Pain physician
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Many patients suffer from abdominal and thoracic pain syndromes secondary to numerous underlying etiologies. Chronic abdominal and thoracic pain can be difficult to treat and often refractory to conservative management. In this systematic literature review, we evaluate the current literature to assess radiofrequency ablation's (RFA) efficacy for treating these debilitating chronic pain conditions in the thoracic and abdominal regions. ⋯ A systematic review of the literature supports RFA as a viable option for managing abdominal and thoracic pain. Future randomized controlled trials are needed to investigate the efficacy of the various RFA modalities to ensure RFA is the source of pain relief as a large body of the current literature focuses only on observational studies.
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Lumbar facet arthropathy is one of the leading causes of back pain. Lumbar radiofrequency lesioning is a therapy for lumbar facet arthropathy that uses heat to ablate the transmission of nerve signals from the medial branches of the spinal nerves associated with the corresponding painful lumbar joints. ⋯ This study highlights significant effectiveness for patients undergoing lumbar radiofrequency ablations for lumbar facet joint pain. A variation in effectiveness appears to be influenced by gender and obesity, and therefore additional studies are warranted to further investigate these differences.
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Percutaneous radiofrequency thermocoagulation (RFT) through the foramen rotundum (FR) is a new approach for the treatment of V2 trigeminal neuralgia (TN). Some studies have shown the novel method seems to have advantages over traditional RFT through the foramen ovale (FO). The optimal interventional surgical strategy for isolated V2 TN remains controversial. ⋯ In conclusion, RFT of the maxillary nerve through the FR for the treatment of primary V2 TN had a better long-term effect rate and fewer complications in comparison with thermocoagulation of the Gasserian ganglion through the FO. No differences were found between both interventions in terms of immediate effect rate and recurrence rate.
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Meta Analysis
Application of Dexmedetomidine as an Opioid Substitute in Opioid-Free Anesthesia: A Systematic Review and Meta-analysis.
Opioid-based general anesthesia was previously used to alleviate perioperative pain; however, several complications associated with using anesthesia have raised several concerns. Various studies have investigated the application prospect of using opioid-free general anesthesia, such as dexmedetomidine, as an opioid substitute. ⋯ These findings indicate that opioid-free general anesthesia based on dexmedetomidine could be effective; however, prolonged extubation time and cardiovascular complications are a few risks associated with dexmedetomidine.
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There have been no recent meta-analysis studies on specific psychological symptoms (depression and anxiety) according to the type of primary headache disorder in children and adolescents. ⋯ Depression is more associated with migraine; whereas, anxiety is more associated with TTH than healthy controls. Therefore, the screening and assessment of psychological symptoms should be performed in children and adolescents with primary headache disorders.