Pain physician
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Observational Study
A Novel Ultrasonographic Method to Quickly and Accurately Access the C2 Dorsal Root Ganglion.
Occipital neuralgia manifests as pain in the cutaneous distribution of occipital nerves, with the greater occipital nerve stemming from the C2 spinal nerve and the lesser occipital nerve originating from the C2 and C3 spinal nerves. While pulsed radiofrequency ablation of the C2 dorsal root ganglion (DRG) is an effective treatment for refractory occipital neuralgia, accessing the C2 DRG remains a clinical challenge even under fluoroscopic guidance. ⋯ We have developed an ultrasonographic method to quickly and accurately access the C2 DRG, which has the potential to greatly facilitate treating the C2 DRG for managing occipital neuralgia.
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Persistent Spinal Pain Syndrome Type II (PSPS II) is a major health concern in patients undergoing spinal surgery. However, there are little data on the prevalence and risk factors of PSPS II post spinal surgery. ⋯ This population-based cohort analysis found a 25.6% prevalence of PSPS II within one year post spinal surgery and 31.5% within two years post spinal surgery. Identified risk factors include old age, being a woman, economic poverty, comorbid status, underlying disability, type of surgery, and lumbar-level surgery. A large dataset was used to document the prevalence and risk factors for PSPS II post spinal surgery.
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Observational Study
Percutaneous Endoscopic Resection of Lumbar Discal Cyst.
Discal cysts, an uncommon condition, can replicate the characteristic signs typically linked to a herniated lumbar disc, encompassing discomfort in the lumbar region and neuralgia that extends along the nerve paths, thereby complicating the process of distinguishing the discal cyst from other conditions. Consensus on the treatment of this disease remains elusive, and the best treatment for it is still a matter of controversy. In numerous past reports, this disease has been treated through either open or microscopic surgical approaches. ⋯ Percutaneous endoscopic resection emerged as a micro-invasive and secure surgical approach for the management of lumbar discal cysts.
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The neurolytic celiac plexus block (NCPB) can be introduced through the posterior para-aortic, anterior para-aortic, posterior transaortic, or endoscopic anterior para-aortic puncture approach, as well as the posterior approach via the intervertebral disc. To reduce the complications of puncture, this block's original manual blind puncture technique can be improved upon by using a C-arm fluoroscope, computed tomography (CT), or an ultrasound, the last of which may be endoscopic. ⋯ An NCPB that uses CT-guided double-needle puncture through the anterior and posterior diaphragmatic crura can improve absolute alcohol's ability to surround the corresponding segment of the abdominal aorta and block the greater and lesser splanchnic nerves and celiac plexus when injected. This approach to the NCPB has a better analgesic effect on patients with intractable visceral cancer pain in the upper abdominal area.
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Review Meta Analysis
The Analgesic Effectiveness of Genicular Nerve-targeted Cooled and Pulsed Radiofrequency Ablation for Osteoarthritis Knee Pain: A Systematic Review and Meta-analysis.
Radiofrequency ablation (RFA) is a form of therapy for knee osteoarthritis (OA) pain that has become more popular in recent years. In addition to standard RF approaches, there are cooled and pulsed options. RFA could be used to treat the superolateral, superomedial, and inferomedial branches of the genicular nerves. Pulsed and cooled RF ablation on the genicular nerve to treat knee OA pain, however, has not yet been shown to be effective. ⋯ At the 6-month follow-up, both cooled and pulsed RFA targeting the genicular nerve provided significant osteoarthritic pain alleviation. There is no different in pain relief between cooled and pulsed RFA targeting the genicular nerve for treating knee osteoarthritis. There was no significant functional improvement of cooled RFA in all follow-ups, but there was a significant functional improvement of pulsed RFA up to 3-month follow-up. According to our study, knee osteoarthritis pain can be efficiently treated with pulsed and cooled radiofrequency with few adverse effects.