Pain physician
-
To evaluate the pattern and flow of epidural contrast in fluoroscopically guided lumbar interlaminar steroid injections. ⋯ Thirty six percent of the injections observed in the study revealed ventral contrast flow. Bilateral contrast flow occurred in 16% of the injections. Caudad contrast flow is less than cephalad. The observed contrast flows need to be studied clinically to determine if this can affect clinical outcome.
-
Spinal surgery, particularly spinal fusion surgery, alters the anatomy of the spine and hence, may increase the difficulty of performing an interventional spine procedure. Transforaminal epidural procedures have gained popularity as an alternative to interlaminar epidural steroids in the management of radicular pain syndromes. ⋯ When included, however, patients with FBSS have typically undergone laminectomies or microdiscectomies: these procedures are less likely to violate the foraminal space in the spine compared to fusion surgery. We describe the specific details of a transforaminal approach to the epidural space/spinal nerve in a patient with a posterolateral and posterior interbody fusion.
-
Plasma Beta endorphin (BE) is an endogenous peptide opioid derived form pro-opiomelanocortin. Although the role of plasma BE in pain regulation is unclear, plasma BE levels have been reported to correlate inversely with pain levels in cancer pain. ⋯ Plasma BE levels increased with improved pain control in patients with upper abdominal gastrointestinal malignancies. Although the role of plasma BE in pain pathophysiology is unclear, it appears that pain relief per se, and not the analgesic technique, modulates plasma BE levels. This suggests that plasma BE levels may serve as an objective measure of cancer pain severity and corroborate the patient's report of pain relief.