Pain physician
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Meta Analysis Comparative Study
Comparing pain reduction following vertebroplasty and conservative treatment for osteoporotic vertebral compression fractures: a meta-analysis of randomized controlled trials.
Osteoporotic vertebral compression fractures (OVCFs) are the most common osteoporotic fractures. Pain is the main symptom. Percutaneous vertebroplasty (PVP) is a therapeutic procedure performed to reduce pain in vertebral compression fractures. Numerous case series and several small, non-blinded, non-randomized controlled studies have suggested that vertebroplasty is an effective means of relieving pain from osteoporotic fractures. However, a recent pooled analysis from 2 multicenter randomized controlled trials concluded that the improvement in pain afforded by PVP was similar to placebo. ⋯ PVP has some value for relieving pain; however, the possibility of a placebo effect should be considered. PVP has gained acceptance as a complementary treatment when conservative management has failed before its benefits have been fully understood. More large scale, double blinded, controlled trials are necessary in order to quantify the pain relief afforded by PVP more precisely.
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Randomized Controlled Trial
Combinations of low-dose antidepressants and low-dose pregabalin as useful adjuvants to opioids for intractable, painful bone metastases.
Systemic analgesics would not provide good enough pain relief for some kinds of cancer pain. Metastatic bone pain is characteristic of one of the refractory cancer pains, since the pain is not only nociceptive but also neuropathic. A low-dose antiepileptic-antidepressant combination with opioids is effective in the management of neuropathic cancer pain. ⋯ Low-dose pregabalin-antidepressant combinations with opioids were effective in the management of painful bone metastases.
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Pulsed radiofrequency (PRF) therapy is a clinical treatment utilizing electromagnetic energy aimed to relieve neuropathic pain. This is the first study examining the modulated expression of pain regulatory genes following the induction of the spared nerve injury (SNI) pain model and subsequently treated with PRF therapy. ⋯ These results indicate that the electromagnetic energy applied via PRF therapy influences the reversal of behavioral and molecular effects of hypersensitivity developed from a peripheral nerve injury.
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No studies have directly measured the false negative rate of medial branch block (MBB) with correlation to medial branch neurotomy (MBN) outcome. We investigated the potential false negative MBB rate and the subsequent MBN outcome on a consecutive audit of all patients undergoing a double MBB protocol. We prospectively collected audit data and retrospectively collected data by phone on 229 consecutive patients undergoing diagnostic MBB. ⋯ The success rate in all patients undergoing MBN was 87% compared to the 75% relief in the false negative groups with no statistically significant difference. In summary, the false negative rate for patients reporting less than 50% relief post MBB is probably less than 20% although there is a high "apparent negative" responds in patients reporting delayed relief or in those who had a second block 2 or more years post initial MBB. Patients reporting between 50 and 69% pain relief have a false negative response rate of 47.1% and should be considered for a confirmatory block.