Pain physician
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Clinical Trial
Repeated onabotulinumtoxin-a injections provide better results than single injection in treatment of painful bladder syndrome.
Onabotulinumtoxin-A (BoNT-A) is effective for the treatment of interstitial cystitis/painful bladder syndrome (IC/PBS). However, long-term follow-up does not show successful outcome after a single injection. ⋯ Repeated intravesical BoNT-A injections were safe and effective for pain relief and they increased bladder capacity and provided a better long-term success rate than a single injection did for treatment of IC/PBS.
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Hypogonadism is frequently diagnosed based on total testosterone (TT) levels alone. However, 99% of testosterone is bound to the sex hormone-binding globulin (SHBG) with only 1% free testosterone. Alternative assessment methods consist of assay of free testosterone (FT) or bioavailable testosterone (BT) by equilibrium dialysis, calculation of FT and BT through the Vermeulen equations, and calculation of the free androgen index (FAI). ⋯ Hypogonadism is common in patients undertaking intrathecal opioid therapy for the management of chronic non-malignant pain; however, diagnostic criteria can influence the diagnosis of this side effect. The assessment of the hypothalamic-pituitary-gonadal axis should include evaluation of total serum testosterone, free testosterone, or bioavailable testosterone.
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Microsurgery for lumbar herniated discs that require surgical intervention is a very successful and well-described technique, whether performed through more traditional "open" microsurgical retractors or through minimally-invasive "tube" retractors. Surgery for extruded lumbar disc fragments that migrate caudad or cephalad from the disc origin may typically require modifying the standard hemilaminotomy by removing additional laminar bone to retrieve the migrated fragment. Although midline and paramedian Wiltse approaches have been the standard methods for resecting herniated lumbar disc fragments, advances in neuroendoscopic techniques have expanded the potential targets for transforaminal endoscopic treatment to include extruded lumbar disc fragments. ⋯ Although more traditional lumbar disc surgery is widely performed and is safe and effective, neuroendoscopic procedures may also allow a safe and effective approach for even extruded disc fragments for patients who cannot tolerate general anesthesia or are seeking the most minimally invasive option. Endoscopic discectomy is a minimally invasive alternative to open back surgery. Maintained spinal stability and absence or minimal formation of scar tissue allow for ease of subsequent surgeries, both open and minimally invasive (if needed).
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Randomized Controlled Trial
Efficacy of pulsed radiofrequency in the treatment of thoracic postherpetic neuralgia from the angulus costae: a randomized, double-blinded, controlled trial.
Postherpetic neuralgia (PHN) is often refractory to existing treatments. Pulsed radiofrequency (PRF) is known to be effective for treating neuropathic pain. In common, the targets of PRF treatment were the segmental dorsal root ganglion (DRG) neurons responsible for the pain. A potential complication that can occasionally occur with PRF treatment is damage to the adjacent tissue and organ. The effectiveness of the angulus costae as a puncture site for PRF has not been tested in thoracic PHN treatment. ⋯ NO ISRCTN25588650.
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Review Case Reports
Cooled sacroiliac radiofrequency denervation for the treatment of pain secondary to tumor infiltration: a case-based focused literature review.
The sacroiliac (SI) joint is a common cause of low back pain, for which radiofrequency (RF) denervation has been shown to provide long-term relief. However, controversy exists surrounding the innervation, which treatment paradigm to utilize, and how best to select patients who might benefit. ⋯ This is the first report of cooled SI joint RF ablation to treat cancer pain. Our patient's positive response to the procedure suggests the possibility that the lateral branches innervate not only the posterior ligaments, but also the bony articulation. The decision to proceed with RF ablation on the same day as a prognostic lateral branch block was based on our patient's terminal condition, and the fact that cooled RF does not require sensory stimulation to ensure proximity to the target nerves. Because of her transitional anatomy, we elected to target L4.