scholarly journals Simplicity Radiofrequency Ablation Demonstrates Greater Functional Improvement Than Analgesia: A Prospective Case Series

2021 ◽  
pp. E185-E190
Keyword(s):  
Radiofrequency Ablation ◽  
Sacroiliac Joint ◽  
Rating Scale ◽  
Case Series ◽  
Numeric Rating Scale ◽  
Pain Clinic ◽  
Functional Improvement ◽  
Data Points ◽  
Prospective Case Series

BACKGROUND: Pain originating from the posterior sacroiliac complex is notoriously difficult to effectively treat due to its complex anatomy and variable innervation. Data on radiofrequency ablation (RFA) is limited. The Abbott Simplicity probe creates 3 monopolar lesions along the medial aspect of the sacroiliac joint and 2 bipolar lesions between the active portions of the probe. This device has been studied previously with improvement of pain-associated disability and pain reduction, but insufficient data is present to determine its utility at this time. Using the most recent literature for the potential innervation of the posterior sacroiliac joint, it is reasonable to explore this novel device and its ability to treat sacroiliac joint pain. OBJECTIVES: Identify the percentage of improved posterior sacroiliac complex pain and improved function in patients who completed posterior sacroiliac complex radiofrequency ablation using the Simplicity probe. STUDY DESIGN: Prospective case series. SETTING: A single outpatient pain clinic. METHODS: This prospective case-series occurred at an outpatient pain clinic. Data were analyzed after completion of follow-up appointments. Inclusion criteria included 2 successful lateral branch blocks. Fourteen patients with posterior sacroiliac complex pain were examined and completed sacroiliac ablation with the Simplicity probe. The numeric rating scale and the Modified Oswestry Disability Index were used as outcome measures for pain and function, respectively. The primary outcome measures were improvement in the numeric rating scale score by a reduction of 2.5 points and an improvement in Modified Oswestry Disability Index by 15% based upon previous studies demonstrating these values as the minimal clinical important difference . Patients were followed at a 3 to 6 month interval and 12 month interval (an average of 88 and 352 days, respectively). RESULTS: In total, 14 patients were examined. At the first follow-up, 29% of patients had analgesia and 38% functionally improved. At the second follow-up, 15% of patients had analgesia and 31% functionally improved. LIMITATIONS: Considering data were collected retrospectively, this study relied on completed charts. Therefore, data points of interest were limited to what was previously documented, which included multiple answers or the absence of numerical data points. In addition, patients were disproportionately female (71.4%). Data were also affected by patients lost to follow-up. Also, this study examined a relatively small number of patients, therefore the results should be carefully considered. CONCLUSIONS: Radiofrequency ablation of the posterior sacroiliac complex with the Simplicity probe resulted in more functional improvement than analgesia. This study provides more data for clinicians to utilize in managing posterior sacroiliac complex pain. IRB: Protocol number 20170342HU. Not registered in clinical trials. KEY WORDS: Posterior sacroiliac complex, sacroiliac pain, chronic low back pain, radiofrequency denervation, functional improvement, strip lesion, multi-lesion, Simplicity probe

A Treatment-Based Classification Algorithm to Treat Achilles Tendinopathy: An Exploratory Case Series

2017 ◽  
Vol 26 (3) ◽  
pp. 260-268
Author(s):  
Patti Syvertson ◽  
Emily Dietz ◽  
Monica Matocha ◽  
Janet McMurray ◽  
Russell Baker ◽  
...  
Keyword(s):  
Outcome Measures ◽  
Repeated Measures ◽  
Rating Scale ◽  
Case Series ◽  
Numeric Rating Scale ◽  
Achilles Tendinopathy ◽  
Global Rating ◽  
Physically Active ◽  
Indirect Treatment

Context:Achilles tendinopathy is relatively common in both the general and athletic populations. The current gold standard for the treatment of Achilles tendinopathy is eccentric exercise, which can be painful and time consuming. While there is limited research on indirect treatment approaches, it has been proposed that tendinopathy patients do respond to indirect approaches in fewer treatments without provoking pain.Objective:To determine the effectiveness of using a treatment-based-classification (TBC) algorithm as a strategy for classifying and treating patients diagnosed with Achilles tendinopathy.Participants:11 subjects (mean age 28.0 ±15.37 y) diagnosed with Achilles tendinopathy.Design:Case series.Setting:Participants were evaluated, diagnosed, and treated at multiple clinics.Main Outcome Measures:Numeric Rating Scale (NRS), Disablement in the Physically Active Scale (DPA Scale), Victorian Institute of Sport Assessment–Achilles (VISA-A), Global Rating of Change (GRC), and Nirschl Phase Rating Scale were recorded to establish baseline scores and evaluate participant progress.Results:A repeated-measures ANOVA was conducted to analyze NRS scores from initial exam to discharge and at 1-mo follow-up. Paired t tests were analyzed to determine the effectiveness of using a TBC algorithm from initial exam to discharge on the DPA Scale and VISA-A. Descriptive statistics were evaluated to determine outcomes as reported on the GRC.Conclusion:The results of this case series provide evidence that using a TBC algorithm can improve function while decreasing pain and disability in Achilles tendinopathy participants.

scholarly journals Genicular Nerve Radiofrequency Ablation for Chronic Knee Pain Using a Three-Tined Electrode: A Technical Description and Case Series

Pain Medicine ◽  
2020 ◽  
Vol 21 (12) ◽  
pp. 3344-3349
Author(s):  
Edvin Koshi ◽  
Cole W Cheney ◽  
Beau P Sperry ◽  
Aaron Conger ◽  
Zachary L McCormick
Keyword(s):  
Radiofrequency Ablation ◽  
Knee Osteoarthritis ◽  
Knee Pain ◽  
Rating Scale ◽  
Case Series ◽  
Numeric Rating Scale ◽  
Vastus Medialis ◽  
The Novel ◽  
Chronic Knee Pain ◽  
Numeric Rating

Abstract Background Genicular nerve radiofrequency ablation (RFA) for the treatment of chronic knee pain has traditionally targeted the superomedial, superolateral, and inferomedial genicular nerves. However, recent cadaveric studies of knee neuroanatomy demonstrate varied locations of these specific nerves as well as additional articular nerves. This work suggests that traditional genicular nerve RFA lesion locations may be inadequate. Objective 1) To describe a novel protocol utilizing a three-tined RFA electrode to target the superomedial (SMGN), superolateral (SLGN), and inferomedial genicular nerves (IMGN), as well as the terminal articular branches of the nerves to the vastus medialis (NVM), intermedius (NVI), and lateralis (NVL). 2) To assess the ability of this technique to reduce chronic knee pain. Methods Case series of consecutive patients with six or more months of refractory knee pain who underwent genicular nerve RFA according to the novel protocol described. Seven discrete RFA lesions were placed to target the SMGN, NVM, NVI, NVL, SLGN, and IGMN. Results Eleven patients underwent RFA, nine with knee osteoarthritis and two postarthroplasty. At one month, 91% (95% CI = 59–100%), 82% (95% CI = 48–98%), and 9% (95% CI = 2–41%), of patients reported ≥50%, ≥80%, and 100% improvement in knee pain on the numeric rating scale, respectively. These results were sustained at six months. There were no complications. Discussion/Conclusions These preliminary data suggest the feasibility and possible effectiveness of genicular nerve RFA using the described novel protocol including a three-tined electrode. Larger-scale studies with comparative groups are warranted.

scholarly journals Could methylene blue be used to manage burning mouth syndrome? A pilot case series

2020 ◽  
Vol 26 (3) ◽  
pp. 35
Author(s):  
Papa Abdou Lecor ◽  
Babacar Touré ◽  
Nathan Moreau ◽  
Adeline Braud ◽  
Wisam Dieb ◽  
...  
Keyword(s):  
Methylene Blue ◽  
Rating Scale ◽  
Topical Therapy ◽  
Case Series ◽  
Numeric Rating Scale ◽  
Burning Mouth Syndrome ◽  
Spontaneous Pain ◽  
Dental Clinic ◽  
Burning Mouth

Objective: Burning mouth syndrome is a disabling condition of complex pathophysiology characterized by spontaneous pain felt in the oral mucosa in the absence of evident mucosal lesions which lacks efficient treatments to this day. The purpose of this study was to demonstrate the efficacy of methylene blue in the management of burning mouth syndrome. Methods: The study was conducted at the dental clinic of the Anta Diop University and Newtown dental clinic of Dakar, Senegal. A solution of methylene blue as a mouth-rinse (0.5%) was applied for 5 minutes in five patients satisfying the ICHD-3 diagnostic criteria for burning mouth syndrome. This procedure was repeated every 6 hours 3 times per 24h, during 7 days. Using numeric rating scale, pain severity was assessed as the mean pain felt during the last day of application. Results: After 7 days, the pain was significantly reduced by two-thirds and almost absent at 3 and 6 months follow-up. No secondary effects of the use of methylene blue were observed. Putative mechanisms of action and potential implications for treatment are discussed. Conclusion: Methylene blue is an old compound but a novel topical therapy that could prove beneficial in the management of burning mouth syndrome.

scholarly journals Twelve-month analgesia and rescue, by cooled radiofrequency ablation treatment of osteoarthritic knee pain: results from a prospective, multicenter, randomized, cross-over trial

2019 ◽  
Vol 44 (4) ◽  
pp. 499-506 ◽  
Author(s):  
Tim Davis ◽  
Eric Loudermilk ◽  
Michael DePalma ◽  
Corey Hunter ◽  
David A Lindley ◽  
...  
Keyword(s):  
Radiofrequency Ablation ◽  
Knee Pain ◽  
Rating Scale ◽  
Numeric Rating Scale ◽  
Clinical Trial Registration ◽  
Provide Pain Relief ◽  
Registration Number ◽  
The Mean ◽  
Numeric Rating

Background and objectivesAs a follow-up to the 6-month report,12 this study investigated the analgesic effect of cooled radiofrequency ablation (CRFA) in patients with knee osteoarthritis (OA) 12 months postintervention and its ability to provide pain relief in patients who experienced unsatisfactory effects of intra-articular steroid injection (IAS).MethodsSeventy-eight per cent (52/67) of patients originally treated with CRFA were evaluated at 12 months, while at 6 months post-IAS, 82% (58/71) of those patients crossed over to CRFA and assessed 6 months later.ResultsAt 12 months, 65% of the original CRFA group had pain reduction ≥50%, and the mean overall drop was 4.3 points (p<0.0001) on the numeric rating scale. Seventy-five per cent reported ‘improved’ effects. The cross-over group demonstrated improvements in pain and functional capacity (p<0.0001). No unanticipated adverse events occurred.ConclusionsThis study demonstrates that analgesia following CRFA for OA knee pain could last for at least 12 months and could rescue patients who continue to experience intolerable discomfort following IAS.Clinical trial registrationThe ClinicalTrials.gov registration number for this study is NCT02343003.

scholarly journals A Prospective Randomized Comparison of the Efficacy of Ultrasound- vs FluoroscopyGuided Genicular Nerve Block for Chronic Knee Osteoarthritis

2019 ◽  
Vol 2 (22.2) ◽  
pp. 139-146
Author(s):  
Seong-Soo Choi
Keyword(s):  
Pain Relief ◽  
Knee Osteoarthritis ◽  
Knee Pain ◽  
Nerve Block ◽  
Rating Scale ◽  
Numeric Rating Scale ◽  
Pain Clinic ◽  
Nerve Blocks ◽  
Numeric Rating

Background: Recently, genicular nerve block and radiofrequency ablation were introduced to alleviate knee pain in patients with chronic knee osteoarthritis. Both ultrasound- and fluoroscopyguided genicular nerve blocks have been used. However, whether one is superior to the other remains unknown. Objectives: The present study compares the efficacy of ultrasound- vs fluoroscopy-guided genicular nerve blocks. Study Design: This research used a prospective randomized comparison design. Setting: The study took place at a single pain clinic within a tertiary medical center in Seoul, Republic of Korea. Methods: From July 2015 to September 2017, a randomized controlled study was performed to analyze the difference in the efficacy of ultrasound- vs fluoroscopy-guided genicular nerve blocks. The Numeric Rating Scale (NRS-11), Western Ontario and McMaster Universities Arthritis Index (WOMAC), Global Perceived Effect Scales (GPES), and complications were evaluated preprocedure, and 1 and 3 months after genicular nerve block. Results: A total of 80 patients were enrolled and randomly distributed to groups U (ultrasoundguided, n = 40) and F (fluoroscopy-guided, n = 40). Those who were lost to follow-up or had undergone other interventions were excluded, resulting in 31 and 30 patients in groups U and F, respectively. No differences in NRS-11 or WOMAC were observed between the 2 groups at baseline or during the follow-up period. GPES and complication rates were also similar between both groups. Limitations: We were unable to perform double-blind randomization and did not evaluate patients’ baseline emotional states. Conclusions: Pain relief, functional improvement, and safety were similar between groups receiving ultrasound- and fluoroscopy-guided genicular nerve blocks. Therefore, either of the 2 imaging devices may be utilized during a genicular nerve block for chronic knee pain relief. However, considering radiation exposure, ultrasound guidance may be superior to fluoroscopic guidance. The study protocol was approved by our institutional review board (2015-0369), and written informed consent was obtained from all patients. The trial was registered with the Clinical Research Information Service (KCT 0002846). This work was presented in part as D-H Kim’s MS thesis at the University of Ulsan College of Medicine (2018). Key words: Genicular nerve block, ultrasound, fluoroscopy, knee osteoarthritis, Numeric Rating Scale, The Western Ontario and McMaster Universities Osteoarthritis Index

scholarly journals Functional improvement of bilateral frozen shoulder by unilateral intra-articular corticosteroid injection: a retrospective study

2021 ◽  
Vol 49 (10) ◽  
pp. 030006052110505
Author(s):  
Minchul Kim ◽  
Ki-Yong Kim ◽  
Yool-Gang Huh ◽  
Sang Hyeok Ma ◽  
Kil-Yong Jeong ◽  
...  
Keyword(s):  
Rating Scale ◽  
External Rotation ◽  
Corticosteroid Injection ◽  
Frozen Shoulder ◽  
Numeric Rating Scale ◽  
Functional Improvement ◽  
Symptom Duration ◽  
The Mean ◽  
Numeric Rating

Objective Bilateral frozen shoulder (FS) is often treated with intra-articular corticosteroid injection (IACI). No studies have been performed to establish whether IACI must be administered in both shoulders or in only one shoulder to improve function. This study was therefore performed to determine whether unilateral IACI improves shoulder pain and passive range of motion (pROM) in bilateral FS. Methods The medical records of 165 patients with bilateral primary FS who underwent ultrasonography-guided IACI (2 mL of 10-mg/mL triamcinolone acetonide mixed with 5 mL of 1% lidocaine) in one shoulder were retrospectively reviewed. The outcome measures, namely the numeric rating scale (NRS) scores and pROM values (abduction, external rotation, flexion, hyperextension, and internal rotation), were evaluated pre- and post-injection. Results The patients’ mean age was 54.0 ± 8.0 years. The mean symptom duration was 6.5 ± 2.8 months. The mean follow-up period after injection was 6.7 ± 0.8 weeks. The NRS scores and pROM values significantly improved in both the injected and non-injected shoulders. Conclusions This study showed that unilateral IACI in patients with bilateral FS improves the clinical outcome of the non-injected shoulder. We suggest that physicians observe the non-injected shoulder after unilateral injection rather than performing bilateral injections.

Punch Grafting for the Management of Hard-to-Heal Diabetic Foot Ulcers: A Prospective Case Series

2021 ◽  
pp. 153473462110310
Author(s):  
Marta García-Madrid ◽  
Irene Sanz-Corbalán ◽  
Aroa Tardáguila-García ◽  
Raúl J. Molines-Barroso ◽  
Mateo López-Moral ◽  
...  
Keyword(s):  
Wound Healing ◽  
Clinical Outcomes ◽  
Diabetic Foot ◽  
Donor Site ◽  
Case Series ◽  
Foot Ulcers ◽  
Diabetic Foot Ulcers ◽  
Wound Debridement ◽  
Prospective Case Series

Punch grafting is an alternative treatment to enhance wound healing which has been associated with promising clinical outcomes in various leg and foot wound types. We aimed to evaluate the clinical outcomes of punch grafting as a treatment for hard-to-heal diabetic foot ulcers (DFUs). Six patients with chronic neuropathic or neuroischemic DFUs with more than 6 months of evolution not responding to conventional treatment were included in a prospective case series between May 2017 and December 2020. All patients were previously debrided using an ultrasound-assisted wound debridement and then, grafted with 4 to 6 mm punch from the donor site that was in all cases the anterolateral aspect of the thigh. All patients were followed up weekly until wound healing. Four (66.7%) DFUs were located in the heel, 1 (16.7%) in the dorsal aspect of the foot and 1 (16.7%) in the Achilles tendon. The median evolution time was 172 (interquartile range [IQR], 25th-75th; 44-276) weeks with a median area of 5.9 (IQR; 1.87-37.12) cm2 before grafting. Complete epithelization was achieved in 3 (50%) patients at 12 weeks follow-up period with a mean time of 5.67 ± 2.88 weeks. Two of the remaining patients achieved wound healing at 32 and 24 weeks, respectively, and 1 patient showed punch graft unsuccessful in adhering. The median time of wound healing of all patients included in the study was 9.00 (IQR; 4.00-28.00) weeks. The wound area reduction (WAR) at 4 weeks was 38.66% and WAR at 12 weeks was 88.56%. No adverse effects related to the ulcer were registered through the follow-up period. Autologous punch graft is an easy procedure that promotes healing, achieving wound closure in chronic DFUs representing an alternative of treatment for hard-to-heal DFUs in which conservative treatment has been unsuccessful.

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