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Pain Physician

Jonghyuk Baek, Seung Heon Yang, Chi Heon Kim, Chun Kee Chung, Yunhee Choi, Ji Han Heo, Sung Bae Park, Sung Hwan Hwang, Jong-Myung Jung, Kyoung-Tae Kim
BACKGROUND: Residual disc fragments are observed on immediate postoperative magnetic resonance imaging (MRI) in 2.8-15% of patients after percutaneous endoscopic lumbar discectomy (PELD). Considering the known postoperative longitudinal outcomes in patients with residual disc tissue, a 'watchful waiting' strategy may be preferable to immediate re-operation in patients with asymptomatic residual disc material. OBJECTIVES: The aim of the present study was to compare the longitudinal clinical outcomes between PELD patients in whom the complete removal of disc fragments was achieved (complete group) and those in whom residual disc fragments were observed on postoperative MRI (residual group)...
July 2018: Pain Physician
Serbulent Gokhan Beyaz, Havva Sayhan
BACKGROUND: Numerous techniques have been developed for the treatment of disc herniation. Oxygen-ozone (O<sub>2</sub>-O<sub>3</sub>) mixture therapy is a minimally invasive percutaneous treatment for disc herniation. OBJECTIVE: The aim of the study is to investigate the 6-month efficacy and safety of O<sub>2</sub>-O<sub>3</sub> mixture therapy in patients with cervical disc herniation (CDH) and chronic neck pain. STUDY DESIGN: This is a cross-sectional, single-center study...
July 2018: Pain Physician
Seon Yoon Nah, Jae Hyup Lee, Ji-Ho Lee
BACKGROUND: Glucocorticoids adversely affect bone mineral density (BMD) and increase the risk of fracture. Yet, the cause-and-effect relationship between epidural steroid injection (ESI) and BMD has not been thoroughly investigated, and available results are inconsistent. This is probably a consequence of differences in the dose of steroids and follow-up duration. OBJECTIVE: This study aimed to evaluate changes in BMD and the risk of fracture according to duration of the follow-up and amount of steroids used for ESI...
July 2018: Pain Physician
Ji Su Jang, Youngsuk Kwon, Sung Mi Hwang, Jong Ho Kim, Taehyung Yun, Young Soo Kim, Rak Min Choi, Jae Jun Lee
BACKGROUND: Combination therapy with a gabapentinoid and an opioid improves the quality of life (QOL) of patients with chronic pain. However, the role of combination therapy in patients with spinal cord stimulation (SCS) has not been evaluated. OBJECTIVE: Our primary objective was to evaluate the clinical outcomes of combination therapy consisting of a gabapentinoid and an opioid in patients undergoing SCS. STUDY DESIGN: Retrospective evaluation...
July 2018: Pain Physician
Carlos J Roldan, Carrie Johnson, Sin-Ong Lee, Andrew Peng, Patrick M Dougherty, Billy Huh
BACKGROUND: Chemotherapy-induced peripheral neuropathy (CIPN) is a common and chronic complication associated with cancer treatment. Prior investigations have demonstrated the presence of subclinical peripheral neuropathy in patients with colorectal cancer even before the patients had received chemotherapy. OBJECTIVE: To investigate subclinical peripheral neuropathy of the upper limbs in patients with squamous cell carcinoma (SCC) of the head and neck which developed before their exposure to neurotoxic anticancer agents...
July 2018: Pain Physician
Pedro Rodrigues, Leticia Correa, Marcelle Ribeiro, Bruno Silva, Felipe Reis, Leandro Nogueira
BACKGROUND: Patients with chronic musculoskeletal pain have a higher chance of presenting impairment in cardiovascular autonomic modulation, which may have implications for cardiovascular events. The autonomic nervous system plays an important role in pain modulation. However, it is unclear whether patients with inefficient descending nociceptive inhibition have poorer cardiovascular autonomic modulation. OBJECTIVE: To compare the cardiovascular autonomic modulation of patients with musculoskeletal pain who had normal versus impaired functioning of descending nociceptive inhibitory system (DNIS)...
July 2018: Pain Physician
Hyeun Sung Kim, Byapak Paudel, Jee Soo Jang, Keun Lee, Seong Hoon Oh, Il Tae Jang
BACKGROUND: Lumbar disc herniation (LDH) is being treated with limited indication by percutaneous full endoscopic lumbar discectomy. However, microscopic lumbar discectomy (MLD) is still considered as a gold standard. OBJECTIVE: With the advances in spinal endoscopic instruments and surgical techniques, all LDHs have now become operable with percutaneous full endoscopic lumbar discectomy procedure. We report the results of percutaneous full endoscopic lumbar discectomy (PELD) for all patients diagnosed with LDH, including severely difficult and extremely difficult LDH cases who visited our clinic with leg pain and lower back pain...
July 2018: Pain Physician
Dipika Bansal, Chandra Sehkar Boya, Rambabu Vatte, Babita Ghai
BACKGROUND: Emerging evidence suggests an association between vitamin D deficiency and low back pain (LBP). OBJECTIVE: To pool evidence on the prevalence of hypovitaminosis D in patients with LBP. STUDY DESIGN: Meta-analysis. METHODS: A comprehensive literature search was done in PubMed, Cochrane Database, and Google scholar for observational studies including cohort, cross sectional (CS), and case control (CC) evaluating the prevalence of hypovitaminosis D in LBP patients...
July 2018: Pain Physician
Matthias H Morgalla, Marcos Fortunato, Guilherme Lepski, Bankim S Chander
BACKGROUND: Dorsal root ganglion stimulation (DRGS) treats discrete, localized areas of neuropathic pain. But there are no long-term results available so far. OBJECTIVES: We studied the long-term outcome of DRGS used in the treatment of chronic neuropathic pain. STUDY DESIGN: A prospective, longitudinal single center investigation. SETTING: Academic medical center in Germany. METHODS: Patients (age >18 years) with chronic neuropathic pain in the hands, back, legs, knees and feet were prospectively examined...
July 2018: Pain Physician
Hilal Telli, Serkan Telli, Murat Topal
BACKGROUND: Although sacroiliac joint dysfunction (SIJD) is generally regarded as a source of lumbar pain, its anatomical position and the absence of a diagnostic 'gold standard' lead to difficulties at examination and differential diagnosis. However, since sacroiliac (SI) joint blocks only provide information about pathologies of joint origin and since SIJD developing secondary to pathologies in structures around the joint can be missed. Provocation and palpation tests also need to be used in diagnosis...
July 2018: Pain Physician
Xin Huang, Bin Zhu, Xiaoguang Liu
BACKGROUND: Percutaneous endoscopic lumbar discectomy (PELD) has become an increasingly popular minimally invasive spinal surgery. Due to the technical evolution of PELD, the focus of decompression has shifted from the central nucleus to the subannular-protruded disc herniation, which allows direct neural decompression. Surgical entry into the spinal canal leads to the greater possibility of bony structure obstruction, thus the location and direction of the working channel are crucial...
July 2018: Pain Physician
Yanjie Zhu, Yongzhao Zhao, Guoxin Fan, Shiyu Sun, Zhi Zhou, Dongdong Wang, Yunshan Fan, Shisheng He, Guangfei Gu
BACKGROUND: Percutaneous transforaminal endoscopic discectomy (PTED) under local anesthesia (LA) is growing popular in recent years because of its safety, effectiveness and increased patient demands for minimally invasive procedures. To avoid neural injuries, local anesthesia that can keep the patient conscious is recommended. However, many patients complain about the severe pain during surgery. Epidural anesthesia (EA) is an alternative choice. We put forward an anesthetic method that combined preemptive analgesia (PA) and local anesthesia...
July 2018: Pain Physician
Po-Chou Liliang, Chao-Ming Hung, Kang Lu, Han-Jung Chen
BACKGROUND: A superior hypogastric plexus block is difficult to perform and hampered by bony structures of the iliac crest and transverse process of L5. OBJECTIVE: We report on a fluoroscopically guided posterolateral transdiscal technique for superior hypogastric plexus neurolysis using a single needle. STUDY DESIGN: A technical note describing interventional procedures. SETTING: The neurosurgery department of a cancer hospital...
July 2018: Pain Physician
Sebastian Ruetten, Patrick Hahn, Semih Oezdemir, Xenophon Baraliakos, Georgios Godolias, Martin Komp
BACKGROUND: Surgery for thoracic disc herniation and stenosis is comparatively rare and often demanding. The goal is to achieve sufficient decompression without manipulating the spinal cord and to minimize surgical trauma and its consequences. Individual planning and various surgical techniques and approaches are required. The key factors for selecting the technique are anatomical location, consistency of the pathology, general condition of the patient, and the surgeon's experience. OBJECTIVES: The objective of the study was the evaluation of the technical implementation and outcomes of a full-endoscopic uniportal technique via the extraforaminal approach in patients with symptomatic soft or calcified disc herniation of the thoracic spine, taking specific advantages and disadvantages and literature into consideration...
July 2018: Pain Physician
Tak Kyu Oh, Nam Woo Kim, Jiyeon Yim, HyunJae Lim, Boram Park, Dae Hyun Kim
BACKGROUND: Interventional pain management is essential for patients with cancer who experience medically uncontrollable chest wall pain to help control their symptoms and improve their quality of life. However, there is a lack of data on this topic, so there is an urgent need for further research. OBJECTIVES: To identify the effects of radiofrequency ablation (RFA) of the thoracic nerve roots on pain outcomes in patients with cancer and intractable chest wall pain...
July 2018: Pain Physician
Andrea Tinnirello, Manuel Todeschini, Deborha Pezzola, Sandra Barbieri
BACKGROUND: Osteoarthritis of the hip joint is a common cause of pain and disability. Patients not responding to conservative management often cannot undergo joint replacement due to the presence of multiple comorbidities, while some other patients prefer to postpone surgery as long as possible. Radiofrequency denervation of articular branches of the femoral and obturator nerves, which supply innervation of the joint, is a novel technique to reduce hip joint pain. Previous studies reported positive results after application of continuous radiofrequency to the target nerves; however, this approach carries the potential risk of neuritis and neuroma formation...
July 2018: Pain Physician
Rongguo Liu, Xueru Xu, Yunlu Xu, Xiangyu Fang, Xingwu Lin
BACKGROUND: Interferon regulatory factor 8 (IRF8), which is induced by peripheral nerve injury (PNI), plays a key role in activating spinal microglia to release inflammatory cytokines in a p38-dependent way, thereafter results in formation of central sensitization. Pulsed radiofrequency (PRF) on dorsal root ganglion (DRG) alleviates neuropathic pain and inhibits the microglial activation in chronic constriction injury (CCI) rats. However, the consequences of PRF on spinal IRF8 of CCI rats remains unknown...
July 2018: Pain Physician
Majid Reza Farrokhi, Golnaz Yadollahikhales, Mehrnaz Gholami, Seyed Reza Mousavi, Amir Reza Mesbahi, Ali A Asadi-Pooya
BACKGROUND: Degenerative lumbar spine disease can lead to lumbar spine instability. Lumbar spine instability is defined as an abnormal response to applied loads characterized kinematically by abnormal movement in the motion segment beyond normal constraints. Patients with lumbar spinal stenosis (LSS) typically present with low back pain (LBP), cramping, cauda equine syndrome, and signs of nerve root compression associated by weakness, numbness and tingling in their legs that are worsened with standing and walking...
July 2018: Pain Physician
Aki Fujiwara, Keisuke Watanabe, Keiji Hashizume, Kozue Shinohara, Masahiko Kawaguchi
BACKGROUND: The acute phase of shingles is characterized by severe pain, and one of the complications of shingles known as postherpetic neuralgia (PHN) is associated with prolonged pain. Although factors predicting the development of PHN, as well as its preventative measures, have been investigated, there is no single treatment effective for PHN. Some studies showed effectiveness of epidural injection to alleviate pain associated with acute-phase shingles. In these studies, epidural injection was performed by interlaminar (IL) approach...
July 2018: Pain Physician
Sybil Skinner-Robertson, Mohamad-Samer Mouksassi, France Varin
BACKGROUND: Understanding analgesic pharmacodynamics (PD) in the elderly is key to optimising pain management. Electrically stimulated pain models (ESPM) permit assessment of pain responses in humans. C and A-delta sensory fibres convey pain and respond to low frequency electrical stimulus (5 and 250 Hz, respectively). Human research suggests pain tolerance threshold (PTT) is similar or decreases with age. OBJECTIVES: To determine whether an ESPM is able to detect a difference in PTT in elderly (>/= 75 years) and young (20-40 years) subjects after single dose administration of a placebo and tramadol, a low potency analgesic...
July 2018: Pain Physician
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