Pain physician
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Case Reports
Minimally invasive interventional therapy for Tarlov cysts causing symptoms of interstitial cystitis.
Tarlov cysts (TC) are present in 4.6% of the population and represent a potential source of chronic pain. When present at lumbosacral levels, symptoms are classically described as perineal pain/pressure, radiculopathy, and headache. Treatment outlined to date primarily includes cyst drainage with fibrin glue sealant and surgical interventions. ⋯ Use of caudal epidural steroid injections proved beneficial in the treatment of pelvic pain symptomatology and so may be considered as an option in patients with identified sacral TC.
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Two studies, each consisting of large sample sets, were recently published on radiation exposure in percutaneous spinal cord stimulation (SCS) trialing procedures. A more rigorous use of statistical methods in the second study more accurately defined benchmark reference levels. Principally, one physician implanter-considered an advanced interventional pain physician-performed all such procedures to nullify inter-physician variability. However, the literature is sparse in articles comparing exposure levels of radiation in pain procedures conducted by novice and advanced interventionally trained physicians, and inferential statistical analysis is seldom included in radiation exposure studies. ⋯ Radiation exposure levels in SCS trialing procedures remain negligible. While no differences in fluoroscopy times for such procedures were detected based on physician experience, the expert implanter demonstrated the ability to use less fluoroscopy time than that of the benchmark reference level.
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Multicenter Study Comparative Study
Linguistic adaptation, validation and comparison of 3 routinely used neuropathic pain questionnaires.
Neuropathic pain questionnaires are efficient diagnostic tools for neuropathic pain and play an important role in neuropathic pain epidemiologic studies in China. No comparison data was available in regards to the Leeds Assessment of Neuropathic Symptoms and Signs (LANSS), the Neuropathic Pain Questionnaire (NPQ) and ID Pain within and among the same population. ⋯ The Chinese versions of LANSS and ID Pain developed and validated by this study can be used as a diagnostic tool in differentiating neuropathic pain in patients whose native language is Chinese (Mandarin).
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Clinical Trial
A prospective evaluation of complications of 10,000 fluoroscopically directed epidural injections.
Among the multiple modalities of treatments available in managing chronic spinal pain, including surgery and multiple interventional techniques, epidural injections by various routes, such as interlaminar epidural injections, caudal epidural injections, transforaminal epidural injections, and percutaneous adhesiolysis are common. Even though the complications of fluoroscopically directed epidural injections are fewer than blind epidural injections, and have better effectiveness, multiple complications have been reported in scattered case reports, with only minor complications in randomized or non-randomized studies and systematic reviews. Thus, prospective studies with large patient series are essential to determine the types and incidences of complications. ⋯ This study illustrates that major complications are rare and minor side effects are common.