Term Pain Relief Research Articles

OPTOGENETICA: CONTROLLARE I NEURONI CON LA LUCE

Optogenetics is a booming technique in neuroscience that allows manipualtion of neuronal activity by light. Neuronal activation can be achieved by the activation of light-gated cation channels while neuronal inhibition relies on the activation of chloride pumps and channels. We have engineered a light-gated potassium (K+) channel (BLINK) by linking the plant photoreceptor module LOV2 to the viral channel Kcv. Upon illumination with blue light (450 nm), BLINK channel hyperpolarizes neurons to EK and this effect persists for several minutes even in the dark. Pilot experiments in a mouse pain model show that this protracted light-off activity can be successfully employed for long term pain relief after activation of the channel by a short pulse of light.

Comparative Efficacy of Methylprednisolone Acetate and Dexamethasone Disodium Phosphate in Lumbosacral Transforaminal Epidural Steroid Injections.

Transforaminal epidural steroid injection (TFESI) is an effective treatment for lumbosacral radicular pain. But in view of accidental intravascular injections and consequent neurological injuries, the safety profile of particulate steroids has been questioned. Dexamethasone (DEXA), being non-particulate, is presumed to be a safe replacement for earlier particulate agents. However, the efficacy of DEXA is still doubtful as compared to particulate steroids. The present study aims to determine the comparative efficacy of DEXA and methylprednisolone (MP) in terms of pain relief and improvement of disability. Seventy-six patients were sorted into two groups (MP and DEXA) to receive lumbar TFESI. A protocol of one-time single- or two-level TFESI with equipotent doses of MP or DEXA was followed. Numeric Rating Scale (NRS) and Roland-Morris Disability Questionnaire (RMDQ) scores were collected pre-treatment and at different times for a duration of 6 months at follow-up appointments. Overall, the extent of pain relief (determined from NRS) and quality of life (determined from RMDQ) were significantly better (p<0.01) in patients belonging to MP group following TFESI. NRS was 2.8±1.2, 3.3±1, 5.1±1.6 and 3.9±1.4, 4.5±1.3, 6.2±1.1 respectively in MP and DEXA group at 1 month, 3 months and 6months of follow-up, whereas RMDQ was 7.9±2.8, 7.4±2.3, 8.5±2.4 and 10±2.2, 11.4±2.6, 12.4±2.7 respectively in MP and DEXA group at similar time points. The immediate and short term pain relief following TFESI in lumbar radicular pain remained satisfactory and is comparable between MP and DEXA groups, but the long term benefit is significantly more with the use of MP, as evidenced by the NRS and RMDQ scores.

Radiofrequency facet joint denervation efficiency based on the severity of spondylarthrosis and in osteoporotic vertebral compression fractures. A retrospective study

ObjectivesRadiofrequency denervation of the facet joints is performed via a well-established method. Its primary, direct indication is a positive response to a nerve block injection (MBB). Our study aimed to find other, effective but indirect indication signs through the retrospective analysis of our patients treated earlier. Patients and methodsIn our institute between 1 January, 2008 and 31 December, 2017 facet joint denervation has been performed in more than 2000 cases, and we included 529 patients in our retrospective study. We had separate groups for vertebral compression fractures and for spondylarthrosis of different severity (Grade 1; 2–3; 4), thus we assessed the postoperative condition of these patients using Visual Analoge Scale (VAS). The efficacy of the intervention was examined in every groups separately according to symptoms and previous spine surgeries. ResultsIn view of our results, chronic lumbago and dorsalgia that are attributable to osteoporotic vertebral compression fracture are obvious indications if they do not respond to conservative therapy, as 76.8% of such patients remained asymptomatic for minimum 6 months (p = 0,000). Another indication is Grade 2 or 3 chronic spondylarthrosis without radicular involvement, since these groups reported a 51.4% success rate (asymptomatic for minimum 6 months) (p = 0,015). Long term pain relief is obviously impaired by the presence of radicular compression, as we were not able to decrease the pain of 97% of such patients. Our findings also suggest that the vast majority of those who have previously undergone spine surgery cannot benefit from the intervention. ConclusionBased on this study, facet joint denervation can serve as an effective therapy supplement in a properly selected group of patients who do not respond to oral NSAIDs, exercise and physiotherapy. By this procedure we found we can reach long term benefit in the groups of osteoporotic vertebral fracture patients and patients with moderate spondylarthrosis. According to our results and the literature datas the properly patient selection for the indication of the RF ablation can be as effective as the controversial diagnostic nerve block injections.

Benefits and harms of spinal manipulative therapy for the treatment of chronic low back pain: systematic review and meta-analysis of randomised controlled trials

ObjectiveTo assess the benefits and harms of spinal manipulative therapy (SMT) for the treatment of chronic low back pain.DesignSystematic review and meta-analysis of randomised controlled trials.Data sourcesMedline, PubMed, Embase, Cochrane...

CT-Guided Lumbar Facet Joint Infiltration: Accessibility, Accuracy and Functional Outcome

Background: Pain generated from lumbar facet joint affection is considered a common cause of low back pain. Image-guided facet joint infiltration is performed to reduce pain severity and to confirm its source. Aim: The objective of this study is to assess the accessibility, and accuracy and to evaluate the functional outcome of the CT-guided lumbar facet joint infiltration in management of low back pain. Subjects and Methods: This retrospective study included thirty four patients. All patients were diagnosed with low back pain due to lumbar facet syndrome. Adequate conservative therapy failed to improve the patient’s symptoms. Totally, 81 lumbar facet joints were treated by CT-guided intra-articular infiltration. Mean time of hospital stay was 6 - 8 hours. In the procedure technique, measures were applied to reduce the patients’ radiation exposure. The response to treatment was evaluated by the visual analogue scale (VAS) before procedure and at follow-up visits. Results: Among 34 adult patients included in this study, 26 were males and 8 were females. The mean age was 49.5 ± 8.5 years. Mean Duration of low back pain on admission was 8.2 ± 3.5 months. Bilateral CT-guided intra-articular infiltration was performed in 23 patients (67.5%). Assessing the response after facet joint infiltration, 82.4% of the patients showed immediate pain improvement after the procedure; 85.3% of the patients reported pain relief after 1 month and 67.6% at 12 month follow up. There was a statistically significant relief of pain after the intervention at 12 month follow up (p < 0.001). Conclusion: Lumbar Facet joint infiltration guided with CT scanning seems to be a reliable and safe procedure for low back pain management. Beside immediate and long term pain relief achieved using this minimally invasive technique; CT guidance provides an accessible and accurate route for the needle with low radiation dose exposure.

Randomised controlled trial comparing the intra-articular hyaluronic acid versus intra-articular steroid in osteoarthritis of knee

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; Osteoarthritis of knee is a chronic degenerative joint disease which leads to pain, swelling and stiffness. Intra-articular hyaluronic acid or steroids are being used for its treatment. The purpose of the present study was to assess the effect of intra articular hyaluronic acid in comparison to steroids for knee osteoarthritis.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; A prospective randomized study including 70 patients (121 knees) diagnosed with osteoarthritis of knee, were randomly divided into two groups: 35 patients (58 knees) were given intra-articular hyaluronic acid and 35 patients (63 knees) were given intra-articular methylprednisolone. The outcome was evaluated with knee society score (KSS) and visual analog scale (VAS) before the injection and 1, 3 and 6 months after the injection.&lt;strong&gt;&lt;/strong&gt;&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; The mean KSS pain and function scores increased while VAS decreased in both the groups. All the scores showed improvement at 6 months follow up. In both the groups, the scores at 6 months were significantly better than the pre injection values, and the scores of hyaluronic acid group were significantly better compared to steroid group.&lt;/p&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; Intraarticular hyaluronic acid seems to be better for long term pain relief and preservation of function in comparison to intraarticular steroids in osteoarthritis of knee.

Adding steroids to lidocaine in a therapeutic injection regimen for patients with abdominal pain due to anterior cutaneous nerve entrapment syndrome (ACNES): a single blinded randomized clinical trial.

Background and aims Anterior cutaneous nerve entrapment syndrome (ACNES) may result in chronic abdominal pain. Therapeutic options include local injection therapy. Data on the efficacy of adding corticosteroids to these injections is lacking. Methods Patients ≥18 years with ACNES were randomized to receive an injection of lidocaine with (LC-group) or without (LA-group) the addition of methylprednisolone into the point of maximal abdominal wall pain. Pain was recorded using a numeric rating scale (NRS: 0-10) and a verbal rating scale (VRS: 0=no pain, 5=unbearable pain) at baseline and 6 weeks after the start of a bi-weekly injection regimen consisting of a total of three injections. A minimal 50% reduction on NRS and/or two points on VRS were considered successful responses. Results Between February 2014 and August 2016, 136 patients (median age 46 year, range 18-79, 75% females) were randomized (68 vs. 68). The proportion of patients demonstrating a successful response after 6 weeks did not significantly differ between groups (LA 38%, LC 31%, p=0.61). At 12 weeks, the number of patients still experiencing a minimal 50% pain relief had decreased but no group difference was observed (LA 20%, LC 18%, p=0.80). Minor side effects included temporary increase of pain, tenderness at injection sites or transient malaise (LA23/68, LC 29/68, p=0.46). Conclusions Adding corticosteroids to a lidocaine does not increase the proportion of ACNES patients with a successful response to injection therapy. Lidocaine alone can provide long term pain relief after one or multiple injections, in approximately 1 of 5 patients.

The Long Term Effectiveness of Genicular Nerve Blocks for Chronic Knee Pain: A Retrospective Study

Chronic knee pain is a leading cause of chronic disability and its symptoms have a profound impact on the lives of those suffering from it. Current treatment modalities for chronic knee pain include pharmacologic and nonpharmacologic interventions. Genicular nerve blocks are a new therapeutic alternative that have been shown to relieve chronic knee pain and may provide significant relief in patients who are either poor surgical candidates or are unwilling to accept the risks associated with surgery. Genicular nerve blocks may provide long term pain relief for chronic knee pain and radiofrequency ablation (RFA) may not be necessary. This Institutional Review Board (IRB) approved retrospective study conducted at a single center university hospital involved 44 patients aged 43 to 87 who received genicular nerve blocks for chronic knee pain. The primary purpose of this study was to determine if genicular nerve blocks provide effective long term pain relief for patients with chronic knee pain. The numeric rating scale was used to measure the patient’s knee pain at baseline, 30, 90, and 120 days post procedure. Patients experienced a mean pain level of 7.43 out of 10 before the genicular nerve block and 4.02 afterward representing an average improvement of 42.6% in pain relief overall post procedure follow-up. A t-test revealed a statistically significant difference between the mean pain score before and after the blocks (t = 8.534, P &lt; 0.01). Overall, the patients experienced significant pain relief of an average of 111.9 days resulting in an average of 42.6 percent pain relief post procedure follow-up. Out of the 44 patients, 15 (34.1%) underwent a RFA after receiving a genicular nerve block procedure to further manage their chronic knee pain symptoms. In conclusion, we have found statistically significant evidence that genicular nerve blocks provide effective long-term pain relief for patients with chronic knee pain. Therefore, for patients who are not surgical candidates, genicular nerve blocks represent a viable alternative treatment for knee pain. Key words: Genicular nerve blocks, chronic knee pain, genicular nerves, genicular nerve radiofrequency ablation

203 Treatment Options Following Failed Gamma Knife Radiosurgery in Trigeminal Neuralgia

Abstract INTRODUCTION Primary treatment of trigeminal neuralgia with gamma knife radiosurgery (GKRS) is an accepted and effective modality, but is associated with a significant failure rate. Many of the patients ultimately require additional treatment for adequate pain relief. The present paper discusses the long term outcome of this group of patients who are treated with either repeat GKRS or microvascular decompression (MVD) as a secondary procedure. METHODS Using the retrospective database, the clinical data was analyzed of the patients who underwent GKRS at our institute between January 2000 and June 2016. The initial GKRS plan included median prescription dose of 80 Gy at a single iso-center using 4 mm collimator. The patients who did not improve after initial therapy and maximal medication dosage were offered either repeat radiosurgery or MVD. Repeat radiosurgery included a similar plan but a reduced median prescription dose of 40 Gy. Long term pain relief was measured using Marseille's score. Multiple factors including demographic factors, the type of pain, post GKRS facial numbness, treatment interval were analyzed to predict association with the final outcome. RESULTS &gt;In the study preriod, a total of 198 patients underwent GKRS for trigeminal neuralgias. Among these patients 42 (21.2%) patients had treatment failure and required additional treatment. The median interval of subsequent interventions was 16 months (range 2 months to 154 months). Six patients (14.2%) required repeat treatment after 5 years of initial treatment. Out of 42 failed GKRS patients, 15 (35.7%) underwent repeat radiosurgery and 27 (64.3%) underwent MVD. The mean follow up duration was 4.3 years. Overall, 34 patients (81%) improved and had adequate pain relief (Marseille's score III or better) after the second procedure. The rate of adequate pain relief after repeat GKRS and microvascular decompression were 86.6% and 77.7% respectively (P = 0.68). Univariate analysis failed to reveal any significant predictor for pain relief after second treatment. CONCLUSION Repeat GKRS and MVD both are valid treatment options after failed initial radiosurgery, with no difference in long term outcome. Unless specifically indicated, repeat GKRS being noninvasive, may be considered over microvascular decompression.

Microvascular Decompression for Trigeminal Neuralgia: Our Experiences at Bir Hospital

Trigeminal neuralgia (TGN) is a very peculiar disease, mostly characterized by unilateral paroxysmal facial pain, often described by patient as ‘one of the worst pain in my life’. This condition is also known as ‘Tic Douloureus’. The annual incidence of TN is about 4.7/100000 population, male and female are equally affected. The diagnosis is usually made by history, clinical fi ndings and cranial imaging is required to rule out compressing vascular loop, organic lesions and Multiple Sclerosis (MS) at Trigeminal nerve (TN). Treatment of TGN ranged from medical to surgical intervention. Between September 2007 and April 2015, 20 patients underwent micro vascular decompression (MVD) of TN for TGN who were refractory to medical treatment at department of Neurosurgery, Bir Hospital. All decompressions were performed using operating microscope. Follow up period ranged from 22 months to 8 years.There were 9 males and 11 females and age ranged from 30-70 years. The neuralgic pain was localized on right side in 13 patients and left on 7 patients. Pain distribution was on V3 (mandibular branch) dermatome in 11, V2( Maxillary branch ) in 4, V2-3 in 2 and V1- 2-3 in 3 patients respectively. On intraoperative fi ndings TN was compressed by superior cerebellar artery ( SCA ) in 8, tumors in 4, unidentifi ed vessels in 3, veins in 2, anterior inferior cerebellar artery ( AICA ) in 1 and no cause was found in 2 patients. 7 patients suffered postoperative complications which included hyposthesia in 3, pseudomeningocele in 3 and meningitis in 1. There was no mortality in this series. 20 patients felt pain relief immediately after procedure and 1 patients came after 3 years with recurrent pain requiring second surgery. In conclusion, MVD for TGN in younger patients who are refractory to medical treatment is one of the best treatment options which is safe and long term pain relief is achieved in majority of cases.Nepal Journal of Neuroscience, Vol. 14, No. 2, 2017 Page:11-15

Peripheral Neurectomy: A Surgical Option for Trigeminal Neuralgia Involving Inferior Alveolar Nerve

Trigeminal neuralgia, a debilitating condition is a commonly diagnosed facial pain with female predominance and with summit of occurrence in the age group of above 40 years. Classic symptoms are excruciating, paroxysmal, shock like pain episodes located in somatosensory distribution of trigeminal nerve. Diagnosis is purely based on typical history and exclusion of secondary causes. Though various treatment options are available, selection of the patient is of utmost important for choosing the appropriate management protocol. No treatment modality is absolutely having recurrence free. Peripheral neurectomy, a minimally invasive and expeditious form of surgical method for the treatment of TN is one of the methods widely practiced even today. Surgical treatment option provides long term pain relief with few complications and also cost effective. We present a case of 62 year-old female patient who has endure peripheral neurectomy of inferior alveolar nerve. No recurrence was noticed in a 3-year follow-up period.

Provider and patient perspectives on opioids and alternative treatments for managing chronic pain: a qualitative study.

BackgroundCurrent literature describes the limits and pitfalls of using opioid pharmacotherapy for chronic pain and the importance of identifying alternatives. The objective of this study was to identify the practical issues patients and providers face when accessing alternatives to opioids, and how multiple parties view these issues.MethodsQualitative data were gathered to evaluate the outcomes of acupuncture and chiropractic (A/C) services for chronic musculoskeletal pain (CMP) using structured interview guides among patients with CMP (n = 90) and primary care providers (PCPs) (n = 25) purposively sampled from a managed care health care system as well as from contracted community A/C providers (n = 14). Focus groups and interviews were conducted patients with CMP with varying histories of A/C use. Plan PCPs and contracted A/C providers took part in individual interviews. All participants were asked about their experiences managing chronic pain and experience with and/or attitudes about A/C treatment. Audio recordings were transcribed and thematically coded. A summarized version of the focus group/interview guides is included in the Additional file 1.ResultsWe identified four themes around opioid use: (1) attitudes toward use of opioids to manage chronic pain; (2) the limited alternative options for chronic pain management; (3) the potential of A/C care as a tool to help manage pain; and (4) the complex system around chronic pain management. Despite widespread dissatisfaction with opioid medications for pain management, many practical barriers challenged access to other options. Most of the participants’ perceived A/C care as helpful for short term pain relief. We identified that problems with timing, expectations, and plan coverage limited A/C care potential for pain relief treatment.ConclusionsThese results suggest that education about realistic expectations for chronic pain management and therapy options, as well as making A/C care more easily accessible, might lead to more satisfaction for patients and providers, and provide important input to policy makers.Trial registrationClinicalTrials.gov NCT01345409, date of registration 28/4/2011Electronic supplementary materialThe online version of this article (doi:10.1186/s12875-016-0566-0) contains supplementary material, which is available to authorized users.

F.09 Neurosurgical Outcomes in patients with Multiple Sclerosis related Trigeminal Neuralgia

Background: The aim of this study was to assess the outcomes of surgery for multiple sclerosis-related trigeminal neuralgia (MS-TN). Methods: All Manitobans undergoing first surgery for medically refractory MS-TN between 2000 and 2014 were identified. The time interval until additional surgeries were required for recurrent pain, defined as the time to fail (TTF), was determined from a retrospective chart review. Kaplan-Meier analyses were performed and outcomes compared. Results: Twenty-one patients (26 sides) underwent first rhizotomy by GammaKnife (GK, 13), glycerol injection (PGR, 10) or balloon compression (BCR, 3). Second procedures were required in 88% at 15±13 months, including GK (24), PGR (19), BCR (25), microvascular decompression (2) and open surgical partial rhizotomy (Dandy, 4) for an overall total of 99 surgeries (1-12 per side). The additional GK, PGR, and BCR eventually failed and required further surgeries in 40%, 60% and 70% at 1, 2, and 3 years respectively with a trend to longer TTF compared to first surgeries (ns). Follow up of Dandy procedures, however, identified no pain recurrence at 4 to 110 months. Conclusions: The minimally invasive rhizotomies for MS-TN were associated with high rates of recurrence and reoperation. Long term pain relief was best achieved with a Dandy procedure, even after multiple prior rhizotomies.

Comparison of transforaminal verse interlaminar epidural steroid injection in low back pain with lumbosacral radicular pain: a meta-analysis of the literature.

The object of the present meta-analysis is to compare the effectiveness of transforaminal epidural steroid injection (TFESI) and interlaminar epidural steroid injection (ILESI) for treating patients with low back pain (LBP) secondary to lumbosacral radicular pain. A systematic search was performed in the PubMed and Embase databases and the Cochrane Library for relevant literature published through January 2016. The randomized controlled trials (RCTs) and controlled observational studies were selected, which did not only compare TFESI with ILESI but also reported the available data. The Cochrane Collaboration's Handbook and Newcastle-Ottawa Scale (NOS) were used for the methodological quality assessments of the RCTs and observational studies respectively. The meta-analysis was performed using the Revman 5.2 software. A total of 931 patients from nine RCTs and four observational studies were subjected to meta-analysis. In primary outcomes, the TFESI patients experienced superior pain relief compared with the TFESI patients in RCTs (P = 0.01), but not in observational studies (p = 0.63). The pooled data of RCTs showed that the TFESI group presented superior clinical results in terms of visual analogue scale (VAS) than the ILESI group (p = 0.0005). Moreover, the numeric rating scale (NRS) specifically favored TFESI in the RCTs (p < 0000.1). Similar functional improvement and oswentry disability index (ODI) score were observed between TFESI and ILESI in RCTs (P = 0.62). In secondary outcomes, meta-analysis of RCTs and observational studies revealed that there were no statistically significant differences between both groups in regard to procedure frequency, surgery rate, and ventral epidural spread. According to the results of meta-analysis, TFESI to manage LBP provides superior short term pain relief and equal functional improvement when compared to ILESI. It has not shown a statistically significant difference between both groups with regard to procedure frequency, surgery rate, and ventral epidural spread.

MP019: Systematic review of the management of lateral epicondylitis using transdermal nitroglycerin

Introduction: Lateral epicondylitis (LE), also known as tennis elbow, is an overuse-underuse tendinopathy originating from the forearm extensor tendons of the elbow. An emerging therapy for the treatment of LE is the use of transdermal nitroglycerin (NTG) patches for pain relief and improved function. Our systematic review assesses 18 to 65 year old patients with clinically diagnosed LE and no structural damage or longstanding elbow injury to determine if transdermal NTG patches provide improved short term and long term pain relief as well as improved function in comparison with placebo. Methods: We included randomised controlled trials (RCT’s) of NTG patch use versus placebo for the treatment of LE. Prospective comparison studies were also eligible for assessing the long term pain relief of NTG patch use. We performed a literature search using MEDLINE, EMBASE, SportDiscus and the Cochrane Database of Systematic Reviews. English language articles were retrieved for review up to November 2015. Risk of bias within the studies was assessed regarding randomisation, allocation sequence concealment, blinding and selective outcome reporting. Results: Three RCT’s were included that compared transdermal NTG patch use (two studies with 1.25mg/24h and one study comparing 0.72, 1.44 and 3.6mg/24h) versus a placebo to treat LE. One prospective comparison study of five years duration was included as a follow-up to one of the included RCT’s to assess pain and function five years after the discontinuation of therapy. Data was not pooled because of heterogeneity in study methods and outcomes. The use of transdermal NTG patches provided short term pain relief (2-6 weeks for dosing of 0.72mg/24h or 1.25mg/24h) compared with placebo as suggested by three RCT’s. Long term pain relief was improved by NTG patch use compared with placebo at six months in one RCT, but not at five years in a prospective comparison study. Function improved in two different RCT’s with NTG patch use at 0.72mg/24h and 1.25mg/24h when compared to placebo. Five years after cessation of treatment, there was no difference between NTG patch and placebo. Conclusion: Overall, the included studies demonstrate that the use of NTG patches compared to placebo improves short term and long term pain relief, as well as elbow function. However, more studies are required to bridge the gaps between the existing studies and reduce heterogeneity between the study designs.

3D navigation of endoscopic rhizotomy at the lumbar spine

We present a detailed description of the surgical technique and the preliminary results of an endoscopic denervation for patients with chronic low back pain (CLBP) originating from the facet joints (FJ). Endoscopic denervation of the medial branches of the dorsal rami supplying the FJ has recently been appraised as providing excellent intraoperative visualization and long term pain relief for these patients. Conventional endoscopic rhizotomy has been expanded to include a the precise localization of 3D navigation. A surgical description and the results of our first four patients treated with 3D navigated endoscopic rhizotomy (3DNER) are presented. Four patients with a mean age of 59years and a follow-up time of 2months were included. All patients reported pain reduction in the immediate postoperative period, while three patients (75%) had long lasting relief. The patient without persisting relief had previously sustained a lumbar disc prolapse and only achieved minor pain relief with preoperative FJ infiltration, compared to the significant relief that was seen in the other patients. In contrast to conventional rhizotomy, 3DNER enables the surgeon to ablate more precisely and extensively, which is especially useful if scar tissue is present from previous injuries or surgeries. When successful, this technique may provide long lasting pain relief, especially if the preoperative FJ infiltrations are followed by a substantial pain reduction.

Percutaneous vertebroplasty and percutaneous balloon kyphoplasty for osteoporotic vertebral compression fracture: A metaanalysis.

Background:Osteoporotic vertebral compression fracture (OVCF) is the most common complication of osteoporosis, however, debate persists over which procedure of percutaneous vertebroplasty (PVP) or balloon kyphoplasty (BKP) is a better treatment. We performed a metaanalysis of prospective, randomized controlled and clinical controlled trials of PVP and BKP to determine the efficacy and safety for the treatment of OVCFs to reach a relatively conclusive answer.Materials and Methods:We searched computerized databases comparing efficacy and safety of PVP and BKP in osteoporotic vertebral compression fractures. These reports included pain relief, functional capacity (Oswestry disability index [ODI] score), anterior vertebral body height (AVBH), kyphotic angle and complications (i.e. cement leakage, incident fractures). Studies were assessed for methodological bias and potential reasons for heterogeneity were explored.Results:As of March 15, 2013, a PubMed search resulted in 761 articles, of which eleven studies encompassing 789 patients, met the inclusion criteria. The average length of followup is 17 months and 4.6% patients were lost to followup. Results of metaanalysis indicated that BKP is more effective for short term pain relief. In addition, BKP is more effective to restore the AVBH (anterior vertebral body height), ODI and kyphotic angle of OVCFs. Moreover, BKP need more polymethylmethacrylate amount.Conclusions:In terms of better effectiveness of BKP procedure, we believe BKP to be superior over PVP for the treatment of osteoporotic VCFs.

The circadian clock in cartilage homeostasis

s / Osteoarthritis and Cartilage 23 (2015) A17eA25 A21 I-14 NEUROVASCULAR CHANGES IN THE OA JOINT D.A. Walsh. Univ. of Nottingham, Nottingham, United Kingdom Purpose: To describe current knowledge leading to a better understanding of OA pain and potential therapeutic targets for symptom and structural modification. Methods: Narrative review. Results: Pain originates from the OA joint, mediated by primary nociceptive neurons that have been localised to the majority of articular structures. Fine, myelinated Ad fibres are localised to joint capsule, periosteum and muscles, whereas unmyelinated C fibres are most abundant with synovium and subchondral bone marrow spaces. Unmyelinated afferents predominantly accompany blood vessels, and serve both sensory (pain) and efferent (control of vascular tone, permeability and proliferation) functions. During OA, sensory nerves change in their distribution, growing with blood vessels into articular cartilage and the inner two thirds of knee menisci. Furthermore, peripheral sensory nerve function is augmented (peripheral sensitisation), accompanied by changes in ion channel phosphorylation, neuromodulator and neurotransmitter expression. Key drivers of peripheral sensitisation offer potential as novel therapeutic targets for OA pain, including nerve growth factor, calcitonin gene-related peptide, and pro-inflammatory cytokines. Neuronal and vascular functions are tightly integrated, with factors originally recognised in pain processing pathways also modulating vascular function, and others, such as vascular endothelial growth factor, now known to also play important roles in neuronal growth and sensitisation. The joint vasculature is key to maintaining articular health, by facilitating metabolic homeostasis, contributing to tissue repair and new bone formation. Inappropriate or inadequate vascular responses might lead to relative hypoxia and acidosis, loss of osteochondral integrity and persistent inflammation; each of which can exacerbate OA pain. Conclusions: Targeting the neurovascular plasticity that is observed in OA joints might not only afford short term pain relief, but also modify symptomatically relevant structural changes and therefore afford sustained reductions in the burden of OA. I-15 ROLE OF ZN2þ IMPORT AND THE ZN2þ/ZIP8/MTF1 AXIS ON OA J.-S. Chun. Gwangju Inst. of Sci. and Technology (GIST), Gwangju, Republic

PD40-06 EFFECT OF OPERATIVE LOCAL ANESTHESIA ON POSTOPERATIVE PAIN OUTCOMES OF INFLATABLE PENILE PROSTHESIS : PROSPECTIVE COMPARISON OF TWO MEDICATIONS

You have accessJournal of UrologySexual Function/Dysfunction/Andrology: Surgical Therapy II1 Apr 2015PD40-06 EFFECT OF OPERATIVE LOCAL ANESTHESIA ON POSTOPERATIVE PAIN OUTCOMES OF INFLATABLE PENILE PROSTHESIS : PROSPECTIVE COMPARISON OF TWO MEDICATIONS Marilin Nicholson, Fernando Bianco, Angel Perez, and Edward Gheiler Marilin NicholsonMarilin Nicholson More articles by this author , Fernando BiancoFernando Bianco More articles by this author , Angel PerezAngel Perez More articles by this author , and Edward GheilerEdward Gheiler More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2015.02.2440AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Contrast efficacy of dorsal penile nerve block (DPNB) in reducing postoperative pain following inflatable penile prosthesis (IPP) compared to patients without block and detect a difference between two injectable anesthetics. METHODS From 1/2013 to 6/2013, 131 patients were randomized prospectively into 3 groups. All IPP were first time, performed under general/spinal anesthesia with supplemental DPNB by high volume IPP surgeon with 24 hour observation. 40 patients were in Bupivacaine DPNB group, 47 in Ropivacaine DPNB group & 44 controls had no DPNB. Postoperative pain was quantitated by Visual analog scale (VAS). Oral/IV pain medication need was measured during hospitalization and every 24 h during first 7 days. RESULTS In first two hours VAS 2.13(CI 1.66-2.60) Bupivacaine group; 2.89(CI 2.44-3.24) Ropivacaine group and 6.55(CI 6.14-6.96) control group There was significant difference between medicated patients and control group (p<0.0001) but no significant difference between the two injectibles. 52.5% of Bupivacaine group were pain free at day 2 compared with 31.9% of Ropivacaine group and 38.6% control group. While most patients responded to oral pain pills, 42% of series required IV Morphine for relief. Mean Morphine IV usage was 0.85 for Bupivacaine group; 1.87 for Ropivacaine group and 1.67 in control group. The Bupivacaine group had less pain on second day and less need of Morphine (27.5%) but neither finding was significant. Virtually all patients required oral pain medication day 2-7. CONCLUSIONS DPNB during IPP with both anesthetics provides effective analgesia in the immediate post operative recovery period but does not impact longer term pain relief when compared to patients without penile block. © 2015 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 193Issue 4SApril 2015Page: e837 Advertisement Copyright & Permissions© 2015 by American Urological Association Education and Research, Inc.MetricsAuthor Information Marilin Nicholson More articles by this author Fernando Bianco More articles by this author Angel Perez More articles by this author Edward Gheiler More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Long-Term Survival of a Semi-Constrained Implant Following Revision for Infection

Revision total knee arthroplasty (TKA) in prosthetic joint infections (PJI) is a challenging problem. We evaluated our institutional experience with a semi-constrained implant placed in a PJI setting. Seventy-eight TKAs in 75 patients with a history of a PJI were identified. The average follow-up was 7.5years. Twenty-three (29%) underwent repeat revision surgery. Five and 10year survivals were 71% and 64%, respectively. The most common reason for repeat revision surgery was recurrent infection (78%). Smoking and elevated BMI increased the risk of repeat revision surgery. Significant improvements were maintained long term in pain and range of motion (P<0.01 and P=0.02). In the absence of repeat infection, long term pain relief and improved function may be expected with the semi-constrained implant.