Pain physician
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Randomized Controlled Trial
Anatomical basis of ulnar approach in carpal tunnel injection.
Local steroid injection may be an effective conservative treatment for carpal tunnel syndrome; however, the use of a blind injection technique can increase the chance of median nerve or ulnar artery injury due to median nerve swelling or the close proximity of the median nerve and ulnar artery around the distal wrist crease. ⋯ It is important to recognize the risk of blind local steroid injection for carpal tunnel syndrome, which is most likely a result of swelling and/or flattening of the median nerve around the distal wrist crease. A real time, ultrasound-guided local steroid injection is preferred as a safe and accurate technique in carpal tunnel syndrome treatment.
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Randomized Controlled Trial
Targeted nanoparticles that mimic immune cells in pain control inducing analgesic and anti-inflammatory actions: a potential novel treatment of acute and chronic pain condition.
The peripheral immune-derived opioid analgesic pathway has been well established as a novel target in the clinical pain management of a number of painful pathologies, including acute inflammatory pain, neuropathic pain, and rheumatoid arthritis. ⋯ The study presents a novel approach of opioid delivery specifically to injured tissues for pain control. The study also highlights a novel anti-inflammatory role for peripheral opioid targeting, which is of clinical relevance. The potential also exists for the modification of these targeted nanoparticles with other therapeutic compounds for use in other painful conditions.
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In this era of escalating health care costs and the questionable effectiveness of multiple interventions, cost effectiveness or cost utility analysis has become the cornerstone of evidence-based medicine, and has an influence coverage decisions. Even though multiple cost effectiveness analysis studies have been performed over the years, extensive literature is lacking for interventional techniques. Cost utility analysis studies of epidural injections for managing chronic low back pain demonstrated highly variable results including a lack of cost utility in randomized trials and contrasting results in observational studies. There has not been any cost utility analysis studies of epidural injections in large randomized trials performed in interventional pain management settings. ⋯ This cost utility analysis of caudal epidural injections in the treatment of disc herniation, axial or discogenic low back pain, central spinal stenosis, and post surgery syndrome in the lumbar spine shows the clinical effectiveness and cost utility of these injections at less than $2,200 per one year of QALY.
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The elderly population is growing in the United States. As the oldest old are projected to be the fastest growing part of the elderly population, we must consider how to best treat their degenerative spine conditions when non-operative treatment fails. ⋯ Endoscopic discectomy is a safe and effective alternative to open back surgery. The 6-month follow-up data presented here appears to indicate that an ultra-minimally invasive approach to the geriatric spine that has a low complication rate, avoids general anesthesia, and is outpatient might be worth studying in a prospective, longer term way. IRB approval: Meridian Health: IRB Study # 201206071J.
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Intrathecal drug delivery (IDD) and spinal cord stimulator (SCS) systems are implantable devices for the management of both chronic and cancer pain. Although these therapies have favorable long-term outcomes, they are associated with occasional complications including infection. The incidence of infectious complications varies from 2 - 8% and frequently requires prolonged antibiotics and device revision or removal. Cancer patients are particularly susceptible to infectious complications because they are immunocompromised, malnourished, and receiving cytotoxic cancer-related therapies. ⋯ The experience of this tertiary cancer pain center demonstrates that infectious complications following implantation of IDD and SCS systems are relatively rare events in cancer patients. Contrary to our initial hypothesis, no difference was found in the infection rate between cancer and non-cancer patients. The main factor associated with increased risk of infectious complications was increased surgical time, indicating a need to minimize patient time in the operating room. The low infectious complication rate seen in this series compared to previous reports in non-cancer patients is likely multifactorial in nature.