Pain physician最新文献

{"title":"Neuropsychiatric Side Effects After Lumbosacral Epidural Steroid Injections: A Prospective Cohort Study.","authors":"Suzanna Shermon, John Maclean, Richard Shim, Chong H Kim","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Background: </strong>The central nervous system contains steroid receptors, particularly in the hypothalamic and limbic systems. These systems are responsible for driving certain emotions in humans, especially stress, anxiety, motivation, energy levels, and mood. Thus, corticosteroids may precipitate patients to experience these emotions. Most existing studies report neuropsychiatric side effects after oral or intravenous corticosteroids rather than epidural.</p><p><strong>Objectives: </strong>This study examines the neuropsychiatric side effects after epidural steroid injections (ESIs), with a focus on whether certain factors in patients' histories further exacerbate symptomatology.</p><p><strong>Study design: </strong>Prospective observational cohort study.</p><p><strong>Setting: </strong>Fluoroscopy suite at an urban academic teaching hospital.</p><p><strong>Methods: </strong>Patients were called 24 hours and one week after their ESIs and asked if they experienced certain neuropsychiatric symptoms more than usual compared to baseline.</p><p><strong>Patients: </strong>Seventy-four patients undergoing a lumbosacral ESI (interlaminar (ILESI), caudal or transforaminal (TFESI)) were invited to take part in the study the day of his or her procedure.</p><p><strong>Intervention/measurement: </strong>Assessed whether psychiatric history, gender, race, type of ESI, or the number of levels injected affected frequency and duration of neuropsychiatric symptoms at one day and one week after an ESI.</p><p><strong>Results: </strong>Significantly (P < 0.05) more patients with a psychiatric history experienced restlessness and irritability at day one than those without a psychiatric history. At week one, male gender (IRR 2.29, 95% CI 1.37, 3.83, P = 0.002), ILESI (IRR 7.75, 95% CI 1.03, 58.6, P = 0.047), and 2-level injections (IRR 2.14, 95% CI 1.13, 4.06, P = 0.019) were significantly associated to more total symptoms.</p><p><strong>Limitations: </strong>Single center study, reliance on subjective responses from patients, lack of follow-up after one week post-ESI.</p><p><strong>Conclusion(s): </strong>This study demonstrates that neuropsychiatric symptoms are rare overall after an ESI, though certain factors may influence patients experiencing these symptoms. Restlessness and irritability were more likely to occur one day after an ESI in those with a psychiatric history. Those who had a 2-level injection were more likely to keep experiencing most symptoms by week one, suggesting a possible correlation between corticosteroid dose and neuropsychiatric symptoms.</p>","PeriodicalId":19841,"journal":{"name":"Pain physician","volume":null,"pages":null},"PeriodicalIF":3.7,"publicationDate":"2024-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140175938","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effectiveness of Radiofrequency Ablation for Treatment of Glossopharyngeal Neuralgia: A Systematic Review of the Current Literature.","authors":"Kenny Do, Eric Kawana, Vladislav Zhitny, Michael C Wajda, Shengping Zou, Jenifer Do, Navdeep Singh, Valeryia Pratasava, Harsha Dannapaneni, Rae Stewart, Ryan T Gualtier","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Background: </strong>Glossopharyngeal neuralgia (GPN) is a rare cause of facial pain that has an incidence of less than one per 100,000 people. The excruciating stabbing pain experienced by patients with GPN can be debilitating, leading to difficulties in activities of daily living, such as eating and speaking. As a result, there has been a recent increase in research on the effectiveness of radiofrequency ablation (RFA) for treating GPN.</p><p><strong>Objective: </strong>The objective of our study was to evaluate the effectiveness of (RFA for treating GPN while examining its impact on patients' quality of life and assesses for any associated side effects.</p><p><strong>Study design: </strong>The Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) model was employed to identify articles from 2 comprehensive medical databases. The patient outcomes and numbers from each article were aggregated and calculated in order to determine the percent efficacy of RFA for treating pain associated with GPN.</p><p><strong>Methods: </strong>In this systematic review, the PRISMA review model was utilized to search through the PubMed and EMBASE databases. A comprehensive literature review was conducted. Of the initial 1,580 articles identified, 18 articles were included for analysis. Studies included in this systematic review encompassed idiopathic cases and secondary causes, such as an elongated styloid process, oropharyngeal cancers, and postsurgical/traumatic pain.</p><p><strong>Results: </strong>Of the 288 patients treated with RFA, 231 experienced relief or complete resolution of pain, yielding an efficacy rate of 80.2%. Most of the patients experienced immediate pain relief after RFA; however, some patients reported numbness, dysphagia, and changes in taste. Our study examines the potential use of RFA as a minimally invasive and effective treatment for GPN.</p><p><strong>Limitations: </strong>Limitations of our study include the absence of comparisons between different types, modes, and settings of RFA procedures. The use of only 2 medical databases is another limitation. Finally, our systematic review does not include any randomized controlled trials.</p><p><strong>Conclusion: </strong>RFA is efficacious in treating GPN with over 80% of patients experiencing postprocedure pain relief. However, further research in the form of clinical and controlled trials is needed to contribute to a better understanding of RFA's long-term outcomes for patients with GPN.</p>","PeriodicalId":19841,"journal":{"name":"Pain physician","volume":null,"pages":null},"PeriodicalIF":2.6,"publicationDate":"2024-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140175935","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comment on \"Associations Between Headache (Migraine and Tension-Type Headache) and Psychological Symptoms (Depression and Anxiety) in Pediatrics\".","authors":"I-Wen Chen, Wei-Ting Wang, Kuo-Chuan Hung","doi":"","DOIUrl":"","url":null,"abstract":"","PeriodicalId":19841,"journal":{"name":"Pain physician","volume":null,"pages":null},"PeriodicalIF":3.7,"publicationDate":"2024-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140175929","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Demographics and PainDETECT as Predictors of 24-Month Outcomes for 10 kHz SCS in Nonsurgical Refractory Back Pain.","authors":"Leonardo Kapural, Chengyuan Wu, Aaron Calodney, Julie Pilitsis, Markus Bendel, Erika Petersen, Dawood Sayed, Colleen Kelly, Rose Province-Azalde, Naresh P Patel","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Background: </strong>Nonsurgical refractory back pain (NSRBP) is broadly defined as chronic refractory back pain in patients who have not had previous spine surgery and, because they are deemed inappropriate candidates for surgery, are reliant on conventional medical management (CMM), which often provides poor long-term outcomes. High-frequency spinal cord stimulation (10kHz SCS) has demonstrated high rates of pain relief and improvements in functioning in patients with NSRBP. However, despite the use of temporary trial stimulation to select patients who will respond to therapy, some patients fail to achieve long-term therapy response with permanent implants. Prediction analysis founded on patients' baseline characteristics may enrich the appropriate selection of patients for permanent implantation.</p><p><strong>Objectives: </strong>To examine baseline patient characteristics to predict long-term pain and functional responses to treatment with 10 kHz SCS for NSRBP.</p><p><strong>Study design: </strong>A retrospective analysis of baseline patient characteristics as predictors of 24-month pain and functional outcomes from a previous multicenter randomized controlled trial of 10 kHz SCS in patients with NSRBP.</p><p><strong>Patients: </strong>Patients diagnosed with chronic, neuropathic, axial, low back pain refractory to CMM who had had no previous spine surgery, were deemed unsuitable candidates for it according to a spine surgeon, were implanted with 10kHz SCS and continued with CMM for up to 24 months.</p><p><strong>Methods: </strong>The baseline characteristics of and 24-month outcomes in the 125 implanted patients who participated in the NSRBP randomized controlled trial (RCT) were included in this analysis. The baseline characteristics included demographics, baseline pain on the visual analog scale (VAS), baseline function based on the Oswestry Disability Index (ODI), mental health according to the patient health questionnaire-9 (PHQ-9), neuropathic pain as measured by PainDETECT, and each patient's temporary trial response. Patient response at 24 months was defined as absolute change from the baseline on the VAS and ODI, and each patient was also classified as a pain responder (achieving at least a 50% decrease in VAS pain score from the baseline) and a function responder (at least a 10-point decrease in ODI or a 24-month score of no more than 20 points). Multivariate prediction models based on regression and classification and regression tree (CART) techniques were developed using the response variables discussed above as the dependent variables and the baseline characteristics as the independent variables.</p><p><strong>Results: </strong>Different factors contributed to pain and functional outcomes. Patients presenting with neuropathic pain (PainDETECT >= 19) and female gender had higher odds of being pain responders to 10 kHz SCS therapy than did males and those without neuropathic pain. Both higher age and depression score (P","PeriodicalId":19841,"journal":{"name":"Pain physician","volume":null,"pages":null},"PeriodicalIF":3.7,"publicationDate":"2024-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140175933","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evaluation and Treatment of Sacroiliac Joint Pain in Patients with History of Vertebral Compression Fractures: A Retrospective Case Series.","authors":"Ibrahim M Umer, Christopher Gharibo, Sudhir Diwan, Steve M Aydin","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Background: </strong>Vertebral compression fractures (VCFs) can affect the entire spinopelvic complex and cause unpredictable patterns of back pain due to their effects on spinal tensegrity and biomechanical compensation. They can lead to significant morbidity and mortality in the aging population and are difficult to diagnose. We aimed to establish a relationship between VCFs and sacroiliac (SI) joint pain.</p><p><strong>Objectives: </strong>Demonstration of SI joint (SIJ) pain relief at up to 6 months after kyphoplasty (KP) in patients with VCFs and diagnosed SI dysfunction.</p><p><strong>Study design: </strong>Retrospective study.</p><p><strong>Setting: </strong>All patients were from a private chronic pain and orthopedics practice in the northeastern United States.</p><p><strong>Methods: </strong>Fifty-one patients with VCFs diagnosed through imaging and SIJ dysfunction diagnosed through 2 diagnostic SIJ blocks who had failed conservative management were considered for KP. Numeric Rating Scale (NRS 11) scores were recorded at the baseline, after each SIJ block, and at 4 weeks and then 6 months after KP.</p><p><strong>Results: </strong>Forty-nine patients underwent KP. At 4 weeks after the procedure, there was an 84% average reduction in NRS scores from the baseline (P < 0.01). At 6 months after the procedure, there was an 80% reduction in NRS scores from the baseline (P < 0.01).</p><p><strong>Limitations: </strong>Larger sample sizes and a randomized control trial would be important steps in furthering the relationship between VCFs and SIJ.</p><p><strong>Conclusion: </strong>VCFs can cause a referred pain pattern to the SIJ that is best treated by KP for long-term management.</p>","PeriodicalId":19841,"journal":{"name":"Pain physician","volume":null,"pages":null},"PeriodicalIF":3.7,"publicationDate":"2024-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140175936","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Pulsed Radiofrequency Therapy at Different Voltages on Dorsal Root Ganglia Using Multifunctional Catheter to Treat Low Back Pain: A Comparative Retrospective Study.","authors":"Dolores Rufolo, Carmelo Attilio Costa, Giulia Bravo, Paola Nosella","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Background: </strong>Applying pulsed radiofrequency (PRF) to the dorsal root ganglion (DRG) is an electrical neuromodulation technique, a valid complementary therapeutic treatment for failed back surgery syndrome (FBBS). Peridurolysis, when applied to vertebral canal adhesions, can be performed with dedicated catheters, providing patients with the benefits of mechanical, electrical, and pharmacological techniques.</p><p><strong>Objectives: </strong>The aim of this study was to evaluate PRF's effects on the DRG as part of FBSS treatment at different follow-up times, comparing 2 groups of patients exposed to distinct levels of voltage (100 V vs. 45 V) from a PRF generator.</p><p><strong>Study design: </strong>A retrospective observational study was performed.</p><p><strong>Setting: </strong>The study was conducted on a sample of patients from an Italian hospital.</p><p><strong>Methods: </strong>PRF's effects on the DRG as part of FBSS treatment were evaluated through the Numeric Rating Scale (NRS) and the monitoring of 155 patients' opioid consumption at 3, 6, and 9 months. A Cosman® G4 model PRF generator was used. During follow-up periods, the Friedman test was applied to detect differences in outcomes between the 2 groups of patients, who were treated with different levels of voltage.</p><p><strong>Results: </strong>The most frequent diagnosis (61.29%) was FBBS in patients at a mean age of 64 (± 11.8) years old. All patients were treated with PRF on the dorsal ganglion, with the addition of a drug mixture. Most were treated with 100 V (62%). A statistically significant decrease (P < 0.001) in the NRS score emerged both as a whole and in the 2 distinct groups. Moreover, the group of 100 V patients showed a significant (P = 0.0360) reduction in the use of opioids.</p><p><strong>Limitations: </strong>This observational retrospective study was based on a convenience sampling that involved a limited number of patients.</p><p><strong>Conclusions: </strong>E-field technology is the only way to generate a constant 38°/42° PRF and 100 V level throughout surgical interventions (respecting the exposure times \"set\" by the operator). The patient will not feel any pain or electric current because the generated milliamperes will be greatly reduced.</p>","PeriodicalId":19841,"journal":{"name":"Pain physician","volume":null,"pages":null},"PeriodicalIF":3.7,"publicationDate":"2024-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140175871","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Do Patients Accurately Recall Pain Levels Following Sacroiliac Joint Steroid Injection? A Cohort Study of Recall Bias in Patient-reported Outcomes.","authors":"Davin C Gong, Aditya Muralidharan, Bilal B Butt, Ronald Wasserman, Joshua D Piche, Rakesh D Patel, Ilyas Aleem","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Background: </strong>Sacroiliac joint (SIJ) injections are crucial in the diagnostic toolkit for evaluating SIJ pathology. Recall bias is an important component in patient-reported outcomes that has not been well studied in SIJ injection.</p><p><strong>Objective: </strong>The purpose of this study was to characterize the accuracy, direction, and magnitude of pain level recall bias following SIJ steroid injection and study the factors that affect patient recollection.</p><p><strong>Study design: </strong>Prospective cohort study.</p><p><strong>Setting: </strong>Level 1 academic medical center.</p><p><strong>Methods: </strong>Using standardized questionnaires, baseline Numeric Rating Scale (NRS-11) scores were recorded for patients undergoing SIJ steroid injections at preinjection, at 4 hours postinjection, and at 24 hours postinjection. At a minimum of 2 weeks postinjection, patients were asked to recall their preinjection, 4-hour, and 24-hour postinjection NRS-11 scores. Actual and recalled NRS-11 scores were compared using paired t tests for each time interval. Multivariable linear regression was used to identify factors that correlated with consistent recall.</p><p><strong>Results: </strong>Sixty patients with a mean age of 66 years (65% women) were included. Compared to their preinjection pain score, patients showed considerable improvement at both 4 hours (mean difference [MD] = 3.28; 95% CI, 2.68 - 3.89), and 24 hours (MD = 3.23; 95% CI, 2.44 - 4.03) postinjection. Patient recollection of preinjection symptoms was more severe than actual (MD = 0.65; 95% CI, 0.31 - 0.99). Patient recollection of symptoms was also more severe than actual at 4 hours (MD = 0.50; 95% CI .04 - 1.04) as well as at 24 hours postinjection (MD = 0.80; 95% CI, 0.16 - 1.44). The magnitude of recall bias was mild and did not exceed the minimal clinically important difference. There was a moderate correlation between actual and recalled pain levels when comparing preinjection with the 4-hour postinjection NRS-11 score (correlation coefficient [r] =0.64; P < 0.001) and moderate correlation when comparing preinjection with the 24-hour postinjection NRS-11 score (r = 0.62; P < 0.001). Linear regression models showed that at preinjection, patients with a lower body mass index and the presence of coexisting psychiatric diagnoses were better at recalling their pain (P < 0.05). Patients with a higher body mass index also experienced less pain relief when comparing preinjection with the 4-hour postinjection NRS-11 score (P < 0.05).</p><p><strong>Limitations: </strong>Recall pain scores were obtained via telephone surveys, which can lead to interview bias. One patient died, and 3 were lost to follow-up. We did not control for patient use of adjunctive pain relief modalities, which may modulate the overall response to injection. SIJ injections can also be diagnostic, so some patients may not have shared the same indication for injection or pain-generating diagnosis.</p><","PeriodicalId":19841,"journal":{"name":"Pain physician","volume":null,"pages":null},"PeriodicalIF":3.7,"publicationDate":"2024-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140175934","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Balloon Pressure and Clinical Effectiveness of Percutaneous Microballoon Compression in the Treatment of Primary Trigeminal Neuralgia.","authors":"Yingqian Peng, Cong Zou, Yonglin Li, Qing Li, Hui Long, Wuzhou Yang, Zhenping Xiao, Liping Jiang, Wei Gao, Yunwu He","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Background: </strong>Primary trigeminal neuralgia (PTN) is a type of chronic neuropathic pain disorder caused by neurovascular compression. Percutaneous balloon compression (PBC) is a widely used method for the treatment of PTN.</p><p><strong>Objectives: </strong>To examine the correlation of balloon pressure (BP) during percutaneous microballoon compression (PBC) with postoperative pain relief and complications in the treatment of primary trigeminal neuralgia (PTN).</p><p><strong>Study design: </strong>Forty-five patients diagnosed with PTN and treated with PBC were recruited. The BP was recorded at 2 time points: when the balloon achieved the ideal pear shape (initial BP [IBP]) and when the pressure was maintained for 2 min (final BP [FBP]).</p><p><strong>Setting: </strong>This study was conducted at the Department of Pain and Rehabilitation of the Second Affiliated Hospital at the University of South China in Hunan, China.</p><p><strong>Methods: </strong>The patients' Barrow Neurological Institute (BNI) pain intensity score, BNI facial numbness score, masticatory muscle weakness score, and recurrence were recorded before and after surgery. The receiver operating characteristic (ROC) curves were generated for the IBP to predict treatment effectiveness, severe facial numbness, and severe masticatory muscle weakness.</p><p><strong>Results: </strong>The BNI pain intensity score, BNI facial numbness score, and masticatory muscle weakness score were significantly decreased after surgery (all P < 0.001). IBP was positively correlated with the difference between IBP and FBP (P < 0.01). Both IBP and the difference between IBP and FBP were negatively correlated with the BNI pain intensity score and positively correlated with the BNI facial numbness score and masticatory muscle weakness score (P < 0.01). The IBP and the difference between the IBP and FBP were significantly lower in patients experiencing recurrence than in the nonrecurrent group (P < 0.05). The areas under the ROC curves of the IBP for predicting effective pain relief, severe facial numbness, and severe masticatory muscle weakness were 0.875, 0.980, and 0.988, respectively.</p><p><strong>Limitations: </strong>The sample size was relatively small, and the follow-up time was short. The correlations between the BP and other factors, such as filling amount, Meckel's cavity, and the size of the foramen ovale, were not investigated. The impact of the BP on long-term postoperative outcomes was not explored.</p><p><strong>Conclusions: </strong>An intraoperative BP of 138.65-153.90 KPa can be maintained for effective PBC treatment without causing serious complications.</p>","PeriodicalId":19841,"journal":{"name":"Pain physician","volume":null,"pages":null},"PeriodicalIF":3.7,"publicationDate":"2024-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140175927","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cervical Nerve Root Block Using a Curved Blunt Needle and Posterior Approach.","authors":"Carl Noe, Michael van Hal, Standiford Helm Ii, Gabor B Racz","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Background: </strong>Cervical transforaminal epidural steroid injections have become less popular due to the risk of catastrophic complications they pose. However, cervical nerve root blocks are useful for surgical planning in patients with cervical radicular pain syndromes.</p><p><strong>Objectives: </strong>Our aim was to find a method of performing cervical selective nerve root blocks that removed the risk of catastrophic complications.</p><p><strong>Study design: </strong>Retrospective case review.</p><p><strong>Setting: </strong>Academic multidisciplinary spine center.</p><p><strong>Methods: </strong>Among patients, 50 consecutive cases were retrospectively reviewed for immediate pain scores and follow-up results. In the intervention, a posterior approach using a curved blunt needle was employed for cervical selective nerve root blocks to minimize the risk of arterial injection. To measure the outcomes, we used quantitative pain severity scores and qualitative responses.</p><p><strong>Results: </strong>This technique detailed in this study has a high immediate analgesic effect that can be used for diagnostic purposes. It is not known if this technique has prognostic value with respect to surgery. The prolonged response rate is about 50%, which is in line with other techniques.</p><p><strong>Limitations: </strong>This study had no control group.</p><p><strong>Conclusion(s): </strong>Cervical selective nerve root blocks using a curved blunt needle and a posterior approach are effective in selectively identifying nerves that cause clinical symptoms. This technique minimizes the risk of arterial or spinal cord impingement and therefore may be safer than transforaminal selective nerve root blocks.</p>","PeriodicalId":19841,"journal":{"name":"Pain physician","volume":null,"pages":null},"PeriodicalIF":3.7,"publicationDate":"2024-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140175928","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Unilateral or Bilateral Percutaneous Endoscopic Debridement and Drainage for Thoracolumbar Infections: A Systemic Review and Meta-analysis.","authors":"Yi Mao, Junchao Zhang, Yunzhong Zhan, Zhou Ye","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Background: </strong>Unilateral percutaneous endoscopic debridement and drainage (UPEDD) and bilateral PEDD (BPEDD) are commonly implemented, and have consistently yielded favorable clinical outcomes. Nevertheless, there is a scarcity of literature contrasting the advantages and disadvantages between these 2 procedures.</p><p><strong>Objective: </strong>The goal of this research was to conduct a meta-analysis to compare the clinical effects of UPEDD and BPEDD.</p><p><strong>Study design: </strong>A systematic review and meta-analysis.</p><p><strong>Methods: </strong>A systematic review of studies reporting outcomes following UPEDD and/or BPEDD procedures was performed. The extracted data were used for meta-analysis. Pooled event rates for positive bacteria culture, pain control satisfaction, reoperation, and complications were estimated. The pooled operation time and blood loss were also calculated.</p><p><strong>Results: </strong>Among 764 retrieved articles, 28 studies with 661 patients met the inclusion criteria and were used for our meta-analysis. A total of 21 studies (462 patients) investigated UPEDD outcomes and 7 studies (199 patients) investigated BPEDD outcomes. For the UPEDD group, the pooled event rates for positive bacteria culture, pain control satisfaction, reoperation, and complications were 72%, 91%, 9% and 4%, respectively; the pooled operation time and blood loss were 89.90 minutes and 59.77 mL. For the BPEDD group, these were 79%, 92%, 4%, 8%, 93.23 minutes and 64.93 mL, respectively.</p><p><strong>Limitations: </strong>First, all included studies were retrospective series, limiting our study design to a single-arm meta-analysis. Second, there was a limited amount of studies that were determined to be fitting, particularly on BPEDD; the sample size was also small. Third, the clinical effects of UPEDD and BPEDD needed to be compared in greater detail, such as the time it took for inflammatory markers to return to normal, the incidence of local kyphosis, and whether the duration of antibiotic use could be shortened after adequate debridement with BPEDD. Lastly, further studies are necessary to compare the clinical outcome of PEDD and percutaneous endoscopic interbody debridement and fusion.</p><p><strong>Conclusions: </strong>Both UPEDD and BPEDD can provide a relatively reliable causative-pathogen identification and satisfactory clinical outcome. The 2 techniques are not significantly different in terms of positive bacteria culture rate, pain control satisfaction rate, complication rate, and reoperation rate.</p>","PeriodicalId":19841,"journal":{"name":"Pain physician","volume":null,"pages":null},"PeriodicalIF":3.7,"publicationDate":"2024-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140175873","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}