Pub Date : 2007-08-01DOI: 10.1179/016911107X376927
W. Raffaeli, D. Righetti, J. Andruccioli, D. Sarti
Abstract Objectives: Periduroscopy has been re-evaluated only recently for the diagnosis, and especially the treatment, of complex rachidian pain, such as that due to the failed back surgery syndrome (FBSS). The classic periduroscopy procedure has major limitations in that it can only use liquids as a method to visualize the dura space, and cannot overcome fibrotic (partial or complete) obstructions of the channel. In order to overcome these limitations, we added two modifications to the classic procedure – the Raffaeli–Righetti technique. Patients and methods: A Fogarty balloon was used to clean the channel. This tool has allowed reduction by 50% of the volume of fluid used in the periduroscopy. The second innovation involves the use of the resaflex for the lysis of channel obstructions (fat and/or fibrotic tissues), which allows reaching the site of pain origin and improving the efficiency of the periduroscopy by 30%. The resaflex uses an electric wave to lyse tender tissues (lysing and coagulating at t...
{"title":"Epiduroscopy and radiofrequency technique: the Raffaeli–Righetti technique","authors":"W. Raffaeli, D. Righetti, J. Andruccioli, D. Sarti","doi":"10.1179/016911107X376927","DOIUrl":"https://doi.org/10.1179/016911107X376927","url":null,"abstract":"Abstract Objectives: Periduroscopy has been re-evaluated only recently for the diagnosis, and especially the treatment, of complex rachidian pain, such as that due to the failed back surgery syndrome (FBSS). The classic periduroscopy procedure has major limitations in that it can only use liquids as a method to visualize the dura space, and cannot overcome fibrotic (partial or complete) obstructions of the channel. In order to overcome these limitations, we added two modifications to the classic procedure – the Raffaeli–Righetti technique. Patients and methods: A Fogarty balloon was used to clean the channel. This tool has allowed reduction by 50% of the volume of fluid used in the periduroscopy. The second innovation involves the use of the resaflex for the lysis of channel obstructions (fat and/or fibrotic tissues), which allows reaching the site of pain origin and improving the efficiency of the periduroscopy by 30%. The resaflex uses an electric wave to lyse tender tissues (lysing and coagulating at t...","PeriodicalId":19808,"journal":{"name":"Pain Clinic","volume":"66 1","pages":"185-191"},"PeriodicalIF":0.0,"publicationDate":"2007-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"74140614","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2007-08-01DOI: 10.1179/016911107X396899
Kouichi Mogi, T. Igarashi, Hideo Suzuki, Y. Hirabayashi, N. Seo
AbstractSpinal canal endoscopy is recognised as a new technique for treatment of chronic low back and leg pain due to lumbar epidural adhesions involving nerve roots. In this paper, the cases of two patients who received orthopaedic surgery combined with spinal canal endoscopy are discussed. In case 1, the patient had a cauda equina tumour and underwent extirpation of the tumour assisted by spinal canal endoscopy. In case 2, the patient was suffering from extensive epidural abscess. He was treated with antibiotics and underwent single-level laminectomy and drainage assisted by spinal canal endoscopy. In case 1, small tumours that could not be identified by magnetic resonance imaging were identified with spinal canal endoscopy: the tumours were then partially removed from the T12 vertebral level to the S1 vertebral level by right hemilaminectomy of S1, and laminectomy of L5 and T12. In case 2, the use of spinal canal endoscopy enabled drainage and lavage of the wide lesion of the abscess by the single–leve...
{"title":"Potential use of spinal canal endoscopy for successful treatment of cauda equina tumour and epidural abscess","authors":"Kouichi Mogi, T. Igarashi, Hideo Suzuki, Y. Hirabayashi, N. Seo","doi":"10.1179/016911107X396899","DOIUrl":"https://doi.org/10.1179/016911107X396899","url":null,"abstract":"AbstractSpinal canal endoscopy is recognised as a new technique for treatment of chronic low back and leg pain due to lumbar epidural adhesions involving nerve roots. In this paper, the cases of two patients who received orthopaedic surgery combined with spinal canal endoscopy are discussed. In case 1, the patient had a cauda equina tumour and underwent extirpation of the tumour assisted by spinal canal endoscopy. In case 2, the patient was suffering from extensive epidural abscess. He was treated with antibiotics and underwent single-level laminectomy and drainage assisted by spinal canal endoscopy. In case 1, small tumours that could not be identified by magnetic resonance imaging were identified with spinal canal endoscopy: the tumours were then partially removed from the T12 vertebral level to the S1 vertebral level by right hemilaminectomy of S1, and laminectomy of L5 and T12. In case 2, the use of spinal canal endoscopy enabled drainage and lavage of the wide lesion of the abscess by the single–leve...","PeriodicalId":19808,"journal":{"name":"Pain Clinic","volume":"67 1","pages":"193-199"},"PeriodicalIF":0.0,"publicationDate":"2007-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"91078371","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2007-08-01DOI: 10.1179/016911107X217464
J. Richardson, S. Shaunak, M. Jones, N. Collighan
AbstractA case report of the complication of postero-inferior cerebellar artery territory ischaemia in a 32-year-old woman during cervical zygapophysial joint neurotomy is presented. Possible causes and methods of avoiding this complication are discussed.
{"title":"Brain stem and cerebellar ischaemia complicating cervical zygapophysial joint neurotomy","authors":"J. Richardson, S. Shaunak, M. Jones, N. Collighan","doi":"10.1179/016911107X217464","DOIUrl":"https://doi.org/10.1179/016911107X217464","url":null,"abstract":"AbstractA case report of the complication of postero-inferior cerebellar artery territory ischaemia in a 32-year-old woman during cervical zygapophysial joint neurotomy is presented. Possible causes and methods of avoiding this complication are discussed.","PeriodicalId":19808,"journal":{"name":"Pain Clinic","volume":"109 1","pages":"33-36"},"PeriodicalIF":0.0,"publicationDate":"2007-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"76513085","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2007-08-01DOI: 10.1179/016911107X376891
Kunihiko Murai, Hideo Suzuki, T. Igarashi, M. Kawanishi, R. Naiki, N. Seo, Tetsuo Sato, Yoshiaki Namiki, K. Hanaoka, S. Ogawa
Abstract Objectives: Several studies have demonstrated the advantages of epiduroscopy versus conservative therapies for low back pain with few studies evaluating the results in operated and non-operated back patients. We compared the effects and complications of epiduroscopy between these patients. Patients and methods: A multi-institutional, prospective, clinical study was performed in 183 patients whose low back and leg pain had failed to respond to conservative therapies. Patients were divided into an operated back (Op) group and a non-operated (Non-op) group. Japanese Orthopedic Association (JOA) score, the Japanese version of the Roland-Morris Disability Questionnaire (JRMDQ) scores, and 100-mm visual analogue scales (VAS) for leg pain, leg numbness, low back pain and dissatisfaction with ADL were recorded before and at 1 month and 3 months after epiduroscopy. Results: All scores significantly improved at 1 month and 3 months after epiduroscopy in both groups. JOA scores in the Non-op group were sign...
{"title":"Epiduroscopy for intractable low back pain or sciatica in operated and non-operated back patients: results from The Japan Society of Epiduroscopy","authors":"Kunihiko Murai, Hideo Suzuki, T. Igarashi, M. Kawanishi, R. Naiki, N. Seo, Tetsuo Sato, Yoshiaki Namiki, K. Hanaoka, S. Ogawa","doi":"10.1179/016911107X376891","DOIUrl":"https://doi.org/10.1179/016911107X376891","url":null,"abstract":"Abstract Objectives: Several studies have demonstrated the advantages of epiduroscopy versus conservative therapies for low back pain with few studies evaluating the results in operated and non-operated back patients. We compared the effects and complications of epiduroscopy between these patients. Patients and methods: A multi-institutional, prospective, clinical study was performed in 183 patients whose low back and leg pain had failed to respond to conservative therapies. Patients were divided into an operated back (Op) group and a non-operated (Non-op) group. Japanese Orthopedic Association (JOA) score, the Japanese version of the Roland-Morris Disability Questionnaire (JRMDQ) scores, and 100-mm visual analogue scales (VAS) for leg pain, leg numbness, low back pain and dissatisfaction with ADL were recorded before and at 1 month and 3 months after epiduroscopy. Results: All scores significantly improved at 1 month and 3 months after epiduroscopy in both groups. JOA scores in the Non-op group were sign...","PeriodicalId":19808,"journal":{"name":"Pain Clinic","volume":"72 1","pages":"163-169"},"PeriodicalIF":0.0,"publicationDate":"2007-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"84176519","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2007-08-01DOI: 10.1179/016911107X376882
J. Heavner, H. Bosscher
Abstract Objectives: To describe the reported and potential complications of epiduroscopy. Materials and methods: Sources of information included the authors' extensive experience with epiduroscopy and their publications related to the topic. A Google search was done to identify recent publications not known to the authors. Results: The literature contains descriptions of a variety of potential complications from minor and transient to life-threatening and permanent. The complications of greatest concern are those related to the injection of relative or absolute large volumes of fluid into the epidural space and those related to instrumentation such as entry into the wrong tissue plane. Discussion: The literature documents the safety of lumbosacral epiduroscopy. As with other technically demanding procedures, the likelihood of complications decline as the operator gains experience and as awareness of potential complications and how to avoid them become known.
{"title":"Complications of lumbosacral epiduroscopy","authors":"J. Heavner, H. Bosscher","doi":"10.1179/016911107X376882","DOIUrl":"https://doi.org/10.1179/016911107X376882","url":null,"abstract":"Abstract Objectives: To describe the reported and potential complications of epiduroscopy. Materials and methods: Sources of information included the authors' extensive experience with epiduroscopy and their publications related to the topic. A Google search was done to identify recent publications not known to the authors. Results: The literature contains descriptions of a variety of potential complications from minor and transient to life-threatening and permanent. The complications of greatest concern are those related to the injection of relative or absolute large volumes of fluid into the epidural space and those related to instrumentation such as entry into the wrong tissue plane. Discussion: The literature documents the safety of lumbosacral epiduroscopy. As with other technically demanding procedures, the likelihood of complications decline as the operator gains experience and as awareness of potential complications and how to avoid them become known.","PeriodicalId":19808,"journal":{"name":"Pain Clinic","volume":"46 1","pages":"178-184"},"PeriodicalIF":0.0,"publicationDate":"2007-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"81850312","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2007-06-01DOI: 10.1179/016911107X268701
F. Lin, T. Lin, Y. Yeh, Chih‐Peng Lin, Wei-Zen Sun
Abstract Introduction: Ketorolac added to morphine solution as a convenient regimen for pain management is common in clinical practice in many centers. However, the analytical confirmation of the compatibility and stability of this combination has rarely been performed. This study examined the compatibility and stability of ketorolac tromethamine and morphine hydrochloride combined in 0.9% sodium chloride injection. Materials and methods: Ketorolac tromethamine and morphine hydrochloride were mixed together in 0.9% sodium chloride injection at pH 5–9 at a final concentration of 2 mg/ml for ketorolac and 1 mg/ml for morphine. In addition, 20 different ketorolac–morphine mixture solutions were prepared by combing various concentrations of each individual drug. The compatibility and stability of these solutions were studied using high performance liquid chromatography. Results: There was no significant loss of drug, neither ketorolac tromethamine nor morphine hydrochloride, with the ketorolac (2 mg/ml) + mor...
{"title":"Compatibility and stability of ketorolac tromethamine and morphine hydrochloride in 0.9% sodium chloride injection","authors":"F. Lin, T. Lin, Y. Yeh, Chih‐Peng Lin, Wei-Zen Sun","doi":"10.1179/016911107X268701","DOIUrl":"https://doi.org/10.1179/016911107X268701","url":null,"abstract":"Abstract Introduction: Ketorolac added to morphine solution as a convenient regimen for pain management is common in clinical practice in many centers. However, the analytical confirmation of the compatibility and stability of this combination has rarely been performed. This study examined the compatibility and stability of ketorolac tromethamine and morphine hydrochloride combined in 0.9% sodium chloride injection. Materials and methods: Ketorolac tromethamine and morphine hydrochloride were mixed together in 0.9% sodium chloride injection at pH 5–9 at a final concentration of 2 mg/ml for ketorolac and 1 mg/ml for morphine. In addition, 20 different ketorolac–morphine mixture solutions were prepared by combing various concentrations of each individual drug. The compatibility and stability of these solutions were studied using high performance liquid chromatography. Results: There was no significant loss of drug, neither ketorolac tromethamine nor morphine hydrochloride, with the ketorolac (2 mg/ml) + mor...","PeriodicalId":19808,"journal":{"name":"Pain Clinic","volume":"22 1","pages":"99-103"},"PeriodicalIF":0.0,"publicationDate":"2007-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"75698918","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2007-06-01DOI: 10.1179/016911107X268684
M. Jung, Keun Ho Lee, E. Yoo, J. H. You
Abstract Introduction: Despite the important contribution of multifaceted risk factors on low back pain (LBP), only few studies have attempted to examine the impact of functional level and environmental factors on LBP in mothers of children with disabilities. Moreover, there has been no previous study investigating the risk factors associated with LBP in mothers of children with cerebral palsy. Hence, the present study was to investigate the risk factors associated with LBP in mothers of children with cerebral palsy. Patients and methods: A sample of 94 mothers of children attending three pediatric physical medicine and rehabilitation clinics at three major medical centers and local community rehabilitation centers for their rehabilitation services were recruited for this study. They were divided into two groups: group 1 (mothers of children with the Functional Independent Measure for Children [WeeFIM] score ≥ 5); and group 2 (mothers of children with WeeFIM score < 5). The independent variables included ...
{"title":"Risk factors associated with low back pain in mothers of children with cerebral palsy","authors":"M. Jung, Keun Ho Lee, E. Yoo, J. H. You","doi":"10.1179/016911107X268684","DOIUrl":"https://doi.org/10.1179/016911107X268684","url":null,"abstract":"Abstract Introduction: Despite the important contribution of multifaceted risk factors on low back pain (LBP), only few studies have attempted to examine the impact of functional level and environmental factors on LBP in mothers of children with disabilities. Moreover, there has been no previous study investigating the risk factors associated with LBP in mothers of children with cerebral palsy. Hence, the present study was to investigate the risk factors associated with LBP in mothers of children with cerebral palsy. Patients and methods: A sample of 94 mothers of children attending three pediatric physical medicine and rehabilitation clinics at three major medical centers and local community rehabilitation centers for their rehabilitation services were recruited for this study. They were divided into two groups: group 1 (mothers of children with the Functional Independent Measure for Children [WeeFIM] score ≥ 5); and group 2 (mothers of children with WeeFIM score < 5). The independent variables included ...","PeriodicalId":19808,"journal":{"name":"Pain Clinic","volume":"25 1","pages":"184-184"},"PeriodicalIF":0.0,"publicationDate":"2007-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"83389925","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2007-06-01DOI: 10.1179/016911107X268710
Y. Ogino, Masumi Miyazaki, H. Shimada, K. Nishikawa, F. Goto, S. Saito
AbstractBurger disease is an inflammatory vascular disease clinically characterized by the development of thrombotic occlusions of the small- and medium-sized arteries of the distal extremities while sparing large arteries. We report here an unusual case of peripheral arterial disease, probably Burger disease, complicated with severe abdominal aortic stenosis due to giant thrombus, which was successfully treated with a multidisciplinary approach including sympathetic blockade, epidural blockade, and surgery. A 40-year-old man presented with cyanosis, ulcer and gangrene in the toes, complicated with ischemic pain. His clinical symptoms and angiography results strongly suggested typical Burger disease. Moreover, the angiography results also revealed severe stenosis in the abdominal aorta. His ischemic pain was ameliorated by medications, lumber sympathetic blockade and continuous epidural blockade. However, the ulcer and gangrene in the toes did not heal, although they stopped expanding. Thus, surgical trea...
{"title":"Peripheral arterial disease treated with a multidisciplinary approach including sympathetic blockade, epidural blockade, and surgery","authors":"Y. Ogino, Masumi Miyazaki, H. Shimada, K. Nishikawa, F. Goto, S. Saito","doi":"10.1179/016911107X268710","DOIUrl":"https://doi.org/10.1179/016911107X268710","url":null,"abstract":"AbstractBurger disease is an inflammatory vascular disease clinically characterized by the development of thrombotic occlusions of the small- and medium-sized arteries of the distal extremities while sparing large arteries. We report here an unusual case of peripheral arterial disease, probably Burger disease, complicated with severe abdominal aortic stenosis due to giant thrombus, which was successfully treated with a multidisciplinary approach including sympathetic blockade, epidural blockade, and surgery. A 40-year-old man presented with cyanosis, ulcer and gangrene in the toes, complicated with ischemic pain. His clinical symptoms and angiography results strongly suggested typical Burger disease. Moreover, the angiography results also revealed severe stenosis in the abdominal aorta. His ischemic pain was ameliorated by medications, lumber sympathetic blockade and continuous epidural blockade. However, the ulcer and gangrene in the toes did not heal, although they stopped expanding. Thus, surgical trea...","PeriodicalId":19808,"journal":{"name":"Pain Clinic","volume":"181 1","pages":"105-108"},"PeriodicalIF":0.0,"publicationDate":"2007-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"84112245","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2007-06-01DOI: 10.1179/016911107X268729
U. Junker, M. Wehner, E. Lotterer, C. Gerke, R. Freynhagen
AbstractOn the basis of the case report of a 13-year-old boy with metastatic pancreatic cancer undergoing palliative treatment, the phenomena of tolerance and opioid-induced hyperalgesia are demonstrated. Both can make efficient pain control much more difficult. Chronic use of opioids, especially in high doses, can trigger pronociceptive processes such as activation of the N-methyldiaspartate (NMDA) receptor, the increase of spinal dynorphin concentration with release of stimulating neurotransmitters, and/or the activation of descending nerve-excitation paths. As far as is known today, the only one of these processes that can be attenuated by ketamine is sensitisation of the NMDA receptor. Alternatively, regionally used methods of analgesia can be employed.
{"title":"Hydromorphone-induced hyperalgesia in a patient with metastatic pancreatic cancer","authors":"U. Junker, M. Wehner, E. Lotterer, C. Gerke, R. Freynhagen","doi":"10.1179/016911107X268729","DOIUrl":"https://doi.org/10.1179/016911107X268729","url":null,"abstract":"AbstractOn the basis of the case report of a 13-year-old boy with metastatic pancreatic cancer undergoing palliative treatment, the phenomena of tolerance and opioid-induced hyperalgesia are demonstrated. Both can make efficient pain control much more difficult. Chronic use of opioids, especially in high doses, can trigger pronociceptive processes such as activation of the N-methyldiaspartate (NMDA) receptor, the increase of spinal dynorphin concentration with release of stimulating neurotransmitters, and/or the activation of descending nerve-excitation paths. As far as is known today, the only one of these processes that can be attenuated by ketamine is sensitisation of the NMDA receptor. Alternatively, regionally used methods of analgesia can be employed.","PeriodicalId":19808,"journal":{"name":"Pain Clinic","volume":"168 1","pages":"109-111"},"PeriodicalIF":0.0,"publicationDate":"2007-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"75362489","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
京公网安备 11010802042870号
京ICP备2023020795号-1
扫码关注我们
求助内容：
应助结果提醒方式：