Pain physician
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Caudal epidural steroid injections are commonly utilized to help reduce radicular pain in lumbar spinal stenosis. There have been studies done to evaluate the effectiveness of this procedure non-fluoroscopically guided. Search revealed no prospective studies evaluating the effectiveness of fluoroscopically guided caudal epidural injections on patients with bilateral radicular pain from degenerative lumbar spinal stenosis. ⋯ Fluoroscopically guided caudal epidural steroid injections may help reduce bilateral radicular pain and improve standing and walking tolerance in patients with DLSS.
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Vertebral augmentation has been widely used to treat vertebral body compression fractures caused by varied pathologies. The lifetime risk of a vertebral body compression fracture is 16% for women and 5% for men, and exponential increase of osteoporotic fractures worldwide. ⋯ Percutaneous vertebroplasty of symptomatic osteoporotic vertebral compression fractures is a minimally invasive procedure that provides immediate and sustained pain relief in patients with refractory pain.
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Electroconvulsive therapy (ECT) is a well-established treatment method for medically refractory depression. ECT has also been used in the treatment of pain for over 50 years. The mechanism of action of ECT is still unknown, although several observations have been made regarding the effect of ECT on pain processes. It has been reported that several patients with medically refractory depression and Complex Regional Pain Syndrome who were treated with ECT for their depression were also cured of their CRPS symptoms. ⋯ ECT was effective in the treatment of severe refractory CRPS in this patient.
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Comparative Study Clinical Trial
Is impedance a parameter to be taken into account in spinal cord stimulation?
Over the last few decades, spinal cord stimulation (SCS) has become one of the main treatments in the therapeutic arsenal available to pain treatment units. New stimulation systems have been developed and the indications of neurostimulation have been expanded. The premises for a successful technique remain the same; good patient selection, good surgical technique, and good management of electrical parameters when programming. ⋯ No correlation was found between impedance and posture. When the results for R and E were analyzed by sex and age, no statistical differences were found in any of the values in any position. The analysis of time since implant greater than or less than 6 months did not find differences in the energy requirement, although there was a significant difference in the impedance value when patients were in the S position. No significant differences were observed in the analysis by age groups.