounding anatomical structures. ⋯ The decision was made that the patient was a suitable candidate for pulsed radiofrequency application in the pterygopalatine fossa. We successfully used an alternative approach through the pterygopalatine fossa to treat trigeminal neuralgia using ultrasound guidance in an office setting. Our case demonstrates the utility of ultrasound-guidance pulsed radiofrequency treatment in the pterygopalatine fossa as a potential alternative to other percutaneous techniques for patients with medical refractory trigeminal neuralgia.
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Observational Study
Percutaneous vertebroplasty combined with percutaneous pediculoplasty for lytic vertebral body and pedicle lesions of metastatic tumors.
Percutaneous pediculoplasty (PP) consists of the injection of Poly(methyl methacrylate) (PMMA) into the fractured pedicle or lytic vertebral pedicle lesions, as a technique derived from vertebroplasty. ⋯ PV and PP via the transpedicular approach for infiltrated vertebral bodies and infiltrated pedicles of metastatic tumors may be considered a valid therapeutic option.
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Psychological factors are recognised as influencing the outcome of spinal cord stimulation (SCS) although there is currently no consensus as to which factors impact upon SCS efficacy. ⋯ This study demonstrates that psychological aspects such as depression and autonomous coping may impact SCS treatment. Addressing these issues prior to SCS implantation may improve SCS long-term outcome.
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Pain interventionists can interrupt pain through anesthetic blockade of neural transmission to virtually any part of the body. Temporary pain relief can be achieved by the direct application of targeted anesthetic. Diagnostically, nerve blocks help identify specific pain generators, refine differential diagnosis, and disrupt the neural transmission mechanisms to stop pain generation peripherally. ⋯ This study's results support the hypothesis that a combined interventional and cognitive motivational counseling treatment program can be effective in decreasing spine pain, reducing prescription pain medication use, and improving overall quality of life in chronic spine pain patients.