Pain practice : the official journal of World Institute of Pain
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Despite the popularity of epidural steroid injections for low back pain, there still remains a lack of consensus on which type of steroid to inject. Most comparison studies regarding epidural steroids are based on an assumption that different types of steroids are equal as long as equipotent doses are utilized. In the spring of 2002, a national shortage of all depo steroids allowed the authors to compare epidural methylprednisolone (Depo-Medrol) to a non depo form of betamethasone in patients with low back pain. ⋯ This study shows that the aqueous steroid betamethasone is not an effective alternative to the commonly used depo-steroid methylprednisolone (Depo-Medrol) when injected epidurally in patients with lumbar pain. The study also shows that the anti-inflammatory effect of a depo-steroid can be greater than a non-depo steroid, even at equipotent doses. This should be an important factor to consider when reviewing epidural steroid outcome studies, where the type of steroid might affect results as much as other variables such as route of administration, volume of injectate, or use of fluoroscopy.
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Complications associated with interventional pain procedures have raised questions regarding the relative safety of sharp vs. blunt needles. It has been speculated that the incidence of hemorrhage, intraneural and/or intravascular injections may be reduced by the use of blunt needles. In this study we compared penetration and bleeding associated with sharp vs. blunt needle punctures. ⋯ Blunt needles are less likely than sharp ones to enter vital structures and/or produce hemorrhage. Thus, blunt needles may be preferable to sharp ones for performing interventional pain procedures.
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Glossopharyngeal neuralgia (GPN) is an uncommon orofacial pain syndrome. Primary GPN is idiopathic, whereas secondary GPN has identifiable causes: tonsillectomy, peritonsillar abscesses, invasive cancer, and trauma. ⋯ Pulsed mode radiofrequency lesioning is a safe, non-destructive treatment method and hence, useful in neuropathic pain conditions. We present the first case of chronic post-tonsillectomy pain (secondary glossopharyngeal neuralgia), that was successfully managed with pulsed radiofrequency lesioning.