Pain physician
-
Epidural injection of corticosteroids is a commonly used treatment for radicular pain. However, the benefits are often short lived, and repeated injections are often limited secondary to concerns of side effects from cumulative steroid doses. In addition, rare, catastrophic complications, including brain and spinal cord embolic infarcts have been attributed to particulate steroid injections. A previous study has shown that dexamethasone has less particulate than other corticosteroids, possibly reducing embolic risk. Furthermore, a recent study indicated that clonidine may be useful in the treatment of radicular pain when administered via epidural steroid injection. The combination of corticosteroid and clonidine is an intriguing, yet unstudied, alternative to traditional treatment. ⋯ Mixing clonidine with corticosteroids did not increase particulation compared to corticosteroids alone. Combining clonidine and corticosteroids for epidural injection may prove to be a useful treatment for radicular pain. The combination of these is unlikely to result in a solution that is more likely to cause embolic infarcts than the use of corticosteroids alone.
-
Guideline development seems to have lost some of its grounding as a medical science. At their best, guidelines should be a constructive response to assist practicing physicians in applying the exponentially expanding body of medical knowledge. In fact, guideline development seems to be evolving into a cottage industry with multiple, frequently discordant guidance on the same subject. ⋯ A recent manuscript published by Chou et al, in addition to previous publications, appears to have limited clinician involvement in the development of APS guidelines, and demonstrates some of these challenges clearly. This manuscript illustrates the deficiencies of Chou et al's criticisms, and demonstrates their significant conflicts of interest, and use a lack of appropriate evaluations in interventional pain management as a straw man to support their argument. Further, this review will attempt to demonstrate that excessive focus on this straw man has inhibited critique of what we believe to be flaws in the approach.
-
Vertebral hemangiomas are benign tumors with a rich vasculature. Symptoms may vary from simple vertebral pain, sometimes resistant to conservative medical treatment, to progressive neurological deficit. Surgery or radiotherapy have been the treatment of choice for several years, but they were worsened by intraoperative and postoperative hemorrhagic complications related to the rich vascularization that characterize these kinds of lesions, often preceded by a preoperative embolization in the acute setting. Recently, a percutaneous, minimally invasive technique of vertebroplasty has been introduced into clinical practice as an alternative to traditional surgical and radiotherapy treatment of symptomatic vertebral hemangiomas with or without features of aggressiveness at imaging studies. ⋯ PVP is an effective technique to treat symptomatic vertebral hemangioma, which is a valuable, minimally invasive, and quick method that allows a complete and lasting resolution of painful vertebral symptoms.
-
Randomized Controlled Trial Multicenter Study
Sensor-driven position-adaptive spinal cord stimulation for chronic pain.
Variation in the intensity of neurostimulation due to body position is a practical problem for many patients implanted with spinal cord stimulation (SCS) systems because positional changes may result in overstimulation or understimulation that leads to frequent need for compensatory manual programming adjustments. ⋯ NCT01106404.