Pain physician
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Randomized Controlled Trial Comparative Study
Interlaminar versus transforaminal epidural steroids for the treatment of subacute lumbar radicular pain: a randomized, blinded, prospective outcome study.
There is uncertainty in the literature over the relative effectiveness of lumbar epidural interlaminar (IL) steroid injection versus transforaminal (TF) steroid injection for lumbar radiculopathy. Most studies to date have been retrospective, or technically focused. ⋯ Results suggest that patients may experience greater subjective relief, at least initially, from TF epidural steroid injections over IL. However, more objective, and likely subacute, therapeutic effects are similar.
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Comparative Study Clinical Trial
An analysis of reasons for failed back surgery syndrome and partial results after different types of surgical lumbar nerve root decompression.
Despite the evident progress in treating vertebral column degenerative diseases, the rate of a so-called "failed back surgery syndrome" associated with pain and disability remains relatively high. However, this term has an imprecise definition and includes several different morbid conditions following spinal surgery, not all of which directly illustrate the efficacy of the applied technology; furthermore, some of them could even be irrelevant. ⋯ The results of our study show that an analysis of the reasons for failures and partial effects of applied interventions for nerve root decompression may help to understand better the efficacy of the interventions and could be helpful in improving surgical strategies, otherwise the validity of the conclusion could be limited because not all sources of residual pain illustrate the applied technology efficacy. In the majority of cases, the cause of the residual or recurrent pain can be identified, and this may open new possibilities to improve the condition of patients presenting with failed back surgery syndrome.
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Adhesive capsulitis is a common but poorly understood disorder of the shoulder. Various treatments have been developed to manage this condition, but the efficacy of these treatments is controversial. We developed an ultrasound-guided, minimally invasive interventional technique to manage adhesive capsulitis of the shoulder using a specially designed needle. ⋯ Ultrasound-guided interventional release of the rotator interval and posteroinferior capsule appears to have clinical significance in the management of adhesive capsulitis of the shoulder.
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Spinal cord stimulation (SCS) is an established treatment option for chronic pain. Prior to permanent implantation, temporary trials are performed to evaluate the SCS treatment. Currently there are multiple manufacturers with varying fundamental differences in delivery and resultant paresthesias. However, trials are typically limited to one manufacturer for the patient to evaluate. ⋯ The OMG Connector offers patients another opportunity to better access the available treatment options during the SCS trial period.
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Comparative Study
Rates of lead migration and stimulation loss in spinal cord stimulation: a retrospective comparison of laminotomy versus percutaneous implantation.
Neuromodulation has been used to treat neuropathic pain. Leads have been implanted using laminotomy or percutaneous approaches. Laminotomy implantation has been shown to be superior in terms of lead migration when compared to percutaneous implantation. Lead migration has been reported as high as 68% with the percutaneous approach. Because of this, newer anchors have been developed but not tested in vivo. ⋯ Rates of stimulation loss and radiographic lead migration are similar for both laminotomy and percutaneous implantation. Time to loss of stimulation was not statistically different in either group, although there was a trend toward laminotomy leads migrating earlier. Lead type and laterality of symptoms do not affect lead migration rates. The effect of the level of implant and diagnosis was indeterminate.