scholarly journals Computed tomography versus fluoroscopic guided-sacroiliac joint injection: a prospective comparative study

2021 ◽  
Vol 12 (1) ◽  
Author(s):  
Ahmed A. A. Bessar ◽  
Mohamed M. Arnaout ◽  
Mohammad Abd Alkhalik Basha ◽  
Shady E. Shaker ◽  
Ashraf E. Elsayed ◽  
...  
Keyword(s):  
Pain Relief ◽  
Sacroiliac Joint ◽  
Fluoroscopic Guidance ◽  
Ct Guided ◽  
Patient’S Satisfaction ◽  
Post Procedure ◽  
Significant Difference ◽  
Clinically Significant ◽  
A Prospective Study

Abstract Background There are limited data discussing long-term pain relief and comparability of different image-guided sacroiliac joint (SIJ) injection. This study compared CT and fluoroscopic-guided SIJ injections regarding statistically and clinically significant differences in numeric pain reduction, radiation doses, and patient’s satisfaction. Methods A prospective study conducted on 52 patients who met specific inclusion criteria of SIJ pain. A mixture of 1 ml of 40 mg methylprednisolone acetate diluted in 2 ml of lidocaine 2% was injected under either CT or fluoroscopic guidance. Numeric rating score (NRS) and Oswestry disability index (ODI) were assessed and recorded for each patient before procedure and one-week, and one-, three-, six-, and 12-months after procedure. The results were compared between both groups. Results Analysis of NRS one-month post-procedure showed a significant decrease from baseline in both groups: 12.5% in CT group (p = 0.002) and 9.5% in fluoroscopic group (p = 0.006). No significant difference in NRS between two groups at one- and three-months post-procedure (p = 0.11 and 0.1, respectively). There was a significant difference in NRS between two groups at six- and 12-months post-procedure (p = 0.001 and < 0.0001, respectively). Comparison of ODI at six-month post-procedure revealed that both groups had a statistically significant improvement (p < 0.0001). There was a significant difference in ODI between two groups at six-months post-procedure (p = 0.01). Conclusions CT-guided SIJ injection compares favorably with fluoroscopic guidance and offers statistically and clinically significant long-term pain relief. The use of dose reduction protocol in CT is important for decreasing the radiation dose.

scholarly journals Long-term follow-up in sacroiliac joint pain patients treated with radiofrequency ablative therapy

2015 ◽  
Vol 73 (6) ◽  
pp. 476-479 ◽  
Author(s):  
Flávio Ramalho Romero ◽  
Roberto Bezerra Vital ◽  
Marco Antônio Zanini ◽  
Luis Gustavo Ducati ◽  
Roberto Colichio Gabarra
Keyword(s):  
Pain Relief ◽  
Sacroiliac Joint ◽  
Joint Pain ◽  
Outcome Measure ◽  
Secondary Outcome ◽  
Secondary Outcome Measure ◽  
Sacroiliac Joint Pain ◽  
Post Procedure ◽  
Radiofrequency Denervation

Sacroiliac joint (SIJ) pain is responsible for up to 40% of all cases of lumbar back pain.Objective Report the long-term efficacy of radiofrequency denervation for sacroiliac joint pain at six, twelve and eighteen months.Method Third-two adults’ patients with sacroiliac join pain diagnosis were included for a prospective study. Primary outcome measure was pain intensity on the Numeric Rating Scale (NRS). Secondary outcome measure was Patient Global Impression of Change Scale (PGIC).Results Short-term pain relief was observed, with the mean NRS pain score decreasing from 7.7 ± 1.8 at baseline to 2.8 ± 1.2 at one month and to 3.1 ± 1.9 at six months post-procedure (p < 0.001). Long-term pain relief was sustained at twelve and eighteen months post-procedure, with NRS pain remaining at 3.4 ± 2.1 and 4.0 ± 2.7, respectively.Conclusion Radiofrequency denervation of the SIJ can significantly reduce pain in selected patients with sacroiliac syndrome.

Percutaneous glycerol rhizotomy for trigeminal neuralgia in patients with multiple sclerosis: a long-term retrospective cohort study

2020 ◽  
Vol 132 (5) ◽  
pp. 1405-1413 ◽  
Author(s):  
Michael D. Staudt ◽  
Holger Joswig ◽  
Gwynedd E. Pickett ◽  
Keith W. MacDougall ◽  
Andrew G. Parrent
Keyword(s):  
Multiple Sclerosis ◽  
Pain Relief ◽  
Trigeminal Neuralgia ◽  
Retrospective Chart Review ◽  
Medication Usage ◽  
Free Response ◽  
Free Survival ◽  
Time To Recurrence ◽  
Significant Difference

OBJECTIVEThe prevalence of trigeminal neuralgia (TN) in patients with multiple sclerosis (MS-TN) is higher than in the general population (idiopathic TN [ITN]). Glycerol rhizotomy (GR) is a percutaneous lesioning surgery commonly performed for the treatment of medically refractory TN. While treatment for acute pain relief is excellent, long-term pain relief is poorer. The object of this study was to assess the efficacy of percutaneous retrogasserian GR for the treatment of MS-TN versus ITN.METHODSA retrospective chart review was performed, identifying 219 patients who had undergone 401 GR procedures from 1983 to 2018 at a single academic institution. All patients were diagnosed with medically refractory MS-TN (182 procedures) or ITN (219 procedures). The primary outcome measures of interest were immediate pain relief and time to pain recurrence following initial and repeat GR procedures. Secondary outcomes included medication usage and presence of periprocedural hypesthesia.RESULTSThe initial pain-free response rate was similar between groups (p = 0.726): MS-TN initial GR 89.6%; MS-TN repeat GR 91.9%; ITN initial GR 89.6%; ITN repeat GR 87.0%. The median time to recurrence after initial GR was similar between MS-TN (2.7 ± 1.3 years) and ITN (2.1 ± 0.6 years) patients (p = 0.87). However, there was a statistically significant difference in the time to recurrence after repeat GR between MS-TN (2.3 ± 0.5 years) and ITN patients (1.2 ± 0.2 years; p < 0.05). The presence of periprocedural hypesthesia was highly predictive of pain-free survival (p < 0.01).CONCLUSIONSPatients with MS-TN achieve meaningful pain relief following GR, with an efficacy comparable to that following GR in patients with ITN. Initial and subsequent GR procedures are equally efficacious.

scholarly journals Outcome and Complications of MR Guided Focused Ultrasound for Essential Tremor: A Systematic Review and Meta-Analysis

2021 ◽  
Vol 12 ◽  
Author(s):  
Mohit Agrawal ◽  
Kanwaljeet Garg ◽  
Raghu Samala ◽  
Roopa Rajan ◽  
Vikas Naik ◽  
...  
Keyword(s):  
Essential Tremor ◽  
Focused Ultrasound ◽  
Rating Scale ◽  
Meta Analysis ◽  
Post Procedure ◽  
Standard Mean Difference ◽  
Significant Difference ◽  
Long Term Follow Up

Background: Magnetic resonance guided focused ultrasound (MRgFUS) is a relatively novel technique to treat essential tremor (ET). The objective of this review was to analyze the efficacy and the safety profile of MRgFUS for ET.Methods: A systematic literature review was done. The post procedure changes in the Clinical Rating Scale for Tremor (CRST) score, hand score, disability and quality of life scores were analyzed.Results: We found 29 studies evaluating 617 patients. DTI based targeting was utilized in six cohorts. A significant difference was observed in the pooled standard mean difference between the pre and postoperative total CRST score (p-value &lt; 0.001 and 0.0002), hand score (p-value 0.03 and 0.02); and the disability at 12 months (p-value 0.01). Head pain and dizziness were the most in procedure complications. The immediate pooled proportion of ataxia was 50%, while it was 20% for sensory complications, which, respectively, declined to 31 and 13% on long term follow up. A significant reduction (p = 0.03) in immediate ataxia related complications was seen with DTI targeting.Conclusion: MRgFUS for ET seems to be an effective procedure for relieving unilateral tremor. Use of DTI based targeting revealed a significant reduction in post procedure ataxia related complications as compared to traditional targeting techniques. Analysis of other complications further revealed a decreasing trend on follow up.

scholarly journals Long-Term Results of a Simultaneous Trial of Deep Brain and Motor Cortex Stimulation in Refractory Neuropathic Pain

2017 ◽  
Vol 3 (1) ◽  
pp. 4-15
Author(s):  
Byung-chul Son ◽  
Jin-gyu Choi ◽  
Sang-woo Ha ◽  
Deog-ryeong Kim
Keyword(s):  
Neuropathic Pain ◽  
Pain Relief ◽  
Motor Cortex ◽  
Success Rate ◽  
Rating Scale ◽  
Long Term Results ◽  
Motor Cortex Stimulation ◽  
Significant Difference ◽  
Deep Brain

Objective Although deep brain stimulation (DBS) and motor cortex stimulation (MCS) are effective in patients with refractory neuropathic pain, their application is still empirical; there is no consensus on which technique is better. Methods To enhance the success rate of trial stimulation of invasive neuromodulation techniques and identify approapriate stimulation targets in individual patients, we performed a simultaneous trial of thalamic ventralis caudalis (Vc) DBS and MCS in 11 patients with chronic neuropathic pain and assessed the results of the trial stimulation and long-term analgesia. Results Of the 11 patients implanted with both DBS and MCS electrodes, nine (81.8%) had successful trials. Seven of these nine patients (77.8%) responded to MCS, and two (18.2%) responded to Vc DBS. With long-term follow-up (56 ± 27.5 months), the mean numerical rating scale decreased significantly (P < 0.05). The degree of percentage pain relief in the chronic MCS (n = 7) and chronic DBS (n = 2) groups were 34.1% ± 18.2% and 37.5%, respectively, and there was no significant difference (P = 0.807). Five out of the seven MCS patients (71%) and both DBS patients had long-term success with the treatments, defined as >30% pain relief compared with baseline. Conclusions With simultaneous trial of DBS and MCS, we could enhance the success rate of invasive trials. Considering the initial success rate and the less invasive nature of epidural MCS over DBS, we suggest that MCS may be a better, initial means of treatment in chronic intractable neuropathic pain. Further investigations including other subcortical target-associated medial pain pathways are warranted.

Neurosurgical Choice for Glossopharyngeal Neuralgia: A Benefit–Harm Assessment of Long-Term Quality of Life

Neurosurgery ◽  
2020 ◽  
Vol 88 (1) ◽  
pp. 131-139 ◽  
Author(s):  
Tao Du ◽  
Bing Ni ◽  
Wei Shu ◽  
Yongsheng Hu ◽  
Hongwei Zhu ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Pain Relief ◽  
Brief Pain Inventory ◽  
Glossopharyngeal Neuralgia ◽  
Significant Difference ◽  
Patient Database ◽  
Global Impression Of Change ◽  
Satisfaction Rates

Abstract BACKGROUND Microvascular decompression (MVD) and vagoglossopharyngeal rhizotomy (VGR) are effective treatment for glossopharyngeal neuralgia (GN). However, surgical choice is controversial due to the need to maximize pain relief and reduce complications. OBJECTIVE To retrospectively compare safety, efficacy, long-term quality of life (QOL), and global impression of change following MVD and VGR for treatment of GN. METHODS Patient database reviews and telephone surveys were conducted to assess baseline characteristics and long-term outcomes. The effects of pain and complications on QOL were assessed using Brief Pain Inventory-Facial (BPI-Facial) questionnaire. Complication tolerance and surgery satisfaction were sorted using the global impression of change survey. RESULTS Of 87 patients with GN, 63 underwent MVD alone, 20 underwent VGR alone, and 4 underwent VGR following a failed MVD. The long-term rate of pain relief was slightly, but not significantly, lower following MVD than VGR (83.6% vs 91.7%, P = .528). However, long-term complications occurred much more frequently following VGR (3.0% vs 50.0%, P &lt; .001). The BPI-Facial, which evaluates pain and complications, showed that MVD had better postoperative QOL than VGR (P &lt; .001). However, 91.7% of patients who underwent VGR experienced no or mild complications. There was no significant difference in the overall satisfaction rates between the groups (83.3% vs 83.6%, P &gt; .99). CONCLUSION Although VGR resulted in lower postoperative QOL due to a high complication rate, most of these complications were mild. The overall satisfaction rates for the 2 surgeries were similar.

scholarly journals The Long-Term Outcome of 3-Dimensional CT-Guided Percutaneous Radiofrequency Thermocoagulation for Tumor-Related Trigeminal Neuralgia

2019 ◽  
Vol 5 (22;5) ◽  
pp. E467-E475
Author(s):  
Luo Fang
Keyword(s):  
Pain Relief ◽  
Trigeminal Neuralgia ◽  
Small Sample ◽  
Cochrane Library ◽  
Gasserian Ganglion ◽  
Term Outcome ◽  
Long Term Outcome ◽  
Ct Guided ◽  
Radiofrequency Thermocoagulation

Background: Percutaneous radiofrequency thermocoagulation (PRFT) has been widely used to treat trigeminal neuralgia. By querying MEDLINE, EMBASE, and the Cochrane Library, no study has reported the long-term outcome of PRFT for tumor-related trigeminal neuralgia (TRTN). Objectives: In this study, we aimed to evaluate the long-term efficacy and safety of PRFT as an alternative treatment for TRTN. Study Design: A retrospective study. Setting: The interventional pain management center in Beijing Tiantan hospital. Methods: We retrospectively analyzed data of all patients who underwent PRFT applied to the Gasserian ganglion under computed tomography guidance for TRTN through a combination of available institutional electronic medical records, patient notes, and radiologic images. Results: Among 38 patients with PRFT treated between March 2007 and February 2018, 13 patients were men and 25 were women. All patients were evaluated as modified Barrow Neurological Institute (BNI) IV-V before the operation and had a total symptom duration of 45.55 ± 23.31 months. The mean operation duration was 59.63 ± 16.89 minutes. All patients experienced satisfactory pain relief defined as a classification of BNI I-IIIb within 3 days after PRFT. The median remission length with satisfactory pain relief was 33 (range, 4-132) months. No serious intraoperative complications, except bradycardia in 6 patients, were recorded. Postprocedure complications, including masticatory muscle weakness, were reported in 5 patients. Although all 38 patients experienced facial dysesthesia, the patients’ Likert scale rating represented that quality of life significantly increased after the procedure. Limitations: The small sample size may have unavoidably caused selection bias in our study. Larger prospective, randomized, multicenter trials are necessary to validate our outcomes. Conclusions: PRFT is an effective and safe treatment that should be considered as an alternative for pain control in the treatment of TRTN. Key words: Pain, secondary trigeminal neuralgia, radiofrequency thermocoagulation, trigeminal neuralgia

Effectiveness and Complications of 0.2% Glyceryl Trinitrate in the Treatment of Chronic Anal Fissure

1970 ◽  
Vol 25 (1) ◽  
pp. 14-17 ◽  
Author(s):  
KM Murshed ◽  
MI Siddique ◽  
MA Rahman
Keyword(s):  
Side Effects ◽  
Pain Relief ◽  
Glyceryl Trinitrate ◽  
Anal Fissure ◽  
Chronic Anal Fissure ◽  
Symptom Relief ◽  
Major Side Effect ◽  
Primary Focus ◽  
A Prospective Study

Background: The aim of this study was to analyze the effectiveness and morbidity of chemical sphincterotomy by 0.2% glyceryl trinitrate (GTN) in the treatment of chronic anal fissure. The main end points were symptom relief, fissure healing and side effects. Methods: A prospective study was conducted to see the effectiveness and side effects of 0.2% glyceryl trinitrate in the treatment of patients with chronic anal fissure attending the outpatient department of surgery from February 2004 to the end of February 2005. All the patients were followed up at 2 weeks interval for 8 weeks. The primary focus was fissure healing and the secondary focus were on improvement of symptoms, need for surgical sphincterotomy and side effects. Results: One hundred and twenty two adult patients, both male and female with chronic anal fissure were treated with local application of 0.2% glyceryl trinitrate. Pain relief occurred earlier than fissure healing. At the end of 8 weeks treatment about two third of the total patients got complete pain relief and fissure healing. Headache was the major side effect. Conclusion: Topical application of 0.2% glyceryl trinitrate (GTN) should be the initial treatment of choice for chronic anal fissure to avoid the long term complication of incontinence following surgical sphincterotomy. (J Bangladesh Coll Phys Surg 2007; 25 : 14-17)

Suicide in probation: Towards the ideation-to-action model

2021 ◽  
pp. 026455052110415
Author(s):  
Charlie Brooker ◽  
Karen Tocque ◽  
Georgia West ◽  
Alice Norman-Taylor ◽  
James Fowler
Keyword(s):  
Suicide Ideation ◽  
Suicide Attempts ◽  
Psychological Treatment ◽  
Secondary Analysis ◽  
Control Group ◽  
Significant Difference ◽  
Action Model ◽  
History Of ◽  
Clinically Significant ◽  
A Prospective Study

Suicide in probation services is far higher than the general population. This paper presents secondary analysis of data previously used to evaluate the outcome of delivering psychological treatment to probationers in London. A sample of probation service users who screened positive for clinically significant symptoms of distress and were subsequently assessed and offered treatment ( n = 274) were allocated retrospectively to one of three groups: those with a history of suicidal ideations but no suicide attempts (ideation group), those with a history of a suicidal act (attempt group) or a control group where suicide was not evident (no history group). Results indicate no significant difference between the ideation and the attempt groups, but significant differences between these and the no history group. The findings are discussed within the context of the suicide ideation-to-action models that have been debated in other offender settings. We conclude that a more nuanced understanding of suicidal acts and suicide attempts is required in probation services including a prospective study that tests the ideation-to-action model.

Long-Term Functional Results of Wrist Arthrodesis in Rheumatoid Arthritis

1999 ◽  
Vol 24 (1) ◽  
pp. 27-31 ◽  
Author(s):  
O. BARBIER ◽  
P. SAELS ◽  
J. J. ROMBOUTS ◽  
J. L. THONNARD
Keyword(s):  
Rheumatoid Arthritis ◽  
Pain Relief ◽  
Functional Results ◽  
Upper Limbs ◽  
Wrist Arthrodesis ◽  
Significant Difference ◽  
Degree Of Satisfaction ◽  
Functional Capacities ◽  
High Degree

The purpose of this study was to evaluate the long-term effectiveness of wrist fusion on the relief of pain and also the functional capacities of the upper limbs in patients with rheumatoid arthritis (RA). Eighteen patients were assessed at a mean of 7 years after wrist arthrodesis and a mean of 17 years after the onset of RA. Radiological measurements, pain assessment and impairment rating of the upper limbs were made of the fused and non-fused sides. The average position of arthrodesis was 8° of extension and 9° of ulnar deviation. All patients were pleased with the procedure and had satisfactory pain relief. Impairment ratings did not detect any significant difference in the sensory and motor function of the hand when the fused and non-fused groups were compared. We conclude that in patients with rheumatoid arthritis, wrist arthrodesis is a reliable procedure that provides predictable pain relief and a high degree of satisfaction without additional functional loss in the upper limb.

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