Pain physician
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Serum 25-hydroxyvitamin D (25[OH]D) deficiency causes osteoporosis and increases muscle weakness, which worsens the risk of falls and osteoporotic vertebral fractures. However, the effect of a lower serum 25(OH)D level on new vertebral fractures, including osteoporotic vertebral refractures and cascade vertebral fractures post percutaneous vertebral augmentation in patients during postmenopause has not been reported. ⋯ A low serum 25(OH)D level is an independent risk factor for new vertebral fractures after percutaneous vertebral augmentation in patients during postmenopause. Appropriate active vitamin D supplementation following percutaneous vertebral augmentation surgery can effectively mitigate the risk of subsequent osteoporotic vertebral fractures.
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Observational Study
The Long-term Outcome of Usual and Unusual Indications for Spinal Cord Stimulation: A Prospective Study.
Evidence of the efficacy of spinal cord stimulation (SCS) has been well demonstrated as a method of pain control for patients who exhibit failed back surgery syndrome (FBSS), complex regional pain syndrome (CRPS), and inoperable peripheral vascular diseases (PVD) ("usual indications"). However, a long-term study comparing the usual indications for which SCS is employed with those of other intractable painful conditions is still lacking. ⋯ Overall, SCS is an effective long-term treatment for chronic refractory pain. However, patients with usual indications for SCS have a higher success rate in SCS trials and a trend toward better outcomes after SCS implantation than do patients with unusual indications.
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Chronic low back pain is a global health burden with significant health care costs. Accurate diagnosis and treatment are often complicated due to its multifactorial nature. The sacroiliac joint has been identified as a major source of lower back pain, especially among the elderly and individuals with a history of lumbar fusion surgery. Conservative treatments frequently fall short in providing relief, leading to the exploration of alternative interventions such as sacroiliac joint radiofrequency ablation (RFA). ⋯ Adipose interference is minimized when a protruding electrode RFA needle is used within a posterior sacral foramen; neural approximation may be enhanced by giving 2% lidocaine prior to ablation. Considerable gaps in knowledge still exist despite advances in our understanding of the effect of tissue on RFA. Thorough research aimed at refining RFA procedures is essential to ensuring the best feasible patient care and sustainable pain relief. For sacroiliac joint RFA, perineural lateral branch ablation is a viable option that needs further clinical research.
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Guidelines on the use of opioids in chronic pain management increasingly recommend consideration of buprenorphine for patients on long-term full agonist opioid therapy. Published strategies for patients' transitions to buprenorphine vary widely in terms of study design, dose, formulation, and timing of buprenorphine initiation. A further limitation in informing an ideal transition strategy is the paucity of data describing factors that influence the likelihood of a successful transition. ⋯ Our findings support the recommendation to trial buprenorphine in patients receiving chronic opioid therapy. This study's results also suggest that patient factors and shared decision-making are more important predictors of success than are the pharmacologic properties, potency, or dose of pre-rotation opioid exposure.
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Chronic low back and lower limb pain occurs in 13% of Americans, and is the leading cause of disability. Patients with this condition have a reduced quality of life, have mental health disorders, and cognitive disfunction. While back pain alone is difficult to manage, back pain with associated leg pain results in further reduced outcomes. Spinal cord stimulation (SCS) is a minimally invasive therapy that has been used for a variety of chronic pain disorders when conservative management strategies have failed. The therapy is appealing because of its ability to provide long-term relief at a reduced cost and it has low rates of serious adverse events. ⋯ The Freedom SCS System is an effective and safe therapy for treating patients with chronic back and leg pain that is resistant to conservative therapy due to nerve compression and CRPS Type I and/or II. These types of patients often report aggravation of symptoms with surgery. Minimal invasive surgery should decrease the chance of extra symptoms.