Articles: chronic-pain.
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Chronic hip pain is often a debilitating problem and many patients are not good surgical candidates. Furthermore, hip replacement surgery has significant associated risks. We offer a conservative approach to hip replacement using radiofrequency lesioning. ⋯ Percutaneous radiofrequency lesioning of the sensory branches of the obturator and femoral nerves appears to be a safe alternative to hip replacement, especially in those patients where surgery is not an option. Further studies are needed to confirm our results.
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The lifetime prevalence of spinal pain has been reported as 65% to 80% in the neck and low back. In the US each year, 500,000 - 1,000,000 spine surgeries and 2 to 5 million interventional procedures are estimated to be performed. The burden created by chronic pain is enormous on the patient and society. ⋯ The optimal course of care requires an integrated delivery system involving a variety of specialists. Due to the complexities of diagnosis and management, patients are best managed utilizing a multidisciplinary approach under an umbrella of services offered by a spinal diagnostic and interdisciplinary pain center. This review identifies various pain syndromes and conditions and provides a model for the establishment of an interdisciplinary pain center as well as the resources, guidelines, and infrastructure required for operating a successful pain center in any setting; free-standing, hospital-based, or academic.
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Facet (zygapophysial) joint pain can be diagnosed by anesthetization of the medial branch divisions of the dorsal rami. In accordance with the criteria established by the International Association for the Study of Pain, lumbar facet (zygapophysial) joints have been implicated as the source of chronic pain in 15% to 45% of the patients with chronic low back pain. The reasons for the wide variations have not been systematically evaluated. ⋯ A false-positive rate of 17% in patients with low back pain only and 21% in patients with involvement of multiple regions of the spine was demonstrated with single blocks. This study demonstrated a lower incidence of facet joint pain in patients with spinal pain of a single region in the low back compared to the patients with multiple region involvement of the spine (21% vs 41%), in an interventional pain management setting. These results may not be extrapolated to the general population or chronic low back pain population at large.
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To determine the long-term efficacy of IDET in the treatment of chronic lumbar discogenic pain. ⋯ IDET appears to be an effective treatment for chronic lumbar discogenic pain in a well-selected group of patients with favorable long-term outcome.
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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.