Pain Relief Rate Research Articles

Gamma Knife Radiosurgery for Trigeminal Neuralgia: Role of Trigeminal Length and Pontotrigeminal Angle on Target Definition and on Clinical Effects

Gamma Knife radiosurgery (GKRS) is a well-defined treatment for trigeminal neuralgia. The aim of this study was to determine how the GKRS planning might change on the basis of the patient's own anatomy and how to best choose the target location. Trigeminal cisternal length, pontotrigeminal angle, and distance between middle of the shot and emergence were evaluated in 112 consecutive GKRS plans for trigeminal neuralgia. Correlations with pain outcomes and facial hypoesthesia were analyzed. The mean angle was 29° ± 4.4° and 37° ± 0.9°, respectively, in patients developing and not developing severe hypoesthesia (P= 0.045), despite no significant difference on brainstem dose (11.9 ± 0.8 and 10.5 ± 0.3 Gy; P= 0.22). The length of the nerve was not relevant on clinical outcomes but the shot-emergence distance (mean 8.1 ± 0.2 mm) depended on both trigeminal length and angle (P= 0.01). At constant prescription dose, 6-month cumulative rates of pain relief and control without therapy were 52.9% when the shot-emergence distance was ≤8 mm, whereas 25% when this distance was >8 mm (P= 0.017). The maintenance of good pain control was more long lasting in the first group (49.5 ± 6.6 vs. 25.4 ± 5 months; P= 0.006) with a 5-year cumulative rate of 70% and 26%, respectively (P < 0.001). The pontotrigeminal angle and the shot-emergence distance should be considered during GKRS planning: the first as a potential risk factor for hypoesthesia, and the second should not exceed 8 mm.

Department of Physical Medicine and Rehabilitation, University of Health Sciences, Fatih Sultan Mehmet Education and Training Hospital, Istanbul, Turkey

Background: Postherpetic neuralgia (PHN) occurs in 9% to 34% of herpes zoster (HZ) patients, and the incidence of PHN is positively correlated with age. A number of patients suffer from poor therapeutic effects or intolerable side effects and need to accept minimally invasive analgesia. Objectives: This study aimed to investigate the effects of spinal cord stimulation (SCS) and pulsed radiofrequency (PRF) on the treatment of elderly patients with HZ-related pain persisting beyond the acute phase. Study Design: A prospective, randomized-controlled trial. Setting: Research was conducted at the National Pain Management and Research Center, ChinaJapan Friendship Hospital (Beijing, China). Methods: We selected 63 patients aged over 50 years with zoster-related pain of 1 to 6 months onset. They were randomly divided into an SCS group and a PRF group. In the SCS group, the stimulus electrodes were placed in the affected spinal ganglion segment of the epidural space for 2 weeks. In the PRF group, the radiofrequency needle was percutaneously punctured in the affected dorsal root ganglion. The main outcome measures were the Numeric Rating Scale (NRS-11) score, response rate, and complete remission rate. The secondary endpoint was defined as the use of analgesics and calcium channel antagonists. Results: The NRS-11 score in the SCS group decreased to 2.90 ± 1.83 (1 week post operation) and 4.37 ± 2.43 (24 weeks post operation), while that in the PRF group decreased to 3.13 ± 1.78 and 4.23 ± 2.64, respectively (compared with baseline, P &lt; .001); there was no significant difference between the 2 groups (P &gt; .05) . The effective rate of pain management was in the range of 56.67% to 81.25%, and the complete pain relief rate ranged from 37% to 71%. The number of patients still using analgesics and calcium channel antagonists after operation were significantly less than those pre-operation (P &lt; .001). Univariate and multivariate logistic regression analyses showed that the operation method, age, gender, and course of disease did not affect surgical efficacy. Limitations: The main limitation of this study is that all the cases were from the same center. Conclusion: It therefore can be concluded that SCS and PRF can effectively relieve PHN. Key words: Spinal cord stimulation, pulsed radiofrequency, postherpetic neuralgia

Health Informatics of Oxycodone Hydrochloride Sustained-Release Tablets for Cancer Pain Treatment with Support of Computed Tomography Diagnosis

Objective: The purpose of this study is to analyze the medical value of oxycodone hydrochloride sustainedrelease tablets in the treatment of advanced cancer pain in adults using biostatistics and computed tomography (CT). Methods: The efficacy, pain relief and adverse reactions of oxycodone hydrochloride sustained-release tablets in 100 patients with moderate to severe adult cancer pain were retrospectively analyzed. To compare the effects of gender, first-visit pain degree, pain type and metastasis on the effectiveness and pain relief. VAS score decreased by 25.0% or more is effective for treatment, in which pain disappeared completely for complete relief, VAS score decreased by 75.0% or more for obvious relief, VAS score decreased by 50.0%–74.9% for moderate relief, VAS score decreased by 25.0%–49.9% for mild relief, and VAS score decreased by less than 25.0% for no relief. Results: The pain relief rate was 93%. There were 12 cases of complete relief, 24 cases of obvious relief (32%), 23 cases of moderate relief (31%), 10 cases of mild relief (14%) and 5 cases of no relief (7%). The incidence of adverse reactions in patients was 56% constipation, 40% nausea and 76% vomiting. After 4 weeks, the incidence of adverse reactions in patients was 24% constipation, 13% nausea and 43% vomiting. Furthermore, CT image analysis shows that oxycodone hydrochloride sustained-release tablets has obvious therapeutic effect on cancer. Discussion: High-dose oxycodone sustained-release tablets are effective in the treatment of patients with advanced cancer pain. It can relieve the pain of patients, and has high safety. This can be verified based on our health informatics analysis and CT image diagnosis. Conclusion: Oxycodone hydrochloride sustained release tablets are effective and safe in the outpatient treatment of moderate and severe cancer pain in adults, and have better control effect on moderate cancer pain patients, which is worthy of further application and promotion for clinical use.

Results of proximal interphalangeal arthroplasty: border digits versus middle digits.

This investigation assessed 106 consecutive primary proximal interphalangeal joint arthroplasties performed on border digits: 73 index or 33 little fingers. This was compared with 193 arthroplasties performed in non-border digits: 121 middle or 72 ring fingers. There were 20 proximal interphalangeal joint arthroplasties in the border digits that required revision surgery for pain and stiffness (10 digits), dislocation (six digits), implant fracture (one digit), and infection (three digits). Risk of revision surgery was not associated with border digit. The 5-year implant survival rate for the border digits was 81%. There was no significant difference in implant revision rate or joint dislocations between border and non-border digits. We conclude that proximal interphalangeal joint arthroplasties performed in border digits had similar pain relief, survivorship, complications, and reoperation rates compared with those performed in non-border digits.Level of evidence: IV.

Spinal metastases treated with bipolar radiofrequency ablation with increased (> 70 °C) target temperature: Pain management and local tumor control

PurposeTo investigate the safety and clinical efficacy of bipolar radiofrequency ablation (b-RFA) with increased (>70°C) target temperature for the treatment of spine metastases with the intent of achieving pain relief or local tumor control. Materials and methodsThirty-one patients with a total of 37 metastases who were treated with b-RFA with increased temperature and vertebroplasty from January 2016 to May 2019 were retrospectively included. There were 20 women and 11 men with a mean age of 62.4±10.5 (SD) years (range: 40–78years). Patients and metastases characteristics, procedure details and clinical outcomes were analyzed. ResultsMetastases were predominantly located in lumbar (22/37; 59.5%) or thoracic spine (13/37; 35.1%). Mean target temperature was 88.4±3.5 (SD) °C (range: 70–90°C). Technical success was 100% (37/37 metastases). One (1/37; 2.7%) major complication unrelated to b-RFA was reported. One (1/37; 2.7%) metastasis was lost to follow-up. Favorable outcome was noted in patients receiving b-RFA for pain management (16/20 metastases; 80%; mean follow-up, 3.4±2.9 [SD] months) or with oligometastatic/oligoprogressive disease (6/6 metastases; 100%; mean follow-up, 5.0±4.6 [SD] months). In patients receiving b-RFA to prevent complications, favorable outcome was noted in 6/10 metastases (60%; mean follow-up, 3.8±4.8 [SD] months). ConclusionsB-RFA with increased target temperature has an excellent safety profile and results in high rates of pain relief and local metastasis control in patients with oligometastatic/oligoprogressive disease. Suboptimal results are achieved in patients receiving b-RFA to prevent complications related to the growth of the index tumor.

Outcomes of Treatment for Elderly Patients With Trigeminal Neuralgia: Percutaneous Balloon Compression Versus Microvascular Decompression.

The study aimed to evaluate the surgical outcomes of percutaneous balloon compression (PBC) and microvascular decompression (MVD) in the treatment of elderly patients with trigeminal neuralgia (TN). A total of 30 patients who underwent PBC surgery (PBC group) and 30 patients who received MVD surgery (MVD group) were included. The treatment efficacy, Barrow Neurological Institute (BNI) pain intensity score, inflammatory response, the rates of complication and recurrence were analyzed respectively. The total efficacy was 93.33% in the PBC group and 90.00% in the MVD group (P > 0.05), respectively. The pain relief rate was 90.00% and 86.67% after PBC and MVD surgery, respectively (P > 0.05). The levels of IL-1β, TNF-α, and IL-6 were significantly decreased at post-operative 3 days and 5 days compared with pre-operation in the 2 groups (P < 0.05). The post-operative complication rates regarding masticatory muscle weakness and facial numbness in the PBC group were higher than MVD group (P < 0.05). Nevertheless, the incidences of herpes simplex and keratohelcosis were similar between the 2 groups (P > 0.05). The recurrence rates were also similar between the 3 groups (P > 0.05). Percutaneous balloon compression and MVD are effective in the treatment for elderly TN, which can effectively improve the post-operative cure rate of pain prognosis and reduce the inflammatory response. However, PBC is a minimally invasive, safe and effective method for patients in poor general condition and refused treatment with craniotomy.

A single-arm, prospective, multicenter study on the efficacy and safety of low-dose transdermal fentanyl patch in opioid-naive patients with moderate to severe cancer pain.

e24149 Background: The efficacy and safety of low-dose fentanyl transdermal patch (TDF) in the treatment of opioid-naive patients with moderate-to-severe cancer pain has no tyet been confirmed. There are little international studies, and none in mainland China. The aim of this study was to explore the effect and tolerability of low dose of TDF in opioid-naive patients with Chinese moderate-to-severe cancer pain, and evaluate the influence on quality of life and cognitive function. Methods: A prospective, single-arm, non-randomized, open-label, multicenter trial was conducted with 285 opioid-naivepatients with moderate-to-severe cancer pain in 14 tertiary hospitals in mainland China. The initial analgesic dose of TDF was 12.5 µg/h, pain assessment (pain score, pain relief and pain response rate) was performed every 3 days for a total of 9 cycles.Adverse reactions and events were monitored over 24 days. In the meantime, quality of life and cognitive function of patient were evaluated with EORTC QLQ-C30 and MMSE. Results: 285 patients with 267(92.00%) completed the trial were enrolled. The average age was 60 (range 28-87) and the average effective therapeutic dose was 6.3±6.08mg.The total pain relief rate was 98.12% (mean pain score ±SD, 5.7±0.89 vs 3.9±1.28; P &lt; 0.001). The efficacy of low-dose TDF on pain relief was consistent in groups separated by gender (p &lt; 0.001), age (p &lt; 0.001), types of cancer (p &lt; 0.001), and baseline pain intensity (p &lt; 0.001). There were 79 patients (29.59%) in the low-dose subgroup, and the pain response rate of the low-dose subgroup was better than other dose groups within one week (p = 0.0018).The adverse effects were mild. The most common adverse reactions are constipation 7.87%, followed by nausea 11.24%, vomiting 4.12%, drowsiness 1.87% and urine retention 1.5%.There was no difference in the incidence of adverse reactions between the low-dose subgroup and the other groups (p &gt; 0.05). Meanwhile, TDF improved the quality of life of patients with moderate-to-severe cancer pain (mean± SD: 46.44±16.96 vs. 67.04±18.02;p &lt; 0.05), without impairing cognitive function(mean ±SD, 29.13±1.54 vs. 28.98±1.99; p &gt; 0.05). Conclusions: Low-dose TDF is effective for opioid-naive patients with moderate-to-severe cancer pain. Adverse reactions are mild and the quality of life of patients is improvedwith little losson cognitive function. Further randomized controlled studies are warranted to investigate the value of low-dose TDF in the treatment of opioid intolerant cancer pain. Clinical trial information: ChiCTR-ONC-17014080 .

Efficacy of WC03 in treating radiotherapy-induced oral mucositis (RIOM): A multicenter nonrandomized controlled clinical trial.

e24127 Background: RIOM is a common side effect of radiotherapy for head and neck cancer patients, however, no standard and effective treatment existed so far. WC03 is an oily Traditional Chinese Herbal Medicine recipe for external-use in mouth, which had been utilized to treat RIOM in China-Japan Friendship Hospital for more than ten years. This trial aimed to investigate the safety and efficacy of WC03 in treating RIOM. Methods: Between May 2017 and June 2018, we conducted a multicenter, non-randomized controlled trial within 7 hospitals in China. Inclusion criteria included head and neck cancer patients who developed RIOM (≥ grade II) undergoing radiotherapy or after radiotherapy (within 6 months). They were assigned to different groups based on their willingness. Patients in treatment group were treated by WC03, which was daily applied to the oral mucosa for 30 min twice a day. Patients in control group were treated with Kangfuxin (Periplaneta americana) Lotion combined with conventional treatment such as vitamin B12 and rhGM-CSF. The interventions lasted for 2 weeks. The primary outcome was overall effective rate, which was calculated through changes of radio-induced oral mucositis grade before and after interventions (according to National Cancer Institute Common Toxicity Criteria). Secondary outcome was oral pain which was measured by Numeric Pain Rating Scale. Results: 48 eligible participants were enrolled, 24 in treatment group and 24 in control group, respectively. 2 patients in treatment group were withdrawn from the study in the first week because of developing secondary infection and treatment got changed. Thus, 22 were included at the terminal of the study. All the 24 participants in control group were included. After the intervention, the overall effective rate was 95.45%(21/22) in the treatment group, which was significantly higher than that of 70.83% (17/24) in the control group (p = 0.049). Similarly, 86.36%(19/22) of the participants in treatment group got cured, which was significantly higher than that of 45.83%(11/24) in the control group(p = 0.007). There is a trend that oral pain relief rate in the treatment group was higher than that of the control group, but not statistically significant (100.00% vs. 87.50%, p = 0.210). Patients in treatment group used less time to get relieved from RIOM than control group (5 vs. 8 days, p &lt; 0.001). No adverse event had been observed in both two groups. Conclusions: WC03 is safe and effective in treating radiotherapy-induced oral mucositis. RCT is necessary in future studies.

Efficacy and Safety of Percutaneous Ozone Injection Around Gasserian Ganglion for the Treatment of Trigeminal Neuralgia: A Multicenter Retrospective Study.

BackgroundOzone injection around Gasserian ganglion (OIAGG) has been reported to be an effective treatment for trigeminal neuralgia (TN); however, there remain areas for improvement. To overcome one of these limitations, a multicenter examination of application would be extremely helpful.ObjectiveThe goal of this report was to assess the efficacy of OIAGG for refractory TN across multiple centers and to explore factors predictive of successful treatment.DesignA multicenter, retrospective study.SettingThe study was conducted across 3 pain centers across China.Patients and MethodsA total of 103 subjects from 3 pain centers were enrolled in the study. An ozone-oxygen mixture gas at a concentration of 30 µg/mL was injected into the area around the Gasserian ganglion performed under C-arm X-ray guidance. Primary outcome measures included a pain assessment using a visual analog scale (VAS) and the Barrow Neurological Institute (BNI) pain intensity scale. Clinical assessment of patients for these outcome measures was performed at pretreatment, post-treatment, 6 months, 1 year and 2 years after the OIAGG.ResultsSuccessful pain relief was defined as a score within BNI grades I–IIIa. The pain relief rates at post-treatment, 6 months, 1 year and 2 years after the procedure were 88.35%, 86.87%, 84.46% and 83.30%, respectively. The VAS at each observation time point was significantly different from the preoperative levels (P<0.05). Logistic regression analysis showed that previous nerve damage had a significant effect on the treatment results. No significant complications or side effects were found during or after treatment.ConclusionThis multicenter research confirms our previous single center results that OIAGG is both effective and safe for patients with TN.

Efficacy of Pulsed Radiofrequency to Cervical Nerve Root for Postherpetic Neuralgia in Upper Extremity.

BackgroundPostherpetic neuralgia (PHN) seriously affects a patient’s quality of life, and it is urgent to find a method that can effectively alleviate the PHN of the upper extremity.ObjectiveTo observe the Efficacy of pulsed radiofrequency (PRF) to cervical nerve root for PHN in upper extremity under CT guidance.Study DesignRetrospective comparative study.SettingShengjing Hospital of China Medical University.MethodsFifty patients with PHN in upper extremity were enrolled in Pain Management. Patients were randomized into two groups: cervical nerve root block (A group, n = 25) and cervical nerve root PRF (B group, n = 25). At each observation time, the general characteristics, visual analog scale (VAS), quality of life scores assessment (SF-36), the total efficacy rate, dosage of antiepileptic and narcotic analgesics, and the incidence of complications were followed up.ResultsCompared with the preoperative, the postoperative VAS decreased, the physical component summary (PCS) and the mental component summary (MCS) increased in both groups (P < 0.05). The differences between group B and group A were statistically significant after 1 month, which could be maintained for 1 year (P < 0.05). The total efficacy rate of group A and group B was 52.0% and 80.0% at 1 Year, respectively. The total efficacy rate of group B was higher than that of group A (P < 0.05). The dosage of antiepileptic and narcotic analgesics in group B decreased significantly, and the decline was significant compared with group A (P < 0.05). The incidence of complications between the two groups were similar (P > 0.05).ConclusionCT-guided PRF to cervical nerve root for the treatment of PHN in the upper extremity is safe and effective. PRF can replicate the location of pain, precise positioning, reduce trauma, and increased pain relief rate.

Incorporating Remote Electrical Neuromodulation (REN) Into Usual Care Reduces Acute Migraine Medication Use: An Open-Label Extension Study.

Background: A recent randomized controlled study showed that 66.7% (66/99) and 37.4% (37/99) of people undergoing remote electrical neuromodulation (REN), a novel non-pharmacological migraine treatment, achieve pain relief and pain freedom, respectively, at 2 h post-treatment. The participants who completed the 6-weeks double-blind phase of this study were offered to participate in an open-label extension (OLE) with an active REN device.Objective: This study investigated the clinical use of REN, focusing on its potential in reducing the use of acute migraine medications.Methods: The parent study for this open-label extension (OLE) was a randomized, double-blind, sham-controlled study of acute treatment conducted on 296 participants enrolled at 12 sites in the USA and Israel. This study included a run-in phase, in which migraine attacks were treated with usual care, and an 8-weeks double-blind treatment phase. One hundred sixty participants continued in an 8-weeks OLE phase in which they could incorporate a REN device into their usual care. Medication use rate (percentage of participants who treated their attacks only with REN and avoided medications in all their attacks) and pain outcomes at 2 h post-treatment were compared between the OLE and the run-in phase in a within-subject design.Results: The analyses were performed on 117 participants with episodic migraine. During the OLE, 89.7% of the participants treated their attacks only with REN and avoided medications in all their attacks compared with 15.4% in the run-in phase (p < 0.0001). The rates of pain relief and pain-free in at least 50% of the treatments at 2 h post-treatment were comparable (pain relief: 58.1% in the run-in phase and 57.3% in the OLE, p = 0.999; pain-free: 23.1% in the run-in vs. 30.8% in the OLE, p = 0.175).Conclusions: REN may reduce the use of acute migraine medications. Thus, incorporating REN into usual care may reduce the risk for medication overuse headache (MOH). Future studies should evaluate whether REN reduces the use of acute migraine medications in a population at risk for MOH.

Dosimetry, efficacy, and safety of three-dimensional printing noncoplanar template-assisted and CT-guided 125I seed implantation for recurrent retroperitoneal lymphatic metastasis after external beam radiotherapy

ObjectivesTo evaluate the dosimetry, efficacy, and safety of radioactive 125I seed implantation (RISI) assisted by three-dimensional printing noncoplanar template (3D-PNCT) and CT for recurrent retroperitoneal lymphatic metastasis (RRLM) after previous external beam radiotherapy. Methods and MaterialsFrom June 2016 to August 2018, 32 patients with RRLM successfully underwent 3D-PNCT–assisted and CT-guided RISI. The dosimetry, pain relief rate, performance improvement rate, overall response rate, disease control rate, local control time (LCT), overall survival (OS), and safety profiles were evaluated. ResultsDosimetric results showed that the D90, D100, V100, V150, V200, and homogeneity index were consistent in preoperation and postoperation (p > 0.05), except for the external index and conformal index (p = 0.048, p = 0.034). After RISI, 81.3% of the patients achieved pain relief, and 71.9% achieved an improvement of performance. The overall response rate and disease control rate were 85.3% and 94.1%, respectively. The LCT rates reached 66.2% and 43.2% in 1 year and two years, respectively, with a median LCT of 15.8 months. The OS rates were 74.1% and 28.1% in 1 year and two year, respectively, with a median OS reaching 17.6 months. Univariate analysis showed that when D90 > 130 Gy or D100 > 63 Gy or tumor size ≤49.8 cm3, LCT was extended significantly, but not for OS. Except for two patients developing Grade 1 retroperitoneal hematomas, no other severe adverse events were observed. Conclusions3D-PNCT and CT guidance provide excellent accuracy for RISI, which can be an effective and safe alternative for RRLM after external beam radiotherapy. Radiation dose and tumor size seem to significantly influence the local control.

Effect of methylene diphosphate combined with strontium chloride in the treatment of bone pain caused by multiple bone metastases

Objective To investigate the clinical efficacy of Yunke(99TC-MDP) combined with strontium 89SrCl2 in the treatment of bone pain in patients with multiple bone metastases. Methods The clinical data of 95 patients with multiple bone metastases admitted to the General Hospital of Datong Coal Group from August 2014 to July 2019 were retrospectively analyzed.According to the different treatment methods, they were divided into three groups: 37 patients in Yunke group were treated with Yunke alone, 29 patients in 89SrCl2 group were treated with 89SrCl2 alone, 29 patients in combination group were treated with Yunke combined with 89SrCl2.All patients were treated for 5 days, with a course of treatment per month.The clinical efficacy, analgesic time and adverse reactions of the three groups were compared. Results After treatment, the pain relief rates of the Yunke group, the 89SrCl2 group and the combination group were 67.6%(25/37), 69.0%(20/29) and 79.3%(23/29), respectively.The pain relief rate of the combined group was higher than that of the Yunke group(χ2=4.25, P<0.05). The effective rate of bone metastases in the combined group was 41.4%(12/29), which was higher than that in the Yunke group[0.0%(0/37)], the 89SrCl2 group[17.2%(5/29)], the differences were statistically significant(χ2=13.09, 10.54, all P<0.01). No serious adverse reactions were found in the three groups. Conclusion Yunke combined with 89SrCl2 is superior to 89SrCl2 alone, and it is safe in the treatment of bone metastases. Key words: Neoplasm metastasis; Metastatic carcinoma of bone; Bone pain; Methylene diphosphate; Strontium chloride; Comparative study

Management of Ganglion: Comparative Study between Surgical Excision and Aspiration followed by Intralesional Steroid Injection

Introduction: Ganglions are tense, smooth, cystic transilluminant swellings. They are the commonest soft tissue swelling of the hand and most commonly found on the dorsum of the wrist. At present aspiration or surgery are the management options of Ganglion. To improve the outcome of treatment some advocated aspiration combined with steroid injection into the cyst.&#x0D; Objectives: To compare pain relief, cosmetic results and recurrence rate in the management of ganglion with aspiration followed by intralesional steroid (triamcinolone acetate) injection and surgical excision.&#x0D; Materials and Methods: Prospective interventional control trial was performed from October 2016 to October 2017. Fifty patients were treated in two groups in group A (33 patients), aspiration followed by intralesional steroid (triamcinolone acetate) injection and group B (17 patients) surgical excision was performed on. Follow up of patients were done on at one, three and six months after treatment up to 1 year.&#x0D; Results: In group A out of 33 patients, pain relief was in all 33 (100%) patients, there was no scar mark and only in 4 (12.12%) patients there was recurrence which was managed by repeating the procedure. In group B, out of 17 patients, pain relief was in 15 (88.23%), 17(100%) patients had linear scar mark, 1(5.8%) patient had hypertrophic scar and 02 (11.76%) patients had recurrence which was managed with intralesional steroid as group A.&#x0D; Journal of Armed Forces Medical College Bangladesh Vol.14 (2) 2018: 190-192

Sphenopalatine ganglion-targeted low-temperature plasma radiofrequency ablation in the treatment of refractory cluster headache.

IntroductionCluster headache (CH) is a refractory headache. Low-temperature plasma radiofrequency ablation is a relatively novel technique with promising applications in neuropathic pain. It may improve the treatment of CH.AimTo evaluate the efficacy and safety of sphenopalatine ganglion-targeted low-temperature plasma radiofrequency ablation in the treatment of patients with refractory CH.Material and methodsA retrospective cohort study including seventy-five patients with refractory cluster headache who underwent computed tomography (CT)-guided sphenopalatine ganglion-targeted low-temperature plasma radiofrequency ablation between January 2015 and December 2017 at the Beijing Xuanwu Hospital was conducted.ResultsEffective pain relief rate 3 months after the procedure was 96% with 40 (53.3%) patients achieving complete relief; 32 (42.7%) patients obtained partial relief and 3 (4%) patients showed no relief. The effective pain relief rate two years after the procedure remained as high as 85.3% with 29 (38.6%) achieving complete relief, 35 (46.7%) partial relief and 11 (14.7%) no relief. The procedure proved equally effective for both episodic and chronic cluster headache. Complications including facial numbness, masseter weakness, facial hypoesthesia and cheek hematoma were observed, but all were mild and disappeared within 6 months.ConclusionsCT-guided low-temperature plasma radiofrequency ablation is an effective and safe strategy for refractory cluster headache. For patients who have not responded to conservative treatment, this minimally invasive intervention is a reliable alternative.

Augmented versus non-augmented percutaneous cementoplasty for the treatment of metastatic impending fractures of proximal femur: A systematic review

IntroductionPercutaneous cementoplasty (PC) has been widely used for the stabilization of impending fractures of the proximal femur due to metastatic lesions. Augmented percataneous cementoplasty (APC) with fixation devices aims to improve mechanical consolidation and stability of the construct. However, the clinical benefit of the combined technique has not been clearly established. The purpose of the current review was to compare the efficacy between APC and PC for impending pathologic proximal femoral fractures from metastatic malignancy, in terms of pain relief, operative time and fracture related complication rates. Material and methodsMedline, Scopus, and the Cochrane central register of controlled trials were searched for clinical studies up to July 2019. Studies relevant to cementoplasty of the proximal femur were included. The primary outcome of the study was pain relief as assessed using the Visual Analogue Scale (VAS) change. Secondary outcomes included incidence of post-intervention fracture, operative time and complication rate. ResultsTwelve studies with a total of 343 patients were included. No difference was found for all outcomes. For pain relief, pooled results showed a mean difference in VAS score -4.6 ± 1.7 for PC, and -4.3 ± 2.5 for APC (p = 0.41). Post-intervention fractures of the proximal femur occurred in 7% of patients with PC and in 5% of patients with APC (p = 0.4), and the mean duration of interventions was 57.9 ± 8.4 and 56.5 ± 27.5 min, respectively (p = 0.58). Cement leakage into the hip joint or the soft tissues occurred in 5% of cases in PC group and in 8% of cases in APC group (p = 0.16). Six patients in the APC group (4%) experienced major systemic complications, which were treated successfully. ConclusionsAPC does not seem to improve pain relief, fracture incidence, and operative time when compared with PC. Both techniques appeared effective in terms of resolution of symptoms, prevention of pathologic fractures, and early facilitation of weight-bearing. PC showed more clinical safety, as no major systemic complications occurred. However, due to the relative paucity of large clinical trials, the decision of augmentation of cementoplasty should be individualized according to the size and location of metastatic lesions and the overall medical condition of patients.

Nonlinear Relation Between Burst Dorsal Root Ganglion Stimulation Amplitude and Behavioral Outcome in an Experimental Model of Painful Diabetic Peripheral Neuropathy

Background and objectiveDorsal root ganglion stimulation (DRGS) has recently emerged as a neuromodulation modality in the treatment of chronic neuropathic pain. The objective of this study was to compare the efficacy of different Burst‐DRGS amplitudes in an experimental model of painful diabetic peripheral neuropathy (PDPN).MethodsDiabetes mellitus was induced in female Sprague–Dawley rats by intraperitoneal injection of streptozotocin (STZ, n = 28). Animals were tested for mechanical hypersensitivity (von Frey paw withdrawal test) before, and four weeks after STZ injection. PDPN rats (n = 13) were implanted with a unilateral bipolar electrode at the L5 DRG. Animals received Burst‐DRGS at 0%, 10%, 33%, 50%, 66%, and 80% of motor threshold (MT) in a randomized crossover design on post‐implantation days 2–7 (n = 9). Mechanical hypersensitivity was assessed before stimulation onset, 15 and 30 min during stimulation, and 15 and 30 min after stimulation.ResultsBurst‐DRGS at amplitudes of 33%, 50%, 66%, and 80% MT resulted in significant attenuation of STZ‐induced mechanical hypersensitivity at 15 and 30 min during stimulation, as well as 15 min after cessation of stimulation. No effect on mechanical hypersensitivity was observed for Burst‐DRGS at 0% MT and 10% MT. Optimal pain relief and highest responder rates were achieved with Burst‐DRGS at 50–66% MT, with an estimated optimum at 52% MT.ConclusionOur findings indicate a nonlinear relationship between Burst‐DRGS amplitude and behavioral outcome, with an estimated optimal amplitude of 52% MT. Further optimization and analysis of DRGS driven by insights into the underlying mechanisms related to the various stimulation paradigms is warranted.

Arthroscopic Treatment of Snapping Scapula Syndrome: A Case Report

Introduction: Snapping scapula syndrome is a condition with audible and palpable grating localized to the superomedial angle of the scapula associated with pain. The etiology is likely secondary to anomalous tissue between scapula and chest wall (e.g. bursitis, hooked superomedial angle scapula, Luschka tubercle, malunited rib/scapula fracture and osteochondroma). Case report: We present a case of a 17year-old gentleman, with chronic pain over bilateral upper scapula associated with grating sound upon shoulders movement. Examination revealed significant audible crepitus on bilateral scapula without restriction of shoulders motion. MRI showed no abnormal finding. An attempt for conservative approach including physical therapy and steroid/local anaesthesia injection has been unsuccessful. We subsequently performed an arthroscopic bursectomy and superomedial angle scapula decompression on the right scapula. There were inflammed bursa with fibrotic tissue and prominent superomedial angle of scapula observed during the surgery. Postoperatively, the symptom over right scapula completely resolved with good patient satisfaction. At present, patient is scheduled for the similar surgery on the remaining symptomatic left scapula. In conclusion, arthroscopic scapulothoracic bursectomy with superomedial angle scapula decompression is a reliable treatment for snapping scapula syndrome with predictably high rates of pain relief, patient satisfaction as well as improvement in functional outcomes.

External physical vibration lithecbole in treatment of ureteral calculi with renal colic used different positions: a prospective multicenter randomized controlled clinical study

Objective To evaluate the efficacy and safety of different positions external physical vibration lithecbole (EPVL) therapy for ureteral calculi related renal colic. Methods This study was a prospective multicenter randomized controlled trial. The inclusion criteria was that patients volunteered to participate in the trial and signed informed consent, patients’age ranged from 18-65 years old, ureteral calculi related with renal colic, stone diameter was less than 7 mm, patients were not treated with analgesia, antispasmodic drugs. The exclusion criteria was that combination of severe urinary tract infection, severe hydronephrosis, urinary malformation, severe hypertension, history of cerebrovascular disease, vital organ dysfunction, obesity (BMI>35 kg/m2), history of ureteral calculi exceeded 2 months, abnormal blood coagulation. Patients were randomized into observation group and control group using random number table method. The observation group and the control group were placed on the physical vibration stone arranging machine with low foot high and high foot low respectively. The inclination angle was 24°. The secondary vibrator vibrated for 6 minutes, then the patient took the prone and opened the main, the secondary vibrator. The treatment is completed after 6 minutes of vibration. The analgesic effect, stone removal, follow-up effects and adverse reactions in the two groups was compared. We defined the pain relief rate as(VAS score before treatment-VAS score after treatment)/VAS score before treatment×100%. Results A total of 100 patients were included in the study, 50 in the observation group and 50 in the control group. There were no statistical difference in the age of the two groups [(41.8±11.7)years and (46.6±13.9 years)], gender distribution [37(male)/13(female) and 42(male)/ 8(female)], location of stones (in the observation group, 19 cases in upper ureter, 7 cases in the middle ureter and 24 cases in the lower ureter; in the control group, 12 cases in the upper ureter, 3 cases in the middle ureter, and 35 in the lower ureter), left and right distribution of stones [21(right)/ 29 (left) and 22 (right)/ 28(left)], long diameter of stones [(5.2±0.9)mm and(5.1±1.1)mm], VAS scores before treatment (7.5±1.4 and 7.6±1.5), and readmission rate [22%(11/50)With 18%(9/50)], 1 week stone removal rate [70%(35/50) and 64%(32/50)]. The incidence of adverse reactions was 8%(4/50) in the observation group including 3 cases of nausea, 1 case of vomiting. The incidence of adverse reactions was 4% in the control group (2/50), which 2 cases showed nausea. The number of patients who chose EPVL, ESWL or surgery for the subsequent treatment in observation group was 35 cases, 9 cases, and 6 cases respectively. The number of patients who chose EPVL, ESWL or surgery for the subsequent treatment in the control group was 35 cases, 10 cases and 5 cases respectively. There was no significant difference between the two groups (P>0.05). The VAS score after treatment of the observation group was lower than that of the control group (2.4±1.3 and 3.7±1.5, P<0.01). The total effective rate of the observation group was higher than that of the control group [94%(47/50) and 76%(38/50), P<0.01]. 46 patients underwent urinary ultrasonography to check the degree of hydronephrosis. The reduction rate of hydronephrosis was higher in the observation group than in the control group [54.5%(18/33) and 30.8%(4/13)], but there was no significant difference between the two groups (P=0.146). In the upper ureteral calculi, the VAS score of the observation group was lower than that of the control group (2.4±0.3 and 3.9±0.4, P<0.01). There was no significant difference in the total effective rate between the two groups. In the lower ureteral calculi, the observation group had low VAS score after treatment. In the control group (2.4±0.2 and 3.5±0.2, P<0.01), there was no significant difference in the total effective rate between the two groups; the middle segment stones were less included (10 in total) and were not discussed. Conclusions The external physical vibration lithecbole adopts high and low position has better effect than head low foot high position in treatment of ureteral calculi with renal colic, and security is acceptable. Key words: Ureteral calculus; Renal colic; Posture; Randomized control research; Multiple center

Efficacy and Safety of Cinobufacin Combined with Chemotherapy for Advanced Breast Cancer: A Systematic Review and Meta-Analysis.

Background Cinobufacin is a Chinese patent medicine widely used for breast cancer in China. However, no systematic review and meta-analysis have been published to validate its effects in breast cancer treatment. We, therefore, summarize the efficacy and safety of Cinobufacin combined with chemotherapy in order to provide rigid evidence for its clinical application. Methods By searching multiple databases incepted to December 2019, the RCTs of breast cancer patients treated with Cinobufacin were screened according to the inclusion criteria, and the meta-analysis and sensitivity analysis were conducted using RevMan5.3. Results A total of 1163 articles were retrieved, and 16 studies were included. The total sample size was 1331 cases, including 666 cases in the treatment group receiving Cinobufacin combined with chemotherapy and 665 cases in the control group receiving chemotherapy alone. Our study found that the ORR (overall response rate) (RR = 1.35, 95% CI: [1.23, 1.49], P < 0.00001), CBR (clinical benefit rate) (RR = 1.14, 95% CI: [1.08, 1.21], P < 0.00001), KPS scores (RR = 1.98, 95% CI: [1.45, 2.68], P < 0.0001), and pain relief rate (RR = 1.34, 95% CI: [1.01, 1.78] P=0.04 of the Cinobufacin combined with chemotherapy group were better than those of the chemotherapy group, and the difference was statistically significant. Our study also discovered that the tumor markers (CA125, CA153, and CEA) in the Cinobufacin combined with chemotherapy group were lower than those in the chemotherapy group, which heterogeneity was derived from the low-quality literature included in the study, but the results were robust. In addition, in terms of safety, we found that the incidences of gastrointestinal reactions (RR = 0.58, 95% CI: [0.48, 0.70], P < 0.00001), liver and kidney damage (RR = 0.57, 95% CI: [0.38, 0.84], P=0.004), and hair loss (RR = 0.61, 95% CI: [0.40, 0.92], P=0.02) in the Cinobufacin combined chemotherapy group were lower than those in the chemotherapy group, and the difference was statistically significant, but the incidences of peripheral neurotoxicity (RR = 0.69, 95% CI: [0.26, 1.85], P=0.46) and myelosuppression (RR = 0.78, 95% CI: [0.46, 1.34], P=0.37) in the combined group were similar to those of the chemotherapy group, and the difference was not statistically significant. Conclusions Cinobufacin combined with chemotherapy can improve the clinical efficacy of breast cancer patients, enhance the quality of life of the patients, reduce the value of tumor markers such as CA125, CA153, and CEA, and lower the occurrence of adverse reactions such as gastrointestinal reactions, liver and kidney damage, and hair loss.