Pain physician
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Phantom limb pain (PLP), defined as a painful sensation in a portion of the body that has been amputated, occurs in upwards of 80% of limb amputees and can significantly impact a patient's quality of life. First hypothesized in 1551, the disease has been poorly understood for much of this time. Still today, the exact etiology of the condition is yet to be elucidated. In the periphery, PLP resembles the neuronal changes seen in other neuropathic pain conditions. However, in the central nervous system (CNS), imaging studies suggest changes unique to PLP, such as cortical reorganization. Despite a growing understanding of its underpinnings, a mechanism-based treatment is not yet available. Rather, a plethora of treatment methodologies are available with varying levels of supporting evidence and many treatments being utilized based on efficacy seen in non-PLP patients. ⋯ While PLP remains a difficult-to-treat condition, practitioners can greatly improve the quality of life of patients suffering from the condition with a wide range of developing treatments. For pain intractable to traditional pharmacologic treatment, neuromodulation therapies have proven to be highly effective with minimal side effect profiles.
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Randomized Controlled Trial Comparative Study
Comparison of Pain Reduction and Changes in Serum Cortisol and Glucose Levels to Different Doses of Lumbar Epidural Dexamethasone: A Prospective Study.
Lumbar epidural steroid injection (LESI) is an effective treatment for low back pain. However, it may result in increased blood glucose levels, decreased plasma cortisol concentrations, and suppression of the adrenocorticotropic hormone axis. ⋯ After the first lumbar epidural injection of either 4 mg or 8 mg of dexamethasone, there was a reduction in pain in both groups. There was no significant difference in serum cortisol and glucose levels before treatment and during follow-up. Therefore, 4 mg or 8 mg of dexamethasone can be considered a treatment for patients who have low back pain.
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Randomized Controlled Trial
Ultrasound-Guided Erector Spinae Block Versus Ultrasound-Guided Thoracic Paravertebral Block for Pain Relief in Patients With Acute Thoracic Herpes Zoster: A Randomized Controlled Trial.
Severe acute pain is a significant risk factor for postherpetic neuralgia (PHN). The importance of early management in alleviating zoster pain cannot be overstated. ⋯ Both ESB and PVB were effective in controlling acute pain and persistent herpetic pain after 6 months (which was evident by lower NRS for pain and doses of pregabalin and acetaminophen), but ESB is safer (no reported pneumothorax and hypotension).
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Multicenter Study
Long-term Outcomes of Pulsed Radiofrequency for Supraorbital Neuralgia: A Retrospective Multicentric Study.
Pulsed radiofrequency (PRF) is a percutaneous, micro-invasive, and micro-destructive neuromodulation technology. It has been reported to be useful in the treatment of supraorbital neuralgia (SN). However, the long-term effectiveness and safety of this technique in SN has not been reported yet. ⋯ The performance of PRF for the treatment of SN was confirmed to be favorable in a multicentric, relatively large scale, and long-term perspective.
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Hemifacial spasm (HFS) is mainly characterized by paroxysmal involuntary twitches of one side of the facial muscles. We developed an awake CT-guided percutaneous puncture of the stylomastoid foramen for radiofrequency ablation (RFA) therapy for the treatment of hemifacial spasm and successfully used it in our clinic. ⋯ There was no difference in the operation time or efficacy between the 2 approaches. The anterior mastoid approach is easier to perform and is recommended based on our experience.