Articles: spinal-nerves.
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Curr Pain Headache Rep · Apr 2013
ReviewOccipital injections for trigemino-autonomic cephalalgias: evidence and uncertainties.
Cluster headache is a debilitating disorder. Oral prophylactic treatments may act with a significant delay, cause side effects, or fail to control the attacks. Injections targeting the occipital nerve have raised interest for the management of CH. ⋯ Occipital injections provide a rapid benefit on the frequency of attacks and can be used as an adjunct to an oral prophylactic for a quicker improvement. Whether or not this approach can be used without any oral prophylaxis is still to be determined. The technique is easy to master, has a low cost, and should be learned by physicians involved in CH management.
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Acta Anaesthesiol Scand · Mar 2013
ReviewNew hypothesis of chronic back pain: low pH promotes nerve ingrowth into damaged intervertebral disks.
The pathogenesis of low back pain is still elusive. Here, we proposed a new hypothesis that low pH is a possible cause of the development and progression of low back pain. ⋯ The inflammation response, evoked by the dorsal root ganglia, changes the delicate nutrient balance in the nucleus, resulting in a vicious cycle and leading to choronic back pain. Our hypothesis may explain many of the available clinical and experimental data on low back pain, thus it may help elucidate the pathogenesis of low back pain and improve clinical management.
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Occipital nerve stimulation may be effective for primary headache disorders. Four studies, including two double-blind show, stimulation-controlled studies that were performed for chronic migraine showed evidence of benefit. ⋯ In chronic cluster headache, several case series have shown improvement, which, combined with the safety of occipital nerve stimulation relative to deep brain stimulation, have led to published reports supporting this as the preferred surgical technique for chronic cluster headache. A few case reports suggest a possible benefit in short-lasting unilateral neuralgiform headache attacks with conjunctival injection tearing and short-lasting unilateral neuralgiform headache.
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Review Case Reports
Updated perspectives on occipital nerve stimulator lead migration: case report and literature review.
Patients with occipital neuralgia are often refractory to or intolerant of standard pharmacological and interventional management strategies. Although occipital nerve stimulation (ONS) may provide a unique alternative for such cases, a steep technical learning curve still exists. Lead migration (LM) is among the most challenging issues facing implanters performing ONS implantation. We present an unusual case of LM after ONS implantation and discuss technical aspects for successful revision. ⋯ In an era in which reducing health care expenditures is becoming increasingly important, current complication rates could curtail future acceptance and utilization of ONS. This fact and our case report underscore the importance of a continued drive toward technical advances and a reduction in complications associated with this important treatment modality. Further prospective investigation into the mechanism of action, mechanism of complications, optimization of surgical techniques, and long-term efficacy is warranted.
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To review the duration of pain relief after initial and repeated radiofrequency neurotomy (RFN) for cervical and lumbar zygapophysial joint pain. ⋯ The results of this review indicate that pain relief after initial RFN generally ends after 7-9 months and that repeating RFN is likely to provide additional pain relief if initial RFN was successful. Results are similar between cervical and lumbar spine studies.