Pain medicine : the official journal of the American Academy of Pain Medicine
-
Current therapies for sacroiliac joint (SIJ) dysfunction offer discouraging results in alleviating low back pain. The innervation and target nerves for radiofrequency denervation (RFD) of the SIJ remain unclear. We present a prospective case series on the treatment of intractable SIJ dysfunction with pulsed radiofrequency denervation (PRFD) of lateral branches from L4-S3. ⋯ PRFD of the lateral branch of the medial branch of L4, posterior primary rami of L5, and lateral branches S1 and S2 is an effective treatment for some patients with SIJ pain unresponsive to other forms of therapy.
-
This report describes a case where pulsed radiofrequency lesioning (RFL) of the greater occipital nerve (GON) offered a valuable and safe treatment for the management of greater occipital neuralgia. The case is considered in relation to a review of the medical literature on greater occipital neuralgia and RFL interventions. ⋯ Pulsed RFL of the GON is an alternative to continuous RFL with the proposed advantage of mitigating pain, as in continuous RFL, but without the potential risk of causing deafferentation pain. While placebo and other nonspecific analgesic effects cannot be ruled out, the apparent safety profile and potential efficacy of pulsed RFL suggests it may be a compelling option to consider before irreversible neuroablative therapies are applied.
-
Pulsed radiofrequency, where short bursts of radiofrequency energy are applied to nervous tissue, has been used by pain practitioners as a non- or minimally neurodestructive technique, alternative to radiofrequency heat lesions. Clinical advantages and mechanisms of this treatment remain unclear. The objective of this study was to review current clinical and laboratory data. ⋯ The accumulation of these data shows that the use of pulsed radiofrequency generates an increasing interest of pain physicians for the management of a variety of pain syndromes. Although the mechanism of action has not been completely elucidated, laboratory reports suggest a genuine neurobiological phenomenon altering the pain signaling, which some have described as neuromodulatory. No side effects related to the pulsed radiofrequency technique were reported to date. Further research in the clinical and biological effects is justified.
-
Case Reports
Spinal cord stimulation is an effective treatment for the chronic intractable visceral pelvic pain.
Recent studies have demonstrated significant involvement of dorsal column pathways in transmission of visceral pelvic pain. Spinal cord stimulation (SCS) suppresses visceral response to colon distension in an animal model and therefore may be an effective therapy for chronic pelvic pain of visceral origin. We are reporting on the value of neurostimulation for chronic visceral pelvic pain in six female patients with the diagnosis of long-standing pelvic pain (history of endometriosis, multiple surgical explorations, and dyspareunia). ⋯ It appears that SCS may have a significant therapeutic potential for treatment of visceral pelvic pain.
-
Randomized Controlled Trial
Duloxetine for patients with diabetic peripheral neuropathic pain: a 6-month open-label safety study.
Duloxetine is a relatively balanced and potent reuptake inhibitor of both serotonin and norepinephrine. Because these neurotransmitters play a role in pain inhibition, duloxetine was considered a possible treatment for diabetic peripheral neuropathic pain (DPNP). This study assessed the 6-month safety and tolerability of duloxetine in patients with DPNP; evaluation of efficacy was a secondary objective. ⋯ In this study, duloxetine 60 mg BID and 120 mg QD were safely administered and well tolerated in patients with DPNP for up to 28 weeks. There were few differences in safety or tolerability between the two dosages. At both doses, duloxetine provided clinically significant pain relief.