Pain physician
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Meta Analysis
Pericranial Total Tenderness Score in Patients with Tension-type Headache and Migraine. A Systematic Review and Meta-analysis.
Increased pericranial tenderness is considered to be a typical characteristic of tension-type headache (TTH). Assessment of pericranial tenderness in TTH using the total tenderness score is recommended by the International Classification of Headache Disorders-3 (ICHD-3). However, to what extent pericranial tenderness differs between patients with TTH or migraine and healthy patients is unknown. ⋯ We found moderate quality evidence for higher tenderness in chronic TTH and migraine, and low quality evidence for higher tenderness in episodic TTH compared to healthy patients. Pericranial tenderness is a common finding in patients with headache and healthy patients. These findings apply for a critical evaluation of the total tenderness score in the current ICHD-3 classification of TTH.
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Thoracolumbar interfascial plane (TLIP) block as a novel plane block technique was proposed in 2015 and can be performed in patients undergoing lumbar spine surgery. However, no meta-analysis demonstrates the effects of TLIP block on postoperative pain undergoing lumbar spine surgery. ⋯ The TLIP block is an effective strategy to improve postoperative pain at rest/movement and to reduce PCA consumption in patients undergoing lumbar spine surgery, which exerts significant analgesia. In the future, it is worth being applied in lumbar spine surgery extensively.
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Post-dural puncture headache (PDPH), or spinal headache, is the most common serious complication resulting from iatrogenic puncture of the dura during epidural or spinal anesthesia and cerebrospinal fluid (CSF) leak in pregnant women. ⋯ Exposure to opioids for any reason after the diagnosis of unintentional dural puncture is not associated with a reduced risk of PDPH and does not decrease the need for therapeutic EBP.
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Several minimally invasive nonsurgical treatments have been widely applied for plantar fasciitis (PF). To date, controversy still exists regarding the effectiveness of these approaches for treating PF. ⋯ The MSN treatment should be recommended as the best therapy, followed by BTA in the gastrocnemius and BTA. CS and PRP are common medications that remain valuable in clinical practice. PEP can be performed after the injection of medication.
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Perineural (PN) dexamethasone (DEX) administration can prolong the analgesic time of a brachial plexus block. However, its efficacy and safety are controversial due to its off-label use and different routes of administration. ⋯ PN dexamethasone can prolong the duration of analgesia, sensory block, and motor block, when compared with IV dexamethasone. In a subgroup analysis without epinephrine, the 2 routes of administration were equivalent to topical anesthesia. There were no differences in secondary outcomes, except for adverse effects, which could be altered if a sensitivity analysis was conducted. Therefore, despite the advantages of PN dexamethasone, caution is needed due to its off-label character. While the results of this study are promising, additional large and well-designed RCTs are needed to validate these initial findings and their implications.