Pain physician
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Studies of radiofrequency ablation (RFA) of genicular nerves have reportedly significantly decreased pain up to 3 months post ablation, but no longer term effects have been reported. We performed an analysis of long-term pain relief of 31 RFA procedures of the genicular nerves to analyze the degree of pain relief past 3 months, culminating at 6 months. ⋯ Based on patient interviews and data collection, RFA of genicular nerves can supply on average greater than 60% pain relief in our patient population for as long as 6 months.Key words: Osteoarthritis, knee osteoarthritis, chronic knee pain, radiofrequency ablation, nerve ablation, genicular nerves, long-term pain relief.
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Ketamine abuse has become a global phenomenon in recent years. Ketamine-induced cystitis (KC) is a new clinical syndrome which can result in severely inflamed bladder and intractable bladder pain. Currently there is no guideline for managing patients with KC. ⋯ AE is effective at treating KC-induced bladder pain and restoring normal lower urinary tract function. However, absolute cessation of ketamine is the key to success in KC treatment.Key words: Ketamine-induced cystitis, augmentation enterocystoplasty, bladder pain, contracted bladder, inflammation, surgery.
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Case Reports
Reversal of Progressive Conscious Disturbance with Epidural Blood Patch for Cerebrospinal Fluid Leakage at C2 Level.
Intracranial hypotension syndrome (IHS) is generally caused by cerebrospinal fluid (CSF) leakage. Complications include bilateral subdural hygroma or haematoma and herniation of the cerebellar tonsils. Epidural blood patch (EBP) therapy is indicated if conservative treatment is ineffective. ⋯ Delivery of EBP via an epidural catheter inserted from the thoracic spine is familiar with most of anesthesiologists. It can be a safe and effective treatment for patients with IHS caused by CSF leak even at C2. Key words: Anaesthetic techniques, regional, thoracic; cerebrospinal fluid leakage; epidural blood patch; heavily T2-weighted magnetic resonance myelography; intracranial hypotension syndrome; Trendelenburg position.
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Case Reports
Pulsed Radiofrequency Ablation of Pudendal Nerve for Treatment of a Case of Refractory Pelvic Pain.
Pudendal neuralgia (PN) is a result of pudendal nerve entrapment or injury, also called "Alcock syndrome." Pain that develops is often chronic, and at times debilitating. If conservative measures fail, invasive treatment modalities can be considered. The goal of this case report is to add to a small body of literature that a pulsed radiofrequency (PRF) ablation can be effectively used to treat PN and to show that high resolution MR neurography imaging can be used to detect pudendal neuropathy.
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Case Reports
Efficacious Dorsal Root Ganglion Stimulation for Painful Small Fiber Neuropathy: A Case Report.
Small fiber neuropathy is a disorder of the peripheral nerves with typical symptoms of burning, sharp, and shooting pain and sensory disturbances in the feet. Pain treatment depends principally on the underlying etiology with concurrent administration of antidepressants, anticonvulsants, opioids, and topical treatments like capsaicin and local anesthetics. However, treatments for pain relief in these patients frequently fail. ⋯ Results from the case report demonstrate that the dorsal root ganglion is a promising neural stimulation target to treat neuropathic pain due to intractable small fiber neuropathy. Prospective controlled studies are warranted to confirm the efficacy of this treatment as an option for the aforementioned condition. Key words: Dorsal root ganglion stimulation, small fiber neuropathy, neuropathic pain.