Articles: chronic-pain.
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Facet or zygapophysial joint blocks are used extensively in the evaluation of chronic spinal pain. However, there is a continuing debate about the value and validity of facet joint blocks in the diagnosis of chronic spinal pain. The value of diagnostic facet joint injections may have been overlooked in the medical literature. ⋯ The diagnostic accuracy of controlled local anesthetic facet joint blocks is high in the diagnosis of chronic spinal pain.
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Objective. The outcomes of different modes of TENS (transcutaneous electrical nerve stimulation) in relieving experimental heat and cold pain were studied. Materials and methods. Three modes of stimulation, conventional, burst, and high rate frequency modulation (HRFM) including placebo, were trancutaneously applied to 20 right handed healthy volunteers (10 males and 10 females). Stimulation was carried out using two pad electrodes placed over the median nerve for 120 s in each case. ⋯ Conclusions. All modes of stimulation statistically decreased both heat and cold pain when compared to placebo. HRFM was the most effective mode of TENS. It might be worthwhile to test the patterns of stimulation in chronic pain patients.
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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.
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Epidural adhesiolysis with spinal endoscopy is an emerging interventional pain management technique in managing chronic refractory low back and lower extremity pain. However, there is a lack of significant data demonstrating the effectiveness of spinal endoscopic adhesiolysis. This randomized, double-blind controlled trial was undertaken to determine the ability of spinal endoscopic adhesiolysis to reduce pain and improve functional and psychological status. ⋯ Based on the definition that less than 6 months of relief is considered as short-term and longer than 6 months is considered as long-term, a significant number of patients obtained long-term relief. The results showed significant improvement in patients undergoing spinal endoscopic adhesiolysis at 1-month, 3-months, and 6-months, compared to baseline measurements, as well as compared to the control group without adhesiolysis. Spinal endoscopic adhesiolysis with targeted injection of local anesthetic and steroid, is an effective treatment in a significant number of patients without major adverse effects at 6-month follow-up.
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Epidural injections with or without steroids are used extensively in the management of chronic spinal pain. However, evidence is contradictory with continuing debate about the value of epidural steroid injections in chronic spinal syndromes. The objective of this systematic review is to determine the effectiveness of epidural injections in the treatment of chronic spinal pain. ⋯ Further, evidence was moderate for caudal epidural injections in managing lumbar radicular pain. The evidence in management of chronic neck pain, chronic low back pain, cervical radiculopathy, spinal stenosis, and post laminectomy syndrome was limited or inconclusive. In conclusion, the evidence of effectiveness of transforaminal epidural injections in managing lumbar nerve root pain was strong, whereas, effectiveness of caudal epidural injections in managing lumbar radiculopathy was moderate, while there was limited or inconclusive evidence of effectiveness of epidural injections in managing chronic spinal pain without radiculopathy, spinal stenosis, post lumbar laminectomy syndrome, and cervical radiculopathy.