Articles: chronic.
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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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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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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.