scholarly journals Bilateral Intra-Articular Radiofrequency Ablation for Cervicogenic Headache

2017 ◽  
Vol 2017 ◽  
pp. 1-6 ◽  
Author(s):  
Charles A. Odonkor ◽  
Teresa Tang ◽  
David Taftian ◽  
Akhil Chhatre
Keyword(s):  
Radiofrequency Ablation ◽  
Pain Relief ◽  
Symptomatic Relief ◽  
Cervicogenic Headache ◽  
Term Treatment ◽  
Medial Branch ◽  
Neck Stiffness ◽  
Intervertebral Disks ◽  
Long Term Treatment ◽  
Improved Function

Introduction. Cervicogenic headache is characterized by unilateral neck or face pain referred from various structures such as the cervical joints and intervertebral disks. A recent study of patients with cervical pain showed significant pain relief after cervical medial branch neurotomy but excluded patients with C1-2 joint pain. It remains unclear whether targeting this joint has potential for symptomatic relief. To address this issue, we present a case report of C1-2 joint ablation with positive outcomes. Case Presentation. A 27-year-old female presented with worsening cervicogenic headache. Her pain was 9/10 by visual analog scale (VAS) and described as cramping and aching. Pain was localized suboccipitally with radiation to her jaw and posterior neck, worse on the right. Associated symptoms included clicking of her temporomandibular joint, neck stiffness, bilateral headaches with periorbital pain, numbness, and tingling. History, physical exam, and diagnostic studies indicated localization to the C1-2 joint with 80% decrease in pain after C1-2 diagnostic blocks. She underwent bilateral intra-articular radiofrequency ablation of the C1-C2 joint. Follow-up at 2, 4, 8, and 12 weeks showed improved function and pain relief with peak results at 12 weeks. Conclusion. Clinicians may consider C1-C2 joint ablation as a viable long-term treatment option for cervicogenic headaches.

scholarly journals The Effectiveness of Radiofrequency Ablation of Medial Branch Nerves for Chronic Lumbar Facet Joint Syndrome in Patients Selected by Guideline-Concordant Dual Comparative Medial Branch Blocks

Pain Medicine ◽  
2019 ◽  
Vol 21 (5) ◽  
pp. 902-909 ◽  
Author(s):  
Aaron Conger ◽  
Taylor Burnham ◽  
Fabio Salazar ◽  
Quinn Tate ◽  
Mathew Golish ◽  
...  
Keyword(s):  
Radiofrequency Ablation ◽  
Pain Relief ◽  
Primary Outcome ◽  
Rating Scale ◽  
Degenerative Spondylolisthesis ◽  
Significant Proportion ◽  
Pain Reduction ◽  
Height Loss ◽  
Medial Branch ◽  
Long Term Treatment

Abstract Objectives Although the effectiveness of lumbar medial branch radiofrequency ablation (RFA) for the treatment of zygapophyseal joint (z-joint)–mediated low back pain has been characterized, few studies have described outcomes in patients selected using a guideline-concordant paradigm of ≥80% pain relief with dual comparative medial branch blocks (MBBs). We investigated long-term treatment outcomes of patients selected according to this paradigm. Design Cross-sectional cohort study. Methods The medical records of 111 consecutive patients were reviewed; 85 met inclusion criteria. A standardized telephone survey was used to capture current numerical rating scale (NRS) and Patient Global Impression of Change (PGIC) scores. The primary outcome was the proportion of patients reporting ≥50% reduction of index pain. Binary logistic regression analysis was performed to explore associations between the primary outcome and covariates, including age, duration of pain, presence of scoliosis, degenerative spondylolisthesis, and >75% disc height loss. Results At six to 12, 12–24, and >24 months, 63.2% (95% confidence interval [CI] = 41–85%), 65.6% (95% CI = 49–82%), and 44.1% (95% CI = 27–61%) of patients reported a ≥50% pain reduction (P = 0.170), respectively. At a minimum of six months, 70.6% of patients reported a pain reduction of two or more points (minimally clinically important change), and 54.1% reported a PGIC score consistent with “much improved” or better. Older age and a smaller Cobb angle were associated with a ≥50% pain reduction (P < 0.05). Conclusion Lumbar medial branch RFA is an effective, durable treatment for a significant proportion of patients with recalcitrant lumbar z-joint pain when candidacy is determined by the guideline-concordant paradigm of ≥80% pain relief with dual comparative MBBs.

Ptosis following botulinum toxin injection in hemifacial spasm

2020 ◽  
Author(s):  
Mansooreh Jamshidian-Tehrani ◽  
Hadi Z. Mehrjardi ◽  
Abolfazl Kasaee ◽  
Samira Yadegari
Keyword(s):  
Botulinum Toxin ◽  
Hemifacial Spasm ◽  
Botulinum Toxin Injection ◽  
Symptomatic Relief ◽  
Symptom Relief ◽  
Spontaneous Remission ◽  
Cataract Extraction ◽  
Glaucoma Surgery ◽  
Term Treatment ◽  
Long Term Treatment

Hemifacial spasm (HFS) is characterized by irregular involuntary tonic or clonic contractions of muscles innervated by the seventh cranial nerve. Patients usually need long-term treatment, as spontaneous remission is infrequent. Repeated botulinum toxin injection has been shown as a safe and successful treatment for symptomatic relief in patients with HFS.1 Side effects are usually mild and transient. Ptosis has been reported in about 24% of patients with HFS probably due to diffusion of toxin to levator palpebrae superioris muscle.2 However, the frequency of ptosis in patients with HFS has not been addressed yet, due to causes other than botulinum toxin side effect. Herein, we present a case of HFS who presented to our clinic with complaint of complete ptosis and progressive pain early after botulinum toxin injection. Despite initial negative evaluations, further work up revealed a compressive lesion. A 75-year-old man presented with left severe ptosis since 3 weeks ago (Figure 1). He was known case of left HFS since 4 years ago, and botulinum toxin had been regularly injected for his symptom relief in orbicularis oculi, corrugator, and procerus muscles.   Figure 1. Left Blepharoptosis one week after botulinum toxin injection   The patient stated that this new ptosis had begun within a week after his last Dysport (Ipsen, Ltd., Slough, Berkshire, UK) injection while he had no ptosis in his previous injections. In past medical history, he had ischemic heart disease, hypertension, cataract extraction of both eyes, and glaucoma surgery on his right eye. He had been admitted to the neurology ward of a general hospital.

scholarly journals Currently Recommended TON Injectate Volumes Concomitantly Block the GON: Clinical Implications for Managing Cervicogenic Headache

2016 ◽  
Vol 7;19 (7;9) ◽  
pp. E1079-E1086 ◽  
Author(s):  
Sayed Emal Wahezi
Keyword(s):  
Methylene Blue ◽  
Radiofrequency Ablation ◽  
Treatment Options ◽  
Academic Medical Center ◽  
Cervicogenic Headache ◽  
Small Sample ◽  
Medial Branch ◽  
Occipital Nerve ◽  
Number Of Patients ◽  
Greater Occipital Nerve

Background: Headache (HA) is a significant cause of morbidity globally. Despite many available treatment options, HAs that are refractory to conservative management can be challenging to treat. Third occipital nerve (TON) and greater occipital nerve (GON) irritation are potential etiologic agents of primary and cervicogenic HAs that can be targeted using minimally invasive treatment options such as nerve blocks or radiofrequency ablation. However, a substantial number of patients that undergo radiofrequency ablation do not experience pain relief despite a positive diagnostic medial branch block (MBB). Objective: In this study, we investigate the underlying cause for the high rate of false positives associated with MBBs by evaluating injectate spread in cadaveric subjects. Study Design: Cadaveric study. Setting: Academic medical center. Methods: After obtaining exemption status from our Institutional Review Board, TON injections were performed on 5 preserved cadavers, a total of 10 TONs, using anatomic landmarks, partial dissection, and palpation to guide needle placement. Cadaveric dissections were performed to evaluate the location, vertical spread, and grossly observed injectate coating of the TON and GON for each quantity of methylene blue injectate, 0.3 mL and 0.5 mL, administered. Results: The average distance between the TON and GON at their respective foraminal exit points was 1.81 cm. The average vertical spread for 0.3 mL and 0.5 mL of methylene blue injectate was 2.02 + 0.35 cm and 3.26 + 0.48 cm when performing a TON block. When using 0.3 mL injectate, both the TON and GON were simultaneously coated 60% of the time. After increasing the injectate volume to 0.5 mL, both the TON and GON were simultaneously coated 100% of the time. Limitations: The cadaveric design of this study presents limitations when translating cadaveric findings to the clinical setting. Also, the small sample size limits its power and generalizability. Lastly, the potential for researcher bias exists as the investigators were not blinded. Conclusions: This study demonstrates that currently recommended injectate volumes for TON blocks may result in concomitant coating of the GON. Conventional radiofrequency ablation (RFA) of these nerves may not lesion both the TON and GON given its restrictive circumferential lesioning diameter of 5 – 7 mm. As such, interventionalists should consider performing radiofrequency ablation to both the TON and GON after a positive TON block. Key Words: Chronic pain, cervicogenic headache, third occipital nerve, greater occipital nerve, injectate spread, radiofrequency ablation

The Effectiveness of Cervical Medial Branch Thermal Radiofrequency Neurotomy Stratified by Selection Criteria: A Systematic Review of the Literature

Pain Medicine ◽  
2020 ◽  
Vol 21 (11) ◽  
pp. 2726-2737
Author(s):  
Andrew Engel ◽  
Wade King ◽  
Byron J Schneider ◽  
Belinda Duszynski ◽  
Nikolai Bogduk
Keyword(s):  
Systematic Review ◽  
Pain Relief ◽  
Evaluation System ◽  
Selection Criteria ◽  
Cervicogenic Headache ◽  
Primary Outcome Measure ◽  
Outcome Data ◽  
Complete Relief ◽  
Medial Branch ◽  
Radiofrequency Neurotomy

Abstract Objective To determine the effectiveness of cervical medial branch thermal radiofrequency neurotomy in the treatment of neck pain or cervicogenic headache based on different selection criteria. Design Comprehensive systematic review. Methods A comprehensive literature search was conducted, and the authors screened and evaluated the studies. The Grades of Recommendation, Assessment, Development, and Evaluation system was used to assess all eligible studies. Outcome Measures The primary outcome measure assessed was the success rate of the procedure, defined by varying degrees of pain relief following neurotomy. Data are stratified by number of diagnostic blocks and degree of pain relief. Results Results varied by selection criteria, which included triple placebo-controlled medial branch blocks, dual comparative medial branch blocks, single medial branch blocks, intra-articular blocks, physical examination findings, and symptoms alone. Outcome data showed a greater degree of pain relief more often when patients were selected by triple placebo-controlled medial branch blocks or dual comparative medial branch blocks, producing 100% relief of the index pain. The degree of pain relief was similar when triple or dual comparative blocks were used. Conclusions Higher degrees of relief from cervical medial branch thermal radiofrequency neurotomy are more often achieved, to a statistically significant extent, if patients are selected on the basis of complete relief of index pain following comparative diagnostic blocks. If selected based on lesser degrees of relief, patients are less likely to obtain complete relief.

scholarly journals Treatment Response of Botulinum-A Toxin Intradetusor Injections for Overactive Bladder (OAB) and Neurological Detrusor Overactivity (NDO) Refractory to Anticholinergics and Beta3-Adrenoceptor Agonists

2021 ◽  
pp. 231-238
Author(s):  
Fouzia Rasool Memon ◽  
Muhammad Ali Suhail ◽  
Anwar Ali Jamali ◽  
Mohammad Matar ◽  
Sikander Ali Sial ◽  
...  
Keyword(s):  
Overactive Bladder ◽  
Symptomatic Relief ◽  
Time Frame ◽  
Term Treatment ◽  
Advanced Age ◽  
Time Period ◽  
Long Term Treatment ◽  
Duration Of Response ◽  
Adrenoceptor Agonists

Introduction: Overactive bladder (OAB), defined as urinary urgency, usually accompanied by frequency and nocturia, with or without urgency urinary incontinence, in the absence of urinary tract infection or other obvious pathology. Methods: A retrospective review of patients getting intradetrusor onabotulinumA injections for OAB and NDO over a 6-year time frame was conducted. The principal outcome measures involved patient’s subjective improvements in OAB and NDO symptoms and the duration of symptomatic relief following every treatment. The secondary results measured relation of patient’s age and duration of each effective treatment cycle. Results: One hundred and thirty-Eight (138) consecutive patients who met the inclusion criteria were included in the study. The average age of women was 59.43 years. Eighty four (61%) of participants were still receiving botox injections while 54 women stopped treatment. The average time period between botulinum A injection and its efficacy in controlling OAB symptoms varied from 3 -8.5 months. There was no decrease in efficacy of the treatment with more cycles of treatment. The average age of women who received one, two, three and four or more cycles were 61.7, 53.87, 63.03, and 56.75 years respectively, which showed with advanced age efficacy of botulinum toxin does not decrease. Conclusions: Our results suggest that in patients who respond to intradetrusor botulinumA treatment, the duration of response does not decline with more treatment cycles, suggesting it as a safe long term treatment option for controlling OAB symptoms. Also there is no relation between advanced age and subsequent efficacy of botulinum A intradetrusor injections.

scholarly journals Medial Branch Radiofrequency Ablation as an Alternative of Vertebroplasty for Pain Treatment after Vertebral Compression Fractures

2019 ◽  
pp. 179-184
Author(s):  
Laureano Delange Segura
Keyword(s):  
Radiofrequency Ablation ◽  
Pain Relief ◽  
Vertebral Fractures ◽  
Compression Fracture ◽  
Persistent Pain ◽  
Vertebral Compression Fractures ◽  
Medial Branch ◽  
Vertebral Augmentation ◽  
Facet Joints ◽  
Augmentation Techniques

Vertebral fractures are very frequent among the population affected by osteoporosis, being pain one of the most distressing associated symptoms. The classic treatment of vertebral fractures is, in principle, conservative. However, in the case of persistent pain, vertebral augmentation techniques and radiofrequency ablation (in the event that vertebral augmentation techniques can’t be applied) have proved to be useful. We present the case of a patient who developed severe pain secondary to an acute T2 and L3 fracture, in addition to a posterior T6 fracture. It was treated successfully with L3 vertebroplasty and facet joints denervation of T1-T2 and later T5-T6, this being justified by the technical impossibility of performing vertebroplasty on said levels. The patient was discharged from the hospital with managed pain relief and more than a 50% reduction in opioids doses. Three months later, she continued experiencing pain relief. Radiofrequency ablation of the medial branch of facet joints can be useful in the treatment of pain associated with vertebral fractures in patients where vertebral augmentation techniques are contraindicated or as a complementary treatment for persistent pain. Key words: Vertebral compression fracture, percutaneous vertebroplasty, radiofrequency ablation, medial branch, facet joints, osteoporosis

scholarly journals Medical Cannabis Use and Pain: An Experience Sampling Study

2021 ◽  
Vol 12 ◽  
Author(s):  
Sharon Rodner Sznitman ◽  
Dennis Rosenberg ◽  
Simon Vulfsons ◽  
David Meiri ◽  
Talya Greene
Keyword(s):  
Pain Relief ◽  
Well Being ◽  
Time Lapse ◽  
Term Treatment ◽  
Medical Cannabis ◽  
Daily Diary Study ◽  
Long Term Treatment ◽  
Pain Affect ◽  
Pain Experiences

Background: Little research has tested associations of pain and MC use after long-term treatment and through methods that have external validity outside experimental settings. The study examined associations of pain, associated painful experiences, and long-term medical cannabis (MC) use in chronic pain (CP) patients using a naturalistic daily diary study that provided novel and externally valid data.Methods: Data were obtained from 78 MC users with CP three times daily over a 10-day period (nobservations = 1,688). Mixed-effects models were used to test the associations between MC use and momentary experiences of pain, affect, and fatigue.Results: Within persons, elevated experiences of pain intensity were associated with greater intention to use MC within the next hour. No evidence was found that the time lapse since last MC use was associated with pain levels, negative affect, or fatigue.Conclusions: The results imply that after long-term use, CP patients intend to use MC in response to pain experiences. Yet, they may not actually achieve the pain relief. More research is needed to examine whether continued MC use despite lack of pain relief is related to relief of other symptoms (e.g., dependence, withdrawal) or positive benefits (e.g., general sense of well-being) or tolerance.

scholarly journals Do NSAIDs Take Us Away From Treatment Goals in Axial Spondyloarthritis: A Story About Dysbiosis or Just a Matter of Bias?

2021 ◽  
Vol 8 ◽  
Author(s):  
Rubén Queiro-Silva ◽  
Andrea García-Valle ◽  
Sara Alonso-Castro ◽  
Mercedes Alperi-López
Keyword(s):  
Barrier Function ◽  
Symptomatic Relief ◽  
Term Treatment ◽  
Treat To Target ◽  
Treatment Goals ◽  
Long Term Treatment ◽  
Gut Mucosa ◽  
Spa Treatment ◽  
Inflammatory Drugs ◽  
Type 3

Non-steroidal anti-inflammatory drugs (NSAIDs) remain the mainstay of treatment for spondyloarthritides (SpA), a group of entities with common clinical and pathophysiological aspects, but also with differential features. Although NSAIDs provide significant symptomatic relief, especially for joint pain and morning stiffness, their role in achieving and maintaining the treatment goals advocated by the treat to target strategy in SpA is not entirely clear. These agents can induce changes in the composition of the intestinal microbiota, also favoring an alteration of the barrier function in the gut epithelium. All of this, favored by a pre-disposing genetic background, could activate a specific type of aberrant immune response in the gut lamina propria, also known as type-3 immunity. This article offers a perspective on how NSAIDs, despite their undeniable value in the short-term SpA treatment, could hinder the achievement of medium and long-term treatment goals by compromising the barrier function of the gut mucosa and potentially altering the composition of the gut microbiota.

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