Pain practice : the official journal of World Institute of Pain
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Review Meta Analysis
Predictors of Pain Relief Following Spinal Cord Stimulation in Chronic Back and Leg Pain and Failed Back Surgery Syndrome: A Systematic Review and Meta-Regression Analysis.
We sought to assess the extent to which pain relief in chronic back and leg pain (CBLP) following spinal cord stimulation (SCS) is influenced by patient-related factors, including pain location, and technology factors. A number of electronic databases were searched with citation searching of included papers and recent systematic reviews. All study designs were included. ⋯ SCS was effective in reducing pain irrespective of the location of CBLP. This review supports SCS as an effective pain relieving treatment for CBLP with predominant leg pain with or without a prior history of back surgery. Randomized controlled trials need to confirm the effectiveness and cost-effectiveness of SCS in the CLBP population with predominant low back pain.
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To undertake a review of the most recent data on the relationship between quality of life (QoL) and chronic pain, as a basis for discussions about healthy aging in Europe. ⋯ There is strong evidence of a correlation between pain severity and QoL. There is some evidence that treatment in chronic pain patients can reduce pain and simultaneously improve QoL. Prevention and treatment of chronic pain may be of significant help in reaching the aim to increase the healthy lifespan.
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Observational Study
Lumbosacral Epiduroscopy Findings Predict Treatment Outcome.
The aim of this study was to evaluate the significance of diagnostic markers obtained through epiduroscopy by evaluating the accuracy of outcome prediction after treatment of epidural pathology using epiduroscopy. ⋯ Our results show that lumbosacral epiduroscopy predicts outcome of treatment accurately in the majority of patients. This suggests that information obtained through epiduroscopy may carry significant diagnostic and prognostic value.
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Radiofrequency ablation of medial branch nerves is considered a safe and effective treatment for chronic facet joint pain in the cervical, thoracic, and lumbosacral spine. Cooled radiofrequency ablation (C-RFA) is gaining popularity over conventional thermal radiofrequency ablation (RFA) in pain management. However, complications of C-RFA have not been reported in the literature. ⋯ With C-RFA, internally cooled electrodes are capable of creating large volume spherical lesions, a size advantage over conventional RFA. Although C-RFA lesion size may overcome the anatomic variability of target nerve location and potentially improve pain outcomes, added vigilance is required in thin patients and in anatomic regions of minimal subcutaneous tissue between the lesion target and the dermis. Skin burns at the site of the RF electrode are a potential risk under such conditions.
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Intrathecal drug delivery systems (IDDSs) are used to treat resistant pain states as well as intractable spasticity via medication delivery into the spinal fluid. Risks associated with implantation of these devices include infection, bleeding, intrathecal granuloma formation, and neurologic sequelae similar to other neuraxial procedures. Intrathecal catheter placement creates the additional risk of persistent spinal fluid leak, which can lead to postdural puncture headaches as well as seroma formation and may require subsequent surgical exploration or explantation. ⋯ The second patient received an IDDS and did well until a seroma developed 1 year later. He was likewise treated with an epidural fibrin glue patch after 2 failed blood patches. In a third patient, a spinal fluid leak developed after explantation of an IDDS and was treated with an epidural fibrin glue patch as initial therapy.