Pain practice : the official journal of World Institute of Pain
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Randomized Controlled Trial
Wearable, noninvasive, pulsed shortwave (radiofrequency) therapy for postoperative analgesia: A randomized, double-masked, sham-controlled pilot study.
Nonthermal, pulsed shortwave (radiofrequency) therapy (PSWT) is a nonpharmacologic, noninvasive modality that limited evidence suggests provides analgesia. Its potential favorable risk-benefit ratio stems from its lack of side effects and significant medical risks, applicability to any anatomic location, long treatment duration, and ease of application by simply affixing it with tape. Even with a relatively small treatment effect, PSWT might contribute to a multimodal analgesic regimen, similar to acetaminophen. However, widespread clinical use is hindered by a lack of systematic evidence. The current randomized, controlled pilot study was undertaken to determine the feasibility and optimize the protocol for a subsequent definitive investigation and estimate the treatment effect of PSWT on postoperative pain and opioid consumption. ⋯ Pulsed shortwave (radiofrequency) therapy did not reduce pain scores and opioid requirements to a statistically significant or clinically relevant degree during the initial postoperative week in this pilot study. These results must be replicated with a subsequent study before being considered definitive. Data from this preliminary study may be used to help plan future trials.
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Comparative Study
A comparison of MRI and intraoperative measurements to determine interspinous spacer device size.
To determine whether preoperative magnetic resonance imaging (MRI) can reliably determine intraoperative measurements in the Vertiflex Interspinous Spacer (ISS) procedure. ⋯ Measuring interspinous space on MRI yielded, on average, a value smaller than the intraoperative measurement in Vertiflex ISS procedures, but the mean differences were not significant. Good agreement and moderate reliability were found between observer MRI and surgeon intraoperative measurements, suggesting MRI can evaluate the intraoperative space for the Vertiflex ISS procedure. Preoperative MRI measurement may help decrease complications by aiding in surgical decision-making through providing a reference for intraoperative measurements. Further prospective study is necessary to determine if preoperative MRI measurement can predict and potentially replace the need for intraoperative measurement.
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Chronic pain is a debilitating, multifactorial condition. The purpose of this study was to examine patient characteristics of those who did not show up for their scheduled first pain medicine appointment in order to identify factors that may improve access to care. ⋯ High no-show rates were present particularly among younger patients. Having a referral from another specialty was an independent predictor of lower no-show rates.
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In the last 20 years, we have seen the flourishing of multiple treatments targeting the dorsal root ganglion (DRG) for pain. However, there is concern regarding the variation in the location of the DRG, which could influence the long-term clinical outcomes. The aim of this work was to determine the exact position of the DRG in the spine and propose a pre-surgical planning. ⋯ Percutaneous treatments for chronic pain directed at the DRG are effective. Clinical outcomes depend of good preoperative planning that allows for optimizing its effects. We propose a DRG morphology evaluation scale useful for the planning process prior to any treatment directed at the ganglion.