Pain physician
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Multicenter Study
Nucleus Pulposus Allograft Supplementation in Patients with Lumbar Discogenic Pain: Initial 6-month Outcomes from a Prospective Clinical Pilot Study.
Preventing disc degeneration remains a clinical challenge; patients experiencing chronic lumbar discogenic pain have limited treatment options. Minimally invasive intradiscal procedures such as allogeneic nucleus pulposus (NP) injection have the potential to fill the treatment gap between failed conservative care and spine surgery. ⋯ These pilot findings demonstrate the feasibility of treating patients with symptomatic lumbar disc degeneration with a single intradiscal injection of allogeneic NP to provide significant and durable improvements in back function and pain.
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Fibromyalgia is a complex condition that has long puzzled the medical community. Hypotheses to explain the chronic widespread pain associated with the disease have evolved significantly over the years. However, research efforts to identify disease-specific biomarkers and develop effective treatments have been largely unsuccessful. ⋯ Fibromyalgia is likely the result of multiple causative factors, genetic and environmental. To date, no clear, reliable etiological biomarker for fibromyalgia has been identified. The considerable variability among patients suggests the presence of multiple disease subtypes with different pathophysiological mechanisms. Effective treatment therefore requires a multimodal, multidisciplinary approach that targets each individual patient's pathophysiological features. The proposed treatment paradigm attempts to address multiple factors that have been implicated more recently in the development and maintenance of fibromyalgia, such as micro-inflammation, metabolic syndrome, and gut dysbiosis.
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Randomized Controlled Trial
Dose Equivalence of Remimazolam and Propofol for Loss of Consciousness in Pediatric Patients: A Randomized Clinical Trial.
Remimazolam and propofol can be used interchangeably for general anesthesia. However, no dosing recommendations exist for the intravenous bolus administration of remimazolam during general anesthesia induction in pediatric patients. Determining the appropriate dose for anesthesia induction in pediatric patients is crucial for safe and effective surgical procedures. ⋯ Remimazolam demonstrates significantly higher sedative efficacy for pediatric patients than does propofol. An induction dose of 0.34 mg/kg-1 remimazolam could be recommended for general anesthesia induction, considering the safety and effectiveness of a 2 mg/kg-1 dose of propofol.
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Comparative Study
L5-S3 Compared to L5-S2 Full-Endoscopic Rhizotomy and Ablation Under a Navigation System for Sacroiliac Joint Pain: A Comparative Study.
Chronic low back pain (CLBP) with sacroiliac joint (SIJ) involvement is a prevalent issue in health care. Surgical intervention, employing an endoscopic technique with a navigation system, targets and ablates nociceptive nerve fibers associated with SIJ pain, although the clinical effect of omitting rhizotomy of the lateral sacral branch of S3 remains uncertain. ⋯ L5-S2 FERA demonstrated clinical outcomes similar to those of L5-S3 FERA for pain relief, functional improvement, and satisfaction. Omitting S3 lateral branch rhizotomy did not adversely affect the outcomes. Surgeons may consider omitting S3 lateral branch rhizotomy for SIJ pain treatment, thereby reducing operative time while maintaining patient benefits.
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Observational Study
Predicting Responses to Interventional Pain Management Techniques for Chronic Low Back Pain: A Single-Center Observational Study (PReTi-Back Study).
Exploring factors linked to the outcomes of certain interventional pain management techniques may optimize the selection of candidates for those procedures. Our hypothesis is that factors that influence responses to interventional therapies for chronic low back pain (CLBP) can be identified by analyzing a prospective cohort. ⋯ Patients satisfied with previously performed interventional therapies or who exhibit findings of radicular compression or listhesis on imaging show approximately twice the likelihood of experiencing a positive response to short-term IMPT than do patients without those characteristics. Patients who are obese or have PSPS-2 exhibit approximately a 50% lower likelihood of short-term response than do patients without these conditions.