Articles: back-pain.
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Reg Anesth Pain Med · May 2014
Comparative StudyClinical Effectiveness of Percutaneous Adhesiolysis Versus Transforaminal Epidural Steroid Injection in Patients With Postlumbar Surgery Syndrome.
A number of patients with postlumbar surgery syndrome (PLSS) do not experience satisfactory results after epidural injection. A main reason for failure is surgically induced perineural fibrosis impeding injected material from spreading effectively into the target area. Percutaneous adhesiolysis (PA) has the ability to eliminate the deleterious effects of such adhesions. This study was to evaluate the effectiveness of PA versus transforaminal epidural steroid injection (TFESI) for treating patients with PLSS and to compare the clinical efficacy of PA according to the type of surgery. ⋯ Percutaneous adhesiolysis was more effective than TFESI in treating patients with PLSS and also showed better clinical efficacy in the decompression subgroup than in the fusion subgroup.
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Psychological factors including fear avoidance beliefs are believed to influence the development of chronic low back pain (LBP). ⋯ Evidence suggests that fear avoidance beliefs are prognostic for poor outcome in subacute LBP, and thus early treatment, including interventions to reduce fear avoidance beliefs, may avoid delayed recovery and chronicity.
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Review Case Reports
Methadone and oedema in the palliative care setting: a case report and review of the literature.
Methadone is a synthetic opioid which is being used with increased frequency in the palliative care setting for management of complex pain. There have been cases published reporting the development of oedema with methadone maintenance therapy but no cases on the association with methadone and peripheral oedema in the palliative care setting. As yet, the underlying mechanisms are unclear. ⋯ This highlights an important potential adverse effect of methadone in a society of increased methadone prescription for pain control. The published literature to date is reviewed and possible underlying mechanisms explored.
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Background: Pulsed radiofrequency (PRF) has been widely used to treat chronic pain, but the effectiveness and mechanisms in preventing early neuropathic pain have not been well explored. Even fewer knowledge is available in its impact on glia-mediated nociceptive sensitization. This study aims to elucidate the modulation of PRF on nerve injury-induced pain development and activation of spinal mitogen-activated protein kinases (MAPKs). ⋯ Conclusions: Low-volt PRF significantly ameliorated SNL-induced acute pain. Inferentially, PRF may inhibit spinal sensitization by down-regulating spinal MAPK activations and activation-mediated cytokine release. We demonstrated that early PRF treatment in acute nerve injury helps to ameliorate neuropathic pain development.