Pain physician
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Randomized Controlled Trial
Short-term Effect of Repetitive Transcranial Magnetic Stimulation on Diabetic Peripheral Neuropathic Pain.
Approximately half of the patients with long-standing diabetes are known to have diabetic peripheral neuropathy (DPN). Pain from DPN deteriorates quality of life and hinders activities of daily living. ⋯ High-frequency rTMS on the left M1 may be useful for managing pain in the lower extremities due to DPN and may improve a patient's the quality of life.
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Multicenter Study
Bi-Needle PELD with Intra-Discal Irrigation Technique for the Management of Lumbar Disc Herniation.
Lumbar disc herniation (LDH) is the most common cause of sciatica. Percutaneous endoscopic discectomy (PELD) is indicated when conservative treatments fail, which has been proved effective. During conventional PELD, ruptured discs and loose fragments inside discs are removed as much as possible to guarantee a lower reherniation rate, but it inevitably would lead to deterioration of disc degeneration and loss of disc height after PELD. Ensuring sufficient decompression while alleviating the post-operation disc degeneration process is still a clinical problem. ⋯ Bi-needle technique with saline irrigation maneuver showed a significant advantage of restoration of disc height and amelioration of disc degeneration compared to conventional PELD surgery.
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Observational Study
A Pilot Study Implementing a Machine Learning Algorithm to Use Artificial Intelligence to Diagnose Spinal Conditions.
Chronic spinal pain is the most prevalent chronic disease, with chronic persistent spinal pain lasting longer than one-year reported in 25% to 60% of the patients. Health care expenditures have been escalating and the financial impact on the US economy is growing. Among multiple modalities of treatments available, facet joint interventions and epidural interventions are the most common ones, in addition to surgical interventions and numerous other conservative modalities of treatments. Despite these increasing costs in the diagnosis and management, disability continues to increase. Consequently, algorithmic approaches have been described as providing a disciplined approach to the use of spinal interventional techniques in managing spinal pain. This approach includes evaluative, diagnostic, and therapeutic approaches, which avoids unnecessary care, as well as poorly documented practices. Recently, techniques involving artificial intelligence and machine learning have been demonstrated to contribute to the improved understanding, diagnosis, and management of both acute and chronic disease in line with well-designed algorithmic approach. The use of artificial intelligence and machine-learning techniques for the diagnosis of spinal pain has not been widely investigated or adopted. ⋯ Software-predicted diagnoses based on the data from patients with spinal pain had an accuracy rate of 72%, suggesting promise for augmented decision making using artificial intelligence in this setting.
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Piriformis syndrome is a constellation of symptoms associated with low back, gluteal, and sciatic pain. One treatment for piriformis syndrome is the injection of local anesthetic, steroid, or botulinum toxin into the piriformis muscle. Various approaches for needle navigation into the piriformis muscle have been described using fluoroscopy or ultrasound. This study introduces a new method of image guidance combining fluoroscopy and ultrasound. ⋯ Piriformis injections using combined fluoroscopic and ultrasound guidance provides comparable efficiency to standard techniques and may result in improved accuracy into the target and thus improved efficacy. Larger prospective trials are required to comprehensively examine the efficacy of this novel technique.
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Cold hypersensitivity in the hands and feet (CHHF) is a disease characterized by abnormal cold in the limbs with limited treatment options. Compared to traditional drug therapy, lumbar sympathectomy is a new minimally invasive surgical method for treating CHHF. ⋯ Lumbar sympathetic RFT had better long-term efficacy, lower recurrence, and fewer complications than the chemical lumbar sympathectomy when treating CHHF.