Pain physician
-
Randomized Controlled Trial Comparative Study
Bilateral spinal decompression of lumbar central stenosis with the full-endoscopic interlaminar versus microsurgical laminotomy technique: a prospective, randomized, controlled study.
Extensive decompression with laminectomy, where appropriate, is often still described as the method of choice when operating on degenerative lumbar spinal stenosis. Nonetheless, tissue-sparing procedures are becoming more common. Endoscopic techniques have become the standard in many areas because of the surgical advantages they offer and the benefits for rehabilitation. One key issue when operating on the spine was the development of instruments to provide sufficient bone resection under continuous visual control. This was achieved by using endoscopes for operations carried out in cases of spinal canal stenosis. ⋯ The recorded results demonstrate that the full-endoscopic interlaminar bilateral decompression adopting a unilateral approach provides an adequate and safe supplement and alternative to the conventional microsurgical bilateral laminotomy technique when the indication criteria are fulfilled. At the same time, it offers the advantages of a minimally invasive intervention.
-
Scientific peer review is pivotal in health care research in that it facilitates the evaluation of findings for competence, significance, and originality by qualified experts. While the origins of peer review can be traced to the societies of the eighteenth century, it became an institutionalized part of the scholarly process in the latter half of the twentieth century. This was a response to the growth of research and greater subject specialization. ⋯ Various types of peer review bias include content-based bias, confirmation bias, bias due to conservatism, bias against interdisciplinary research, publication bias, and the bias of conflicts of interest. Consequently, peer review would benefit from various changes and improvements with appropriate training of reviewers to provide quality reviews to maintain the quality and integrity of research without bias. Thus, an appropriate, transparent peer review is not only ideal, but necessary for the future to facilitate scientific progress.
-
Stereotactic radiosurgery is accepted as an alternative for patients with refractory trigeminal neuralgia, but existing evidence is fundamentally based on the Gamma Knife, which is a specific device for intracranial neurosurgery, available in few facilities. Over the last decade it has been shown that the use of linear accelerators can achieve similar diagnostic accuracy and equivalent dose distribution. ⋯ Paucity of literature and clear lack of clarification for clinical utilization of this technique.
-
The high prevalence of chronic persistent neck pain not only leads to disability but also has a significant economic, societal, and health impact. Among multiple modalities of treatments prescribed in the management of neck and upper extremity pain, surgical, interventional and conservative modalities have been described. Cervical epidural injections are also common modalities of treatments provided in managing neck and upper extremity pain. They are administered by either an interlaminar approach or transforaminal approach. ⋯ This systematic review with qualitative best evidence synthesis shows Level II evidence for the efficacy of cervical interlaminar epidural injections with local anesthetic with or without steroids, based on at least one high-quality relevant randomized control trial in each category for disc herniation, discogenic pain without facet joint pain, central spinal stenosis, and post surgery syndrome.
-
Case Reports
Pain relief with percutaneous trochanteroplasty in a patient with bilateral trochanteric myelomatous lytic lesions.
Multiple myeloma is a hematologic malignancy associated with destructive bone loss. Lytic lesions, a hallmark of this cancer, can result in significant morbidity because of associated pain and structural osseous compromise. Osteoplasty has demonstrated efficacy in the treatment of myelomatous pain within the axial skeleton; however, there is limited evidence supporting the utility of osteoplasty to treat extra-spinal lesions. ⋯ The intended goals of this novel procedure were to determine the cause of the suspected lytic lesions, provide pain relief, and offer structural stability by safely implanting bone cement as part of a fracture prevention strategy. At 12 month follow-up, the patient's pain improved by 70% and she no longer required the use of pain medication. The patient also displayed a significant improvement in her day-to-day functioning and quality of life.