Pain physician
-
Post lumbar laminectomy syndrome with its resultant chronic low back pain is estimated to occur in 20% to 50% of the patients. Among various procedures available, lysis of epidural adhesions is considered as one of the effective therapeutic modalities of management in these patients, and may be performed either non-endoscopically or endoscopically. This retrospective evaluation included 120 post lumbar laminectomy patients who underwent either non-endoscopic adhesiolysis (Group I) or endoscopic adhesiolysis (Group II) with 60 consecutive patients in each group. ⋯ Cost effectiveness analysis showed Group I patients experiencing significant relief at a cost of $40 per week, with one year quality of life improvement for $2,080, whereas it was $135 per week improvement in Group II with a one year quality of life improvement at a cost of $7,020 with significant difference noted in cost effectiveness. In conclusion, non-endoscopic epidural adhesiolysis and administration of corticosteroids and hypertonic saline is a safe and cost effective procedure for relieving chronic intractable pain in post lumbar laminectomy patients who failed to respond to other modalities of treatment. Similarly, endoscopic adhesiolysis with the administration of corticosteroids is also a safe and possibly cost-effective technique for relief of chronic intractable pain failing to respond to other modalities of treatments.
-
Chronic neck pain, headache, and arm pain are some of the most common patient complaints confronting today's health care provider. Chronic neck pain is reported to be a frequency symptom in 34% of the general population with 14% of the general population reporting neck pain that lasted for more than 6 months. The magnitude of the problem is demonstrated by increase of cervical spine surgery by 45% and cervical fusion by 70% over a ten year period from 1979 through 1988. ⋯ Neural blockade in the cervical spine, though introduced in 1912, lagged behind that of the lumbar spine. At the present time, neural blockade is an extremely popular tool for diagnostic purposes in evaluation of neck pain, even though it has not developed a definitive role in the management of chronic neck pain and associated syndromes. The object of this review is to focus on various aspects of neural blockade in the management of chronic neck pain and associated syndromes including its rationale, clinical effectiveness, indications, and complications.