scholarly journals ULTRASOUND-GUIDED CONTINUOUS RADIOFREQUENCY ABLATION OF PAINFUL RESIDUAL LIMB NEUROMA IN INDIVIDUALS WITH LIMB AMPUTATION- A RETROSPECTIVE CASE SERIES

2019 ◽  
Author(s):  
Shigong Guo ◽  
Ramy Mansour ◽  
David Henderson Slater
Keyword(s):  
Radiofrequency Ablation ◽  
Steroid Injection ◽  
Case Series ◽  
Limb Amputation ◽  
Residual Limb ◽  
Ultrasound Guided ◽  
Retrospective Case ◽  
Prosthetic Limb ◽  
Pain Scores ◽  
Retrospective Case Series

BACKGROUND: Residual limb neuromas are a significant cause of post-amputation pain. There is little knowledge concerning ultrasound-guided (US) radiofrequency ablation (RFA) as treatment. OBJECTIVE: To investigate US-guided RFA for neuroma associated pain in individuals with limb amputation. METHODOLOGY: The notes of nine consecutive patients were retrospectively reviewed. Information obtained included neuroma size and nerve, RFA duration/temperature, pain scores, analgesic requirements and ease/comfort of prosthetic use. Eight patients had lower-limb amputations and one had a trans-radial amputation.  All except one, underwent diagnostic US-guided steroid injection to confirm the neuroma as the source of pain, prior to RFA. RESULTS: Six patients reported significant reduction in pain scores (defined as at least 50% reduction) and an improvement in comfort/ease of wearing their prosthetic limb, with no adverse effects. Three of these six patients also reported a reduction in analgesic requirements. Of the three remaining patients – one had a large sciatic nerve neuroma that was eventually surgically excised, another had confounding pain from an adjacent bony spur, whilst the third patient did not receive a routine diagnostic steroid injection prior to RFA.   CONCLUSIONS: Our findings suggest that US-guided RFA is safe and effective for small to medium-sized residual limb neuroma associated pain in individuals with limb amputation. It can reduce pain and analgesic requirements, improve comfort/ease of wearing the prosthesis and potentially avoid surgical excision. We recommend patients should undergo a diagnostic steroid injection prior to RFA to confirm that the neuroma is the source of pain. LAYMAN’S ABSTRACTAfter amputation, many patients can get a neuroma which can cause significant pain leading to discomfort wearing the prosthetic limb. Ultrasound-guided radiofrequency ablation can successfully treat painful residual limb neuromas in individuals with limb amputation which in turn can reduce the patient’s pain medications and improve the comfort of wearing the prosthetic limb. Article PDF Link: https://jps.library.utoronto.ca/index.php/cpoj/article/view/33061/25509 How to Cite: Guo S, Mansour R, Henderson Slater D. Ultrasound-guided continuous radiofrequency ablation of painful residual limb neuroma in individuals with limb amputation- A retrospective case series. Canadian Prosthetics & Orthotics Journal. 2019; volume2, Issue1, No.4. https://doi.org/10.33137/cpoj.v2i1.33061 CORRESPONDING AUTHOR:Shigong Guo,LLM MSc(Orth Eng) MRCS, Specialty Registrar in Rehabilitation MedicineOxford Centre for Enablement, Nuffield Orthopaedic Centre, Oxford, UK.Email: [email protected]

scholarly journals Osteopathic interventions via telehealth in a pediatric population: a retrospective case series

2021 ◽  
Vol 0 (0) ◽  
Author(s):  
Joanna L. Kramer ◽  
Kathleen De Asis
Keyword(s):  
Pain Score ◽  
Pediatric Population ◽  
Healthcare Delivery ◽  
Case Series ◽  
P Value ◽  
Retrospective Case ◽  
Unique Challenge ◽  
Pain Scores ◽  
Retrospective Case Series ◽  
Chief Complaints

Abstract Context Healthcare delivery was dramatically affected during the coronavirus disease 2019 (COVID-19) pandemic. Many outpatient visits were cancelled or forgone for fear of exposure to the virus, allowing telemedicine to take on a much larger role in healthcare. The delivery of manual therapies, such as osteopathic manipulative treatment (OMT), via telehealth posed a unique challenge as these are typically provided in-person by a trained osteopathic physician. This study provides a description of one osteopathic pediatrician’s experience in delivering osteopathic interventions to pediatric patients via telehealth. To our knowledge, these techniques have not previously been described in the literature. Objectives To detail the experience of one osteopathic pediatrician’s experience in delivering osteopathic interventions via telehealth. Methods Patients were offered the option of converting their existing OMT appointment to a telehealth visit. Prior to the appointment, instructions were emailed to the patient’s parent or guardian along with a voluntary survey to provide feedback. Thirty-minute telehealth visits were conducted during which the provider gave verbal and visual instructions to a parent or guardian over a video platform to guide them in providing treatment to the patient based on osteopathic principles. Patients aged 3 and older rated their pain before and after the appointment using the Wong-Baker FACES scale. Deidentified patient demographics, chief complaints, treatments, anatomic locations, and pain scores were recorded in a REDcap database. Descriptive statistics were analyzed and paired samples t-tests were used with a p-value of <0.05 used to determine significance. Results Eighteen patients ranging from 6 months to 19 years of age were treated utilizing osteopathic interventions via telehealth during 54 distinct visits. The most common chief complaints treated were back (n=31; 26.3%) and neck (n=28; 23.7%) pain. The most common osteopathic techniques upon which instruction was based were inhibition (n=131; 29.7%) soft tissue (n=127; 28.8%) and counterstrain (n=78; 17.7%). The average post-treatment pain score (2.57) was significantly lower than the average pre-treatment pain score (6.77) p<0.01. No serious complications were observed. Conclusions In our small retrospective case series, osteopathic interventions via telehealth resulted in decreased average pain scores following treatment while minimizing risk of viral exposure and transmission. Further study is needed to determine if such treatment methods could be effective on a larger scale when distance or illness preclude an in-person OMT visit.

Patient Outcomes and Spinal Cord Stimulation: A Retrospective Case Series Evaluating Patient Satisfaction, Pain Scores, and Opioid Requirements

Pain Practice ◽  
2015 ◽  
Vol 16 (7) ◽  
pp. 899-904 ◽  
Author(s):  
Rebecca A. Sanders ◽  
Susan M. Moeschler ◽  
Halena M. Gazelka ◽  
Tim J. Lamer ◽  
Zhen Wang ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Patient Satisfaction ◽  
Patient Outcomes ◽  
Spinal Cord Stimulation ◽  
Case Series ◽  
Retrospective Case ◽  
Pain Scores ◽  
Retrospective Case Series
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