Articles: chronic-pain.
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The precise cause of low back pain based on clinical history, physical examination, radiological imaging, and electrophysiological testing can be identified in only 15% of patients in the absence of disc herniation and neurological deficit. The prevalence of chronic lumbar zygapophysial (facet) joint pain ranges from 15% to 45% utilizing comparative local anesthetic blocks in controlled settings in accordance with the criteria established by the International Association for the Study of Pain. Currently, facet joint injection procedures are considered as the gold standard in the diagnosis of facet joint pain. ⋯ Since we are unable to apply reference standards of biopsy, surgery, or autopsy, and pain relief has been argued as an inconsistent feature, long-term follow-up has been considered as the best indicator. This study was undertaken to evaluate stability of the diagnosis of lumbar facet joint pain following comparative local anesthetic blocks at a follow-up after 2 years. The results showed that 85% of the patients available for follow-up withstood the diagnosis of facet joint pain at the end of 2 years, whereas this proportion decreased to 75%, if all the patients in the study were included in the analysis.
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Reliability and ease of use of the Itrel 3 System (Medtronic Inc., Minneapolis, MN) were prospectively assessed over 5 years in patients with a range of pain syndromes (mainly low back and/or leg pain, or ischemic pain due to peripheral vascular disease). The longevity of the implantable pulse generator (IPG) battery, the frequency with which system settings were changed, and the ease of use of the EZ patient programmer were assessed. Data on adverse events, pain relief, and patient satisfaction with therapy were also collected. ⋯ The intensity and duration of pain were reduced significantly and patient satisfaction with therapy was high. We conclude that the Itrel 3 System performed well over 5 years and was easy to use. Its safety and effectiveness for the relief of chronic intractable pain of the trunk or limbs were also confirmed.
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Evidence-based practice guidelines for interventional techniques in the management of chronic spinal pain are systematically developed and professionally derived statements and recommendations that assist both physicians and patients in making decisions about appropriate health care in the diagnosis and treatment of chronic or persistent pain. The guidelines were developed utilizing an evidence-based approach to increase patient access to treatment, to improve outcomes and appropriateness of care, and to optimize cost-effectiveness. All types of relevant and published evidence and consensus were utilized. ⋯ It is expected that a provider will establish a plan of care on a case-by-case basis, taking into account an individual patient's medical condition, personal needs, and preferences, and the physician's experience. Based on an individual patient's needs, treatment different from that outlined here could be warranted. These guidelines do not represent "standard of care."
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Cervicogenic headache and cervicobrachialgia are frequent diagnoses of chronic cervical pain. After failure of conservative treatment, an interventional approach may be indicated in the absence of any indication for causal surgical treatment. The pulsed radiofrequency (PRF) technique exposes the nerve to a high-frequency electric field while the temperature of the electrode tip does not exceed 42°C. ⋯ Satisfactory pain relief of at least 50% was achieved in 13 of 18 (72%) patients at 8 weeks. More than one year after treatment, six patients (33%) continue to rate treatment outcome as good or very good. No side effects were reported. j.
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Spinal cord stimulation (SCS) was performed to test the hypothesis that pain relief data during acute (15 minute intraoperative) and prolonged (5 day) SCS screening have equivalent predictive value for long-term successful SCS control of chronic low back pain and/or lower extremity pain. A retrospective series of patients with chronic low back and/or lower extremity pain underwent either percutaneous or open (ie, laminectomy) SCS implantation during which acute intraoperative followed by prolonged screening trials for percentage pain relief (%PR) were performed. Data were analyzed for (a) correlation between positive predictive value (PPV) of acute and prolonged SCS screening for %PR and (b) PPV of acute vs. prolonged screening %PR for long-term SCS %PR. ⋯ After permanent SCS implantation, at mean follow-up = 9.4 ± 1.5 months, acute and prolonged SCS screening %PR PPV's were each statistically significant for predicting long-term SCS relief of chronic pain (n = 31/38, PPV = 82% and n = 31/36, PPV = 86%, SRCC = 0.462 and 0.433, respectively, p < 0.01). We conclude that successful pain relief during acute SCS screening is highly correlated with successful prolonged SCS screening of chronic low back and/or lower extremity pain relief. Acute and prolonged SCS screening appear to have equivalent predictive value for successful long-term SCS control of chronic low back and/or lower extremity pain. These preliminary results suggest potential justification for eliminating prolonged and retaining acute (intraoperative) SCS screening for selection of permanent SCS implantation candidates.