Pain practice : the official journal of World Institute of Pain
-
The effectiveness of spinal cord stimulation (SCS) as pain-relieving treatment for failed back surgery syndrome (FBSS) has already been demonstrated. However, potential structural and functional brain alterations resulting from subsensory SCS are less clear. The aim of this study was to test structural volumetric changes in a priori chosen regions of interest related to chronic pain after 1 month and 3 months of high-frequency SCS in patients with FBSS. ⋯ In patients with FBSS, high-frequency SCS influences structural brain regions over time. The volume of the hippocampus was decreased bilaterally after 3 months of high-frequency SCS with a positive correlation with back pain intensity.
-
Observational Study
Predictors of the analgesic efficacy of CT-guided percutaneous pulsed radiofrequency treatment of Gasserian ganglion in patients with idiopathic trigeminal neuralgia.
Although pulsed radiofrequency (PRF) has few postoperative adverse reactions, its analgesic efficacy for trigeminal neuralgia (TN) is not always guaranteed. The response rate of PRF targeting the Gasserian ganglion for patients with TN varies. This study aims to identify the predictors of the analgesic efficacy of CT-guided percutaneous PRF in patients with idiopathic TN. ⋯ For patients who previously had positive responses to peripheral branch nerve block of the trigeminal nerve, PRF is likely to have better efficacy.
-
Cervical selective nerve root blocks (C-SNRBs) maintain utility for presurgical planning in patients with cervical radiculopathy. Traditional fluoroscopic or stationary computed tomography (CT)-guided methods have been associated with complications, including catastrophic neurologic insults, while ultrasound guidance has been investigated based on its theoretical advantages. Maximizing patient safety by obtaining superior anatomic and procedural details promotes the exploration for better alternative guidance. ⋯ We propose the PL-EF approach as the safest protocol for C-SNRBs. When compared with fluoroscopy or CT, CBCT/fluoroscopy is an advanced imaging system that provides superior anatomic neurovascular detail, while offering precise needle control, contrast media monitoring, and easy operation in an office setting. These advanced features support it as the ideal guidance method for maximizing both the safety and efficiency of the PL-EF C-SNRB approach. However, the claimed advantages cannot be concluded without increasing its accessibility to pain specialists and conducting a prospective study with a large sample size.
-
Low-back pain (LBP) pathophysiological conditions include nociceptive back pain, somatic referred pain, radicular pain (RP), and radiculopathy. Differential diagnosis is challenging; guidance may come from patients' thorough clinical history and physical examination and, particularly for lumbar RP, from the evaluation of subjective responses of injured lumbar nerves to a strain applied at the buttock (buttock applied strain [BUAS] test). ⋯ Among patients with LBP, the BUAS test showed satisfactory sensitivity, specificity, prior probability, and inter-rater reliability; thus, it may be considered a useful adjunctive tool to diagnose RP in patients with LBP. For more generalized results, more research, in clinical settings other than pain clinics, is needed.
-
Responses of spinal progenitors to spinal cord stimulation (SCS) following spinal cord injury (SCI) in rats were assessed to reveal their potential contribution to SCS-induced analgesia. ⋯ Spinal progenitor cells appear to be activated by SCS via descending pathways, which may be enhanced by gabapentin and potentially contributes to relief of SCI-induced neuropathic pain.