Pain physician
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Chronic pelvic pain (CPP) is a complex, heterogeneous condition affecting both female and male patients with significant effects on quality of life. Chronic pelvic pain is a prevalent but often underdiagnosed condition due to the variation in patient presentation, a gap in communication among specialties, under-reporting of the syndrome, and lack of standardized diagnostic criteria with a subsequent delay in diagnosis. The mechanism of CPP is complex due to multifactorial etiologies of pain and its vast anatomy and innervation. Potential causes of pelvic pain include the nerves, muscles, bone, or organs of the reproductive, gastrointestinal, urological, musculoskeletal, vascular, neurological, and psychological systems. ⋯ Neuromodulation may include spinal cord stimulation, dorsal root ganglion stimulation, and peripheral nerve stimulation. Specifically, neuromodulation utilizes electrical stimulation or pharmacological agents to modulate a nerve and alter pain signals. Currently used locations for lead placement include intracranial, spinal cord, dorsal root ganglion, sacral nerve roots, or at a peripheral nerve. As the field of pelvic pain continues to evolve, continued evidence for neuromodulatory interventions is needed.
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Randomized Controlled Trial
The Therapeutic Efficacy of Pulsed Radiofrequency Alone Versus a Dexamethasone and Pulsed Radiofrequency Combination in Patients With Trigeminal Postherpetic Neuralgia: A Double-blind, Randomized Controlled Trial.
Pulsed radiofrequency (PRF) of the Gasserian ganglion is a common surgical intervention used to treat trigeminal postherpetic neuralgia (PHN). Dexamethasone has been reported to possess anti-inflammatory effects and potential analgesic benefits. ⋯ The therapeutic efficacy of PRF combined with a dexamethasone injection into the Gasserian ganglion was superior to that of PRF{and saline injection} alone of the Gasserian ganglion for trigeminal PHN.
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Randomized Controlled Trial
Ultrasound-guided Erector Spinae Muscle Block Versus Ultrasound-guided Caudal Block in Pediatric Patients Undergoing Lower Abdominal Surgeries.
The erector spinae plane block is a new regional anesthetic technique that is gaining popularity in pediatric medicine. ⋯ Ultrasound-guided erector spinae block was safe and effective in pediatric patients undergoing unilateral lower abdominal surgery as it provided a longer duration of analgesia and less analgesic requirement than caudal block and fewer side effects.
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Randomized Controlled Trial
Postoperative Pain in Adolescent Idiopathic Scoliosis Surgery: A Randomized Controlled Trial.
Adolescent idiopathic scoliosis (AIS) is the most common type of scoliosis, and its treatment is essentially surgical for curves above 40 degrees. Posterior spinal instrumentation (PI) is the usual technique, while the vertebral body tethering (VBT) method is tested technique for this study as a new treatment option. ⋯ From our results, both techniques can be employed for AIS surgery, but a meticulous approach is essential for the prevention of acute pain for VBT.
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Randomized Controlled Trial
Comparison of Changes in the Optic Nerve Sheath Diameter Following Thoracic Epidural Normal Saline Injection in Laparoscopic Surgery.
Thoracic epidural analgesia is useful for postoperative pain control after upper abdominal surgery. However, epidural analgesia in patients undergoing laparoscopic surgery may potentiate an increase in intracranial pressure (ICP). ICP can be effectively evaluated by measuring the optic nerve sheath diameter (ONSD). ⋯ The lapa-saline group showed the most pronounced increase in the ONSD. The ONSD values higher than 5.8 mm were observed only in the lapa-saline group. The increase in the ONSD continued even after the deflation of pneumoperitoneum only in the lapa-saline group.