Pain physician
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Lumbar spinal stenosis and neurogenic claudication functionally impact thousands of patients per year. Those who fail conservative therapies and are not surgical candidates due to co-morbid conditions have few interventional options available. The recently described mild® procedure (Minimally Invasive Lumbar Decompression) is a candidate to fill this void. While 2 studies have reported no major adverse events with this procedure, the typical post-procedure patient course has not been previously described. ⋯ The mild procedure appears to be a safe and likely effective option for treatment of neruogenic claudication in patients who have failed conservative therapy and have ligamentum flavum hypertrophy as the primary distinguishing component of the stenosis.
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Persistent neck pain is a common problem after surgery of the cervical spine. No therapy recommendation exists for these patients. ⋯ For persistent postsurgical neck pain only limited therapy recommendations exist. This study suggests treating these patients in a first instance with therapeutic medial branch blocks. The success rate is 52.9 %.
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Randomized Controlled Trial Comparative Study
Comparative effectiveness of a one-year follow-up of thoracic medial branch blocks in management of chronic thoracic pain: a randomized, double-blind active controlled trial.
Thoracic facet joints have been implicated as the source of chronic pain in the mid back or upper back in 34% to 42% of patients when the modified criteria of the International Association for the Study of Pain (IASP) is utilized. Various therapeutic techniques utilized in managing chronic thoracic pain of facet joint origin include intraarticular injections, medial branch blocks, and radiofrequency neurotomy of thoracic medial branch nerves. ⋯ NCT00355706.
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Randomized Controlled Trial Comparative Study
Reduced cognitive and psychomotor impairment with extended-release oxymorphone versus controlled-release oxycodone.
Opioids provide effective pain control, yet have risks including adverse events (AEs) (e.g., constipation, nausea/vomiting, sedation) and cognitive/psychomotor effects. ⋯ Single oral intact low and high doses of OM-ER produced less cognitive and psychomotor impairment plus less sedation than equianalgesic OC-CR in this exploratory study. ClinicalTrials.gov registration NCT00955110.
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Case Reports
Phantom radiculitis effectively treated by fluoroscopically guided transforaminal epidural steroid injections.
Lower back and extremity pain in the amputee patient can be challenging to classify and treat. Radicular compression in a patient with lower limb amputation may present as or be superimposed upon phantom limb pain, creating diagnostic difficulties. Both patients and physicians classically find it difficult to discern phantom sensation from phantom limb pain and stump pain; radicular compression is often not considered. ⋯ Lumbar radiculitis in lower extremity amputee patients may be difficult to differentiate from baseline phantom limb pain. When conservative techniques fail, fluoroscopically guided spinal nerve injection may be valuable in determining the etiology of lower extremity pain. Our experience supports the notion that epidural steroid injections can effectively treat phantom lumbar radiculitis in lower extremity amputees.