Pain physician最新文献

Background: Persistent Spinal Pain Syndrome Type II (PSPS II) is a major health concern in patients undergoing spinal surgery. However, there are little data on the prevalence and risk factors of PSPS II post spinal surgery.

Objectives: We examined the prevalence and factors associated with diagnosing PSPS II post spinal surgery using a nationwide database in the Republic of Korea.

Study design: A retrospective, population-based cohort study.

Setting: Nationwide cohort study in the Republic of Korea.

Methods: Adult patients who underwent spinal surgery under general anesthesia from January 1, 2016 through December 31, 2020 were included. Patients previously diagnosed with PSPS II were excluded from the study in order to focus only on patients who were newly diagnosed post spinal surgery. We determined that a PSPS II diagnosis must be made within  one year of the date of spinal surgery, with an additional evaluation for diagnoses occurring within 2 years to capture longer-term cases. A multivariate logistic regression model was developed to identify the factors associated with diagnosing PSPS II post spinal surgery.

Results: In total, 530,644 patients who underwent spinal surgery were included. Of these, 25.6% and 31.5% were diagnosed with PSPS II within one and 2 years post spinal surgery, respectively. The multivariate logistic regression model indicated that being a woman, old age, being a member of a medical aid program group, an increased Charlson Comorbidity Index score, discectomy, laminectomy, and lumbar level surgery were associated with an increased prevalence of PSPS II within one year post spinal surgery. Similar results were observed in the multivariate logistic regression model for PSPS II within 2 years post spinal surgery.

Limitation: Our study's retrospective cohort design is a limitation.

Conclusions: This population-based cohort analysis found a 25.6% prevalence of PSPS II within one year post spinal surgery and 31.5% within two years post spinal surgery. Identified risk factors include old age, being a woman, economic poverty, comorbid status, underlying disability, type of surgery, and lumbar-level surgery. A large dataset was used to document the prevalence and risk factors for PSPS II post spinal surgery.

Background: Low back pain is a highly prevalent condition with substantial costs. Superior cluneal neuralgia is present in up to 14% of low back pain cases. This etiology of back pain is often overlooked because the symptoms of superior cluneal neuralgia manifest similarly to those of other conditions, such as radiculopathy and sacroiliac joint pain. Peripheral nerve stimulation (PNS) is an emerging pain management modality used to treat various chronic pain conditions. This retrospective study will examine the outcomes of patients who have back pain caused by neuralgia and are treated with the permanent Freedom® PNS System (Curonix LLC) at the superior cluneal nerve.

Objectives: The primary objective was to examine the responder rate (proportion of patients who experienced greater than 50% relief) and changes in pain scores after the trial procedure. Secondary objectives included changes in pain scores from at least one month after permanent implantation, adverse event occurrences, changes in function and quality of life, and reductions in medication usage.

Setting: This was a retrospective single-site study. All procedures were performed by the same interventional pain physician.

Methods: A retrospective chart review was conducted to assess baseline and follow-up parameters. Inclusion criteria consisted of requirements that patients be 18 years or older and have a confirmed superior cluneal neuralgia diagnosis responsible for their pain presentation. Exclusion criteria included the presence of another active implanted device for pain management. The 11-point verbal rating scale (VRS) was used to assess pain scores.

Results: Twenty-one patients were included in this study. All 21 responded to the trial procedure with a 77% average reduction in VRS scores. At the follow-up (mean = 11 months), 20 patients reported an average 57% reduction in pain scores with the verbal rating scale. The same proportion of patients reported improved function and quality of life. Five patients reported reduced medication usage, including one who stopped taking pain medication altogether. No complications were reported.

Limitations: We were limited to the data available in the patient charts since this was a retrospective study investigating the efficacy and safety of the Freedom® PNS System for patients with refractory chronic back pain.

Conclusion: When used to target the superior cluneal nerve, the Curonix Freedom® PNS System is an effective and safe treatment for neuralgia-caused chronic lower back pain resistant to conservative therapy.

Background: Occipital neuralgia manifests as pain in the cutaneous distribution of occipital nerves, with the greater occipital nerve stemming from the C2 spinal nerve and the lesser occipital nerve originating from the C2 and C3 spinal nerves. While pulsed radiofrequency ablation of the C2 dorsal root ganglion (DRG) is an effective treatment for refractory occipital neuralgia, accessing the C2 DRG remains a clinical challenge even under fluoroscopic guidance.

Objective: We aimed to develop an ultrasonographic method for quickly and accurately accessing the C2 DRG.

Study design: This is a prospective, observational cohort study.

Setting: Our study was conducted in the Department of Pain Management, Xuanwu Hospital, Capital Medical University, Beijing, China.

Methods: Unlike the C3-C8 foramina, which are ventral to the corresponding facet joints, the C2 foramen is positioned more posteriorly, dorsal to the C1-C2 atlantoaxial joint and longitudinally aligns with the cervical facet joints of C2-C3 and C3-C4. This unique anatomical feature allowed us to rapidly identify the C2 foramen in the sonographic longitudinal-axis view, what we call the "Stage-light Sign." Further exposure of the C2 DRG in the oblique-axis view we call the "Turtle Sign." The following procedural parameters were prospectively obtained: the time required to identify the C2 DRG target, the time needed to reach the target from the point of skin puncture, the number of puncture attempts required to reach the target, and the minimum sensory testing voltage to evoke paresthesia responses in the cutaneous occipital nerve distributions. Clinical outcomes were assessed by serial pain severity using the Numeric Rating Scale at baseline and up to 3 months post the C2 DRG pulsed radiofrequency ablation procedure.

Results: The correct placement of the needle tip was initially confirmed with fluoroscopy, with the injected contrast medium distributed along the C2 spinal nerve. Importantly, electrical sensory stimulation elicited paresthesia in the headache area in all patients, with the required voltage being 0.35 ± 0.02 V. Furthermore, treatment outcomes supported the correct needle tip position, as pulsed radiofrequency ablation treatment led to sustained pain reduction. It took 36.2 ± 2.2 seconds to obtain the final "TurtleSign" view of the C2 DRG. Once the target was identified, it required a single puncture attempt to reach it, with a duration of 36.3 ± 2.5 seconds from puncturing the skin to reaching the target.

Limitation: We only followed patients for up to 3 months postprocedure.

Conclusion: We have developed an ultrasonographic method to quickly and accurately access the C2 DRG, which has the potential to greatly facilitate treating the C2 DRG for managing occipital neuralgia.

Background: Chronic low back pain (CLBP) with sacroiliac joint (SIJ) involvement is a prevalent issue in health care. Surgical intervention, employing an endoscopic technique with a navigation system, targets and ablates nociceptive nerve fibers associated with SIJ pain, although the clinical effect of omitting rhizotomy of the lateral sacral branch of S3 remains uncertain.

Objectives: This study aimed to compare the clinical outcomes of 2 full-endoscopic rhizotomy and ablation (FERA) techniques for SIJ pain and to determine the effect of omitting rhizotomy of the lateral sacral branch of S3 on patient outcomes.

Study design: This study adopted a retrospective cohort study design.

Setting: This study was conducted at a single medical institution by a neurosurgeon.

Methods: From January 2018 through March 2021, the records of 73 patients undergoing L5-S3 or L5-S2 FERA for SIJ pain associated with CLBP were retrospectively reviewed. The patients were evaluated using the Visual Analog Scale (VAS) for pain, Oswestry Disability Index (ODI) for functional disability, and MacNab criteria for satisfaction. The procedures were guided by 3-D robotic C-arm navigation. The L5-S3 FERA group underwent rhizotomy and ablation of the L5-S3 lateral branches, whereas the L5-S2 FERA group did not undergo rhizotomy of the S3 lateral sacral branch.

Results: Both groups showed significant  improvements at one year in VAS and ODI scores with similar trends. The L5-S2 FERA group had a shorter operative time, particularly bilaterally, without complications. Although the L5-S3 FERA group initially presented a slightly higher recurrence rate at 6 months, their recurrence rate was equal with that of the L5-S2 FERA group at one year. Furthermore, the MacNab criteria showed comparable satisfaction rates in both groups.

Limitation: This was a small retrospective study.

Conclusion: L5-S2 FERA demonstrated clinical outcomes similar to those of L5-S3 FERA for pain relief, functional improvement, and satisfaction. Omitting S3 lateral branch rhizotomy did not adversely affect the outcomes. Surgeons may consider omitting S3 lateral branch rhizotomy for SIJ pain treatment, thereby reducing operative time while maintaining patient benefits.