Pain practice : the official journal of World Institute of Pain
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Pain from the cervical facet joints, either due to degenerative conditions or due to whiplash-related trauma, is very common in the general population. Here, we provide an overview of the literature on the diagnosis and treatment of cervical facet-related pain with special emphasis on interventional treatment techniques. ⋯ Cervical facet pain is diagnosed based on history, physical examination, and a diagnostic block of the medial branches innervating the painful joints. Conservative management, including exercise therapy, is the first line of treatment. When conservative management does not result in adequate improvement of pain, radiofrequency treatment of the medial branches should be considered, which often results in adequate pain relief.
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In the last 20 years, we have seen the flourishing of multiple treatments targeting the dorsal root ganglion (DRG) for pain. However, there is concern regarding the variation in the location of the DRG, which could influence the long-term clinical outcomes. The aim of this work was to determine the exact position of the DRG in the spine and propose a pre-surgical planning. ⋯ Percutaneous treatments for chronic pain directed at the DRG are effective. Clinical outcomes depend of good preoperative planning that allows for optimizing its effects. We propose a DRG morphology evaluation scale useful for the planning process prior to any treatment directed at the ganglion.
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Review Meta Analysis
Semi-invasive therapies for pain in knee osteoarthritis: A systematic review and network meta-analysis.
The increasing number of semi-invasive pain therapies in knee osteoarthritis poses challenges in decision-making. This review aimed to simultaneously compare established intra-articular therapies with newer peri-articular therapies and explore effect modifiers. ⋯ Although there is robust evidence suggesting greater efficacy of PRP, potentially including biologics, over other interventions, future research is needed to identify the phenotype or patient subgroup that would benefit most from PRP.
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Review Meta Analysis
Semi-invasive therapies for pain in knee osteoarthritis: A systematic review and network meta-analysis.
The increasing number of semi-invasive pain therapies in knee osteoarthritis poses challenges in decision-making. This review aimed to simultaneously compare established intra-articular therapies with newer peri-articular therapies and explore effect modifiers. ⋯ Although there is robust evidence suggesting greater efficacy of PRP, potentially including biologics, over other interventions, future research is needed to identify the phenotype or patient subgroup that would benefit most from PRP.
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Chronic knee pain is defined as pain that persists or recurs over 3 months. The most common is degenerative osteoarthritis (OA). This review represents a comprehensive description of the pathology, diagnosis, and treatment of OA of the knee. ⋯ When conservative measures fail to provide satisfactory pain relief, a multidisciplinary approach is recommended including psychological therapy, integrative treatments, and procedural options such as intra-articular injections, radiofrequency ablation, and surgery.