Pain practice : the official journal of World Institute of Pain
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Randomized Controlled Trial
Reduction in Migraine and Headache Frequency and Intensity with Combined Antioxidant Prophylaxis (N-acetylcysteine, Vitamin E and Vitamin C: NEC): A Randomized Sham-Controlled Pilot Study.
To investigate the preventive effects of a combined antioxidant drug (N-acetylcysteine, vitamin E, and vitamin C [NEC]) on migraine outcomes. Migraine is characterized by increased oxidative stress and neurogenic inflammation in the brain; therefore, antioxidants may have a migraine preventive effect. ⋯ This is the first randomized controlled trial to find that combined antioxidant therapy with NEC reduces headaches and migraines in adult migraineurs. Given the limitations of this pilot study, an adequately powered randomized controlled trial is planned to further investigate antioxidant prophylaxis in migraine.
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Multicenter Study Clinical Trial Observational Study
Prospective, Multicenter Feasibility Study to Evaluate Differential Target Multiplexed SCS Programming in Subjects with Chronic Intractable Back Pain with or Without Leg Pain.
This prospective, open-label, multicenter study evaluated the feasibility of spinal cord stimulation (SCS) therapy programming for chronic low back pain that uses multiple electrical pulsed signals (Differential Target Multiplexed). ⋯ In this difficult-to-treat patient population, subjects reported significant reduction in chronic back pain when using multiplexed programming. A randomized clinical trial is needed to confirm the results from this feasibility study.
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Transforaminal epidural steroid injection (TFESI) can be used to control radicular pain following lumber spinal stenosis (LSS). However, limited information is available on the long-term prognosis of TFESI in patients with LSS. ⋯ The prognosis after TFESI for controlling LSS-induced radicular pain is thought to be relatively poor. However, considering poor long-term outcome and complications after surgery, we believe that TFESI is worth considering as a safe modality for controlling radicular pain following LSS.
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Dorsal root ganglion stimulation (DRG-S) has emerged as a treatment for complex regional pain syndrome (CRPS) of the lower extremities, and recent small studies are demonstrating its potential efficacy in pain syndromes that are traditionally considered nociceptive in nature, such as axial low back pain. While improvements in neuromodulation technology have been substantial over the past decade, with DRG-S systems patients occasionally require additional interventional pain treatments for treatment of pain from other sources. Radiofrequency ablation (RFA) of medial branch nerves innervating the facet joints is an accepted therapy for pain arising from the facet joints. ⋯ RFA can interfere with implanted DRG-S systems, resulting in overstimulation with motor recruitment. Specific anatomical considerations and device settings that may prevent interference are discussed.
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Numerous mechanical and pathologic variables contribute to sacroiliac joint (SIJ) pain. The oncologic population has additional considerations, including tumor burden causing fracture, nerve compression, joint instability, and periosteal inflammation. Post-treatment changes may also restrict joint mobility, causing transitional pain. Currently, fluoroscopically guided SIJ injections, aimed at the inferior one third of the SIJ, are the gold standard for treatment but have only been described in the nononcologic population. Ultrasound (US) guidance may confer several benefits, including positioning, ease of procedure, lower costs, and, importantly, guidance to avoid neovascularization, metastatic disease, and other soft tissue structures. ⋯ We propose a decision framework for inferior vs. superior approach US-guided SIJ injections in the oncologic population with SIJ pain from metastases to the pelvis or sacrum. Having multiple techniques to approach the SIJ is important in the oncologic population, in whom metastatic tumor burden poses a technical challenge to performing these injections.