Pub Date : 2019-12-12DOI: 10.5772/intechopen.90479
V. Vanaclocha-Vanaclocha, N. Saiz-Sapena, J. Ortiz-Criado, Leyre Vanaclocha
Lateral epicondylitis is a painful condition that impairs the quality of life and the working capacities of many middle-aged people. Conservative treatments offer an opportunity for improvement in the majority of cases. Surgical alternatives can be considered in those patients with persisting pain. Open, arthroscopic and percutaneous extensor tendon procedures offer similar results with 10–20% failure rates. Radiofrequency microtenotomies have been introduced with comparable results to traditional surgical procedures. Although both thermal and pulsed radiofrequency techniques have been applied, there is more experience with the thermal. In the past, thermal radiofrequency has been applied through a 3–5 cm skin incision, but now some researchers have reported its percutaneous application with radiofrequency cannulas. The results are similar to former techniques but with significantly reduced surgical aggressiveness that correlates with less postoperative discomfort and a faster recovery.
{"title":"Chronic Pain Associated with Lateral Epicondylitis: Treatment with Radiofrequency","authors":"V. Vanaclocha-Vanaclocha, N. Saiz-Sapena, J. Ortiz-Criado, Leyre Vanaclocha","doi":"10.5772/intechopen.90479","DOIUrl":"https://doi.org/10.5772/intechopen.90479","url":null,"abstract":"Lateral epicondylitis is a painful condition that impairs the quality of life and the working capacities of many middle-aged people. Conservative treatments offer an opportunity for improvement in the majority of cases. Surgical alternatives can be considered in those patients with persisting pain. Open, arthroscopic and percutaneous extensor tendon procedures offer similar results with 10–20% failure rates. Radiofrequency microtenotomies have been introduced with comparable results to traditional surgical procedures. Although both thermal and pulsed radiofrequency techniques have been applied, there is more experience with the thermal. In the past, thermal radiofrequency has been applied through a 3–5 cm skin incision, but now some researchers have reported its percutaneous application with radiofrequency cannulas. The results are similar to former techniques but with significantly reduced surgical aggressiveness that correlates with less postoperative discomfort and a faster recovery.","PeriodicalId":422274,"journal":{"name":"Chronic Pain [Working Title]","volume":"22 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-12-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"127829928","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 : 2019-10-23DOI: 10.5772/intechopen.82165
F. G. Ugurlucan, C. Yaşa
Chronic pelvic pain affects 2–24% of women in the reproductive period. There are various causes of chronic pelvic pain in women including gynecologic, urologic, gastrointestinal, and musculoskeletal problems. The treatment of pain is directed toward the underlying pathology. However, in some cases, no pathology can be found, and sometimes, more than one underlying pathology may be found in the same patient. Surgical denervation methods may be used in the treatment of chronic pelvic pain in women including uterosacral nerve ablation and presacral neurectomy. Uterosacral nerve ablation has been used as a treatment method for uterine causes of pelvic pain. It has been used widely in the treatment of dysmenorrhea- and endometriosis-related pain. But recent randomized studies and meta-analysis have questioned the effect of uterosacral nerve ablation in the treatment of chronic pelvic pain. Presacral neurectomy involves damage of the uterine sympathetic innervation at the level of superior hypogastric plexus. It is effective in the treatment of midline pelvic pain. It has been found to be more effective than laparoscopic uterosacral nerve ablation in a randomized study. The method, effect, and studies evaluating uterosacral nerve ablation and presacral neurectomy will be discussed in this chapter.
{"title":"Uterosacral Nerve Ablation and Presacral Neurectomy in the Treatment of Chronic Pelvic Pain in Women","authors":"F. G. Ugurlucan, C. Yaşa","doi":"10.5772/intechopen.82165","DOIUrl":"https://doi.org/10.5772/intechopen.82165","url":null,"abstract":"Chronic pelvic pain affects 2–24% of women in the reproductive period. There are various causes of chronic pelvic pain in women including gynecologic, urologic, gastrointestinal, and musculoskeletal problems. The treatment of pain is directed toward the underlying pathology. However, in some cases, no pathology can be found, and sometimes, more than one underlying pathology may be found in the same patient. Surgical denervation methods may be used in the treatment of chronic pelvic pain in women including uterosacral nerve ablation and presacral neurectomy. Uterosacral nerve ablation has been used as a treatment method for uterine causes of pelvic pain. It has been used widely in the treatment of dysmenorrhea- and endometriosis-related pain. But recent randomized studies and meta-analysis have questioned the effect of uterosacral nerve ablation in the treatment of chronic pelvic pain. Presacral neurectomy involves damage of the uterine sympathetic innervation at the level of superior hypogastric plexus. It is effective in the treatment of midline pelvic pain. It has been found to be more effective than laparoscopic uterosacral nerve ablation in a randomized study. The method, effect, and studies evaluating uterosacral nerve ablation and presacral neurectomy will be discussed in this chapter.","PeriodicalId":422274,"journal":{"name":"Chronic Pain [Working Title]","volume":"1 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-10-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"130968250","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 : 2019-02-21DOI: 10.5772/INTECHOPEN.84700
V. Vanaclocha, N. Saiz-Sapena, J. Ortiz-Criado, Leyre Vanaclocha
Chronic pain is a pathological condition that requests specific medical attention. Its treatment has been imperative since the origin of our species, taking advantage of herbs and natural remedies available in the primitive environment. Morphine has stood the test of time as has been continuously used for the past 8 millennia. The anatomical knowledge of the nociceptive sensation pathways led to the introduction of some surgical techniques directed to stop this pain transmission. Due to their aggressiveness and to the fact that they are irreversible, these techniques were soon replaced by neurostimulation procedures. Being reversible and allowing a change in stimulation parameters soon became the preferred treatment strategy. Over the years a small subset of patients continues to suffer from chronic pain refractory to the usual neurostimulation and pain-controlling medications. These patients can perhaps benefit from one of the surgical ablative procedures. Some of these techniques have been proven particularly effective throughout the years. For some limited income patients in underdeveloped countries, these techniques may be their only accessible option. Doctors have to keep in mind these surgical techniques to put them at the service of our patients in the very few cases in which they are needed. Letting these ablative techniques to die in oblivion would be a disservice to our patients.
{"title":"Where We Come From and Are We Aware of Where We Are Going To?","authors":"V. Vanaclocha, N. Saiz-Sapena, J. Ortiz-Criado, Leyre Vanaclocha","doi":"10.5772/INTECHOPEN.84700","DOIUrl":"https://doi.org/10.5772/INTECHOPEN.84700","url":null,"abstract":"Chronic pain is a pathological condition that requests specific medical attention. Its treatment has been imperative since the origin of our species, taking advantage of herbs and natural remedies available in the primitive environment. Morphine has stood the test of time as has been continuously used for the past 8 millennia. The anatomical knowledge of the nociceptive sensation pathways led to the introduction of some surgical techniques directed to stop this pain transmission. Due to their aggressiveness and to the fact that they are irreversible, these techniques were soon replaced by neurostimulation procedures. Being reversible and allowing a change in stimulation parameters soon became the preferred treatment strategy. Over the years a small subset of patients continues to suffer from chronic pain refractory to the usual neurostimulation and pain-controlling medications. These patients can perhaps benefit from one of the surgical ablative procedures. Some of these techniques have been proven particularly effective throughout the years. For some limited income patients in underdeveloped countries, these techniques may be their only accessible option. Doctors have to keep in mind these surgical techniques to put them at the service of our patients in the very few cases in which they are needed. Letting these ablative techniques to die in oblivion would be a disservice to our patients.","PeriodicalId":422274,"journal":{"name":"Chronic Pain [Working Title]","volume":"79 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-02-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"131357321","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 : 2018-12-19DOI: 10.5772/INTECHOPEN.82576
K. Ledermann, C. Martin-Sölch
There have been several indications that pain and reward are partly mediated by similar neural pathways in the central nervous system, and that these common pathways are related to both the dopamine (DA) and the opioid systems. Several studies have demonstrated the analgesic effects of rewarding stimuli or activities on positive affective states. On the other hand, chronic pain was shown to impair several aspects of reward processing by possibly altering pain-reward interac-tions. However, the precise mechanisms of the mutual pain-reward interaction are unclear and few studies have investigated the influence of pain on rewards and vice versa in humans. Therefore, we aim to summarize recent findings on the neuroana-tomical and molecular chances associated with chronic pain conditions, particularly fibromyalgia syndrome (FMS) with a focus on the dopamine system. Recent findings on the mechanisms involved in the alterations of the brain reward circuit in chronic pain and FMS as well as the role of DA in the pathophysiology of FMS and other chronic pain conditions will be discussed. Furthermore, we aim to discuss the interplay between the dopaminergic reward system and depression in chronic pain, as the prevalence of co-morbid depression in chronic pain is quite high.
{"title":"Chronic Pain, Dopamine and Depression: Insights from Research on Fibromyalgia","authors":"K. Ledermann, C. Martin-Sölch","doi":"10.5772/INTECHOPEN.82576","DOIUrl":"https://doi.org/10.5772/INTECHOPEN.82576","url":null,"abstract":"There have been several indications that pain and reward are partly mediated by similar neural pathways in the central nervous system, and that these common pathways are related to both the dopamine (DA) and the opioid systems. Several studies have demonstrated the analgesic effects of rewarding stimuli or activities on positive affective states. On the other hand, chronic pain was shown to impair several aspects of reward processing by possibly altering pain-reward interac-tions. However, the precise mechanisms of the mutual pain-reward interaction are unclear and few studies have investigated the influence of pain on rewards and vice versa in humans. Therefore, we aim to summarize recent findings on the neuroana-tomical and molecular chances associated with chronic pain conditions, particularly fibromyalgia syndrome (FMS) with a focus on the dopamine system. Recent findings on the mechanisms involved in the alterations of the brain reward circuit in chronic pain and FMS as well as the role of DA in the pathophysiology of FMS and other chronic pain conditions will be discussed. Furthermore, we aim to discuss the interplay between the dopaminergic reward system and depression in chronic pain, as the prevalence of co-morbid depression in chronic pain is quite high.","PeriodicalId":422274,"journal":{"name":"Chronic Pain [Working Title]","volume":"67 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2018-12-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"121566112","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 : 2018-11-05DOI: 10.5772/INTECHOPEN.81133
Antonios El Helou, Charbel Fawaz, R. Adams, D. Charest
Low back pain is one of the most reported symptoms in adult life. Different etiologies have been evoked. Degenerative disease of the spine is the most common cause. Facet joint arthropathy is the second leading cause of low back pain in degenerative disease. Failure of medical treatment will lead to more invasive therapeutic option. Radio frequency is a well-known therapeutic option for refractory low back pain related to facet arthropathy. We present our results analyzed retrospectively between January 2015 and March 2018. In addition, we describe our workflow, our procedure technique, and our results. According to our findings, 73% improved their VAS pain score by at least 50% over 3 months. Twenty-seven percent failed to improve with this procedure. There was a 20-point improvement on the SF-36 QOL; the overall satisfaction was high. When patients are selected carefully, radio-frequency ablation technique is a safe and efficient procedure. Its complication rate and cost are low. We recommend it as one of the therapeutic tools in the management of low back pain related to facet joint disease.
{"title":"Radio Frequency in the Treatment of Lumbar Facet Joint Arthropathy: Indications and Technical Notes","authors":"Antonios El Helou, Charbel Fawaz, R. Adams, D. Charest","doi":"10.5772/INTECHOPEN.81133","DOIUrl":"https://doi.org/10.5772/INTECHOPEN.81133","url":null,"abstract":"Low back pain is one of the most reported symptoms in adult life. Different etiologies have been evoked. Degenerative disease of the spine is the most common cause. Facet joint arthropathy is the second leading cause of low back pain in degenerative disease. Failure of medical treatment will lead to more invasive therapeutic option. Radio frequency is a well-known therapeutic option for refractory low back pain related to facet arthropathy. We present our results analyzed retrospectively between January 2015 and March 2018. In addition, we describe our workflow, our procedure technique, and our results. According to our findings, 73% improved their VAS pain score by at least 50% over 3 months. Twenty-seven percent failed to improve with this procedure. There was a 20-point improvement on the SF-36 QOL; the overall satisfaction was high. When patients are selected carefully, radio-frequency ablation technique is a safe and efficient procedure. Its complication rate and cost are low. We recommend it as one of the therapeutic tools in the management of low back pain related to facet joint disease.","PeriodicalId":422274,"journal":{"name":"Chronic Pain [Working Title]","volume":"31 3","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2018-11-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"132270743","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}
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